EXAM #3: NON-INFECTIOUS GI MOTILITY DISORDERS Flashcards Preview

Gastrointestinal System > EXAM #3: NON-INFECTIOUS GI MOTILITY DISORDERS > Flashcards

Flashcards in EXAM #3: NON-INFECTIOUS GI MOTILITY DISORDERS Deck (31)
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1
Q
What is a primary motility disorder?
A
Motility disorder that is secondary to impaired NM control of the gut e.g. achalasia

****This is in contrast to a functional GI disorder i.e. abnormal function without structural or biochemical abnormality****
2
Q
What are the signs/symptoms of primary motility disorders?
A
- Chronic N/V
- Bloating
- Abdominal pain/ discomfort
- Constipation or diarrhea
3
Q
What causes dysmotility of the gut?
A
Disruption of the:
1) CNS
2) ANS
3) ENS
4
Q
List the common causes of extrinsic neuropathy leading to dysmotility.
A
1) DM
2) Trauma
3) PD
4) Amyloidosis
5) Paraneoplasic Syndrome****

****Likely to be tested
5
Q
What causes Enteric Neuropathy?
A
1) Idiopathic degeneration
2) Inflammatory/ infiltrative processes
6
Q
What commonly causes smooth muscle cell disease leading to dysmotility?
A
1) Metabolic muscle disorder
2) Myotonic dystrophy
7
Q
What are the two most common causes of GI dysmotility?
A
1) Gastroparesis
2) Pseudo-obstruction
8
Q
What are the severe manifestations of GI dysmotility?
A
- Weight loss
- Post-parandial vomiting
- Nutritional deficiency
- Dehydration and electrolyte disturbance
9
Q
What should be included in the differential diagnosis of a GI dysmotility disorder?
A
1) Mechanical obstruction
2) Crohn's Disease/ IBD
3) Autonomic neuropathy
4) Functional GI disorders
5) Eating disorders
10
Q
What should your initial evaluation of a patient with GI dysmotility focus on?
A
1) Family history
2) Meds
3) ROS
11
Q
What is a classic PE finding associated with GI dysmotility?
A
Distention
12
Q
What may be heard when listening for bowel sounds in a patient with GI dysmotility?
A
Succussion splash

*A sloshing sound heard through the stethoscope during sudden movement of the patient on abdominal auscultation
13
Q
How can you rule/out mechanical obstuction in a patient with an x-ray that has a bowel gas/air pattern?
A
1) EGD
2) Barium swallow
3) CT abdomen

*May do one, some, or all of these.*
14
Q
Once mechanical obstruction has been ruled out, what next?
A
Scintigraphy= patient eats radiolabeled meal and scanned at various timepoints afterward
15
Q
If dysmotility has been confirmed with Scintigraphy, what is the next step?
A
Differentiate between a neuropathic or myopathic etiology with GASTRODUODENAL MANOMEETRY

****This will measure the contraction of the GI system/ pressure generated with contraction****
16
Q
How will a neuropathic problem appear on gastroduodenal manometry?
A
Abnormal contractile pattern with normal amplitude of firing
17
Q
How will a myopathic problem appear on gastroduodenal manometry?
A
Low pressure generation with contractions
18
Q
What is the definition of IBS?
A
- Abdominal pain 3x days per month for 3 months
- + 2x of the following:
1) Relieved by defecation
2) Change in stool frequency
3) Change in stool form/ appearance
19
Q
What are the four different subtypes of IBS?
A
IBS-D= diarrhea
IBS-C= constipation
IBS-M= mixed
IBS-A= alternating

*Note that most patients will change subtypes
20
Q
What should you focus on prior to diagnosing IBS?
A
Ruling out organic disease
21
Q
What are the red flag symptoms in the evaluation of a patient with IBS-like symptoms?
A
1) Weight loss
2) Blood in stool
3) Nocturnal diarrhea or pain
4) Steatorrhea
5) Fever, sweats, chills
22
Q
What is "pencil thin" stool pathognmeonic for?
A
Colorectal carcinoma
23
Q
How is the abdominal pain typically described in IBS?
A
Diffuse without radiation
- LLQ
- Meal exacerbate
- Defection relief
24
Q
In addition to a normal physical exam, what additional procedures should be completed>
A
1) DRE
2) Pelvic exam in female
25
Q
What labs can you order to rule out organic disorders that may mimic IBS?
A
1) Celiac antibodies
2) TSH
3) CRP/ESR for inflammation
4) Stool studies
5) Imaging
26
Q
What is the treatment approach to IBS?
A
Symptom relief
27
Q
What agents can be used to manage the pain associated with IBS?
A
1) Anti-spasmodics
2) Anti-depressants
28
Q
How is the constipation of IBS managed?
A
1) Fiber
2) Catharthics e.g. milk of magnesia and senna
29
Q
How is the diarrhea of IBS managed?
A
Loperamide
5-HT antagonist
30
Q
What should you be sure to do when treating a patient with IBS?
A
1) Validate the patient's symptoms
2) Reassure
3) Manage to improve quality of life
31
Q
What are the mixed neural and muscle causes of dysmotility?
A
- Amyloidosis
- Mitochondrial cytopathies
- Scleroderma