Flashcards in EXAM #3: NON-INFECTIOUS GI MOTILITY DISORDERS Deck (31):
What is a primary motility disorder?
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****
What are the signs/symptoms of primary motility disorders?
- Chronic N/V
- Abdominal pain/ discomfort
- Constipation or diarrhea
What causes dysmotility of the gut?
Disruption of the:
List the common causes of extrinsic neuropathy leading to dysmotility.
5) Paraneoplasic Syndrome****
****Likely to be tested
What causes Enteric Neuropathy?
1) Idiopathic degeneration
2) Inflammatory/ infiltrative processes
What commonly causes smooth muscle cell disease leading to dysmotility?
1) Metabolic muscle disorder
2) Myotonic dystrophy
What are the two most common causes of GI dysmotility?
What are the severe manifestations of GI dysmotility?
- Weight loss
- Post-parandial vomiting
- Nutritional deficiency
- Dehydration and electrolyte disturbance
What should be included in the differential diagnosis of a GI dysmotility disorder?
1) Mechanical obstruction
2) Crohn's Disease/ IBD
3) Autonomic neuropathy
4) Functional GI disorders
5) Eating disorders
What should your initial evaluation of a patient with GI dysmotility focus on?
1) Family history
What is a classic PE finding associated with GI dysmotility?
What may be heard when listening for bowel sounds in a patient with GI dysmotility?
*A sloshing sound heard through the stethoscope during sudden movement of the patient on abdominal auscultation
How can you rule/out mechanical obstuction in a patient with an x-ray that has a bowel gas/air pattern?
2) Barium swallow
3) CT abdomen
*May do one, some, or all of these.*
Once mechanical obstruction has been ruled out, what next?
Scintigraphy= patient eats radiolabeled meal and scanned at various timepoints afterward
If dysmotility has been confirmed with Scintigraphy, what is the next step?
Differentiate between a neuropathic or myopathic etiology with GASTRODUODENAL MANOMEETRY
****This will measure the contraction of the GI system/ pressure generated with contraction****
How will a neuropathic problem appear on gastroduodenal manometry?
Abnormal contractile pattern with normal amplitude of firing
How will a myopathic problem appear on gastroduodenal manometry?
Low pressure generation with contractions
What is the definition of IBS?
- 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
What are the four different subtypes of IBS?
*Note that most patients will change subtypes
What should you focus on prior to diagnosing IBS?
Ruling out organic disease
What are the red flag symptoms in the evaluation of a patient with IBS-like symptoms?
1) Weight loss
2) Blood in stool
3) Nocturnal diarrhea or pain
5) Fever, sweats, chills
What is "pencil thin" stool pathognmeonic for?
How is the abdominal pain typically described in IBS?
Diffuse without radiation
- Meal exacerbate
- Defection relief
In addition to a normal physical exam, what additional procedures should be completed>
2) Pelvic exam in female
What labs can you order to rule out organic disorders that may mimic IBS?
1) Celiac antibodies
3) CRP/ESR for inflammation
4) Stool studies
What is the treatment approach to IBS?
What agents can be used to manage the pain associated with IBS?
How is the constipation of IBS managed?
2) Catharthics e.g. milk of magnesia and senna
How is the diarrhea of IBS managed?
What should you be sure to do when treating a patient with IBS?
1) Validate the patient's symptoms
3) Manage to improve quality of life