Gastric Motility & Dyspepsia Flashcards Preview

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Flashcards in Gastric Motility & Dyspepsia Deck (28):
0

What is responsible for the receptive relaxation of the proximal stomach?

A swallowing-induced vagal response.

1

What is responsible for the accommodation of the proximal stomach?

Gastric mechanoreceptors and a vagovagal response.

2

What serves as the gastric pacemaker?

The interstitial cells of Cajal along the greater curvature of the proximal stomach.

3

What is the frequency for gastric slow waves?

3 per minute.

4

What 3 factors determine the gastric emptying rate?

(1) food volume
(2) food consistency
(3) food content

5

What food profile would result in the fastest emptying rate? Slowest?

Fastest: a large volume of liquid
Slowest: a small volume of solid

carbohydrates > protein > fat

6

What can trigger inhibition of the pyloric pump (either neuronal or hormonal) by the duodenum?

(1) too much gastric acid
(2) high protein or high fat
(3) excessive volume of chyme
(4) hypertonic fluids

7

What are the 3 sources of neuronal feedback on the pyloric pump?

(1) inhibitory vagal efferent nerve
(2) enteric nerves connecting the duodenum to the stomach
(3) inhibitory sympathetic nerves

8

What hormones inhibit gastric emptying?

(1) cholecystokinin
(2) somatostatin
(3) dopamine
(4) secretin

9

J: This refers to an impaired transit of food from the stomach to the duodenum, not caused by a mechanical obstruction.

What is gastroparesis?

10

What are causes of gastroparesis?

(1) diabetes mellitus
(2) surgery (gastric, esophageal, thoracic)
(3) idiopathic (viral?)
(4) medication

11

What is the clinical presentation of gastroparesis?

(1) nausea and vomiting
(2) early satiety
(3) post-prandial distention and pain

12

How is gastroparesis diagnosed?

Through a gastric-emptying test using radiolabelled egg substitute.

13

How is gastroparesis treated?

(1) small and frequent meals
(2) low-fat and low-residue diet
(3) pro-kinetic agents
(4) antiemetics
(5) gastric electric stimulation
(6) surgery

14

What is the role of brief phase III during fasting?

To perform gastric house-keeping. It consists of 5-10 minutes of intense contractions (every ~1.5 hours), stimulated by motilin.

15

What are the 7 classes of pro-kinetic agents?

(1) dopamine antagonists
(2) motilin agonists
(3) muscarinic agonists
(4) acetylchlinesterase inhibitors
(5) opioid receptor antagonists
(6) CCK receptor antagonists
(7) 5-HT4 agonists

16

What are the notable dopamine antagonists used for gastroparesis?

(1) metoclopramide
(2) domperidone

17

What are adverse effects of dopamine antagonists?

(1) increased prolactin
(2) arrhythmias?

18

How does erythromycin work as a pro-kinetic agent?

It is a motilin agonist.

19

What are adverse effects of erythromycin?

(1) abdominal cramping
(2) nausea
(3) vomiting

20

What are the 8 classes of antiemetic agents?

(1) dopamine antagonists
(2) 5-HT3 antagonists
(3) tricyclic antidepressants
(4) M1 antagonists
(5) H1 antagonists
(6) cannabinoids
(7) neurokinin antagonists
(8) benzodiazepines

21

When is gastric electric stimulation an indicated treatment?

Chronic, intractable nausea and vomiting due to diabetic or idiopathic gastroparesis.

22

What is the MoA of gastric electric stimulation?

Unknown.

23

What surgery is performed for the purpose of initiating enteral nutrition?

Jejunostomy.

24

What is the clinical presentation of early dumping syndrome?

(1) nausea
(2) flushing
(3) diarrhea
(4) syncope

25

What is the clinical presentation of late dumping syndrome?

Hypoglycemia.

26

How is non-ulcer dyspepsia defined?

(1) post-prandial distress syndrome
(2) epigastric pain
(3) no structural disease
(4) symptoms for > 3 months

27

J: This refers to a psychological etiology for non-ulcer dyspepsia.

What is visceral hypersensitivity?