Gastroparesis Flashcards Preview

GI- Week 1 > Gastroparesis > Flashcards

Flashcards in Gastroparesis Deck (35):
1

The motility of the stomach is initiated in the pacemaker region of the stomach which is in the _______

fundus. Waves then propagate toward the pylorus

2

How frequently does the stomach contract?

about once every 20 seconds or 3x/min

3

Note about movement of food through the stomach

peristaltic waves push food from the fundal region into the plyoric region where at most times the pyloric sphincter is constricted to almost produce retrograde movement and continue to break down food until it is small enough to pass through the pylorus into the duodenum

4

What is gastric accommodation?

ingestion of food is associated with distension of the stomach fundus/body from abotu 200ml to about 500ml

5

Describe gastric emptying 

At 60 minutes most of the food is still in the fundus (~80%), 30-40% at 2 hrs and, and by 4 hrs the vast (95%) majority as passed out of the stomach

Below is a normal solid meal

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In contrast, liquids pass much more quickly through the stomach with 50% being passed in about an hour

7

What is gastroparesis?

delayed gastric emptying NOT caused be mechanical obstruction

8

What are the cardinal symptoms of gastroparesis?

Nausea (93%)

, vomiting,

early satiety (60-86%),

bloating 

abdominal pain (46-90%)- probably not the primary symptom

weight loss as the condition becomes more severe

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What are some main causes of gastroparesis?

-idiopathic (most common)

-Infiltrative processes (scleroderma, amyloidosis)

Dysautonomia (diabetic or amyloid neuropathy)

-CNS disorders (stress, Parkinsonism, MS, etc.)

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12

What are some medications that can delay gastric emptying?

-opiates/narcotics

-clonidine

-CCBs

-tricyclic antidepressants

 

13

Up to 50% of all cases of gastroparesis are due to _______

idiopathic 

14

How common is gastroparesis in diabetics?

Up to 30-60% of type I diabetics will develop GP after longstanding disease while

up to 30% of type II diabetics will

15

What part of diabetes caused gastroparesis?

The entire pathogenesis is not completely understood but it is partially due to neuropathy and hyperglycemia itslef can delay gastric emptying

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17

What surgeries most commonly lead to gastroparesis?

billroth II

fundoplication (an anti-reflux surgery)

18

How can a mechanical obstruction be eliminated from the Ddx in pts with suspected gastroparesis?

usually via an upper endoscopy

or CT or barium studies

19

What is this?

gastric outlet obstruction (stenosed pylorus)- not technically gastroparesis. This is usually due to an ulcer and can actually be dilated at the time of the procedure or may be treated with a PPI

20

What is this?

barium study showing gastric outlet obstruction. Usually followed by endoscopy

21

Notice how much the stomach is dilated

22

What is the test of choice to make the diagnosis of gastroparesis?

a gastric emptying study

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Typically, the 4hr is more important

25

What things need to be on the differential for gastroparesis?

-psychiatric disease

-rumination syndrome

-functional dyspepsia

-cyclic vomiting syndrome

26

What is rumination disease?

Rumination syndrome, or Merycism, is an under-diagnosed chronic motility disorder characterized by effortless regurgitation of most meals following consumption, due to the involuntary contraction of the muscles around the abdomen. There is no retching, nausea, heartburn, odour, or abdominal pain associated with the regurgitation, as there is with typical vomiting. The disorder has been historically documented as affecting only infants, young children, and people with cognitive disabilities (the prevalence is as high as 10% in institutionalized patients with various mental disabilities). Today it is being diagnosed in increasing numbers of otherwise healthy adolescents and adults, though there is a lack of awareness of the condition by doctors, patients and the general public.

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Dietary management of gastroparesis

High fat diets will delay gastric emptying

30

Pharm management of GP

31

What is Metoclopramide?

A dopamine receptor 2 antagonist that enhances gastric antral contractions

5-20 mg QID. Approved for use up to 12 weeks

32

What limits Metoclopramide use?

Side effects are seen in up to 30% of users including:

drowsiness, fatigue, agitation and hyperprolactinemia (galactorrhea, amenorrhea, etc.). These are reversible

tardive dyskinesia in 1-10% of pts. when taken 3+ months (irreversible)

 

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What is Domperidone?

a dopamine 2 antagonist (not readily available in the US). 10-20 mg TID

Can prolong the QT interval

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