Gastroparesis: Ray

Question 1

What is gastroparesis?

Answer 1

Syndrome of delayed gastric emptying in the absence of mechanical obstruction
Cardinal symptoms of: n/v, early satiety, bloating, abd. pain

Question 2

What are the CNS causes of gastroparesis?

Answer 2

Stress
Psychiatric dz
Brainstem CVA/tumor
Parkinsonism
MS
Spinal cord injury

Question 3

What are the dysautonomic causes of gastroparesis?

Answer 3

Diabetic neuropathy
Amyoid neuropathy
Primary autonomic neuropathy

Question 4

What are the infiltrative causes of gastroparesis?

Answer 4

Scleroderma

Amyloidosis

Question 5

3 MCC of gastroparesis:

Answer 5

Idiopathic (50%)
Diabetic neuropathy, and hyperglycemia itself delays emptying (decr. gastric motility)
Post-surgical (damage to vagal n.)

Question 6

Describe the test of choice for Dx of gastroparesis.

Answer 6

Gastric emptying study.
Stop meds.
Glu 60% retention at 2 hrs and > 10% retention at 4 hrs.

Question 7

Describe dietary management of gastroparesis.

Answer 7

Low fat diet
Small, freq meals
Control blood glu
Avoid insoluble fiber (fruits and veggies)

Question 8

Describe pharm management of gastroparesis.

Answer 8

::Metoclopramide (dopamine receptor-2 antagonist) enhances gastric antral contractions. BBW: Tardive dyskinesia!
::Domperidone- Dopamine R-2 antagonist. Can prolong Q-T int.
::Erythromycin- motilin agonist
::Antiemetics

Question 9

What is the prognosis of post-viral gastroparesis?

Answer 9

Good prog., most improve within a yr. Can be caused by vaccination.