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Flashcards in GI motility [3] Deck (20):
1

What GI motility disorders?

Neuropathic - ENS affected
Myopathic - Gi muscles diseased
Abnormalities in interstitital cells of Cajal - pacemaker
CNS disorders (parasymp vagal n. is domin. driver)

2

Scleroderma
What is it?
What % results in GI manifestations?
What is the main abnormality of the GI tract?
(hint: what type of GI motility disorder is scleroderma?)

aka Progressive systemic sclerosis (PSS)

Multisystem disorder characterized by:
- obliterative small vessel vasculitis
- CT proliferation with fibrosis of mult organs

80-90% GI manif.
SM atrophy and gut wall fibrosis
- MYOPATHIC!

3

Spastic disorders of Esophagus
- Myo or neuropathic?
- Esophageal manometry shows?

Can be myopathic or neuropathic
Jackhammer esophagus!

(nl swallowing and peristalsis, just MASSIVE peristalsis - chartruss)

4

Receptive relaxation of the stomach is _____ mediated inhibition of body tone.

Liquid emptying is by _______
Solid emptying is by _________

swallowing induced vagally

tonic P gradient
vagally mediated contraction

5

Residual solids are emptied during non fed state by ____ every _____ min

MMC, 90-120 min

6

functional dyspepsia (FD)
- what is it?
- what % of FD pts have impaired gastric accomodation?
- What type of GI motility disorder is it?

dyspepsia (discomfort/pain centered in upper abdo usually related to eating) with no organic etiologies

40%

- can be either myopatic, neuropatic, or CNS

7

What two stomach responses result in maintenance of low intragastric pressure?

receptive relaxation
- vagal mediated inhib of body tone

accomodation
- sm relaxation by mech distention of stom
- gastric mechanoreceptors + vagovagal response

8

Presentation of FD

dyspepsia (upper ab discomfort/pain to eating)
postprandial heaviness
early satiety
epigastric pain/burning

9

Gastroparesis
- what is it?
- neuro or myo or CNS disorder

"stomach paralysis"
- gastric emptying prob fr. stomach → duodenum

CNS disorder
- ie: vagal n injury post thoracic surgery

tx: lifestyle, diet, meds

10

Presentation of gastroparesis

postprandial abdominal distention
postprandial abdominal pain
early satiety
nausea/vomiting

11

Chronic intestinal pseudo-obstruction (CIPO)
- what is it
- what do you see on imaging?
- it is a major manifestation of small intestinal _____
- complication of CIPO?
- what type of motility disorder?

- Small bowel peristalsis problem
- See dilatation due to mechanical obstruction of small bowel without a lesion obstructing flow of intestinal contents
- Dysmotility
- stasis → bacterial overgrowth → fermentation and malabsorption

- can be myo, neuro, or mixed

12

Presentation of CIPO

N/V
abd. pain
distention
constipation
diarrhea
urinary sx

13

Prognosis for infants with CIPO

1/3 die in 1st year of life
- mechanical obstruction of small bowel → peristalsis problem

14

Neuropathic small intestinal motility disorders

CIPO
Degenerative neuropathies (PD)
Chagas
Diabetic neuropathy
Paraneoplastic autoimmune

(hirshsprung is colon disorder)

15

24 radiopaque Sitz markers are given in 1 day. On day 5, how many remaining is abnormal?

>5 abnl
- in recto-sigmoid: defecatory disorder
- throughout colon: slow transit

16

What type of muscle - innervation
internal anal sphincter
External anal sphincter

I: circular SM
- Autonomic: pelvic plexus

E: striated - volitional
- pudendal n

17

Hirshsprung's disease
- what is it?
- type of motility disorder?

Sphincter dysfxn
congenital absence of myenteric neurons of distal colon
(neuropathic motility disorder)

18

What reflex is absent in Hirshsprung's?

Recto-anal inhibitory reflex
- involuntary IAS relaxation in response to rectal distension → descend into anal canal
- INTERNAL ANAL SPHINCTER WONT CHILLAX

19

Pelvic floor dysfxn
- what is it

inability to coordinate the abdominal, rectoanal and pelvic floor muscles during defecation

DYSSYNERGIC DEFECATION (spincter dysfxn)
- paradoxical contraction of pelvic floor and EAS

20

Test used to measure fxn of lower esophageal sphincter

esophageal manometry
- tells you if your esophagus can move food down to sotmach nl

Note: Achalasia (type I): absence of peristalsis and no LES relaxation