GI Motility

Question 1

Describe Xerostomia

Answer 1

• Atrophy/destruction of salivary glands
• Many causes like Sjogren’s, Radiation, medications, etc
• Results in dental caries and halitosis, difficulty speaking and swallowing
• Oral pilocarpine helps but has side effects

Question 2

Describe Candida albicans and related pathology of it vs a viral esophagitis

Answer 2

• pathologic yeast
• Cause Adynophagia and oral thrush
• Viral esophagitis has no dys[phagia or thrush
• Viral is usually immunosuppressive patients

Question 3

What is Zenker’s diverticulum?

Answer 3

• Herniation of esophageal mucosa though esophageal wall
• Weak cricothyroid muscle is rock factor
• Symptoms: Dysphagia, Regurgitation, and foul smelling breath

Question 4

Describe Barrett’s esophagus.

Answer 4

• Abnormal healing of erosive esophagitis
• Columnar cells take place of squamous cells
• increased risk of esophageal cancer

Question 5

Describe Achalasia and treatment for it

Answer 5

• Inability to swallow solids and liquids
• Differs from stomach cancer (Starts as solids and progresses to liquids)
• Bolus retained at LES
• Treated with Botox

Question 6

What are the two main types of esophageal cancer?

Answer 6

Squamous cell Carinoma —> Upper Esophagus from smoking/alcohol

Adenocarcinoma —> Lower 1/3; Barrett’s esophagus; uncontrolled reflux

Question 7

How does CCK affect the stomach?

Answer 7

• Increases distensibility

- Inhibits gastric emptying

Question 8

Describe the Vago-vagal reflex

Answer 8

Distal Stomach wall Stretch receptor —> Vagus nerve (Ach) —> Proximal stomach relaxation Through VIP/NO.

Question 9

What is the role of Motilin?

Answer 9

Motilin is an enzyme which is highly associated with Phase II Gastric High amplitude contractions

*** Most patients with a motility disorder have problems with Motilin

Question 10

Describe normal MMC and associated pathology.

Answer 10

• During fasting, Undigested material are moved along the GI track a.k.a. “Housekeeping.”
• This is mediated by the MMC
• Bezoars is the absence of MMC contractions leading to accumulation and obstruction (Particularly in the stomach)

Question 11

What are the two motility patterns of the SI and it’s role?

Answer 11

Segmental: Mixing

Peristaltic: Moving along GI tract

Question 12

Which chemical is used in producing peristaltic contractions? Which cell is responsible?

Answer 12

Enterochormatin cells release 5HT

Question 13

Describe the Slow waves produced in peristalsis.

Answer 13

• Generated by no Contractile pacemaker Interstitial cell of Cajal
• Lowest in stomach, highest in Duodenum
• Slow waves determined frequency of contractions in GI
• Oral to anal direction

Question 14

What are the types of motility int he LI?

Answer 14

Segmental: Mixing

Mass movement: Propels content from one segment to another

Defecation: Voluntary/involuntary reflexes which cause evacuation through anal canal

Question 15

Describe Dumping syndrome

Answer 15

• Obese patient’s stomach stapled
• If larger meals are eaten, Rapid absorption of glucose occurs resulting in rapid release of Insulin leading to HYPOGLYCEMIA
• Symptoms: weakness, dizziness, and SWEATING a.k.a. “Dumping”