Motility disorders Flashcards Preview

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Flashcards in Motility disorders Deck (62):
1

Primary or functional disorder: achalasia

Primary

2

Primary or functional disorder: esophageal spasm

Primary

3

Primary or functional disorder: globus sensation

Functional

4

Primary or functional disorder: gastroparesis

Primary

5

Primary or functional disorder: acute/chronic intestinal pseudo-obstruction

Primary

6

Primary or functional disorder: IBS

Functional

7

Primary motility disorders are secondary to what?

Impaired control of the neuromuscular apparatus of the gut

8

True or false: the ssx of gastric motility disorders are largely the same

True-- N/v bloating

9

What are the ssx of gastric motility disordrs?

n/v
Bloating
ABD pain
Constipation or diarrhea

10

What are the factors that motility depends on?

Smooth muscle contraction along with integration with and modulation by extrinsic/enteric nerves

11

What are the three nerves plexi that are involved in motility?

CNS
ANS
ENS

12

What are the causes of extrinsic neuropathy causes of dysmotility? (5)

-DM
-Trauma
-Parkinson's
-Amyloidosis
-Paraneoplastic syndromes

13

What is the effect of paraneoplastic syndrome on gut motility?

Abs deposit in neurons causing dysmotility

14

What is the cause of enteric neuropathy?

Idiopathic degeneration or inflammatory/infiltrative processes

15

What are the two smooth muscle cell diseases taht cause dysmotility?

Metabolic muscle disorders

Myotonic dystrophy

16

What are the nerve/muscle overlaps of GI dysmotility?

Amyloidosis
Mitochondrial cytoptahies
scleroderma

17

What are the severe ssx of impaired gastric dysmotility?

Dysphagia
Postprandial vomiting
Weight loss
Nutritional deficiencies

18

What is in you ddx with gastric dysmotility?

Mechanical obstruction
Crohn's/IBD
Autonomic neuropathy
Eating disorders

19

What are the things that should be focused on in the H&P of pts with dysmotility ssx?

FMH
Meds
ROS

20

What is diltiazem? HOw does it cause GI problems?

CCB

Inhibits motility

21

What is the succession splash seen with dysmotility disorders?

a sloshing sound heard through the stethoscope during sudden movement of the patient on abdominal auscultation

22

Is generalized TTP or focal TTP more common with dysmotility disorder?

Generalized

23

When is an x-ray indicated for an abdominal exam?

If distention is present

24

If there is air all the way down to the rectum is suggestive of what?

non-obstructive pathology

25

What are the three tests that can r/o a mechanical obstruction?

EGD
Barium swallow
CT abdo

26

What does a diffuse esophageal spasm look like with a barium swallow?

Zig-zaggy

27

What is a scintigraphy?

Pt ingests radiolabeled meal.

Scans taken at 0, 1, 2, 4 and 6 hours

tests for dysmotility disorders

28

What is Manometry? When is it used?

Pressure sensitive device is placed in the stomach and duodenum, and measures the contraction of the GI system.

Used if dysmotility is confirmed with other means

29

What are the results of a Manometry with neuropathic problems?

Contraction of normal amplitude, but abnormal contractile patter

30

What are the results of a Manometry with myopathic

Low average amplitude of contraction

31

What are the ROME II criteria for IBS?

1. Relieved by defecation
2. Onset associated with change in stool frequency
3. Onset associated with a change in stool form or appearance

32

What is IBS?

Recurrent abdo pain for at least 3 days during the previous 3 months and associated with 2 of the criteria

33

What are the supporting symptoms of IBS?

1. Altered stool frequency
2. altered stool form
3. Altered stool passage
4. Mucorrhea
5. Abdo bloating or distension

34

What is IBS-D?

Diarrhea predominant

35

What is IBS-C?

Constipation predominant

36

What is IBS-M

Mixed diarrhea and constipation

37

What is IBS-A?

Alternating diarrhea and constipation

38

True or false: it is common that IBS pts change type within a year

True

39

What are the pmhx flags for IBS?

Onset of abdominal pain and altered bowel habits in childhood

40

The development of IBS symptoms in people older than what age should prompt a closer search for an underlying organic cause?

40 years old

41

What is the key to diagnosing IBS?

H&P

42

What are the "alarm" symptoms of IBS (5)

-Weight loss
-Bloody stools
-Nocturnal diarrhea or pain
-Steatorrhea
-B symptoms

43

The focus of an evaluating a pt with suspected IBS is what?

rule out organic disease prior to dx IBS (e.g. lactose intolerance, gluten intolerance)

44

Fatty stool indicates what?

Infectious or absorptive problem

45

What is the description of constipation for IBS pts?

Hard stools of narrow caliber, or infrequent defecation

46

What are the two major symptoms of IBS in regard to bowel habits?

Postprandial urgency
Alternating habits

47

Where is the abdominal pain with IBS?

Lower or LLQ

GERD variant

48

What is the pain like in IBD?

Dull pain with intermittent sharp pain.

49

What does eating/defecation do to the pain in IBS?

Eating = precipitate
Defecate = improves

50

What are the other PMHX bits that are common to IBD?

Fibromyalgia
Depression
Endometriosis

51

What is the relationship between surgeries and IBD?

Multiple surgeries (adhesions?)

52

What are the social history bits common to IBD pts?

h/o sexual abuse

53

What are the family medical hx bit common to IBD?

Celiac
IBD
Colon CA

54

Is a rectal/pelvic exam indicated for IBD symptoms?

Yeah, Duh

55

Why check TSH with IBD symptoms?

hyperthyroid may cause increased stools

56

What percent of pts with IBD have celiac abs?

10%

57

Why are stool studies done for IBD symptoms?

Infectious etiology

58

Who usually gets mesenteric ischemia?

Older person with heart disease

59

What is the treatment for IBD? (2)

Antispasmodics
Antidepressants

60

What are the ways to manage constipation secondary to IBD?

Fiber
Cathartics

61

How do you manage diarrhea secondary to IBD?

Loperamide
serotonin antagonists

62

What is the MOA of alosetron?

5HT (3) antagonist (recall that these nerves are the ones that run from the gut to the CNS. Blocking these will block the pain associated with IBS. Note that this is only used in women with refractory IBS.