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Gastrointestinal > Motility disorders > Flashcards

Motility disorders Flashcards

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1
Q

Primary or functional disorder: achalasia

A

Primary

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2
Q

Primary or functional disorder: esophageal spasm

A

Primary

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3
Q

Primary or functional disorder: globus sensation

A

Functional

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4
Q

Primary or functional disorder: gastroparesis

A

Primary

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5
Q

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

A

Primary

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6
Q

Primary or functional disorder: IBS

A

Functional

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7
Q

Primary motility disorders are secondary to what?

A

Impaired control of the neuromuscular apparatus of the gut

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8
Q

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

A

True– N/v bloating

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9
Q

What are the ssx of gastric motility disordrs?

A

n/v
Bloating
ABD pain
Constipation or diarrhea

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10
Q

What are the factors that motility depends on?

A

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

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11
Q

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

A

CNS
ANS
ENS

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12
Q

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

A
  • DM
  • Trauma
  • Parkinson’s
  • Amyloidosis
  • Paraneoplastic syndromes
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13
Q

What is the effect of paraneoplastic syndrome on gut motility?

A

Abs deposit in neurons causing dysmotility

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14
Q

What is the cause of enteric neuropathy?

A

Idiopathic degeneration or inflammatory/infiltrative processes

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15
Q

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

A

Metabolic muscle disorders

Myotonic dystrophy

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16
Q

What are the nerve/muscle overlaps of GI dysmotility?

A

Amyloidosis
Mitochondrial cytoptahies
scleroderma

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17
Q

What are the severe ssx of impaired gastric dysmotility?

A

Dysphagia
Postprandial vomiting
Weight loss
Nutritional deficiencies

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18
Q

What is in you ddx with gastric dysmotility?

A

Mechanical obstruction
Crohn’s/IBD
Autonomic neuropathy
Eating disorders

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19
Q

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

A

FMH
Meds
ROS

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20
Q

What is diltiazem? HOw does it cause GI problems?

A

CCB

Inhibits motility

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21
Q

What is the succession splash seen with dysmotility disorders?

A

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

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22
Q

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

A

Generalized

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23
Q

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

A

If distention is present

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24
Q

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

A

non-obstructive pathology

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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.

Gastrointestinal (42 decks)

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