109B GI Motility disorders

Question 1

Name the 4 broad things that can cause GI motility disorders and examples

Answer 1

1) CNS disorder - stroke, parkinson’s
2) ANS neuropathy - diabetic gastroparesis, ogilvie’s syndrome
3) ENS neuropathy - Achalasia, Hirchspring’s
4) Visceral myopathy - scleroderma

Question 2

What the nt that leads to LES relaxation? What nerve does the signal come from?

Answer 2

NO

Vagus

Question 3

what is lost that causes achalasia? what does this lead to?

Answer 3

idopathic enteric neuropathy leading to loss of myenteric inhibitory neurons
impaired LES relaxation

Question 4

Achalasia Rx

Answer 4

drugs - nitrates, ccb (-pines), botox, PDE-5 inhibitors
pneumatic dilation
myotomy

Question 5

sildenafil, tadalafil, vardenafil - mechanism and use

Answer 5

PDE-5 inhibitors –> increase cAMP –> increase NO in smooth muscle
Use for spastic motility disorders (achalsia)

Question 6

what is a mechanical obstruction that mimics dysmotility called?

Answer 6

pseudo-achalasia (Cancer)

Question 7

top 3 causes of secondary achalasia?

Answer 7

pseudo-achalasia (cancer)
post fundoplication (reflex surgery)
chagas disease (parasites in south america)

Question 8

what is damaged in diabetic gastroparesis

Answer 8

autonomic (vagal) neuropathy from long standing DM with additional diabetic sequella

Question 9

what motility abnormalities are seen with diabetic gastroparesis? what symptoms do these cause?

Answer 9

abnormal gastric accommodation –> early satiety
decreased antral contractions –> retained food
pyloric spasm –> upper abdominal pain

Question 10

name 3 gastric motility disorders

Answer 10

diabetic gastropareiss
post surgery vagotomy
infantile hypertrophic pyloric stenosis

Question 11

gastroparesis Rx

Answer 11

dietary mod (small, freq meals)
prokinetic agents (suck balls though)
Rx for 2ndary GERD

Question 12

2 general patterns for small bowel motility

Answer 12

fed pattern - segmentation (many focal contractions)
fasting pattern - MMC (Phase III are propagated contractions occuring every 90 minutes while fasting, pylorus opens wide)

Question 13

scleroderma presentation

Answer 13

esophagus dysmotility
abdominal distension, diarrhea, weight loss
stiff hands/skin
raynauds

Question 14

scleroderma in small bowel - appearance on xray

Answer 14

dilatation with stacked coin appearance

Question 15

what general type of gi disease is scleroderma?

Answer 15

Intestinal pseudo-obstruction
1st is neuropathic via antibodies against muscarinic receptor
2nd is visceral myopathy leading to muscle atrohpy and fibrosis
90% esophagus, 50% small bowel

Question 16

what diseases cause intestinal pseudo-obstruction?

Answer 16

post op ileus

scelroderma

Question 17

pseudo-obstruction symptoms

Answer 17

abd bloating and gas
diarrhea, constipation
nausea and vomiting
weight loss

Question 18

pseudo-obstruction manifestations?

Answer 18

maldigestion - poor food mixing

bacteria overrgrowth - compete for nutrients

Question 19

pseudo-obstruction management

Answer 19

diet - easy digesting foods
rotating antiobiotics
avoid narcotics and ccb
no surgery

Question 20

acute colonic pseduo-obstruction/”ogilvie syndrome” - pathology, symptoms

Answer 20

hindgut autonomic neural dysfunction –> impaired autonomic balance; often from surgery, trauma, sepsis
colon distension
adb pain, nausa, SOB, constipation
Rx- neostigmine, support

Question 21

Hirschsprung;s

Answer 21

congenital megacolon proximal to bad segment
lack of ganglion cells due failure of neural crest migration –> cant relax
chronic constipation at birth
Rx - resection