Al-Mehdi: Motility Disorders Flashcards
difficulty swallowing food or liquid (fx impaired)
dysphagia
painful swallowing due to mucosal ulceration
odynophagia
inability to swallow due to complete esophageal obstruction by food bolus or foreign body
Aphagia
CN X, CN V, CN VII, and CNXII innervate what
UES
what autonomics constrict the sphincters
sympathetics
what autonomics relax the sphincters
parasympathetics
proximal esophagus innervated by _____ to regulate peristalsis
CN X
distal esophagus innervated by _____ to regulate peristalsis
myenteric plexus neurons in ENS
excitatory neurons in ENS (myenteric plexus)
Ach, substance P
inhibitory neurons in ENS (myenteric plexus)
VIP, NO
liquid + solid dysphagia
motility disorder (motor)
only solid food dysphagia
structural dysphagia
hoarseness 1st then dysphagia
vocal cord tumor
dysphagia 1st then hoarseness
recurrent laryngeal n. damage
episodic dysphagia to solids unchanged over years
Schatzki ring
eosinophilic esophagitis
pathogenesis of this includes:
autoimmine myenteric plexopathy——loss of ganglion cells to loss of esophageal peristalsis
Achalasia
another cause of this includes loss of NO——insufficient relaxation of LES
Achalasia
to dx Achalasia
esophageal manometry
barium radiography
drug contraindicated in Achalasia
anti-D2 metoclopramide
_____causes Chagas disease (prevalent in south america)
Trypanosoma cruzi
chronic phase of this disease after many years of infection has destruction of autonomic ganglion cells
Chagas disease
most common cause of death in Chagas disease
Chronic cardiomyopathy
organs most affected in Chagas disease
esophagus, duodenum, colon
Rx of Achalasia
surgery
marker for ICC (pacemaker of stomach)
KIT
_____mutation leads to hypertrophic pyloric stenosis
KIT
2 things that can happen from pt with gastroparesis vomiting
mallory-weiss tear or boerhaave syndrome
PE to detect gastroparesis
succussion splash
D2 blockers used to treat gastroparesis
Metoclopramide
Domperidone
motilin receptor agonist used to treat gastroparesis
Erythromycin
somatostatin analogue used to treat gastroparesis that stimulates MMC activity
Octreotide
occurs when the muscles that move food through the intestines are temporarily paralyzed, which can lead to constipation, bloating, and gas
ileus
THE drug to use for ileus
anti-D2 METOCLOPRAMIDE
D2 blocker METOCLOPRAMIDE
drug used for post op ileus, gastroparesis, and GERD; N/V
Metoclopramide
CI in Achalasia
Metoclopramide
main way to treat constipation
12-30g fiber
treatment of constipation if fiber doesnt help
PEG (osmotic laxative)
treatment of constipation if PEG doesnt work
Bisacodyl (stimulant)
bulk forming laxatives for chronic constipation
PSYLLIUM
salt osmotic laxative
MgSO4 (PO)
non-salt osmotic laxatives
lactulose
PEG
Sorbitol
Cl- channel activator used for IBS-C
LUBIPROSTONE
u blockers used for constipation
Methylnaltrexone
naloxone
CLONIDINE
ALOSETRON
LOPERAMIDE
DIPHENOXYLATE
drugs to treat diarrhea
opioids used to treat diarrhea
diphenoxylate
loperamide
this drug decreases liquid content of stool and is an anti-diarrheal
bismuth
Rx for diarrhea in carcinoid syndrome (somatostatin analog)
OCTREOTIDE
this drug that confuses me stimulates MMC to help with gastroparesis and inhibits intestinal secretion to help with diarrhea
OCTREOTIDE
2 exchangers that mediate fluid influx in mucosal cells of gut
Na/H (NHE)
Na/glucose (SGLT-1)
(water is brought in when these are functioning)
____inactivates NHE (Na/H exchanger)
Cholera
Rx cholera induced dehydration
Na+ and glucose (SGLT-1)
3 forms of IBS
IBS-C
IBS-D
IBS-A
antidepressant used to treat IBS
Amitryptiline
anti-M drug used to treat IBS pain
Dicyclomine
drug to treat IBS-D
Alosetron (5-HT3 blocker)
drug to treat IBS-C
LUBIPROSTONE (EP4 agonist)
what 2 things can increase risk for C. diff
antibiotics and PPIs
2 Ab’s to treat C. diff
Vancomycin (cell wall synthesis inhibitor)
Fidaxomicin (50S binder)
narrowing of distal colon due to non-development of myenteric neurons and ICC (hypomotility disorder) (RET mutation); diagnosed at birth
Hirschsprung disease
difficulty swallowing food for 2 weeks; child; peanut allergy
Eosinophilic Esophagitis
Rx hiccups (hiccough)
Baclofen (GABA agonist that will stop diaphragmatic spasms) and hypoventilation can work too (distracts diaphragm and phrenic n.)