DDSEP Motility II Flashcards
What are the dietary interventions to treat gastroparesis?
Smaller low fat and low fiber meals.
If severe delay you can homogenize solid food, avoid non-digestible solids (Uncooked veggies) and supplement with liquid foods.
What is cisapride?
Propulsid. It can be given for gastroparesis under limited program by Janssen.
Limited due to cardiac FX and many other meds are prohibited when you give this
What are the two limited access meds for gastroparesis?
Cisapride and domperidone (domperidone doesn’t have CNS side effects and gives good benefits over other agents in studies for gastroparesis)
How do you dose erythromycin for gastroparesis?
Lower dose to mitigate cramping/side FX. 50mg TID.
It stimulates antral contractions and phase III of MMC.
What is the new injectable diabetic gastroparesis medication and how does it work?
Relamorelin is a ghrelin agonist that increases gastric emptying.
It improves several of the symptoms of GP including vomiting, nausea, abdominal pain.
What is the generic name for jardiance and how does it work?
Empagliflozin. It is an SGLT2 inhibitor which reduces renal absorption of filtered glucose and thus increases urinary glucose excretion.
What is the generic name for trulicity and how does it work?
Dulaglutide.
It works similarly to ozempic as a GLP-1 synthetic agonist.
How does the enterra stimulator work?
It seems to active central mechanisms of controlling nausea/vomiting (not so much increasing emptying)
Somewhat better in diabetics/post-surgical than idiopathic. Poor responders generally are on narcotics, predominant abdominal pain, history of migraines.
What happens to gastric motility when you do a gastric sleeve?
You remove fundus and greater curve of stomach which will cause early satiety but also removes gastric pacemaker causing accelerated emptying.
This may cause dumping syndrome. Sometimes you generate an ectopic distal pacemaker.
What are the typical causes of dumping syndrome?
Gastrojejunostomy, pylorus disrupting surgery, or vagotomy.
May also come with diabetics and idiopathic presentations.
What are the early symptoms of dumping syndrome?
Within 30 mins of meal you have systemic and abdominal symptoms.
Systemic- palpitations, tachycardia, fatigue, diaphoresis, hypotension
Abdominal- Early satiety, epigastric fullness/pain, diarrhea, bloating
What are the late manifestations of dumping syndrome?
1-3 hours after a meal with reactive hypoglycemia characterized by perspiration, faintness, decreased concentration, altered LOC.
