DDSEP Motility V Flashcards
What effect will opioids have on the esophagus?
incomplete LES relaxation, premature esophageal contractions, and sphincter hypertonia
Consider especially with EGJOO and TIII achalasia.
How can you try to differentiate rumination from gastroparesis?
Rumination episodes usually occur earlier in the meal compared to gastroparesis.
How can you try to diagnose rumination episodes?
How do you treat it?
Meal time esophageal HRM with impedance as elevations in intragastric pressure over 30 mmHg followed by oral esophageal propulsion of gastric contents
Primary treatment for rumination involves behavioral modification with diaphragmatic breathing both in the fasting and postprandial state.
How do we divide generally the control of the colon?
Proximal colon (reservoir) is ENS controlled, while defecation is under voluntary control.
Thus we divide colonic motility into function of the colon and anorectum.
What is the average transit time from eating to BM?
How does fiber affect this?
Mouth to cecum is typically 6 hours, then to sigmoid another 12 hours.
As dietary fiber increases the mean colonic transit time decreases.
What is Ogilvie’s syndrome?
Acute colonic pseudo-obstruction.
Presents with significant colon dilation in the absence of mechanical obstruction.
Most typically in post-op setting but can happen otherwise (or with non-bowel surgeries)
What IV med can you give for Ogilvie’s syndrome? How do you monitor it?
IV administered neostigmine (0.5-2.0).
HR and BP should be monitored, and atropine available to reverse if cardiovascular compromise.
Don’t give if obstruction or sensitivity. Caution if recent MI, acidosis, asthma, bradycardia, PUD, beta blocker therapy
What are the Rome Criteria for IBS?
Abdominal pain > 1 day per week in last 3 months a/w 2 of the following:
- Related to defecation
- Change in stool frequency
- Change in stool form/appearance
At least 3 months with symptom onset at least 6 months before diagnosis.
What is an alternative to the sitz marker study we don’t think about?
wireless motility capsule which can also show upper GI transit as well
What is colonic inertia?
How can you treat it?
Absence of motor response of the colon to pharmacologic stimuli.
Surgery if not responding to meds, only if no evidence of evacuation disorder or severe motility disorder on upper GI transit or manometry
