Disorders of gut motility

Question 1

Achalasia

Answer 1

LOS fails to relax, causing difficulty in swallowing, and can cause regurgitation of food
Caused by damage to nerves in wall of oesophagus

Question 2

Scleroderma in oesophagus

Answer 2

Connective tissue disorder
No muscular function in LOS, and no peristalsis
Causes acid reflux leading to oesophagitis

Question 3

Nutcracker oesophagus

Answer 3

High pressure during peristaltic wave
Pain on swallowing
Normal muscular function in LOS

Question 4

Diffuse oesophageal spasm

Answer 4

Peristalsis of distal oesophagus occurs faster

Causes dysphagia and regurgitation

Question 5

Disorders of gastric emptying

Answer 5

Accelerated gastric emptying: diarrhoea

Delayed gastric emptying (gastroperesis) - causes abdominal pain, vomiting, poorly controlled gastro-oesophageal reflux, malnutrition
- Can be caused by opiates, diabetes, post-viral

Question 6

Chronic intestinal pseudo-obstruction

Answer 6

Symptoms of obstruction of intestines, but no blockage exists
- Chronic abdominal pain, constipation, vomiting, weight loss
Due to damage to nerves, muscles or intestinal cells of Cajal, causing abnormal contractions in intestinal tract (peristalsis)

Question 7

Acute Post-Operative Ileus

Answer 7

Hypomotility causing constipation and intolerance of oral intake, in the absence of mechanical obstruction after surgery
Causes accumulation of gas and fluids within the bowel.

Question 8

Acute Colonic Pseudobstruction (Ogilvie’s Syndrome)

Answer 8

• Large bowel parasympathetic dysfunction
• Dilatation of the colon, in the absence of obstruction
• Most comon after cardiothoracic or spinal surgery
• Risk of caecal perforation

Question 9

Problems with Anorectal Function

Answer 9

Incontinence - Due to excessive rectal distension or anal sphincter weakness

Anorectal Constipation (Hirschrung’s Disease (children)):
- absence of nerves in distal colon causing 
 paradoxical contraction of
puborectalis and external sphincter during defecation - obstructive defecation (unable to evacuate bowels)

Question 10

Spinal Cord Injury

Answer 10

Injury to T12 or above

• Reflex bowel
• Upper motor neurons damaged
• Bowel opens spontaneously but without control

Injury to sacral nerve roots

• Lower motor neurons damaged
• “Flaccid bowel” - slow propulsion through colon, flaccid anal sphincter causing incontinence