EXAM #3: NON-INFECTIOUS GI MOTILITY DISORDERS

Question 1

What is a primary motility disorder?

Answer 1

Motility disorder that is secondary to impaired NM control of the gut e.g. achalasia

This is in contrast to a functional GI disorder i.e. abnormal function without structural or biochemical abnormality

Question 2

What are the signs/symptoms of primary motility disorders?

Answer 2

• Chronic N/V
• Bloating
• Abdominal pain/ discomfort
• Constipation or diarrhea

Question 3

What causes dysmotility of the gut?

Answer 3

Disruption of the:

1) CNS
2) ANS
3) ENS

Question 4

List the common causes of extrinsic neuropathy leading to dysmotility.

Answer 4

1) DM
2) Trauma
3) PD
4) Amyloidosis
5) Paraneoplasic Syndrome**

**Likely to be tested

Question 5

What causes Enteric Neuropathy?

Answer 5

1) Idiopathic degeneration

2) Inflammatory/ infiltrative processes

Question 6

What commonly causes smooth muscle cell disease leading to dysmotility?

Answer 6

1) Metabolic muscle disorder

2) Myotonic dystrophy

Question 7

What are the two most common causes of GI dysmotility?

Answer 7

1) Gastroparesis

2) Pseudo-obstruction

Question 8

What are the severe manifestations of GI dysmotility?

Answer 8

• Weight loss
• Post-parandial vomiting
• Nutritional deficiency
• Dehydration and electrolyte disturbance

Question 9

What should be included in the differential diagnosis of a GI dysmotility disorder?

Answer 9

1) Mechanical obstruction
2) Crohn’s Disease/ IBD
3) Autonomic neuropathy
4) Functional GI disorders
5) Eating disorders

Question 10

What should your initial evaluation of a patient with GI dysmotility focus on?

Answer 10

1) Family history
2) Meds
3) ROS

Question 11

What is a classic PE finding associated with GI dysmotility?

Answer 11

Distention

Question 12

What may be heard when listening for bowel sounds in a patient with GI dysmotility?

Answer 12

Succussion splash

*A sloshing sound heard through the stethoscope during sudden movement of the patient on abdominal auscultation

Question 13

How can you rule/out mechanical obstuction in a patient with an x-ray that has a bowel gas/air pattern?

Answer 13

1) EGD
2) Barium swallow
3) CT abdomen

May do one, some, or all of these.

Question 14

Once mechanical obstruction has been ruled out, what next?

Answer 14

Scintigraphy= patient eats radiolabeled meal and scanned at various timepoints afterward

Question 15

If dysmotility has been confirmed with Scintigraphy, what is the next step?

Answer 15

Differentiate between a neuropathic or myopathic etiology with GASTRODUODENAL MANOMEETRY

This will measure the contraction of the GI system/ pressure generated with contraction

Question 16

How will a neuropathic problem appear on gastroduodenal manometry?

Answer 16

Abnormal contractile pattern with normal amplitude of firing

Question 17

How will a myopathic problem appear on gastroduodenal manometry?

Answer 17

Low pressure generation with contractions

Question 18

What is the definition of IBS?

Answer 18

• Abdominal pain 3x days per month for 3 months
• • 2x of the following:
    1) Relieved by defecation
    2) Change in stool frequency
    3) Change in stool form/ appearance

Question 19

What are the four different subtypes of IBS?

Answer 19

IBS-D= diarrhea 
IBS-C= constipation
IBS-M= mixed 
IBS-A= alternating

*Note that most patients will change subtypes

Question 20

What should you focus on prior to diagnosing IBS?

Answer 20

Ruling out organic disease

Question 21

What are the red flag symptoms in the evaluation of a patient with IBS-like symptoms?

Answer 21

1) Weight loss
2) Blood in stool
3) Nocturnal diarrhea or pain
4) Steatorrhea
5) Fever, sweats, chills

Question 22

What is “pencil thin” stool pathognmeonic for?

Answer 22

Colorectal carcinoma

Question 23

How is the abdominal pain typically described in IBS?

Answer 23

Diffuse without radiation

• LLQ
• Meal exacerbate
• Defection relief

Question 24

In addition to a normal physical exam, what additional procedures should be completed>

Answer 24

1) DRE

2) Pelvic exam in female

Question 25

What labs can you order to rule out organic disorders that may mimic IBS?

Answer 25

1) Celiac antibodies
2) TSH
3) CRP/ESR for inflammation
4) Stool studies
5) Imaging

Question 26

What is the treatment approach to IBS?

Answer 26

Symptom relief

Question 27

What agents can be used to manage the pain associated with IBS?

Answer 27

1) Anti-spasmodics

2) Anti-depressants

Question 28

How is the constipation of IBS managed?

Answer 28

1) Fiber

2) Catharthics e.g. milk of magnesia and senna

Question 29

How is the diarrhea of IBS managed?

Answer 29

Loperamide

5-HT antagonist

Question 30

What should you be sure to do when treating a patient with IBS?

Answer 30

1) Validate the patient’s symptoms
2) Reassure
3) Manage to improve quality of life

Question 31

What are the mixed neural and muscle causes of dysmotility?

Answer 31

• Amyloidosis
• Mitochondrial cytopathies
• Scleroderma