Gastrointestinal Motility

Question 1

sub-threshold slow waves

Answer 1

produce a weak contraction

Question 2

slow waves depolarize

Answer 2

much stronger or phasic contractions

Question 3

serotonin

Answer 3

• activates sensory neurons

- activates myenteric plexus.

Question 4

substance P and ACh

Answer 4

contraction

Question 5

NO, VIP, neuropeptide y, ATP

Answer 5

relaxation

Question 6

Migrating Motor Complex (MMC)

Answer 6

Sweeps the stomach & small intestine of indigestible materials in preparation for the next meal

Question 7

Loss of the MMC

Answer 7

can cause bacterial overgrowth in the small intestine

Question 8

Esophagus transit time

Answer 8

10 seconds

Question 9

Stomach transit time

Answer 9

1-3 hours

Question 10

Small Intestine transit time

Answer 10

7-9 hours

Question 11

Large Intestine transit time

Answer 11

25-30 hours

Question 12

GASTRO-ESOPHAGEAL REFLUX DISEASE (GERD)

Answer 12

LES is incompetent

Associated with tobacco, alcohol, scleroderma

Presentation: heartburn, sour taste, dysphagia, regurgitation

Complications: Barret’s esophagus

Question 13

Barret’s esophagus

Answer 13

stratified squamous epithelium is replaced by intestinal simple columnar epithelium with goblet cells

Complication: adenocarcinoma of the lower esophagus

Question 14

Achalasia Cardia

Answer 14

degeneration ofAuerbach’s (myenteric) plexus in the DISTAL ESOPHAGUS

“bird’s beak” appearance

Question 15

*** Migrating motility complexes (MMC) occur about every 90 min between meals and are thought to be stimulated by the gastrointestinal hormone, motilin. An absence of MMCs causes an increase in which of the following?

Answer 15

Intestinal bacteria

Question 16

*** A 68-year-old male presents to his primary care physician with complaints of heartburn, belching, and epigastric pain. He states that the symptoms are aggravated by drinking coffee or eating fatty foods and improved by taking chewable heartburn relievers. He is started on a trial of omeprazole, which relieves his discomfort for several weeks, but his symptoms return. When counseling this patient, which of the following statements must be made?

Answer 16

He is at increased risk of esophageal cancer and should have further tests

Question 17

Mallory-Weiss tear

Answer 17

Superficial longitudinal mucosal lacerations

Question 18

Boerhaave’s syndrome

Answer 18

full-thickness rupture of the distal thoracic esophagus

complication ofbulimia

Question 19

*** A 21-year-old male presents to the emergency department with hematemesis. He had been out drinking every night that week with his friends in celebration of his 21st birthday. He reports having vomited each night, but tonight when he started vomiting, his friends noticed that there was streaking of blood and brought him into the emergency department. An upper endoscopy is conducted and reveals superficial lacerations of the distal esophagus as shown in the figure. Which of the following abnormalities is associated with this patient’s presenting condition?

Answer 19

Mallory-Weiss tear

Question 20

*** A 20-year-old female presents to the hospital with severe chest pain. She states that the pain started suddenly and is retrosternal in nature. The pain began shortly after lunch and is worse with swallowing. She has no prior medical history except for a brief inpatient stay for what she describes as an “eating disorder.” On exam, her vitals are as follows: HR 120, RR 22, BP 145/90. She is flushed and taking deep breaths. Which of the following abnormalities is associated with this patient’s presenting condition?

Answer 20

Boerhaave’s syndrome

Question 21

Gastric emptying time faster with

Answer 21

Liquid contents

Isotonic contents

Question 22

Gastric emptying time slower with

Answer 22

Fatty acids
H+ ions
Hypertonic or hypotonic contents

Question 23

GASTROPARESIS

Answer 23

damage to the vagus nerve

Question 24

*** A 48-year-old female visits your office complaining that she has trouble swallowing solids and liquids, has persistent bad breath, and sometimes wakes up with food on her pillow. Manometry studies show an absence of functional peristalsis and a failure of the lower esophageal sphincter to collapse upon swallowing. The patient’s disorder is associated with damage to which of the following?

Answer 24

Myenteric (Auerbach’s) plexus

Achalasia Cardia

Question 25

*** A 3-week-old male is brought to the emergency department with vomiting. The vomit is non-bloody, non-bilious and occurs consistently with feeding. What is the most likely diagnosis?

Answer 25

Pyloric stenosis