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Block 3; Week 2 > Gastroparesis > Flashcards

Gastroparesis Flashcards

1
Q

What is gastroparesis?

A

gastrointestinal motility disorder of the stomach in which there is delayed emptying of food from the stomach into the SI.
It is NOT due to a mechanical obstruction

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2
Q

Is gastroparesis more common in men or women?

A

women

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3
Q

T/F People with Type I & Type II Diabetes have significant rates of gastroparesis.

A

True.

55% of Type I patients

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4
Q

What are common symptoms of gastroparesis?

A 
vomiting
postprandial nausea (right after eating)
epigastric fullness after eating just a few bites
abdominal bloating
heartburn
gastroesophageal reflux
changes in blood sugar levels
lack of appetite
weight loss & malnutrition
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5
Q

What are some bad results of gastroparesis?

A

esophagitis
mallory-weiss tears
severe peptic ulcer disease

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6
Q

What are 3 things that could aggravate the symptoms of gastroparesis?

A

eating high fiber foods (raw fruits & veggies)
eating high fat foods (stomach naturally empties more slowly w/ high fat)
eating greasy or rich foods

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7
Q

What are some drugs or substances that could aggravate gastroparesis?

A 
alcohol
anticholinergic drugs
calcium channel blockers
dopamine agonists
H2 antagonists
nicotine
proton pump inhibitors
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8
Q

Describe the symptoms of Grade 1 Gastroparesis.

A

mild symptoms that are avoided w/ diet modifications

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9
Q

Describe the situation of a Grade 2 Gastroparesis patient.

A

moderate symptoms

patients need pro kinetics & anti-ememtics for control of symptoms

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10
Q

Describe the situation of a Grade 3 Gastroparesis patient.

A

extreme symptoms
need IV fluids
need enteral or parenteral nutrition
need endoscopic surgery

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11
Q

Describe what happens with an upper GI endoscopy.

A

liquid or general anesthesia
test can show bezoars (blockages of food, hair etc)
can dissolve the bezoars

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12
Q

What does ultrasonography help you do in diagnosis of gastroparesis?

A

it can distinguish b/w gastroparesis & a different condition like pancreatitis or gall bladder disease

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13
Q

Describe how scintigraphy can help in the diagnosis of gastroparesis.

A

this watches gastric emptying
solids labeled w/ a radioisotope are consumed & watched 1-4 hours after a meal…
If it takes more than 4 hours to empty the stomach–>gastroparesis

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14
Q

How can a smart pill help in diagnosis of gastroparesis? Which types of patients would not qualify to use this?

A

it can calculate temp, pH, pressure & transit time
**patients w/ swallowing disorders, narrowing or obstructions along their GI tract, Crohn’s disease, diverticulitis, or a cardiac pacemaker shouldn’t use the smart pill

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15
Q

How does paracetamol/acetaminophen testing help in diagnosing gastroparesis?

A

after you administer the acetaminophen…you wait & take blood tests to assess gastric emptying

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16
Q

T/F You can use radio opaque markers w/ x-rays to diagnose gastroparesis.

A

true.

17
Q

The idea behind a breath test is that you ingest a material & take breath samples to see how quickly the gastric emptying & intestinal absorption of the material takes place.
What is the breath test for the following:
H. Pylori
Lactose Intolerance
Gastroparesis

A

H. Pylori: Urea Breath Test
Lactose Intolerance: Hydrogen Breath Test
Gastroparesis: Octanoic Acid Breath Test

18
Q

What are 5 of the main complications with gastroparesis?

A 
Severe Dehydration
GERD
Bezoars
Malnutrition
Decreased Quality of Life
19
Q

Why are gastroparesis patients sometimes severely dehydrated?

A

b/c of persistent vomiting

20
Q

What can happen to gastroparesis patients with GERD?

A

the GERD can lead to esophagitis

21
Q

What’s the problem with bezoars & gastroparesis?

A

it can cause nausea, vomiting & obstruction
it can interfere with medication absorption
it can lead to difficulty managing blood glucose levels in Type II Diabetes patients

22
Q

What are 13 diseases that could lead to gastroparesis?

A 
Type II Diabetes
Autonomic Neuropathy
Diabetic Autonomic Neuropathy
Myopathy
Viral Infections
-------------
Gastroduodenitis
Neuroendocrine tumors
duodenitis
esophagitis
postcholecystectomy syndrome
IBS
Endocrine disorders
autoimmune diseases
23
Q

What are 5 possible causes of gastroparesis?

A 
impaired glycemic control
extrinsic & intrinsic neuropathies
abnormalities of ICC cells (pacemakers) in the GI tract
loss of NO synthase
myopathy
24
Q

What are the steps to treatment of gastroparesis?

A 
Suspect Gastroparesis
Diagnose Gastroparesis
Restore Fluids
Optimize Glycemic Control
Make dietary modifications
Take pro kinetics
Enteral Nutrition
Gastric Pacing
Surgery (last resort)
25
Q

What types of diet changes are recommended for patients w/ gastroparesis?

A 
eating smaller, more frequent meals
chewing food well
not drinking carbonated drinks
taking a walk after a meal
avoid high fat & fibrous foods (could form bezoars)
maybe need a liquid diet
26
Q

How does metoclopramide/Reglan work? What are the side effects?

A

dopamine antagonist
makes the GI contractions work better
prevents nausea & vomiting
Side Effects: fatigue & depression

27
Q

How does erythromycin work? What are the side effects?

A

motilin receptor agonist–>Migrating Motor Complex
increases smooth muscle contraction
Side Effects: cramps, nausea, altered cardiac contraction

28
Q

What happens with cisapride?

A

stimulates the 5-HT receptor

29
Q

How does gastric electrical stimulation help w/ gastroparesis?

A

reduces symptoms of dyspepsia & vomiting
reduces the need for nutritional supplementation
**electrodes are placed in the stomach & connect them to a neurostimulator in the abdominal wall

30
Q

What does hemin do?

A

increases levels of HO-1 which is expressed in some macrophages
no idea how this helps gastroparesis, but apparently it does.

Block 3; Week 2 (9 decks)

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