Gastroparesis Flashcards
What is gastroparesis?
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
Is gastroparesis more common in men or women?
women
T/F People with Type I & Type II Diabetes have significant rates of gastroparesis.
True.
55% of Type I patients
What are common symptoms of gastroparesis?
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
What are some bad results of gastroparesis?
esophagitis
mallory-weiss tears
severe peptic ulcer disease
What are 3 things that could aggravate the symptoms of gastroparesis?
eating high fiber foods (raw fruits & veggies)
eating high fat foods (stomach naturally empties more slowly w/ high fat)
eating greasy or rich foods
What are some drugs or substances that could aggravate gastroparesis?
alcohol anticholinergic drugs calcium channel blockers dopamine agonists H2 antagonists nicotine proton pump inhibitors
Describe the symptoms of Grade 1 Gastroparesis.
mild symptoms that are avoided w/ diet modifications
Describe the situation of a Grade 2 Gastroparesis patient.
moderate symptoms
patients need pro kinetics & anti-ememtics for control of symptoms
Describe the situation of a Grade 3 Gastroparesis patient.
extreme symptoms
need IV fluids
need enteral or parenteral nutrition
need endoscopic surgery
Describe what happens with an upper GI endoscopy.
liquid or general anesthesia
test can show bezoars (blockages of food, hair etc)
can dissolve the bezoars
What does ultrasonography help you do in diagnosis of gastroparesis?
it can distinguish b/w gastroparesis & a different condition like pancreatitis or gall bladder disease
Describe how scintigraphy can help in the diagnosis of gastroparesis.
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
How can a smart pill help in diagnosis of gastroparesis? Which types of patients would not qualify to use this?
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
How does paracetamol/acetaminophen testing help in diagnosing gastroparesis?
after you administer the acetaminophen…you wait & take blood tests to assess gastric emptying
T/F You can use radio opaque markers w/ x-rays to diagnose gastroparesis.
true.
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
H. Pylori: Urea Breath Test
Lactose Intolerance: Hydrogen Breath Test
Gastroparesis: Octanoic Acid Breath Test
What are 5 of the main complications with gastroparesis?
Severe Dehydration GERD Bezoars Malnutrition Decreased Quality of Life
Why are gastroparesis patients sometimes severely dehydrated?
b/c of persistent vomiting
What can happen to gastroparesis patients with GERD?
the GERD can lead to esophagitis
What’s the problem with bezoars & gastroparesis?
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
What are 13 diseases that could lead to gastroparesis?
Type II Diabetes Autonomic Neuropathy Diabetic Autonomic Neuropathy Myopathy Viral Infections ------------- Gastroduodenitis Neuroendocrine tumors duodenitis esophagitis postcholecystectomy syndrome IBS Endocrine disorders autoimmune diseases
What are 5 possible causes of gastroparesis?
impaired glycemic control extrinsic & intrinsic neuropathies abnormalities of ICC cells (pacemakers) in the GI tract loss of NO synthase myopathy
What are the steps to treatment of gastroparesis?
Suspect Gastroparesis Diagnose Gastroparesis Restore Fluids Optimize Glycemic Control Make dietary modifications Take pro kinetics Enteral Nutrition Gastric Pacing Surgery (last resort)
What types of diet changes are recommended for patients w/ gastroparesis?
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
How does metoclopramide/Reglan work? What are the side effects?
dopamine antagonist
makes the GI contractions work better
prevents nausea & vomiting
Side Effects: fatigue & depression
How does erythromycin work? What are the side effects?
motilin receptor agonist–>Migrating Motor Complex
increases smooth muscle contraction
Side Effects: cramps, nausea, altered cardiac contraction
What happens with cisapride?
stimulates the 5-HT receptor
How does gastric electrical stimulation help w/ gastroparesis?
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
What does hemin do?
increases levels of HO-1 which is expressed in some macrophages
no idea how this helps gastroparesis, but apparently it does.
