Gastroparesis Flashcards
Gastroparesis aka
Delayed gastric emptying
Gastrostasis
Etiology
Multifactoral:
Diabetic - form of neuropathy affecting vagus nerve, hypoglycemia can also cause delayed emptying
Idiopathic - can occur after viral infection
Postsurgical
Clinical symptoms
Nausea
Vomiting
Post-prandial fullness
Symptoms of gastroparesis can overlap with symptoms of functional dyspepsia:
Early satiety
Nausea
Post-prandial fullness/bloating
DD Nausea/Vomiting
List is extensive and includes broad range of pathologic and physiologic conditions including GI tract, CNS, metabolic/endocrine fxns
Assessment
Hx to fully understand symptoms
Differentiate vomiting from regurgitation, rumination, bulimia
Duration, frequency and severity of symptoms
Pain - usually localized to upper abdomen, described as burning, vague, or crampy. Many c/o pain exacerbated by eating and pain interfering with sleep
Rumination
a syndrome that consists of daily effortless regurgitation of undigested food within minutes of eating
Abdominal Exam
May show epigastric distention or tenderness but not rigidity
May be succession splash
Abdominal Pain
Usually upper abdomen
Burning
Cramping
Vomit Characteristics
May contain old food, ingested several hours previously
Labs/Radiation
NOT useful in dx of gastroparesis itself but can test for nutritional status
Dx Tests
Upper Endoscopy
or
Barium Meal
Confirms the presence of gastric stasis by the finding of retained food after an overnight period of fasting
Barium follow through - necessary in presence of colicky pain to exclude bowel lesion
Scintigraphic Gastric Emptying
most cost-effective, simple, and widely available technique to confirm the presence of postprandial gastric stasis is scintigraphic gastric emptying
In clinical practice, the most useful parameters are gastric retention of >10 percent at 4 hours and >70 percent at 2 hour
Management
Supportive measures to provide hydration and nutrition
Controlling blood sugars in DM
Utilizing meds - like prokinetic and antiemetics, Erythromycin May be used to “restart” or “kick-start” the stomach during acute episodes of gastric stasis in which oral intake is not tolerated.
Occasional surgical therapy
Dietary Modifications
Consume: Low fat diet (without nondigestable fibers), Small, frequent meals
Avoid: Fat, Fresh fruits and veggies
Surgery
Rarely indicated in gastroparesis except:
provision of effective decompression (venting gastrostomy or jejunostomy) or
completion of subtotal gastrectomy in patients with a previous partial gastrectomy
