GI motility [3]

Question 1

What GI motility disorders?

Answer 1

Neuropathic - ENS affected
Myopathic - Gi muscles diseased
Abnormalities in interstitital cells of Cajal - pacemaker
CNS disorders (parasymp vagal n. is domin. driver)

Question 2

Scleroderma
What is it?
What % results in GI manifestations?
What is the main abnormality of the GI tract?
(hint: what type of GI motility disorder is scleroderma?)

Answer 2

aka Progressive systemic sclerosis (PSS)

Multisystem disorder characterized by:

• obliterative small vessel vasculitis
• CT proliferation with fibrosis of mult organs

80-90% GI manif.
SM atrophy and gut wall fibrosis
- MYOPATHIC!

Question 3

Spastic disorders of Esophagus

• Myo or neuropathic?
• Esophageal manometry shows?

Answer 3

Can be myopathic or neuropathic
Jackhammer esophagus!

(nl swallowing and peristalsis, just MASSIVE peristalsis - chartruss)

Question 4

Receptive relaxation of the stomach is _____ mediated inhibition of body tone.

Liquid emptying is by _______
Solid emptying is by _________

Answer 4

swallowing induced vagally

tonic P gradient
vagally mediated contraction

Question 5

Residual solids are emptied during non fed state by ____ every _____ min

Answer 5

MMC, 90-120 min

Question 6

functional dyspepsia (FD)

• what is it?
• what % of FD pts have impaired gastric accomodation?
• What type of GI motility disorder is it?

Answer 6

dyspepsia (discomfort/pain centered in upper abdo usually related to eating) with no organic etiologies

40%

• can be either myopatic, neuropatic, or CNS

Question 7

What two stomach responses result in maintenance of low intragastric pressure?

Answer 7

receptive relaxation
- vagal mediated inhib of body tone

accomodation

• sm relaxation by mech distention of stom
• gastric mechanoreceptors + vagovagal response

Question 8

Presentation of FD

Answer 8

dyspepsia (upper ab discomfort/pain to eating)
postprandial heaviness
early satiety
epigastric pain/burning

Question 9

Gastroparesis

• what is it?
• neuro or myo or CNS disorder

Answer 9

“stomach paralysis”
- gastric emptying prob fr. stomach → duodenum

CNS disorder
- ie: vagal n injury post thoracic surgery

tx: lifestyle, diet, meds

Question 10

Presentation of gastroparesis

Answer 10

postprandial abdominal distention
postprandial abdominal pain
early satiety
nausea/vomiting

Question 11

Chronic intestinal pseudo-obstruction (CIPO)

• what is it
• what do you see on imaging?
• it is a major manifestation of small intestinal _____
• complication of CIPO?
• what type of motility disorder?

Answer 11

• Small bowel peristalsis problem
• See dilatation due to mechanical obstruction of small bowel without a lesion obstructing flow of intestinal contents
• Dysmotility
• stasis → bacterial overgrowth → fermentation and malabsorption
• can be myo, neuro, or mixed

Question 12

Presentation of CIPO

Answer 12

N/V
abd. pain
distention
constipation
diarrhea
urinary sx

Question 13

Prognosis for infants with CIPO

Answer 13

1/3 die in 1st year of life

- mechanical obstruction of small bowel → peristalsis problem

Question 14

Neuropathic small intestinal motility disorders

Answer 14

CIPO
Degenerative neuropathies (PD)
Chagas
Diabetic neuropathy
Paraneoplastic autoimmune

(hirshsprung is colon disorder)

Question 15

24 radiopaque Sitz markers are given in 1 day. On day 5, how many remaining is abnormal?

Answer 15

> 5 abnl

• in recto-sigmoid: defecatory disorder
• throughout colon: slow transit

Question 16

What type of muscle - innervation
internal anal sphincter
External anal sphincter

Answer 16

I: circular SM
- Autonomic: pelvic plexus

E: striated - volitional
- pudendal n

Question 17

Hirshsprung’s disease

• what is it?
• type of motility disorder?

Answer 17

Sphincter dysfxn
congenital absence of myenteric neurons of distal colon
(neuropathic motility disorder)

Question 18

What reflex is absent in Hirshsprung’s?

Answer 18

Recto-anal inhibitory reflex

• involuntary IAS relaxation in response to rectal distension → descend into anal canal
• INTERNAL ANAL SPHINCTER WONT CHILLAX

Question 19

Pelvic floor dysfxn

- what is it

Answer 19

inability to coordinate the abdominal, rectoanal and pelvic floor muscles during defecation

DYSSYNERGIC DEFECATION (spincter dysfxn)
- paradoxical contraction of pelvic floor and EAS

Question 20

Test used to measure fxn of lower esophageal sphincter

Answer 20

esophageal manometry
- tells you if your esophagus can move food down to sotmach nl

Note: Achalasia (type I): absence of peristalsis and no LES relaxation