GI Motility and Functional Disorders

Question 1

What is ileus?

Answer 1

disruption of normal propulsive ability of the gastrointestinal tract due to a failure of peristalsis in the absence of mechanical obstruction

Question 2

What are the consequences of ileus? (5)

Answer 2

1. constipation
2. distension
3. discomfort
4. nausea
5. absent bowel sounds

Question 3

What are the causes of ileus? (5)

Answer 3

1. post surgery/trauma
2. severe illness
3. electrolyte and acid-base abnormalities
4. drugs - anti-muscarinics, opioids
5. hypothyroidism

Question 4

What is the ROME III criteria for IBS?

Answer 4

abdominal pain that improves with defaecation, onset is associated with change in stool frequency and change in stool form/appearance

Question 5

What is the cause of IBS?

Answer 5

multifactorial

bio-psycho-social model

Question 6

What are the subtypes of IBS? (4)

Answer 6

1. IBS-Constipation
2. IBS-Diarrhoea
3. IBS-Mixed
4. IBS-Unsubtyped

Question 7

What IBS subtypes are associated with aberrant autonomic nervous system function? (2)

Answer 7

1. excess sympathetic tone in IBS-D

2. Insufficient parasympathetic tone IBS-C

Question 8

What are the triggers for IBS? (3)

Answer 8

1. Gut flora
2. Food triggers
3. psychosocial triggers

Question 9

How is IBS managed? (5)

Answer 9

1. identify dietary triggers
2. manipulate dietary fibre and exercise
3. manipulate gut flora
4. pharmacologically modulate gut motility
5. investigate, explain, reassure

Question 10

What is chronic idiopathic intestinal pseudo-obstruction?

Answer 10

intestinal dilation

Question 11

What is the cause of intestinal pseudo-obstruction?

Answer 11

1. insufficient actin in the inner circular smooth muscle layer
2. auto-immune inflammatory mixed connective tissue disorder

Question 12

What is the diameter of the lumen in slow transit constipation?

Answer 12

normal diameter

Question 13

What cells are decreased in slow transit constipation?

Answer 13

1. interstitial cells of cajal (pacemakers)

2. enteric neurofilaments

Question 14

What are the characteristics of systemic sclerosis?

Answer 14

1. chronic inflammation
2. widespread small vessel damage
3. progressive perivascular and interstitial fibrosis

Question 15

In whom is systemic sclerosis most severe?

Answer 15

African-American women

Question 16

What auto antibodies are seen in systemic sclerosis? (3)

Answer 16

1. anti-nuclear antibodies (all)
2. anti DNA topoisomerase (10-20%)
3. anti centromere antibody (20-30%)

Question 17

What are the classifications of systemic sclerosis?

Answer 17

1. diffuse cutaneous SScl

2. limited cutaneous SScl (60%)

Question 18

What autoantibody is associated with diffuse cutaneous SScl?

Answer 18

anti-DNA topoisomerase 1

Question 19

What autoantibody is associated with limited cutaneous SScl?

Answer 19

anti-centromere antibody

Question 20

What is limited cutaneous SScl associated with? (5)

Answer 20

1. Calcinosis
2. raynaud’s
3. esophageal dysmotility
4. sclerodactyly
5. telangiectasia

Question 21

What is the causative agent of Chaga’s disease?

Answer 21

trypanosoma cruzi

Question 22

What is the presentation of acute Chaga’s disease?

Answer 22

1. papule
2. fever
3. adenopathy
4. myocardial damage

Question 23

What is Hirchsprung’s disease?

Answer 23

congenital aganglionic megacolon

Question 24

What is Hirchsprung’s disease associated with? (2)

Answer 24

1. trisomy 21

2. loss of function mutation of RET gene

Question 25

What is the pathogenesis of Hirchsprung’s disease?

Answer 25

1. absent ganglion cells in meissner’s (submucosal) and auerbach’s (myenteric) plexuses
2. failure of caudal migration

Question 26

how does Hirchsprung’s disease present?

Answer 26

neonatal failure to pass meconium and obstipation