GI Motility and Functional Disorders Flashcards
What is ileus?
disruption of normal propulsive ability of the gastrointestinal tract due to a failure of peristalsis in the absence of mechanical obstruction
What are the consequences of ileus? (5)
- constipation
- distension
- discomfort
- nausea
- absent bowel sounds
What are the causes of ileus? (5)
- post surgery/trauma
- severe illness
- electrolyte and acid-base abnormalities
- drugs - anti-muscarinics, opioids
- hypothyroidism
What is the ROME III criteria for IBS?
abdominal pain that improves with defaecation, onset is associated with change in stool frequency and change in stool form/appearance
What is the cause of IBS?
multifactorial
bio-psycho-social model
What are the subtypes of IBS? (4)
- IBS-Constipation
- IBS-Diarrhoea
- IBS-Mixed
- IBS-Unsubtyped
What IBS subtypes are associated with aberrant autonomic nervous system function? (2)
- excess sympathetic tone in IBS-D
2. Insufficient parasympathetic tone IBS-C
What are the triggers for IBS? (3)
- Gut flora
- Food triggers
- psychosocial triggers
How is IBS managed? (5)
- identify dietary triggers
- manipulate dietary fibre and exercise
- manipulate gut flora
- pharmacologically modulate gut motility
- investigate, explain, reassure
What is chronic idiopathic intestinal pseudo-obstruction?
intestinal dilation
What is the cause of intestinal pseudo-obstruction?
- insufficient actin in the inner circular smooth muscle layer
- auto-immune inflammatory mixed connective tissue disorder
What is the diameter of the lumen in slow transit constipation?
normal diameter
What cells are decreased in slow transit constipation?
- interstitial cells of cajal (pacemakers)
2. enteric neurofilaments
What are the characteristics of systemic sclerosis?
- chronic inflammation
- widespread small vessel damage
- progressive perivascular and interstitial fibrosis
In whom is systemic sclerosis most severe?
African-American women
What auto antibodies are seen in systemic sclerosis? (3)
- anti-nuclear antibodies (all)
- anti DNA topoisomerase (10-20%)
- anti centromere antibody (20-30%)
What are the classifications of systemic sclerosis?
- diffuse cutaneous SScl
2. limited cutaneous SScl (60%)
What autoantibody is associated with diffuse cutaneous SScl?
anti-DNA topoisomerase 1
What autoantibody is associated with limited cutaneous SScl?
anti-centromere antibody
What is limited cutaneous SScl associated with? (5)
- Calcinosis
- raynaud’s
- esophageal dysmotility
- sclerodactyly
- telangiectasia
What is the causative agent of Chaga’s disease?
trypanosoma cruzi
What is the presentation of acute Chaga’s disease?
- papule
- fever
- adenopathy
- myocardial damage
What is Hirchsprung’s disease?
congenital aganglionic megacolon
What is Hirchsprung’s disease associated with? (2)
- trisomy 21
2. loss of function mutation of RET gene
What is the pathogenesis of Hirchsprung’s disease?
- absent ganglion cells in meissner’s (submucosal) and auerbach’s (myenteric) plexuses
- failure of caudal migration
how does Hirchsprung’s disease present?
neonatal failure to pass meconium and obstipation
