GI Motility and Functional Disorders Flashcards
Non-ulcer dyspepsia treatment
If H. pylori present, treat like PUD
- PPI + clarithromycin + amoxicillin 10-14 days
TCA if PPI fails
Metoclopramide if TCA fails
(try things until something works, cause unknown so no definitive tx)
Differentiate between IBS and IBD
IBS
- not an autoimmune condition like
- no risk of cancer, often a self-contained disease
IBD
- autoimmune mediated
- extraintestinal manifestations
- risk of malignancy (UC)
Gastroparesis physical exam sign
Succussion splash
(sloshing sound in stethoscope when patient moves)
IBS is most common in these people
Young women
(rare after age 50)
Treatment for IBS
Soluble fiber
(insoluble fiber may trigger symptoms by increasing water contents of stools)
Exercise
Moderate/severe:
- PEG for IBS-C
- Loperamide for IBS-D
- Consider TCAs for IBS-D
Normal transit constipation treatment
- Fiber (insoluble), psyllium, prunes
- PEG, MOM, lactulose for long-term
- Bisacodyl, senna for short-term
Symptoms of IBS
Abdominal pain and altered bowel movements
Cramping pain related to defecation
Exacerbated by meals/emotional stress
Defecatory disorder/outlet transit constipation treatment
Biofeedback and muscle relaxation exercises
Increase dietary fiber
Increase water intake
Bulk-forming laxatives
Enemas (rescue therapy only)
Surgery
These two anatomical abnormalities are present in >90% of patients with defecatory disorder/outlet transit constipation
Rectocele
Internal mucosal prolapse
Diagnosis of non-ulcer dyspepsia
By exclusion (endoscopy and h.pylori etc negative)
“Waste basket diagnosis”
Hirschprung disease treatment
Surgical resection of aganglionic portion of bowel
Slow-transit constipation diagnosis
Delayed passage of radiopaque markers through the colon
Most common cause of gastroparesis
Diabetes
(also idiopathic, postsurgical)
Hirschprung disease is most common in these patients
Down syndrome
Defecatory disorder/outlet transit constipation cause
Anatomical abnormality or inability to coordinate the abdominal and pelvic floor muscles to evacuate stool
Is defecatory disorder/outlet transit constipation more common in males or females?
Females
IBS diagnostics
No definitive test, just exclude other conditions
(stool sample for bacterial/parasitic, serologic for celiac, breath testing for lactase deficiency, endoscopy)
Gastroparesis treatment
Dietary modification:
- small, frequent meals
- low fat, high insoluble (?) fiber
Metoclopramide
(Domperidone + erythromycin if metoclopramide fails)
Normal transit constipation symptoms
Persistently difficult, infrequent, or seemingly incomplete defecation, without evidence of a primary anatomic or biochemical cause
(symptoms but no clear cause, like non-ulcer dyspepsia)
Symptoms of non-ulcer dyspepsia
Postprandial fullness
Early satiety
Epigastric pain
(feel full early and discomfort after eating)
Name of condition characterized by rapid gastric emptying leading to nausea, diarrhea, light-headedness
Dumping syndrome/accelerated gastric emptying
Diagnostic criteria for IBS
Pain and change in stools at least once a week for at least 3 months
No other known cause
(Rome IV criteria)
Defecatory disorder/outlet transit constipation symptoms
Fragmented stools, straining, sense of incomplete evacuation, tenesmus
Symptoms of Hirschprung disease
Intestinal obstruction with bilious emesis/distension/no stool within 48 hours of birth
Most common cause of dumping syndrome
Surgery of the stomach (gastric bypass)/esophagus
Gastroparesis symptoms
Delayed gastric emptying in the absence of mechanical obstruction
Upper GI symptoms:
- nausea/vomiting
- early satiety
- bloating
- pain
Hirschprung disease diagnosis
Rectal biopsy
Slow-transit constipation is more common in these people
Young women
Gastroparesis diagnostics
Delayed gastric emptying on scintigraphy is required to make diagnosis
(after excluding other causes with endoscopy, barium swallow, CT)
Slow-transit constipation treatment
Behavioral training (breathing exercises, timed toilet training)
Increase dietary fiber
Osmotic laxatives (magnesium, PEG)
Stimulant laxatives (bisacodyl, senna)
Dumping syndrome treatment
5-6 small meals a day
Avoid liquids (with meals?)
Go lie down for 30 minutes
(may resolve on its own in 3 months)
This disease is also known as “congenital aganglionic megacolon”
Hirschprung disease
(absence of ganglion cells in distal rectum)
Slow-transit constipation cause
Motility disorder of colon, caused by abnormalities of enteric nerves
Dumping syndrome diagnosis
Gastric emptying scan
True or false. IBS can have bloody or oily stools
False
Three forms of primary constipation
Normal transit
Slow transit
Outlet transit
Which, IBS or IBD is more likely to wake patients from sleep?
IBD
