GI Pathophysiology Flashcards
Two major categories of motility disorders
Neuropathic (ENS) or Myopathic dysfunction
Uncommon motility disorder
CNS-related (ex pacemakers)
Achalasia pathophys
Failure of LES relaxation, usually from inflammatory destruction of myenteric plexus interneurons with sparing of cholinergic neurons
Achalasia Symptoms and Dx
gradual dysphagia of solids liquids with occasional regurgitation
Diagnose with manometry (no relaxation of LES, sometimes loss of body peristalsis)
Scleroderma pathophys
Systemic disorder of fibrosis that produces vascular, nervous, and immune dysfunction. Likely small vessel vasculitis causing smooth muscle damage and leading to fibrosis
Scleroderma Symptoms and Dx
Dysphagia (weak peristalsis), GERD (weak LES)
Dx with manometry: weak peristalsis, no LES function!
Complications of Scleroderma (esophagus)
Strictures from GERD, Barretts too?
What would not be affected by scleroderma? (esophagus)
upper 1/3. Skeletal muscle
Characteristic manometry of spastic esophagus?
None. Highly variable but look for high contractile vigor
Receptive Relaxation
A vago-vagal reflex stimulated by LES relaxation. Allows proximal stomach to expand
Gastroparesis Pathophys
delayed emptying from neurologic damage (diabetic neuropathy of vagal or autonomic system, vagotomy, scleroderma, MS, viral, etc)
Gastroparesis Symptoms and Dx
Sx: early satiety, bloating, nausea, anorexia, vomiting, abdominal pain, weight loss
Dx: Gastric emptying study (radiotracer in food measured at 4 hours; 35% left is severe) or wireless motility capsule measuring pH and pressure
Intestinal Pseudo-obstruction (CIPO)
obstructive symptoms w/o anatomical blockage, considered chronic w/ no bowel dilation. Etiologies are neuropathic, myopathic, and CNS.
CIPO symptoms and Dx
Sx: abdominal pain, bloating, distension
Dx: wireless capsule, manometry
Hirschprung’s Pathophys
absence of myenteric neurons in distal colon, always involving internal anal sphincter. Lack of reflex inhibition
