L14 GI Motility and Functional Disorders

Question 1

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

Answer 1

Ileus

Question 2

Consequences of Ileus?

Answer 2

*Constipation
*Distension
*Discomfort
*Nausea, vomiting, belching
*Absent bowel sounds

Question 3

Causes of Ileus?

Answer 3

Post surgery, trauma (particularly spinal)
Severe illness (pancreatitis, ICU), neutropaenia
Electrolyte and acid-base abnormalities
Drugs: anti-muscarinics, opioids
Hypothyroidism

Question 4

Acute Colonic Pseudo-obstruction (colonic dilation in absence of mechanical obstruct

Answer 4

Ogilvie Syndrome

Variant of Ileus

Question 5

Management of Ileus?

Answer 5

Drip and Suck: try to tease the intestine into restarting peristaltic motions
Nil by mouth
Sham feeding
“gentle” NG tube feeding

Question 6

Criteria for Diagnosis of IBS?

Answer 6

ROME III Criteria
Abdominal Pain (3 Months of the Year at least 3 days a week)
+
≥ 2 of the following
*Improves with defecation
*Onset associated with change in stool frequency
*Onset associated with change in stool form/appearance

Question 7

Bio-psycho-social model of IBS?

Goal of Interventions?

Answer 7

Disrupted “brain-gut axis”: Genetic, Environmental and psychological factors interact=> Threshold (for movement/Pain moves)
Interventions aimed at cause and to optimize threshold

Question 8

Triggers of IBS?

Answer 8

Anxiety and eating d/o
Stress including abuse
GI infection (7-30%)
Antibiotic use (Gut Flora)- Probiotics effective at helping
Pelvic surgery

Question 9

Management of IBS?

Answer 9

Identify dietary triggers
Increase fiber/excercise
Manipulate gut flora (Rifaximin (poorly absorbed - only impacts gut)
Pharmacologically manipulate gut motility
Address psychological co-morbidities with drugs that don’t exacerbate GI symptoms

Question 10

Chronic Idiopathic Intestinal Pseudo-Obstruction versus IBS?

Answer 10

IBS (Functional Gastrointestinal Disorder, Involves stool symptoms)

CIIPO (GI neuromuscular disorders, Pain/Gas/Bloating but No Stool Symptoms)

Question 11

GI Motility disorder associated with decreased Interstitial Cells of Cajal?

Answer 11

Slow Transit Constipation

Normal Diameter (unlike chronic idiopathic intestinal pseudoobstruction)

Question 12

GI Motility disorder associated with Intestinal Dilation?

Answer 12

Chronic Idiopathic Intestinal Pseudo-Obstruction

Question 13

Disease characterized by:
chronic inflammation (probably autoimmune)
widespread small vessel damage
progressive perivascular and interstitial fibrosis (skin and organs)

Answer 13

Systemic Sclerosis

Question 14

GI Motility disorder associated with anti-nuclear autoantibodies?

Answer 14

Systemic Sclerosis

Diffuse: Anti DNA topoisomerase 1 (Organ failure (<5 years)

Limited: Anti centromere antibody (10-30 years before visceral involvement)

Question 15

Main cause of death for those with Systemic Sclerosis?

Answer 15

Lungs

Question 16

What is Raynaud’s Phenomenon and what condition is it associated with?

Answer 16

Diffuse Cutaneous Systemic Sclerosis

Question 17

GI Effects of Systemic Sclerosis?

Answer 17

Rubber hose Esophagus
Dysmotility
Malabsorption

Question 18

Motility disorder associated with collagenous replacement of the lamina propria, submucosa and muscularis propria of the ____________ of the oesophagus leading to __________

Answer 18

Systemic Sclerosis: Collagenous replacement of the lamina propria, submucosa and muscularis propria of the lower 2/3 of the oesophagus “rubber hose” (dysphagia)

Question 19

Epidemiology/Pathogenesis of Chaga’s Disease?

Answer 19

Protozoa Trypanosoma Cruzi

Arthropod vector: feces of “kissing/assasin bugs” enters through skin scratches => skeletal, cardiac and smooth muscle

Question 20

Clinical Manifestations of Chaga’s Disease?

Answer 20

Dilated rounded heart
Megacolon (constipation, left to right)
Megaesophagus (dysphagia, achalasia and aspiration pneumonia)
Ganglionitis: Infection surrounding ganglion cells

Question 21

Congenital aganglionic megacolon is also known as?

Answer 21

Hirschsprung’s Disease

Question 22

Epidemiology of Hirschsprung’s Disease?

Answer 22

1/5000 live births
3-4 times more likely in boys
Polygenic (associated with trisomy 21)

Question 23

Pathogenesis of Hirschsprung’s Disease?

Answer 23

Absent ganglion cells in Meissner’s (submucosal) & Auerbach’s (myenteric) plexuses

Due to failure of caudal migration caused by loss of function mutation of RET Gene

Question 24

Neonatal failure to pass meconium and obstipation is indicative of what condition?

Answer 24

Hirschsprung’s Disese

Short segment may be missed