L14 GI Motility and Functional Disorders Flashcards
Disruption of normal propulsive ability of the gastrointestinal tract due to a failure of peristalsis in the absence of mechanical obstruction?
Ileus
Consequences of Ileus?
*Constipation
*Distension
*Discomfort
*Nausea, vomiting, belching
*Absent bowel sounds
Causes of Ileus?
Post surgery, trauma (particularly spinal)
Severe illness (pancreatitis, ICU), neutropaenia
Electrolyte and acid-base abnormalities
Drugs: anti-muscarinics, opioids
Hypothyroidism
Acute Colonic Pseudo-obstruction (colonic dilation in absence of mechanical obstruct
Ogilvie Syndrome
Variant of Ileus
Management of Ileus?
Drip and Suck: try to tease the intestine into restarting peristaltic motions
Nil by mouth
Sham feeding
“gentle” NG tube feeding
Criteria for Diagnosis of IBS?
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
Bio-psycho-social model of IBS?
Goal of Interventions?
Disrupted “brain-gut axis”: Genetic, Environmental and psychological factors interact=> Threshold (for movement/Pain moves)
Interventions aimed at cause and to optimize threshold
Triggers of IBS?
Anxiety and eating d/o
Stress including abuse
GI infection (7-30%)
Antibiotic use (Gut Flora)- Probiotics effective at helping
Pelvic surgery
Management of IBS?
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
Chronic Idiopathic Intestinal Pseudo-Obstruction versus IBS?
IBS (Functional Gastrointestinal Disorder, Involves stool symptoms)
CIIPO (GI neuromuscular disorders, Pain/Gas/Bloating but No Stool Symptoms)
GI Motility disorder associated with decreased Interstitial Cells of Cajal?
Slow Transit Constipation
Normal Diameter (unlike chronic idiopathic intestinal pseudoobstruction)
GI Motility disorder associated with Intestinal Dilation?
Chronic Idiopathic Intestinal Pseudo-Obstruction
Disease characterized by:
chronic inflammation (probably autoimmune)
widespread small vessel damage
progressive perivascular and interstitial fibrosis (skin and organs)
Systemic Sclerosis
GI Motility disorder associated with anti-nuclear autoantibodies?
Systemic Sclerosis
Diffuse: Anti DNA topoisomerase 1 (Organ failure (<5 years)
Limited: Anti centromere antibody (10-30 years before visceral involvement)
Main cause of death for those with Systemic Sclerosis?
Lungs
What is Raynaud’s Phenomenon and what condition is it associated with?
Diffuse Cutaneous Systemic Sclerosis
GI Effects of Systemic Sclerosis?
Rubber hose Esophagus
Dysmotility
Malabsorption
Motility disorder associated with collagenous replacement of the lamina propria, submucosa and muscularis propria of the ____________ of the oesophagus leading to __________
Systemic Sclerosis: Collagenous replacement of the lamina propria, submucosa and muscularis propria of the lower 2/3 of the oesophagus “rubber hose” (dysphagia)
Epidemiology/Pathogenesis of Chaga’s Disease?
Protozoa Trypanosoma Cruzi
Arthropod vector: feces of “kissing/assasin bugs” enters through skin scratches => skeletal, cardiac and smooth muscle
Clinical Manifestations of Chaga’s Disease?
Dilated rounded heart
Megacolon (constipation, left to right)
Megaesophagus (dysphagia, achalasia and aspiration pneumonia)
Ganglionitis: Infection surrounding ganglion cells
Congenital aganglionic megacolon is also known as?
Hirschsprung’s Disease
Epidemiology of Hirschsprung’s Disease?
1/5000 live births
3-4 times more likely in boys
Polygenic (associated with trisomy 21)
Pathogenesis of Hirschsprung’s Disease?
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
Neonatal failure to pass meconium and obstipation is indicative of what condition?
Hirschsprung’s Disese
Short segment may be missed
