Lecture 9: Motility Flashcards

1
Q

Mucosal plexus = ; Myenteric plexus =

A

Meissner’s, Auerbach’s

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2
Q

Peristalsis

A

Slow movement, longitudinal smooth muscle

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3
Q

Segmentation

A

Contractile, circular smooth muscle

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4
Q

Interstitial Cells of Cajal

A

Pacemaker cells of the gut

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5
Q

Two types of electrical activity of GI tract

A

Slow waves (phasic contractions) and spike activity

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6
Q

What controls peristalsis?

A

Serotonin, contraction: ACh, substance P; relaxation: NO

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7
Q

GI motility disorders: sx

A

N/V, pain, early satiety, D, C, gas/bloat

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8
Q

When we start to eat, what does the fundus do?

A

Relax to accept contents

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9
Q

How fine must the antrum grind food?

A

1-2 mm particles

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10
Q

Which part of the stomach regulates emptying of liquids? Solids?

A

Fundus/body; antrum

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11
Q

Gastroparesis: associated diseases (account for 2/3)

A

50% w/ diabetes due to neuropathy, thyroid, CT disorders, pregnancy

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12
Q

Another name for accelerated gastric emptying

A

Dumping syndrome

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13
Q

Test for gastric motility

A

Gastric emptying scan

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14
Q

Small intestinal motility: 2 states

A

Fed: segmental, promote mixing/absorbing; Fasting: cyclic, keeps intestine clean of bacteria/residue, “Migrating Motor Complex” (MMC)

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15
Q

Small bowel dysmotility (5 classes)

A

Neurologic (PD, post-viral); SM (collagen vascular disorder, etc); Endocrine (diabetes/thyroid); Drugs (opiates, anticholinergics); Myenteric Plexus Disorders

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16
Q

Chronic intestinal pseudo-obstruction: definition and classes of causes

A

Disease that behaves as if there is a bowel obstruction due to a variety of reasons: myopathy, enteric neuropathy, idiopathic (note: sx the same as other motility disorders)

17
Q

Tests of small bowel motility (2)

A

Small bowel manometry with a catheter; breath test (calculate H produced…higher early H is related to slow motility)

18
Q

Normal colonic motility (2 types of activity)

A

High amplitude propagating contractions = associated with defecation, 6x day, > 100 mmHg and; Low amplitude propagating contraction = associated with fluid transport, distension and flatus, 100x day,

19
Q

Primary causes of constipation

A

Slow transit constipation, defecation disorders, functional constipation (most common)

20
Q

Functional constipation: definition

A

2 of the following: straining, hard stools, sense of incomplete evacuation, sense of anorectal block (can’t get it out), manual maneuvers, less than 3 defecations per week

21
Q

IBS: definition

A

Abdominal pain/discomfort with: improvement with defecation, change in stool freq, change in stool form

22
Q

Other causes of constipation (4)

A

Diet (low fiber), eating disorders, surgerical history (change in anatomy or post-op), medications (narcotics, calcium)

23
Q

Ogilvie’s Syndrome/Acute Pseduoobstruction: define, etiology, tx

A

Non-obstructive colonic dilatation due to drugs, post-op, immobility; tx = underlying condition, decompress colon, neostigmine (stimulate parasympathetics)

24
Q

IBS: women or men?

25
Types of IBS
IBS w/ diarrhea, constipation, mixed, unsubtyped
26
Four "causes"/highlights of IBS
Increased motor reactivity to luminal contents, altered visceral sensation (decreased pain threshold), involves small and large intestine, CNS-ENS dysregulation
27
Describe serotonin normally and IBS hypothesis
5-HT release stimulates motility and secretion via enteric nerve reflexes; in IBS there is less 5-HT, so feces sit in colon causing pain, and also less secretion
28
5-HT hypothesis works best for patient with what kind of IBS?
Constipation
29
How to deal with IBS syndrome (2 main categories)
Dietary and behavior modification (decrease stress, therapy), pharmacology (laxatives, anti-diarrheal medications, anti-depressants, 5-HT receptor agents)
30
Tests for colonic motility (2)
Sitz marker study (give markers that should be expelled for a certain amount of time) and scintigraphy (nuclear medicine)
31
Describe process of defecation
Propagation of intraluminal contents to rectum associated with rectal fullness --> internal anal sphincter relaxation (signal to brain) --> external anal sphincter contraction --> socially acceptability --> squatting --> puborectalis muscle and pelvic floor muscles relax --> strain --> defecation
32
Maintenance of continence: structure
Internal/external anal sphincter, levator ani muscles (creates angle), rectal curvature and transverse rectal folds (delays passage)
33
Maintenance of continence: function
Anal sensation must be intact, storage capacity must be intact, nerve integrity must be maintained, stool volume/consistency are factors, and mental status
34
Fecal incontinence: %, who, tx
8%, common in women (related to number of pregnancies), elderly, institutionalized; tx = anti-diarrheal medications, fiber, biofeedback (training), surgery
35
Pelvic floor function tests (2)
MRI defecography w/ contrast enema while trying to have defecation; anorectal manometry