Motility

Question 1

Esophageal pressure in Manometry

Answer 1

• Above upper esophageal sphincter is +20
• Between upper and lower esophageal sphincters is -5
• Below lower esophageal sphincter is +10

Question 2

Disorder of esophageal motility

Answer 2

• Achalasia (bird beak on barium swallow. Rx: Ca++ channel blockers like nifedipine, Botox or by placing ballon)
• Gastroesophageal reflux disease (GERD)
• Diffuse esophageal spasm (presents as severe chest pain resembling heart attack with barium swallow revealing repeated, spontaneous waves of contraction)

Question 3

Gastric Motility

Stimulants

Answer 3

• Pacemaker (basic electrical rhythm of 3/min)
• Parasympathetic stimulation through ACh and GRP
• Distention (also through ACh and GRP)

Question 4

Gastric Motility

Inhibitors

Answer 4

• Fat in duodenum (via CCK and GIP)
• Acid in duodenum (via secretin)
• Duodenal distention
• Hyperosmolarity in duodenum

Question 5

Stomach emptying

Order of emptying

Answer 5

Liquids > carbohydrates > proteins > fat

Question 6

Migrating Myoelectric Complex (MMC)

Physiology, Rate, Control, Benefit

Answer 6

• Propulsive movement initiated during fasting that begins in stomach, when one movement reaches distal ileum a new one starts in stomach
• 90-120 min during fasting
• Correlated with high circulating levels of motilin
• Move undigested material from stomach and samll intestine into colon and prevents backflow of bacteria from colon into ileum

Question 7

Defecation

Physiology

Answer 7

• A reflex involving CNS
• A mass movement in terminal colon fills the rectum and causes a reflex relaxation of internal anal sphincter and a reflex contraction of external anal sphincter
• Voluntary relaxation of external anal sphincter accompanied with propulsive contraction of distal colon complete defecation