Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI Boards November 20th 2024 > Motility Disorders > Flashcards

Motility Disorders Flashcards

1
Q

Jackhammer (nutcracker) Esophagus and Hypertensive LES are classified under THIS esophageal dysmotility disorder?

A

HYPERcontraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Ineffective Esophageal Motility is classified under THIS esophageal dysmotility disorder?

A

HYPOcontraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Distal (diffuse) Esophageal Spasm is what type of esophageal dysmotility disorder?

A

Uncoordinated contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the Deglutitive EGJ Relaxation Window?

A

10 SECOND window of what occurs at the EGJ, pressure-wise from time of SWALLOW

Normal Swallow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The LOWEST mean RELAXATION PRESSURE for a 4 SECOND period WITHIN the Deglutative EGJ Relaxation Window is called? and what is considered NORMAL?

A

IRP (Integrated Relaxation Pressure) < 15 mmHg
anything >15 mmHg is considered IMPAIRED EGJ Relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The VOLUME of the contraction BELOW the transition zone of the esophagus that contains ONLY SMOOTH MUSCLE is called?

A

Distal Contractile Integral (DCI)
Normal is >450 but < 8,000 mmHg/cm/sec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The point in the swallow curve that SHARPLY BENDS away from the donwslope indicating a TRANSITION from the esophageal PERYSTALTIC CLEARANCE to esophageal EMPTYING?

A

Contractile Deceleration Point (CDP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The TIME from the start of a SWALLOW to the contractile deceleration point (CDP) is called what? What is NORMAL?

A

Distal Latency (DL)
Normal is >4.5 seconds (if its shorter, its a SPASTIC contraction)

CDP and Distal Latency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

If DYSPHAGIA is NOT explained by stenoses or inflammation, CHEST PAIN is not explained by heart diseae or PRIOR to fundoplication procedure to exclude ACHALASIA, this TEST should be done?

A

High-resolution esophageal manometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Do esophageal MANOMETRY abnormalities mean that there is actual underlying DISEASE?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

SECONDARY ACHALASIA is caused by what two disorders?

A

CHAGAS disease (trypanosoma cruzi)
MALIGNANCY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Swallowing that fails to induce perystalsis and fails to induce LES relaxation is called?

A

ACHALASIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is COMMON to ALL THREE subtypes of ACHALASIA?

A

IRP >15 mmHg
ABNORMAL peristalsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What DISTINGUISHES the THREE subtypes of ACHALASIA?

A

PRESSURE response in the BODY of the ESOPHAGUS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In this TYPE of ACHALASIA, you see TWO HIGH PRESSURE zones where SWALLOWING FAILS to result in PERISTALSIS and the LES FAILS TO RELAX with SWALLOWING (therefore IRP >15 mmHg)?

A

CLASSIC TYPE-I ACHALASIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

In this TYPE of ACHALASIA, you see a “TREE TRUNK” appearance where there is SIMULTANEOUS PRESSURIZATION >30 mmHg, of the ENTIRE ESOPHAGUS?

A

TYPE-II ACHALSIA (most treatable)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

In this TYPE of ACHALASIA, >20% of SWALLOWS result in PREMATURE CONTRACTION of the esophagus with DISTAL LATENCY < 4.5 SECONDS?

A

TYPE-III (SPASTIC ACHALASIA) - hypercontractions with DCI >8,000 worst response to treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What MEDICATIONS are used to treat ACHALASIA?

A

Calcium Channel Blockers & Nitrates (only used when other methods don’t work)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the only TWO DEFINITIVE treatments for ACHALASIA?

A

Pneumatic Dilation (balloons 30-40 mm to TEAR the LES)
Heller Myotomy (or POEM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the most COMMON complication post LES tearing for ACHALASIA (dilation, Heller, POEM)?

A

GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the TREATMENT of CHOICE for TYPE-III ACHALASIA?

A

POEM (can get a longer myotomy than with a HELLER)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

WHEN should BOTOX be used to TREAT patients with ACHALASIA?

A

When PNEUMATIC DILATION, HELLER MYOTOMY of POEM are not options

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is TRUE of ALL treatments for ACHALASIA that patients MUST be informed about?

A

ALL DETERIORATEover TIME and will eventually need other treatments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Is ACHALASIA curable?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

In a patient undergoinf high-resolution esophageal manometry and they are found to have an IRP >15 mmHg AND they have NO PERISTALSIS AT ALL, what’s the diagnosis?

A

ACHALASIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

In a patient undergoinf high-resolution esophageal manometry and they are found to have an IRP >15 mmHg AND they have ANY PERISTALSIS AT ALL, what’s the diagnosis?

A

EGJ OUTFLOW OBSTRUCTION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Achalasia VARIANT, EoE, infiltrative CANCER, extrinsic VASCULAR obstruction, HIATAL hernia, OBESITY, OPIOIDS can all result in?

A

ELEVATED IRP with PRESERVED PERISTALSIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Does an ELEVATED IRP by itself mean much?

A

NO (20-40% resolve spontaneously)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

SUPINE IRP measurements are HIGHER than those done UPRIGHT, so what does an UPRIGHT IRP distinguish?

A

IMPORTANT from unimportant EGJ outlet obstruction
UPRIGHT IRP >12 98% EGJ outlet obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

IRP > ULN in BOTH SUPINE and UPRIGHT positions, there is SOME PERISTALSIS and >20% of swallows, there is INTRABOLUS PRESSURE?

A

EGJ Outlet Obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

EGJ Outlet Obstruction means what CLINICALLY?

A

It is INCONCLUSIVE (must distinguish cilinically RELEVANT - symptoms of dysphagia, chest pain and a test supporting the obstruction such as BARIUM tablet or FLIP from IRRELAVANT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is considered a NORMAL EGJ DI (Distensibility Index) in FLIP?

A

>2 with a 60 mL FILL VOLUME

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is considered a NORMAL EGJ DIAMETER in FLIP?

A

>16 with a 60-70 mL FILL VOLUME

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

During FLIP test, what is CONSIDERED an ABNORMAL Rapid Drink Challenge (RDC)?

A

BOTH the IRP >12 mmHg AND there is PAN-PRESSURIZATION of the esophagus
If EITHER but not both are present, then its INTERMEDIATE
Normal is IRP < 12 mmHg AND no pan-pressurization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Clinical DYSPHAGIA, CHEST pain, TERTIARY contractions on imaging and PREMATURE contractions on manometry?

A

Distal Esophageal SPASM (short Distal Latency < 4.5 seconds)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Normal IRP and >20% of swallows with DCI >8,000?

A

HYPERcontractile (jackhammer) esophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What MUST be RULED OUT when diagnosing a HYPERcontractile/SPASTIC esophagus?

A

OPIOID use, GERD, EoE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

PPI trial, Calcium Channel Blockers, Nitrates, Sildenafil, Peppermint Oil are all treatments for what ESOPHAGEAL disorder?

A

HYPERcontractile/SPASM esophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is the MOST COMMON cause of a HYPOcontractile esophagus?

A

SCLERODERMA (fibrous and vascular oblitertion of esopahgeal muscle and nerves) - low amplitude contractions and hypotensive LES
Otherwise Ineffective Esophageal Motility (DM, amyloidosis, GERD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

>70% INEFFECTIVE swallows (weak contraction with DCI >100 & < 450)

FAILED PERISTALSIS (DCI < 100)

FRAGMENTED swallows (peristaltic break >5 cm) and DCI >450
OR
>50% FAILED SWALLOWS

A

Ineffective Esophageal Motility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What TEST can you use to PREDICT post fundoplication DYSPHAGIA?

A

Multiple Rapid Swallows test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

If a patient undergoes high-resolution esophageal manometry and is found to have one of these three (EGJ Outlet Obstruction, Distal Esophageal Spasm or HYPOcontractile Esophagus), what else MUST they have to make the DIAGNOSIS?

A

SYMPTOMS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What class of medications IMPAIRS LES RELAXATION, causes HYPERcontraction with ELEVATED DCI and causes SPASM with SHORTENED DL?

A

OIPIDS (can mimic achalasia type III, EGJ outflow obstruction, distal esopahgeal spasm and HYPERcontractile esophagus on manometry) - STOP the opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What nerve controls the UGI and SMALL BOWEL motiliy?

A

VAGUS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Pelvic and Lumbar nerves (sympathetics and parasympathetics) control motility for which portion of the GIT?

A

Colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

In patients with POST-INFECTIOUS Functional Dyspepsia, what motility phase was affected most?

A

Gastric ACCOMODATION (no effect on gastric emptying)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What medication has been shown to significantly REDUCE symptoms in FUNCTIONAL DYSPEPSIA?

A

BUSPIRONE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are the THREE most common causes of GASTROPARESIS?

A

IDIOPATHIC
DM
Upper GI, heart/lung SURGERY (VAGUS injury)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Patients with WHAT condition present with APPARENT GATROPARESIS even with slowed emptying (due to the disorder itself)?

A

Eating Disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

TCAs, OPIATES, SMOKING, LITHIUM, PPIs and CANNABINOIDS can all cause this GI disorder?

A

GASTROPARESIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What do you see on an UPPER GI SERIES that is diagnostic for gastroparesis?

A

POOLING of contrast in the STOMACH in the ABSENCE of an obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What finding on EGD is highly-suggestive for GASTROPARESIS?

A

BEZOAR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is considered GOLD standard TEST for GASTROPARESIS?

A

SOLID-PHASE Gastric Emptying Study (nuclear)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Does GASTRIC EMPTYING correlate with SYMPTOMS (nausea, vomiting, abdominal pain)?

A

NO

55
Q

What is considered the UPPER LIMIT of NORMAL for a STANDARD (4 HOUR) Gastric Emptying Scan for DELAYED GASTRIC EMPTYING at 4 HOURS?

A

>10% retention at 4 HOURS is abnormal

56
Q

What constitutes a GASTROPARESIS DIET?

A

SMALL FREQUENT MEALS (6/day), LOW-FAT (carbs and proteins are best), LOW-FIBER, liquid SUPPLEMENTATION

57
Q

What is the RECOMMENDED treatment of FUNCTIONAL (post-infectious) DYSPEPSIA with ABNORMAL GES (gastroparesis symptoms post infection)?

A

METOCLOPRAMIDE

58
Q

What is the ONLY approved drug for GASTROPARESIS that IMPROVES MOTILITY, NAUSEA and VOMITING?

A

METOCLOPRAMIDE

59
Q

Besides NEUROLOGIC side effects of METOCLOPRAMIDE, what other side effect is seen in some?

A

HYPERprolactinemia

60
Q

HOW LONG should a patient take METOCLOPRAMIDE before its STOPPED (higher risk of side effects, tardive dyskinesia)?

A

No more than 9 MONTHS

61
Q

Is DOMPERIDONE approved in the US for use for gastroparesis?

A

NO

62
Q

Is BOTOX recommended for treatment of GATROPARESIS?

A

NO (because NO difference to PLACEBO)

63
Q

Is it RECOMMENDED to place a GASTRIC STIMULATOR in a patient who has a NORMAL GES, or has PRIMARILY ABDOMINAL PAIN and uses OPIATES?

A

NO

64
Q

What is the ONLY role of a GASTRIC STIMULATOR?

A

Improve symptoms of NAUSEA & VOMITING (not pain, not motility) in DIABETIC GASTROPARESIS ONLY

65
Q

For what ETIOLOGY of GASTROPARESIS does a gastric stimulator treat the NAUSEA and VOMITING symptoms?

A

DIABETES

66
Q

When is the ONLY time a G-POEM should be CONSIDERED (must be VERY SELECTIVE)?

A

GES >20% retention at 4 HOURS
and
GCSI score (1-5) >2.6 (moderately-severe symptoms)

67
Q

Is a GASTRECTOMY (completion) recommended for GASTROPARESIS?

A

NO

68
Q

Does ERYTHROMYCIN have ANY EFFECT on NAUSEA and VOMITING?

A

NO

69
Q

In a patient with gastroparesis SYMPTOMS of NAUSEA, VOMITING and abdominal pain with a HISTORY of MIGRAINES/ANXIETY/DEPRESSION, how do you treat?

A

NORTRIPTYLINE (cyclical vomiting syndrome)

70
Q

RECURRENT episodes of SEVERE NAUSEA and VOMITING separated by SYMPTOM-FREE intervals with NO WEIGHT LOSS and gastric emptying is RAPID or NORMAL?

A

Cyclical Vomiting Syndrome (nortriptyline)

71
Q

Cyclical Vomiting Syndrome associated with COMPULSIVE HOT WATER BATHING, NO response to TCAs (nortriptyline)?

A

CANNABINOID HYPEREMESIS (stop smoking marijuana for at least 6 MONTHS)

72
Q

What is the TREATMENT of Cyclical Vomiting Syndrome (non-cannabinoid ie no hot water bathing compulsion)?

A

TCAs or Neurokinin-1 Antagonists

73
Q

The MMC (Migrating Motor Component) of the SMALL BOWEL exists ONLY in what state?

A

FASTING (to keep SB free of bacteria and debris)

74
Q

What is Chronic Intestinal Pseudoobstruction (myopathic or neuropathic)?

A

Intestine does NOT MOVE contents as expected

75
Q

Familial, COLLAGEN, THYROID disease, AMYLOIDOSIS, HIRSCHPRUNG’s (full thickness intestinal biopsy), CHAGAS, PARANEOPLASTIC syndromes can all cause this MOTILITY DISORDER?

A

Chronic Intestinal Pseudoobstruction

76
Q

GI Motility Disorder that affects most PROMINENTLY the ESOPHAGUS, ANAL SPHINCTERS & SB and advanced cases cause SIBO and MALABSORPTION with WEIGHT LOSS?

A

SCLERODERMA (abdominal bloating, distention, diarrhea, weight loss) - check scleroderma antibodies and Hydrogen (GLUCOSE) breath test

77
Q

A patient is well, then SUDDENLY develops WEIGHT LOSS caused by AUTOIMMUNE attack on ENTERIC NEURONS causing CHRONIC INTESTINAL PSEUDOOBSTRUCTION?

A

PARANEOPLASTIC SYNDROME (stain MYENTERIC NEURONS)

78
Q

If suspecting PARANEOPLASTIC SYNDROME for cause of CHRONIC INTESTINAL PSEUDOOBSTRUCTION, what TWO tests should you do?

A

CT CHEST (most malignancies causing this will be in the MEDIASTINUM)
MAYO paraneoplastic antibody panel

79
Q

If suspecting AMYLOID as a cause of INTESTINAL CHRONIC PSEUDOOBSTRUCTION or DYSMOTILITY, what is the BEST DIAGNOSTIC method?

A

RECTAL BIOPSY

80
Q

If in >25% of the time, a patient experiences ≥2 of: STRAINING, LUMPY or HARD stools, sense of INCOPLETE evacuation, ANORECTAL obstruction, uses MANUAL MANUVERS to help move bowels or < 3 Spontaneous BMs/week, what is the DIAGNOSIS?

A

FUNCTIONAL CONSTIPATION

81
Q

If a patient is experiencing INFREQUENT BOWEL MOVEMENTS alone, is that sufficient to diagnose FUNCTIONAL CONSTIPATION?

A

NO

82
Q

If a patient has only ONE BM per week, is that enough to diagnose FUNCTIONAL CONSTIPATION?

A

NO (need at least one more of the ROME criteria)

83
Q

SEROTONIN agonists (5H3), OPIATES, Ca-CHANNEL BLOCKERS, ALUMINUM, IRON SUPPLEMENTS and ANTIDEPRESSANTS, ANTIPSYCHOTICS can all cause this GI motility disorder?

A

CONSTIPATION

84
Q

DO STIMULANT LAXATIVES (bisacodyl, Senna, picosulfate) HARM the colon (melanosis, etc.)?

A

NO

85
Q

With what FREQUENCY should FIBER or OSMOTIC laxatives be used?

A

DAILY

86
Q

When using STIMULANT laxatives (bisacodyl, picosulfate, Senna) what should the GOAL in BMs be?

A

2-4 BMs/week

87
Q

LEAST ESPENSIVE, SAFEST and MOST EFFECTIVE laxatives are what?

A

OTC (psyllium, lactulose, PEG, Senna, bisacodyl)

88
Q

Which LAXATIVE should NOT be used in PREGNANCY?

A

LINACLOTIDE

89
Q

If PEG fails in a PREGNANT patient, what LAXATIVE should be recommended?

A

SENNA

90
Q

SAFEST LAXATIVE to be used in PREGNANCY?

A

PEG (if not effective, SENNA)

91
Q

A patient with constipation that becomes unresponsive to multiple laxatives of different classes should have what evaluation done?

A

BALLOON expulsion test and ANORECTAL MANOMETRY

92
Q

What is the FIRST best method to assess an issue with DEFECATION?

A

DIGITAL RECTAL EXAM

93
Q

Why is ANORECTAL MANOMETRY ALONE, insufficient to diagnose defecation problems?

A

Because many of its patters can be seen in NORMAL individuals

94
Q

What is considered a SLOW BALLOON EXPULSION test?

A

Anything >60 seconds once balloon is inflated

95
Q

When is BARIUM DEFACOGRAPHY used?

A

When BOTH STRUCTURE and FUNCTION is being tested (looking for a poorly contacting musle or anatomic obstruction suce as a RECTOCELE)

96
Q

Does the BALLOON EXPULSION test + ANORECTAL MANOMETRY test for STRUCTURE and FUNCTION of defecation?

A

NO, FUNCTION ONLY

97
Q

SLOW colonic transit (sitz marker study) with a NORMAL colon DIAMETER, NORMAL ANORECTAL function (balloon expulsion and anorectal manometry) with a DECREASED repsonse to FATTY meals, cholinergics and laxatives and decreased contractions?

A

COLONIC INERTIA

98
Q

What is the FIRST TEST to perform for REFRACTORY CONSTIPATION (no or poor response to multiple laxatives)?

A

BALLOON EXPULSION + ANORECTAL MANOMETRY (function)

99
Q

If the BALLOON EXPULSION + ANORECTAL MANOMETRY (function only) studies are BOTH NORMAL, what’s EXCLUDED and what do you test for next, in a patient with REFRACTORY CONSTIPATION (no or poor response to multiple laxatives)?

A

DEFECATION DISORDER is EXCLUDED
NEXT: colonic TRANSIT study (SITZ markers)

100
Q

What does the colonic TRANSIT (SITZ marker) sudy tell you if its SLOW (>60 seconds)?

A

COLONIC INERTIA

101
Q

If the BALLOON EXPULSION + ANORECTAL MANOMETRY (function only) studies are BOTH ABNORMAL, what’s the NEXT STEP?

A

BIOFEEDBACK

102
Q

How do you TREAT INTRACTABLE COLONIC INERTIA?

A

MISIPROSTOL (+/- PEG) - effective in 40%
EXCEPT in WOMEN of CHILDBEARING AGE (abortive agent)

103
Q

What is RECOMMENDED for a patient that has INTRACTABLE COLONIC INERTIA with no response to ANY meds including MISOPROSTOL, has intractable and disabling symptoms, a colonic inertia PATTERN, no intestinal PSEUDOOBSTRUCTION and NORMAL ANORECTAL FUNCTION and ABDOMINAL PAIN IS NOT the PROMINENT FEATURE?

A

SUBTOTAL COLECTOMY

104
Q

Should a SUBTOTAL COLECTOMY be recommended for a patient with PREDOMINANLTY ABDOMINAL PAIN in INTRACTABLE COLONC INERTIA?

A

NO (won’t help)

105
Q

Institutionalized ELDERLY, patients with SCHIZOPHRENIA and other PSYCHOTIC disorders, those with PARKINSONS and other neurologic disorders are at risk for this COLONIC COMPLICATION?

A

CHRONIC MEGACOLON

106
Q

How is CHRONIC MEGACOLON treated MEDICALLY?

A

LOW FIBER diet, low-dose PEG, ENEMAS (this is a FAILED colon, not constipation)

107
Q

If a patient with CHRONIC MEGACOLON has DISABLING SYMPTOMS, how do you treat?

A

DIVERTING ostomy or subtotal COLECTOMY with ileostomy

108
Q

What is the FIRST CHOICE in treating OPIOID-INDUCED constipation in a patient with CHRONIC PAIN who needs the opioids?

A

TRADITIONAL LAXATIVES like PEG not PAMORAS (naldemedine, naloxagol or methylnaltrexone)

109
Q

What is TENAPANOR?

A

Similar to LINACLOTIDE, used for IBS-C therapy, reduces absorption of sodium and phosphate in the colon thus increasing water

110
Q

When are PAMORAs used to treate OPIOID-INDUCED CONSPITATION?

A

PAMORAS (naldemedine, naloxagol or methylnaltrexone) are used ONLY when TRADITIONAL LAXATIVES FAIL

111
Q

GI SYMPTOMS not explained by STRUCTURAL or BIOCHEMICAL abnormalities?

A

FUNCTIONAL BOWEL DISORDERS

112
Q

A DISORDER of GUT-BRAIN interaction?

A

IBS (visceral hypersensitivity)

113
Q

CHRONIC or RECURRENT lower abdominal PAIN and DISCOMFORT, ALTERED bowel habits and BLOATING?

A

IBS

114
Q

What demographic is most likely to have post-infectious IBS?

A

FEMALE, ANXIOUS

115
Q

By what MECHANISM does STRESS INCREASE colonic MOTILITY and this is MORE PRONOUNCED in patients with IBS?

A

Hyothalamic release of CORTICOTROPIN RELEASING FACTOR (CRF)

116
Q

Which DIAGNOSTIC TESTS are RECOMMENDED when working up IBS?

A

CELIAC serologies, fecal CALPROTECTIN/LACTOFERRIN, GIARDIA

117
Q

In a patient with IBS-like symptoms that started in >50 years OLD, is this likely to be IBS?

A

NO

118
Q

In a patient experiencing a STEADY-PROGRESSIVE IBS-like symptom course, is this likely to be IBS?

A

NO

119
Q

In a patient with IBS-like symptoms that experiences FREQUENT AWAKANING by PAIN, is this likely to be IBS?

A

NO

120
Q

In a patient with IBS-like symptoms that expereinces WEIGHT LOSS NOT ASSOCIATED WITH DEPRESSION, is this likely to be IBS?

A

NO

121
Q

If a patient >50 presents with a CHRONIC history of intermittent CRAMPS, BLOATING, DIARRHEA, without weight loss and normal CBC, what should yuo check for NEXT?

A

ITS NOT IBS, check a fecal calprotectin (IBD) and COLONOSCOPY if POSITIVE

122
Q

Does a RELIABLE BREATH TEST exist for SIBO?

A

NO!!!

123
Q

What SUBSTRATE should NOT be used for SIBO testing?

A

LACTULOSE

124
Q

What is the ONLY SUBSTRATE that should be used for SIBO testing?

A

GLUCOSE

125
Q

What measures can IMPROVE symptoms and quality of life in IBS patients?

A

FODMAP diet and QUALITY of physician/patient interaction and patient education

126
Q

For a patient with IBS, what is the LENGTH of the FODMAP diet TRIAL RECOMMENDATION?

A

4-6 WEEKS (this is NOT a permanent diet, it is meant to IDENTIFY certain problem-foods for the patients)

127
Q

What is the UNIVERSALLY recommended MEDICATION for ALL IBS patients (costipation or diarrhea predominant)?

A

NORTRIPTYLINE

128
Q

If ALL OTHER meds FAIL to treat IBS-C, what is the RECOMMENDED medication for a WOMAN < 65 yo?

A

TEGASEROD

129
Q

Is LOPERAMIDE recommended for IBS-D treatment?

A

NO

130
Q

If a patient has a history of CHOLECYSTECTOMY, PANCREATITIS, ALCOHOL >3 dinks/day, HEPATIC IMPAIRMENT (CHILD’s C), SOD, BILIARY OBSTRUCTION, what IBS-D drug CANNOT BE USED?

A

EULOXADOLINE

131
Q

If AMYTRIPTYLINE or NORTRIPTYLINE cause side effects such as DISORIENTATION, PALPITATIONS, FATIGUE, in a patient with IBS, what do you do?

A

STOP the DRUG, start DESIPRAMINE (fewer side effects than the other 2)

132
Q

What DOSAGE should be used in patients with IBS when using TCAs (amitriptyline, nortriptyline) and when do you INCREASE?

A

Start LOW, increase every 2-3 WEEKS, wait at least 3 WEEKS to see effect

133
Q

A patient with IBS-C has tried FODMAP, LINACLOTIDE, LUBIPROSTONE, PEG, normal colonoscopy, normal labs, no constipating meds. What do tou RECOMMEND next?

A

COGNITIVE BEHAVIORAL THERAPY

134
Q

Can you safely use MISOPROSTOL in a woman of CHILD-BEARING age who is NOT on birth control?

A

NO (abortifacent drug)

GI Boards November 20th 2024 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions