Motility disorders Flashcards
What is achalasia and how do we test for it?
Is it poor relaxation of the oesophagus leading to poor swallow. It is investigated through manometry. Endoscopy isn’t very useful, because it has a low NPV
What is the treatment of achalasia?
The best treatment is surgery (laparoscopic myotomy), although if a patient is older (>40 years) one would start with pneumatic dilatation.
In high surgical risk patients, one would look at botulinium toxin.
What is functional dyspepsia?
This is a condition with:
- bothersome post prandial fullness
- early satiety
- epigastric pain
- epigastric burning
with no evidence of structural lesion
What is the Rome III diagnostic criteria for IBS?
3 days/month for at least 3 months:
abdominal discomfort associated with:
- 3 BM/day
- hard or lumpy stools
- relieved by defecation.
What are some risk factors for post-infectious IBS? What form does it usually take?
More likely to be diarrhoea dominant IBS.
RF include, young, female, bloody stools, abdo cramps
What is the goal of therapy in functional bowel disorders?
The main focus is symptom driven therapy, focussing on dietary measures, prokinetics, TCAs, PPI if acid problems
CBT may have a role in co-morbid psych issues
The most common mechanism for GORD is?
It appears to be related to transient relaxations of the lower oesophageal sphincter.
Less so, presence of a hiatus hernia.
Where abouts are the G cells located in the stomach? What do they do?
These cells are located in the antrum of the stomach, and they release gastrin.
Gastrin can be elevated in PPI therapy, pernicious anaemia, ZE syndrome and vagotomy.
What is the best investigation for new onset dysphagia?
What is the second investigation?
The first investigation should be an endoscopy.
Once this has been performed, one should consider a barium swallow
Are there any micronutrient supplementation that can cause oesophageal ulceration?
Iron supplements can irritate the gullet :)
In a chest xray, are there any disorders of the oesophagus that could cause absence of a gastric bubble?
Achalasia may cause an absent gastric bubble on CXR, provided the patient hasn’t just had an endoscopy. A barium swallow should also show a bird-beak sign on xray.
