Motility disorders Flashcards
Primary or functional disorder: achalasia
Primary
Primary or functional disorder: esophageal spasm
Primary
Primary or functional disorder: globus sensation
Functional
Primary or functional disorder: gastroparesis
Primary
Primary or functional disorder: acute/chronic intestinal pseudo-obstruction
Primary
Primary or functional disorder: IBS
Functional
Primary motility disorders are secondary to what?
Impaired control of the neuromuscular apparatus of the gut
True or false: the ssx of gastric motility disorders are largely the same
True– N/v bloating
What are the ssx of gastric motility disordrs?
n/v
Bloating
ABD pain
Constipation or diarrhea
What are the factors that motility depends on?
Smooth muscle contraction along with integration with and modulation by extrinsic/enteric nerves
What are the three nerves plexi that are involved in motility?
CNS
ANS
ENS
What are the causes of extrinsic neuropathy causes of dysmotility? (5)
- DM
- Trauma
- Parkinson’s
- Amyloidosis
- Paraneoplastic syndromes
What is the effect of paraneoplastic syndrome on gut motility?
Abs deposit in neurons causing dysmotility
What is the cause of enteric neuropathy?
Idiopathic degeneration or inflammatory/infiltrative processes
What are the two smooth muscle cell diseases taht cause dysmotility?
Metabolic muscle disorders
Myotonic dystrophy
What are the nerve/muscle overlaps of GI dysmotility?
Amyloidosis
Mitochondrial cytoptahies
scleroderma
What are the severe ssx of impaired gastric dysmotility?
Dysphagia
Postprandial vomiting
Weight loss
Nutritional deficiencies
What is in you ddx with gastric dysmotility?
Mechanical obstruction
Crohn’s/IBD
Autonomic neuropathy
Eating disorders
What are the things that should be focused on in the H&P of pts with dysmotility ssx?
FMH
Meds
ROS
What is diltiazem? HOw does it cause GI problems?
CCB
Inhibits motility
What is the succession splash seen with dysmotility disorders?
a sloshing sound heard through the stethoscope during sudden movement of the patient on abdominal auscultation
Is generalized TTP or focal TTP more common with dysmotility disorder?
Generalized
When is an x-ray indicated for an abdominal exam?
If distention is present
If there is air all the way down to the rectum is suggestive of what?
non-obstructive pathology
What are the three tests that can r/o a mechanical obstruction?
EGD
Barium swallow
CT abdo
What does a diffuse esophageal spasm look like with a barium swallow?
Zig-zaggy
What is a scintigraphy?
Pt ingests radiolabeled meal.
Scans taken at 0, 1, 2, 4 and 6 hours
tests for dysmotility disorders
What is Manometry? When is it used?
Pressure sensitive device is placed in the stomach and duodenum, and measures the contraction of the GI system.
Used if dysmotility is confirmed with other means
What are the results of a Manometry with neuropathic problems?
Contraction of normal amplitude, but abnormal contractile patter
What are the results of a Manometry with myopathic
Low average amplitude of contraction
What are the ROME II criteria for IBS?
- Relieved by defecation
- Onset associated with change in stool frequency
- Onset associated with a change in stool form or appearance
What is IBS?
Recurrent abdo pain for at least 3 days during the previous 3 months and associated with 2 of the criteria
What are the supporting symptoms of IBS?
- Altered stool frequency
- altered stool form
- Altered stool passage
- Mucorrhea
- Abdo bloating or distension
What is IBS-D?
Diarrhea predominant
What is IBS-C?
Constipation predominant
What is IBS-M
Mixed diarrhea and constipation
What is IBS-A?
Alternating diarrhea and constipation
True or false: it is common that IBS pts change type within a year
True
What are the pmhx flags for IBS?
Onset of abdominal pain and altered bowel habits in childhood
The development of IBS symptoms in people older than what age should prompt a closer search for an underlying organic cause?
40 years old
What is the key to diagnosing IBS?
H&P
What are the “alarm” symptoms of IBS (5)
- Weight loss
- Bloody stools
- Nocturnal diarrhea or pain
- Steatorrhea
- B symptoms
The focus of an evaluating a pt with suspected IBS is what?
rule out organic disease prior to dx IBS (e.g. lactose intolerance, gluten intolerance)
Fatty stool indicates what?
Infectious or absorptive problem
What is the description of constipation for IBS pts?
Hard stools of narrow caliber, or infrequent defecation
What are the two major symptoms of IBS in regard to bowel habits?
Postprandial urgency
Alternating habits
Where is the abdominal pain with IBS?
Lower or LLQ
GERD variant
What is the pain like in IBD?
Dull pain with intermittent sharp pain.
What does eating/defecation do to the pain in IBS?
Eating = precipitate Defecate = improves
What are the other PMHX bits that are common to IBD?
Fibromyalgia
Depression
Endometriosis
What is the relationship between surgeries and IBD?
Multiple surgeries (adhesions?)
What are the social history bits common to IBD pts?
h/o sexual abuse
What are the family medical hx bit common to IBD?
Celiac
IBD
Colon CA
Is a rectal/pelvic exam indicated for IBD symptoms?
Yeah, Duh
Why check TSH with IBD symptoms?
hyperthyroid may cause increased stools
What percent of pts with IBD have celiac abs?
10%
Why are stool studies done for IBD symptoms?
Infectious etiology
Who usually gets mesenteric ischemia?
Older person with heart disease
What is the treatment for IBD? (2)
Antispasmodics
Antidepressants
What are the ways to manage constipation secondary to IBD?
Fiber
Cathartics
How do you manage diarrhea secondary to IBD?
Loperamide
serotonin antagonists
What is the MOA of alosetron?
5HT (3) antagonist (recall that these nerves are the ones that run from the gut to the CNS. Blocking these will block the pain associated with IBS. Note that this is only used in women with refractory IBS.
