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Gastrointestinal > Motility disorders > Flashcards

Motility disorders Flashcards

1
Q

Primary or functional disorder: achalasia

A

Primary

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2
Q

Primary or functional disorder: esophageal spasm

A

Primary

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3
Q

Primary or functional disorder: globus sensation

A

Functional

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4
Q

Primary or functional disorder: gastroparesis

A

Primary

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5
Q

Primary or functional disorder: acute/chronic intestinal pseudo-obstruction

A

Primary

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6
Q

Primary or functional disorder: IBS

A

Functional

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7
Q

Primary motility disorders are secondary to what?

A

Impaired control of the neuromuscular apparatus of the gut

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8
Q

True or false: the ssx of gastric motility disorders are largely the same

A

True– N/v bloating

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9
Q

What are the ssx of gastric motility disordrs?

A

n/v
Bloating
ABD pain
Constipation or diarrhea

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10
Q

What are the factors that motility depends on?

A

Smooth muscle contraction along with integration with and modulation by extrinsic/enteric nerves

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11
Q

What are the three nerves plexi that are involved in motility?

A

CNS
ANS
ENS

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12
Q

What are the causes of extrinsic neuropathy causes of dysmotility? (5)

A
  • DM
  • Trauma
  • Parkinson’s
  • Amyloidosis
  • Paraneoplastic syndromes
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13
Q

What is the effect of paraneoplastic syndrome on gut motility?

A

Abs deposit in neurons causing dysmotility

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14
Q

What is the cause of enteric neuropathy?

A

Idiopathic degeneration or inflammatory/infiltrative processes

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15
Q

What are the two smooth muscle cell diseases taht cause dysmotility?

A

Metabolic muscle disorders

Myotonic dystrophy

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16
Q

What are the nerve/muscle overlaps of GI dysmotility?

A

Amyloidosis
Mitochondrial cytoptahies
scleroderma

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17
Q

What are the severe ssx of impaired gastric dysmotility?

A

Dysphagia
Postprandial vomiting
Weight loss
Nutritional deficiencies

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18
Q

What is in you ddx with gastric dysmotility?

A

Mechanical obstruction
Crohn’s/IBD
Autonomic neuropathy
Eating disorders

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19
Q

What are the things that should be focused on in the H&P of pts with dysmotility ssx?

A

FMH
Meds
ROS

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20
Q

What is diltiazem? HOw does it cause GI problems?

A

CCB

Inhibits motility

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21
Q

What is the succession splash seen with dysmotility disorders?

A

a sloshing sound heard through the stethoscope during sudden movement of the patient on abdominal auscultation

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22
Q

Is generalized TTP or focal TTP more common with dysmotility disorder?

A

Generalized

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23
Q

When is an x-ray indicated for an abdominal exam?

A

If distention is present

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24
Q

If there is air all the way down to the rectum is suggestive of what?

A

non-obstructive pathology

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25
Q

What are the three tests that can r/o a mechanical obstruction?

A

EGD
Barium swallow
CT abdo

26
Q

What does a diffuse esophageal spasm look like with a barium swallow?

A

Zig-zaggy

27
Q

What is a scintigraphy?

A

Pt ingests radiolabeled meal.

Scans taken at 0, 1, 2, 4 and 6 hours

tests for dysmotility disorders

28
Q

What is Manometry? When is it used?

A

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

29
Q

What are the results of a Manometry with neuropathic problems?

A

Contraction of normal amplitude, but abnormal contractile patter

30
Q

What are the results of a Manometry with myopathic

A

Low average amplitude of contraction

31
Q

What are the ROME II criteria for IBS?

A
  1. Relieved by defecation
  2. Onset associated with change in stool frequency
  3. Onset associated with a change in stool form or appearance
32
Q

What is IBS?

A

Recurrent abdo pain for at least 3 days during the previous 3 months and associated with 2 of the criteria

33
Q

What are the supporting symptoms of IBS?

A
  1. Altered stool frequency
  2. altered stool form
  3. Altered stool passage
  4. Mucorrhea
  5. Abdo bloating or distension
34
Q

What is IBS-D?

A

Diarrhea predominant

35
Q

What is IBS-C?

A

Constipation predominant

36
Q

What is IBS-M

A

Mixed diarrhea and constipation

37
Q

What is IBS-A?

A

Alternating diarrhea and constipation

38
Q

True or false: it is common that IBS pts change type within a year

A

True

39
Q

What are the pmhx flags for IBS?

A

Onset of abdominal pain and altered bowel habits in childhood

40
Q

The development of IBS symptoms in people older than what age should prompt a closer search for an underlying organic cause?

A

40 years old

41
Q

What is the key to diagnosing IBS?

A

H&P

42
Q

What are the “alarm” symptoms of IBS (5)

A
  • Weight loss
  • Bloody stools
  • Nocturnal diarrhea or pain
  • Steatorrhea
  • B symptoms
43
Q

The focus of an evaluating a pt with suspected IBS is what?

A

rule out organic disease prior to dx IBS (e.g. lactose intolerance, gluten intolerance)

44
Q

Fatty stool indicates what?

A

Infectious or absorptive problem

45
Q

What is the description of constipation for IBS pts?

A

Hard stools of narrow caliber, or infrequent defecation

46
Q

What are the two major symptoms of IBS in regard to bowel habits?

A

Postprandial urgency

Alternating habits

47
Q

Where is the abdominal pain with IBS?

A

Lower or LLQ

GERD variant

48
Q

What is the pain like in IBD?

A

Dull pain with intermittent sharp pain.

49
Q

What does eating/defecation do to the pain in IBS?

A 
Eating = precipitate
Defecate = improves
50
Q

What are the other PMHX bits that are common to IBD?

A

Fibromyalgia
Depression
Endometriosis

51
Q

What is the relationship between surgeries and IBD?

A

Multiple surgeries (adhesions?)

52
Q

What are the social history bits common to IBD pts?

A

h/o sexual abuse

53
Q

What are the family medical hx bit common to IBD?

A

Celiac
IBD
Colon CA

54
Q

Is a rectal/pelvic exam indicated for IBD symptoms?

A

Yeah, Duh

55
Q

Why check TSH with IBD symptoms?

A

hyperthyroid may cause increased stools

56
Q

What percent of pts with IBD have celiac abs?

A

10%

57
Q

Why are stool studies done for IBD symptoms?

A

Infectious etiology

58
Q

Who usually gets mesenteric ischemia?

A

Older person with heart disease

59
Q

What is the treatment for IBD? (2)

A

Antispasmodics

Antidepressants

60
Q

What are the ways to manage constipation secondary to IBD?

A

Fiber

Cathartics

61
Q

How do you manage diarrhea secondary to IBD?

A

Loperamide

serotonin antagonists

62
Q

What is the MOA of alosetron?

A

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.

Gastrointestinal (42 decks)

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