SM_136b: Disorders of GI Motility Flashcards
Gastrointestinal motility disorders include ____, ____, ____, and ____
Gastrointestinal motility disorders include CNS disorder, autonomic neuropathy, enteric neuropathy, and visceral neuropathy
Esophagus functions to ____ and ____
Esophagus functions to transport ingested material from mouth to stomach and prevent reflux of gastric contents
Enteric nervous system ___
Enteric nervous system governs the function of the GI system
(functions independently of sympathetic and parasympathetic nervous systems)
Pressure in GI system is greatest near ____
Pressure in GI system is greatest near pharynx
Describe the Chicago Classification
Chicago Classification: disorders of EGJ outflow obstruction, major disorders of peristalsis, minor disorders of peristalsis, and normal esophageal motor function
Achalasia is when ____
Achalasia is when the lower esophageal sphincter fails to open during swallowing
- Retention of food / saliva
- Esophageal dilatation
- Constriction of gastroesophageal junction
Achalasia is caused by ____
Achalasia is caused by a loss of inhibitory ganglion cells in the myenteric plexus, resulting in failure of the lower esophageal sphincter to open during swallowing
Achalasia histopathology is a ____
Achalasia histopathology is an idiopathic enteric neuropathy characterized by degeneration of myenteric neurons, specifically inhibitory nitric oxide neurons
____ has highest sensitivity for diagnosis of achalasia
Esophageal manometry has highest sensitivity for diagnosis of achalasia
Describe the manometric subtypes of achalasia
Achalasia monometric subtypes
- Type I: IRP>15 mmHg, absent peristalsis, absent contractile activity
- Type II: IRP>15 mmHg, absent peristalsis, >20% swallows with panesophageal pressurization
- Type III: IRP>15 mmHg, absent peristalsis, ≥ 2 spastic contractions w/ or w/o periods of compartmentalized pressurization
Describe therapy of achalasia
Achalasia therapy
- Smooth muscle relaxants
- Botulinum toxin
- Pneumatic dilation
- Per oral endoscopic myotomy
- Esophageal stent
- Percutaneous gastrostomy tube
- Heller myotomy
Pseudo-achalasia is ____ and is secondary to ____
Pseudo-achalasia is mechanical obstruction of the GI tract that can mimic the radiographic and manometric features of GI dysmotility and is secondary to cancer
Pseudoachalasia mechanisms include ____, ____, and ____
Pseudoachalasia mechanisms include
- Direct involvement of gastroesophageal junction
- Submucosal infiltration of gastroesophageal junction and muscularis with destruction of myenteric neurons
- Paraneoplastic syndrome: anti-Hu antibodies (small cell lung cancer)
Most common cancers implicated in pseudoachalasia are ____, ____, and ____
Most common cancers implicated in pseudoachalasia are squamous cell carcinoma of the esophagus, adenocarcinoma of the esophagus, and gastric adenocarcinoma
Secondary achalasia can occur due to ____, ____, and ____
Secondary achalasia can occur due to pseudoachalasia (cancer associated), post fundoplication, and Chagas disease
Stomach functions in ____, ____, and ____
Stomach functions in storing food to allow time for proper digestion, mechanical and chemical digestion of food, and sieving to allow maximal surface area for activity of enzymes
____ presents with nausea / vomiting / regurgitation, early satiety, and bloating / upper abdominal discomfort, and weight loss
Gastroparesis presents with nausea / vomiting / regurgitation, early satiety, and bloating / upper abdominal discomfort, and weight loss
_____ physical exam involves upper abdominal distention and succussion splash
Gastroparesis physical exam involves upper abdominal distention and succussion splash
Diagnostic tests for gastroparesis are ____, ____, ____, and ____
Diagnostic tests for gastroparesis are
- Endoscopy and / or upper GI study to rule out gastric outlet obstruction
- Gastric emptying study (scintigeaphy)
- Wireless motility capsule
- Antroduodenal manometry
Diabetic gastroparesis is an ____
Diabetic gastroparesis is an autonomic (vagal) neuropathy
- Impaired accomodation, decreased antral contractions, and pyloric spasm
Small intestine functions in ____, ____, and ____
Small intestine functions in mixing pancreatic and biliary secretions with food, propulsion of chyme along the surface area of intestine to allow for maximum absorption, and sampling of luminal antigens by immune system
_____ is the intestinal housekeeper that allows larger indigestible contents to be removed during phase III
Migrating motor complex is the intestinal housekeeper that allows larger indigestible contents to be removed during phase III
- Phase III of MM: cycles every 90 minutes in the fasting state, consists of high amplitude contractile waves that propel residual contents across an open pylorus into the duodenum and continues to the distal ileum
____ is a visceral myopathy that presentswith small bowel dysmotility and esophageal dysmotility
Scleroderma is a visceral myopathy that presentswith small bowel dysmotility and esophageal dysmotility
Small bowel dilatation with stacked coin appearance of valvulae conniventes is ____
Small bowel dilatation with stacked coin appearance of valvulae conniventes is scleroderma
____ and ____ can cause intestinal pseudo-obstruction
Postoperative ileus and scleroderma can cause intestinal pseudo-obstruction
Describe presentation of chronic intestinal pseudo-obstruction
Presentation of chronic intestinal pseudo-obstruction
- Abdominal bloating and pain
- Abdominal distension
- Diarrhea / constipation / obstipation
- Nausea and vomiting
- Weight loss
- Borborygmi
- Excessive flatus
Clinical manifestations of chronic intestinal pseudo-obstruction are ____, ____, ____, ____, and ____
Clinical manifestations of chronic intestinal pseudo-obstruction are maldigestion, small bowel bacterial overgrowth, pseudo-obstruction, small bowel diverticulosis, and pneumatosis cystoides intestinalis
Colon functions in ____, ____, and ____
Colon functions in absorbing 1-1.5 L of water and electrolytes oper day, storing stools to prevent frequent defecation, and promoting absorption of short chain fatty acids via bacterial colonization
- Bacterial colonization converts poorly or non-absorbed carbohydrates into short chain fatty acids that can be absorbed and serve as a source of energy
Describe colonic motility
Colonic motility
- Slow waves and contractions migrate in an oral direction -> produce reverse peristalsis in the proximal colon
- Mass movements: lumen obliterating contractions of circular muscle that propel fecal material short distances in aboral direction
- Volitional reservoir
____ is hindgut autonomic neural dysfunction
Acute colonic pseudo-obstruction (Ogilvie’s syndrome) is hindgut autonomic neural dysfunction
- Marked colonic distension in absence of mechanical obstruction
- Decreased parasympathetic activity and/or increased sympathetic activity
- Symptoms: abdominal pain, nausea / vomiting, shortness of breath, obstipation
____ and ____ cause colonic motility disorders
Ogilvie’s syndrome and spinal cord injury cause colonic motility disorders
Anorectum functions in ___ and ___
Anorectum functions in storage and maintaining continence
(anorectal inhibitory reflex)
Hirschsprung’s disease is an ____
Hirschsprung’s disease is an enteric neuropathic disorder characterized by absence of enteric neurons in the rectum and distal colon due to the failed migration of neuroblasts into the terminal bowel
Absence of enteric neurons in rectum and distal colon due to failed migration of neuroblasts into the terminal bowel is ____
Absence of enteric neurons in rectum and distal colon due to failed migration of neuroblasts into the terminal bowel is Hirschsprung’s disease
