Ward: Gastroparesis

Question 1

Characterized by delayed emptying of food from the stomach into the small bowel in the absence of mechanical obstruction

Answer 1

gastroparesis

Question 2

Symptoms of gastroparesis

Answer 2

vomiting
postprandial nausea
epigastric fullness after eating
abdominal bloating
gastroesophageal reflux
lack of appetite

Question 3

Additional symptoms:
Esophagitis
Mallory-Weiss tears
Severe peptic ulcer disease

Answer 3

gastroparesis

Question 4

What things aggravate the symptoms of gastroparesis?

Answer 4

eating large quantities of fruits/veggies
eating greasy or rich foods
drinking beverages high in fat or carbonation

Question 5

What are these?
Alcohol.
Anticholinergic drugs.
Calcium channel blockers.
Dopamine agonists.
Histamine (H2) receptor antagonists.
Nicotine.
Proton Pump Inhibitors.

Answer 5

Things that make gastroparesis worse

Question 6

What’s the grading system for gastroparesis severity?

Answer 6

Grade 1: patients with mild intermittent symptoms that can be controlled with diet/avoidance
Grade 2: patients with moderate/severe symptoms that require prokinetic drugs
Grade 3: patients who can’t even maintain oral nutrition, and make frequent ER visits for IV, etc

Question 7

When performing an endoscopy, what are you looking for?

Answer 7

bezoars-solid collections of food, mucus, vegetable fiber, hair, etc

Question 8

Unlike an endoscopy which requires anesthesia, this method of diagnosis can distinguish between gall bladder disease and pancreatitis vs gastroparesis.

Answer 8

ultrasound

Question 9

What is this method of diagnosing gastroparesis?
Gastric emptying study using solids labeled with a ϒ-emitting radioisotope. Examinations, 1-4 hrs. after a meal.
If more than 10% of meal is in
stomach after 4 hrs. –Gastroparesis!

Answer 9

scintigraphy

Question 10

What is this method of diagnosing gastroparesis? Temperature, pH, and pressure measurements can be used to calculate gastric emptying, small bowel transit, colonic transit

Answer 10

wireless motility capsule; smart pill

Question 11

Paracetamol/Acetaminophen Testing

Answer 11

administer paracetamol or acetaminophen and take serial blood samples to see if its being absorbed and at what rate

Question 12

T/F: radio opaque markers can also be used to diagnose gastric emptying

Answer 12

True

Question 13

Patient eats a meal containing a small amount of radioactive material. Breath samples are taken over a period of several hours to measure the amount of radioactive material in the exhaled breath. The results determine how fast the stomach is emptying.

Answer 13

Octanoic Acid Breath Test

Question 14

Used to diagnose lactose intolerance

Answer 14

hydrogen breath test

Question 15

Used to diagnose H. Pylori

Answer 15

urea breath test

Question 16

Problems associated with gastroparesis

Answer 16

severe dehydration
GERD
Bezoars
Malnutrition
Decreased quality of life

Question 17

Diabetes melitus
autonomic neuropathy
diabetic autonomic neuropathy
myopathy
viral infections

Answer 17

Diseases that can lead to gastroparesis

Question 18

Possible causes of gastroparesis

Answer 18

impaired glycemic control
extrinsic/intrinsic neuropathies
abnormalities of ICC cells
loss of nitric oxide synthase
myopathy

Question 19

Treatment options for gastroparesis

Answer 19

surgery
gastric pacing
enteral nutrition
intrapyloric botox
dietary modifications
avoid exacerbating factors
glycemic control

Question 20

• Six small meals a day instead of three large ones.
• Chewing food well, drinking noncarbonated liquids with a meal, and walking after a meal.
• Avoiding high-fat and fibrous foods. Undigested foods can form bezoars. Phytobezoars often leads to nausea

Answer 20

Treatment options for gastropareisi

Question 21

2 prokinetic drugs in the treatment of gastroparesis

Answer 21

metoclopramide

erythromycin

Question 22

Laparoscopic placement of electrodes in the stomach, which are connected to a neurostimulator in a pocket of the abdominal wall

Answer 22

gastric electrical stimulation

Question 23

Treatment used for phase 3 patients who cannot eat

Answer 23

parenteral nutrition

Question 24

Treatment used to increase low levels of heme oxygenase-1

Answer 24

hemin injection