Ward: Gastroparesis Flashcards
Characterized by delayed emptying of food from the stomach into the small bowel in the absence of mechanical obstruction
gastroparesis
Symptoms of gastroparesis
vomiting postprandial nausea epigastric fullness after eating abdominal bloating gastroesophageal reflux lack of appetite
Additional symptoms:
Esophagitis
Mallory-Weiss tears
Severe peptic ulcer disease
gastroparesis
What things aggravate the symptoms of gastroparesis?
eating large quantities of fruits/veggies
eating greasy or rich foods
drinking beverages high in fat or carbonation
What are these? Alcohol. Anticholinergic drugs. Calcium channel blockers. Dopamine agonists. Histamine (H2) receptor antagonists. Nicotine. Proton Pump Inhibitors.
Things that make gastroparesis worse
What’s the grading system for gastroparesis severity?
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
When performing an endoscopy, what are you looking for?
bezoars-solid collections of food, mucus, vegetable fiber, hair, etc
Unlike an endoscopy which requires anesthesia, this method of diagnosis can distinguish between gall bladder disease and pancreatitis vs gastroparesis.
ultrasound
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!
scintigraphy
What is this method of diagnosing gastroparesis? Temperature, pH, and pressure measurements can be used to calculate gastric emptying, small bowel transit, colonic transit
wireless motility capsule; smart pill
Paracetamol/Acetaminophen Testing
administer paracetamol or acetaminophen and take serial blood samples to see if its being absorbed and at what rate
T/F: radio opaque markers can also be used to diagnose gastric emptying
True
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.
Octanoic Acid Breath Test
Used to diagnose lactose intolerance
hydrogen breath test
Used to diagnose H. Pylori
urea breath test
Problems associated with gastroparesis
severe dehydration GERD Bezoars Malnutrition Decreased quality of life
Diabetes melitus autonomic neuropathy diabetic autonomic neuropathy myopathy viral infections
Diseases that can lead to gastroparesis
Possible causes of gastroparesis
impaired glycemic control extrinsic/intrinsic neuropathies abnormalities of ICC cells loss of nitric oxide synthase myopathy
Treatment options for gastroparesis
surgery gastric pacing enteral nutrition intrapyloric botox dietary modifications avoid exacerbating factors glycemic control
- 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
Treatment options for gastropareisi
2 prokinetic drugs in the treatment of gastroparesis
metoclopramide
erythromycin
Laparoscopic placement of electrodes in the stomach, which are connected to a neurostimulator in a pocket of the abdominal wall
gastric electrical stimulation
Treatment used for phase 3 patients who cannot eat
parenteral nutrition
Treatment used to increase low levels of heme oxygenase-1
hemin injection
