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8 Cards in this Set
- Front
- Back
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What are the esophageal motility disorders?
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Achalasia (most common)
Diffuse esophageal spasm |
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*What are the clinical features and treatment of achalasia?
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-dysphagia to solids and liquids, regurgitation, chest pain, weight loss, aspiration pneumonia
-manometry: complete abscence of peristalsis and incomplete LES relaxation -CXR: air-fluid levels in esophagus -dilated esophagus w/ abrupt tapering (bird's beak) Tx: relax LES, botulinum toxin at gej (most common), dilatation (pneumatic), surgical myotomy |
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*What are the clinical features of a diffuse esophageal spasm?
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-dysphagia (esp liquids), heartburn, chest pain.
-increased wave amplitude and duration, triple peak contraction on esophageal manometry -corkscrew esophagus/ rosary bead on barium swallow -normal endoscopy Tx: nitrates, CCB, botulinum toxin if LES is high |
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*What's the clinical presentation of delayed gastric emptying?
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bloating, nausea, vomiting after meals (undigested food), not associated with abdominal pain
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*What are the causes of delayed gastric emptying?
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1) gastric outlet obstruction: peptic ulcer scarring --> stenosis, compression (eg pancreatic cancer). Evaluate by endoscopy. Treat problem.
2) gastroparesis (motility problem): longstanding DM, idiopathic (incoordinated contractions, usually young women). Find delayed empyting on scan without an obstruction. Treat with prokinetics, botox in pyloric sphincter, gastric pacemaker (usually disastrous). |
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What is chronic idiopathic intestinal pesudoobstruction (CIIP)?
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rare, can also involve stomach and colon.
patients have scleroderma, DM, or idiopathic. can be confused with small bowel obstuction: dilated colon and small bowel. Don't send to surgery! |
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*What are the causes of chronic constipation?
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1. colonic inertia/slow transit (serotonin, cells of Cajal problems)
2. meds-- antacids, anticholinergics (atropine, tricyclics), anticonvulsants, diuretics, ganglionic blockers, Fe, MAOI, opiates, Parkinson's drugs, phenothiazines. 3. obstruction-- colon cancer (recent onset), scarring from surgeries 4. hypothyroid, hypercalcemia 5. hirshprung (nonrelaxation of internal anal sphincter, congenital megacolon) 6. pelvic floor dysfunction, aka anismus, puborectalis spasm |
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*What are the symptoms of IBS (not IBD!!!)? Which ones differentiate IBS from organic disease?
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abdominal pain, altered bowel habits.
Manning criteria: abdominal distention, pain relief with bowel movement, pain --> more frequent and/or looser stool, passage of mucus, sensation of incomplete evacuation. Don't find: blood in stool, weight loss, fever (only organic disease); usually no change in sleeping patterns due to pain/diarrhea; no structural, biochemical or infectious etiology found. typically young women, very common worldwide, increased risk w/ hx of abuse |
