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8 Cards in this Set

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What are the esophageal motility disorders?
Achalasia (most common)
Diffuse esophageal spasm
*What are the clinical features and treatment of achalasia?
-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
*What are the clinical features of a diffuse esophageal spasm?
-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
*What's the clinical presentation of delayed gastric emptying?
bloating, nausea, vomiting after meals (undigested food), not associated with abdominal pain
*What are the causes of delayed gastric emptying?
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).
What is chronic idiopathic intestinal pesudoobstruction (CIIP)?
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!
*What are the causes of chronic constipation?
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
*What are the symptoms of IBS (not IBD!!!)? Which ones differentiate IBS from organic disease?
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