Gastroparesis: Difference between revisions

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*More common in women
*More common in women
**Gastric motility reduced by progesterone
**Gastric motility reduced by progesterone
**Vs. Functional dyspepsia
*Vs. Functional dyspepsia
*Disease associated with reduced quality of life
 
==Causes of Non-obstructive delayed gastric emptying==
*Idiopathic
*[[Diabetic mellitus]]
*Postsurgical/Vagal nerve injury
*GI disorders associated with delated gastric emptying
**[[GERD]]
**[[Achalasia]]
**Atrophic gastritis
**Functional dyspepsia
**Hypertrophic [[Pyloric stenosis]]
**Celiac disease
*Non-GI disorders associated with delayed gastric emptying
**Eating disorders: [[Anorexia]]
**Neurologic disorders such as parkinson's
**Collagen vascular disorders
**Endocrine and metabolic disorders
***Thyroid/Parathyroid dysfunction
***Chronic renal insufficiency
**Medication associated
***Most commonly used: Opioid analgesics, anticholinergics, progesterone, PPIs, alcohol, tobacco


==Clinical Features==
==Clinical Features==
*Symptons variable and including
*Symptons variable and include:
**Early satiety  
**Early satiety  
**Nausea and vomiting
**Nausea and vomiting
**Bloating and upper abdominal discomfort
**Bloating and upper abdominal discomfort
**Abdominal pain (not predominant symptom)
**Abdominal pain (not predominant symptom)
*Signs, long standing disease:
**Dehydration
**Malnourishment
*Functional dyspepsia- abdominal pain is the predominant symptom
*Functional dyspepsia- abdominal pain is the predominant symptom


==Differential Diagnosis==
==Differential Diagnosis==
===By organ system===
====GI====
*[[Peptic ulcer disease]]
*Mechanical Obstruction
**Adhesion
**[[Small bowel obstruction]]/LBO
**Gastric outlet obstruction/[[Pyloric stenosis]]
**[[Volvulus]]
**Strangulated hernia
*[[Pancreatitis]]
*[[Appendicitis]]
*[[Cholecystitis]]
*[[Cholangitis]]
*[[Acute Hepatitis]]
*IBD
*[[Intussusception]]
*Malignancy
*[[Mesenteric ischemia]]
*Esophageal disorders (e.g. achalasia, GERD, [[esophagitis]]
*Functional disorders
**Psychogenic
**[[IBS]]
====Neurologic====
*[[Cannabinoid hyperemesis syndrome]]
====Infectious====
*Bacterial toxins
*[[SBP]]
*[[UTI]]
*Viruses (adeno, norwalk, rota
====Drugs/Toxins====
*Heavy metal poisoning
*Methanol poisoning
====Endocrine====
*[[DKA]]
*Thyroid/parathyroid disorders
*[[Uremia]]
====Miscellaneous====
*Anorexia/bulimia
*Depression


==Evaluation==
==Evaluation==
 
*Diagnosed by demonstrating delayed gastric emptying in a symptomatic patient after other etiologies are excluded
==Management==
*Initial diagnosis requires exclusion of other etiologies and may include an upper endoscopy or gastrointestinal series


==Disposition==
==Disposition==

Revision as of 02:16, 6 January 2017

Background

  • Symptomatic chronic stomach disorder characterized by delayed gastric emptying without mechanical obstruction
  • More common in women
    • Gastric motility reduced by progesterone
  • Vs. Functional dyspepsia
  • Disease associated with reduced quality of life

Causes of Non-obstructive delayed gastric emptying

  • Idiopathic
  • Diabetic mellitus
  • Postsurgical/Vagal nerve injury
  • GI disorders associated with delated gastric emptying
  • Non-GI disorders associated with delayed gastric emptying
    • Eating disorders: Anorexia
    • Neurologic disorders such as parkinson's
    • Collagen vascular disorders
    • Endocrine and metabolic disorders
      • Thyroid/Parathyroid dysfunction
      • Chronic renal insufficiency
    • Medication associated
      • Most commonly used: Opioid analgesics, anticholinergics, progesterone, PPIs, alcohol, tobacco

Clinical Features

  • Symptons variable and include:
    • Early satiety
    • Nausea and vomiting
    • Bloating and upper abdominal discomfort
    • Abdominal pain (not predominant symptom)
  • Signs, long standing disease:
    • Dehydration
    • Malnourishment
  • Functional dyspepsia- abdominal pain is the predominant symptom

Differential Diagnosis

By organ system

GI

Neurologic

Infectious

  • Bacterial toxins
  • SBP
  • UTI
  • Viruses (adeno, norwalk, rota

Drugs/Toxins

  • Heavy metal poisoning
  • Methanol poisoning

Endocrine

Miscellaneous

  • Anorexia/bulimia
  • Depression

Evaluation

  • Diagnosed by demonstrating delayed gastric emptying in a symptomatic patient after other etiologies are excluded
  • Initial diagnosis requires exclusion of other etiologies and may include an upper endoscopy or gastrointestinal series

Disposition

See Also

External Links

References

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