Gastroparesis: Difference between revisions
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==Differential Diagnosis==
==Differential Diagnosis==
===By organ system===
===By organ system===
====GI====
*GI
*[[Peptic ulcer disease]]
**[[Peptic ulcer disease]]
*Mechanical Obstruction
**Mechanical Obstruction
**Adhesion
***Adhesion
**[[Small bowel obstruction]]/LBO
***[[Small bowel obstruction]]/LBO
**Gastric outlet obstruction/[[Pyloric stenosis]]
***Gastric outlet obstruction/[[Pyloric stenosis]]
**[[Volvulus]]
***[[Volvulus]]
**Strangulated hernia
***Strangulated hernia
*[[Pancreatitis]]
**[[Pancreatitis]]
*[[Appendicitis]]
**[[Appendicitis]]
*[[Cholecystitis]]
**[[Cholecystitis]], [[Cholangitis]]
*[[Cholangitis]]
**[[Acute Hepatitis]]
*[[Acute Hepatitis]]
**[[Inflammatory Bowel Disease]]
*IBD
**[[Intussusception]]
*[[Intussusception]]
**Malignancy  
*Malignancy  
**[[Mesenteric ischemia]]
*[[Mesenteric ischemia]]
**Esophageal disorders (e.g. achalasia, GERD, [[esophagitis]])
*Esophageal disorders (e.g. achalasia, GERD, [[esophagitis]])
**Functional disorders such as [[Irritable Bowel Syndrome]]
*Functional disorders
*Neurologic
**Psychogenic
**[[Cannabinoid hyperemesis syndrome]]
**[[IBS]]
*Infectious
 
**Bacterial toxins
====Neurologic====
**[[Spontaneous bacterial peritonitis]]
*[[Cannabinoid hyperemesis syndrome]]
**[[Urinary tract infection]
 
**Viruses (adeno, norwalk, rota)
====Infectious====
*Drugs/Toxins
*Bacterial toxins
**Heavy metal poisoning
*[[SBP]]
**Methanol poisoning
*[[UTI]]
*Endocrine
*Viruses (adeno, norwalk, rota
**[[Diabetic ketoacidosis]]
 
**Thyroid/parathyroid disorders
====Drugs/Toxins====
**[[Uremia]]
*Heavy metal poisoning
*Miscellaneous
*Methanol poisoning
**[[Anorexia nervosa]], [[Bulimia]]
 
====Endocrine====
*[[DKA]]
*Thyroid/parathyroid disorders
*[[Uremia]]
 
====Miscellaneous====
*Anorexia/bulimia


==Evaluation==
==Evaluation==

Revision as of 03:06, 6 January 2017

Background

  • Symptomatic chronic stomach disorder characterized by delayed gastric emptying without mechanical obstruction
  • More common in women, presumed due to elevated progesterone
  • Disease associated with reduced quality of life
  • Most commonly seen in diabetics, but other etiologies listed below

Causes of Non-Obstructive Delayed Gastric Emptying

  • Idiopathic
  • Diabetes mellitus
  • Postsurgical/Vagal nerve injury
  • GI disorders associated with delated gastric emptying
  • Non-GI disorders associated with delayed gastric emptying
    • Eating disorders: Anorexia nervosa
    • 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

Differential Diagnosis

By organ system

Evaluation

  • Diagnosed by demonstrating delayed gastric emptying in a symptomatic patient after other etiologies are excluded
    • Gold standard to evaluate for delayed gastric emptying:
      • Gastric emptying scintigraphy of a solid-phase meal
        • Test quantifies the emptying of a physiologic caloric meal (0, 1, 2, and 4 hours post-prandial measurements)
    • Alternative tests assessing gastric emptying include:
      • Breath tests
      • Upper GI barium study
      • Ultrasound for serial changes in antral area
    • Abnormal gastric emptying suggests but does not prove that symptoms are caused by Gastroparesis
        • Disorder of gastric motor function not excluded in patients with normal gastric emptying
          • Regional dysfunctions of the stomach such as impaired fundic relaxation or gastric myoelectric dysrhythmias
      • Screen for secondary causes of Gastroparesis
        • Thyroid function tests
        • Rheumatologic serologies
        • HbA1C

Workup To Exclude Alternative Etiologies

  • CBC
  • Chem
  • LFTs
  • Lipase
  • Coags
  • Urinalysis
  • Urine pregnancy (females)
  • ?ECG (if >50 or at risk for cardiac disease)
  • ?RUQ US
  • ?Acute abdominal series including an upright CXR
    • Consider if at risk for perforated ulcer
  • Upper endoscopy or radiographic upper GI series to exclude mechanical obstruction or ulcer disease
  • Consider CT with oral and/or IV contrast to assess for intestinal obstruction

Complications

Disposition

See Also

External Links

References

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