Gastrointestinal Motility Disorders Jassin M. Jouria, MD Dr. Jassin M. Jouria is a medical doctor, professor of academic medicine, and medical author. He graduated from Ross University School of Medicine and has completed his clinical clerkship training in various teaching hospitals throughout New York, including King’s County Hospital Center and Brookdale Medical Center, among others. Dr. Jouria has passed all USMLE medical board exams, and has served as a test prep tutor and instructor for Kaplan. He has developed several medical courses and curricula for a variety of educational institutions. Dr. Jouria has also served on multiple levels in the academic field including faculty member and Department Chair. Dr. Jouria continues to serve as a Subject Matter Expert for several continuing education organizations covering multiple basic medical sciences. He has also developed several continuing medical education courses covering various topics in clinical medicine. Recently, Dr. Jouria has been contracted by the University of Miami/Jackson Memorial Hospital’s Department of Surgery to develop an e-module training series for trauma patient management. Dr. Jouria is currently authoring an academic textbook on Human Anatomy & Physiology. Abstract The muscles of the gastrointestinal (GI) tract perform an important job. The GI tract peristalsis, or contractions, mix the contents of the stomach and propel contents throughout the entire GI tract until they exit as waste. When these muscles underperform or fail to perform, it can create serious and painful consequences, diagnosed as GI motility disorders. Although these disorders are rarely fatal, they can cause physical and emotional effects that negatively impact a patient's quality of life. However, there are many options for treatment of GI motility disorders available to healthcare professionals. Treatment is discussed in context of the current research and trends to develop new criteria to diagnose and clinically manage care. nursece4less.com nursece4less.com nursece4less.com nursece4less.com 1 Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. It is the policy of NurseCe4Less.com to ensure objectivity, transparency, and best practice in clinical education for all continuing nursing education (CNE) activities. Continuing Education Credit Designation This educational activity is credited for 7 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Pharmacology content is 1 hour. Statement of Learning Need Clinical criteria to treat patients diagnosed with a gastrointestinal motility disorder have developed options for primary and acute care clinicians involved in managing treatment. Research in the area of neurogastroenterolgy is focused on primary care to access new criteria to diagnose and guidelines to treat. Course Purpose To provide health clinicians with knowledge of gastrointestinal motility disorders diagnosis, treatment and interventions to support improved quality of life. nursece4less.com nursece4less.com nursece4less.com nursece4less.com 2 Target Audience Advanced Practice Registered Nurses and Registered Nurses (Interdisciplinary Health Team Members, including Vocational Nurses and Medical Assistants may obtain a Certificate of Completion) Course Author & Planning Team Conflict of Interest Disclosures Jassin M. Jouria, MD, William S. Cook, PhD, Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures Acknowledgement of Commercial Support There is no commercial support for this course. Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article. Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course. nursece4less.com nursece4less.com nursece4less.com nursece4less.com 3 1. Ninety percent of absorption of nutrients occurs in the a. stomach. b. duodenum. c. small intestine. d. large intestine. 2. True or False: The small intestine is referred to as “small” because it is the shortest segment of the GI tract. a. True b. False 3. The junction between the small intestines and the colon is the a. ileocecal valve. b. cecum. c. pyloric sphincter. d. duodenum. 4. When disorders of motility occur in the small intestine, the affected patient may suffer from a. malnutrition. b. fluid and electrolyte imbalances. c. overgrowth of intestinal bacteria. d. All of the above 5. True or False: An opioid analgesic, a drug used to manage moderate-to-severe pain, may cause side effects, such as nausea, vomiting, and constipation. a. True b. False nursece4less.com nursece4less.com nursece4less.com nursece4less.com 4 Introduction The gastrointestinal (GI) tract serves a multitude of important functions to keep the body healthy and active. Much of the work of the GI tract goes on behind the scenes within the body and is beyond physical or voluntary control. Gastrointestinal motility describes the process of food, fluids, and other secretions moving through the GI tract. The intestinal tract normally carries out a certain number of contractions that advance food and liquids through the gastrointestinal system as part of digestion and absorption of nutrients. When disorders of motility occur, the GI tract is said to have some sort of abnormal amount of motility; it may be working too fast, pushing food and fluids through at an abnormal rate, resulting in dumping syndrome or diarrhea. Alternatively, GI motility may be sluggish and working at a rate much slower than normal or, in the case of aperistalsis, not at all. The muscles that move and transition food and waste through the GI tract are involuntary and cannot be physically controlled. The work of the GI musculature continues at a set pace that makes up part of a complex system of digestion, absorption of nutrients, and excretion of waste. If the pace of GI motility is abnormally fast or slow, the affected person will experience symptoms that can cause discomfort and that could lead to illness. Whether GI motility problems occur as a result of chronic disease, damage to the intestinal tract, or short-term illness, the affected patient typically suffers the effects when normally routine motility and transfer of food goes awry. The Gastrointestinal Tract A pathway that extends throughout the body from the upper portion in the face and head to its terminal location below the pelvis, the gastrointestinal tract, is between 23 and 26 feet long, beginning with the mouth and ending with the anus. Instead of being one complete organ, the GI tract consists of nursece4less.com nursece4less.com nursece4less.com nursece4less.com 5 a number of different organs throughout the length of the system. Together these organs are designed to carry out the processes of digestion but each organ has its specific purpose and function. The various organs include those of the upper GI tract, which consists of the structures of the mouth and throat, the esophagus, the stomach, and the duodenum of the small intestine. The lower GI tract is comprised of most of the small intestine and the colon, including the distal portions of the large intestine containing the sigmoid colon, the rectum, and the anus. Accessory organs of the gastrointestinal tract are those that are not technically considered gastrointestinal organs; however, they do play important roles in the process of digestion and in supporting the work of the GI tract. Accessory organs include the tongue, salivary glands, the liver, gall bladder, and pancreas. This course will focus primarily on the main organs of the GI tract, their functions and disorders of motility. Esophagus The esophagus, also referred to as the alimentary canal, is a hollow tube found in the upper GI tract that is vertically located at approximately the level of the chest. It is about 10 inches long and connected to the pharynx at the back of the throat on one end and the stomach at the other end. The esophagus runs through an opening in the diaphragm known as the diaphragmatic hiatus before connecting with the stomach. The process of digestion actually begins before food reaches the esophagus. It starts in the mouth as a person chews his or her food. The enzymes in saliva interact with food and start to break food down before it is even swallowed. As an individual chews and prepares to swallow, ptyalin, the main enzyme within saliva, works to break down starches and carbohydrates nursece4less.com nursece4less.com nursece4less.com nursece4less.com 6 in foods. Chewing involves using the teeth to break down food until it is in small enough pieces that it can enter the esophagus; the tongue then pushes the food toward the back of the mouth so that it can be swallowed. When swallowing, the food passes through the pharynx and enters the esophagus as it travels toward the stomach. Despite being a hollow tube that stretches from the neck to the abdomen, the esophagus does not simply act as a chute for food to slide from the mouth to the stomach. Instead, the esophagus contains three layers of tissue where each has a different function: the interior layer lining or the inner lumen of the esophagus, a mucosal layer that secretes mucus to provide lubrication for food as it moves through the esophagus, and, the layer underneath the mucosal layer, which contains smooth muscles that contract in sequence to propel food along the tract. The esophageal muscles work in sequence to control the food’s movement instead of letting it slide toward the stomach by gravity. The muscles are arranged circumferentially around the esophagus and also longitudinally along the length of the esophageal lumen. Toward the top of the esophagus, near the pharynx, the muscles work voluntarily. When swallowing, a person has more control over muscular processes used in this area and can better manage the passage of food.