Editing Small bowel motility disorders

== Chronic idiopathic intestinal pseudo-obstruction ==

* Mimics mechanical small bowel obstruction
* Three forms - All lead to disorganised motility with ineffective, uncoordinated contractile activity, and markedly slowed propagation and transit of intestinal content
** Histopathologic myopathy of smooth muscle - familial visceral myopathy
*** Markedly abnormal amplitude of contractions and coordination
*** Affects entire GIT and GUT over time - megacolon, megaureter, etc
** Histopathologic neuropathy - familial visceral neuropathy
*** Discoordinated contractile activity, ineffective transit
** Neuromotor dysmotility without histopathologic findings - neuromotor dysmotility
* Presentation
** Variable
** Megaduodenum in teenagers
** Some have had a colectomy for slow transit constipation
** Should be a family history
** Very often confused with SBO
* Diagnosis
** Often one of exclusion
** Have to read between the lines of previous operation notes, where an actual obstruction may not have been seen, but instead assumed to have resolved already or something
** The best way to diagnose may well be a diagnostic lap. Look for diffuse distension with no obstructing site.
* Treatment
** Avoid surgery
** A full thickness biopsy may give an answer if appropriate pathological expertise is available 
** Nothing really can be done
** Long-term TPN if the disease is progressive
** Intestinal transplant may become an option at some point in time

== Post-vagotomy diarrhoea ==

* Very rare - hopefully will become even rarer now that we don't do vagotomies for PUD
* Poorly understood
* No known effective treatment
* Presentation
** Diarrhoea and cramping after eating
** Generally no real malabsorption
* Diagnosis
** Exclusion - exclude all other forms of diarrhoea

[[Category:Small bowel]]