# Motility / Pseudo-obstruction — GCMD Library living collection

Also covered as: Hirschsprung disease · constipation · soiling · outlet obstruction · slow transit constipation · segmental dysmotility · motility disorders · functional constipation

Experts: Dr. Rod Gerardo, Dr. Jason Frischer, Dr. Marc Levitt, Dr. Amanda Jensen

Updated: n/a · 7 episodes · 208 cited statements

## Episodes
### Foundations
- [Intestinal rehabilitation: What is intestinal rehab? - Episode 1](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741) — video · 14:33 · [machine version](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741.md)
- [Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742) — podcast · 14:33 · [machine version](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742.md)

### Diagnosis & Workup
- [Colorectal Collaboration: Neurogastroenterology/Motility Disorders](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366) — video · 14:55 · [machine version](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366.md)

### Case-Based Learning
- [The Colorectal Quiz Episode 8: Motility Disorders Part 1](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824) — podcast · 14:04 · [machine version](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824.md)
- [The Colorectal Quiz Episode 9: Motility Disorders Part 2](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888) — podcast · 13:52 · [machine version](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888.md)
- [Colorectal Quiz: Episode 42 - HD Constipation](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506) — podcast · 14:48 · [machine version](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506.md)

### In-Depth Reviews
- [Intestinal Failure with Dr. Brad Warner](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296) — podcast · 52:46 · [machine version](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=0) Introduction and Definition of Intestinal Failure (Ep 1)
- [1:42](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=102) Prognostic Factors and Bowel Length Criteria (Ep 1)
- [7:07](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=427) Medical Management and TPN Strategy (Ep 1)
- [12:55](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=775) Lipid Formulations and Cholestasis Management (Ep 1)
- [17:51](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1071) Enteral Feeding Strategy and Adaptation (Ep 1)
- [26:01](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1561) Surgical Interventions: Lengthening Procedures (Ep 1)
- [38:10](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2290) Bacterial Overgrowth and Microbiome (Ep 1)
- [43:35](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2615) Growth Factors and Future Therapies (Ep 1)
- [46:32](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2792) Intestinal Transplantation and Multidisciplinary Care (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=0) Introduction and Episode Setup (Ep 2)
- [1:31](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=91) Case Presentation and Guest Introductions (Ep 2)
- [2:51](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=171) Defining Failure of Medical Management (Ep 2)
- [4:46](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=286) Initial Evaluation Approach (Ep 2)
- [6:10](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=370) Contrast Enema Interpretation and Limitations (Ep 2)
- [8:59](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=539) Anorectal Manometry and Its Clinical Value (Ep 2)
- [11:19](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=679) Summary and Conclusion (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=0) Introduction and App Promotion (Ep 3)
- [0:30](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=30) Case Recap (Ep 3)
- [1:45](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=105) Diagnostic Workup: Sitz Marker Study and Manometry (Ep 3)
- [4:35](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=275) Alternative Diagnostic Modalities (Ep 3)
- [6:47](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=407) Colonic Manometry Deep Dive (Ep 3)
- [9:55](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=595) Case Management and Treatment Philosophy (Ep 3)
- [12:03](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=723) Closing Remarks and Joke (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=0) Introduction and Speaker Introductions (Ep 4)
- [1:24](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=84) Fundamentals of Colonic Motility and Constipation Types (Ep 4)
- [3:13](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=193) Methods for Studying Bowel Transit (Ep 4)
- [6:05](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=365) Colonic Contractions and High-Amplitude Propagated Contractions (Ep 4)
- [7:38](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=458) Manometry Catheter Placement and Tracing Interpretation (Ep 4)
- [9:31](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=571) Treatment Algorithm for Segmental Dysmotility (Ep 4)
- [11:15](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=675) Case Presentation: 13-Month-Old with Anal Stenosis and Gastroparesis (Ep 4)
- [0:00](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=0) Introduction and Program Expansion (Ep 5)
- [1:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=106) Defining Intestinal Failure (Ep 5)
- [4:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=290) Three Categories of Intestinal Failure (Ep 5)
- [8:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=499) Timing of Diagnosis and Referral (Ep 5)
- [10:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=604) Team Approach and Long-term Outcomes (Ep 5)
- [13:14](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=794) Series Goals and Closing (Ep 5)
- [0:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=4) Introduction and Program Context (Ep 6)
- [1:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=106) Defining Intestinal Failure (Ep 6)
- [4:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=290) Three Categories of Intestinal Failure (Ep 6)
- [8:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=499) Timing of Diagnosis and Referral (Ep 6)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Intestinal failure is defined as insufficient gut function to absorb enough nutrients, fluids, and calories to support survival and, in children, growth" — Paul Wales (clinical) [Ep 6 · 2:05](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=125)
- "For a patient to be defined as having intestinal failure, they must have inadequate intestinal function necessitating parenteral support for at least 60 days" — Rod Gerardo (guideline) [Ep 6 · 2:24](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=144)
- "An intestinal rehabilitation program is a multidisciplinary collaborative patient care paradigm that brings coordinated care for children with intestinal failure through comprehensive management of their specialized nutrition and associated needs" — Paul Wales (clinical) [Ep 6 · 3:03](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=183)
- "Short bowel syndrome is by far the most common category of intestinal failure in pediatric patients" — Paul Wales (epidemiological) [Ep 6 · 4:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=290)
- "Causes of short bowel syndrome include congenital anomalies such as intestinal atresia, malrotation, volvulus, gastroschisis, and long segment Hirschsprung's disease" — Paul Wales (clinical) [Ep 6 · 5:06](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=306)
- "Acquired diseases of the newborn such as necrotizing enterocolitis can cause short bowel syndrome" — Paul Wales (clinical) [Ep 6 · 5:18](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=318)
- "Motility disorders occur when the bowel is unable to push contents through in a coordinated way due to abnormalities of the muscle itself or the nerves that control that muscle" — Paul Wales (clinical) [Ep 6 · 5:45](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=345)
- "Congenital enteropathies are conditions where the patient has all of their bowel but the mucosa does not work, leading to hypersecretion and profuse fluid losses" — Paul Wales (clinical) [Ep 6 · 6:17](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=377)
- "Some patients will have elements of two or three categories of intestinal failure in the way they present" — Paul Wales (clinical) [Ep 6 · 7:11](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=431)
- "A child with gastroschisis could have short bowel because it was not all viable, inflammation affecting absorption, and motility issues" — Ellen Encisco (clinical) [Ep 6 · 7:22](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=442)
- "Older pediatric patients can develop intestinal failure from inflammatory bowel disease or Crohn's disease where they have lost gut as a result of complications" — Paul Wales (clinical) [Ep 6 · 7:56](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=476)
- "Trauma, malignancy, and vascular thrombosis leading to gut loss are diagnoses seen more in older patients or adult series and less in pediatrics" — Paul Wales (epidemiological) [Ep 6 · 8:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=484)
- "There are three time points where families reach intestinal rehabilitation programs: prenatal diagnosis, postnatal acquired problems, and later presentations after discharge" — Michael Helmrath (clinical) [Ep 6 · 8:53](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=533)
- "Prenatal diagnoses that lead to intestinal rehabilitation typically include atresia with cystic fibrosis and gastroschisis" — Michael Helmrath (clinical) [Ep 6 · 9:15](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=555)
- "Postnatal acquired problems leading to intestinal rehabilitation include volvulus and necrotizing enterocolitis" — Ellen Encisco (clinical) [Ep 6 · 9:29](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=569)
- "Dietitians play a key role in understanding the nutritional needs of children in intestinal rehabilitation" — Michael Helmrath (opinion) [Ep 6 · 11:52](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=712)
- "Social work is a key component of the intestinal rehabilitation team" — Michael Helmrath (opinion) [Ep 6 · 12:01](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=721)
- "The survival overall in big intestinal rehabilitation programs is usually over 90% long-term survival" — Rod Gerardo (epidemiological) [Ep 6 · 12:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=754)
- "Children with intestinal failure who survive long-term now develop chronic comorbidities including renal dysfunction, metabolic bone disease, neurocognitive issues, and quality of life issues" — Paul Wales (clinical) [Ep 6 · 12:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=766)
- "Earlier recognition and taking advantage of the biology of the gut to adapt are time dependent" — Michael Helmrath (clinical) [Ep 6 · 2:40](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=160)
- "Intestinal rehabilitation streamlines care and improves communication with families and between care providers and team members" — Paul Wales (opinion) [Ep 6 · 3:55](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=235)
- "Intestinal rehabilitation comes down to key factors that drive the process: nutrition in the gut, nutrition in the body, and healing" — Michael Helmrath (clinical) [Ep 6 · 4:07](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=247)
- "Pattern recognition from multiple eyes on a baby who have seen them over time is important in intestinal rehabilitation" — Michael Helmrath (opinion) [Ep 6 · 4:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-episode-1-what-is-intestinal-rehabilitation-4742?t=259)
- "Intestinal failure is defined as insufficient gut function to absorb enough nutrients, fluids, and calories to support survival and, in children, growth" — Paul Wales (clinical) [Ep 5 · 2:05](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=125)
- "New guidelines define intestinal failure as requiring parental support for at least 60 days" — Rod Gerardo (guideline) [Ep 5 · 2:24](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=144)
- "An intestinal rehabilitation program is a multidisciplinary collaborative patient care paradigm providing coordinated care for children with intestinal failure through comprehensive management of specialized nutrition and associated needs" — Paul Wales (clinical) [Ep 5 · 3:03](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=183)
- "Short bowel syndrome is by far the most common category of intestinal failure in pediatric patients" — Paul Wales (epidemiological) [Ep 5 · 4:50](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=290)
- "Causes of short bowel syndrome include congenital anomalies such as intestinal atresia, malrotation, volvulus, gastroschisis, and long segment Hirschsprung's disease" — Paul Wales (clinical) [Ep 5 · 5:06](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=306)
- "Acquired diseases of the newborn such as necrotizing enterocolitis cause short bowel syndrome" — Paul Wales (clinical) [Ep 5 · 5:18](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=318)
- "Motility disorders occur when abnormalities of the intestinal muscle itself or the nerves that control that muscle prevent coordinated movement of food and stool" — Paul Wales (clinical) [Ep 5 · 5:45](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=345)
- "Children with motility disorders are dependent on intravenous support" — Paul Wales (clinical) [Ep 5 · 6:10](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=370)
- "Enteropathies or congenital diarrheas are conditions where the patient has all of their bowel but the mucosal lining that digests and absorbs does not work" — Paul Wales (clinical) [Ep 5 · 6:17](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=377)
- "Mucosal defects lead to hypersecretion and profuse fluid losses such that the bowel is unable to tolerate or absorb nutrients" — Ellen (clinical) [Ep 5 · 6:30](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=390)
- "Some patients will have elements of one, two, or all three categories of intestinal failure" — Paul Wales (clinical) [Ep 5 · 7:11](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=431)
- "A child with gastroschisis could have short bowel because it was not all viable, inflammation affecting absorption, and motility issues" — Ellen (clinical) [Ep 5 · 7:22](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=442)
- "Most intestinal failure patients are infants or babies, but some older kids develop intestinal failure" — Paul Wales (epidemiological) [Ep 5 · 7:45](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=465)
- "Inflammatory bowel disease or Crohn's disease can lead to gut loss and intestinal failure in older patients" — Paul Wales (clinical) [Ep 5 · 7:56](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=476)
- "Trauma, malignancy, and vascular thrombosis leading to gut loss are diagnoses seen more in older patients or adult series and less in pediatrics" — Paul Wales (epidemiological) [Ep 5 · 8:04](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=484)
- "There are three time points when families reach intestinal rehab programs: prenatal diagnosis, postnatal acquired problems, and later diagnosis after discharge" — Rod Gerardo (clinical) [Ep 5 · 8:51](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=531)
- "Prenatal diagnoses that lead to intestinal rehab referral include atresia with cystic fibrosis and gastroschisis" — Michael Helmrath (clinical) [Ep 5 · 9:15](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=555)
- "Postnatal acquired problems leading to intestinal rehab referral include volvulus and necrotizing enterocolitis" — Ellen (clinical) [Ep 5 · 9:29](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=569)
- "The intestinal rehab team includes surgeons, GI doctors, neonatologists, dietitians, social work, nurse practitioners, pharmacy, interventional radiology, pathology, endocrinology, and nephrology" — Michael Helmrath (clinical) [Ep 5 · 11:43](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=703)
- "Survival overall in big intestinal rehab programs is usually over 90% long-term survival" — Rod Gerardo (epidemiological) [Ep 5 · 12:34](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=754)
- "Long-term survivors now develop chronic comorbidities including renal dysfunction, metabolic bone disease, neurocognitive issues, and quality of life issues" — Paul Wales (clinical) [Ep 5 · 12:46](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=766)
- "Earlier recognition and taking advantage of the gut's biology to adapt are time dependent" — Michael Helmrath (opinion) [Ep 5 · 2:40](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=160)
- "Intestinal rehabilitation comes down to key factors: nutrition in the gut, nutrition in the body, and healing" — Michael Helmrath (clinical) [Ep 5 · 4:07](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=247)
- "Pattern recognition from multiple experienced providers seeing patients over time is essential in intestinal rehabilitation" — Michael Helmrath (opinion) [Ep 5 · 4:19](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=259)
- "Families living within the region can benefit from understanding that delivery at an intestinal rehab center from the beginning is probably beneficial" — Michael Helmrath (opinion) [Ep 5 · 8:30](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=510)
- "Access and availability to an intestinal rehab program is still very rare" — Rod Gerardo (epidemiological) [Ep 5 · 8:41](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=521)
- "Innovation comes from multiple approaches to the problem and different visions, with more expertise bringing better outcomes" — Michael Helmrath (opinion) [Ep 5 · 10:25](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=625)
- "Transitioning older children with intestinal failure into their late teen years and later is a major obstacle that needs to be addressed" — Michael Helmrath (clinical) [Ep 5 · 10:51](https://library.globalcastmd.com/watch/intestinal-rehabilitation-what-is-intestinal-rehab-episode-1-4741?t=651)
- "Intestinal failure is an umbrella term for when the small intestine is unable to absorb or digest enough nutrition to support the patient entirely by oral or enteral feeding" — Brad Warner (clinical) [Ep 1 · 1:42](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=102)
- "The intestine of a newborn or fetus doubles in length in the last trimester of gestation" — Brad Warner (clinical) [Ep 1 · 3:03](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=183)
- "For a neonate with ileocecal valve and entire colon, 10 to 15 centimeters of small intestine is a ballpark figure for salvageability" — Brad Warner (clinical) [Ep 1 · 4:03](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=243)
- "Without the colon and ileocecal valve, at least 15 to 20 centimeters would be a ballpark figure for salvageability" — Brad Warner (clinical) [Ep 1 · 4:37](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=277)
- "In adults with less than 50 centimeters of intestine, about 40% will not be alive after 5 to 10 years" — Brad Warner (epidemiological) [Ep 1 · 4:51](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=291)
- "For a patient with 15 centimeters of bowel and ileocecal valve, long term 50% should be able to wean from TPN, 25% would require transplant, and 25% would die" — Brad Warner (epidemiological) [Ep 1 · 5:56](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=356)
- "Intestinal adaptation in humans probably takes place over about a year or two after small bowel resection" — Brad Warner (clinical) [Ep 1 · 7:49](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=469)
- "Stool outputs of up to 40 ccs per kilo per day are acceptable when advancing enteral feeding" — Brad Warner (guideline) [Ep 1 · 8:30](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=510)
- "For TPN, shoot for about 100 to 120 calories per kilo per day for total calories, with about 50% from glucose and remainder from fat and protein" — Brad Warner (guideline) [Ep 1 · 10:22](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=622)
- "Generally shoot for about 2 to 3 g of protein per kilo per day and about 2 to 3 g of fat per kilo per day in TPN" — Brad Warner (guideline) [Ep 1 · 10:45](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=645)
- "A baby should gain about 20 to 30 g a day, which approximates in utero progression for a newborn" — Brad Warner (clinical) [Ep 1 · 12:05](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=725)
- "Lipid reduction strategy takes patients from 2 to 3 g per kilo per day of fat delivered daily down to about 1 g per kilo per day delivered twice or 3 times a week to reduce cholestasis" — Brad Warner (guideline) [Ep 1 · 12:53](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=773)
- "Omegaven is a fish oil-based fat primarily containing omega 3 fatty acids that are anti-inflammatory, compared to soybean-based intralipid with omega 6 fatty acids that are pro-inflammatory" — Brad Warner (clinical) [Ep 1 · 14:03](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=843)
- "SMOF lipid contains soybean (essential fatty acids), medium chain triglycerides (easily digested), olive oil, and fish oil, and has become the most commonly used lipid in Canada" — Brad Warner (clinical) [Ep 1 · 15:08](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=908)
- "Breast milk is the best choice for neonates because it contains growth factors like EGF and IGF, milk oligosaccharides that enhance adaptation, and other beneficial components" — Brad Warner (opinion) [Ep 1 · 18:11](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1091)
- "Complex formulas fed enterally may stimulate adaptation better than elemental formulas by causing secretion of enterotrophic hormones to a greater extent" — Brad Warner (clinical) [Ep 1 · 19:26](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1166)
- "There is a threshold percentage of enteral calories that prevents onset of liver damage from TPN, though the exact number is unknown" — Brad Warner (clinical) [Ep 1 · 21:19](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1279)
- "Time to consider surgical intervention is when patient hits a plateau enterally and starts backing away, or if going backward rather than forward in enteral tolerance" — Brad Warner (guideline) [Ep 1 · 22:33](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1353)
- "Multiple episodes of sepsis along with abdominal distention and dilated bowel loops is an indication for surgical intervention" — Brad Warner (guideline) [Ep 1 · 23:01](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1381)
- "If child is starting to get jaundiced, there is a role to evaluate the gut for subclinical portal bacteremia arising from dilated bowel loops" — Brad Warner (clinical) [Ep 1 · 23:18](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1398)
- "Dilated bowel loops cause bacterial overgrowth leading to secretory diarrhea that is not related to digestion-absorption capacity but to enzyme dysfunction" — Brad Warner (clinical) [Ep 1 · 23:53](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1433)
- "More than 4 to 5 centimeters of bowel dilation with failure to advance enteral feeds or going backward is an indication for surgical intervention" — Brad Warner (guideline) [Ep 1 · 25:43](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1543)
- "In a child who is completely stable after 3 years but not progressing, would interrogate bowel and if dilated would proceed with lengthening" — Brad Warner (opinion) [Ep 1 · 26:07](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1567)
- "If a child has over 100 centimeters of intestine, less than 5 or 10% should require TPN, suggesting possible underlying motility or mucosal problem" — Brad Warner (clinical) [Ep 1 · 27:53](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1673)
- "With less than 50 centimeters of intestine and bowel at least 4 to 5 centimeters dilated, there is an option for either Bianchi or STEP procedure" — Brad Warner (guideline) [Ep 1 · 28:37](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1717)
- "The STEP procedure has emerged to be the most commonly performed lengthening operation because it is easier to do with less risk of injuring mesenteric blood supply" — Brad Warner (clinical) [Ep 1 · 29:31](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1771)
- "STEP procedures can redilate requiring redo procedures, and outcomes are not as good if a redo STEP is needed compared to never needing a redo" — Brad Warner (clinical) [Ep 1 · 32:54](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1974)
- "You can do a Bianchi and then later do a STEP on top of it, but you cannot do a Bianchi once a STEP has been done" — Brad Warner (clinical) [Ep 1 · 33:26](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2006)
- "STEP procedures can cause dysmotility acting as a brake on intestinal transit" — Brad Warner (clinical) [Ep 1 · 35:04](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2104)
- "Would taper a child with dilated bowel who had at least 90 to 100 centimeters of intestinal length rather than performing a lengthening procedure" — Brad Warner (opinion) [Ep 1 · 38:21](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2301)
- "Chenodeoxycholic acid bile salts can be used to improve bile flow in TPN cholestasis" — Brad Warner (clinical) [Ep 1 · 39:00](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2340)
- "Cholecystokinin administration to promote bile flow and mitigate TPN cholestasis did not work in clinical trials" — Brad Warner (clinical) [Ep 1 · 39:23](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2363)
- "Gut bacteria in short gut syndrome become more efficient and help adapt by encouraging greater absorption and digestion, similar to an obesogenic microbiome" — Brad Warner (clinical) [Ep 1 · 41:54](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2514)
- "In mouse models, oral vancomycin to knock out gram positive organisms completely prevented hepatic steatosis after bowel resection" — Brad Warner (clinical) [Ep 1 · 42:19](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2539)
- "Teduglutide, a GLP-2 analog, has been demonstrated in randomized trials to reduce TPN requirements by about 1-2 liters per week in adults with short gut syndrome" — Brad Warner (clinical) [Ep 1 · 43:45](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2625)
- "Teduglutide is not yet approved for children in the United States due to concerns about malignancy risk from promoting proliferation" — Brad Warner (clinical) [Ep 1 · 44:34](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2674)
- "Growth hormone and glutamine combinations have shown primarily mixed results and have not been a huge advance in TPN weaning" — Brad Warner (clinical) [Ep 1 · 45:40](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2740)
- "Survival for small bowel transplant is about 50 to 60% at 5 years, with one year survivals now above 70 to 80%" — Brad Warner (epidemiological) [Ep 1 · 46:51](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2811)
- "The intestine is an immunogenic organ filled with white cells and macrophages that mount a huge graft versus host response requiring industrial strength immunosuppression" — Brad Warner (clinical) [Ep 1 · 47:11](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2831)
- "Ethanol locks for central lines have reduced significantly the number of sepsis episodes in patients with short gut syndrome" — Brad Warner (clinical) [Ep 1 · 49:22](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2962)
- "Multidisciplinary teams including pharmacists, nutritionists, surgeons, GI doctors, ID, radiology, and interventional radiology improve survival of intestinal failure patients" — Brad Warner (clinical) [Ep 1 · 51:16](https://library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=3076)
- "Approximately one-third of Hirschsprung patients are constipated post-operatively and need proactive, aggressive management to avoid trouble" — Marc Levitt (epidemiological) [Ep 7 · 1:47](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=107)
- "Hirschsprung disease is a very anatomically fixable problem and with a good operation you should get a good result" — Marc Levitt (clinical) [Ep 7 · 1:38](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=98)
- "Surgeons might leave behind the dilated segment right above the aganglionic segment as an anatomic reason for decompensation" — Marc Levitt (clinical) [Ep 7 · 2:11](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=131)
- "The most relevant reason for decompensation is that the patient never figured out how to successfully empty their sphincters and the pull-through decompensates" — Marc Levitt (clinical) [Ep 7 · 2:22](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=142)
- "Calretinin hangs out with ganglion cells, so normal calretinin staining provides double evidence of good ganglion cells" — Marc Levitt (clinical) [Ep 7 · 3:14](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=194)
- "In younger children age less than 3 or so, hypertrophic nerves are defined as greater than 40 microns in diameter" — Jason Frischer (clinical) [Ep 7 · 3:47](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=227)
- "The definition of hypertrophic nerve is more gray in older patients and in patients who have chronic constipation issues" — Jason Frischer (clinical) [Ep 7 · 4:01](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=241)
- "If there are no ganglion cells and no calretinin staining, that is a retained Hirschsprung and the patient needs a redo to a higher level" — Marc Levitt (clinical) [Ep 7 · 4:27](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=267)
- "Nerve hypertrophy with good ganglion cells could represent transition zone or could represent that the bowel has decompensated over time because it hasn't emptied and gotten dilated" — Marc Levitt (clinical) [Ep 7 · 4:38](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=278)
- "An absent rectal anal inhibitory reflex means the internal anal sphincter doesn't relax when the rectum is distended, which can contribute to constipation" — Felipe Glu (clinical) [Ep 7 · 6:35](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=395)
- "Many patients are going to have an abnormal anorectal manometry but they're OK" — Marc Levitt (clinical) [Ep 7 · 6:47](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=407)
- "Botox helps patients learn to overcome non-relaxing sphincters by other maneuvers like pushing on their abdominal wall" — Marc Levitt (clinical) [Ep 7 · 6:56](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=416)
- "Many patients are completely asymptomatic doing great with Hirschsprung's that have residual absent rectal anal inhibitory reflex" — Marc Levitt (clinical) [Ep 7 · 7:11](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=431)
- "In Hirschsprung patients with constipation, the colon is not the problem; the problem usually is the sphincters or the pelvic floor" — Marc Levitt (clinical) [Ep 7 · 7:39](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=459)
- "If you get an awake anorectal manometry in a cooperative patient with a normal rectal anal inhibitory reflex and can detect the resting pressure, the evaluation is complete without anesthesia or procedure" — Marc Levitt (clinical) [Ep 7 · 8:14](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=494)
- "If the rectal anal inhibitory reflex is absent, you're obligated to do a biopsy and give Botox" — Marc Levitt (guideline) [Ep 7 · 8:29](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=509)
- "Botox is given if the resting pressure of the external sphincter is also high" — Marc Levitt (clinical) [Ep 7 · 8:36](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=516)
- "Pelvic floor dysynergia can be detected on anorectal manometry and is a good indication that pelvic floor physical therapy will help the patient" — Marc Levitt (clinical) [Ep 7 · 8:41](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=521)
- "Colonic manometry should not be done in Hirschsprung patients with obstructive symptoms because it's not the colon but the distal pull-through that's the problem" — Marc Levitt (guideline) [Ep 7 · 9:55](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=595)
- "Anatomic and pathologic causes must be ruled out before any colonic manometry is considered" — Marc Levitt (guideline) [Ep 7 · 10:11](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=611)
- "Colonic manometry in a patient with a distal obstruction is the wrong test" — Marc Levitt (guideline) [Ep 7 · 10:18](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=618)
- "Once distal obstruction is ruled out or fixed and the colon is still not working, then you have a problem warranting colonic manometry" — Jason Frischer (clinical) [Ep 7 · 10:27](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=627)
- "If there's a segment less than 30 centimeters of inadequate high amplitude propagating contractions, the approach is not super aggressive; over 30 centimeters is definitely more of a red flag" — Jason Frischer (clinical) [Ep 7 · 11:01](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=661)
- "High amplitude propagating contractions aid in the transfer of colonic contents over long distance and often precede emptying" — Felipe Glu (clinical) [Ep 7 · 11:17](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=677)
- "In a PCPLC Consortium study of close to 100 patients with functional constipation and segmental dysmotility of the sigmoid, 97% successfully responded to Malone only without needing resection" — Marc Levitt (epidemiological) [Ep 7 · 11:54](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=714)
- "Five years ago, surgeons were taking sigmoids out of patients with segmental dysmotility, but this practice has changed based on new data" — Marc Levitt (clinical) [Ep 7 · 12:28](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=748)
- "A Malone procedure is a route for medical treatment, providing antegrade access to the colon for gastroenterologists to give better medical treatment" — Marc Levitt (clinical) [Ep 7 · 13:24](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=804)
- "While surgery can correct the underlying anatomical problem in Hirschsprung disease, many other factors can contribute to constipation including motility disorders, pelvic floor dysfunction, and behavioral issues" — Felipe Glu (clinical) [Ep 7 · 14:15](https://library.globalcastmd.com/watch/colorectal-quiz-episode-42-hd-constipation-9506?t=855)
- "Manometry is a catheter-based study of pressure changes within the lumen of the gut, involving visual pattern recognition of tracings to identify deviations from normal." — Ajay Hall (clinical) [Ep 4 · 1:24](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=84)
- "Colonic motility has four key components: diameter of the colon, tone, compliance of the colonic wall, and contraction pressures (how strong the contractions are), plus the length of the colon." — Ajay Hall (clinical) [Ep 4 · 1:34](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=94)
- "In megacolon, tone and compliance are usually abnormal, but colonic manometry may still show normal high-amplitude propagated contractions and transit may be normal." — Ajay Hall (clinical) [Ep 4 · 1:58](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=118)
- "There are three types of constipation: normal transit constipation, slow transit constipation (a problem with the neuromuscular integrity of the colonic wall), and outlet obstruction or withholding." — Ajay Hall (clinical) [Ep 4 · 2:35](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=155)
- "Outlet obstruction or withholding is the most common type of constipation in the pediatric population, including children with anorectal malformations." — Ajay Hall (epidemiological) [Ep 4 · 2:55](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=175)
- "In a Sitz marker study, a patient ingests radio-opaque markers and an X-ray is obtained after about 5 days; normally all markers should be evacuated, but remaining markers indicate abnormal transit." — Ajay Hall (clinical) [Ep 4 · 3:19](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=199)
- "When Sitz markers are collected in the dilated rectum at 5 days, this is indicative of outlet obstruction or withholding." — Ajay Hall (clinical) [Ep 4 · 3:48](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=228)
- "When Sitz markers are scattered all over the colon at 5 days, this is indicative of slow transit constipation." — Ajay Hall (clinical) [Ep 4 · 4:06](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=246)
- "Scintigraphy studies colonic transit by tracking the geometric center of an ingested radioisotope and can identify specific colonic locations with transit issues." — Ajay Hall (clinical) [Ep 4 · 4:15](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=255)
- "The smart pill is a large capsule that measures pH, temperature, and pressure; it is suitable for children around 10 or 12 years old and measures transit time from mouth to anus." — Ajay Hall (clinical) [Ep 4 · 4:51](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=291)
- "Colonic contractions include phasic (brief) or tonic (sustained) contractions, segmental non-propagated contractions (most common), and propagated contractions." — Ajay Hall (clinical) [Ep 4 · 6:05](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=365)
- "High-amplitude propagated contractions (HAPCs) move stool along the length of the colon and correspond to what radiologists see on contrast enema as mass movement." — Ajay Hall (clinical) [Ep 4 · 6:26](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=386)
- "The orthocolonic reflex (stimulus to colonic motility upon waking) and the gastrocolonic reflex (stimulus upon eating) affect colonic contractions." — Ajay Hall (clinical) [Ep 4 · 6:45](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=405)
- "Sennosides or bisacodyl can be used to induce high-amplitude propagated contractions." — Rod Gerardo (clinical) [Ep 4 · 6:54](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=414)
- "The majority of HAPCs originate in the proximal colon, most do not propagate beyond the midcolon, and fewer than 5% reach the rectum." — Ajay Hall (clinical) [Ep 4 · 7:05](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=425)
- "When an HAPC occurs, the internal anal sphincter should relax (choloanal reflex) to allow stool evacuation." — Rod Gerardo (clinical) [Ep 4 · 7:15](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=435)
- "Manometry catheters are typically placed during endoscopy, which allows evaluation of the colonic mucosa, though interventional radiologists can also place them under fluoroscopy." — Ajay Hall (clinical) [Ep 4 · 7:48](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=468)
- "The rectal motor complex appears as multiple small spikes on manometry tracings at the level of the rectum." — Ajay Hall (clinical) [Ep 4 · 8:33](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=513)
- "If more than 40 to 50 centimeters of colon does not have HAPCs, that segment is considered dysfunctional colon." — Ajay Hall (clinical) [Ep 4 · 10:16](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=616)
- "Management at Cincinnati Children's prioritizes maximizing medical therapy and understanding anatomic and functional issues before resorting to surgical resection." — Jason Frischer (guideline) [Ep 4 · 10:31](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=631)
- "The first step in management is to maximize stimulant laxatives to ensure evacuation; if that fails, irrigation or enemas are tried, and only then are other surgical interventions discussed." — Ajay Hall (guideline) [Ep 4 · 10:48](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=648)
- "Resection should not be performed immediately based on one abnormal finding; multiple factors must be considered." — Jason Frischer (opinion) [Ep 4 · 11:04](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=664)
- "The first step in evaluating a patient with suspected motility disorder is to ensure normal anatomy, which can be assessed with contrast studies." — Jason Frischer (guideline) [Ep 4 · 12:13](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=733)
- "In a child with gastroparesis, the stomach may appear enlarged on upper GI study." — Ajay Hall (clinical) [Ep 4 · 12:52](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=772)
- "Duodenal and colonic manometry can rule out more widespread dysmotility, which is invaluable information in a patient with an anorectal malformation." — Rod Gerardo (opinion) [Ep 4 · 14:03](https://library.globalcastmd.com/watch/colorectal-collaboration-neurogastroenterology-motility-disorders-4366?t=843)
- "Failure of medical management is defined as appropriate treatment with no appropriate response, patient cannot take treatment, persistent symptoms or pain with treatment, or failure to grow" — Kahleb Graham (clinical) [Ep 2 · 2:51](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=171)
- "Failure of retrograde enemas is considered failure of medical management" — Kahleb Graham (clinical) [Ep 2 · 3:21](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=201)
- "Reliance on rectal therapy or retrograde enemas with continued soiling causing significant effect on functioning is considered failure of medical management" — Anil Darbari (clinical) [Ep 2 · 3:35](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=215)
- "General pediatricians typically prescribe osmotic laxatives like MiraLax or lactulose and stimulant laxatives such as Senna or bisacodyl, but there are other medications that pediatricians are not used to prescribing that GI doctors are" — Anil Darbari (clinical) [Ep 2 · 3:57](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=237)
- "Some children stool every day but do not completely evacuate" — Rod (clinical) [Ep 2 · 4:58](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=298)
- "Initial evaluation includes history of triggers, stooling frequency, timing, and sensation of complete emptying, plus physical exam looking for palpable stool and distension, rectal exam, and diagnostic imaging" — Anil Darbari (clinical) [Ep 2 · 4:46](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=286)
- "In patients with long-standing constipation where appropriate treatments have been tried and failed, the first step in management is diagnostic studies including contrast enema" — Kahleb Graham (clinical) [Ep 2 · 5:27](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=327)
- "Contrast enema is used to assess degree of colonic dilatation and redundancy and to ensure the ratio is normal" — Kahleb Graham (clinical) [Ep 2 · 5:56](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=356)
- "There are probably many people with redundant colons that stool perfectly normally without imaging documentation" — Jason Frischer (opinion) [Ep 2 · 6:53](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=413)
- "It is unclear whether colonic dilation and redundancy precedes constipation or results from outlet obstruction" — Rod (clinical) [Ep 2 · 6:59](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=419)
- "Contrast study is not a great predictor of how patients will respond to medical or surgical management" — Rod (clinical) [Ep 2 · 7:12](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=432)
- "Crazy looking colons can respond really nicely to treatment, and colons that look totally normal on contrast study may not respond at all to treatment" — Rod (clinical) [Ep 2 · 7:19](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=439)
- "Colons used to be resected based on appearance, but patients with motility disorders did not need resection" — Marc Levitt (clinical) [Ep 2 · 7:36](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=456)
- "Many dilated colons will respond to treatment" — Marc Levitt (clinical) [Ep 2 · 7:54](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=474)
- "Water-soluble contrast is used instead of barium because it helps empty the colon and acts as a cleanout for patients starting new medical therapy" — Jason Frischer (clinical) [Ep 2 · 8:06](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=486)
- "Reviewing diagnostic imaging with the family helps them understand anatomy and issues and builds rapport" — Rod (clinical) [Ep 2 · 8:37](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=517)
- "The rectoanal inhibitory reflex (RAIR) is when the rectum becomes distended with stool and the internal anal sphincter relaxes" — Rod (clinical) [Ep 2 · 9:11](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=551)
- "Anorectal manometry uses a catheter with sensors measuring pressure and a balloon to assess anal sphincter function and its relationship to the rectum" — Anil Darbari (clinical) [Ep 2 · 9:35](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=575)
- "High pressures on anorectal manometry may suggest underlying inability to relax causing functional obstruction" — Anil Darbari (clinical) [Ep 2 · 10:00](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=600)
- "Patients with Hirschsprung disease have an absent rectoanal inhibitory reflex (RAIR)" — Anil Darbari (clinical) [Ep 2 · 10:09](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=609)
- "Anorectal manometry provides information about defecation dynamics by having patients bear down, squeeze, and attempt to defecate while comparing sensation to defecate versus internal anal sphincter response" — Anil Darbari (clinical) [Ep 2 · 10:19](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=619)
- "Anorectal manometry is a functional test that provides baseline and functional information" — Anil Darbari (clinical) [Ep 2 · 10:36](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=636)
- "In the past, the sphincter and its major role in constipation patients was not well understood" — Jason Frischer (clinical) [Ep 2 · 10:51](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=651)
- "Anorectal manometry is critical for determining whether a patient needs surgery or resection, because patients with motility disorders do not need resection" — Rod (clinical) [Ep 2 · 12:03](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-8-motility-disorders-part-1-3824?t=723)
- "Water-soluble contrast enema showed a tortuous and redundant colon that was dilated and full of stool" (clinical) [Ep 3 · 0:53](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=53)
- "Anorectal manometry showed an absent rectoanal inhibitory reflex (RAIR)" — Rogerardo (clinical) [Ep 3 · 1:03](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=63)
- "The patient is showing massively dilated colon as a result of colonic dysfunction, although the dilatation is predominantly in the rectal sigmoid" — Anil Darbari (clinical) [Ep 3 · 2:04](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=124)
- "High resting pressure on manometry might indicate a patient amenable to anal Botox" — Kahleb Graham (clinical) [Ep 3 · 2:35](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=155)
- "Dyssynergia is when patients push from their belly but create a negative pressure at the bottom instead of relaxing the sphincter" — Kahleb Graham (clinical) [Ep 3 · 3:02](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=182)
- "Patients with dyssynergia might benefit from pelvic floor physical therapy or biofeedback" — Kahleb Graham (clinical) [Ep 3 · 3:15](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=195)
- "Sitz marker study is performed by taking markers and obtaining an X-ray at day 5" — Kahleb Graham (clinical) [Ep 3 · 3:39](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=219)
- "If Sitz markers are scattered throughout the colon or predominantly on the right side, it suggests colonic dysmotility and may warrant colonic manometry" — Kahleb Graham (clinical) [Ep 3 · 3:48](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=228)
- "If all markers are sitting at the bottom of the colon, it fits more with an outlet issue" — Rogerardo (clinical) [Ep 3 · 4:07](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=247)
- "If all markers have disappeared on day 5 X-ray, the patient did stool even if they reported not stooling" — Kahleb Graham (clinical) [Ep 3 · 4:13](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=253)
- "Sitz markers do not dissolve" — Kahleb Graham (clinical) [Ep 3 · 4:22](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=262)
- "Colonic manometry is not available everywhere, but Sitz marker study should be available pretty much anywhere" — Marc Levitt (epidemiological) [Ep 3 · 4:38](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=278)
- "Sitz marker study can be used as a colonic transit study by obtaining X-rays at day 0, 1, 2, and 4 to see transit of markers" — Anil Darbari (clinical) [Ep 3 · 4:51](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=291)
- "Sitz marker study is not a replacement for colonic manometry" — Amanda Jensen (opinion) [Ep 3 · 5:17](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=317)
- "Nuclear scintigraphy is available in most centers that have nuclear medicine capacity" — Marc Levitt (epidemiological) [Ep 3 · 5:32](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=332)
- "Three colonic motility scenarios: diffusely slow but functional, normal motility with segmental obstruction, and entire colon severely slow and amodal" — Marc Levitt (clinical) [Ep 3 · 5:40](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=340)
- "Anorectal manometry is the gold standard but is a sophisticated, expensive test not available everywhere" — Rogerardo (opinion) [Ep 3 · 6:40](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=400)
- "Colonic manometry provides information on peristaltic activity, which is the motion of the colon" — Anil Darbari (clinical) [Ep 3 · 7:07](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=427)
- "Throughout the day, you should have two really strong contractions throughout your colon called high amplitude propagating contractions (HAPCs)" — Rogerardo (clinical) [Ep 3 · 7:21](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=441)
- "HAPCs start on the right side of the colon in the cecum area and progress distally" — Anil Darbari (clinical) [Ep 3 · 7:32](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=452)
- "If a patient has two HAPCs during an 18 or 24 hour study period, they do not have colonic dysmotility" — Rogerardo (clinical) [Ep 3 · 7:45](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=465)
- "Many patients get colonic manometry but the results come back normal" — Jason Frischer (epidemiological) [Ep 3 · 8:02](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=482)
- "No one normal or typical gets a colonic motility test" — Marc Levitt (opinion) [Ep 3 · 8:10](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=490)
- "If the colon moves uniformly with HAPCs throughout, antegrade flush will work well and reliably" — Marc Levitt (clinical) [Ep 3 · 8:22](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=502)
- "Some patients have a truly outlet issue and their colon is actually normal on manometry" — Kahleb Graham (clinical) [Ep 3 · 8:38](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=518)
- "Manometry can characterize if contractions are well coordinated (neuropathic problem) or low amplitude (myopathic problem)" — Kahleb Graham (clinical) [Ep 3 · 8:47](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=527)
- "Contractions should go from the right side of the colon all the way down to the rectum, but the rectum does not have those same contractions" — Kahleb Graham (clinical) [Ep 3 · 9:03](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=543)
- "In Hirschsprung's patients post pull-through, the rectal sigmoid brake is removed and contractions may go all the way to the sphincters" — Kahleb Graham (clinical) [Ep 3 · 9:12](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=552)
- "If there is no response to stimulants on colonic manometry, the patient does not have normal colonic motility by definition" — Anil Darbari (clinical) [Ep 3 · 9:36](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=576)
- "The case was concluded to not be Hirschsprung's disease; the absent RAIR was a sampling error" — Marc Levitt (clinical) [Ep 3 · 10:11](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=611)
- "The surgeon did not re-biopsy because of calretinin positivity" — Marc Levitt (clinical) [Ep 3 · 10:20](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=620)
- "Anorectal manometry showed the colon was diffusely slow and the problem was the sphincter due to absent RAIR" — Rogerardo (clinical) [Ep 3 · 10:26](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=626)
- "The patient was offered a Malone for antegrade flushes in combination with Botox and biofeedback physiotherapy" — Rogerardo (clinical) [Ep 3 · 10:38](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=638)
- "Over time, the colon could probably rehab and the patient may eventually need just laxatives alone" — Rogerardo (opinion) [Ep 3 · 10:50](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=650)
- "A perfectly good endpoint is to have a mechanically emptying colon, not necessarily weaning to laxatives alone" — Marc Levitt (opinion) [Ep 3 · 11:00](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=660)
- "Enemas from below or from above (through a Malone or cecostomy) are acceptable long-term management; resection is reserved for failures of conservative therapy" — Marc Levitt (opinion) [Ep 3 · 11:11](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=671)
- "Patients who fail conservative management are those with slow transit throughout or segmental disease" — Rogerardo (clinical) [Ep 3 · 11:24](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=684)
- "The vast majority of patients with segmental disease respond to antegrade enema only and never need resection" — Marc Levitt (clinical) [Ep 3 · 11:32](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=692)
- "A collaborative model between surgery and gastroenterology should be promoted in every center providing colorectal care" — Anil Darbari (opinion) [Ep 3 · 12:17](https://library.globalcastmd.com/watch/the-colorectal-quiz-episode-9-motility-disorders-part-2-3888?t=737)

## Changelog
- Aug 31: 18 doctors auto-found from episode dossiers
- Aug 30: 18 doctors auto-found from episode dossiers
- Aug 30: 18 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 18 doctors auto-found from episode dossiers
- Aug 29: 18 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 10 items, 10 dossiers, summaries for 4 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 8 items, 8 dossiers, summaries for 4 audience(s)

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