GI complications of SCI

1. What is the likely cause of gastroesophageal bleeding in SCI patients?
2. What is the most common cause of emergency abdominal surgery in SCI patients?
3. What complication should be suspected if an adynamic ileus does not improve?
4. What is SMA syndrome? What are the symptoms? What predisposes SCI patients to this syndrome?
5. How is SMA syndrome diagnosed and treated?

Answers:
1. Ulcers secondary to interruption of sympathetic vasoconstrictors, steroid use, or increased gastric secretion.
2. Cholecystitis.
3. Pancreatitis.
4. Superior Mesenteric Artery syndrome is when the third portion of the duodenum is compressed by the overlying SMA, resulting in obstruction. The symptoms are postprandial n/v, bloating, and abdominal pain. SCI patients are predisposed due to rapid weight loss, prolonged supine position, spinal orthosis, and hyperextension of the back (due to flaccid abdominal wall).
5. It is diagnosed by an UGI series, which demonstrates duodenal obstruction to barium flow. The treatment is to eat small frequent meals upright, lie in left lateral decubitus position after eating, and Reglan.