Common condition of the lower GI tract - relevance to dentistry

Question 1

Small bowel physiological function?

Answer 1

• Villi – large surface area
• Enzymatic digestion
• Absorption
• Gut hormone secretion
• Immune role

Question 2

Large bowel physiological function?

Answer 2

• storage and elimination of waste
• fluid and electrolyte (water) reabsorption

Question 3

Commonest condition of bowel?

Answer 3

Colorectal cancer (CRC)

Question 4

Symptoms of CRC?

Answer 4

• Change in bowel habit
• Rectal blood loss
• Abdominal pain
• Weight loss
• Co-incidental anaemia
• Detection at screening

Question 5

2 pathways to test bowel disorder?

Answer 5

Change in bowel habit - bleeding, pain, weight loss
- stool sample

Filters designed for backlog form Covid

Positive result = colonoscopy

Question 6

QFIT?

Answer 6

Stool sample - bowel cancer screening

In adults 50-74 every 2 years

Question 7

Inflammation and cancer?

Answer 7

Inflammation e.g. in mouth can promote oncogenic formation

Question 8

Stages of CRC?

Answer 8

Dukes A-D

Dukes A and B better outcome to treatment

Question 9

Surgical management of CRC?

Answer 9

Dukes A ‘cancer polyps’
- endoscopic resection possible

Question 10

Cancer polyp?

Answer 10

polyp contains abnormal cells or cells that may become abnormal (malignant)

Question 11

What is the cause of most CRCs?

Answer 11

Sporadic with no heridenry influence

Question 12

Gardeners syndrome and CRC?

Answer 12

Multiple osteomas, particularly in mandible (cotton—wool like appearance on x-ray)

• pt often have many polyps in colon nut can manifest orally

Supplementary teeth

In-erupted teeth

Dental changes often pre-date any intestinal symptoms

Question 13

Types of Inflammatory bowel disease?

Answer 13

Crowns disease

Ulcerated colonitis

Question 14

Aetiology of IBS?

Answer 14

• Environmental trigger in genetically
  susceptible individuals
• Genetic component
• Candidate genes identified (eg
  NOD2)

Triggering factors
- role of bacterial infection, dietary
antigen, vaccination history, social
factors including smoking

Question 15

What does ulcerated colitis affect?

Answer 15

Only colon

Question 16

What is ulcerated colitis?

Answer 16

Continuous mucosal inflammation

Question 17

Symptoms of ulcerated colitis?

Answer 17

Blood diarrhoea

Abdominal cramping

Weight loss

Malaise

Question 18

Common site of crohns disease?

Answer 18

Large bowel most common

But in any art of gut

Question 19

Symptoms of Crohn’s disease?

Answer 19

Abdominal pain

Diarrhoea

Bleeding

Peri-anal symptoms

Weight loss

Question 20

Skin manifestations of inflammatory bowel disease?

Answer 20

Pyoderma

Gangrenosum

Erthyema

Nodosum

Vasculitis

Question 21

Who is at highest risk of colon cancer?

Answer 21

Inflammatory bowel disease: ulcerative colitis or Crohn’s disease

Question 22

Medical tx for IBD?

Answer 22

• Immunosuppression
• Corticosteroids for acute exacerbations
• Thiopurines (azathioprine)
• Bone marrow suppression; risks of infection

Also new biologics
- Monoclonal antibodies against TNF (anti-TNF) or even integrins (stop binding of neutrophils…)

Vedolizumab
Ustekinumab
Tofacitinib and many other new oral agents

Question 23

If pt is on biologics - what do you need to consider?

Answer 23

Need to ensure no dental infection ongoing prior to administration

Question 24

Types of Small bowel disease?

Answer 24

Coeliac disease

Small bowel infarctions

Question 25

Features of coeliac disease?

Answer 25

Loss of illi = malabsorption Intolerance to gluten

Question 26

Effect of eating disorders in dentistry?

Answer 26

Severe palatal erosions Occlusal erosion of the maxillary teeth - causing the incisal edges of the incisors to be thin and knife-edged - the occlusal surfaces have a flat to cupped-out appearance - Swollen parotid glands

Question 27

Hereditary Haemorrhagic Telangiectasia (HHT)?

Answer 27

Characteristic peri-oral telangiectasia - small bowel lesion can bleed

Question 28

Peutz-Jeghers Syndrome Clinical appearance in dentistry?

Answer 28

Characteristic mucocutaneous, pigmented macules

Question 29

What can Crohn’s disease manifest orally as?

Answer 29

Mouth ulcers Orofacial Granulomatosis

Question 30

What is shown and what could it show

Answer 30

Angular stomatitis - said to be seen in iron- deficient anaemia Oral manifestation of GI disease

Question 31

Orofacial Granulomatosis?

Answer 31

◼ Inflammatory condition affecting the oral mucosa ◼ Non-caseating granulomas ◼ “Cobblestone” appearance Can be isolated or manifestation of crohn’s