Common condition of the lower GI tract - relevance to dentistry Flashcards
Small bowel physiological function?
- Villi – large surface area
- Enzymatic digestion
- Absorption
- Gut hormone secretion
- Immune role
Large bowel physiological function?
- storage and elimination of waste
- fluid and electrolyte (water) reabsorption
Commonest condition of bowel?
Colorectal cancer (CRC)
Symptoms of CRC?
- Change in bowel habit
- Rectal blood loss
- Abdominal pain
- Weight loss
- Co-incidental anaemia
- Detection at screening
2 pathways to test bowel disorder?
Change in bowel habit - bleeding, pain, weight loss
- stool sample
Filters designed for backlog form Covid
Positive result = colonoscopy
QFIT?
Stool sample - bowel cancer screening
In adults 50-74 every 2 years
Inflammation and cancer?
Inflammation e.g. in mouth can promote oncogenic formation
Stages of CRC?
Dukes A-D
Dukes A and B better outcome to treatment
Surgical management of CRC?
Dukes A ‘cancer polyps’
- endoscopic resection possible
Cancer polyp?
polyp contains abnormal cells or cells that may become abnormal (malignant)
What is the cause of most CRCs?
Sporadic with no heridenry influence
Gardeners syndrome and CRC?
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
Types of Inflammatory bowel disease?
Crowns disease
Ulcerated colonitis
Aetiology of IBS?
- 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
What does ulcerated colitis affect?
Only colon
What is ulcerated colitis?
Continuous mucosal inflammation
Symptoms of ulcerated colitis?
Blood diarrhoea
Abdominal cramping
Weight loss
Malaise
Common site of crohns disease?
Large bowel most common
But in any art of gut
Symptoms of Crohn’s disease?
Abdominal pain
Diarrhoea
Bleeding
Peri-anal symptoms
Weight loss
Skin manifestations of inflammatory bowel disease?
Pyoderma
Gangrenosum
Erthyema
Nodosum
Vasculitis
Who is at highest risk of colon cancer?
Inflammatory bowel disease: ulcerative colitis or Crohn’s disease
Medical tx for IBD?
- 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
If pt is on biologics - what do you need to consider?
Need to ensure no dental infection ongoing prior to administration
Types of Small bowel disease?
Coeliac disease
Small bowel infarctions
Features of coeliac disease?
Loss of illi = malabsorption
Intolerance to gluten
Effect of eating disorders in dentistry?
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
Hereditary Haemorrhagic Telangiectasia (HHT)?
Characteristic peri-oral telangiectasia
- small bowel lesion can bleed
Peutz-Jeghers Syndrome Clinical appearance in dentistry?
Characteristic mucocutaneous, pigmented
macules
What can Crohn’s disease manifest orally as?
Mouth ulcers
Orofacial Granulomatosis
What is shown and what could it show
Angular stomatitis
- said to be seen in iron- deficient anaemia
Oral manifestation of GI disease
Orofacial Granulomatosis?
◼ Inflammatory condition
affecting the oral mucosa
◼ Non-caseating granulomas
◼ “Cobblestone” appearance
Can be isolated or manifestation of crohn’s
