Gastro Pathology Flashcards
What are the 3 ways gastrointestinal disorders can be divided into?
Inflammatory - peptic ulcer disease, coeliac, Crohns, ulcerative colitis
Neoplastic - carcinoma of the oesophagus, stomach, colon
Functional - achalasia, diverticulosis, IBS
What three things do oesophageal disorders present with?
Dysphasia - difficulty swallowing
Pain - acid reflux, spasm, similar to cardiac pain
Cough/vomit - reflux
What is a pharyngeal pouch?
Herniation of mucosa
Weakness in pharyngeal constrictor muscles
Behind sternocleidomastoid
How does a pharyngeal pouch present?
Hangs due to gravity
Dysphagia
Swelling in lower neck on left side
Regurgitation
Overflow into lungs - respiratiory
What are the 2 causes of dysphagia?
Obstructive - tumours, inflammation, fibrosis, drugs, surgery, narrowing
Neuromuscular - stroke, Parkinson’s, MS, spasm, achalasia
What is achalasia?
Loss of ganglia from intramural plexus
LOS does no relax
Oesophagi does not empty
Failure of peristalsis and dilation of oesophagus
Regurgitation
What is the treatment for achalasia?
Nifedipine to relax sphincter
Balloon dilation
Cardiomyotomy
What are some causes of an oesophageal spasm?
Achalasia
Reflux
Motor disorders
Obstruction
Neuromuscular
How does oesophageal web occur?
Mucosa turns to atrophic, fibrous stricture
Upper end of oesophagus
Web on barium swallow
Pre-malignant
Iron deficiency anaemia
What is the treatment for oesophageal web?
Dilatation of stricture
Correction of iron deficiency
What are the causes of carcinoma of oesophagus?
Smoking
Alcohol
Pharyngeal pouch
Peptic ulcer disease
Achalasia
Coeliac
Iron deficiency - oesophageal web
What is the pathology of oesophageal carcinomas?
Squamous cell carcinoma
Spread to lymph nodes
Metastasises to liver
What are the clinical features of carcinomas of the oesophagus?
Dysphagia
Pain on swallowing
Local spread pain
What is the treatment of oesophageal carcinomas?
Surgery for cure
Radiotherapy - not adenocarcinoma
Stenting
What is the dental relevance of oesophagus carcinoma?
Dysphagia could be malignancy
Medicines in liquid form
What areas do peptic ulcers affect?
Oesophagus
Stomach
Duodenum
What is the cause of peptic ulcer disease?
Mucosal inflammation - H. Pylori infection
Oesophagus ulceration - acid reflux
Stomach ulceration - NSAIDs
Duodenal ulceration - gastric acid production
What is the pathology of peptic ulcer disease?
Ulcers lead to healing with scarring - strictures
Chronic ulcers
Acute perforation
What are the clinical features of peptic ulcer disease?
Pain relieved by eating
Stricture - vomiting
Perforation - vomit blood
What is the treatment of peptic ulcer disease?
Antacids
H2 blockers
Proton pump ihibitors
Eradicate H. Pylori infection
What is the dental relevance of peptic ulcer disease?
Do not prescribe NSAIDs
Which 2 places does IBS affect?
Small intestine - low organisms, aciduric, streptococci, lactobacilli
Large intestine - complex, obligate anaerobes, E. coli
What is the cause of coeliac disease?
Sensitivity to gluten
Autoimmune disorder of small intestine
Genetic
What are the clinical features of coeliac disease?
Change in bowel habit
Frequency
Bulky poo
Abdominal colic, weight loss
Stunted growth in children
What is the dental relevance of coeliac disease?
Malabsorption
B12, Iron - glossitis, burning mouth, anaemia
Vit K - bleeding
Vit D - osteomalacia
Enamel defects
What does chrons disease affect?
Chronic granulomatous disease
GI tract
Usually termino ileum - small bowel
What is the cause of Chrons?
Unknown
What is the pathology of chrons?
Thickness of bowel wall
Fistulas and fissures
What is the clinical presentation of chrons?
Intermittent abdominal pain
Anaemia
Weight loss
Diarrhoea
Uveitis
Clubbing
Arthritis
What is the dental relevance of chrons?
Ulceration
Cobblestone
Labial swelling
Mucosal tags
Immunosuppression increases infection risk
What is the treatment for chrons?
Correct nutrition deficiencies
Immunosuppressives
Surgical stoma bag
What is ulcerative colitis?
Chronic IBS
Affects large bowel of colon
Backwash of terminal ileum
Inner lining
What is the cause of ulcerative colitis?
Unknown
Genetic
What is the clinical presentation of chrons?
Rectum
Painless
Bloody diarrhoea with mucus
Superficial ulceration in colon
What is the treatment for ulcerative colitis?
High protein fibre diet
Corticosteroids for acute
Azathioprine long term
Surgical
What is the dental relevance of ulcerative colitis?
Oral ulceration
Anaemia due to blood loss
Immunosuppression increased risk of infection
Corticosteroids
What is carcinoma of the colon predisposed by?
Neoplastic polyps
Long ulcerative colitis
Family history
What is the clinical presentation of carcinoma of the colon?
Unexplained anaemia
Mass on rectal
Left tumour - bleeding, COBH
Right tumour - anaemia, weight loss, ab pain
Both - obstruction, perforation, haemorrhage, fistula
Where does carcinoma of the colon spread to?
Via lymphatics
Liver
Lung
Bone
What are the 4 stages of colon carcinoma?
A: confined to bowel wall
B: extension through bowel wall
C: regional lymph nodes
D: distant metastases
What is the dental relevance of colon carcinoma?
Anaemia
Osteomalacia, Gardners increased risk
What is diverticular disease?
Herniation of bowel mucosa
Through bowel wall
Occurs at weak point pierced by blood vessels
What is the cause of diverticulitis?
Low fibre diet
Segmental contraction
High pressure zones
What is the treatment for diverticular disease?
High fibre diet
Surgery
How des IBS present?
Intermittent diarrhoea
Ab pain
Bloating
What is IBS caused by?
Psychological
Food intolerances
What is the treatment for IBS?
High fibre diet
Avoidance of dietary trigger
What is the dental relevance of IBS?
Facial pain
Burning mouth
TMJ
What is haematemesis?
Vomiting of blood
Upper GI bleeding
What ishaematemesis caused by?
Congenital
H. Pylori induced ulceration
NSAIDs, warfarin
Inflammatory
Neoplasia, fistula
