Gastro Pathology Flashcards by Aisha Mohammed

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

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What three things do oesophageal disorders present with?

Dysphasia - difficulty swallowing
Pain - acid reflux, spasm, similar to cardiac pain
Cough/vomit - reflux

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What is a pharyngeal pouch?

Herniation of mucosa
Weakness in pharyngeal constrictor muscles
Behind sternocleidomastoid

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How does a pharyngeal pouch present?

Hangs due to gravity
Dysphagia
Swelling in lower neck on left side
Regurgitation
Overflow into lungs - respiratiory

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What are the 2 causes of dysphagia?

Obstructive - tumours, inflammation, fibrosis, drugs, surgery, narrowing
Neuromuscular - stroke, Parkinson’s, MS, spasm, achalasia

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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

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What is the treatment for achalasia?

Nifedipine to relax sphincter
Balloon dilation
Cardiomyotomy

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What are some causes of an oesophageal spasm?

Achalasia
Reflux
Motor disorders
Obstruction
Neuromuscular

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How does oesophageal web occur?

Mucosa turns to atrophic, fibrous stricture
Upper end of oesophagus
Web on barium swallow
Pre-malignant
Iron deficiency anaemia

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What is the treatment for oesophageal web?

Dilatation of stricture
Correction of iron deficiency

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What are the causes of carcinoma of oesophagus?

Smoking
Alcohol
Pharyngeal pouch
Peptic ulcer disease
Achalasia
Coeliac
Iron deficiency - oesophageal web

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What is the pathology of oesophageal carcinomas?

Squamous cell carcinoma
Spread to lymph nodes
Metastasises to liver

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What are the clinical features of carcinomas of the oesophagus?

Dysphagia
Pain on swallowing
Local spread pain

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What is the treatment of oesophageal carcinomas?

Surgery for cure
Radiotherapy - not adenocarcinoma
Stenting

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What is the dental relevance of oesophagus carcinoma?

Dysphagia could be malignancy
Medicines in liquid form

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What areas do peptic ulcers affect?

Oesophagus
Stomach
Duodenum

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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

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What is the pathology of peptic ulcer disease?

Ulcers lead to healing with scarring - strictures
Chronic ulcers
Acute perforation

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What are the clinical features of peptic ulcer disease?

Pain relieved by eating
Stricture - vomiting
Perforation - vomit blood

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What is the treatment of peptic ulcer disease?

Antacids
H2 blockers
Proton pump ihibitors
Eradicate H. Pylori infection

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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