Gastroenterology

Question 1

What is the aetiology for peptic ulcer disease?

Answer 1

high acid secretion - duodenal
normal acid secretion - stomach (occurs when tissue barrier is weak)
drugs - NSAIDs, steroids

Question 2

What are the signs and symptoms for peptic ulcer disease?

Answer 2

asymptomatic
epigastric burning pain (worse before/after meals; worse at night; relieved by food, alkali and vomiting)
usually no physical symptoms (only when complications e.g. bleed, perforation)

Question 3

Compare ulcerative colitis and Crohn’s disease.

Answer 3

Ulcerative colitis: continuous disease, rectum always involved, anal fissures 25%, ileum involved 10%, mucosa granulomatous and ulcerated, vascular, serosa normal, symptoms - diarrhoea, abdominal pain, PR bleeding
Crohn’s disease: discontinous disease, rectum involved 50%, anal fissures 75%, ileum involved 30%, mucosa cobbled and fissured, non-vascular, serosa inflamed, symptoms same as UC and can have OFG

Question 4

What are the investigations for peptic ulcer disease?

Answer 4

Endoscopy, radiology (barium meal), anaemia (FBC and faecal occult blood test)
Helicobacter pylori - breath, antibodies, mucosa

Question 5

What are the complications of peptic ulcer disease?

Answer 5

Local: perforation, haemorrhage, stricture, malignancy
Systemic: anaemia

Question 6

What are the treatment options for peptic ulcer disease?

Answer 6

Medical: reversible problem, lifestyle changes
Stop smoking, small regulator meals, eradication therapy, ulcer healing drugs, surgical, vagotomy
H. Pylori drugs - triple therapy - 2 week course of 2 antibiotics (amoxycillin, metronidazole) and proton pump inhibitor (omeprazole)

Question 7

What is coeliac disease and its aetiology?

Answer 7

Sensitivity to alpha-gliaden component of gluten

Genetic (DQw2), T lymphocytes, villous atrophy

Question 8

What are the signs and symptoms of coeliac disease?

Answer 8

Weight loss, lassitude, weakness, abdominal pain/swelling, diarrhoea, aphthae/glossitis, steatorrhea, dysphagia, malabsorption (iron, folate, vit B12, fat)

Question 9

What are the investigations and treatment for coeliac disease? What is the dental relevance?

Answer 9

Jejunal biopsy, faecal fat, haematinics, autoantibodies
Gluten free diet
Associated with oral disease, aphthae

Question 10

What is the aetiology for colon cancer?

Answer 10

Polyps, diet (low fibre, high fat, high meat, low veg), smoking, alcohol, exercise, genetics (P53 in 75%), ulcerative colitis

Question 11

What are the signs and symptoms for colon cancer?

Answer 11

None

Possibly anaemia, rectal blood loss

Question 12

What are the investigations for colon cancer? What is Duke’s classification?

Answer 12

Screening (FOB, barium enema, endoscopy, CT/MRI, all adults over 50 asked for a FOB sample via post)

Dukes Classification
A - sub mucosal 80% 5 yr survival
B - muscularis 65% 5 yr survival
C - lymph nodes 45% 5 yr survival
D - liver 5% 5 yr survival

Question 13

What are the treatment options for colon cancer?

Answer 13

Surgery, radiotherapy, chemotherapy

Question 14

What are the different types of intestinal polyposis?

Answer 14

Small intestine - low risk - Peutz-Jeghers syndrome ORAL PIGMENTATION
large intestine - high risk - Gardiners syndrome, Cowdens syndrome (tremendous polypoid mucosa)

Question 15

What are the signs and symptoms of orofacial granulomatosis?

Answer 15

facial and lip swelling, ulcers, mucosal cobblestoning and tagging