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Gastroenterology Flashcards

1
Q

what takes place in the gut?

A 
digestion/absorption of nutrients
stomach - alcohol and water
duodenum - iron and B12
jejunum - folate
large intestine - water
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2
Q

what takes place in the pancreas?

A

exocrine portion - production of enzymes to digest food

endocrine - production of insulin

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3
Q

what takes place in the gall bladder?

A

concentration/storgae of bile

fat digestion and absorption

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4
Q

what takes place in the liver?

A

metabolism of nutrients and toxins
production of bile
protein synthesis

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5
Q

GI symptoms?

A 
pain - localised/referred
dysphagia
dyspepsia - discomfort of upper tract
nausea/vomitting
diarrhoea
constipation
steatorrhoea 
bleeding - haemaemesis, melanea - upper and lower tract
weight loss
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6
Q

investigations for upper GI tract?

A

endoscopy

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7
Q

investigations for lower GI tract?

A

sigmoidoscopy

colonoscopy

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8
Q

radiographs show?

A

plain

contrast - caused by barium swallow, meal, enema

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9
Q

ultrasound taken to look at?

A

especially biliary tract, liver

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10
Q

MRI taken to look at?

A

biliary tract, liver, pancreas

gut

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11
Q

antacids suppress acid - what are examples of antacids?

A

aluminium hydroxide
calcium carbonate - rennie
aligante based - gaviscon

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12
Q

gastric acid reduction caused by?

A

histamine receptor antagonists - H2 blockers
ranitidine, cimetidine

PPI’s - omeprazole, lansoprazole

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13
Q

when do you treat the CNS with anti emetics? and what are some examples?

A

when there is chemical stimulation of the vomitting centre treat the CNS
domperidone
metoclopramide ondasteron

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14
Q

when to treat the gut? with what?

A

distension of the gut is causing sickness
anti histamines - cyclizine
ondansetron - serotonin antagonist

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15
Q

what is GORD?

A

gastro oseophageal reflux disease
excess acid at oseophageal sphinctor
= loss of tone
delayed gastric emptying

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16
Q

what is GORD associated with?

A

associated with obesity
lying flat
fatty foods
smoking

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17
Q

gord symptoms?

diagnosed by?

A

heart burn

endoscopy

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18
Q

how to treat gord?

A

lifestyle
drugs - antacids, PPI’s
rarely surgery

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19
Q

complications caused by GORD?

A

stricture formation

cancer - via barretts oseophagus

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20
Q

what is peptic ulcer disease?

A

gastric/duodenal - gastric can become malignant
15-20% of population affected, more in elderly and men
caused by helicopter pylori
NSAIDS - esp gastric

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21
Q

symptoms of peptic ulcer disease?

A

epigastric pain
dyspepsia
vomitting
anorexia

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22
Q

complications from peptic ulcers?

A

bleeding - haematemesis, malaena

perforation

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23
Q

investigations for peptic ulcers?

A

endoscopy
biopsy if gastric
H.pylori - biopsy, breath test, serology

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24
Q

treatment of acute ulcer?

A

endoscopically stop bleeding

rarely surgery

25
treatment of non acute ulcer?
acid suppression with PPI | tx of h pylori - PPI/antibiotics
26
what is a hiatus hernia?
may cause heartburn structural abnormality of the stomach leaving segment above diaphragm treat with meds or surgery - flundoplication
27
dentally be cautious with what meds?
NSAIDS, corticosteroids
28
what might you see with oral ulceration that might indicate anaemia?
chronic blood loss
29
what might acid reflux cause?
NCTSL
30
what is coeliac disease?
multi symptom autoimmune disease not an allergy sensitivity to gluten - wheat, rye, barley small intestinal villous atrophy STVA
31
coeliac symptoms?
malabsorption - malaise, diarrhoea, steatorrhea, weight loss, iron/folate deficiency, protein deficiency
32
diagnosing coeliac disease?
atibodies - tissue transglutaminase antibody TTGA | endoscopy and biopsy
33
how to treat coeliac disease?
gluten free diet | osteoporosis prophylaxis
34
what to be aware of dentally when it comes to pt's with coeliac disease?
oral features of malabsorption - iron/folate oral ulceration bisphoshponates
35
types of inflammatory bowel disease?
crohns - entire GI tract | ulcerative colitis - large intestine
36
pathological appearance of crohns?
not continuous - skip lesions | transmural inflammation
37
pathological appearance of UC?
continuous | mucosal inflammation
38
symptoms of crohns?
malabsorption, abdominal pain, bleeding, abscess, fistula, sinus formation
39
symtopms of UC?
bloody diarrhoea | abdominal pain
40
extraintestinal symptoms of IBD?
``` autoimmune arthritis skin lesions - erythema nodosum, pyodema gangrenosum autoimmune hepatitis DVT, PE ocular inflammation ```
41
cancer result of what type of IBD?
long term complication of UC
42
how to diagnose IBD?
clinical radiology - small bowel disease colonoscopy/biopsy definitive stool sample - rule out infective cause, faecal calprotection
43
treatment of IBD?
suppress the inflammation with 5 aminosalicylic acid preps - sulfazalasine corticosteroids - oral enema immunosuppressants - azathioprine, methotraxate for crohns biologics - anti TNF agents
44
IBD surgery options?
remove diseased bowel colectomy in UC - curative sections of bowel in crohns - not curative abscess of drainage
45
parenteral nutrition/elemental diet causes? | antibiotics cause?
bowel resting/acute episodes | infective complications
46
dental aspects of IBD?
oral features of crohns and malabsorption | side effects of immunosuppressants/steroids
47
what is diverticulitis?
due to pouches/pockets 50% are over 50's no symptoms usually, could be bleeding, pain from abscess formation/obstructions
48
what is functional GI disease?
symtpoms without demonstratable disease 80% of GI pt's altered bowel smooth muscle tone? ?high cho diet in childhood
49
common symptoms of functional gi disease?
oseophageal - lump in throat/globus, regurgitation gastric - dyspepsia, endoscopy if alarm symptoms and age over 40 IBS
50
treatment of functional GI disease?
reassurance, fibre, anti spasmodic | low dose -amitryptilines, SSRI's
51
types of liver disease?
acute inflammation - hepatitis chronic inflammation - cirrhosis cancer
52
causes of liver disease?
``` viruses hep a,b,c,d,e iron overload - haemachromatosis drugs autoimmune - primary bilary cirrhosis chronic active hepatitis scleorsing cholangitis diabetes ayptogenic ```
53
liver. pancreas, biliary tract disease symptoms?
``` jaundice ascites - fluid overload in belly telangriectasia - red blood vessels on skin renal failure encephalopathy - confusion variceal haemorrhage - life threatening upper gi tract bleed coagulopathy prone to infections ```
54
tx of liver, pancreas, biliary tract disease?
remove and trear underlying cause support - liver can regenerate if no cirrhosis liver transplant
55
what is dentally relevant to liver, pancreas and biliary tract disease?
coagulopathy/reduced platelets possible infectious underlying cause - hepatitis, liability to infection liver transplant pt's on immunosuppressants
56
gall bladder problems?
gall stones cholecystitis - inflamm of gall bladder, cholangitis - inflamm of ducts = pain, jaundice, pancreatitis treatment - endoscopic, open cholecystectomy
57
what is pancreatitis?
inflammation of the pancreas caused by gall stones, alcohol, drugs high amylase in blood gives diagnosis treatment - support in hospital
58
GI bleeding commonly from?
``` oseophagus - 5% varices - 15% mallory weiss tear = secondary to vomitting - 10% peptic ulcers - 50% gastritis - 20% ```

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