Gastroenterology Flashcards
what takes place in the gut?
digestion/absorption of nutrients stomach - alcohol and water duodenum - iron and B12 jejunum - folate large intestine - water
what takes place in the pancreas?
exocrine portion - production of enzymes to digest food
endocrine - production of insulin
what takes place in the gall bladder?
concentration/storgae of bile
fat digestion and absorption
what takes place in the liver?
metabolism of nutrients and toxins
production of bile
protein synthesis
GI symptoms?
pain - localised/referred dysphagia dyspepsia - discomfort of upper tract nausea/vomitting diarrhoea constipation steatorrhoea bleeding - haemaemesis, melanea - upper and lower tract weight loss
investigations for upper GI tract?
endoscopy
investigations for lower GI tract?
sigmoidoscopy
colonoscopy
radiographs show?
plain
contrast - caused by barium swallow, meal, enema
ultrasound taken to look at?
especially biliary tract, liver
MRI taken to look at?
biliary tract, liver, pancreas
gut
antacids suppress acid - what are examples of antacids?
aluminium hydroxide
calcium carbonate - rennie
aligante based - gaviscon
gastric acid reduction caused by?
histamine receptor antagonists - H2 blockers
ranitidine, cimetidine
PPI’s - omeprazole, lansoprazole
when do you treat the CNS with anti emetics? and what are some examples?
when there is chemical stimulation of the vomitting centre treat the CNS
domperidone
metoclopramide ondasteron
when to treat the gut? with what?
distension of the gut is causing sickness
anti histamines - cyclizine
ondansetron - serotonin antagonist
what is GORD?
gastro oseophageal reflux disease
excess acid at oseophageal sphinctor
= loss of tone
delayed gastric emptying
what is GORD associated with?
associated with obesity
lying flat
fatty foods
smoking
gord symptoms?
diagnosed by?
heart burn
endoscopy
how to treat gord?
lifestyle
drugs - antacids, PPI’s
rarely surgery
complications caused by GORD?
stricture formation
cancer - via barretts oseophagus
what is peptic ulcer disease?
gastric/duodenal - gastric can become malignant
15-20% of population affected, more in elderly and men
caused by helicopter pylori
NSAIDS - esp gastric
symptoms of peptic ulcer disease?
epigastric pain
dyspepsia
vomitting
anorexia
complications from peptic ulcers?
bleeding - haematemesis, malaena
perforation
investigations for peptic ulcers?
endoscopy
biopsy if gastric
H.pylori - biopsy, breath test, serology
treatment of acute ulcer?
endoscopically stop bleeding
rarely surgery
treatment of non acute ulcer?
acid suppression with PPI
tx of h pylori - PPI/antibiotics
what is a hiatus hernia?
may cause heartburn
structural abnormality of the stomach leaving segment above diaphragm
treat with meds or surgery - flundoplication
dentally be cautious with what meds?
NSAIDS, corticosteroids
what might you see with oral ulceration that might indicate anaemia?
chronic blood loss
what might acid reflux cause?
NCTSL
what is coeliac disease?
multi symptom autoimmune disease not an allergy
sensitivity to gluten - wheat, rye, barley
small intestinal villous atrophy STVA
coeliac symptoms?
malabsorption - malaise, diarrhoea, steatorrhea, weight loss, iron/folate deficiency, protein deficiency
diagnosing coeliac disease?
atibodies - tissue transglutaminase antibody TTGA
endoscopy and biopsy
how to treat coeliac disease?
gluten free diet
osteoporosis prophylaxis
what to be aware of dentally when it comes to pt’s with coeliac disease?
oral features of malabsorption - iron/folate
oral ulceration
bisphoshponates
types of inflammatory bowel disease?
crohns - entire GI tract
ulcerative colitis - large intestine
pathological appearance of crohns?
not continuous - skip lesions
transmural inflammation
pathological appearance of UC?
continuous
mucosal inflammation
symptoms of crohns?
malabsorption, abdominal pain, bleeding, abscess, fistula, sinus formation
symtopms of UC?
bloody diarrhoea
abdominal pain
extraintestinal symptoms of IBD?
autoimmune arthritis skin lesions - erythema nodosum, pyodema gangrenosum autoimmune hepatitis DVT, PE ocular inflammation
cancer result of what type of IBD?
long term complication of UC
how to diagnose IBD?
clinical
radiology - small bowel disease
colonoscopy/biopsy definitive
stool sample - rule out infective cause, faecal calprotection
treatment of IBD?
suppress the inflammation
with 5 aminosalicylic acid preps - sulfazalasine
corticosteroids - oral enema
immunosuppressants - azathioprine, methotraxate for crohns
biologics - anti TNF agents
IBD surgery options?
remove diseased bowel
colectomy in UC - curative
sections of bowel in crohns - not curative
abscess of drainage
parenteral nutrition/elemental diet causes?
antibiotics cause?
bowel resting/acute episodes
infective complications
dental aspects of IBD?
oral features of crohns and malabsorption
side effects of immunosuppressants/steroids
what is diverticulitis?
due to pouches/pockets
50% are over 50’s
no symptoms usually, could be bleeding, pain from abscess formation/obstructions
what is functional GI disease?
symtpoms without demonstratable disease
80% of GI pt’s
altered bowel smooth muscle tone?
?high cho diet in childhood
common symptoms of functional gi disease?
oseophageal - lump in throat/globus, regurgitation
gastric - dyspepsia, endoscopy if alarm symptoms and age over 40
IBS
treatment of functional GI disease?
reassurance, fibre, anti spasmodic
low dose -amitryptilines, SSRI’s
types of liver disease?
acute inflammation - hepatitis
chronic inflammation - cirrhosis
cancer
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
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
tx of liver, pancreas, biliary tract disease?
remove and trear underlying cause
support - liver can regenerate if no cirrhosis
liver transplant
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
gall bladder problems?
gall stones
cholecystitis - inflamm of gall bladder, cholangitis - inflamm of ducts = pain, jaundice, pancreatitis
treatment - endoscopic, open cholecystectomy
what is pancreatitis?
inflammation of the pancreas
caused by gall stones, alcohol, drugs
high amylase in blood gives diagnosis
treatment - support in hospital
GI bleeding commonly from?
oseophagus - 5% varices - 15% mallory weiss tear = secondary to vomitting - 10% peptic ulcers - 50% gastritis - 20%
