Gastroenterology Flashcards
what are the 8 components of the GI tract?
- esophagus
- stomach
- gall bladder
- liver
- pancreas
- small intestine
- large intestine
- rectum
what are the 2 main functions of the gut?
- digestion and absorption of nutrients
what is absorbed in the stomach?
- water and alcohol
what is absorbed in the duodenum?
iron and vit B12
where is folate absorbed?
jejunum
what are the 2 divisions of the pancreas?
exocrine and endocrine
what is the hormone made by the endocrine division of the pancreas?
insulin
what is the function of the gall bladder?
concentration and storage of bile
what is the 3 functions of the liver?
- metabolise nutrients and toxins
- protein synthesis
- production of bile
what are 9 GI symptoms?
- pain
- dysphagia
- dyspepsia
- nausea and vomiting
- diarrhoea
- constipation
- weight loss
- bleeding
- steatorrhoea
define dysphagia
difficulty swallowing
define dyspepsia
discomfort in upper GI tract (eg heartburn)
what is steatorrhoea?
pale bulky stools
what are the main investigations of the GI tract?
- endoscopy
- colonoscopy
- sigmoidoscopy
- radiographs
- ultrasound (esp liver and billary tract)
- MRI
what 2 types of medication can be given to suppress acid?
- antacids
2. gastric acid reduction
name 3 types of antacid
- calcium carbonate (rennies)
- aluminium hydroxide
- alginate based (gaviscon)
what are the 2 types of gastric acid reducers?
- proton pump inhibitors
2. histamine receptor antagonists
name two histamine receptor antagonists?
- ranitidine
- cimetidine
name 2 types of PPIs
- lanzoprazole
- omeprazole
what does GORD stand for?
gastro oesophageal reflux disease
define GORD as a condition
excess acid at the lower oesophageal spincter
name 4 things associated with GORD
- smoking
- lying flat
- obesity
- fatty foods
what is the main symptoms of GORD?
heartburn
how can a diagnosis of GORD be made?
endoscopy
how is GORD treated? 3 things
- lifestyle changes
- drugs (PPIs and antacids)
- rarely surgery
name the 2 types of peptic ulcers
- gastric ulcer
2. duodenal ulcer
what is the main worry with a gastric ulcer?
they have the tendency to become malignant
what is the aetiology of peptic ulcers?
- NSAIDs (esp for gastric)
- helibacter pylori
what are the 4 main symptoms of a gastric ulcer?
- anorexia
- vomiting
- dyspepsia
- epigastric pain
what complications can come from a peptic ulcer?
bleeding and perforation
what is the treatment of an acute peptic ulcer?
endoscopically stop bleeding (sometimes surgery)
what is the treatment for non-acute peptic ulcer disease? 2 things
- acid suppression (PPI)
- treat H. pylori (PPI and antibiotics)
what are the symptoms of a hiatus hernia?
heartburn
what are the 2 treatment options for a hiatus hernia?
- medication
- surgery (fundoplication)
what is a hiatus hernia?
a structural abnormality of the stomach leaving a segment above diaphragm
With patients who have a GI disorder you should be cautious with what during dental treatment… 3 things
- NSAIDs
- may have oral ulceration due to anaemia due to chronic blood loss
- NCTSL mat occur due to acid reflux
define coeliac disease
multi-system auto-immune disease that is caused by a sensitivity to gluten in the diet.
what happens to the villous of the small intestine in those with coeliac disease?
villous atrophy
what are 5 symptoms of coeliac disease?
- malaise
- diarrhoea
- weight loss
- iron and folate deficiency
- protein deficiency
how is coeliac disease diagnosed? 2 things
- blood test showing TTGA antibodies
- endoscopy with biopsy
what does TTGA stand for?
tissue transglutaminase antibody
what is the treatment for those with coeliac disease? 2 things
- gluten free diet
- osteoporosis prophylaxis
what are the 2 main types of Inflammatory disease?
- Crohn’s disease
- Ulcerative colitis
where in the body is affected by chron’s disease?
the whole GI tract from the mouth to anus
where in the body is affected by ulcerative colitis
the large intestine
what type of conditions are inflammatory bowel diseases?
auto-immune with unknown aetiology
what type of inflammation occurs in chron’s disease?
transmural - at walls or organs and blood vessels
what type of inflammation occurs in ulcerative colitis?
mucosal - of mucous membranes in the intestine
true or false - the symptoms for inflammatory bowel conditions can relapse and remit?
true
what are the 5 symptoms of Chron’s disease
- malabsorption
- abdominal pain
- bleeding
- abscess formation
- oral features
what are the main two symptoms of ulcerative colitis?
- bloody stools
- abdominal pain (less than with chrons)
what is the extra-intestinal symptoms of IBD? 5 things
- autoimmune arthritis (rarerly in TMJ)
- skin lesions
- autoimmune hepatitis
- DVT and PE
- ocular (eye) inflammation
which IBD are you more likely to have long term complications that can lead to cancer?
Ulcerative colitis
how is IBD diagnosed in the lower GI tract? 4 things
- clinical
- radiology
- colonoscopy
- stool sample
what are the 2 uses of taking a stool sample?
- rule out an infective cause
- faecal calprotectin
what is the drug treatment of IBD? 4 things
- 5-aminosalicylic acid preperations
- corticosteroids (oral/enema)
- immunosuppressants
- biologics (anti-TNF agents)
what kind of surgery can be done on those with IBD?
- remove diseased bowel
- abscess drainage
is is curative to remove diseased sections of the bowel in IBD?
yes, for ulcerative colitis
no, for Chron’s disease
True or false : patients with IBD should NOT undergo “bowel resting” during acute episodes?
False, they should have parenteral nutrition/elemental diet
how common is diverticula in over 50s?
50%
what are the symptoms of diverticula?
- usually none
- bleeding
- pain (abscess formation and obstruction)
what % of GI patients have symptoms but no demonstrable disease?
80%
what are 5 symptoms of Irritable bowel syndrome?
- cramps
- wind
- diarrhoea
- constipation
- bloating
what is the treatment of a patient with functional bowel disease (ie IBS)?
- reassurance
- dietary changes (increases fibre)
- anti-spasmodics
- amitriptyline or SSRIs
what is acute liver disease described as?
hepatitis
what is chronic liver disease described as?
cirrhosis
what are 7 causes of liver disease?
- alcohol
- viruses (hepatitis a-e)
- iron overload (heamachromatosis)
- drugs (formulary and herbal)
- auto-immune
- diabetes
- cryptogenic (unknown)
what are the 7 clinical features of liver or biliary tract disease?
- jaundice
- ascites (abdominal fluid accumulation)
- telangiectasia (dilation of capillaries that leads to spider like purple appearance)
- encephalopathy (impaired consciousness/confusion)
- variceal haemorrhage (life treatening bleed)
- coagulopathy (impaired clotting)
- prone to infections
treatment of liver disease is… 3 things
remove underlying cause
supportive (possibility of regeneration)
transplant
when treating patients with liver disease you must consider which 3 things..
- their reduced platelets (less clotting)
- their susceptibility to infections
- immunosuppressants following transplant
what are the symptoms and treatment for gall stones?
- pain
- jaundice
- pancreatitis
all can be alleviated by
1. endoscopic surgery
2. open cholecystectomy (removal of the gall bladder)
how would you diagnose someone who had pancreaitits?
blood test - if shows high amylase in blood then pancreatitis
what is the 2 common causes for pancreaitis?
- gall stones
2. alcohol/drugs
what type of patients are at highest risk of getting mouth cancer?
patients who already have cancer of the GI tract.
what are 4 non-specific signs that could indicate mouth cancer?
- angular cheilitis
- burning mouth syndrome
- candidal infections
- recurrent oral ulceration
what is burning mouth syndrome usually cause by?
deficiency in -iron -folate -vitB12 having anaemia
in 20% of cases recurrent oral ulceration indicates..
underlying anaemia
can you get primary oral side effects in patients with ulcerative colitis?
no as it only affects the large intestine
can you get primary oral side effects in patients with Crohn’s disease?
yes.
