Gastroenterology and nutritional disorders dentally relevant questions Flashcards
What inflammatory bowel disease affects the oral cavity?
Crohn’s disease
What concern would you have if patient presents with lumpy lesions like cobblestones in mouth?
Think something wrong in bowels
What are the presentations of crohns?
Pain, diarrhoea, intestine obstruction, inflammation, transmural process, fistula
Other complications - ulcers, uveitis, arthritis
What test shows someone has crohns?
Increased serum ACE levels = sarcoidosis (granulomatous disease)
What symptoms appear in a child with crohns?
Fever, anaemia, arthritis, failure of growth and development
What is Barret’s oesophagus?
Epithelial cells undergo dysplastic change = produce mucus
What is in saliva to neutralise acid?
Bicarbonate
What drug treatment is given for someone with GORD?
Protein pump inhibitors –> omeprazole/ lansoprazole
What treatment is given for peptic ulcers?
Histamine blockers (cimetidine), long term antacid, proton pump inhibitors
What is diverticular disease?
Inflamed out-pouching of large bowel
How many pairs of teeth are needed for a functioning occlusion?
> 5 pairs
What is the difference between 1.parenteral and 2.enteral feeding?
- IV nutrition
2. Feed directly into the gut via tube
What drugs should be avoided in peptic ulcers?
NSAIDs and corticosteroids
What causes peptic ulcers?
H.pylori infection, stress/smoke/alcohol, NSAIDs/corticosteroids
Gastric acid, pepsin
What natural offers protection for peptic ulcers in the stomach?
Prostaglandins
Mucus
HCO3 (Bicarbonate)
How do H2-receptor antagonists work in peptic ulcer management? and give an example.
Decrease acid secretion
Cimetidine and ranitidine
How do proton pump inhibitors work in peptic ulcer management? and give an example.
Final step in acid production is action of H+/K+ aptase (proton pump), therefore PPIs inhibits enzyme
Active only in an acidic environment
Example - end in -azoles
How do antacids work in peptic ulcer management? and give an example.
Increase gastric pH, therefore inhibiting pepsin
E.g. Al and Mg salts (milk of Mg)
How do chelates and complexes work in peptic ulcer management? and give an example.
Physical barrier and coats mucosa
Stimulates bicarbonate and mucous and inhibits pepsin
E.g. sucralfate, bismuth chelates
How is H.pylori infection eliminated?
Triple therapy:
- PPIs
- Clarithromycin
- Metronidazole/amoxicillin
What are the dental side effects of ranitidine?
Erythema multiforme, tongue staining
What are the dental side effects of omeprazole/sucralfate?
Xerostomia
What are the dental side effects of H2 receptor antagonists?
Pain and swelling of salivary glands
What is the drug interaction of antacids and tetracyclines?
Decreased absorption of tetracyclines as chelate formed
What drug interactions occur between omeprazole and 1.anti-fungals, 2.diazepam, 3.warfarin?
- Inhibits absorption of some anti-fungals
- Inhibits diazepam metabolism - may over sedate
- Increases warfarin effect
Why would a patient on high dose prednisolone be prescribed proton pump inhibitors?
To decrease acid secretion as steroids are bad for producing ulcers
