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HUMAN HEALTH AND DISEASE > Gastroenterology II: Ulcerative Colitis & Crohn's Disease > Flashcards

Gastroenterology II: Ulcerative Colitis & Crohn's Disease Flashcards

1
Q

Describe the anatomy of the lower GI tract.

A

The lower GI tract runs from the small intestine to the large intestine to the anus.

look at slide

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2
Q

What is coeliac disease?

A

Gluten sensitivity/intolerance associated with HLA B8 tissue type with a prevalence of ~1 in 1800 but it is under-diagnosed in most people

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3
Q

How does coeliac disease present?

A

Presents with change of bowel habit (COBH):
-Pale, bulky, offensive, greasy stool

-Abdominal colic:
Abdominal pain that comes and goes in waves

-Weakness; weight loss

-Short stature/failure to thrive

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4
Q

What are the classical GI symptoms of coeliac disease?

A

-Diarrhoea (45-85%)
-Flatulence (28%)
-Borborygmus (35-72%) a rumbling or gurgling noise made by the movement of fluid and gas in the intestines.
-Weight loss (45%)
-Weakness; fatigue (80%)
-Abdominal pain (30-65%)
-Secondary lactose intolerance
-Steatorrhea

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5
Q

What are the classical extra-intestinal symptoms of coeliac disease

A

Anaemias (10-15%): especially Fe, B12

Neurological symptoms (8-14%)

Skin disorders (10-20%) e.g dermatitis herpetiformis-maculopapular pruritic.

Endocrine disturbances including infertility, impotence, amenorrhea, delayed menarche

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6
Q

What investigations should you undertake to diagnose coeliac disease?

A

Serology test check for the presence or level of specific antibodies in the blood look at slide 8.

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7
Q

How is coeliac disease treated?

A

Gluten restriction curative in 95%

Refractory in 5%- so use corticosteroids (poor outcome)

Involve dietician, support groups, on-line recipes

Read labels including medications, cosmetics, etc.

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8
Q

What is important to be aware of if someone has coeliac disease?

A

Although rare, remember there is increased risk of lymphoma and adenocarcinoma of the pancreas, oesophagus, small bowel, biliary tract, including T & B cell non-Hodgkin’s lymphoma.

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9
Q

What are some long-term effects of coeliac disease?

A

People with it are more likely to be affected with problems relating to malabsorption, including:

-Osteoporosis
-Tooth enamel defects
-Central & PNS disease
-Pancreatic disease
-Internal haemorrhaging
-Organ disorders
-Gynaecological disorders

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10
Q

What is the dental relevance of coeliac disease?

A

Problems related to malabsorption:

-B12, folate, ferritin: can orally manifest as glossitis, angular cheilits, anaemia, burning mouth, smooth tongue

-Vitamin K: bleeding tendency

-Vitamin D:osteomalacia and rickets in children

Enamel defects may occur in the permanent dentition if the onset is in childhood

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11
Q

Contrast the environmental aetiology between Crohn’s & UC.

A

Appendicectomy = removal of the appendix

look at slides

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12
Q

How does Crohn’s manifest?

A

Patchy distribution of ‘skip lesions’ is quite common.

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13
Q

Contrast the epidemiology of Crohn’s disease & ulcerative colitis (UC).

A

Crohn’s:

-Slightly less common (27-106/100,000)
-Females: 1.2:1
-Younger: 26

UC:
-Slightly more common (80-150/100,000)
-Males: 1.2:1
-Older: 34

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14
Q

Is the aetiology of Crohn’s & UC well known?

A

No, but there are concerns about genetic tissue types, polygenic inheritance patterns, & familial patterns, as well as host immunology.

slides 16

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15
Q

Contrast the pathology of Crohn’s with UC.

A

Backwash ileitis- inflammatory reaction in the distal ileum

look at slides 18

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16
Q

What is Crohn’s disease?

A

Chronic Inflammatory bowel disease, specifically chronic and recurring inflammation of the GI tract.

Aetiology unknown - inflammatory response to intestinal microbes + environmental factors + genetic factors.

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17
Q

How do patients commonly present with Crohn’s disease?

A

-Intermittent abdominal pain, diarrhoea, abdominal distension (90%)

-Decreased appetite- anaemia and weight loss (50%)

-Fresh blood or melaena (40%)

-Fistulae and perianal sepsis (20%)

-Episodes of flares with asymptomatic intervals

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18
Q

What are some symptoms of Crohn’s disease?

A

Fat wrapping, cobble-stoning and thickened wall of the vessels

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19
Q

What are the 3 phenotypes of Crohn’s disease?

A

Stricturing: gradual thickening of intestinal wall- leads to stenosis/ obstruction

Penetrating: intestinal fistulas (abnormal passage from one organ to another) between GI tract and other organs (can occasionally be external fistulas-skin)

Non-penetrating: anal fissures, abscesses

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20
Q

What characterises Crohn’s in terms of macroscopic changes?

A

-Bowel is thickened
-Lumen is narrowed
-Deep ulcers
-Mucosal fissures
-Cobblestone
-Fistulae
-Abscess
-Apthoid ulceration

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21
Q

Contrast the microscopic changes in Crohn’s disease against UC.

A

Crohn’s:
-Transmural
-Lymphoid hyperplasia
*Granulomas

UC:
-Mucosal (chronic inflammatory cells: lamina propria)
-Goblet cell depletion
-Crypt abscess

22
Q

How do you diagnose Crohn’s disease?

A

Diagnosis:

-Barium enema: rose thorn, skip lesion, string sign

-Sigmoidoscopy and biopsy, colonoscopy

-Differential diagnosis includes TB and sarcoidosis

23
Q

How do you treat Crohn’s disease?

A

Symptomatic relief; reduction of inflammation; increase Quality Of Life

Medical- glucocorticoids

immunomodulators

biologics

Surgical- intestinal resection

24
Q

What are the specific lesions you get in Crohn’s disease?

A

-Diffuse labial and buccal swelling
-Cobblestones
-Mucosal tags
-Linear ulcers
-Mucogingivits
-Staghorning - enhancement of submandibular ducts
-Granulomatous Cheilitis - swollen lips

25
Q

What are the non-specific lesions you get in Crohn’s disease?

A

-Aphthous ulcers
-Angular Cheilitis
-Glossitis
-Dental Caries
-Gingivitis/Periodontitis

26
Q

What does orofacial granulomatosis (OFG) have similar signs & symptoms to?

A

Crohn’s disease (concurrent Crohn’s occurs in ~40% of children diagnosed with OFG).

27
Q

Who is OFG more prevalent in?

A

Children & young adults

28
Q

What benefits 70% of people with OFG?

A

Avoiding cinammon & benzoates

29
Q

What is UC (ulcerative colitis)?

A

Chronic inflammatory bowel disease where there is diffuse mucosal inflammation of the colon with backwash involvement of the terminal ileum: rectum always involved.

30
Q

What is the hypothesis behind the aetiology of UC?

A

Dysregulated interaction mucosal immunology & intestinal microflora, and genetic predisposition.

31
Q

How do patients with UC commonly present?

A

Painless, bloody diarrhoea with mucus

Associated fevers and remission periods where the patient returns to near normal

32
Q

Visually compare UC and Crohn’s disease:

A

UC = Ulceration, surviving mucosa (pseudo-polyps), loss of haustra.

33
Q

Visually compare a normal colon and a colon affected by ulcerative colitis:

A

Absence of goblet cells

Crypt distortion and abscess

Affects mucosal layer only

34
Q

What is the risk with UC?

A

Chronic inflammation leading to colorectal cancer

35
Q

How do you diagnose UC?

A

Colonoscopy and biopsy- findings include exudates, ulcerations, loss of vascular pattern, friability , continuous granularity (very fragile, bleeding)

Superficial inflammation with loss of haustration

36
Q

How do you treat UC?

A

High protein, high fibre diet

5-ASA (5- amino salicyclic acid), sulphasalazine & mesalazine, thioprines, corticosteroids

Surgery

37
Q

What do extra GI manifestations of UC look like?

A

It can include these issues:

-Occular (uveitis, episcleririts, conjunctivitis)

-Renal (Gall stones, fat liver, hepatitis, sclerosing cholangitis)

-Dermatological (erythema nodosum, pyoderma gangrenosum)

ORAL
-Hepato-billiary
-Vascular
-Skeletal

38
Q

What is the dental relevance of UC?

A

Oral manifestations:

Pyostomatitis vegetans (PV)- benign, multiple small white and yellow pustules, erythematous/oedematous background (‘snail track’ ulcers)

^Primary involved sites include labial attached gingivae, soft/hard palate, buccal mucosa, sulcus

The intestinal symptoms usually precede PV

39
Q

What are some other common conditions to have alongside UC?

A

-Aphthous ulcers
-Tongue coating
-Gingivitis
-Periodontitis
-Halitosis
-Acidic taste
-Cutaneous manifestations

40
Q

What investigations would you carry out for IBD?

A

look at sldes

41
Q

How do you generally treat IBD (inflammatory bowel disease)?

A

+ imaging = lead pipe sign/string signing or thinning of parts of the bowel.

Chest x-rays looking for perforations

42
Q

If concerned about UC or Crohn’s, what should you ask your patient about?

A

-Rashes
-Mouth ulcers
-Joint/back pain
-Eye problems
-Family history
-Smoking status

43
Q

Which meds work better for Crohn’s & UC?

A

Crohn’s:
-Azathioprine
-Methotrexate
-Cyclosporin
-Humera (adalimumab/anti TNF)
-Steroids for flares

UC:
-Aminosalicylates (mesalazie)
-Steroids (foam/PR; oral; IV)
-Azathioprine

44
Q

Does surgery work in IBD?

A

Surgery can be curative for UC but 80% of Crohn’s have resections and generally it helps very little.

45
Q

What are some indications for surgery in UC?

A

Acute:
-Failure of medical treatment for 3 days
-Toxic dilatation
-Haemorrhage
-Perforation (hole)

Chronic:
-Poor response to medical treatment
-Excessive steroid use
-Non compliance with medication
-Risk of cancer

I CHOP = acronym for main indication for surgery

46
Q

What are the prognoses for Crohn’s & UC?

A

UC:
-1/3 have single attack
-1/3 have relapsing attacks
-1/3 progressively worsen requiring colectomy within 20 years

Crohn’s:
-Varied prognosis, new biological agents improving

Cancer:
-Both have increased risk of colon cancer, though UC>Crohn’s Screening colonoscopy done every 2 years after 10 years disease and every year after 20 years disease

47
Q

What are some predisposing factors for carcinoma of the colon?

A

Neoplastic polyps, UC FH, familial polyposis coli, previous cancer.

48
Q

How does carcinoma of the colon present

A

Depends on the site:

Left colon- bleeding per rectum, change in bowel habit, and tenesmus

Right colon- anaemia, weight loss & abdo pain

Both- obstruction, perforation, haemorrhage/fistulae

Troisier’s sign/Virchow’s node (enlargement of left-sided supraclavicular lymph node)

49
Q

Difference between colostomy and ileostomy:

A

Colostomy : the surgical creation of an artificial excretory opening between the colon and the body surface

Ileostomy: creation of an artificial opening into the ileum

50
Q

What are some examples of functional bowel disorders?

A

Diverticular disease

Irritable bowel syndrome

Herniation= tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles.

51
Q

What are the potential differential diagnoses of IBD?

A

IBS is the most common first diagnosis of many GI disorders and therefore can mask other inflammatory conditions.

HUMAN HEALTH AND DISEASE (58 decks)

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