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CHHD > Gastroenterology - Lower GIT > Flashcards

Gastroenterology - Lower GIT Flashcards

1
Q

What is the lower GI tract made up of

A 
Small intestine:
- Duodenum
- Jejunum
- Ileum
Large intestine:
- Colon
- Ascending, transverse, descending segments
Rectum and Anus
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2
Q

What are the main functions of the small intestine

A

Digestion

Absorption

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3
Q

What is absorbed in the duodenum of the small intestine

A

Iron + folate

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4
Q

What is absorbed in the jejunum of the small intestine

A

Other substances - miscellaneous i suppose

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5
Q

Name some of the things that are absorbed in the terminal ileum of the small intestine

A
  • Gastric intrinsic factor
  • Vitamin B12
  • Bile salts
  • Fats and fat soluble vitamins
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6
Q

What are some common disease of the small intestine

A

Coeliac disease

Crohn’s disease

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7
Q

What are the key features of small intestine diseases

A
  • Malabsorption
  • Diarrhoea or steatorrhoea
  • Abdominal discomfort or pain
  • Nutritional deficiencies - loss of weight, anaemia etc
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8
Q

What are the features of Steatorrhoea

A
  • Bulky stools
  • Float
  • Greasy or fatty or frothy appearance
  • Foul smell
  • Difficult to flush away
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9
Q

What are the causes of Steatorrhoea

A
  • Coeliac disease/Crohn’s
  • Cystic fibrosis
  • Pancreatitis
  • Liver disease
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10
Q

What are some typical clinical features of coeliac disease

A
  • Diarrhoea
  • Weight loss
  • Anaemia
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11
Q

What is the GIT sensitive to in coeliac disease

A

Has a toxic reaction/hypersensitivity to the alpha-gliadin component of gluten (wheat, oats, rye, barley etc)

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12
Q

What causes coeliac

A

T cell mediated autoimmune disease

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13
Q

What happens to the small intestine villous with gluten in coeliac patients

A

The jejunal villous atrophy and inflame which leads to malabsorption

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14
Q

What are the clinical features of Coeliac disease

A
  • ## Features can occur in the GIT or other parts of the body like mouth
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15
Q

What are the consequences of villous atrophy in coeliac disease

A
  • Growth retardation in children
  • Vitamin deficiencies –> anaemia, bleeding tendencies
  • Mineral deficiencies - osteomalacia
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16
Q

What are the clinical manifestations of villous atrophy in coeliac disease

A
  • Glossitis
  • Burning mouth
  • Angular chelitis
  • Tiredness
  • Malaise
  • Easy bruising
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17
Q

What are the clinical manifestations of inflammation in coeliac patients

A

Crampy abdominal pain and bloating

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18
Q

AY BAWS CAN I HABE DE NOTE PLZ

A

Theres a small risk of developing GI T cell lymphomas and other malignancies

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19
Q

What are some of the special investigaytions that can be done for coeliac patients

A
  • FBC - iron deficiency anaemia
  • Haematinics screen - low vitamin B12, folate, iron
  • Stool examination - excess fat
  • Serology - IgA antibodies
  • Endoscopy - villous atrophy
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20
Q

How are oral lesions relevant to coeliac disease

A
  • Diagnostic importance - CD is often a latent and insidious disease
  • Recurrent oral ulceration or dental hyperplasia may be only presenting feature of adults with CD
  • Involvement of small bowel mucosa –> reduced absorption of B12, folate and iron
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21
Q

What is a GFD in coeliac

A

GFD = Gluten Free Diet

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22
Q

What are the clinical features of the oral lesions from coeliac disease i think

A
  • Dental hypoplasia
  • Glossitis/burning mouth symptoms
  • Angular cheilitis
  • Cheilosis/recurrent oral ulceration
  • Associated autoimmune disease (sjogrens, DM)
  • Malignant disease (oesophageal + oropharyngeal squamous cell carcinoma, small bowel carcinoma)
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23
Q

What are some common non-neoplastic association with coeliac disease

A
  • Dermatitis herpetiformis
  • Linera IgA disease
  • Selective IgA deficiency
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24
Q

What does dermatitis herpetiformis often present with

A
  • Pruritic vesiculopapular rash

- 70% of patients with this have oral lesions

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25
Q

Is dental hypoplasia common among CD patients

A

Yes very common in children and adults, usually just mild enamel defects - rough surface with horizontal grooves or shallow pits

26
Q

What ways can we manage coeliac disease

A
  • GFD for life is the only treatment

- Correct any nutritional deficiencies - vitamin B2, calcium, vitamin D etc

27
Q

What are the dental aspects to consider in patients with coeliac disease

A
  • early onset coeliac disease = short stature, diarrhoea, enamel defects
  • Anaemia may predispose to oral lesions
  • Anaemia may complicate general anaesthesia
28
Q

What are the main functions of the large intestine

A
  • Recovery of water and electrolytes (Na+ and Cl-)

- Formation, storage and expulsion of faeces (stool)

29
Q

What are some common diseases of the large intestine

A

Inflammatory bowel diseases:

  • Crohn’s disease
  • Ulcerative colitis
30
Q

Describe the morphology of crohn’s disease

A
  • Patchy full thickness ulceration involving any part of GIT from mouth to anus
  • Discontinuous involvement - skip lesions
31
Q

What is the most commonly affected area for Crohn’s disease

A

The terminal ileum

32
Q

Describe the histology of crohn’s disease

A

Transmural granulomatous inflammation

33
Q

What are the typical clinical features of crohn’s disease

A
  • Fever
  • Anorexia
  • Abdominal pain
34
Q

What are some of the clinical features if the mouth is affected by Crohn’s

A
  • Peri-oral and lip swelling
  • Mucosa tags or cobblestoning of the mucosa
  • Angular stomatitis
  • Atypical ulcers - large, linear and ragged
  • Recurrent apthous stomatitis
  • Lesions associated with nutritional deficiencies
35
Q

What are some of the clinical features if the small intestine is affected by Crohn’s

A
  • Abdominal pain - appendicitis
  • Abnormal bowel habits - diarrhoea and constipation
  • Weight loss
  • malabsorption
36
Q

What are some of the clinical features if the Large intestine is affected by Crohn’s

A
  • Non-bloody diarrhoea lasting more than 6 weeks
  • Bleeding and pain related to defecation
  • Intestinal obstruction due to structuring disease
37
Q

What are some of the clinical features if the perianal area is affected by Crohn’s

A
  • Anal tags
  • Anal fistulae, fissure
  • Anal abscess formation
38
Q

What musculoskeletal system effects can form from Crohn’s disease

A
  • Arthiritis

- Ankylosing spondylitis

39
Q

What skin effects can form from Crohn’s disease

A
  • Erythema nodosum
  • Psoriasis
  • Pyoderma gangrenosum
40
Q

What special investigations can be carried out for Crohn’s disease

A
  • FBC - anaemia, microcytosis, thrombocytosis
  • Inflammatory markers - ESR, CRP increased
  • Haematinic screen - decreased folate, ferritin, iron studies, B12, potassium, zinc
  • Increased faecal calprotectin
  • Stool microscopy to exclude infective diarrhoea
41
Q

What radiological investigations can be done for crohn’s

A
  • Lower GI endoscopy - sigmoidoscopy/colonoscopy
  • MRI and CT scanning
  • Barium follow through - skip lesions may be identified
42
Q

What histological investigations can be done for crohn’s

A

Mucosal biopsies - non caseating granuloma

43
Q

Describe some of the histological findings in Crohn’s disease

A
  • Inflammed small intestine mucosa
  • Granulomatous inflammation
  • Ulceration
  • Dilated and sclerotic lymphatic channels
44
Q

What life style management is advised for crohn’s patients

A
  • Stop smoking
  • Avoiding stress
  • Exercise
  • Balanced diet
  • Staying well hydrated
45
Q

What anti-inflammatory drugs are recommended for crohn’s patients

A

Sulfasalazine/Mesalazine

46
Q

What immunomodulators might be used in Crohn’s patients

A
  • Prednisolone
  • Methotrexate
  • Azathioprine
47
Q

What surgery might be done for Crohn’s patients

A
  • To drain abscesses

- Repair fistulae and fissures and failure to respond to therapy

48
Q

What biological therapy might be used on Crohn’s patients

A

Anti-TNFalpha

Infliximab/Adalimumab

49
Q

What are the dental aspects to consider in Crohn’s patients

A
  • Stressful situations can precipitate an acute disease flare up
  • Avoid antibiotics for treatment of oral infections which can aggravate existing diarrhoea
  • Always evaluate history of corticosteroid use particularly when major dentistry is anticipated
  • Delay routine dentistry during acute flare-up
  • Oro-facial granulomatosis (OFG) may precede gastrointestinal manifestation of Crohn’s disease
50
Q

What layers of the intestinal walls are affected by UC inflammation

A

The superficial layers

51
Q

What are the clinical features of UC

A
  • Abdominal pain
  • Bloody diarrhoea
  • Pus
  • Intermixed mucus with/out systemic toxicity
  • Systemic toxicity - fever, anorexia, weight loss, anaemia and raised ESR and CRP

Others include:
- Joint pain, conjunctivitis

52
Q

What is a complication of UC

A

Carcinoma of the colon

53
Q

When does pseudomembranous colitis tend to occur

A

After high doses and/or for prolonged oral antibiotic use

More susceptible in elderly or debilitated patients

54
Q

What antibiotics tend to be associated with pseudomembranous colitis

A

Lincomycin and clindamycin

55
Q

What bacterial proliferation is pseudomembranous colitis associated with

A

C. Diff

56
Q

What does pseudomembranous colitis manifest as

A

Painful diarrhoea and mucus passage in the stool

57
Q

What is pseudomembranous colitis treated with

A

Oral metronidazole or Vancomycin

58
Q

What might the aetiology of irritable bowel syndrome be linked to

A
  • An infection
  • Stressful life event
  • Anxious personality type
59
Q

What are the clinical features of IBS

A
  • Patient usually looks healthy
  • Crampy abdominal pain relieved by defecation or flatulence
  • Bloating or abdominal distension
  • Altered bowel habits
  • Examination is usually normal
60
Q

What are the dental aspects of IBS

A
  • Patient may present psychogenic oral symptoms
  • Burning mouth syndrome
  • Persistent idiopathic facial pain
  • Sore tongue
61
Q

What is Peutz-Jegher’s syndrome and what is it characterised by

A

Autosomal dominant condition characterised by mucocutaneous hyperpigmentation that present as:

  • macules on the lips and buccal mucosa
  • Occasional macules circumorally
  • Gastrointestinal harmatomatous polyps
62
Q

What are some complications associated with Peutz-Jegher’s syndrome

A
  • Intestinal obstruction
  • Abdominal pain
  • Gastrointestinal bleeding

CHHD (27 decks)

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