Gastroenterology: Lower GIT diseases

Question 1

What does the Lower GIT anatomically consist of? (4)

Answer 1

• Small intestine
• Large intestine
• Rectum
• Anus

Question 2

What are the 3 components of the small intestine?

Answer 2

• Duodenum
• Jejunum
• Ileum

Question 3

What are the 4 components of the large intestine?

Answer 3

• Colon
• Ascending segment
• Transverse segment
• Descending segment

Question 4

What are the two main functions of the small intestine?

Answer 4

• Digestion

- Absorption

Question 5

Where in the small intestine are the following substances absorbed?

• Iron + folate
• Gastric intrinsic factor + Vitamin B12
• Bile salts , fats and fat soluble vitamins
• Other substances

Answer 5

• Duodenum
• Terminal Ileum
• Terminal Ileum
• Jejunum

Question 6

Name two common small intestine diseases

Answer 6

• Coeliac disease

- Crohn’s disease

Question 7

What is steatorrhoea?

Answer 7

The presence of excess fat in faeces (fatty stools)

Question 8

What is coeliac disease

Answer 8

A disease in which the small intestine is hypersensitive to gluten, leading to difficulty in digesting food.

Question 9

A toxic reaction to the α-gliadin component of gluten is a characteristic of which disease?

Answer 9

Coeliac disease

Question 10

At what age can coeliac disease present itself?

Answer 10

Any age

Question 11

Coeliac disease can cause villous atrophy (malabsorption), what are the consequences of this? (3)

Answer 11

• Growth retardation (child)
• Vitamin deficiencies
• Mineral deficiencies

Question 12

What are some clinical manifestations of malabsorption?

3 Dental
3 General

Answer 12

• Glossitis
• Burning mouth
• Angular chelitis
• Tiredness
• Malaise
• Easy bruising

Question 13

When investigating Coeliac disease what will these tests determine;

• Full blood count?
• Haematinics (nutrients) screen?
• Stool examination?
• Serology? (what antibodies are present)
• Endoscopy?

Answer 13

• Anaemia
• Vitamin B12, Folate, Iron deficiency
• Excess fat
• Antigliadin and antiendomysial antibodies
• Villous atrophy

Question 14

What is the dental relevance of coeliac disease? (3)

Answer 14

• Dental enamel defects
• Glossitis
• Angular cheilitis

Question 15

How would you manage coeliac disease?

Answer 15

Gluten free diet for life

ONLY treatment

Question 16

What are the two main functions of the large intestine?

Answer 16

• Recovery of water and electrolytes

- Formation, storage and expulsion of faeces

Question 17

Name two Inflammatory bowel diseases (IBD).

Answer 17

• Crohn’s disease

- Ulcerative colitis

Question 18

What is Crohn’s disease

Answer 18

Patchy full thickness ulceration involving any part of GIT from mouth to anus

Question 19

What is the most commonly affected area in Crohn’s disease?

Answer 19

Terminal ileum

Question 20

Are Crohn’s disease lesions continuous?

Answer 20

Discontinuous involvement (Skip lesions)

Question 21

Name 3 common clinical features of Crohn’s disease

Answer 21

• Fever
• Anorexia
• Abdominal Pain

Question 22

If Crohn’s disease affects the mouth what clinical features may arise? (4)

Answer 22

• Oral swelling
• Mucosa tags
• Angular chelitis
• Atypical ulcers

Question 23

How can Crohn’s disease affect the Musculoskeletal system? (2)

Answer 23

• Arthritis

- Ankylosing spondylitis (Arthritis of spine)

Question 24

What is a common skin problem with Crohn’s disease?

Answer 24

Erythema nodosum

Question 25

What 5 investigations would take place when investigating Crohn's disease?

Answer 25

- Full blood count - Inflammatory markers - Haematinic screen - Faecal calprotectin - Stool microscopy

Question 26

What symptoms would need to be present for you to refer a 40 year old patient for potential Crohn's disease? (4)

Answer 26

- Diarrhoea of >6 weeks’ duration - Abdominal pain with weight loss - Raised faecal calprotectin - Unexplained vitamin B12 or folate deficiency

Question 27

What diet advice would you give someone with Crohn's disease?

Answer 27

Exclusion of offending substances | benzoates/ cinnamonaldehyde, E-preservatives

Question 28

What lifestyle advice would you give someone with Crohn's disease?

Answer 28

- Smoking cessation - Avoid stress - Exercise - Balanced diet - Well hydrated

Question 29

What anti-inflammatory drugs are given to patients with Crohn's disease? (2) S M

Answer 29

- Sulfasalazine | - Mesalazine

Question 30

What Immunomodulators are given to patients with Crohn's disease? (3) P M A

Answer 30

- Prednisolone - Methotrexate - Azathioprine

Question 31

What are the dental aspects to consider while treating a patient with Crohn's disease? - Stress? - Prescribing? - History? - Features?

Answer 31

- 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 steroid use - Check for Oro-facial granulomatosis

Question 32

What is Ulcerative colitis?

Answer 32

Long term condition that results in inflammation and ulcers of the colon and rectum

Question 33

What are some clinical features of Ulcerative colitis? (6)

Answer 33

- Abdominal pain - Bloody diarrhoea - Pus - Joint pain - Conjunctivitis - Finger clubbing

Question 34

How is Ulcerative colitis graded?

Answer 34

- Mild - Moderate - Severe

Question 35

How does Pseudomembranous colitis occur?

Answer 35

Occurs after high doses and/or for prolonged oral antibiotic use

Question 36

What is Pseudomembranous colitis treated with? (2) M V

Answer 36

- Metronidazole | - Vancomycin

Question 37

What are the symptoms of Pseudomembranous colitis? (2)

Answer 37

- Painful diarrhoea | - Mucus passage in stool

Question 38

Which gender is more affected by irritable bowel syndrome?

Answer 38

Female

Question 39

What are some clinical features of irritable bowel syndrome? (3)

Answer 39

- Crampy abdominal pain relived by defecation - Bloating - Altered bowel habit

Question 40

What are the dental aspects of irritable bowel syndrome? (3)

Answer 40

Psychogenic oral symptoms; - Burning mouth syndrome - Persistent idiopathic facial pain - Sore tongue