Gastroenterology: Lower GIT diseases Flashcards
What does the Lower GIT anatomically consist of? (4)
- Small intestine
- Large intestine
- Rectum
- Anus
What are the 3 components of the small intestine?
- Duodenum
- Jejunum
- Ileum
What are the 4 components of the large intestine?
- Colon
- Ascending segment
- Transverse segment
- Descending segment
What are the two main functions of the small intestine?
- Digestion
- Absorption
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
- Duodenum
- Terminal Ileum
- Terminal Ileum
- Jejunum
Name two common small intestine diseases
- Coeliac disease
- Crohn’s disease
What is steatorrhoea?
The presence of excess fat in faeces (fatty stools)
What is coeliac disease
A disease in which the small intestine is hypersensitive to gluten, leading to difficulty in digesting food.
A toxic reaction to the α-gliadin component of gluten is a characteristic of which disease?
Coeliac disease
At what age can coeliac disease present itself?
Any age
Coeliac disease can cause villous atrophy (malabsorption), what are the consequences of this? (3)
- Growth retardation (child)
- Vitamin deficiencies
- Mineral deficiencies
What are some clinical manifestations of malabsorption?
3 Dental
3 General
- Glossitis
- Burning mouth
- Angular chelitis
- Tiredness
- Malaise
- Easy bruising
When investigating Coeliac disease what will these tests determine;
- Full blood count?
- Haematinics (nutrients) screen?
- Stool examination?
- Serology? (what antibodies are present)
- Endoscopy?
- Anaemia
- Vitamin B12, Folate, Iron deficiency
- Excess fat
- Antigliadin and antiendomysial antibodies
- Villous atrophy
What is the dental relevance of coeliac disease? (3)
- Dental enamel defects
- Glossitis
- Angular cheilitis
How would you manage coeliac disease?
Gluten free diet for life
ONLY treatment
What are the two main functions of the large intestine?
- Recovery of water and electrolytes
- Formation, storage and expulsion of faeces
Name two Inflammatory bowel diseases (IBD).
- Crohn’s disease
- Ulcerative colitis
What is Crohn’s disease
Patchy full thickness ulceration involving any part of GIT from mouth to anus
What is the most commonly affected area in Crohn’s disease?
Terminal ileum
Are Crohn’s disease lesions continuous?
Discontinuous involvement (Skip lesions)
Name 3 common clinical features of Crohn’s disease
- Fever
- Anorexia
- Abdominal Pain
If Crohn’s disease affects the mouth what clinical features may arise? (4)
- Oral swelling
- Mucosa tags
- Angular chelitis
- Atypical ulcers
How can Crohn’s disease affect the Musculoskeletal system? (2)
- Arthritis
- Ankylosing spondylitis (Arthritis of spine)
What is a common skin problem with Crohn’s disease?
Erythema nodosum
What 5 investigations would take place when investigating Crohn’s disease?
- Full blood count
- Inflammatory markers
- Haematinic screen
- Faecal calprotectin
- Stool microscopy
What symptoms would need to be present for you to refer a 40 year old patient for potential Crohn’s disease? (4)
- Diarrhoea of >6 weeks’ duration
- Abdominal pain with weight loss
- Raised faecal calprotectin
- Unexplained vitamin B12 or folate deficiency
What diet advice would you give someone with Crohn’s disease?
Exclusion of offending substances
benzoates/ cinnamonaldehyde, E-preservatives
What lifestyle advice would you give someone with Crohn’s disease?
- Smoking cessation
- Avoid stress
- Exercise
- Balanced diet
- Well hydrated
What anti-inflammatory drugs are given to patients with Crohn’s disease? (2)
S
M
- Sulfasalazine
- Mesalazine
What Immunomodulators are given to patients with Crohn’s disease? (3)
P
M
A
- Prednisolone
- Methotrexate
- Azathioprine
What are the dental aspects to consider while treating a patient with Crohn’s disease?
- Stress?
- Prescribing?
- History?
- Features?
- 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
What is Ulcerative colitis?
Long term condition that results in inflammation and ulcers of the colon and rectum
What are some clinical features of Ulcerative colitis? (6)
- Abdominal pain
- Bloody diarrhoea
- Pus
- Joint pain
- Conjunctivitis
- Finger clubbing
How is Ulcerative colitis graded?
- Mild
- Moderate
- Severe
How does Pseudomembranous colitis occur?
Occurs after high doses and/or for prolonged oral antibiotic use
What is Pseudomembranous colitis treated with? (2)
M
V
- Metronidazole
- Vancomycin
What are the symptoms of Pseudomembranous colitis? (2)
- Painful diarrhoea
- Mucus passage in stool
Which gender is more affected by irritable bowel syndrome?
Female
What are some clinical features of irritable bowel syndrome? (3)
- Crampy abdominal pain relived by defecation
- Bloating
- Altered bowel habit
What are the dental aspects of irritable bowel syndrome? (3)
Psychogenic oral symptoms;
- Burning mouth syndrome
- Persistent idiopathic facial pain
- Sore tongue
