Gastroenterology + nutrition Flashcards
what is the difference between Crohn’s and ulcerative colitis?
crohns = any part of GI - ORAL MANIFESTATIONS
ulcerative colitis = just colon - large bowel
2 types of IBD
crohns + ulcerative colitis
how do you diagnose IBS
diagnosis of exclusion - not IBD
oral complication of IBD related to inflammatory activity
aphthous stomatitis - repeated formation of benign + non-contagious ulcers
3 common causes of aphthous ulcers
menstruation, gut problems, medications
how do you test for sarcoidosis
serum ACE levels raised
rectal bleeding in IDB may cause mouth ulcers because..
patient anaemic
what is protocolitis
inflammation of anus + rectum lining
what is Barretts oesophagus?
complication of GORD - disease in which ep cells in oesophagus undergo dysplastic change
3 components of the anti-reflux barrier
- Lower oesophageal sphincter - LOS
- diaphragm - external sphincter
- small part of stomach rolled up
In GORD what damages the oesophageal mucosa
hydrochloric acid + pepsin
2 components of oesophageal clearance
gravity + peristalsis
what does saliva contain to neutralise acid?
bicarbonate - therefore xerostomia = erosion/caries
3 protective components of GI mucosa - against GORD + peptic ulcers
mucosa, bicarbonate, prostaglandins
how can hiatus hernia affect GORD
impairs oesophageal clearance
6 risk factors for GORD
genetic
smoker
diet - late at night, high fat content, caffeine, xs alcohol
pregnancy
hiatus hernia
drugs - TCAs, anticholinergics, nitrates, Ca2+ blockers
typical symptoms of GORD
heartburn retrosternal discomfort acid brash water brash odynophagia
atypical symptoms of GORD
non cardiac chest pain
dental eroding
resp symptoms
what is Russell sign
callous at back of fingers where vomiting induced
what would you do if patient complained of acute gastro-intestinal bleeding
sign post to GP, for them to refer immediatly
what would you do if a patient presented with indigestion and any of the following: gastrointestinal bleeding weight loss unintentional progressive difficulty swallowing persistent vomiting iron deficiency anaemia epigastric mass
refer immediately for endoscopy
what is the drug treatment for GORD
proton pump inhibitors - omeprazole/lansoprazole
what is haematemesis
vomiting blood
what is melaena
pooing blood
signs + symptoms of upper GI bleeding
abdominal discomfort haematemesis melaena signs of shock change in orthostatic vital signs
3 main causes of oesophageal varices
- portal hypertension
- chronic alcohol abuse + liver cirrhosis
- ingestion of caustic substance
how are peptic ulcers formed
erosion caused by gastric acid
3 mains causes of peptic ulcers
NSAID use
alcohol/tobacco
h. pylori
2 types of drugs used to treat peptic ulcers
histamine blockers (H2 receptor antagonists) (less acid made) + long term antacids (neutralises acid)
inflammation of gingiva/mucosa may be caused by 3 conditions
- gingivitis
- crohns
- sarcoidosis - granulomatous
2 common drugs causing aphthous ulcers
nicorandil + methotrexate
most common oral manifestations of GI disorder
ulcer + sore throat
what common medications must patients not take if they suffer from peptic ulcers?
NDAIDs
2 types of peptic ulcer
gastric + duodenal
infection by which bacteria causes peptic ulcers
h. pylori
how do H2 receptor agonists treat peptic ulcers
reduce acid secretion - block histamine H2 receptor
-idine
how do prostaglandin analogues treat peptic ulcers
inhibit acid secretion + increase mucus + bicarbonate
how do proton pump inhibitors treat peptic ulcers
stop final step in acid production - action of H+/K+ atlases pump
how do antacids treat peptic ulcers
weak base that interact with acid to produce salts + neutralise - this inactivates pepsin
how to chelates treat peptic ulcers
coat mucosa - physical barrier, stimulate bicarb + mucous, inhibit pepsin
e.g. sulfracate - xerostomia + metallic taste
3 components of triple therapy against h. pylori
proton pump inhibitors, clarithroymicin (do not give in history of UC), metronidazole/amoxicillin
dental side effect of omeprazole
xerostomia
what antibiotics does antacids reduce absorption of?
tetracyclines - dentists can prescribe doxycycline
how does omeprazole effect dental IV sedation?
inhibits metabolism of diazepam - may overstate
if a patient with a peptic ulcer needs prednisolone or NSAIDs what might you have to co-prescribe?
Proton pump inhibitor
3 ways individuals become malnourished
- inadequate intake
- excessive loss
- increased metabolic requirements
nutritional screening vs nutritional assessment
screening = any health care workers assessment = nutritional expert
parenteral vs enteral delivery of nutrition
parenteral = IV enteral = tube to gut
enteral > parenteral (except when non functioning GI tract)
what is MUST?
malnutrition university screening tool
2 solid GI organs
pancreas + liver
what autoimmune disease may cause dysphagia ? - autoantibodies against ACH receptors at neuromuscular junctions
myasthenia gravis
what is pernicious anaemia?
autoimmune disease - ab against intrinsic factor
3 complications of peptic ulcers
perforation, bleeding, stricture
-oscopys also offer opportunity for what?
biopsies
what is diverticulitis?
mucosa out-patches through wholes in walls - popular in 65+yrs = diverticular disease
if become inflamed = diverticulitis
which parts of GI system can you not get direct vision?
jejunum + ileum
which medications cause indigestion? and how can this be combated?
aspirin + NSAIDs
give PPI
why is hiatus hernia important if patient having GA?
causes acid reflux - pt can spill over
what can you view with an OGD?
oesophagus to upper jejunum
3 signs of jaundice
- yellow skin
- dark urine/pale stool
- itch
3 components of charcot’s triangle
fever, pain, jaundice
sign of ascending cholangitis
3 main categories of benign hepatic-pancreato-biliary disease
- biliary obstruction - stones (choledocholithiasis) + strictures
- pancreatitis - acute vs chronic
- gallbladder disease - symptomatic gallstones
