Gastroenterology: Upper GIT Pathologies Flashcards
How are GI disorders classified?
GI disorders are defined by anatomical location:
- Upper GIT
- Lower GIT
- Liver, biliary tract, and pancreas
List the principal foods absorbed by different parts of the GIT
Absorption:
- Stomach: Alcohol, water
- Duodenum: Vitamin B12, iron
- Jejunum: Vitmain B9 (folate)
- Large intestine: water
List the functions of the liver and gallbladder
Gallbladder stores and concentrates bile
Liver:
- Produces bile
- Metabolises nutrients and toxins
- Synthesises proteins
List the functions of the pancreas
Pancreas functions:
- Endocrine: produce insulin
- Exocrine: produce digestive enzymes
Define the following:
- Dysphagia
- Odynophagia
- Dyspepsia
- Gastritis
- Peptic
- Peptic ulcer
- Hiatus hernia
- Dysphagia: difficulty in swallowing
- Odynophagia: pain when swallowing (in mouth or throat, with or without dysphagia)
- Dyspepsia: indigestion = discomfort or pain in upper GI tract (heartburn, pain, acidity)
- Gastritis: when the lining of the stomach becomes inflamed after it’s been damaged. It’s a common condition with a wide range of causes
- Peptic: an adjective that refers to any part of the body that normally has an acidic lumen, or is related to or promotes digestion
- Peptic ulcer: Peptic ulcer disease (PUD) is a break in the inner lining of the stomach, the first part of the small intestine, or sometimes the lower esophagus. An ulcer in the stomach is called a gastric ulcer, while one in the first part of the intestines is a duodenal ulcer.
- Hiatus hernia: A hiatus hernia is when the top part of your stomach slides upwards into your chest. It’s a very common condition, affecting nearly a third of people over 50. You don’t necessarily need any treatment for a hiatus hernia if it isn’t causing you any problems. If you do have symptoms, the main one is heartburn.
Define the following
- Haematemesis
- Melaena
- Constipation
- Steatorrhoea
- Sigmoidoscopy vs Colonoscopy
- Haematemesis: vomiting blood
- Melaena: black, tarry faeces caused by bleeding in upper GIT
- Constipation: infrequent (<2/week) or hard stools
- Steatorrhoea: pale bulky stools with abnormal quantities of fat due to reduced fat absorption in intestine
- Sigmoidoscopy vs Colonoscopy: colonoscopy examines the entire length of the colon, sigmoidoscopy only the lower third
Define the following:
- Angular cheilitis
- Glossitis
- Oesophagitis
- Barrett’s oesophagus
- Oesophageal stricture
- Adinocarcinoma
- Varices
- Mallory-weiss tear
- Angular cheilitis: inflammation of one or both corners of the mouth
- Glossitis: soreness of the tongue, or more usually inflammation with depapillation of the dorsal surface, leaving it smooth and glossy in appearance
- Oesophagitis: inflammation or irritation of the oesophagus
- Barrett’s oesophagus: an abnormal change in the mucosal cells lining the lower oesophagus, from normal stratified squamous epithelium to simple columnar epithelium with interspersed goblet cells that are normally present only in the small intestine, and large intestine. Considered to be a premalignant condition since associated with a high incidence of further transition to esophageal adenocarcinoma
- Oesophageal stricture: narrowing or tightening of the esophagus that causes swallowing difficulties
- Adinocarcinoma: a malignant tumour formed from glandular structures in epithelial tissue.
- Varices: Varices are dilated blood vessels in the esophagus or stomach caused by portal (liver) hypertension
- Mallory-weiss tear: a tear in the mucous membrane where the oesophagus meets the stomach
What are symptoms of upper GI bleeding vs lower GI bleeding?
Upper GI bleeding:
- Haematemesis
- Melaena
Lower GI bleeding:
- fresh blood, may be mixed with stools
What are the causes of upper GI bleeding (haematemesis and melaena) in order of importance?
Causes of upper GI bleeding:
- Peptic ulcer: 50%
- Gastritis: 20%
- Varices: 15%
- Mallory-weiss tear: 10%
- Oesophagitis: 5%
What are investigations for upper vs lower GI tract?
What are some additional general GI investigations?
Upper GI investigation:
- endoscopy
Lower GI investigations:
- colonoscopy
- sigmoidiscopy
Other GI investigations:
- radiographs
- MRI
- Ultrasound: esp. for biliary tract, liver
What are different classes of oral manifestations of GIT disease?
Name some oral symptoms
What should the dentist be aware of?
Oral manifestations of GIT disease may come about as:
- Direct involvement of the oral and peri-oral tissues mucosa by the disease process
OR
- Secondary to disease elsewhere in the gastro-intestinal tract as a result of malabsorption or blood loss
Non-specific oral signs and symptoms include
- angular cheilitis
- glossitis
- burning mouth syndrome
- candidal infections
- recurrent oral ulceration
- halitosis
- unpleasant taste
- NCTSL with acid reflux
Dentists should have caution with NSAIDs
- Especially older patients
- In presence of symptoms
- With corticosteroids
What kind of disorder is GORD and define it
What are its causes?
What are risk factors associated with it?
What is its prevalence?
Gastro-oesophageal reflux disease is a disorder of the upper GIT: complication result from reflux of gastric contents into the oesophagus or beyond, into the oral cavity (including larynx) or lung
It is caused by excess acid at lower oesophageal sphincter due to
- loss of tone
- delayed gastric emptying
Associated risk factors:
- age
- family history
- obesity
- hiatus hernia
10-30% of the population in developed countries have GORD
What are general and oral symptoms of GORD?
How is it managed? List any drugs
Symptoms of GORD:
- heartburn
- regurgitation
- relieved by antacids
Oral symptoms of GORD:
- reflux dental erosion syndrome
- globus
- unpleasant taste in mouth
- halitosis
- burning mouth syndrome
Management:
- lifestyle changes
- PPIs (proton pump inhibitors)
- Omeprazole
- Lansoprazole
- Antacids
- Aluminium hydroxide, calcium carbonate: e.g. Rennie
- Alginate-based: e.g. Gaviscon
- Gastric acid reduction: Histamine receptor (H2) blockers
- Ranitidine
- Cimetidine
What are complications arising from GORD?
Complications:
- Barrett’s oesophagus
- stricture
- adenocarcinoma
- ulceration
Define peptic ulcer disease - Where can it occur?
What is its aetiology?
What is its treatment?
Peptic ulcer disease: A break on the mucosal lining of the of the stomach or duodenum more than 5 mm in diameter with depth to the submucosa (gastric can become malignant)
Aetiology
- Helicobacter pylori
- NSAIDs - non-steroidal anti inflammatory drug e.g. advil, ibuprofen
- esp. causes gastric ulcers
Treatment
- Acutely
- Endoscopically – can stop bleeding
- Rarely surgery
- Non-acute
- Acid suppression
- PPI
- Treat H. Pylori
- PPI and antibiotics (see BNF for regime)
