Gastrointestinal Disease

Question 1

Where are most peptic ulcers found? how many?

Answer 1

duodenum; 1

Question 2

What is the most common cause of peptic ulcer disease?

Answer 2

heliobactor pylori

Question 3

Where is H pylori found?

Answer 3

H pylori hangs out where the gastric epithelium meets the overlying mucosa

Question 4

H pylori produce ___ that hydrolyzes urea to ___ and ___. Host inflammatory response to ___ causes tissue injury.

Answer 4

urease; ammonia; CO2; ammonia

Question 5

___ are the 2nd most common cause of ulcers due to there decrease ___ production, inhibition of mucous secretion and decrease mucosal blood flow.

Answer 5

NSAIDS; prostaglandins

Question 6

T/F. NSAIDS induced ulcers are more often found in the duodenum.

Answer 6

False, it’s the stomach.

Question 7

Who is at increased risk of developing ulcers if taking NSAIDS?

Answer 7

>60yo
high-dose long-term therapy (>1mo)
NSAIDs with long half-life
simultaneous use of alcohol
steroids
anticoagulants
aspirin

Question 8

What are some complications of peptic ulcer disease?

Answer 8

Erode into arteries/veins of intestinal wall = hemorrhage
Peritoneal perforation
Fibrosis from healed ulcers
pyloric stenosis = delayed gastric emptying

Question 9

Chronic cases of peptic ulcer cases have an increased risk for ___ and ___.

Answer 9

lymphoma; carcinoma

Question 10

T/F. Peptic ulcer patients have localized, burning gnawing pain either with an empty stomach or 90 min - 3 hrs after eating.

Answer 10

True.

Question 11

How do peptic ulcer patients find relief?

How do worsening ulcers manifest?

Answer 11

Relief with food, milk, antacids

Worsening ulcer may manifest as change in symptoms (increased pain, no therapeutic relief, pain radiates to back, tarry stools)

Question 12

How are peptic ulcers diagnosed and managed?

Answer 12

Fiberoptic endoscopy (direct visualization, biopsy, treats bleeding)

Management:
treat acid - PPI, histamine receptor antagonists
treat infection - 2 antibiotics + PPI
eliminate risk factors

Question 13

T/F. Dentists should manage stress, avoid NSAIDS, aspirin, and corticosteriods with ulcer patients.

Answer 13

True.

prescribe: acetaminophen, acetaminophen combos

Question 14

T/F. Ulcerative colitis is a full-thickness bowel wall and can involve any portion of the alimentary canal.

Answer 14

False, CROHN’s disease is a full-thickness bowel wall and can involve any portion of the alimentary canal.

Ulcerative colitis is in the mucosa and large intestine and rectum

Question 15

T/F. Ulcerative colitis is characterized as a chronic, relapsing disease with ulcerations that “skip” along the intestines causing the small bowel to thicken and become stenosed leading to resections.

Answer 15

False, CROHN’S DISEASE is characterized as a chronic, relapsing disease with ulcerations that “skip” along the intestines causing the small bowel to thicken and become stenosed leading to resections.

Ulcerative colitis patients undergo remission and exacerbations and this lifelong disease can progress to colon carcinoma.

Question 16

How is IBS managed?

Answer 16

Manageable, not curable, with drug therapy
1st line: antidiarrheal, antiinflammatory
2nd line: immunosuppressive agents and antibiotics
Corticosteroids to induce remission in moderately-severely ill patients
Surgery for severe, refractory cases

Question 17

How should dentist handle the following in patients with IBS:

1. appointments
2. anti-inflammatory drugs (ibuprofen)
3. antibiotics
4. anti-inflammatory (sulfasalazine)

Answer 17

1. Schedule appointments during remissions
2. Avoid anti-inflammatory drugs
   Ibuprofen
3. Caution with antibiotics (Clindamycin)-monitor for signs/symptoms of pseudomembranous colitis
4. Sulfasalazine (an anti-inflammatory) can cause leukopenia & thrombocytopenia
   Pre-op CBC to evaluate WBC & platelets

Question 18

Pseudomembranous colitis is caused by ___-spectrum antibiotics like ___ and ___ that eliminate normal gut bacteria. This results in an overgrowth of ___ ___, which release potent enterotoxins.

Answer 18

broad; amoxicillin; clindamycin; Clostridium difficle

Question 19

*What are the signs and symptoms of pseudomembranous colitis?

Answer 19

Timing: within 4-10d of antibiotic administration
Diarrhea
Mild: watery and loose
Severe: bloody diarrhea, abdominal cramps & tenderness, fever
Severe dehydration, hypotension, peritonitis

Question 20

How are psuedomembranous colitis patients medically managed?

Answer 20

Discontinue offending antibiotic
Treat C. difficile infection
Oral metronidazole
Vancomycin
Supportive therapy
Mild infection: Outpatient treatment

Question 21

T/F. Pseudomembranous colitis patients can receive elective procedures there should be an appropriate selection of antibiotics, dosage and duration.

Answer 21

False, Delay elective dental care until free of disease symptoms

Sound indication and prescription for antibiotic use!!
Risk increases with higher dose, longer duration of administration, and greater number of antibiotics used
Appropriate selection of antibiotic, dosage, and duration

Question 22

T/F. Pseudomembranous colitis has NOT been reported after a single dose for IE prophylaxis.

Answer 22

True.