Gastrointestinal disease Flashcards
What drug eliminates formed acids
Antacids
What drugs reduce acid secretion
H2 receptor blockers/antagonists
Proton pump inhibitors
How do H2 receptor blockers work
They reduce acid production by preventing the histamine activation of acid production
Why do H2 receptor antagonists have limited benefit
They only limit 1 of the pathways there is still 2 other; Acetylcholine and Gastrin
Name a H2 receptor blocker
Cimentanide
Name a proton pump inhibitor
Omeprazole
What is dysphagia
Difficulty swallowing
What are the causes of dysphagia
External compression e.g. the aorta
Dysmolity
What is dysmolity
Condition in which the muscles of the digestive system dont work as they should
Name 2 causes of dysmolity disorders
Fibrosis (e.g. Scleroderma) Nueromuscular dysfunction (e.g. parkinsons)
What is GORD
GORD (Gastro-oesophageal reflux disease) is when acid from the stomach leaks up into the oesophagus
What are the 3 main causes of GORD
Defective lower oesophageal sphincter
Impaired lower clearing
Impaired gastric emptying
What are the effects of GORD
Ulceration, Inflammation, metaplasia, barretts oesphagitis
What are the signs and symptoms of GORD
Epigastric burning, Dysphagia, GI bleeding, severe pain that mimics a MI
What treatment is there for GORD
Antacids, H2 receptor blockers, proton pump inhibitors
What is a hiatus hernia
When part of the stomach is in the Thorax
What site is affected by peptic ulcer disease
ANY acid affected site- oesophagus, stomach, duodenum
What is the main problem of peptic ulcer disease
The ulcer fully erodes through the lining and into a artery causing a major bleed or straight through the viscous wall into the periotineum
What is a perforated ulcer
A ulcer that has gone straight through the viscous wall into the periotineum
What type of ulcers would high acid secretion make
oesphageal and duodenal ulcers
How can a normal acid secretion cause peptic ulcers
If there is a reduced protective layer in the stomach
What can cause a loss of the mucosal barrier in the stomach
Heliobacter Pylori bacteria infection
What does the loss of the mucosal barrier in the stomach lead to
Ulceration and the chronic inflammation of the gastric mucosa which could then cause the lymphoma of the stomach
How can you eliminate a H. pylori infection
through triple therapy
What does triple therapy encompass
2 antibiotics (amoxicillin, metronidazole) and 1 proton pump inhibitor (omeprazole)
What are the symptoms and signs of peptic ulcer disease
Normally asymptomatic but can have epigastric burning pain
What nvestigations is there for peptic ulcer disease
Endoscopy, radiology, Anemia(FBC test)
H. pylori test- breath, antibodies,mucosa
What are the systemic complications of peptic ulcer disease
Anaemia
What are the local complications of peptic ulcer disease
Perforation, Haemorrhage, stricture, malignancy
What treatment is there for peptic ulcer disease
Medical: stop smoking, ulcer healing drugs, small regular meals, eradication therapy
Surgical: Endoscope, vagotomy, surgical repair(gastectomy)
How can you improve the mucosal barrier of the stomach
eliminate heliobacter
Inhibit Prostagaldin removal- avoid NSAIDs and steroids
What are the 2 PUD surgerys and what happens in them
Bilroth1- Top half of stomach is atatched to the duodenum
Bilroth2- Top half of the stomach is attached to the small bowel
What is the small intestine compromised of
duodenum, Jejunum, Ileum
What diseases/ conditions can lead to malabsorption
Coeliac disease, prenicious anemia, crohns, infections, tumours
What is coeliac disease caused by
Sensitivity to the aplha-gliaden component of Gluten
What does coeliac disease lead to
Villous atrophy of the jejunum
What is villous atrophy
When the villi in the intestines erode away leaving a virtualy flat surface
What are the clinical effects of Jejunal atrophy
Growth failure, oral ulceration
What are the ‘classical’ symptoms of coeliac disease
Weight loss, lassitude, weakness, abdomail pain, dirrhoea, oral aphthae, toung papillary loss
What is oral aphthae
An ulcer that forms on the mucous membrane
What investigations are there for coeliac disease
Autoantibody test- Serum Transglutaminase(TTG) and anti-glidan antibodies
Jejunal biopsy- capsule, endoscopic biopsy
Haematinics- B12, Folate, Ferrin levels
In coelaic disease what would cause reversal of the jejunal villi atrophy
A gluten free diet
What skin disease is associated with coeliac disease
Dermatitis Herpetiforms
What happens in dermatitis herpetiformis
Granular IgA deposits in the skin and mucosa
What is pernicious anaemia caused by
Vit. B12 deficency
What helps the intestines absorp Vit. B12
Intrinsic factor
What is the only Vit. B12 absorption site in the bowel
Terminal Ilium
How do you diagnose Pernicious anaemia
carry out a blood test for antibodies to intrisnic factor
Causes of Pernicious anaemia
lack of B12 in diet
disease of the gastric parietal cells
Inflammation bowel disease of the terminal ileum(Crohns)
Bowel cancer at the ilei-coecal junction
What are the age ranges of Inflam. bowel disease
15-25yrs 50-80yrs
What gender is Crohns more prelevant in
Male
What gender is ulcerative colitis more prelevant in
Female
Aetiology of IBD
Food inolerance, persisting viral infection, smoking, genetic
What is thought to be a possible aetiology of Crohns
Infection with Mycobacteria
Where does Crohns affect
Any part of the GI tract
Where does ulcerative colitis affect
Colon and rectum
What is IBD
Chronic inflam. of the GI tract
What are the differences between crohns and ulcerative colitis
Crohns:
Disontinous, rectum involved 50%, Anal fissures 75%, Ileum involved 30%, mucosa cobbled and fissures, Non-vascular, Serosa inflamed.
Ulc. Col:
Continous, Rectum always involved, Anal fissures 25%, Ileum involved 10%, Mucosa granuloma and ulcers, Vascular, Serosa normal
What are the microscopic diffrences between Crohns and Ulc. Col.
Crohns:
Transmural, Oedematous, granulomas
Ulc. Col:
Mucosal, Vascular, mucosal abcesses
What is meant by saying Ulc col. is continous
The disease spreads in one way si it starts at the rectum and can spread continously through the colon
What are the symptoms of Ulc. Col.
Dirrhoea, abdominal pain, PR bleeding
What are the symptoms of Crohns
Colonic- Dirrhoea, abdominal pain, PR bleeding
Small bowel disease- Pain from obstruction and malabsorption
Mouth- OFG
Investigations for IBD
Blood tests (anaemia, C reactive protien- a inflam. marker) Faecal calprotectin Endoscopy Leukocyte scan Barium studies Bullet endoscopy
What does Ulc. Col. have the risk of developing
carcinoma
What is the medical treatment for IBD
Systemic steroids
Local steroids
Anti inflam. drugs
Non steroid immunosuppressants
What is the cure for Ulc Col.
Colectomy
What are ASA drugs and what are they used for
They are anti inflam. drugs used to treat IDB as they are not absorbed in the small intestine and pass through the bowel and effect the surface mucosa topically
Name 2 ASA based drugs
Pentasa, Mesalazine, Suphasalazine
What surgical treatment is there for Crohns
Remove obstructed bowel segments, drain abcesses, close fistulae
in bowel cancer what do most carcinomas arrise in
Polyps
What is acute liver failure
Sudden loss of liver function (In days or weeks)
What will a patient die from in acute liver failure
bleeding and encephalopathy
Can a liver recover from acute liver failure
Yes, if given time and patient still alive
What can cause chronic Liver failure
Cirrhosis, primary liver cancer and secondary liver cancer
What is cirrhosis
A mixed picture of damage, fibrosis and regeneration of liver structure
What is chronic liver failure
It is a progressive deterioration of liver functions for more than six months
What is the aetiology of cirrhosis
It is multifactorial:
Alcohol, primary biliary cirrhosis, viral disease, autoimune chronic hepatitis, haemachromatosis and cystic fibrosis
What viral disease can cause cirrhosis
Chronic active hepatitis
Wha are the signs and symptoms of cirrhosis
Normally NONE but a large or small liver
Acute bleed (Oespahgeal varices), portal hypertension, jaundice, oedema and ascites, encephalopathy, spider naevi and palmar erythema
What causes the spider naevi and palmar erythema in cirrhosis
The high levels of oestergen from reduced metabolism
What causes oesophageal varices
Blood entering the portal system has no exit route as the portal vein cannot communicate with the hepatic vein due to disordered portal triads in liver cirrhosis
Blood engorges as passes through vessels at the end of the embryological gut – lower oesophagus – getting from the portal vein to the systemic circulation
Veins dilated and fragile(thin walled) and Protrude into oesophageal lumen
What are the 2 functions lost in liver failure
Synthetic and metabolic
What does the loss of synthetic action affect
Plasma proteins, clotting factors
What does the loss of metabolic function affect
Drug metabolism (esp. first pass) Detoxification Conjugation of RBC breakdown products
What tests are there for liver function
Hepatic cell enzyme levels(ALT,GGT)- which in liver inflam. is raised
INR test, which is most useful
What INR level is high for none warafin patients
1.3
As a dentist, when treating someone with liver failure what must you avoid and why
Intravenous sedation as with thte metabolic changes it will have prolonged effect
Is there a problem with LA with patients of liver failure
NO as metabolised in the plasma not liver
What are the 3 types of jaundice
Pre-Hapatic, Hepatic, Post-Hepatic
what is the cause of prehepatic jaundice
Due to factors BEFORE liver metabolism
-usually excessive quantities of red blood cell breakdown products
What is the cause of hepatic jaundice
Liver failure
What is the cause of post-hepatic jaundice
obstruction to bile flow (e.g. gal stone)
What treatment is there for Prehepatic jaundice
identify the cause and treat it
What treatment is there for post-hepatic jaundice
Remove the obstruction
What treatment is there for liver failure
Supportive
Transplant(only cure)
Artifical liver systems
-Molecular Adsorbent Recirculating System (MARS)
