Gastrointestinal Disorders Flashcards by Simran Sandhu

why are GI disorders relevant to a dentist?

may influence treatment
may show oral manifestations
may show first presentation via oral examination

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Give 3 diseases relating to the oesophagus

Reflux Oesophagitis
Barretts Oesophagus
Oesophageal Carcinoma

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give a disease relating to the stomach

Gastric Carcinoma

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give 2 diseases relating to the small bowel

Coeliac Disease
Inflammatory Bowel Disease

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give 3 diseases relating to the colon

Inflammatory Bowel Disease
Colonic Polyps
Colonic Carcinoma

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describe the structure of the oesophagus.

25cm muscular tube
- mostly lined by squamous epithelium

upper end = sphincter
lower end = gastro-oesophageal junction
bottom 1.5-2cm = lined by columnar mucosa
the squamo-columnar junction is around 40cm below the incisor teeth

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Reflux Oesophagitis - description and what its caused by

inflammation of the oesophagus, known as GORD
- sphincter is damaged
- caused by reflux of gastric acid and/or bile

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Reflux Oesophagitis - clinical features, oral features and morphological features

clinical features:
- heart burn
- belching
- bloating
- cough
- can mimic heart pain
- ulcerations
- haemorrhages
- perforations

dentally - 5-47% erosion

morphological features:
- hyperplasia of basal cells
- elongation of papillae
- increased cell desquamation
- inflam cell infiltration - neutrophils, eosinophils, lymphocytes

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what is sliding hiatus hernia? how does it happen and its results.

when stomach slides from abdominal region into the thoracic cavity

due to:
- increase abdominal pressure or decreased diaphragm tone

results in:
- loss in sphincter competence
- gastric acid regurgitation
= oesophagitis/GORD

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what is paraesophageal hiatus hernia? how does it happen and the results.

the sphincter stays intact but an abnormal portion of the stomach bulges through the diaphragm

due to:
- increase abdominal pressure or decreased diaphragm tone

results:
- no regurgitation as sphincter is intact
- strangulated stomach
- can turn ischaemic
- emergency

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Barretts Oesophagus - description and aetiology

metaplasia of a change in oesophageal epithelium
- from squamous cells to columnar cells with goblet cells

aetiology:
GORD

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with Barrett’s Oesophagus, what is the risk of developing adenocarcinoma? how it is detected?

x30 more likely, its a premalignant condition

regular endoscopic surveillance

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Barretts Oesophagus - morphological features

morphological features:
a change in oesophageal epithelium from squamous cells to columnar cells with goblet cells

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Oesophageal Carcinoma - state the two types

a cancer which occurs in the oesophagus
2 types
- squamous cell carcinoma
- adenocarcinoma

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Oseophageal Adenocarcinoma - location and aetiology (3)

location: lower oesophagus

aetiology:
- Barrett’s Oesophagus
- smoking
- radiation

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Adenocarcinoma - appearance (5) and 2 morphological features

clinical features:
- plaque-like
- nodular
- fungating
- ulcerated
- depressed

morphological features:
- malignant cells form glandular structures
- glandular structures infilitrate connective tissue

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Squamous Carcinoma - location and aetiology (4)

location: middle to lower 1/3

aetiology:
- tobacco and alcohol
- nutrition
- thermal injury
- HPV

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Squamous carcinoma - morphological features

squamous dysplasia
- increase abnormal cell growth

appears like lots of black dots when it penetrates through basement membrane

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define dysplasia.

abnormal development of tissues

Gastric Carcinoma - what is the common tumour and least common tumour, aetiology

most frequently: adenocarcinoma
less frequently: endocrine tumours, lymphomas, mesenchymal tumours

aetiology:
- diet - smoked fish/cured meat, pickled vegetables
- infections by Helicobacter pylori
- 1% hereditary

Gastric Carcinoma - the two types with morphological features

2 types
- diffused type - invades diffusely - rings
- intestinal type - forms discrete mass - tubes

Coeliac Disease - description (2),aetiology and pathogenesis

gluten sensitive enteropathy
chronic immune-mediated

aetiology:
- genetically predisposed individuals

pathogenesis:
- gluten is broken down to gliadin
- gliadin is resistant to further break down

in the intolerant:
gliadin activates CD4 T cells
immune response
local inflammation
B cells produce anti-gliadin and anti-TTG antibodies
gliadin cause IL-15 proliferation from epithelium lining small bowel
activates CD8 (intra-epithelial lymphocytes)
= cytotoxic and kill enterocytes gut cells

*CD4 and IL15 secretion

Coeliac Disease - clinical features (2), oral manifestations (11) and morphological features (3)

diarrhoea
abdominal pain

oral:
- delayed tooth eruption
- smaller teeth
- enamel defects
- risk of caries

cheilitis - lip inflammation
oral lichen planus
salivary gland dysfunction
recurrent aphthous stomatitis
atrophic glossitis
burning feeling of tongue
lingual geografica

morphological features:
- villi atrophy - villi disappear
- flat surface
- lots of intraepithelial lymphocytes

describe how Coeliac Disease is diagnosed and treated.

2 ways to diagnose
Tissue Biopsy
Blood Test
- IgA antibodies to TTG - tissue transglutaminase
- IgA or IgG antibodies to deaminated gliadin
- anti-endomysial antibodies

treatment
- gluten-free diet

give some other diseases associated with Coeliac Disease (5) - skin - GIT - 2 cancers

10% patients have dermatitis herpetiformis - blistering skin lymphocytic gastritis lymphocytic colitis enteropathy-associated T-cell lymphoma small intestinal adenocarcinoma

Inflammatory Bowel Disease -description and aetiology

chronic inflammatory process within the bowel aetiology = inappropriate mucosal immune-cell activation

what are the 2 types of inflammatory bowel disease?

- Crohn's Disease - Ulcerative Colitis

a third type of Inflam Bowel Disease is Indeterminate Colitis. What is it?

has features of UC and CD but cant be classified

Ulcerative Colitis - describe the affected area, mucosal surface, distribution, bowel wall, percent of anal lesions and give 2 other characteristics.

Affected area: colon only Mucosal Surface - red, granular flat ulcers - pseudo polyps Distribution - continuous from the rectum Bowel Wall: - thinned - rare for it to become narrow - 25% anal lesions - inflammation is just mucosal - pseudo polyps

Ulcerative Colitis - 7 clinical features, how often it is present and 5 oral manifestations.

- diarrhoea or constipation - rectal bleeding - abdominal pain - weight loss or anorexia - anaemia present intermittently - 3 relapses/year oral manifestations - ulceration - tongue coating - thick layer of keratin - halitosis - pyostomatitis vegetans - small pustules on mucosal surface - caries/perio

Crohn's Disease - describe the affected area, mucosal surface, distribution, bowel wall, percent of anal lesions and give 7 other characteristics

Affected are: - ileum and colon - also any other region of the entire GIT Musosal Surface - cobblestone appearance - linear fissure ulceration Distribution: - skip lesions - skip parts of the bowel, varied affects Bowel wall: - thickens - becomes strictured = narrow - 75% anal lesions - fistulae - tract connecting anal skin to bowel - fat wrapping - fat thickens and wraps around bowel - granulomas - 35-60% - inflammation - deep ulceration - lymphocytic reactions - fibrosis

Crohn's disease - 6 clinical features and oral manifestations.

chronic relapsing - diarrhoea - abdominal pain - weight loss/ anorexia - fever - peri-anal disease - anaemia specific oral manifestations: - buccal cobblestoning - mucosal tags - deep linear ulcerations - buccal swelling - mucogingivitis - granulomatous cheilitis - other oral manifestations are same as UC

does Inflammatory Bowel Disease have a high risk for colorectal cancer? what are 7 risk factors

yes - early age onset - long duration of disease - family history - severity of inflammation - pre-malignant changes - pancolitis - disease affecting all colon - primary sclerosing cholangitis - associated

Colonic Polyps - description, give 2 types of classification

a projection of mucosa that protrudes into the bowel or lumen - can be single or multiple - polyposis - can be neoplastic or non-neoplastic

give 2 examples of neoplastic polyps and 3 non-neoplastic polyps

neoplastic - adenomas - malignant cancers non-neoplastic - inflammatory polyps - hamartomatous (juvenile or peutz-jeghers) - hyperplastic

what are hamartomas? what are the 2 types.

autosomal non-neoplastic tissue elements - typical for the site of origin but abnormal in organisation juvenile putz-jegher

describe juvenile hamartomatous polyps. which gene is affected, level of cancer risk, size and area

- genetic - mutation on SMAD4/BMPR1A gene, increases cancer risk - sporadic - no cancer risk - size = <3cm - area = rectal

describe peutz-jegher hamartomatous polyps. which gene is affected, appearance, area affected, cancer risk

- germ line mutation in LKB1 gene - tree-like structure - mucocutaneous hyperpigmentation - multiple polyps in small intestine, stomach and colon - positive family history - increase in cancer risk independent from polyps

describe where hyperplastic polyps are common and their appearance (3)?

- common in left colon - in multiples - size = <5mm - appearance = ragged, teeth-like, serrated

describe neoplastic polyps: adenomas

benign tumours of colonic glandular epithelium

Colonic Carcinoma - what increases (6) and decreases risks (9)

increases risk: - red/processed meat - fats, alcohol - smoking - age - obesity - diabetes decreases risk: - fibre - milk/calcium - fruit/veg - vitamin D - exercise - screening - aspiring - NSAIDS - stains

what are the 2 types of hereditary colorectal cancers?

familial adenomatous polyposis - 80% of patients have mutation - adenomatous polyposis coli (APC) tumour suppressor gene - if untreated = 100% risk of CRC by 40 yrs Lynch syndrome

What is the Adeno-Carcinoma Sequence?

1. APC mutation 2. methylation abnormalities 3. protocongene mutations 4. develop into carcinoma

what syndrome is associated with oral manifestions with CRC - what are the symptoms - toilets in the garden

Gardener Syndrome = FAP + extra-colonic manifestations - 75% have dental abnormalities - osteoma - benign tumour in bone - odontoma - benign tumour linked to tooth development - supra-numerary teeth - impacted teeth

symptoms of CRC

change in bowel habits - diarrhoea - constipation abdominal pain unexplained weight loss, tiredness, anaemia