Gastrointestinal Disorders Flashcards
why are GI disorders relevant to a dentist?
- may influence treatment
- may show oral manifestations
- may show first presentation via oral examination
Give 3 diseases relating to the oesophagus
Reflux Oesophagitis
Barretts Oesophagus
Oesophageal Carcinoma
give a disease relating to the stomach
Gastric Carcinoma
give 2 diseases relating to the small bowel
Coeliac Disease
Inflammatory Bowel Disease
give 3 diseases relating to the colon
Inflammatory Bowel Disease
Colonic Polyps
Colonic Carcinoma
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
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
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
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
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
Barretts Oesophagus - description and aetiology
metaplasia of a change in oesophageal epithelium
- from squamous cells to columnar cells with goblet cells
aetiology:
GORD
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
Barretts Oesophagus - morphological features
morphological features:
a change in oesophageal epithelium from squamous cells to columnar cells with goblet cells
Oesophageal Carcinoma - state the two types
a cancer which occurs in the oesophagus
2 types
- squamous cell carcinoma
- adenocarcinoma
Oseophageal Adenocarcinoma - location and aetiology (3)
location: lower oesophagus
aetiology:
- Barrett’s Oesophagus
- smoking
- radiation
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
Squamous Carcinoma - location and aetiology (4)
location: middle to lower 1/3
aetiology:
- tobacco and alcohol
- nutrition
- thermal injury
- HPV
Squamous carcinoma - morphological features
squamous dysplasia
- increase abnormal cell growth
appears like lots of black dots when it penetrates through basement membrane
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?
- APC mutation
- methylation abnormalities
- protocongene mutations
- 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
