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YR 3 - Illness and Wellbeing > Gastrointestinal Disorders > Flashcards

Gastrointestinal Disorders Flashcards

1
Q

why are GI disorders relevant to a dentist?

A
  • may influence treatment
  • may show oral manifestations
  • may show first presentation via oral examination
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2
Q

Give 3 diseases relating to the oesophagus

A

Reflux Oesophagitis
Barretts Oesophagus
Oesophageal Carcinoma

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3
Q

give a disease relating to the stomach

A

Gastric Carcinoma

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4
Q

give 2 diseases relating to the small bowel

A

Coeliac Disease
Inflammatory Bowel Disease

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5
Q

give 3 diseases relating to the colon

A

Inflammatory Bowel Disease
Colonic Polyps
Colonic Carcinoma

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6
Q

describe the structure of the oesophagus.

A

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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7
Q

Reflux Oesophagitis - description and what its caused by

A

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

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8
Q

Reflux Oesophagitis - clinical features, oral features and morphological features

A

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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9
Q

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

A

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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10
Q

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

A

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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11
Q

Barretts Oesophagus - description and aetiology

A

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

aetiology:
GORD

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12
Q

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

A

x30 more likely, its a premalignant condition

regular endoscopic surveillance

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13
Q

Barretts Oesophagus - morphological features

A

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

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14
Q

Oesophageal Carcinoma - state the two types

A

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

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15
Q

Oseophageal Adenocarcinoma - location and aetiology (3)

A

location: lower oesophagus

aetiology:
- Barrett’s Oesophagus
- smoking
- radiation

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16
Q

Adenocarcinoma - appearance (5) and 2 morphological features

A

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

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

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17
Q

Squamous Carcinoma - location and aetiology (4)

A

location: middle to lower 1/3

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

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18
Q

Squamous carcinoma - morphological features

A

squamous dysplasia
- increase abnormal cell growth

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

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19
Q

define dysplasia.

A

abnormal development of tissues

20
Q

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

A

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

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

21
Q

Gastric Carcinoma - the two types with morphological features

A

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

22
Q

Coeliac Disease - description (2),aetiology and pathogenesis

A
  • 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

23
Q

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

A
  • 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

24
Q

describe how Coeliac Disease is diagnosed and treated.

A

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

25
Q

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

A

10% patients have dermatitis herpetiformis - blistering skin

lymphocytic gastritis
lymphocytic colitis

enteropathy-associated T-cell lymphoma
small intestinal adenocarcinoma

26
Q

Inflammatory Bowel Disease -description and aetiology

A

chronic inflammatory process within the bowel

aetiology
= inappropriate mucosal immune-cell activation

27
Q

what are the 2 types of inflammatory bowel disease?

A
  • Crohn’s Disease
  • Ulcerative Colitis
28
Q

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

A

has features of UC and CD but cant be classified

29
Q

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

A

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
30
Q

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

A
  • 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

31
Q

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

A

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
32
Q

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

A

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
33
Q

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

A

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
34
Q

Colonic Polyps - description, give 2 types of classification

A

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

35
Q

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

A

neoplastic
- adenomas
- malignant cancers

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

36
Q

what are hamartomas? what are the 2 types.

A

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

juvenile
putz-jegher

37
Q

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

A
  • genetic - mutation on SMAD4/BMPR1A gene, increases cancer risk
  • sporadic - no cancer risk
  • size = <3cm
  • area = rectal
38
Q

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

A
  • 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
39
Q

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

A
  • common in left colon
  • in multiples
  • size = <5mm
  • appearance = ragged, teeth-like, serrated
40
Q

describe neoplastic polyps: adenomas

A

benign tumours of colonic glandular epithelium

41
Q

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

A

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

42
Q

what are the 2 types of hereditary colorectal cancers?

A

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

43
Q

What is the Adeno-Carcinoma Sequence?

A
  1. APC mutation
  2. methylation abnormalities
  3. protocongene mutations
  4. develop into carcinoma
44
Q

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

  • toilets in the garden
A

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
45
Q

symptoms of CRC

A

change in bowel habits
- diarrhoea
- constipation

abdominal pain

unexplained weight loss, tiredness, anaemia

YR 3 - Illness and Wellbeing (31 decks)

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