GI 2 Flashcards
What are the three parts of the small intestine?
Duodenum
Jejunum
Ileum
What is the aetiology of coeliac disease?
Autoimmune condition where APC in the small intestine take up undigested gliadin and display them on their surface.
T cells get activated and go on to activate B antibodies
What are the main symptoms of coeliac disease?
- Pale, bulky, greasy stools
- Abdominal pain
- Weight loss
- Short stature
- Weakness
- Diarrhoea
- Tummy rumbling
What are the main extra-intestinal symptoms of coeliac disease?
- Anaemia (iron and B12 malabsorption)
- Bleeding risk (malabsorption of vitamin K)
- Tingling nerves
- Skin disorders due to reaction to glucose
- Endocrine disturbances around reproduction
What are the 2 investigations done to diagnose coeliac disease?
1) Blood test :
- Antibodies for gliadin, endomysium and transglutaminase
(IgA antibodies to transglutaminase is the main test)
2) Endoscopic biopsy
- Inflamed and deranged small gut lining and loss of epithelium integrity after eating gluten
What is the treatment for coeliac disease?
- Avoid gluten
- Corticosteroids (Anti-inflammatory)
What is the dental relevance of coeliac disease?
- Malabsorption of B12 and folate leads to oral manifestations
- Vitamin K deficiency leads to bleeding
- Enamel defects can occur during amelogenesis of the permanent dentition
Crohns or UC?
- Which one is more common?
- Which one is more common in women?
- Which one presents at a younger age?
- UC
- Crohns
- Crohns
What is the tissue type that is most likely to lead to UC and Crohn’s?
HLA DRB
What is the difference in pathology between UC and Crohn’s?
Crohns: Entire bowel is affected UC: only affects the colon (mainly the rectum)
Crohns : skip lesions, affected the terminal ileum mainly and ascending colon
UC: mainly affects the anal ring and descending colon
Crohns : causes a deeper inflammation with granulomas forming UC : superficial inflammation with goblet cell depletion
What are the main symptoms of Crohns disease?
- Abdominal pain
- Diarrhoea
- Decreased appetite
- Anaemia and weight loss
- Fresh blood passed through rectum
How does Crohns appear on an endoscope?
- Thickened walls with deep fissures
- Fat wrapping around bowel
- Cobble stoning of mucosa
- Excess mucus secretion
- Lumen narrowed
- Mucosal fissures
- Deep ulcers
- Fistulae
What are the 3 main Crohn’s phenotypes?
- Stricturing (gradual thickening of the intestinal wall leading to stenosis / obstruction)
- Penetrating (intestinal fistulas form between the gut and other organs (perforation out the bowel forming abnormal connections of the intestine with other organs such as bladder, vagina or skin)
- Non penetrating
What do we do to diagnose Crohns?
Biopsy Endoscopy Barium enema (skip lesions, string sign)
How do we treat Crohn’s disease?
Medical (glucocorticoids such as prednisolone) (immunomodulators such as azathioprine)
Surgically (intestinal resection if too much obstruction has occurred)
What is the dental relevance of crohn’s?
Oral manifestations including ulcers, facial and labial swelling, mucosal tags
Malabsorption of b12 leading to oral complications (glossitis, ulcers, angular chelitus, burning mouth, itch)
Immunosuppressants (methotrexate) increases infection risk)
Name some of the specific and nonspecific oral manifestations of Crohn’s?
Specific:
- Labial and buccal swelling
- Cobblestones
- Mucosal tags (sticking out mucosa)
- Linera (slit like) ulcers
- Inflammation of the gingiva (mucogingivits)
- Granulomatous cheilitis (lip swelling)
- Staghorning
Non specific conditions:
- Typical ulcers (aphthous ulcers - small shallow lesions on the soft tissues in the mouth)
- Angular chelitits (corners of the mouth are inflamed)
- Glossitis (inflammation of tongue)
- Dental caries (typically due to dry mouth)
- Gingivitis / periodontitis
What is orofacial granulomatosis?
Orofacial granulomatosis = a slightly different condition to Crohns presenting ORALLY only
- Similar symptoms to Crohns orally
- Unknown aetiology
What are the main symptoms for UC?
- Painless and bloody diarrhoea with excess mucus
- Fevers
- Remissions to near normal
How do Crohns and UC compare endoscopically?
UC has a lot less fat wrapping around the bowel
UC has a thinner bowel wall
UC has loss of striations
UC can lead to bumpy mucosa (pseudo polps) compared to Crohns where cobble stoning occurs
UC: ulcers are far more superficial, loss of micro vascular pattern with red mucosa, inflamed and bleeds easily
What is the treatment of UC?
High protein and high fibre diet
NSAIDS taken or injected through colon and into rectum
MEDICATION : Corticosteriods (anti-inflammatory), sulphasalazine, mesalazine = anti-rheumatic drug, mesalazine (anti-inflammatory), thriopurines (immunosupressive drug)
Surgery may be required partially if this is long term as there is a risk of chronic inflammation leading onto colorectal cancer
What is the dental relevance of UC?
Oral manifestations:
SPECIFIC TO UC : Pystomatitis vegetans = Benign small white and yellow pustules
Erythematous ulcers
Snail track ulcers (painless white irregular white patch)
Labial attached gingiva, soft/hard palate, buccal mucosa and sulcus are the main sites involved here
General:
- Periodontitis
- Gingivitis
- Aphthous ulcers
- Glossitis
- Angular cheilitis
- Halitosis
- Acidic taste
What indications in UC suggest for us to do surgery?
Acute: Failure of medical treatment for 3 days Toxic dilatation = large bowel is obstructed and inflating Haemorrhage Perforation
Chronic: - Poor response to medical treatment Excessive steroid use over a long time risking addisonian dependance Non compliance with medication Risk of cancers
Is Crohn’s or UC more of a risk of colon cancer?
UC
What site of the colon is cancer most common?
Rectum
What is the difference in presentation of a colon cancer of the left colon and right colon?
Left colon (descending part dealing with harder faeces that gets stuck) = bleeding rectum, tenesmus (feeling the need for a poo but there is an empty rectum) Right colon (ascending colon dealing with liquid food) = anaemia, weight loss and abdominal pain
What are the symptoms for colon cancer?
Bleeding rectum Blood in stool Abdominal bloating Weight loss Abdominal pain Change in bowel habits including diarrhoea or constipation Weakness and fatigue Secondary affects : loss of appetite, symptoms of anaemia (shortness of breath, headaches) due to loss of blood
What is diverticular disease?
Due to herniation of the bowel mucosa through the bowel wall at a weak point
Mimics many other conditions
Inflammation results in pain and discomfort
Treatment is high fibre diet
May need surgery if small deposits have calcified is eroding the mucosal surface risking peritonitis
Example = Killian’s dehiscence through Zenerkers diverticulum
What are the main symptoms of irritable bowel syndrome?
- Intermittent diarrhea
- Abdominal pain
- Bloating
