GI Flashcards
Peptic Ulcer
Ulcer from chronic acid / pepsin (protease) secretion in stomach
1 Helicobacter pylori.
Causes:
Location: duodenum (western), stomach (asian)
Risk factors: alcohol, smoking, Blood type O, phys+psych stress, NSAIDs
NSAIDS reduce prostaglandins (Pg protective role for GI mucosa)
Peptic Ulcer - Complications
Symptoms: sharp and long-standing (hours) of burning/gnawing epigastric pain. Vomiting = gastric outlet obstruction. Melena (bloody stools) or black tarry stools = GI hemorrhage.
Complications: Risk of perforation, hemorrhage, anemia, potential shock. Untreated ulcers heal by fibrosis, lead to pyloric stenosis, gastric outlet obstruction, dehydration, alkalosis.
Gastric Cancer: H. pylori: definite class I human carcinogen. Low-grade gastric mucosa-associated lymphoid tissue lymphoma. Greater risk for CA with stomach than duodenum
Peptic Ulcer - Diagnosis and Treatment
Diagnosis: Endoscopy with biopsy, staining for H. pylori (Warthin-Starry stain).
Treatment: combo H2 blockers/PPI + Antibiotics
Peptic Ulcer - Dental Management
Analgesics: Use Tylenol instead of NSAIDs/ASA
Abx: choice may be influenced by current regimen. Alert PCP if GI symp worsen/pseudomembranous colitis
Drug interaction: H2 blockers / PPI 2 hours before/after other drugs
Dental findings
Candidiasis (Abx), enamel erosion (gastric acid), vascular malformations of lip
IBD - Crohn’s Disease
Ulcerations at any point along GI tract (mouth-anus) but usu terminal ileum (affects entire thickness of bowel wall).
Cause: immune dysfunc due to environmental factors
Disease course: Remission/relapse. Increase risk of cancer.
Symptoms: diarrhea (no blood), abdominal pain/cramping, anorexia, weight loss. May require surgery.
Oral manifestation: mucosal ulceration (linear or cobblestone appearance), diffuse swelling of lips/checks (orofacial granulomatosis)
IBD - Ulcerative Colitis
Inflammatory disease in large intestine and rectum.
Cause: immune dysfunc due to environmental factors
Disease course: Remission/relapse. Increase risk of cancer.
Symptoms: diarrhea, rectal bleeding, abdomimnal cramps.
Progression: epith erosion, hemorrhage, pseudopolyp, crypyt abscess, fibrosis, colon shortening/constriction, toxic dilatation (toxic megacolon, can perforate) and carcinoma of intestine
Oral manifestations: aphthous-like lesions occur with GI flareup. Pyostomatitis vegetans (raised pustules) can become ulcerated. Lesions respond to topical steroid/surgery
IBD - Management for Crohn’s/UC
Medical management:
antidiarrheal
anti-inflammatory (sulfasalazine)
immunosupressants
surgery (only if severe)
Dental management:
- Moderate-severe disease refer to physician (4-6+/day, blood, fever, anemia)
- Use Tylenol instead of NSAIDs/ASA (pt usu. on steroids+NSAIDs. NSAIDs can cause flareups)
- Abx: minimize Clindamycin (C. diff).
- Adrenal suppression possible (pt on steroids).
- Immunosuppressant-induced pancytopenia (increase risk for lymphoma and infection).
Oral ulcerations: resolve when GI state is controlled. Topical steroids when symptomatic
Pseudomembranous colitis
C difficile overgrowth (gram+, anaerobic rod/spore, soil/feces).
Loss of competative anaerobic gut bacteria.
Risk factors:
- inhaled spores (hospital/farm)
- prolonged Abx, high dose, broad spectrum
- Old age
Associated Abx: Penicillins, Clindamycin, celphalosporins.
Symptoms: Usu begin 4days - 2months after admin.
Mild: watery and loose stool.
Severe: bloody diarrhea with cramps and fever.
Complications: dehyration, hypotension, metabolic acidosis
AHA prophylactic regime OK (no reported case since short term)
Treatment:
Mild: Cease offending Abx
Moderate: Metronidazole
Severe: Vancomycin or Rifaximin
Prescribing Precautions for NSAIDs
- Gastrointestinal diseases
- Cardiovascular diseases
- Asthma
- Pregnancy (esp. in 3rd trimester due to premature closure of the ductus arteriosus)
- Children (monitor dosing, overdose risk)
- Hematologic diseases
