GI Tract- diseases Flashcards

1
Q

What medication can be used to eliminate acid formed in the GI tract?

A

Antacid

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2
Q

What medications can be used to reduce acid secretion in the GI tract?

A

Proton pump inhibitors e.g. omeprazole

H2 receptor blockers which prevent the activation of acid production of histamine

e.g. Ranitidine

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3
Q

How can we improve the mucosal barrier in the GI tract?

A

Eradicate the helicobacter plylori-

Inhibit prostoglandin removal.

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4
Q

What is an aphthae?

A

An ulcer

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5
Q

Compare the types of aphthae.

A

Minor- surrounded by a red and inflamed border

Major- larger than a cm

Herpetiform- many small ulcers only found on keratinised mucosa (e.g. floor of the tounge)

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6
Q

A patient exhibits these symptoms. Name the symptoms and diagnose the patient.

A

Cobblestoning

Angular Chelitis

Swollen lips

The patient has orofacial granulomatosis OR oral chrons (dependent on if there is GI tract involvement)

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7
Q

what is orofacial granulomatosis?

A

When granuloma cells cause a blockage in the lymphatic channels. The lymph fluid still coming from the capillaries causes the swelling.

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8
Q

Name the inflamatory disease that can be caused by amalgam fillings?

A

Lichen planus

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9
Q

What is dysphagia?

A

Difficulty swallowing

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10
Q

What are the symptoms of Gastro-oesophageal reflux disease?

A

epigastric burning

dysphagia

GI bleeding

pain due to osephageal muscle spasm

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11
Q

Discuss the causes of GORD

A
  • defective lower oesophageal sphincter
  • impared lower clearing
  • impaired gastric emptying

What you are putting in is not being cleared out leaving the patient’s stomach fuller than it should be.

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12
Q

How is GORD treated?

A

Antacids

H2 blockers and PPIs

Stop smoking

lose weight and avoid triggering activity.

Increase GI motility and gastric emptying.

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13
Q

What does Gastro-Osophageal reflux disease cause?

A
  • Ulceration
  • Inflammation
  • Metaplasia (Barretts’ oesophagus)

The stomach acid has changed columnar epithelium into sqaumous epithelium. (pre-cancerous)

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14
Q

Compare the two types of hiatus hernia.

A

Sliding- stomach is wider at the bottom of the oesophagus

Rolling- Fundus extends at a seperate site to the oesophagus

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15
Q

What is peptic ulcer disease?

A

Acid associated ulceration

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16
Q

What causes peptic ulcer disease?

A

Helicobactor pylori

Drugs- NSAIDs and Steroids can cause ulcers.

Too much acid produced in the duodenum (Thinner wall so easier to perforate)

normal acid secretion in the stomach but reduced resistance of the stomach to the acid.

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17
Q

Discuss the symptoms of Peptic ulcer disease?

A

Epigastric burning pain- worse before or after meals.

Relieved by eating or vomiting.

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18
Q

How can we investigate peptic ulcer disease?

A

endoscopy

barium swallow

Has the bleeding from the ulcer caused anaemia.

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19
Q

Discuss the local and systemic complications of peptic ulcer disease?

A

local-

perforation (hole)

stricture (scarring)

Haemorrhage

malignancy.

systemic- anaemia.

20
Q

How can we treat Peptic ulcer disease?

A

medical -

eliminate the helibactor pylori

Ulcer healing drugs

Lifestyle- eat regular meals &stop smoking

Surgical

Gastrectomy (remove part of stomach)

Vagotomy (sever the vagus nerve to reduce acetyl choline so less acid is secreted )

21
Q

Compare a bilroth 1 and bilroth 2 surgical procedure.

A

Bilroth 1- top half of stomach is connected to the duodenum

bilroth 2- top half of stomach is connected to the small bowel

22
Q

Discuss helibacter pylori

A

This is a bacteria that lives in the stomach and causes inflamation of the gastric muocsa.

It results in gastric ulcers and chronic gastric wall inflamation.

23
Q

How do we eradicate helibactor pylori?

A

Triple therapy for 2 weeks

2 antibiotics:

Amoxicillin

metronidazole

1 Proton Pump inhibitor-

Omeprazole

24
Q

What is coeliac disease?

A

This is a loss of surface area (and villi) in the jejunum due to a sensitivity of gluten

25
Q

Compare the effects of coeliac disease on an adult and a child?

A

malabsorption causes malnourishment in a child means they will not grow at the same rate.

Coeliac disease in an adult will not be as obvious as you don’t need to grow

26
Q

How does coeliac disease present in a patient’s mouth?

A

There are mouth ulcers due to a folic acid malabsorption.

27
Q

List symptoms of coeliac disease?

A

Weight loss

lassitude (lack of energy)

weakness

Statorrhoea

dysphagia

Diahorrea

Apthae

Abdominal swelling.

28
Q

How do we investigate coeliac disease?

A

jejunal biopsies

look at faecal fat levels

Autoantibodies (sensitive test but not specific)

29
Q

How do we treat coeliac disease?

A

Gluten free diet to reverse jejunal atrophy.

30
Q

What are the symptoms of a bowel carcinoma.

A

Rectal bleeding

anaemia

Can be asymptomatic

31
Q

How do we screen for a bowel carcinoma?

A

We invite for screenings from age 50 every 5 years.

FOB- looking for blood in bowel motions

If there is blood in the stool sample we complete an endoscopy.

32
Q

Describe the aetiology of a bowel carcinoma?

A

Most cancers arise in polyps.

Polyps can be flat or pedunculated (on a stalk).

Irritation and trauma will cause polyp bleeding.

33
Q

What is shown in this patient image? and what does it tell us about the patient?

A

Peutz- Jehgers syndrome.

The patient has a small intestine polyposis.

34
Q

What is shown in this patient image? and what does it tell us about the patient?

A

This is cowden’s syndrome.

The patient has a polyp in the large intestine (high risk of carcinoma)

35
Q

Compare Chron’s disease to Ulcerative colitis in terms of:

  • site
  • inflamation progress
  • features
  • serosa involvement
A

Site: Chron’s disease can occur all down the GI tract, Ulcerative colitis occurs in the colon.

Inflamation progress: Chron’s disease is discontinuous. Ulcerative colitis is continuous, it starts in the rectum and works its way up.

Features: Chron’s is non vascular/ Ulcerative colitis is vascular

Chrons has a cobbled mucosa and fissures

Ulcerative colitis has granular mucosa and ulcers.

Serosa involvment- Chrons inflamation extends the full thickness of the bowel wall. Ulcerative colitis only the top layer is inflamed no serosa involvement.

36
Q

Compare the symptoms of chrons and ulcerative colitis.

A

Ulcerative colitis-

Blood from elsewhere that passes through the rectum.

abdominal pain

Diahorrea

Intestinal chrons= ulcerative colitis symptoms.

Oral chrons- Orofacial granulomatosis symptoms

37
Q

Why do we check for faecal calprotectin when investigating chrons disease?

A

Calprotectin is released when there is inflamation. The level of calprotectin will tell us if the bowel is inflamed or not.

38
Q

Discuss the medical treatment of inflamatory bowel diseases

A

If to do with the patient’s immune system we want to supress it using:

  • systemic Steroids (prednisolone)
  • local steroids
  • NSAIDs (Pentasa/ Mesalazine/ Sulphasalazine)
  • Non steroidal immunosupressants (azathioprine/ methotrexate)
39
Q

Compare the surgical treatment of chrons disease and ulcerative colitis?

A

In Chron’s disease you remove the obstructed bowel segments

in Ulcerative colitis it is a colectomy (where all or part of the colon is removed)

40
Q

How do we stage a colonic carcinoma

A

Dukes classification.

41
Q

What is dukes classification A?

A

Carcinoma in the submucosa

42
Q

What is duke’s classification B?

A

A colonic carcinoma that extends into the muscularis

43
Q

What is duke’s classification C?

A

A colonic carcioma that extends into the lymph nodes

44
Q

What is duke’s classification D?

A

A colonic carcinoma that has spread (metastases) most commonly to the liver.

45
Q

Discuss the dental relevance of GORD?

A

Erosion of teeth.

46
Q

How would we treat a patient with recurrent ulcers?

A

Benzthiazide- a steroid spray which getrs rid of ulcers quicker.

The patient should not rinse their mouth out after use.