GI Tract- diseases Flashcards
What medication can be used to eliminate acid formed in the GI tract?
Antacid
What medications can be used to reduce acid secretion in the GI tract?
Proton pump inhibitors e.g. omeprazole
H2 receptor blockers which prevent the activation of acid production of histamine
e.g. Ranitidine
How can we improve the mucosal barrier in the GI tract?
Eradicate the helicobacter plylori-
Inhibit prostoglandin removal.
What is an aphthae?
An ulcer
Compare the types of aphthae.
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)
A patient exhibits these symptoms. Name the symptoms and diagnose the patient.
Cobblestoning
Angular Chelitis
Swollen lips
The patient has orofacial granulomatosis OR oral chrons (dependent on if there is GI tract involvement)
what is orofacial granulomatosis?
When granuloma cells cause a blockage in the lymphatic channels. The lymph fluid still coming from the capillaries causes the swelling.
Name the inflamatory disease that can be caused by amalgam fillings?
Lichen planus
What is dysphagia?
Difficulty swallowing
What are the symptoms of Gastro-oesophageal reflux disease?
epigastric burning
dysphagia
GI bleeding
pain due to osephageal muscle spasm
Discuss the causes of GORD
- 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.
How is GORD treated?
Antacids
H2 blockers and PPIs
Stop smoking
lose weight and avoid triggering activity.
Increase GI motility and gastric emptying.
What does Gastro-Osophageal reflux disease cause?
- Ulceration
- Inflammation
- Metaplasia (Barretts’ oesophagus)
The stomach acid has changed columnar epithelium into sqaumous epithelium. (pre-cancerous)
Compare the two types of hiatus hernia.
Sliding- stomach is wider at the bottom of the oesophagus
Rolling- Fundus extends at a seperate site to the oesophagus
What is peptic ulcer disease?
Acid associated ulceration
What causes peptic ulcer disease?
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.
Discuss the symptoms of Peptic ulcer disease?
Epigastric burning pain- worse before or after meals.
Relieved by eating or vomiting.
How can we investigate peptic ulcer disease?
endoscopy
barium swallow
Has the bleeding from the ulcer caused anaemia.
Discuss the local and systemic complications of peptic ulcer disease?
local-
perforation (hole)
stricture (scarring)
Haemorrhage
malignancy.
systemic- anaemia.
How can we treat Peptic ulcer disease?
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 )
Compare a bilroth 1 and bilroth 2 surgical procedure.
Bilroth 1- top half of stomach is connected to the duodenum
bilroth 2- top half of stomach is connected to the small bowel
Discuss helibacter pylori
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.
How do we eradicate helibactor pylori?
Triple therapy for 2 weeks
2 antibiotics:
Amoxicillin
metronidazole
1 Proton Pump inhibitor-
Omeprazole
What is coeliac disease?
This is a loss of surface area (and villi) in the jejunum due to a sensitivity of gluten
Compare the effects of coeliac disease on an adult and a child?
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
How does coeliac disease present in a patient’s mouth?
There are mouth ulcers due to a folic acid malabsorption.
List symptoms of coeliac disease?
Weight loss
lassitude (lack of energy)
weakness
Statorrhoea
dysphagia
Diahorrea
Apthae
Abdominal swelling.
How do we investigate coeliac disease?
jejunal biopsies
look at faecal fat levels
Autoantibodies (sensitive test but not specific)
How do we treat coeliac disease?
Gluten free diet to reverse jejunal atrophy.
What are the symptoms of a bowel carcinoma.
Rectal bleeding
anaemia
Can be asymptomatic
How do we screen for a bowel carcinoma?
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.
Describe the aetiology of a bowel carcinoma?
Most cancers arise in polyps.
Polyps can be flat or pedunculated (on a stalk).
Irritation and trauma will cause polyp bleeding.
What is shown in this patient image? and what does it tell us about the patient?
Peutz- Jehgers syndrome.
The patient has a small intestine polyposis.
What is shown in this patient image? and what does it tell us about the patient?
This is cowden’s syndrome.
The patient has a polyp in the large intestine (high risk of carcinoma)
Compare Chron’s disease to Ulcerative colitis in terms of:
- site
- inflamation progress
- features
- serosa involvement
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.
Compare the symptoms of chrons and ulcerative colitis.
Ulcerative colitis-
Blood from elsewhere that passes through the rectum.
abdominal pain
Diahorrea
Intestinal chrons= ulcerative colitis symptoms.
Oral chrons- Orofacial granulomatosis symptoms
Why do we check for faecal calprotectin when investigating chrons disease?
Calprotectin is released when there is inflamation. The level of calprotectin will tell us if the bowel is inflamed or not.
Discuss the medical treatment of inflamatory bowel diseases
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)
Compare the surgical treatment of chrons disease and ulcerative colitis?
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)
How do we stage a colonic carcinoma
Dukes classification.
What is dukes classification A?
Carcinoma in the submucosa
What is duke’s classification B?
A colonic carcinoma that extends into the muscularis
What is duke’s classification C?
A colonic carcioma that extends into the lymph nodes
What is duke’s classification D?
A colonic carcinoma that has spread (metastases) most commonly to the liver.
Discuss the dental relevance of GORD?
Erosion of teeth.
How would we treat a patient with recurrent ulcers?
Benzthiazide- a steroid spray which getrs rid of ulcers quicker.
The patient should not rinse their mouth out after use.
