GI Tract Diseases

Question 1

Caries or cavity

Answer 1

bacterial infection that erodes + invades the tooth structure (common in children)

prevented by Fluoride !!

can lead to growth restrictions + slow development and predispose to other illnesses

Question 2

peridontal disease

Answer 2

bacterial invasion of gingival pockets around tooth root from Porphyromonas gingivalis leading to tooth loss and halitosis

worsens with pneumonia, DM, CVD, CVA, pregnancy

Question 3

oral and oropharyngeal cancer

Answer 3

RF: tobacco use, ETOH use, and age
oral cancer is 75% squamous cell carcinoma on hard palate or gums

oropharyngeal cancer is 70% human papilloma virus on soft palate, pharynx, tonsils

Question 4

sialedenitis: what is it? how is it caused? symptoms?

Answer 4

inflammation of salivary glands from viral infection (mumps) or autoimmune disease (SLE or Sjorgrens)

Sjorgren’s syndrome: clicking + dry mouth

transient puffy cheeks

Question 5

salivary tumors: most common location?

Answer 5

only 3% of all tumors; 75% are benign + usually affects parotid gland in older adults

Question 6

causes of esophageal disease

Answer 6

reflux of gastric juices, infection, idiopathic, exogenous irritants, obstructing scar, tumor, neurologic disease

Question 7

symptoms of esophageal disease

Answer 7

dysphagia + achalasia + hematemesis from mallory-weiss tear(more common and less severe) or varices (more concerning due to enlarged veins in esophagus)

Question 8

GERD

Answer 8

gastroesophageal reflux disorder

transient gastric reflux back into esophagus (20% of adults) due to abnormal lower esophageal sphincter from smoking, pregnancy, caffeine, or hiatal hernia (stomach above duodenum)

Question 9

what can hiatal hernia lead to

Answer 9

barrett’s esophagus (inflammation with glandular cells) + esophageal cancer or gastric strangulation (very rare + need sx)

Question 10

gastritis: what is it? how do you dx? what is it caused by? symptoms? tx?

Answer 10

inflamed gastric mucosa (stomach) that is acute or chronic that is diagnosed with endoscopy

caused by infection, meds (NSAIDS, steroids), ETOH abuse

may be asymptomatic or decreased appetite + pain with N/V

Tx: lifestyle changes or meds

Question 11

Gastric or duodenal ulcer

what is it? symptoms? associated with?

Answer 11

small lesions that extend into submucosa

asymptomatic OR N/V (Coffee grounds) + melena (dark feces)

Associated with H. pylori infection, alcohol and NSAID use, stress or brain injury

Question 12

h pylori

Answer 12

more than 50% of US adults affected and 10-20% get ulcers

invades the gastric mucosa and initiates inflammation

causes 90% of chronic gastritis

Dx: blood, breath, biopsy and stool
Tx: antibiotics

Question 13

Peptic Ulcer Disease

Answer 13

80% duodenum and 20% stomach

caused by h pylori or chronic aspirin/NSAIds, steroids and ETOH

chronic, recurrent deep and usually 1-2 and DO NOT resolve on its own

Question 14

outcomes of bariatric surgeries

Answer 14

low vitamin deficiency, malnutrition, poor outcomes

Question 15

indications for bariatric surgeries

Answer 15

BMI of 40 or higher OR 100 lbs overweight

BMI of 35 or higher + more than 2 comorbidities related to obesity (DM, high cholesterol, HTN, NAFLD, GI disorder)

Question 16

Gastroenteritis: what is it? what is it caused by?

how is it transmitted?

Answer 16

inflammation of stomach, colon, and SI due to infection

Viral: norovirus (low mortality and epidemic diarrhea for 3 days) or rotavirus (vaccine available, more severe, usually affects children)

Bacterial: Salmonella or C jejuni (uncooked poultry or raw milk) or e coli

food-borne, water-borne or person to person

Question 17

signs of gastroenteritis

Answer 17

abdominal pain, diarrhea, fever, dehydration

Question 18

ileus: what is it? what can it lead to? how do you treat it?

what was it caused by?

What should you avoid?

Answer 18

peristaltic paralysis - no movement which can lead to constipation, bloating, distention, nausea, vomit, absent bowel sounds

Tx: IV fluids + NG suction (nasogastric)

Caused by abdominal surgery, gastroenteritis, chemical or electrolyte imbalance, mesenteric ischemia

AVOID OPIOIDS AND ANTI-ACH

Question 19

celiac disease: what is it? what does it affect and lead to? what is tx?

Answer 19

gluten-sensitive enteropathy (type IV hypersensitivity)

affects the villi of the small intestine – atrophy, chronic diarrhea, unexplained anemia, chronic fatigue, weight loss

Tx: avoid wheat (gluten)

Question 20

IBS

Answer 20

functional disorder with NO pathology (recurrent + onset around late teens)

abdominal pain, bloating and altered frequency/consistency of stool

Tx: increase fiber + decrease FODMAPS, exercise, decrease stress, probiotics ~ tailored to individual

Question 21

inflammatory bowel disease caused by?

ocular manifestations?

onset?

Tx?

Answer 21

ulcerative colitis: nongranulamatous lesions in colon + continuous (SUPERFICIAL)

crohn disease: granulamatous lesions, discontinued, in GI tract (DEEP)

Ocular: conjunctivitis, uveitis, episcleritis

autoimmune etiology onset, family history, involvement of extra-intestinal tissue

Tx: immunosuppressants or sx (strictures or obstructions)

Question 22

Diverticulosis

Answer 22

low fiber diet and 50% are over 60 years old

usually obese + low physical activity

Question 23

diverticulum

Answer 23

blind pouch usually in sigmoid colon

diverticulitis: inflammation of the pouch ususally in sigmoid colon (lower left quadrant) with fever, pain, and tenderness

Tx: can be avoided with diet so initially lower fiber + fluids and long term increase fiber in diet

Question 24

what can a diverticulitis lead to

Answer 24

fistula, abscess, scarring, fibrosis of walls

Question 25

acute appendicitis: common in what age? symptoms? pathology?

Answer 25

common in teens and affects 10% of population

lower right tenderness, abdominal pain, fever, nausea, fever, anorexia

the initial obstruction will increase pressure and lower the blood flow and lead to edema, ischemia, necrosis, bacterial overgrowth, and rupture or peritonitis

Question 26

CEA

Answer 26

carcinoembryonic antigen

monitoring tool for colon cancer treatment

not for screening bc rarely detected when it is treatable carcinoma

Question 27

2nd leading cause of cancer deaths

Answer 27

colorectal cancer - prognosis depends on time of diagnosis

RF: genetics + diet + age

adenocarcinomas arise from colonic adenomas that are usually benign and transform over the years

Question 28

colon polyps

Answer 28

common in lower colon and rectum (usually benign)
in-situ: 5 year prognosis

sessile polyp: broad and short base (more common)

pedunculate polyp: long and narrow stalk

Question 29

familial adenomatous polyposis

genetics? pathology? symptoms?

Answer 29

autosomal dominant disease (APC gene) also called Gardner Disease

polyps develop in teen years + develop to colon cancer by 30s

Ocular: Bear Tracks + CHRPE (multiple in 65%) or bilateral in 87%
- if you see this, ask about colon cancer history