Lower GI Flashcards
List some non-specific oral signs and symptoms of lower GI disorders:
- secondary to malabsorption and/or blood loss
- haematinic deficiency with or w/out anaemia
- recurrent oral ulceration
- angular cheilitis
- candidal infections
- glossitis
- burning mouth syndrome
What is coeliac disease?
Characterised by?
Pre-disposing factors?
Coeliac disease: autoimmune condition in which glutens activate abnormal mucosal response with chronic inflammation and damage to the lining of the small intestine
Characterised by villous atrophy and crypt hyperplasia
Pre-disposing factors:
- genetic
- autoimmune thyroid gland disease
- type 1 DM
What are the symptoms of coeliacs disease?
Diagnosis?
Symptoms:
- malabsorption: malaise, diarrhoea, steatorrhoea, weight loss, iron and folate deficiency, protein deficiency
- severe or persistent mouth ulcers
- dental enamel defects
Diagnosis: blood test - serology for IgA tTGA, if positive, endoscopy and biopsy
How is coeliacs disease managed?
Dental aspects?
Management:
- gluten free diet, correct deficiencies, assess osteoporosis risk
Dental aspects of Coeliacs Disease:
- oral features of malabsorption - oral ulceration
- bisphosphonates (osteoporosis risk)
- choice of drug preparations - affects absorption of drugs (small intestine)
What is the distinct pathological appearance of Crohns and Ulcerative Colitis?
Crohn’s - from mouth to anus, not continuous (‘‘skip lesions’’) - areas of gut unaffected between areas affected
- transmural inflammation - affects all layers of gut wall
Ulcerative Colitis - large intestine, continuous
- mucosal inflammation - only affects superficial layer
What are the symptoms of inflammatory bowel disease?
Relapsing and remitting Symptoms:
Crohn’s:
- malabsorption
- adbominal pain
- bleeding
- abscess, fistula, sinus formation
- oral features
Ulcerative Colitis
- bloody diarrhoea
- abdominal pain (less so than with Crohns)
How is inflammatory bowel disease diagnosed?
Treated?
- clinical: colonoscopy/endoscopy –> biopsy
- radiology
- stool sample: rule out infective cause, faecal calprotectin
Treatment:
- suppress inflammation: DMARDS, corticosteroids, immunosuppressant’s, biologics
- surgery: remove diseased bowel, abscess drainage
- parenteral nutrition/elemental diet: bowel resting during acute episodes
- antibiotics: infective complications
Dental aspects of IBD?
Crohns oral aspects?
- recognition and link to associated systemic symptoms
- side effects of immunosuppressants and steroids
Crohns:
- oral ulceration
- mucosal tags
- cobblestone mucosa
- lip and/or facial swelling
- angular cheilitis
- stag horning of tissue around submandibular/lingual ducts, anterior FOM
- full width gingival inflammation
Dental aspects of ulcerative colitis:
Ulcerative Colitis: confined to colon
- oral manifestations are rare
- oral ulceration may be due to anaemia/iron deficiency
- pyostomatitis vegetans - diffuse mucosal oedema and erythema with multiple tiny pustules below the surface
What is diverticulitis?
Diverticulitis - due to diverticula (pouches/pockets)
- poor fibre intake in diet is a risk factor
Symptoms:
- nil usually
- bleeding
- pain - abscess formation/obstruction, infection, fever
