Lower GI disease Flashcards
understand the anatomy of the lower GI tract and understand the pathophysiology and management of coeliac disease, Crohn's disease, ulcerative colitis and bowel cancer
what is coeliac disease?
autoimmune disease triggered by eating gluten (barley, rye, wheat)
what is the pathophysiology of coeliac disaese?
4
- loss of tolerance to gluten
- autoantibodies created (anti-tTG)
- target epithelial cells of the small intestine
- inflammation of the intestinal wall
how does coeliac disease affect absorption in the GI tract?
- mucosa of small intestine arranged into villi
- inflammation causes atrophy of villi
- reduced SA for absoprtion so decreased absorption
what are the gut symptoms of coeliac disease?
8
- abdominal pain
- bloating
- diarrhoea
- nausea and vomiting
- weight loss
- fatigue
- recurrent oral ulcers
- chilren - failure to thrive
what does coeliac disease cause malabsorption of?
6
- iron
- folic acid
- vitamin B12
- calcium
- vitamin D
- fat
iron, folic, B12 have oral manifestations
how do you investigate coeliac disease?
2
- bloods - FBC, haematinics, anti-tTG antibody, EMA (endomysial antibody)
- endoscopy and duodenal biopsy - to find villous atrophy and crypt hyperplasia
how do you manage coeliac disease?
2
- gluten free diet
- correct deficiencies - iron, folate, B12
what are the complications of coeliac disease?
5
- nutritional deficiencies
- anaemia
- osteoporosis
- dermatitis herpetiformis - IgA deposited in skin
- lymphoma of the small intestine
what are the dental implications of coeliac disease?
6
- tooth development in children
- recurrent oral ulceration
- glossitis
- oral dysaesthesia
- angular cheilitis
- candidal infections
last 5 due to haematinic malabsorption
what is inflammatory bowel disease? what is its two main entities?
immunologially driven recurrent episodes of inflammation in the GI tract
* Crohn’s disease
* ulcerative colitis
what are the shared symptoms of infalmmatory bowel disease?
5
- weight loss
- fatigue
- abdominal pain
- diarrhoea (bloody)
- rectal bleeding
what is Crohn’s diease?
inflammation of the full thickness of the GI tract wall involving any part of the GI tract but in “skip lesions” - alternating regions of involved and non-involved tissue
what is the pathophysiology of Crohn’s disease?
6
- trigger
- inflammatory infiltrate
- ulceration of mucosal layers
- invasion of deeper mucosal layers
- formation of granulomas
- formation of crypt abcesses
what is a granuloma?
tight cluster of immune cells in an attempt to isolate foreign pathogen or irritant
how do you investigate Crohn’s disease?
3
- bloods - FBC, haematinics, CRP (non-specific inflammatory marker), anti-tTG
- faecal calprotectin - calprotectin produced when inflammation present
- colonoscopy and biopsy - findings: transmural inflammation, granulomas, crypt abcesses
how do you manage Crohn’s disease?
3
- inducing remission - corticosteroids (oral prednisolone, IV hydrcortisone)
- maintenance - immunosuppressants (azathioprine, mercaptopurine, methotrexate, biologics)
- surgery - resection of persistently inflamed bowel, results in stoma
what are the complications of Crohn’s disease?
4
- fistula - cavity between intestine and abdomen
- severe abdominal infection - bacteria from intestines
- anaemia - malabsorption of haematinics
- orofacial involvement
give examples of orofacial involvement in Crohn’s disease
5
- buccal oedema
- cobblestoning
- linear, sulcal ulceration
- mucosal tags
- lip fissuring
what is ulcerative colitis?
continuous inflammation of the GI tract wall, only limited to the colon and rectum and superficial layers of the wall
what is the pathophysiology of ulcerative colitis?
6
- trigger
- leaky gut epithelial barrier
- antigens activate mucosal immune cells
- dysregulated immune response
- ulceration of gut mucosa
- formation of crypt abcesses
how do you investigate for ulcerative colitis?
3
- bloods - FBC, haematinics, CRP (non-specific inflammatory marker), anti-tTG (to exclude coeliac disease)
- faecal calprotectin - calprotectin produced in gut when inflammation present
- colonoscopy and biopsy - findings: no inflammation beyond submucosa, widespread ulceration, crypt abcesses, no granulomas
how do you manage ulcerative colitis?
3
- inducing remission - rectal or oral mesalazine, IV hydrocortisone
- maintenance - rectal mesalazine, azathioprine, mercaptopurine
- surgery - panproctocolectomy (removal of entire large bowel and rectum - curative)
what are the complications of ulcerative colitis?
5
- toxic megacolon - colon swells and bursts = sepsis/death
- bleeding (haemorrhage, anaemia)
- bowel cancer - due to inflammation
- primary sclerosis cholangitis - bile duct scarring due to back flow
- red eye conditions - due to inflammation
what is the difference between Crohn’s disease and ulcerative colitis?
what are the dental implications of inflammatory bowel disease?
5
- orofacial features of Crohn’s disease
- malabsorption of haematinics - recurrent oral ulceration
- stomatitis granulosum - ulcer with necrotic borders
- drug related - corticosteroids = candidosis, methotrexate = oral ulcers
- orofacial granuloma (OFG)
what kind of cancer is bowel cancer?
adenocarcinoma - cancer of glandular tissue
what are the modifiable and non-modifiable risk factors of bowel cancer?
6,4
modifiable
* dietary red meat
* low dietary fibre
* obesity
* smoking
* alcohol
* not engaging with screening
non-modifiable
* age > 50
* family history
* IBD (ulcerative colitis)
* intestinal polyps
what are the signs/symptoms of bowel cancer?
6
- change in bowel habits
- bleeding - in stool or wiping
- iron deficiency anaemia
- unexplained weight loss
- abdominal mass
- abdominal pain/discomfort
what investigations would you use for bowel cancer?
2
- colonoscopy and biopsy
- staging CT scan - look for metastasis
how would you manage bowel cancer? what does it depend on?
4
- surgery
- chemotherapy
- radiotherapy
- palliative care
depends on stage and grade of cancer, medial history, fitness and patient wishes
what method is used to stage the cancer?
3
TNM
* Tumour size
* Nodal involvement
* distant Metastases
what is the name of the test done when screening for bowel cancer? what does it look for?
FIT - faecal immunohistochemical test
looks for haemoglobin quantity
what are the dental implications of bowel cancer?
2
- anaemia as a presenting symptom
- effects of cancer treatment
