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Diseases of human systems > Lower GI tract > Flashcards

Lower GI tract Flashcards

1
Q

What makes up the lower GI tract

A

Jejunum
Ileum​
(appendix)​
Caecum​
Colon (ascending, transverse, descending, sigmoid)​
Rectum ​
Anus

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2
Q

What are the diseases associated with the lower GI tract

A

Coeliac disease​

Inflammatory bowel disease ​

Bowel cancer

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3
Q

What percentage of the popln have coeliac disease

A

1%

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4
Q

What is coeliac disease

A

An autoimmune disease
Triggered by eating gluten (barley, rye, wheat)​

Peptide molecules

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5
Q

What is the pathophysiology of coeliac disease

A

Loss of immune tolerance to gluten​

Autoantibodies created (anti-tTG*)​

Target the epithelial cells of small intestine​

Inflammation of intestinal wall - reduced area for absorption

Results in gut symptoms and malabsorption

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6
Q

What reduces the surface area with coeliac disease

A

Inflamation (atropphy) of the villi

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7
Q

Absorption of what substances are impacted by coeliac disease

A

Iron*​

Folic acid​

Vitamin B12​

Calcium​

Vitamin D​

Fat

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8
Q

What are the symptoms of coeliac disease

A

Abdominal pain​

Bloating​

Diarrhoea​

Nausea and vomiting​

Weight loss​

Fatigue​

Recurrent oral ulcers​

Children – failure to thrive

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9
Q

How is coeliac disease tested for

A

Patient must continue eating gluten when being investigated for coeliac​

Bloods: - FBC, haematinics ​
- anti-tTG antibody (tissue transglutaminase) – first line*​
- EMA (endomysial antibody) – second line​

Endoscopy + duodenal biopsy (gold standard)​
Classic findings: villous atropy, crypt hyperp

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10
Q

How is coeliac disease managed

A

Gluten-free diet - dietician input (barley, rye, wheat)​

Improves symptoms​
Reverses histological changes​
Reduces lymphoma risk ​

​
Correct deficiencies (iron, folate, B12

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11
Q

What are some possible complications/effects of having coeliac disease

A

Nutritional deficiencies​

Anaemia​

Osteoporosis​

Dermatitis herpetiformis​

Lymphoma of small intestine*

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12
Q

What causes dermatitis herpetiformis

A

As a result of autoantibodies (IgA) being deposited in skin

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13
Q

What are the dental implications of coeliac disease

A

Children​
Tooth development (enamel hypoplasia, delayed eruption)​

​

Haematinic malabsorption​
-Recurrent oral ulceration – need to exclude coeliac disease​
-Glossitis (atrophic if iron)​
-Oral dysaesthesia​
-Angular cheilitis​
-Candidal infections

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14
Q

What is inflammatory bowel disease

A

Recurrent episodes of inflammation in the gastrointestinal tract​

Exacerbation and remission

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15
Q

What are the two main types of inflammatory bowel disease

A

Crohn’s disease​

Ulcerative colitis

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16
Q

What causes inflammatory bowel disease

A

Immunologically driven, cause = unknown

Genetic susceptibility​

Gut microbiome​

Psychosocial (stress, trauma)

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17
Q

What are the shared symptoms of crohn’s disease and ulceerative colitis

A

Weight loss​

Fatigue​

Abdominal pain​

(Bloody) diarrhoea​

Rectal bleeding

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18
Q

What does crohn’s disease do to the lower GI tract

A

Inflammation of GI tract wall​
-Can involve any part of GI tract (mouth to anus)​
-Most commonly ileo-caecal and perianal regions​

​

Transmural inflammation​
-Full thickness of GI wall – all layers​

​

“Skip lesions”​
-Alternating regions of involved and non-involved tissue

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19
Q

What is the pathophysiology of crohn’s disease

A

Trigger ​

Inflammatory infiltrate (CD4, CD8, B cells, monocytes)​

Ulceration of mucosa​

Invasion of deeper mucosal layers​

Formation of granulomas​

Formation of crypt abscesses

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20
Q

What is a granuloma

A

A tight cluster of immune cells, in an attempt to isolate a foreign pathogen or irritant

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21
Q

What are the tests for crohn’s disease

A

Bloods:​
-FBC, haematinics​
-CRP (inflammatory marker)​
-anti-tTG (to exclude coeliac disease)​

Faecal calprotectin: ​
stool sample analysed, calprotectin produced by gut when inflammation is present​

Colonoscopy + biopsy- Classic biopsy findings: ​
Transmural inflammation ​
Granulomas (non-caseating)​
Crypt abscesses

22
Q

What surgical management of crohn’s disease is there

A

Up to 80% patients​

Resection of persistently inflamed bowel​

Usually results in stoma (ileostomy/colostomy)

23
Q

What madication is given for crohns disease

A

Immunosuppressants:
Azathioprine​
Mercaptopurine​
Methotrexate​
Biologics (infliximab)

24
Q

What induces remission of crohns disease

A

Corticosteroids (e.g. oral prednisolone, IV hydrocortisone)

25
Q

What are the possible complications of crohn’s disease

A

Fistula​

Severe abdominal infections​

Anaemia (malabsorption of iron/folate/B12)​

Orofacial involvement* (up to 60%)​

26
Q

What are the dental implications/symptomsof crohns disease

A

Buccal oedema​

Cobblestoning (buccal surface bumpy)

Linear, sulcal ulceration

Mucosal tags

Lip fissuring

27
Q

What is orofacial granulomatosis (OFG)

A

Heterogenous group of conditions resulting in orofacial swelling​

Granulomatous inflammation​

28
Q

What would a very swollen face and lips possibly indicate

A

Crohn’s disease
(OFG)

29
Q

What is the difference in the inflammation of ulcerative colitis and crohn’s disease

A

Only superficial mucosa affected​

Unlike Crohn’s

30
Q

What is ulcerative colitis

A

Inflammation of GI tract wall​
Limited to colon and rectum, never into small intestine​

​

Only superficial mucosa affected

Continuous inflammation​
Starts at rectum and moves proximally (“up the GI tract”)

31
Q

What is the pathophysiology of ulcerative colitis

A

Trigger (genetic/environmental/previous GI infection/smoking is protective)​

Leaky gut epithelial barrier​

Antigens activate mucosal immune cells​

Dysregulated immune response​

Ulceration of gut mucosa​

Formation of crypt abscesses

32
Q

How is ulcerative colitis tested for

A

Bloods:​
FBC, haematinics​
CRP (inflammatory marker)​
anti-tTG (to exclude coeliac disease)​

Faecal calprotectin: ​
stool sample analysed, calprotectin produced by gut when inflammation is present​

Colonoscopy + biopsy-Classic biopsy findings: ​
No inflammation beyond submucosa​
Widespread ulceration​
Crypt abscesses​
No granulomas

33
Q

What surgery is suggested for ulcerative colitis

A

Panproctocolectomy is curative (removal of entire large bowel and rectum)

34
Q

What management options for ulcerative colitis are there

A

Inducing remission​
Mild/moderate: rectal or oral mesalazine (5-ASA)​
Severe: IV hydrocortisone ​

Maintenance​
-Rectal mesalazine​
-Azathioprine​
-Mercaptopurine

35
Q

What are some complications of ulcerative colitis

A

Toxic megacolon – sepsis/death​

Bleeding (haemorrhage)​

Bowel cancer*​

Primary sclerosing cholangitis ​

Bile duct scarring​

Red eye conditions (episcleritis, anterior uveitis)

36
Q

What are the dental implications of IBD

A

Orofacial features of CD​
-Buccal oedema​
-Linear, sulcal ulcers​
-Mucosal tags​
-Buccal cobblestoning​
-Lip fissure​

Malabsorption​
-Haematinic deficiency – recurrent oral ulceration​

Stomatitis gangrenosum (1%)​
-Ulcer with necrotic borders​

Drug-related​
-Corticosteroids – candidosis​
-Methotrexate – oral ulcer

37
Q

What are the modifiable risk factors of bowel cancer

A
  • Dietary red meat​
  • Low dietary fibre​
  • Obesity​
  • Smoking​
  • Alcohol​
  • Not engaging with screening
38
Q

What are the Non-modifiable risk factors of bowel cancer

A
  • Age >50​
  • Family history​
  • IBD (UC)​
  • Intestinal polyps
39
Q

What does bowel cancer affect

A

Colon or rectum
small intestine less common

40
Q

What type of tumour is bowel cancer

A

Adenocarcinoma

41
Q

How is bowel cancer detected

A

Colonoscopy + biopsy (gold standard)​

Staging CT scan (chest, abdomen and pelvis – to look for metastasis)

42
Q

What are the symptoms/signs of bowel cancer

A

Change in bowel habits (constipation, diarrhoea, tenesmus)​

Bleeding (in stool or on wiping)​

Unexplained weight loss​

Iron deficiency anaemia​

Abdominal mass​

Abdominal pain/discomfort

43
Q

How is the treatment for any cancer patient decided

A

By multidisciplinary team
Surgeons / radiologists / pathologists / oncologists / nurse specialists

And by patients wishes

44
Q

What are the management options for bowel cancer

A

Surgery​

Chemotherapy​

Radiotherapy​

Palliative care

45
Q

What does the MDT’s decision depend on when deciding how to treat cancer

A

Stage of cancer​

Grade of cancer​

Medical history​

Performance status (fitness)​

Patient and family wishes

46
Q

What is required after surgical management of bowel cancer

A

Stoma

47
Q

How is bowel cancer screening carried out in scotland

A

Every 2 years to men and women aged 50-74 (Scotland)​

FIT (faecal immunohistochemical test)​
Essentially identifies and quantifies haemoglobin in stool

48
Q

What is done if a screening patients sample is abnormal

A

Colonoscopy

49
Q

What are the dental implications of bowel cancer

A

Anaemia as a presenting symptom​
-We can pick this up and signpost​

Effects of cancer treatment​
-Chemo- / radiotherapy

50
Q

What guidelines can a dentist consult when treating cancer patients

A

RCS - the oral management of oncology patients requiring radiotherapy,chemotherapyand/or bone marrow transplantation

Diseases of human systems (7 decks)

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