Lower GIT

Question 1

what are the components of the lower GIT?

Answer 1

small intestine - jejunum, ileum

large intestine - colon

Question 2

what occurs in the small intestine?

Answer 2

digestion and absorption of nutrients

Question 3

what is absorbed in the duodenum?

Answer 3

iron

Question 4

what is absorbed in the jejunum? 2

Answer 4

iron
folate

Question 5

what is absorbed in the ileum?

Answer 5

vitamin B12

Question 6

what occurs in the large intestine? 3

Answer 6

absorption of water and electrolytes
faeces is formed and stored temporarily
bacteria ferment indigestible material

Question 7

what is required for vitamin B12 absorption?

Answer 7

intrinsic factor produced by the gastroparietal cells

Question 8

how does lower GIT bleeding present?

Answer 8

fresh blood mixed with stool - haematochezia
may not be visible - occult blood

Question 9

what radiological investigations are used to look at the GIT?

Answer 9

Barium swallow
Barium meal
Barium enema

Question 10

what is the difference between barium swallow and meal?

Answer 10

barium meal follows through to the small intestine

Question 11

what is a barium enema?

Answer 11

administered by a tube inserted into rectum
for imaging of the colon

Question 12

how can the small intestine be imaged visually?

Answer 12

endoscopy

Question 13

how can the large intestine be examined?

Answer 13

sigmoidoscopy
colonoscopy

Question 14

what is the difference between a sigmoidoscopy and colonoscopy

Answer 14

colonoscopy - the whole colon is explored
sigmoidoscopy - lower 1/3 of colon

Question 15

name 4 lower GI disorders

Answer 15

coeliac disease
inflammatory bowel disease
diverticular disease
irritable bowel syndrome

Question 16

what is coeliac disease?

Answer 16

autoimmune condition where gluten activated an abnormal mucosal response with chronic inflammation and damage to the lining of the small intestine

Question 17

what is gluten found in? 3

Answer 17

wheat
barley
rye

Question 18

what results from the inflammatory response from coeliac disease? 2

Answer 18

villous atrophy
crypt hyperplasia

Question 19

what is villous atrophy?

Answer 19

villi of small intestine erode away leaving a virtually flat surface

Question 20

what is crypt hyperplasia?

Answer 20

when the intestinal crypts are longer than normal

Question 21

what factors increase the risk of developing coeliac disease? 3

Answer 21

genetic
autoimmune thyroid gland disease
type 1 diabetes

Question 22

what are the symptoms of coeliac disease? 4

Answer 22

malaise - general feeling of illness/fatigue
abdominal discomfort
diarrhoea
weight loss

Question 23

coeliac disease can cause malabsorption so leads to deficiencies in? 3

Answer 23

iron
folate
B12

Question 24

how is coeliac disease managed? 3

Answer 24

gluten free diet
correct any deficiencies
asses osteoporosis risk

Question 25

how is coeliac disease monitored?

Answer 25

annual review with blood tests

Question 26

what is dermatitis herpetiformis?

Answer 26

immunobullous disease linked to coeliac disease may affect the oral mucosa

Question 27

what are the most common oral manifestations of coeliac disease? 2

Answer 27

oral ulceration enamel hypoplasia

Question 28

patients with coeliac disease who have osteoporosis may be taking bisphosphonates, what dental affect does this have?

Answer 28

increase risk of developing osteonecrosis of the jaws after certain dental treatment

Question 29

irritable bowel disease includes what two diseases?

Answer 29

Crohn's disease ulcerative colitis

Question 30

where in the body is ulcerative colitis found?

Answer 30

large intestine

Question 31

where in the body is Crohn's disease found?

Answer 31

entire GI tract

Question 32

what is inflammatory bowel disease?

Answer 32

chronic inflammatory diseases of unknown cause

Question 33

what are the differences in inflammation between Crohn's and ulcerative colitis?

Answer 33

ulcerative colitis the inflammation is continuous and mucosal Crohn's the inflammation is not continuous and transmural

Question 34

oral features of Crohn's disease 5

Answer 34

oral ulceration mucosal tags lip swelling gingival inflammation cobblestone mucosa

Question 35

how is inflammatory bowel disease investigated? 3

Answer 35

blood test stool sample colonoscopy

Question 36

how is Crohn's disease managed? 3

Answer 36

corticosteroids immunosuppressants biological therapy

Question 37

how is ulcerative colitis managed? 4

Answer 37

aminosalicylates corticosteroids immunosuppressants biological therapy

Question 38

how is IBD treated?

Answer 38

surgery (Crohn's not curative) parenteral nutrition (IV) - bowel resting antibiotics for complications

Question 39

what does diverticula mean?

Answer 39

they are pouches of the colonic mucosa which have passed through the muscular wall of the colon

Question 40

what is diverticulosis?

Answer 40

Diverticula are present but asymptomatic

Question 41

what is diverticular disease?

Answer 41

Symptoms, e.g. lower abdominal pain, are present

Question 42

what is diverticulitis

Answer 42

The diverticula are inflamed and infected, the patient may feel generally unwell, feverish and suffer from acute abdominal pain

Question 43

name 3 functional GI disease

Answer 43

irritable bowel syndrome functional dyspepsia functional consitpation

Question 44

what is IBS

Answer 44

abdominal pain with altered bowel habit

Question 45

how is IBS treated? 4

Answer 45

fibre anti-spasmodics amitriptyline SSRIs

Question 46

what drugs can exacerbate IBD and IBS

Answer 46

NSAID's

Question 47

name some symptoms associated with GIT diseases secondary to aneamia/haematinic deficiency as a result of malabsorption and blood loss 5

Answer 47

aphthous like ulceration angular cheilitus (corners of mouth) oral candidosis (thrush) glossitis (tongue) burning sensation in mouth