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Systemic Disease In Dentistry > Pathology of GI > Flashcards

Pathology of GI Flashcards

1
Q

Give 4 common symptoms of GI disease

A

Nausea and vomiting
Diarrhoea
Dyspepsia and heartburn
Abdominal pain and heartburn

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2
Q

What affected organs present as upper abdomen pain?

A

Stomach – Gastritis
Gall Bladder – Gall stone in common bile duct
Duodenum – Peptic ulcer

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3
Q

What affected organs present as lower abdomen?

A

Appendix – Appendicitis
Large intestine – Crohn’s disease, Ulcerative Colitis
*Bladder – Infection

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4
Q

What affected organs present as back pain?

A

Pancreas – Pancreatitis
Colon – Crohn’s disease, Ulcerative Colitis
*Kidney (upper back) – UTI, kidney stones

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5
Q

Name signs of upper GI disease

A

Weight loss
Dysphagia
Ulceration
Bleeding

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6
Q

What are the 4 types of GI bleeding

A

Melena, haematochezia, haematemesis, faecal occult bleeding

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7
Q

What is melena?

A

Black stool caused by haemoglobin being altered by enzymes

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8
Q

What is haematochezia?

A

bright red fresh blood through ANUS

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9
Q

What is haematemesis?

A

Vomiting blood

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10
Q

What is faecal occult bleeding?

A

Blood in faeces that is not visibly apparent

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11
Q

What are sign of Crohn’s in the face and hands?

A

Angular cheilitis, facial swelling, orofacial ganulomatosis, beefy tongue, oral ulcers and joint pain

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12
Q

What are sign of coeliac disease in the face and hands?

A

Pallor of face and hands blistering rash, bruising and swelling of hands.

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13
Q

Name 2 signs of ulcerative colitis in face and hands

A

Angular cheilitis and finger clubbing

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14
Q

What 6 investigations can be used for GI queries

A
  1. Stool analysis
  2. Urea Breath Test
    ❖ HELICOBACTER PYLORI converts urea → CO2 + Ammonia
  3. Full Blood Count
  4. Endoscopy
    ❖ To assess a mass or ulcer
  5. Biopsy
  6. Ultrasound
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15
Q

What is acute abdomen?

A

Sudden onset of severe abdominal pain developing over a short period of time

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16
Q

What are the surgical and medical causes of acute abdomen?

A

Surgical - ruptured aortic aneurysm, perforation of organ

Medical - addisons disease, diabetic ketoacidosis

17
Q

What is the aetiology, pathogenesis, symptoms, investigations, complications and pathological appearance (macro and micro) of gastritis and peptic ulcers

A 
❖ Aetiology 
▪ HELICOBACTER PYLORI, NSAIDS, alcohol 
❖ Pathogenesis 
▪ INFLAMMATION of the INNER LINING of the stomach 
❖ Symptoms 
▪ Nausea and vomiting 
▪ Abdominal bloating 
▪ Abdominal pain
▪ Dyspepsia 
❖ Investigation
▪ Endoscopy 
▪ Urea breath test
❖ Complications 
▪ Vomiting blood
▪ Perforation of stomach wall 
❖ Pathological Appearance 
▪ Macroscopic 
[ Oval shaped with slightly raised boarders
▪ Microscopic
[ Necrosis, granulation tissue, fibrosis
18
Q

What is the aetiology, pathogenesis, symptoms, investigations, complications and pathological appearance of coeliac disease?

A 
❖ Aetiology 
▪ AUTOIMMUNE DISEASE triggered by GLUTEN 
❖ Pathogenesis 
▪ Hereditary intolerance to GLUTEN 
▪ Gluten stimulates ANTIBODIES that damage the INNER LINING of the small intestine, 
resulting in FLATTENING of the VILLI 
❖ Symptoms 
▪ Diarrhoea 
▪ Weakness and fatigue 
▪ Abdominal pain 
▪ Weight loss 
❖ Investigation 
▪ IgA TTG 
▪ Endoscopy 
❖ Complications 
▪ Malnutrition 
▪ Bone loss 
▪ Lactose intolerant 
❖ Pathological Appearance 
▪ Villous atrophy
19
Q

What is the aetiology, pathogenesis, symptoms, investigations, complications and pathological appearance of Crohn’s disease?

A 
Aetiology 
▪ NO SPECIFIC CAUSE (unknown) 
❖ Pathogenesis 
▪ Various GENETIC ABNORMALITIES that lead to an OVERLY AGGRESSIVE T-CELL 
response to a subset of commensal enteric bacteria 
❖ Symptoms
▪ Mucosal ulceration 
▪ Mucosal swelling 
▪ Angular cheilitis 
[ Consider CANDIDA infection FIRST 
▪ Full width gingivitis 
▪ Mucosal tags 
▪ Abdominal pain
❖ Investigation 
▪ Biopsy 
❖ Complications
▪ Small bowel obstruction 
▪ Fistula formation 
▪ Nutrition deficiency 
▪ Colon cancer

Macroscopic appearances of small intestine:
Thickened wall, narrowed lumen, cobblestoning
of mucosa
Microscopic appearances from biopsy:
Non-caseating granulomata (non-necrotizing),
transmural inflammation (affects whole
thickness of wall)

20
Q

Histology of Crohn’s?

A

Stratified squamous epithelium of buccal
mucosa
Granuloma – Accumulation of epithelioid
macrophages/histiocytes

21
Q

What is the aetiology, pathogenesis, symptoms, investigations, complications and pathological appearance of Ulcerative Colitis?

A 
❖ Aetiology 
▪ Unknown 
❖ Pathogenesis 
▪ Various GENETIC ABNORMALITIES that lead to an OVERLY AGGRESSIVE T-CELL 
response to a subset of commensal enteric bacteria 
❖ Symptoms 
▪ Diarrhoea with bleeding 
▪ Mucosal ulcers 
▪ Pyostomatitis vegetans – Definitive symptom
▪ Fever 
▪ Weight loss 
❖ Investigation
▪ Endoscopy with biopsy 
❖ Complications 
▪ Severe bleeding 
▪ Perforated colon 
▪ Colon cancer 
▪ Nutrition deficiency
22
Q

Name 4 conditions predisposing to malignancy

A

Intestinal metaplasia
Dysplasia
Adenomatous polyp
Polyposis syndromes

23
Q

What is the aetiology pathophysiology an symptoms, complications and risk factors of intestinal metaplasia?

A 
❖ Aetiology
▪ GASTROESOPHAGEAL REFLUX DISEASE (GERD) 
▪ Usually driven by INFLAMMATORY processes 
❖ Pathophysiology 
▪ REPLACEMENT of normal SQUAMOUS epithelium with a normal GLANDULAR 
epithelium resembling those in the intestine in the WRONG PLACE
❖ Symptoms
▪ Heartburn 
▪ Dysphagia 
▪ Halitosis 
▪ Vomiting 
❖ Complications
▪ May lead to 
ADENOCARCINOMA 
❖ Risk factors:
▪ Smoking
▪ Alcohol
24
Q

What is the definition and significance of dysplasia of the GI

A

❖ Definition
▪ HISTOLOGICAL DISTURBANCE in the way the EPITHELIUM is ORGANISED
❖ Significance
▪ May or may not be cancer, may be next to cancer
▪ GRADE of DYSPLASIA signifies LIKELIHOOD of development of cancer
▪ Likelihood of low grade dysplasia transforming into high grade dysplasia is LOW
▪ High grade dysplasia indicates transformation into MALIGNANCY

25
Q

What is definition, aetiology and types of adenomatous polyps

A

❖ Definition
▪ Small protuberant mass of tissue that projects outwards from the surface
Abnormal colour indicates increased
cellularity, a sign of proliferation of
epithelium
❖ Types
▪ Developmental polyps
▪ Inflammatory polyps
Associated with Crohn’s disease & ulcerative colitis
▪ Hamartomatous polyps are benign polyps occurring close to Ampulla of Vater and duodenum
▪ Neoplastic polyps
❖ Aetiology
▪ Single or a few polyps can be due to inflammation, acquired, hereditary

26
Q

What are the 3 types of hereditary polyposis syndromes

A

Familial adenomatous polyposis
Hamartomatous polyposis syndrome
Hereditary mixed polyposis syndrome

27
Q

What is the predisposing factors for neoplasia in GI for these sites

Upper & middle thirds of oesophagus 
Lower third of oesophagus 
Stomach
Duodenum 
Ileum 
Large intestine 
Anus
A

Upper & middle thirds of oesophagus Smoking
Lower third of oesophagus Alcohol, obesity
Stomach Diet high in salt, Helicobacter Pylori
Duodenum Chronic smoking, diet rich in fat but low in
nutrients
Ileum Coeliac disease
Large intestine Old age, African-American, obesity
Anus Human Papillomavirus (HPV) – associated with
anal sex

28
Q

What are the symptoms for neoplasia in GI for these sites

Upper 1/3 of oesophagus 
Lower 1/3 of oesophagus 
Cardio-oesophageal junction
Pylorus 
Caecum 
Sigmoid colon 
Ampulla of Vater 
Rectum
A

Upper 1/3 of oesophagus Dysphagia, dyspepsia, weight loss
Lower 1/3 of oesophagus Dysphagia, dyspepsia, weight loss
Cardio-oesophageal junction Obstruction, dysphagia
Pylorus Vomiting, stomach pain
Caecum Beefy tongue, weight loss, abdominal pain
Sigmoid colon Obstructio
Ampulla - jaundice and weight loss
Rectum - rectal bleeding

29
Q

Name 4 common metastasizing sites of colorectal cancer with symtpoms

A

➢ Lymph Nodes
▪ Bloating, swollen belly, loss of appetite
Small part of lymph node replaced by tumour

➢ Liver 
▪ Jaundice, nausea, extreme fatigue, swelling of hands and feet, yellow/itchy skin
➢ Lungs 
▪ Shortness of breath, chest pain
➢ Bones
▪ Pain, fractures
30
Q

What are the 2 types of carcinoma

A

SCC and adenocarcinoma

31
Q

What 2 reasons could be for GI symptoms yet not GI problems?

A

Pregnancy and liver disease

32
Q

With regards to GI problems how would this influence your response to medical emergencies, treatment planning and drug contraindications

A
  1. Medical Emergencies
    ❖ Acid reflux (VOMITING when LYING DOWN)
    ❖ Peptic ulcer or severe gastritis
    (Vomiting BLOOD)
  2. Treatment Planning
    ❖ Coeliac disease
    ▪ From EARLY CHILDHOOD, CALCIUM absorption affected
    ▪ Enamel defects, dry mouth, aphthous ulcers
    ▪ Enamel may not be able to adhere to fissure sealants
  3. Drug contraindications
    ❖ Peptic Ulcer
    ▪ Cannot take NSAIDS as will cause severe pain as prostaglandin on lining of stomach as
    protection diminished

Systemic Disease In Dentistry (5 decks)

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