Test 3 Flashcards
What is chemical esophagitis?
Irritants to squamous mucosa
What is infectious esophagitis?
Usually immunosupressed (often herpes, candidia, or CMV)
CMV affects entire GI tract. the elderly or immunocompromised have ___. It may be associated with ___.
Multiple discrete, well-circumscribed superficial ulcers
Irritable bowel disease
True or false… herpes simplex causes large ulcers in GI tract.
False.. small ulcers
CMV affects [part of/entire] GI tract. It may be associated with ___. Most likely in ___ epithelium and endothelial cells.
Entire
IBS
Glandular epithelium
What is reflux esophagitis?
Relaxation or malfunction of gastroesophageal sphincter combined with reflux of gastric acid. Can reflux into sinuses or mouth
What are the symptoms of reflux esophagitis?
Burning
Excessive salivation
Choking
What are 5 aggravating factors of reflux esophagitis?
Obesity
Pregnancy
Alcohol/tobacco use
Caffeine
Nicotine
Many prescription drugs
What are medical treatments of reflux esophagitis?
Antacids
H2 blockers
PPI
Lose weight, stop smoking/drinking
What are the complications involved with reflux esophagitis?
Ulceration
Stricture
Barret esophagus
What is Barrett esophagus?
Long tongues of extended columns of epithelium cells into esophagus lining. Takes on a small intestine appearance due to chronic irritation.
Metaplasia goes to dysplasia and becomes adenocarcinoma
*barrett esophagus frequently becomes adenocarcinoma
What are three medications used to treat reflux esophagitis?
Antacids
H2 blockers
Proton pump
What is reactive (erosive) gastropathy induced by?
Alcohol
NSAIDS
Iron
Stress
Bile reflux
Corticosteroids
What is acute gastritis?
Acute injury that is asymptomatic with possible significant blood loss
Caused by Alcohol, NSAIDs, iron, stress, physical injury
What are the symptoms and causes of acute peptic ulceration?
Symptoms: nausea, vomiting
Causes: NSAIDs, stress, alcohol, radiation
What are different types of chronic gastritis?
H. Pylori gastritis
Autoimmune gastritis
Peptic ulcer disease
H.pylori gastritis causes ___ and ___ ulcers and may lead to ___
Duodenal
Pyloric
Cancer
___ and ___ are the causative agents of peptic ulcer disease. It causes [decreased/increased] acid production. It causes ___ ulcers that are potential for ______. Can lead to gastric ulcer, ___, and eventually to ___.
H.pylori and NSAIDs
Increased
Punched-out
Perforation and hemorrhage
Dysplasia
Adenocarcinoma
True or false… H.pylori can be treated with antibiotics
True
What allows H.pylori to thrive in the stomach?
Flagella
Secrete urease
Adhesions
Toxins
Gastric polyps are hyperplastic lesions that are a response to ____ around ulcers. It may contain some __
Gastric injury
Dysplasia
Gastric adenocarcinoma has two forms: intestinal and diffuse type
Intestinal type forms ___
Diffuse type have ____
Glands
Signet cell morphology
What is the most common cause of intestinal obstruction?
Usually mechanical (80%) (Hernia or postsurgical adhesions)
What is the second most common cause of an intestinal obstruction?
Neoplasm and infarction (20%)
___ disease may cause intestinal obstructions. It is a ___ defect that results in a lack of ___ cells, thus cant stimulate ____ and pass ___.
Hirschprung
Congenital
Ganglia
Smooth muscles
Meconium
What is meconium?
Earliest stool of a mammalian infant. (Formed during the time the infant spends in the uterus)
Peptic ulcers are most frequently formed in the ___ (__%)
Duodenum (80%)
Name four selected diarrheal diseases
Celiac sprue
Irritable bowel syndrome
Infectious self-limiting colitis
Pseudomembranous colitis
Celiac sprue is a diarrheal disease which is ___-mediated. It is triggered by ___, its metabolite causes ___ and will cause ____ of the villi.
Immune mediated
Gluten (metabolite causes tissue damage especially in the small bowel)
Tissue damage
Blunting
What are three oral effects of celiac sprue?
Enamel defects
Delayed eruptions
Recurrent aphthous ulcers
What are the symptoms of irritable bowel syndrome?
Relapsing pain, bloating, constipation/diarrhea
What are the causes of IBS?
Diet
Abnormal motility
Stress
IBS is diagnosed when everything else is ruled out
What are the microscopic abnormalities of irritable bowel syndrome?
There are no gross microscopic abnormalities
Everything is functional, without structural correlates
What is infectious self-limiting colitis caused by?
Microorganisms such as salmonella and E.coli
Pseudomembranous colitis is usually caused by ____ (heat resistant and difficult to destroy). It is spread via ___. Pseudomembranous colitis usually follows ___. It is the most common ___ infection in older adults. Toxin cause ____ formation, ___, and ___. ___% of neonates are carriers
Clostridium difficile
Person to person
Antibiotic therapy
Nosocomial
Pseudomembranous formation, fluid secretions, and ulcerations (may cause perforation of intestinal wall)
50%
True or false.. inflammatory bowel disease may result in some oral lesions
True
What are two examples of inflammatory bowel disease?
Crohn disease
Ulcerative colitis
Crohn disease is similar to ___. It has skipped areas that are ____ and has ___. Crohn disease will involve the formation of ___, ___ and ___. It usually affects the [upper/lower] GI tract but may affect the other. It can lead to ___. It may form ___ lesions. Oral manifestations are typically associated with ___ changes to mucosal layers
Ulcerative colitis
Non-lesioned and has intermediate strictures
Granulomas, fistula, and perianal disease
Upper but may affect lower (including rectum)
Can lead to cancer
Transmural lesions
Rectal
Ulcerative colitis is more ___ and ___ than crohn disease
Continuous (especially in the colon and no strictures)
Superficial
True or false.. hyperplastic colon polyps have significant malignant potential
False. They have no malignant potential
True or false… adenoma colon polyps may become malignant
True
Invasive colonic adenocarcinoma causes __% of cancer death in the U.S.
15%
What are the prognostic factors for invasive colonic adenocarcinoma?
Depth of invasion and lymph node involvement
The deeper the involvement the more likely to metastasize
What are the dietary factors that may influence invasive colonic adenocarcinoma?
Low vegetable soluble fiber
High fat/carbohydrate diet
Malabsorption is typically due to nutrient not being absorbed by the ___. It can be associated with ___ (high fat content in stools)
Small intestine
Steatorrhea
What is pernicious anemia? How is it detected?
Pernicious anemia is malabsorption of B-12.
It is detected by the schilling test
Zollinger-elision syndrome causes ___ and ___ in the ___.
Causes tumors and ulcers in the duodenum
Autoimmune gastritis is usually ___. It does not cause ___. It causes destruction of ___ and ___ cells with antibodies. It causes generalized ___. It can cause a vitamin ___ deficiency leading to ___.
Genetic
Ulcers
Parietal and chief cells
Metaplasia
B12
Adenocarcinoma
Where does peptic ulcer disease typically occur?
Proximal duodenum and lower stomach
What is the treatment for Hirschprung disease?
Remove section of colon that can’t contract
A variety of colitis-related disorders are ___-based and cause diarrhea
Inflammatory
True or false… inflammatory bowel disease is chronic and contagious.
False. Although it is a chronic colitis, it is not contagious
What is the difference between GERD (gastroesophageal reflux disease) and “acid reflux”?
GERD is chronic
Acid reflux is acute (isolated incidences)
Episodes of acid reflux is referred to as __ and occurs daily in __% of the population
Heartburn
7%
What are the aggravating factors of GERD?
Empty stomach
Inclined position
Increased age
Obesity
Fatty foods
Caffeine/alcohol/smoking
Large meals
Some drugs
What things relieve GERD?
Small meals
Reduced fat
Reduced weight
Elevated head of bed
Avoid aspirin/NSAIDs
What are the dental tips that should be given to GERD pts?
Protect teeth from erosion by gastric acids
Use mouth guard, neutralize acid with basic solution, don’t brush teeth after gastric juices are in mouth
Antacids are used to treat GERD as they neutralize gastric HCl. Name four different antacids and their side effects.
Magnesium salts - can cause diarrhea
Bicarbonate - causes gas
Calcium carbonate - chalky and constipation
Aluminum salts - not very effective
H2 receptor blockers are used to treat GERD. They are not effective at the __ receptors, thus not good antihistamines for ___. H2 blockers reduce ___ ___ by blocking H2 receptors in gut.
H1
Allergies
Gastric secretions
Name three different types of H2 blockers for GERD?
Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepcid)
What are three side effects of H2 blockers?
Headaches
Diarrhea
Drowsiness
True or false… proton pup inhibitors (PPIs) are available by Rx only
False. Also available OTC
What is the mechanism of PPIs?
Disrupts hydrogen exchange for K in gastric parietal cells, which blocks production and release of HCl into cut.
What are 4 side effects of PPIs?
Diarrhea
Interferes with digestion
Increases food allergies
Oral sores/ulcers
True or false… PPIs are often combined with H2 blockers
True
Name four different drugs/drug combinations of PPIs
Omeprazole (Prilosec)
Omeprazole + sodium bicarbonate for fast release
Lansoprazole (Prevacid)
Esomeprazole (nexium)
Peptic ulcer disease includes gastric and duodenal ulcers. Name three causes of peptic ulcer disease.
Inflammation of epithelium
Erosion (can be caused by NSAIDs)
Infection by H. Pylori (70-80% incidence)
Peptic ulcer disease causes __ burning, which is [alleviated/worsened] by eating or taking antacids
Epigastric
Alleviated
Peptic ulcer disease pain is worse on [empty/full] stomach and during the [day/night]
Empty
Night
True or false… peptic ulcer disease pain is often mistaken for a heart attack and vice versa
True
What is hematemesis?
Bleeding in stools or in vomit
A symptom of peptic ulcer disease
What are the treatments of peptic ulcer disease?
Antacids
PPIs
H2 blockers
(Same as GERD)
True or false… the drugs taken for peptic ulcer disease may actually cure the disease.
False.. it suppresses acidity to heal sores but does not cure
When can peptic ulcer disease actually be cured?
If it is H.Pylori related.
True or false… H pyloria is contagious
True. Especially within family members.
Name two drugs that may be taken if peptic ulcer disease is caused by H.pylori
Prevpac (combination of Iansoprazole (a PPI) and the antibiotics amoxicillin and clarithromycin
Milk of magnesia (magnesium based) may also help kill bacteria
What is prevpac?
Combination of…
Iansoprazole (a PPI)
Amoxicillin
Clarithromycin
What is absorbed in the stomach?
Water
Alcohol
What is absorbed in the duodenum?
Fe
Ca
Mg
Na
Fats
Water
Proteins
Vitamins
What is absorbed in the jejunum?
Carbohydrates
Proteins
What is absorbed in the ileum?
Bile salts
B12
Cl
What is absorbed in the colon?
Water
Electrolytes
What is constipation?
Mobility too slow
Too much water absorption
What are the drugs used to treat constipation?
Laxatives such as…
Bisacodyl
Docusate
Bisacodyl is a laxative that is a stimulant of ___. It is __-acting. It is available by [OTC/Rx]. It is used orally or suppository. It may cause ___ as a side effect.
Smooth muscle
Fast
OTC
Cramps
Docusate is a laxative that causes ___ retention in stools in order to ___. It is available OTC (dulcelax).
Water
Soften stools
What is diarrhea?
Loose, watery stools
Motility too fast
Not enough absorption
What are the consequences of diarrhea?
Dehydration
Malnutrition
*worse in young and elderly
What are three medications used to treat diarrhea?
Loperamine-Imodium
Bismuth subsalicylate (pepto-bismol)
Anti-cholinergics such as atropine
What is loperamine-Imodium?
Mild opioid agonist
If severe, use a stronger opioid agonist
IBS (irritable bowel syndrome) cause is unknown. There is no ___ defect. IBS typically causes ___ pain and bloating. It could be a ___-dependent neuromuscular disorder.
Structural
Episodic
5HT
___% of the population have suffered IBS. It is the most common GI disorder
20
IBS is most common in ____ and ____. It has a possible association with ___ and ___.
Young adults and adults ~50 years old
Stress and poor diet
What drugs are typically used for IBS?
Drugs to treat symptoms (deal with diarrhea or constipation with diet and anti-stress changes)
What is the only FDA approved drug for IBS with constipation?
Linaclotide (linzess)
Linaclotide is a ___ agonist. It [increases/decreases] bowel movement and fluid secretion. It relieves pain.
Guanylate-cyclase-C
Increases
What are the side effects of linaclotide?
Diarrhea
Gas
___% of the population has IBD (inflammatory bowel disease)
<1%
IBD is a spectrum of disorders. One IBD is Crohn’s disease. Crohn’s disease causes chronic ___ problems. It can affect entire GI, but it is most intense in ___ and ___. It has intermittent areas with ___ between. This leads to ___, ___, and ___
Diarrheal
Ileum and colon
Strictures
Ulcerations, swelling, scarring
Crohn’s disease causes ___ pain. ___ fissures/fistules. These pts have a higher incidence of ___.
Hypogastric
Perianal
Arthritis
Crohn’s disease pts have a ___ liver. The disease has a possible ___ link. It is possible caused due to an abnormal inflammatory response to ___. Crohn’s disease [does/does not] have remission. It increases the incidence of ___.
Fatty
Genetic
Normal flora
Does
Colon cancer
What are the medications used to treat Crohn’s disease?
Mesalamine (topical anti-inflammatory)
corticosteroids (act systemically)
Metronidazole (antibiotic mechanism (?))
What is ulcerative colitis?
Similar to Crohn’s disease but limited to colon and more generalized. (No strictures)
True or false.. the medications used to treat ulcerative colitis are similar to Crohn’s disease
True
