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CMS > Topic 6 - Gastroenterology > Flashcards

Topic 6 - Gastroenterology Flashcards

1
Q

What is the most common cancer?

A

CRC - colorectal cancer

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2
Q

What is the GIT lined with from mouth to anus?

A

Mucosa

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3
Q

Define IBD

What are the types?

A

A collection of inflammatory disorders of the GIT.

Ulcerative colitis, Chron’s disease, and indeterminate colitis.

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4
Q

Are presentations of IBD varied?

What is the impact on morbidity and mortality?

A

Yes

Impact on morbidity and mortality - high.

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5
Q

Which three main areas interplay to cause IBD?

A

Environmental factors:

  • Smoking increases risk of Chron’s 2x.
  • Stress and depression
  • Appendicectomy increases risk of Chron’s
  • Hygiene hypothesis

Genetic predisposition:
- Familial aggregation - higher concordance rates in monozygotic twins.

Immune response:
There’s an altered mucosal immune response to bacteria found in lumen of the gut.

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6
Q

What affects your bowel habits?

A

Exercise, diet, hydration

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7
Q

Symptoms of IBD?

A 
Diorrhoea.
Blood or mucous in stool.
Urgency (sudden need to defecate) and tenesmus.
Nocturnal bowel symptoms.
Vomiting.
Nausea.
Abdominal pain.
Fatigue.
Perianal and genital symptoms.
Weight loss
Arthritis
Skin lesions - erythema nodosum
Aphthous stomatitis
Ocular signs - uveitis or scolaritis
Hepatobiliary disease such as primary sclerosing colingitis may happen as a comorbid condiiton.

Serious complications include pancreatitis or potential pancreatic insufficiency, where the pancreas doesn’t produce the appropriate level of enzymes and insulin.

Increased risk from thromboembolic events.
You may see vasculitis, which is an inflammation of the blood vessels.

The kidneys - glomerulonephritis or nephrolithiasis.

There can be lung manifestations.

Secondary amylodoisis.

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8
Q

How can IBD be managed?

A

Medical management: corticosteroids, aminosalicylates, immunomodulatory drugs, biologics

Surgical management: resections (sections of colon removed and healthy parts joined together) and stoma formation, where part of the colon is brought up to the abdominal cavity and faecal matter is expelled into a bag attached to the abdominal skin.

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9
Q

Why can IBD increase cancer risk?

A

Immunomodulatory drugs and biologics can result in higher risk of cancer.

Just having IBD puts you at a higher risk of CRC.

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10
Q

Define Coeliac disease.

A

An immune response to gluten from the diet in the small bowel.

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11
Q

What age range does Coeliac disease affect?

A

Any age range.

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12
Q

What is the dentist’s role in Coeliac disease?

A

Can identify it as patient may present with ulcers, dermatitis herpetiform, or angular cheilitis.

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13
Q

Is tolerance varied in Coeliac?

A

Yes, some people can’t tolerate any gluten but others can

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14
Q

How is Coeliac treated and what problem can this cause?

A

Can be cured by maintaining a life-long gluten-free diet.
It can cause nutritional deficiencies as food options are very limited. Nutritional deficiencies can present as oral manifestations.

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15
Q

What can Coeliac disease increase risk of?

A

IBD, CRC and lymphomas.

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16
Q

How is Coeliac disease diagnosed?

A

First they’ll have bloods taken to see if there’s any antigens present to anti-TTG or anti-gliadin proteins.
Then if that’s successful there’ll be upper GI endoscopy where they look to see if they’re microvillus atrophy which is typical of Coeliac disease.

Must be on gluten diet for 6-8 weeks prior.

17
Q

What is another name for colorectal cancer?

A

Bowel cancer

18
Q

What is colorectol cancer and what causes it?

A

Malignant lesions of the colon or rectum.

Development of an adenocarcinoma from a colonic polyp. Polyps in colon can become dysplastic and undergo malignant change to become adenocarcinomas.

19
Q

What are the risk factors for CRC?

A
  • Age
  • Diet - refined sugars and dietary saturated fat from animal sources
  • Colorectal polyps
  • Smoking
  • Family history of bowel cancer
  • Family or personal history of IBD
  • Abdominal radiotherapy
  • Acromegaly
20
Q

What are the clinical features of CRC?

A
  • Altered bowel habit
  • Bleeding and tenesmus
  • Symptomatic anaemia
  • Rectal/abdominal mass
  • Asymptomatic
21
Q

How can you treat CRC?

A
  • Tumour resection
  • Stoma formation possibly (perm/temp)
  • Adjunctive chemo in some cases
  • No radiation
22
Q

What does the prognosis of CRC treatment depend on?

A

Cancer stage (progress of metastasis).
Earlier tumours have a better prognosis
Less aggressive tumours.
Younger patients better prognosis.

23
Q

What is the most common GI presentation?

Is it varied in symptoms?

A

IBS.

Yes symptoms vary from minor GI upset to diorrhoea/constipation.

24
Q

What are some triggering effects on IBS?

A
  • Poor diet associated with IBS
  • Fibromyalgia
  • Adverse life events
  • Anxiety
  • Menstrual dysfunction
25
Q

What is needed to diagnose IBS?

A

Clinical history is enough.

Any tests, in case they were done, would be negative.

26
Q

What management is needed for IBS?

A
  • These pts are high service users - reassure them there’s nothing sinister about these symptoms.
  • Dietary modification advice. High fibre, less sugar
  • Medicines like laporamide for diorrhoea or laxatives for constipation but diet should be sufficient
27
Q

What is diverticulitis and diverticulosis?

What clinical effect does it have?

A

Diverticulitis - inflammatory flare of diverticular disease, usually triggered by bacterial infection.

Diverticulosis - small outpouchings of the bowel where the bowel basically herniates. Can result in small stools being passed or constipation. Cause of this is advancing age so less peristaltic control of smooth muscle in the bowel, or could be due to poor diet with low fibre, or could be due to straining when passing small amounts of stool.

Very common but won’t have any clinical effect.

28
Q

What are haemarrhoids and what are the cause?

What investigations are done?

A

Straining away to pass small stool can result in engorged rectal veins which can bleed when opening the bowel.

Investigations will be done to rule out cancer.

29
Q

What enteric infection is common in the UK?

What is the cause, side effects and route of transmission?

A

Acute gastroenteritis - you’d get vomiting, diorrhea, abdominal pain, nausea.

The cause would be C.diff or norovirus.

Can be transmitted by poor handwashing practices: HCAI
Foecal oral.

30
Q

Define odonophagia

What causes are there?

A

Painful swallowing

Ulcers, strep sore throat, GORD

31
Q

What are the two types of dysphagia?

A

Perceived - due to anxiety called globus pharyngeas

Objective - swallowing problems or could be malignancy in or around the throat. try to figure it out

32
Q

What is a red flag in dysphagia?

A

Persistent or progressive dysphagia with weight loss or other symptom

33
Q

What causes of dysphagia are there?

A

Check lec.

34
Q

What should you do if you suspect a malignancy?

A

Urgent referral

35
Q

What are the potential dental ramifications of dysphagia?

A

Food regurgitation can lead to erosion

36
Q

How do you investigate for dysphagia?

A

OGD - endoscope used in upper GI tract

37
Q

Peptic ulcer disease - learn from e-book.

A

CMS (17 decks)

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