Topic 6 - Gastroenterology Flashcards
What is the most common cancer?
CRC - colorectal cancer
What is the GIT lined with from mouth to anus?
Mucosa
Define IBD
What are the types?
A collection of inflammatory disorders of the GIT.
Ulcerative colitis, Chron’s disease, and indeterminate colitis.
Are presentations of IBD varied?
What is the impact on morbidity and mortality?
Yes
Impact on morbidity and mortality - high.
Which three main areas interplay to cause IBD?
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.
What affects your bowel habits?
Exercise, diet, hydration
Symptoms of IBD?
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.
How can IBD be managed?
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.
Why can IBD increase cancer risk?
Immunomodulatory drugs and biologics can result in higher risk of cancer.
Just having IBD puts you at a higher risk of CRC.
Define Coeliac disease.
An immune response to gluten from the diet in the small bowel.
What age range does Coeliac disease affect?
Any age range.
What is the dentist’s role in Coeliac disease?
Can identify it as patient may present with ulcers, dermatitis herpetiform, or angular cheilitis.
Is tolerance varied in Coeliac?
Yes, some people can’t tolerate any gluten but others can
How is Coeliac treated and what problem can this cause?
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.
What can Coeliac disease increase risk of?
IBD, CRC and lymphomas.
How is Coeliac disease diagnosed?
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.
What is another name for colorectal cancer?
Bowel cancer
What is colorectol cancer and what causes it?
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.
What are the risk factors for CRC?
- 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
What are the clinical features of CRC?
- Altered bowel habit
- Bleeding and tenesmus
- Symptomatic anaemia
- Rectal/abdominal mass
- Asymptomatic
How can you treat CRC?
- Tumour resection
- Stoma formation possibly (perm/temp)
- Adjunctive chemo in some cases
- No radiation
What does the prognosis of CRC treatment depend on?
Cancer stage (progress of metastasis).
Earlier tumours have a better prognosis
Less aggressive tumours.
Younger patients better prognosis.
What is the most common GI presentation?
Is it varied in symptoms?
IBS.
Yes symptoms vary from minor GI upset to diorrhoea/constipation.
What are some triggering effects on IBS?
- Poor diet associated with IBS
- Fibromyalgia
- Adverse life events
- Anxiety
- Menstrual dysfunction
