Upper GI

Question 1

What is the function of the gut? What is it made up from?

Answer 1

Gut: digestion and absorption of nutrients

• stomach - alcohol and weak acids
• small intestine - absorbs products of digestion (CHO, protein, fat) electrolytes, vitamins and water

Consists of duodenum (iron), Jejunum (folate), ileum (vitamin B12)

• large intestine - water absorbed

Question 2

What is the function of the pancreas?

Answer 2

Exocrine - production of pancreatic enzymes and aqueous alkaline solution: proteolytic enzymes, amylase, lipase

Endocrine - production of insulin and glucagon

Question 3

What makes up the biliary system?

Answer 3

Biliary system - liver and gall bladder

Question 4

What are some functions of the liver?

Answer 4

• metabolism of nutrients after absorption from GIT
• detoxifying and degrading toxins
• store glycogen
• breaks down fats

Question 5

What is the function of the gall bladder?

Answer 5

Concentration and storage of bile (fat digestion/absorption)

• the bile duct opens into the duodenum

Question 6

List symptoms of GI disorders:

Answer 6

• pain
• dysphagia
• difficulty swallowing - red flag for oesophageal cancer
• dyspepsia - discomfort related to upper GI tract: heart burn, pain, acidity (waterbrash)
• regurgitation
• unpleasant taste
• odynophagia - pain on swallowing - red flag for oesophageal cancer
• nausea and vomiting, diarrhoea, constipation, steatorrhoea Bleeding - upper GI (vomiting blood - haematemesis - medical emergency)
• lower GI - fresh blood may be mixed with stools
• unexplained weight loss

Question 7

How is the GIT investigated?

Answer 7

Direct visualisation: (+/- biopsy)

• endoscopy, sigmoidoscopy, colonoscopy

Radiology - radiographs, ultrasound, MRI

Stool tests

• faecal calprotectin (inflammation of gut)
• quantitative faecal immunochemical test (qFIT) (blood in stool)

Question 8

Why should dental practitioners be aware of GI disease?

Answer 8

• may be first to pick up undiagnosed issue
• orofacial manifestations may be first or only manifestation
• must know when to refer
• direct involvement or oral/perioral tissue mucosa by disease process e.g. crohns
• secondary to disease elsewhere in the GIT as a result of malabsorption or blood loss

Question 9

List some upper GI disorders:

Answer 9

• upper GI bleeding (GI emergency): oesophagitis, varcies, mallory-weiss tear, peptic ulcer, gastritis
• gastro-oesophageal reflux disease (GORD): erosion, globus, unpleasant taste, halitosis, burning mouth syndrome
• peptic ulcer disease - caution with NSAIDs

Question 10

List some non-specific oral signs and symptoms of upper GI disease:

Answer 10

• secondary to blood loss and malabsorption
• bloods - FBC, B12, ferritin, folate

Haematinic deficiency with or w/out anaemia:

• recurrent oral ulceration, angular cheilitis, candidial infections, glossitis, burning mouth syndrome