Upper GI disease

Question 1

what anatomy is in the upper GI tract?

5

Answer 1

1. mouth
2. pharynx
3. oesophagus
4. stomach
5. small intestine (duodenum)

Question 2

what anatomy is in the lower GI tract?

4

Answer 2

1. small intestine (jejunum and ileum)
2. colon (ascending, transverse, descending, sigmoid)
3. rectum
4. anus

Question 3

what is the function of the GI tract?

4

Answer 3

• ingestion of food - mouth, pharynx
• digestion of food - teeth, saliva, stomach acid, stomach enzymes, bile, pancreatic enzymes
• absorption of nutrients - small intestine, colon
• excretion of waste products - anal canal

Question 4

what prevents the reflux of food and stomach contents in the oesophagus?

Answer 4

sphincters - upper and lower oesophageal sphincter

Question 4

what are the layers of the GI tract?

Answer 4

• mucosa
• submucosa
• muscularis externa
• adventitia/serosa

Question 5

what kind of tissue is the oesophagus made of? what is its purpose?

Answer 5

fibromuscular tissue
* transports food from pharynx to somach via peristalsis

Question 6

what are the functions of the stomach?

3

Answer 6

• digestion - chemical (HCl, pepsin, lipase) and mechanical
• absorption - B12, alcohol, water
• endocrine - gastrin (HCl secretion), CCK (gall bladder)

Question 7

what do chief cells and parietal cells produce?

Answer 7

• chief cells - pepsin (protein breakdown into polypeptides)
• parietal cells - HCl, intrinsic factor (needed for the absorption of B12)

Question 8

what is gastro-oesophageal reflux disease (GORD)?

Answer 8

acid and stomach contents flow through the lower oesophageal sphincter and into the oesophagus

Question 9

what are the causes of GORD?

3

Answer 9

• laxity of lower oesophageal sphincter - caffiene
• increasead gastric pressure - obesity, pregnancy
• delayed gastric emptying - eating too much

Question 10

what does GORD cause?

Answer 10

gastric acid irritates the oesophageal mucosa
* causes metaplasia of oesophageal epithelium (Barrett’s oesophagus = precancerous)

Question 11

what are the signs/symptoms of GORD?

6

Answer 11

• dyspepsia (indigestion/heartburn)
• epigastric pain
• bloating
• nausea/vomiting
• vocal hoarseness
• **dental erosion **

Question 12

what are the risk factors for GORD?

8

Answer 12

• stress/anxiety
• smoking
• alcohol
• trigger foods (caffiene, chocolate, fatty meals)
• obesity
• NSAIDs
• pregnancy
• lying flat after large meal

Question 13

how do you diagnose GORD? what are the red flag features?

6

Answer 13

GP referral for upper GI endoscopy
* unexplained weight loss
* loss of appetite
* dysphagia (difficult swallowing)
* vomiting blood
* rectal bleeding or blood in snot
* unexplained iron deficiency anaemia

Question 14

how do you manage GORD?

5

Answer 14

• lifestyle changes - weight loss, stop smoking, reduce alcohol, smaller meals
• antacids - gaviscon, rennie
• proton pump inhibitors - omeprazole, lansoprazole
• H2 receptor antagonist - ranitidine
• surgery - tighten lower oesophageal sphincter

Question 15

how do antacids, proton pump inhibitors and H2 receptor antagonists work?

Answer 15

• antacids - create a layer on surface of gastric acid, neutalising pH and relieving symptoms
• PPIs - inhibits the proton pump of parietal cells, reducing the production of HCl
• H2 receptor antagonists - bind to H2 receptors on parietal cells, preventing the binding of histamine and stimulation of parietal cells to produce HCl

Question 16

what is Barrett’s oesophagus?

Answer 16

metaplasia of oesophageal epithelium at the gastro-oesophageal junction
* squamous to columnar epithelium

Question 16

what are the dental inplications of GORD?

3

Answer 16

• erosion (intrinsic)
• burning mouth symptoms
• taste disturbance - dysgeusia

Question 17

what kind of cancer is oesophageal cancer?

Answer 17

• lower 1/3 adenocarcinoma - cancer of glandular tissue (Barrett’s oesophagus)
• upper 2/3 squamous cell carcinoma - smoking and alcohol

Question 18

how do you manage oesophageal cancer?

4

Answer 18

• chemo/radiotehrapy
• surgery
• palliative

Question 19

what is peptic ulcer disease?

Answer 19

a lack of mucus leading to ulceration in the stomach, duodenum and oesophagus

Question 20

what are the risk factors of peptic ulcer disease?

2

Answer 20

• disruption to mucus barrier - NSAIDs and Helicobacter Pylori
• increased stomach acid production - stress, caffiene, smoking, alcohol, spicy foods

Question 21

what are the symptoms of peptic ucler disease?

3

Answer 21

• dyspepsia - indigestion/heartburn
• epigastric pain
• nausea and vomiting

Question 22

what are the complications from PUD?

5

Answer 22

• bleeding
• anaemia
• perforation of stomach/duodenum
• stricture - narrowing of oesophagus, hard to swallow
• stomach cancer

Question 23

what is *Helicobacter Pylori*?

Answer 23

bacteria that lives in the **stomach** whose **toxins** cause mucosal damage and ulceration

Question 24

how do you test or *H. Pylori*? | 2

Answer 24

* breath test (looking for urea) * stool antigen

Question 25

how do you treat *H. Pylori*? how long is the treatment?

Answer 25

eradication therapy / triple therapy 1. **proton pump inhibitor ** 2. **amoxixillin** 3. **clarithromycin or metronidazole** 7 days

Question 26

what is the mechanism of action for NSAIDs?

Answer 26

inhibit the formation of prostaglandins via COX enzyme pathway | prostaglandins involved in inflammation

Question 27

what is the difference between the COX-1 and COX-2 pathway?

Answer 27

* COX-1: prostaglandins help with gastric mucosal integrity and platelet aggregation * COX-2: prostaglandins drive pain and inflammation | want to inhibit COX-2 not COX-1

Question 28

how is PUD diagnosed?

Answer 28

endoscopy

Question 29

how do you manage PUD? | 4

Answer 29

* lifestyle measures - stress, alcohol, smoking, caffiene * stopping NSAIDs * eradication of *H. Pylori* * long term PPI

Question 29

what are the dental implications of PUD? | 2

Answer 29

* NSAIDs - avoid use * shared risk factors with oral cancer- smoking alcohol