Week 3 Flashcards
What diseases can present with oral manifestations?
Anaemia
Diabetes
Haematinic deficiencies
Adverse reactions to drugs
What is the ‘Torsus Madibularis’ ?
A bony growth in the mandible which is just a developmental feature - it can develop in normal individuals but is often *mistaken for something more serious!
What is ‘Angular Cheilitis’ ?
Cracking at the skin at the corner of the lips
- Causes include;
Anaemia, Candidiasis, Haematinic deficiencies
What is meant by recurrent ‘Aptithous Stomatitis’ ?
Mouth ulcers
What does herpetiform involve?
Multiple ulcers all over the mouth
What are the possible oral manifestations of Crohn’s Disease?
Swollen lips Oral ulceration Angular Cheilitis Cobblestone mucosa Mucosal Tags
What is a possible oral manifestation of type 2 diabetes?
Thrush (acute pseudomembranous candidiasis)
What drug used to treat angina can cause mouth ulcers?
Nicorandil - a potassium channel activator
Lichen Planes is an idiopathic inflammatory disease. What parts of the body can it affect?
Skin Nails Scalp Genitals Oesophagus
How does Lichen Planus appear in the mouth?
Small white lumps or striations which can’t be removed by scraping like thrush can be
How does Lichen Planus appear on the skin?
Raised purple lesions
If lichen planus is symptomatic, what class of drugs are used to treat it?
Topical corticosteroids
What is mucous membrane pemphigoid?
- Autoimmune disorders
- Involve blistering lesions on mucous membranes
- Blisters in the mouth can form ulcers
- Blisters in the eyes can heal with scarring and causeless of sight
What is Sjogren’s Syndrome? List some signs/symptoms?
A chronic inflammatory autoimmune disorder
- Dry cough
- Dry eyes
- Dry mouth
- Dysphagia
- Fatigue
- Joint paint
How does ‘hairy leukoplakia’ present and what disease is it associated with?
Shaggy white patches on the side of the tongue
- HIV
How does Kaposi’s Sarcoma present in the mouth?
Dark red lesions
List some risk factors for oral cancers
Smoking Alcohol Poor diet Candida Syphilis
Which areas in the mouth are the high risk sites for oral cancers to present?
Floor of the mouth
Lateral borders of the tongue
Ventral tongue
List some of the warning signs/ symptoms for oral cancer
Red/white lesions Ulcers (persistent without known cause) Lip/ face numbness Dysphagia Voice changes
What scoring system is used for measuring dental caries?
DMF index
What does BPE stand for?
Basic Periodontal Examination
What diseases can endoscopy look for?
Coeliac disease Crohn's disease Ulcerative Colitis Tumours Ulcers Oesophagitis/ Gastritis
What vascular abnormalities can be detected by an endoscopy?
Varices
Angiodysplasia
Ectatic blood vessels
List three types of bleeding and how they can be managed
VARICEAL - Sclerotherapy - Banding - Histocryl glue ARTERIAL BLEEDING - Adrenaline - Heater probe coagulaiton - Clips ANGIODYSPLASIA - Argon plasma coagulation - Radio-frequency ablation
How are strictures treated?
Dilatation/ Stenting
What is polypectomy?
Removal of a polyp (type of tumour removal)
What is endoscopic mucosal resection?
A type of tumour removal
Where is a PEG tube for nutrition inserted and withdrawn from?
Inserted in to the abdomen and pulled out of the mouth
What parts of the GI tract wall arise from the endoderm layer?
Epithelium (mucosa)
Ducts and glands
What parts of the GI tract arise from the visceral mesoderm?
Lamina Propria
Muscuaris mucosa
Musculares externa
Submucosa
Which mesentery (ventral or dorsal) are the lesser omentum, lesser curvature of the stomach and falciform ligament associated with?
VENTRAL MESENTERY
Which mesentery (ventral or dorsal) are the greater omentum and greater curvature of the stomach associated with?
DORSAL MESENTERY
At which weeks in development do the circular and longitudinal muscle layers of the GI tract wall develop?
CIRCULAR - WEEK 5
LONGITUDINAL - WEEK 8
Which area in development does the liver bud grow into?
Mesoderm of the septum transversum
What is meant by the condition ‘annular pancreas’?
A ring of pancreatic tissue encircles then duodenum
At what week does the spleen develop?
WEEK 5
Early in development the midgut communicates with the yolk sac. Later this communication narrows into which structure?
The vitelline duct
At which week does the appendix develop?
WEEK 8
What is Meckel’s Diverticulum?
Remnant of the vitelline duct due to failure of complete regression
What is the vitelline ligament?
A fibrous remain of the connection with the yolk sac
What is a vitelline fistula?
The connection to the umbilicus and the outside world persists, meaning there is open communication
What is a vitelline cyst?
A closed capsule along the vitelline ligament connection
What is a urorectal fistula?
A congenital defect which results in the passage of urine through the rectum
What is the lining of the nasal cavity and nasopharynx?
Respiratory epithelium
Which papillae occupy a lot of the dorsal surface of the tongue but don’t have tastebuds?
Filiform Papillae
State the 4 major layers of the digestive tract from the lumen out
MUCOSA - Epithelium - Lamina Propria - Muscularis Mucosae SUBMUCOSA - Loose connective tissue - Glands MUSCULARIS EXTERNA - Circular and longitudinal muscle layers SEROSA/ADVENTITIA - Connective tissue
What transition of epithelium occurs at the gastro-oesophageal junction?
Stratified squamous epithelium (oesophagus) to columnar epithelium (stomach)
What 4 areas make up a gastric gland and what is the cell type in each?
GASTRIC PITS (mucous cells)
ISTHMUS (parietal cells)
NECK (mucous cells)
BASE (chief cells, parietal cells and enteroendocrine cells)
What do chief cells secrete?
Digestive enzymes
What do parietal cells secrete?
HCL acid
What is unique about the muscular is external in the stomach?
It has an additional muscle layer to aid with the churning function of the stomach
Which cells of the small intestine epithelium are the principle absorptive cells?
Enterocytes
Which cells of the small intestine epithelium are the mucin producing cells?
Goblet cells
Which cells of the small intestine epithelium are the hormone (gastrin/CCK/VIP) producing cells?
Enteroendocrine cells
Which cells in the small intestine are the defensive cells?
Paneth cells
What is the function of ‘Brunner’s Glands’ within the submucosa of the duodenum?
Produce mucous to neutralise chyme
Which part of the small intestine has many villi?
Jejunum
Which part of the small intestine has Peyer’s Patches?
Ileum
What are the two main cell types of the large intestine?
Absorptive cells
Goblet cells
What are the three muscular strips of the longitudinal muscle layer in the large intestine called?
Teniae Coli
What is the function of the ‘myenteric plexus’ and where can it be found?
Controls gut motility
- found in the muscular externa
What is the function of the ‘submucosal plexus’ and where can it be found?
regulates secretions
- found in the submucosa
What is reflux oesophagitis?
Inflammation of the oesophagus due to reflux of gastric contents
List causes of reflux oesophagitis
Hiatus hernia
Defective sphincter
Abnormal oesophageal motility
Increased intra-abdominal pressure e.g pregnancy
What microscopic changes occur due to reflux oesophagitis?
Basal zone epithelial expansion
Lengthening of papillae
What is Barrett’s Oesophagus
Replacement of stratified squamous epithelium with metaplastic columnar epithelium
What is a common cause of Barrett’s?
GORD - reflux of acid/ bile
What cell type increase in allergic oesophagitis?
Eospinophils increase
With which drugs is allergic oesophagitis treated?
Steroids
Chromoglycate
Montelukast
What are benign oesophageal tumours called?
Squamous Papillomas
What are malignant oesophageal tumours called?
Squamous cell carcinomas
Adenocarcinomas
Describe the pathogenesis to adenocarcinoma
Chronic inflammation - Barrett’s Oesophagus - Low grade dysplasia - High grade dysplasia - Adenocarcinoma
What is a Mallory-Weiss Tear?
A tear in the lower oesophagus due to persistent vomiting and retching
What are oesophageal varies?
Abnormally enlarged veins in the oesophageal wall
What is the most common type of oral cancers?
Squamous cell carcinomas
What are possible causes of acute gastritis?
Chemicals Severe burns Shock Trauma Head injury
What are the ‘ABC’ causes of chronic gastritis and which is the most common?
Autoimmune (Least common)
Bacterial (Most common)
Chemical
What effects does autoimmune chronic gastritis have?
Atrophy
Intestinal metaplasia
What is the culprit in bacterial chronic gastritis?
H.pylori
What does H.pylori increase risk of?
Gastric and duodenal ulcers
Gastric carcinomas and lymphomas
What substances can cause chemical chronic gastritis?
Bile reflux
Alcohol
NSAIDs
What are benign gastric tumours referred to as?
Polyps
There are two subtypes of gastric adenocarcinomas; intestinal type and diffuse type. Which has better prognosis?
Intestinal type
Which type of gastric adenocarcinoma involves signet ring cells and expands, infiltrating the stomach wall
Diffuse type
List causes of GORD
Hiatus hernia Incompetent lower oesophageal sphincter Loss of oesophageal peristaltic function Abdominal obesity Smoking Alcohol Drugs
What are the signs/ symptoms of GORD?
Heart burn (retrosternal) 'Acid brash' - Acid/bile regurgitation 'Water brash' - Increased saliva secretion Dysphagia Odynophagia Weight loss Hoarse voice Chronic cough (worse in the mornings) Nocturnal asthma
Which is more likely to be a sign of cancer;
Dysphagia/ Odynophagia?
Dysphagia
What investigations are done for GORD?
Endoscopy
Barium swallow
24hour oesophageal pH monitoring and manometry
Nuclear studies
What are the three possible drug groups used for GORD?
Antacids
H2 antagonists
Proton Pump Inhibitors
What is the name of the surgery which is a possibility for serious GORD?
Nissen Fundoplication surgery
What is meant by the term ‘Gastroparesis’?
Delayed gastric emptying despite no physical obstruction, food remains in the stomach for an abnormal amount of time
What are the symptoms of gastroparesis?
Feeling of fullness Nausea Vomiting Weight Loss Upper Abdominal Pain
What is the most common cause of gastroparesis?
Diabetes
How is gastroparesis managed?
Liquid/ soppy diet
Promotility agents
Gastric pacemaker
What is achalasia?
When the lower oesophageal sphincter fails to relax due to degeneration of the myenteric plexus, causing dysphagia, regurgitation and weight loss - the oesophagus becomes stuffed with food
What are the investigations and treatments of achalasia?
CXR
Barium Swallow
- Treated with endoscopic balloon dilatation and proton pump inhibitors
What happens in vomiting?
Abdominal muscles and the diaphragm contract for forceful expulsion of stomach contents
Which process is in reverse in retching?
Peristalsis
Is the chemoreceptor trigger zone (CTZ) located inside or outside of the BBB
Outside the BBB
What is vomiting often preceded by?
Profuse salivation
Sweating
Increased heart rate
Nausea
What does the vomiting centre in the medulla receive input from?
The tractus solitarius
What are the consequences of severe vomiting?
Dehydration Mallory-Weiss tear Hypokalaemia Hypocholaraemic metabolic alkalosis Aspiration of vomitus
List the antiemetic drug classes
Dopamine antagonists Prokinetic drugs 5HT3 receptor antagonists H1 antihistamines Anticholinergics Adjuvant antiemetics
What is the ‘triple drug regimen’ used to treat chemotherapy induced nausea and vomiting (CINV)?
5HT3 receptor antagonists
Dexamethason
Aprepitant
What hormone produced by the placenta is associated with pregnancy associated nausea and vomiting?
Human Chorionic Gonadotropin
What is Hyperemesis Gravidarum?
Fluid and electrolyte disturbances and nutritional deficiencies which can develop from vomiting in pregnancy
What is the first line treatment of Hyperemesis Gravidarum?
Antihistamines
What part of the gut does epigastric pain originate from?
FOREGUT
What are the organic causes of dyspepsia?
Peptic ulcer disease
Gastric cancer
Drugs e.g NSAIDs
What is meant by a functional cause of dyspepsia? Give examples
Idiopathic dyspepsia in which there is no actual structural abnormality in the upper GI tract
- Abnormal reflexes
- Disrupted gut-immune interactions
- Visceral hypersensitivity
What are some of the signs of dyspepsia that can be found on examination?
Cachexia - muscle weakness and wasting
Masses
Abdominal distension - due to gastric outflow obstruction causing fluid to build up in the stomach
What are the two main important things to consider in the management of dyspepsia?
Eradication of H.pylori if present
Acid inhibition treatment
Which ulcers are aggravated by eating and which are commonly relieved by eating?
Duodenal ulcers - aggravated by eating
Gastric ulcers - relieved by eating
What are the most common causes of peptic ulcer disease?
H.PYLORI!!
NSAIDs
Gastric dysmotility/ outflow obstruction
What kind of organism is H.pylori?
Gram -ve microaerophilic flagellated bacillus
Which kind of ulcers does gastritis localised to the pyloric region of the stomach cause?
Duodenal Ulcers
Which kind of ulcers does gastritis localised in the body of the stomach cause?
Gastric Ulcers
What happens with duodenal ulcers?
G cells increase gastrin secretion and decrease somatostatin secretion.
- Gastrin stimulates parietal cell proliferation and causes HYPER-secretion of acid.
What happens with gastric ulcers?
Inflammation induces apoptosis of parietal cells which causes HYPO-secretion of acid
What is the word for hypo secretion of acid?
Hypochlorydria
Which drugs are used to decrease acid secretion?
Histamine antagonists
Proton pump inhibitors
What tests are used to identify H.pylori?
Gastric biopsy
Urease breath test
Faecal antigen test
Serology for IgA antibodies
Which class of drugs are used for symptomatic relief of peptic ulcer disease?
Antacids
What does the ‘triple therapy’ for eradication of H.pylori involve?
PPI, amoxycillin and clarithromycin
List some of the causes of GI bleeding
Ulcers
Varices
Mallory-Weiss Tear
What is the ‘100 rule’ used to assess?
The severity of the haemorrhage
What is the ‘Rockall Risk Scoring System’ used for?
Estimating the risk of adverse outcomes following a GI bleed
What is the ‘Blatchford Bleeding Score’ used for?
Assessing the likelihood of a patient requiring intervention due to a bleed. E.g blood transfusions
What can indicate a recent haemorrhage?
Active bleeding/ oozing
Vissible vessels
Clots
What treatment/management is used for a bleeding peptic ulcer?
Adrenaline injections Heater probe coagulation Combinations therapy^ Clips Haemospray
What treatment/management is used for variceal bleeding?
ABCDE
Haemostasis
Coagulotherapy
