Week 3 - Gastroenterology Flashcards
GI system: physiology gut: function? what do the following absorb: - stomach? - duodenum? - jejunum? - large intestine? pancreas function? (exocrine and endocrine)
gut: digestion and absorption of nutrients
stomach: alcohol and water
duodenum: iron & B12
jejunum: folate
large intestine: water
pancreas:
exocrine - production of enzymes to digest food
endocrine: production of insulin
gall bladder: function?
concentration and storage of bile, fat absorption and digestion
liver: function? x3
- metabolism of nutrients and toxins
- production of bile
- protein synthesis
examples of GI symptoms?
- pain: can suggest site, but could also be referred pain
- dysphagia
- dyspepsia: discomfort related to upper GI tract (heartburn, acidity, pain)
- nausea & vomiting
- diarrhoea
- constipation: infrequent <2/week stools
- steatorrhoea: pale bulky stools
- bleeding
- weight loss: unintentional weight loss could be a sign that the patient is not absorbing well
bleeding: describe upper and lower GI types of bleeding
upper GI bleeding:
- haematemesis: blood or “coffee grounds”
- melaena: black sticky stools, as a result of digested blood
lower GI bleeding:
- fresh blood, may be mixed with stools
GI investigations - direct visualisation + biopsy:
methods for upper GI tract?
methods for lower GI tract?
upper GI tract: endoscopy
lower GI tract: sigmoidoscopy and colonoscopy
GI investigations: what other methods of investigation?
- radiographs: plain or contrast. can be done by barium swallow, meal, or enema
- ultrasound: for biliary tract, liver
- MRI: biliary tract, liver, pancreas, gut (lesser degree)
upper GI disorders: acid suppression drugs?
antacids:
- aluminium hydroxide, calcium carbonate
- alginate based e.g. Gaviscon
gastric acid reduction:
- histamine receptor antagonists (H2 blockers)
- proton pump inhibitors
list examples of the following:
- antacids?
- alginate based antacid?
- histamine receptor antagonist?
- proton pump inhibitors?
- aluminium hydroxide, calcium carbonate
- gaviscon
- ranitidine, cimetidine
- omeprazole, lansoprazole
upper GI disorders: anti-emetics?
the drug used depends on?
- dopamine antagonists
- anti-histamines
- serotonin antagonists
- drug used depends on the cause of the nausea and vomiting:
if chemical stimulation of vomiting centre: treat brain
if distension of the gut: treat the gut
list examples of the following:
- dopamine antagonists?
- anti-histamines?
- serotoni antagonists?
- domperidone, metoclopramide
- cyclizine
- ondansetron (CNS and gut)
upper GI disorders - GORD: describe disease causes? associated with? symptoms?
- excess acid at lower oesophageal sphincter
- due to loss of tone or delayed gastric emptying
- obesity, lying flat, fatty foods, smoking
- heartburn
upper GI disorders - GORD:
how to make diagnosis?
treatment? x4
what complications may arise?
- clinical diagnosis: endoscopy
- change lifestyle;
- drugs: antacids, PPIs, rarely surgery
- stricture formation (narrowing)
- cancer (Barrett’s oesophagus)
upper GI disorders - peptic ulcer disease:
can occur where? which can become malignant?
- can be gastric or duodenal
- gastric can become malignant
upper GI disorders - peptic ulcer disease:
epidemiology?
- 15-20% of population
- more in men
- more in elderly
upper GI disorders - peptic ulcer disease:
aetiology?
- Helicobacter pylori
- NSAIDs (esp for gastric ulcers)
upper GI disorders - peptic ulcer disease:
symptoms?
complications?
- epigastric pain, dyspepsia, vomiting, anorexia
- complications: bleeding - haematemesis, melaena
- perforation; could be lethal
upper GI disorders - peptic ulcer disease:
- methods for investigation?
- endoscopy: biopsy if gastric
- presence of H. pylori: determined with breath test, biopsy, serology
upper GI disorders - peptic ulcer disease:
treatment for acute and non-acute disease?
acutely:
- endoscope: can stop bleeding
- rarely surgery
non-acute:
- acid suppression: PPIs
- treat H. pylori: PPIs and antibiotics
upper GI disorders - other disorders? (describe + treatment methods)
- hiatus hernia: structural abnormality of stomach, leaving segment above diaphragm
may cause heartburn, treated with medication or surgery - cancer
upper GI disorders - dental aspect:
for patients with oesophagus and stomach problems, what to take note of?
- caution with NSAIDs
- especially in older patients - anaemia can manifest as oral ulcerations
- non-carious tooth surface loss with acid reflux
lower GI tract: coeliac disease - what is it? what kind of disease? why is it not an allergy? characterised as?
- sensitivity to gluten: wheat, barley, rye
- multi-system autoimmune disease, not an allergy as it involves IgA
- atrophy of the villi in the small intestine, resulting in its flattened surface (reduction of surface area)
coeliac disease: symptom? list the many ways it can manifest
- malabsorption malaise, diarrhoea, steatorrhoea, weight loss, iron and folate deficiency, protein deficiency
coeliac disease: diagnosis?
treatment?
- antibodies
- endoscopy with biopsy
- gluten free diet
- osteoporosis prophylaxis:
diagnosis of coeliac disease: what antibody to check for?
TTGA: tissue transglutaminase antibody
coeliac disease: dental aspects
what are the oral features of malabsorption?
what to take note of with pts taking bisphosphonates?
- oral ulceration
- stop from losing bone density. can cause problems in the event of surgical procedures
lower GI tract: inflammatory bowel disease (IBD): what are the 2 main forms? where does each occur? what kind of disease?
- crohn’s disease: entire GI tract can be affected
- ulcerative colitis: large intestine
- IBD is an autoimmune inflammatory condition, with its cause unknown
IBD: describe the distinct pathological appearance of crohn’s disease and ulcerative colitis
crohn’s disease:
- not continuous (skip lesions)
- transmural inflammation
ulcerative colitis:
- continuous
- mucosal inflammation (does not involve entire wall)
IBD - crohn’s disease: symptoms? x5
- malabsorption
- abdominal pain
- bleeding
- abscess, fistula, sinus formation
- oral features
IBD - ulcerative colitis: symptoms? x2
- bloody diarrhoea
- abdominal pain
IBD - UC & crohn’s: what are the extra-intestinal symptoms?
- autoimmune arthritis
- skin lesions (erythema nodosum, pyoderma gangreonosum)
- autoimmune hepatitis
- DVT and PE
- ocular inflammation
IBD - UC & crohn’s:
cancer as a complication?
- long term complication in UC, less so in Crohn’s disease
IBD: diagnosis?
- clinical
- radiological: small bowel disease
- colonoscopy and biopsy definitive
- stool sample: rules out infective cause, faecal calcoprotein levels - higher meaning there is more infection ongoing
IBD - treatment?
- suppress inflammation
- surgery
- parenteral nutrition/elemental diet
- antibiotics
IBD - treatment: methods to suppress inflammation?
- 5-Aminosalicylic acid preparations: sulfasalazine, mesalazine, olsalazine
- corticosteroids (oral, enema)
- immunosuppressants: azathioprine, methotrexate (crohn’s)
- biologics: anti-TNF agents
IBD - treatment: methods to carry out surgery?
- remove diseased bowel:
- UC: colectomy (curative)
- sections of bowel in Crohn’s (not curative) - abscess drainage
IBD: dental aspects?
- recognize oral features of Crohn’s and UC
- take note of side effects of immunosuppresants and steroids
lower GI tract - diverticulitis:
what is it?
how common?
symptoms?
- inflammation of a diverticulum in the colon, causing pain and disturbance of bowel function
- 50% over 50’s
- usually NIL, if not bleeding and pain: due to abscess formation/obstruction
functional GI disease: symptoms present without demonstrable disease - what could be the causes?
- psychological
- altered bowel smooth muscle tone
- high CHO diet in childhood
functional GI disease: common symptoms - think about oesophagus, gastric, and irritable bowel syndrome
- oesophageal: lump in throat “globus”, regurgitation
- gastric: dyspepsia
- irritable bowel syndrome: cramps, wind, diarrhoea, constipation, bloating
functional GI disease:
treatment?
- reassurance
- fibre/other dietary changes
- anti-spasmodics
- amitriptyline or SSRIs
liver disease:
types of liver disease?
- acute inflammation: hepatitis
- chronic inflammation: cirrhosis
- cancer
liver disease: causes?
- alcohol
- viruses: Hep A-E
- iron overload: haemachromatosis
- drugs: formulary, herbal
- autoimmune
primary biliary cirrhosis
chronic active hepatitis
sclelrosing cholangitis - diabetes
- cryptogenic
liver disease: clinical features?
- jaundice
- ascites: accumlation of fluid in peritoneal cavity, resulting in abdominal swelling
- telangiectasia; dilation of capillaries causing them to appear as red or purple clusters
- renal failure/hepato-renal syndrome
- encephalopathy: confusion, impaired consciousness
- variceal haemorrohage: life threatening upper GI bleeding
- coagulopathy
- prone to infections
liver disease: treatment?
- remove and treat underlying cause
- supportive treatment: liver has capacity for regeneration if not cirrhotic
- liver transplant
liver, pancreas and biliary tract: dental aspects?
- coagulopathy, reduced platelets: bleeding risk
- possible infectious underlying cause: hepatitis viruses, liability to infection
- liver transplant: patient will be on immunosuppresants
gall stones:
results in?
symptoms?
- cholecystitis/cholangitis
- pain, jaundice, pancreatitis
gall stones:
treatment?
- surgery: endoscopic, open cholecystectomy (remove gallbladder)
pancreatitis:
cause?
diagnosis?
treatment?
inflammation of the pancreas
- caused by gallstones, alcohol, drugs
- high amylase enzyme in blood
- supportive (hospitalization)
upper GI bleeding: signs?
- haematemesis: fresh blood, “coffee grounds”
- melaena
- rectal bleeding
upper GI bleeding: causes?
- oesophagitis
- varices
- mallory-weiss tear
- peptic ulcers
- gastritis
