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Dentistry Human Disease > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What are the two idiopathic chronic inflammatory diseases?

A
  1. Ulcerative colitis
  2. Crohn’s disease
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2
Q

When theres an overlap between ulcerative colitis and Crohn’s disease, what is this termed?

A

Indeterminate colitis

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3
Q

What is the clinical presentation of Crohn’s disease?

A
  • abdominal pain
  • diarrhoea
  • peri-anal disease
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4
Q

What is the clinical presentation of ulcerative colitis?

A
  • diarrhoea & bleeding
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5
Q

What three factors are involved in the pathogenesis of IBD?

A
  1. Genetic predisposition
  2. Mucosal immune system
  3. Environmental triggers
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6
Q

What is the name of a particular disease susceptibility gene involved in IBD?

A

NOD2/CARD15

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7
Q

What is the specific function of gene NOD2/CARD15?

A

Encodes a protein involved in bacterial recognition

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8
Q

Crohn’s disease is mediated by what cells?

A

Type 1 T helper (Th1) cells

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9
Q

Ulcerative colitis is mediated by what cells?

A

Mixed:
- type 1 T helper (Th1) cells
- type 2 T helper (Th2) cells
- natural killer T cells

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10
Q

What effects does smoking have on Crohn’s disease and ulcerative colitis?

A
  1. Aggravates Crohn’s disease
  2. Protects against ulcerative colitis
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11
Q

What medication should not be used in the case of IBD, as it can trigger a flare up?

A

NSAIDS

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12
Q

What part/s of the bowel does ulcerative colitis effect?

A

Colon (specifically the rectum)

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13
Q

What are the terms given for the three different extents of ulcerative colitis within the large intestine?

A
  1. Proctitis
  2. Left-sided colitis
  3. Pancolitis
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14
Q

What is meant by Proctitis?

A

Inflammation of the lining of the rectum

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15
Q

What is meant by left-sided colitis?

A

Inflammation extending from the rectum through the sigmoid and descending portions of the colon

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16
Q

What is meant by Pancolitis?

A

This is a form of ulcerative colitis that effects the entire large intestine

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17
Q

What are common symptoms of ulcerative colitis?

A
  • diarrhoea + bleeding
  • increased bowel frequency
  • tenesmus (feeling of needing to go to toilet)
  • Incontinence
  • lower abdominal pain
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18
Q

How would you categorise severe ulcerative colitis?

A

> 6 bloody stools/24 hour period + 1 or more of:

  • fever
  • tachycardia
  • anaemia
  • elevated erythrocyte levels
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19
Q

What components would you expect to see in blood in a patient with ulcerative colitis?

A
  • C-reactive protein (CRP)
  • albumin
  • platelets
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20
Q

What is the purpose of a colonoscopy?

A

This maps and assesses the extent of the colon involved in disease process

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21
Q

In an endoscopy, what signs would indicate active inflammation?

A
  • loss of vessel pattern
  • granular mucosa
  • contact bleeding
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22
Q

True or false, ulcerative colitis affects the sbumcosual layers of cells?

A

False

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23
Q

What is the incidence of Crohn’s disease?

A

5 per 100,000/ year

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24
Q

What is a skip lesion?

A

Where there is an area of inflamed tissue, with area of normal tissue in front and behind

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25
Q

What is transmural inflammation?

A

Where the bowel wall thickens and in some cases the lumen narrow

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26
Q

What determines the symptoms of Crohn’s disease?

A

Determined by the site of the disease

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27
Q

What are the symptoms of Crohn’s disease in the small intestine?

A
  • abdominal cramps
  • diarrhoea
  • weight loss
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28
Q

What are the symptoms of Crohn’s disease in the colon?

A
  • Abdominal cramps
  • diarrhoea with blood
  • weight loss
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29
Q

What are the symptoms of Crohn’s disease in the mouth?

A
  • angular chelitis
  • Painful ulcers
  • swollen lips
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30
Q

What are the symptoms of Crohn’s disease in the anus?

A
  • Peri-anal pain
  • Abscess
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31
Q

What is a characteristic feature of the large intestine wall in Crohn’s disease?

A

“Cobble stoning” effect

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32
Q

What are the three therapeutic strategies for IBD?

A
  • lifestyle advice
  • drugs
  • surgery
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33
Q

What type of diet should you maintain if you have Crohn’s disease?

A
  • low residue (fibre) diet
  • elemental diet (e.g. modulen- has anti-inflammatory properties)
  • strict gut rest (e.g. parenteral nutrition)
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34
Q

What medication should be used to treat acute flare ups of ulcerative colitis?

A

Steroids

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35
Q

What medication should be used to treat acute flare ups of Crohn’s disease?

A

Steroids

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36
Q

What medication/s should be used to treat chronic ulcerative colitis?

A
  • mesalazine (5-ASA)
  • immunosuppressants
  • biologics
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37
Q

What medication/s should be used to treat Crohn’s disease?

A
  • immunosuppressants
  • biologics
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38
Q

Give an example of a corticosteroid given by IV to treat IBD.

A

Methylprednisolone/ hydrocortisone

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39
Q

Give an example of a corticosteroid given by orally or topically to treat IBD.

A

Prednisolone

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40
Q

What immunosuppressive medication is usually first line for treating Crohn’s disease and ulcerative colitis?

A

azathioprine

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41
Q

What is anti-TNF therapy?

A

Interferes with action of protein TNF which is overactive in the body in people with inflammatory disease

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42
Q

What is vedolizumab and its action?

A

It is a gut-selective integrin blocker. It blocks integrin which stops white blood cells entering the gut and this reduces inflammation

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43
Q

When would surgery be the best option for an individual with IBD?

A

In an emergency where there is failure to respond to medical therapy, small bowel obstruction, abscess or fistulae

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44
Q

Name the 5 therapies used for Crohn’s disease and/or ulcerative colitis.

A
  • steroids
  • 5-ASA
  • immunosuppressives
  • biologics
  • JAK inhibitors
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45
Q

Name the three significant GI diseases that can occur due to malabsorption?

A
  1. Pernicious anaemia
  2. Coeliac disease
  3. Crohn’s disease
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46
Q

How do antacids function?

A

They are alkalis which form a salt with the gastric acid in GI tract and therfore neutralise its effect on tissues

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47
Q

What are the three main triggers which make parietal cells in the stomach produce acid?

A
  1. Acetylcholine
  2. Gastrin
  3. Histamine
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48
Q

How can acetylcholine be reduced?

A

By reducing the vagus nerve stimulation to the stomach, this can be done surgically by cutting the nerve

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49
Q

How can histamine production be reduced?

A

Using H2 receptor blockers

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50
Q

What drugs directly inhibit the release of acid?

A

Proton pump inhibitors

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51
Q

What is the action of H2 receptor antagonists?

A

Reduce acid production by preventing histamine activation of acid production

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52
Q

Name a H2 receptor which is safe for clinical use and licensed for over the counter sale?

A

Ranitidine

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53
Q

Name an example of a commonly used proton pump inhibitor

A

Omeprazole

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54
Q

Give three examples of oesophageal disorders

A
  1. Dysphagia
  2. Fibrosis (scleroderma or acid related)
  3. neuromuscular dysfunction (e.g. Parkinson’s)
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55
Q

Define scleroderma

A

Where elastic tissue is replaced by fibrous tissue

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56
Q

What is GORD?

A

Chronic irritation due to repeated acid reflux into the oesophagus

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57
Q

What is achalasia?

A

Where the nerve supply to the oesophagus does not form properly

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58
Q

What is functional dysphagia?

A

When anxiety causes loss of normal control of oesophageal function

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59
Q

What is dysmotility Dysphagia?

A

Where fibrous tissue replaces muscle tissue

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60
Q

What might cause Dysphagia in regards to surrounding structures?

A

Compression of the oesophagus by surrounding structures

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61
Q

What are the three main causes of GORD?

A
  • defective lower oesophageal sphincter
  • impaired lower clearing (not emptying properly into stomach)
  • impaired gastric emptying
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62
Q

What are the effects/consequneces of GORD?

A
  • ulceration
  • inflammation
  • metaplasia
  • Barrett’s oesophagitis ( potentially malignant)
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63
Q

What cancer can result from Barrett’s oesophagitis?

A

Adenocarcinoma

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64
Q

What are the 4 main signs and symptoms of GORD?

A
  • epigastric burning
  • dysphagia
  • GI bleeding
  • severe pain (oesophageal muscle spasm)
65
Q

What is a hiatus hernia?

A

When part of the stomach is in the thorax (chest)

66
Q

What is peptic ulcer disease?

A

Where there are open sores or raw areas in the lining of the stomach or intestine

67
Q

What are the causes of peptic ulcer disease?

A
  • high acid secretion (duodenal)
  • normal acid secretion (stomach)
  • drugs (NSAIDS, steroids)
68
Q

How can peptic ulcers cause significant bleeding?

A

If they erode through to an artery

69
Q

What bacteria will cause loss of stomach mucosal barrier and by doing so allows the normal level of acid to reach the gastric wall and cause peptic ulceration?

A

Helicobacter pylori

70
Q

What can the effects of helicobacter pylori result in?

A
  • gastric ulcers
  • chronic gastric wall inflammation (lymphoma of the stomach)
71
Q

What triple therapy is used to eliminate helicobacter pylori?

A
  • 2 antibiotics: usually amoxicillin and metronidazole
  • 1 proton pump inhibitor: e.g. omeprazole
72
Q

What are the possible signs/ symptoms of PUD?

A
  • can be asymptomatic
  • can have epigastric burning pain
73
Q

What investigations can be carried out for suspected PUD?

A
  • endoscopy
  • radiology: barium meal
  • anaemia: faecal occult blood test (FOB’s)
  • H.pylori testing: breath, antibodies, mucosa
74
Q

What are the local complications of PUD?

A
  • perforation
  • haemorrhage
  • stricture
  • malignancy
75
Q

What are the systemic complications of PUD?

A

Anaemia due to loss of haemoglobin

76
Q

What surgical treatments can be used for PUD?

A
  • endoscopy
  • surgical repair (gastrectomy)
  • vagotomy
77
Q

What is a vagotomy?

A

A surgical procedure which reduces acid secretion by dividing the vagus nerve branches to the stomach

78
Q

What are the two types of PUD surgery called?

A

Bilroth 1 and bilroth 2

79
Q

What happens during bilroth 1 surgery?

A

Allowed excision of part of the stomach containing the ulcers (usually the distal part of the stomach) and an anastomosis of the duodenum to the remaining part of the stomach. This makes the stomach smaller, which makes the diet reduced but allows a good flow from the stomach to the duodenum.

80
Q

What is the disadvantage of bilroth 1 surgery?

A

There is not a sphincter present and therefore food tends to flow fairly freely into the duodenum and this can cause some problems

81
Q

What happens during bilroth 2 surgery?

A

Allowed excision of part of the stomach containing the ulcers and an anastomosis of the duodenum to the remaining part of the stomach ( but much further down in the duodenum than in bilroth surgery 1)

82
Q

Name 3 small bowel diseases

A
  1. Coeliac disease
  2. Pernicious anaemia
  3. Crohn’s disease
83
Q

What area of the bowel is normally affected by peptic ulcer disease?

A

Duodenum

84
Q

How can tumours develop from small bowel diseases?

A

Inflammatory changes can take place at a low level over many years leading to a lymphoma

85
Q

What disease is characterised by sensitivity to alpha-gliaden component of Gluten?

A

Coeliac disease

86
Q

What are the main food groups that gluten is found in?

A

Wheat, barley, spelt, rye, kaput, oats

87
Q

What are the aetiology’s of coeliac disease?

A
  • genetic
  • environmental triggers
  • consumption of gluten
  • T lymphocytes damage mucosal tissues
  • villus atrophy
88
Q

How does coeliac disease result in the destruction of villus tissue?

A

The gluten alpha-gliaden component is passed through the bowel wall and an immune reaction develops. This produces antibodies and T cells which cause damage to the villus tissue in the jejunum.

89
Q

What are the consequences of acute inflammation changes which take place due to coeliac disease?

A
  • villus atrophy, with loss of projections and significant reduction in surface area available for food absorption
90
Q

How is it easier to diagnose coeliac disease in a child compared to an adult?

A

It is more obvious as the malabsorption will effect the child’s ability to grow properly

91
Q

What are the general symptoms associated with coeliac disease?

A
  • weight loss
  • lack of energy
  • weakness
  • abdominal pain/swelling
  • diarrhoea
  • steatorrhoea
  • dysphagia
92
Q

What are the oral symptoms of coeliac disease?

A
  • oral aphthae (ulceration)
  • tongue papillary loss
93
Q

What are the typical malabsorption issues associated with coeliac disease?

A

Deficiencies in :
- iron
- folate
- vitamin B12
- fat

94
Q

What syndrome can deficiency in iron lead to which can cause issues with the pharynx such as dysphagia?

A

Plumber Vincents syndrome (PVS)

95
Q

What are the 4 investigations for coeliac disease?

A
  • autoantibody test
  • jejunal biopsy
  • faecal fat
  • Haematinics blood test
96
Q

What are haematinics? Give examples

A

Substances that are essential as components in blood. E.g. folic acid, B12, folate

97
Q

What levels of faecal fat would you expect to find in an individual with coeliac disease and why?

A

Increased levels due to malabsorption

98
Q

What is the auto-antibody test used for coeliac disease investigation?

A
  • serum transglutaminase (TTG)
99
Q

If you have a positive TTG result, what does this indicate about a patient having coeliac disease?

A

The patient may or may not have coeliac disease

100
Q

If you have a negative TTG result, what does this indicate about a patient having coeliac disease?

A

The patient does not have coeliac disease

101
Q

What is the best way to manage coeliac disease?

A

Having a gluten free diet

102
Q

What are the three advantages of a gluten free diet for a coeliac patient?

A
  1. Reversal of jejunal atrophy
  2. Improved well being
  3. Reduced risk of lymphoma
103
Q

What skin disease is coeliac disease associated with?

A

Dermatitis herpetiformis

104
Q

Why does dermatitis herpetiformis occur?

A

Due to granular IgA deposition in the skin and mucosal tissue

105
Q

What characterises dermatitis herpetiformis?

A

Itchy blisters- usually over the shoulders but can be widespread, can also affect oral mucosa

106
Q

What screening tool is used when patients present with oral aphthous ulcers and for what purpose?

A

Screened by haematinic assays to detect deficiencies

107
Q

What result from haematinic assay screening would suggest malabsorption and potential coeliac disease?

A

Folate, or combined ferritin & folate deficiency

108
Q

What disease is caused by vitamin B12 deficiency?

A

Pernicious anaemia

109
Q

What protein, made in the stomach helps the intestines absorb vitamin B12?

A

Intrinsic factor (IF)

110
Q

What group of individuals are most prone to vitamin B12 deficiency? And why?

A

Vegans, because B12 is present in food such as dairy products and meat.

111
Q

What is the only B12 absorption site in the bowel?

A

Discrete area of the terminal ileum

112
Q

What 4 factors can cause pernicious anaemia?

A
  1. Lack of vitamin B12 in diet
  2. Disease of gastric parietal cells
  3. Inflammatory bowel disease of terminal ileum (Crohn’s disease)
  4. Bowel cancer at ileo-coecal junction
113
Q

What can be a barrier for some individuals when they require vitamin B12 supplements due to a deficiency?

A

Vitamin B12 supplements are usually made from animal products, can be an issue for vegans.

114
Q

What medical treatment can be given for B12 deficiency if GI absorption is not possible?

A

IM injections of vitamin B12 every month for 3 months to restore patients stores

115
Q

What can be severe consequences of B12 deficiency?

A
  • neuorlogical damage
  • affect bone marrow production for red blood cells
116
Q

What is another word for bowl cancer?

A

Colonic cancer

117
Q

What cancer of the large bowel is the second most common malignancy in the western world?

A

Colonic adenocarcinoma

118
Q

What are the symptoms of colonic carcinoma?

A
  • can have none
  • anaemia
  • rectal blood loss (high risk)
119
Q

What is the aetiology of colonic carcinoma?

A
  • Most arise in polyps within the surface of the lumen
  • these polyps will grow with time and eventually progress into tumours
120
Q

What is the aim of bowel cancer screening?

A

To detect polyps before they become cancerous

121
Q

Why do polyps tend to bleed?

A

Due to irritation and trauma from bowel contents passing through

122
Q

What are medical and familial factors linked to colonic carcinoma?

A
  • genetics (p53 gene)
  • ulcerative colitis
  • intestinal polyps
123
Q

What syndrome is characterised by development of polyps in the GI tract, and usually presents with dark-coloured spots on the lips?

A

Peutz-Jehgers syndrome

124
Q

What part of the GI tract is at higher risk of colonic carcinoma, small or large intestine?

A

Large intestine

125
Q

What two inherited conditions are characterised by many polyps/growths in the small and large intestine?

A
  • Gardiners syndrome
  • cowdens syndrome
126
Q

Which inherited condition is particularly associated with mucosal polyposis?

A

Cowdens syndrome

127
Q

How are Colton cancers staged?

A

According to the level of invasion of the bowel wall

128
Q

What is stage 0 colon cancer?

A

There is no evidence of cancer in the colon or rectum

129
Q

What is stage 1 colon cancer?

A

The tumour has grown into the submucosa

130
Q

What is stage 2 colon cancer?

A

Tumour has grown into the Muscularis propria, a deeper thicker layer of muscle that contracts to force content along the intestines

131
Q

What is stage 3 colon cancer?

A

Tumour has grown through Muscularis propria and into connective tissue or into tissues surrounding the colon or rectum.

132
Q

What is stage 4 colon cancer?

A

The tumour has grown through the bowl wall and to the regional lymph nodes and beyond to other surrounding organs and structures

133
Q

What are the 4 potential treatments for colonic carcinoma?

A
  1. Surgery (primary treatment)
  2. Hepatic metastases
  3. Radiotherapy
  4. Chemotherapy
134
Q

What is involved in the surgery for colonic carcinoma?

A
  1. Resection of the bowl tissue
  2. Bowl brought out through patients abdomen as a stoma
  3. Lumen empties into a bag which is placed over the stoma
135
Q

What is a stoma?

A

Mucosal surface of the bowl turned upwards so that the lumen empties into a bag

136
Q

What is the screening test used for colonic carcinoma in the UK?

A

FiT test (Faecal immunochemical test)

137
Q

If an FiT test (Faecal immunochemical test) comes back negative, when is it next necessary to repeat the test?

A

2 years later

138
Q

If an FiT test (Faecal immunochemical test) is positive, what procedure usually follows?

A

Endoscopy

139
Q

Define, “ the loss of the surface of teeth due to acids you eat or drink, or acids coming up from your stomach”?

A

Erosion

140
Q

Define, “ the wearing of incisal or occlusal surfaces of teeth as a result of functional tooth-to-tooth contact”?

A

Attrition

141
Q

Define, “ the wearing away of tooth surface caused by friction or mechanical process”

A

Abrasion

142
Q

What is the most common site to be effected by erosion?

A

palatal surfaces of upper anterior teeth

143
Q

What are the three main causes of dental erosion?

A
  1. Acidic foods/diet
  2. GORD
  3. Excessive vomiting (bulimia, morning sickness)
144
Q

Why do oral manifestations of coeliac disease occur?

A

Due to the effects of nutritional deficiency from malabsorption

145
Q

What are oral signs of coeliac disease?

A
  • apthous ulcers
  • glossitis
  • angular cheilitis
146
Q

What size is a minor apthous ulcer?

A

<1cm

147
Q

What size is a major apthous ulcer?

A

> 1cm

148
Q

What is the most common orofacial sign of Crohn’s disease?

A

Facial/labial swelling

149
Q

In Crohn’s disease, what orofacial sign usually results from granulomatis inflammation and oedema of tissues?

A

Cobblestone mucosa

150
Q

What is meant by “staghorning”?

A

Submandibular ducts become raised and prominent in appearance, this is secondary to swelling

151
Q

Define, a chronic inflammatory disorder of the orofacial region characterised by non-caseating granuloma on histopathology?

A

Oro-facial Granulomatosis (OFG)

152
Q

How does OFG commonly present in individuals?

A

As lip/oral/facial swelling and gingival involvement

153
Q

Histologically and clincially, what disease is very similar to OFG?

A

Crohn’s disease

154
Q

What is the most notable difference between OFG and Crohn’s disease?

A

OFG tends to have absence of GI symptoms

155
Q

How are OFG and crohn’s similar histologically?

A

They both have presence of non-keratinising granuloma within tissues

156
Q

What is thought to be the most likely cause of OFG, although aetiology still remains largely unknown?

A

Hypersensitivity to food preservatives/ dental materials

157
Q

What are the three potential oral manifestations of ulcerative colitis?

A
  • apthous ulcers
  • lesions related to anaemia
  • pyostomatitis vegetans
158
Q

What is pyostomatitis vegetans?

A

A rare disorder characterised by erythema and oedema of the mucosa and numerous small superficial yellow pustules

Dentistry Human Disease (29 decks)

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