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DEN303 - IHD > Gastroenterology for Dentists > Flashcards

Gastroenterology for Dentists Flashcards

1
Q

Function of GI tract

A

Turns the food you eat into energy
Waste removal
Intake of water - hydration

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2
Q

Dysphagia
History taking
Dysphagia can be (x3)

A

Difficulty swallowing
Duration
Solids or liquids
Pain (odynophagia) - more common in people with damaged oesophageal passages
Weight loss - common in pts with malignant diseases
Prev. medical history
Medications - NSAIDs cause inflammation of upper GI tracts
Cigarettes and alcohol

Oropharyngeal
Oesophageal
Gastric

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3
Q

dysphagia - oropharyngeal
involves x3
can be caused by

A

salivary gland - sjogrens
tongue - amyloid, hypothyroidism, MS

palatal/epiglottal/upper oesophageal disorder - Cerebrovascular disease, MND, Parkinson’s

neurological disorders

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4
Q

Bile duct

A

Secretes bile from gall bladder which emulsifies fat suitable for absorption

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5
Q

dysphagia - oesophageal

A

Benign mucosal disease e.g peptic strictures where mucosa heals with scarring

e. g 2 oesophageal webs
e. g 3 candidal oesophagi’s

malignant mucosal disease - carcinoma

motility disorders
- oesophageal spasm, achalasia, oesophageal pouch

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6
Q

dysphagia - gastric

A

Carcinoma

Outlet obstruction e.g peptic ulceration

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7
Q

Pharyngeal pouch

A

Defect between constrictor and transverse cricopharyngeus muscle - diverticulum is created

Dangerous in endoscopy of entering pouch and perforating into mediastinal cavity

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8
Q

Stricture

A

Forms due to scar tissue

Surgery can cut through muscle

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9
Q

Management of dysphagia

A

treat underlying cause

Provide supplementation e.g malnourished people - oral supplements, PEG feeding

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10
Q

Indigestion and upper abdominal discomfort

Causes

A 
GORD - gastric upper reflux disease 
Hiatus hernias 
Peptic ulceration 
Non ulcer dyspepsia 
Pancreatic carcinoma 
Pancreatitis
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11
Q

Polypoid carcinoma

A

malignant cause of dysphagia

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12
Q

GORD

Signs+symptoms

Physical mechanism

A

Heartburn, epigastric pain, acid reflux, waterbrash, nausea, vomiting, tooth decay, asthma

Excessive relaxation of lower oesophageal sphincter and raised intra-abdominal pressure

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13
Q

Causes of GORD

A

Hiatus hernia - part of stomach herniates above diaphragm
Inflammatory lesions in the oesophagus leading to diaphragm
Diaphragmatic fibres around hiatus can become loose and upper stomach can be pushed upwards into chest cavity
reflux more readily occurs
mechanical abnormality

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14
Q

Management of GORD

A

Proton pump inhibitors omeprazole and lansoprazole
H2 antagonist - stops reaction of histamines with squamous epithelium
Lifestyle advice (weight loss, smoking cessation, reduce alcohol)

Surgery - fundopliation - part of fundus of stomach is removed and is wrapped around diaphragmatic hiatus

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15
Q

Types of hiatus hernia

A

Normal
Pre stage
Sliding hiatal hernia
Paraoesophageal type

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16
Q

Oesophageal manometry

A

Measures pH of fluids coming out

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17
Q

Peptic ulceration

Symptoms

A

Epigastric pain sometimes radiates into back
worsened by food = associated with weight loss or improved by eating

Complicated by bleeding or perforation

Vomiting/haemastasis (de to gastric ulcer or pyloric outlet obstruction due to duodenal obstruction

Helicobacter pylori or NSAIDs

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18
Q

Management of peptic ulcers

A

Argon probe to coagulate blood
Clips to isolate vessels
PPI given

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19
Q

Indigestion - upper abdo discomfort - Gastric carcinoma
Symptoms

Management
Treatment

A

Epigastric pain, weight loss, vomiting
Late diagnosis

Management

Treatment - surgery/gastrectomy if poss

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20
Q

Upper abdominal - non-ulcer dyspepsia

A

Upper abdominal discomfort, nausea, eructation (belch), bloating
motility disturbance

Pancreatitis
acute inflammation of pancreas causing severe pain, vomiting
chronic relapsing pain (chronic pancreatitis)
commonest cause alcohol > gallstones > pancreatic trauma, drugs, hypercalcamia / lipidaemia, familial

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21
Q

Lower abdominal pain

A

Acute
Chronic

Crescendo of events
See lecture slide for details

22
Q

Management of acute abdominal pain

A

Surgical; referral
Usually kept nil by mouth
IV antibiotics
Imaging - uss/ct scan (small bowel, obstruction and Crohn’s disease)

23
Q

Chronic abdo pain for more than 6 weeks, things to consider

A

Organic vs inorganic
Investigate as previous
Management - usually difficult, analgesics and surgery

24
Q

Vomiting
Causes

Management

A 
Multiple 
Systemic illness
Drugs/alcohol
Centrally mediated 
- middle ear
- cerebellar disease
- raised IC pressure due to tumour e.g 
Psychiatric disorders 
Oesophageal 
Gastric disease 
Small bowel disease
Colonic disease - obstruction due to tumours and volvulus

Identify underlying cause
Antiemetics
PPI
CBT

25
Q

Diarrhoea - acute

A

Infectious - gastroenteritis - bacterial or viral e.g campylobacter, salmonella, shigella, E.coli
Drugs - abs or alcohol
Food allergy/intolerance

26
Q

Diarrhoea - chronic

A

> 6 weeks

Small bowel
lactase deficiency
Coeliac disease
Crohn‘s disease

Pancreatic
pancreatic insufficiency
pancreatic carcinoma
cystic fibrosis

Colonic
ulcerative colitis
Crohn’s disease
carcinoma

27
Q

Coeliac disease - history

definition

A

First discovered in 1887
1940s link to wheat
1961 immunological response to gliadin - Water is held within intestinal mucosa –> diarrhoea

definition:
abnormal proximal small intestinal mucosa that improves morphologically on a gluten free diet (GFD) and relapses when gluten is reintroduced”

28
Q

Normal duodenal mucosa

A

Normal IELs
No crypt hyperplasia
Normal villous structure

29
Q

Coeliac duodenal mucosa

A

Increased inflammatory cells
Crypt hyperplasia
Loss of villous structure - loss of SA
Less absorption - more leaving in faeces

30
Q

Coeliac disease background

A 
1/100 
40-60 years 
9x more adult presentations 
Normal or overweight 
subtle symptoms
GI most common mode of presentation
31
Q

Dermatitis herpetiformis

A

2/3 will have coeliac symptoms

32
Q

Diarrhoea - small bowel/pancreatic

A 
Malabsorption
Pale, floating
Throughout day 
Pain variable timing
Pain not relieved by defecation
33
Q

Diarrhoea - colonic

A 
Irritation of colon lining 
Blood and mucus 
Often in morning
Pain read to defecation 
Pain relieved by defecation
34
Q

Crohn’s disease

A

Chronic inflammatory disease affecting any part of GI tract from mouth to perineum
May be discontinuous and affect several different parts of GI tract at the same time
Ileal-caecal disease
Affects all layers of the gut

35
Q

Ulcerative colitis

A

Chronic inflammatory disease invariably affecting rectum and extending more proximally to involved all or part of the colon

36
Q

Crohn’s disease - symptoms

diagnosis

A 
Pain 
Diarrhoea 
Weight loss
Anorexia
Fever
Vomiting
Lassitude 
Nausea
Acute abdomen 
Nutritional disturbance
Fistula
Miscellaneous

Barium tracing

37
Q

Ulcerative colitis

Symptoms

A 
Only affects superficial subcutaneous mucosa of gut 
Diarrhoea 
Rectal bleeding 
Pain 
Weight loss
38
Q

Associated diseases

A

Skin e.g erythema nodosum is blotchy red rash appears typically on legs, pyoderma gangrenosum
Mouth - ulcers, crohn’s, lips, buccal mucosa
Joints - arthritis, ankylosing spondylitis
Eyes - episcleritis, uveitis
Vascular - thromboses
Liver - cirrhosis, CAH, pericholangitis, UC, primary sclerosing cholangitis

39
Q

Colon cancer
Polyps
Symptoms

A 
35000/year diagnosed
Indicate pre-cancer likelihood - removed
None- bowel cancer screening
rectal bleeding
altered bowel habits
lethargy/weight loss
40
Q

Colon cancer
Investigations

Management

A

Colonoscopy/barium enema
CT

Evaluate extent of disease
Limited disease to colon = surgical resection
Chemo radiotherapy if not limited

41
Q

Jaundice

Causes

A

Liver disease, cirrhosis
Blockage e.g carcinoma, gall stones
Bilirubin cannot be excreted

42
Q

Hepatic jaundice

A

Drug related or in people with hepatitis

43
Q

Pre-Hepatic jaundice

A

Haemolytic anaemia
Red cells broken down
Bilirubin released and has to be broken down
Liver cannot cope with quantity
Jaundice results as bilirubin is not excreted

44
Q

Post-hepatic jaundice

Causes

A

Choledocholithiasis - gall stones - biliary colic, fever, jaundice - bacteria can escape up bile duct and infect it - impaction and disimpaction

malignancy - pancreatic carcinoma, cholangiocarcinoma - pain radiation to back, weight loss

benign biliary structure (post operative, sclerosing cholangitis) - fever and pain

45
Q

Jaundice - hepatic causes

A

Infection - Malaise, lethargy, anorexia, distaste for cigarettes, jaundice, pale stools, dark urine, right upper quadrant discomfort

Alcoholic hepatitis - above, plus history of excess alcohol

Drugs - augmentin, flucloxacillin, many others

Decompensated chronic liver disease (alcoholic cirrhosis, haemachromatosis, PBC, CAH, Chronic hepatitis B or C, Wilson’s disease)
jaundice, ascites (accumulation of fluid in abdominal cavity), varices, hepatic encephalopathy

46
Q

Haemolytic anaemia

Causes and presentation

A

hereditary spherocytosis, G6PD deficiency, sickle cell disease)
anaemia, jaundice, gallstones, splenomegaly, leg ulcers

47
Q

Sign of chronic liver disease

A

Nail clubbing, erythema on palms

48
Q

Oesophageal varices

A

Smoothed mucosa going towards stricture
Portal venous flow is impaired mechanically
Blood has to find another way and finds collateral openings to return to systemic circulation
Occurs in upper part of stomach to oesophageal veins
Veins become engorged and bloated
40% mortality rate

49
Q

Liver fx
Synthetic

Metabolic

A

Clotting factor producer - affects PT time
Produces proteins e.g albumin
Processes and produces bile for digestion

Excretion of nitrogenous compounds e.g NH3
If liver is failing, NH3 sometimes crosses blood brain barrier –> potential cause of confusion in liver failure patients
Excretion of some drugs or metabolites

50
Q 
Upper abdominal discomfort - peptic ulceration 
History 
Worsening with eating 
Improvement with eating 
Complications 
Cause 
Endoscopic appearance
A 
Epigastric pain 
Radiation into back 
Worsened by food so associated with weight loss = gastric ulcer
Improved = duodenal ulcer 
Bleeding or perforation 
Helicobacter pylori/NSAIDs

Clean ulcer
Adherent clot
Visible vessel

51
Q

Upper abdominal discomfort/pain - Pancreatic carcinoma at ampulla

A

Unremitting pain, often radiating to back and associated with weight loss and may cause jaundice as bile duct can become blocked by it as at same junction as pancreatic duct
bilirubin not excreted

52
Q

Upper abdominal discomfort/pain - Pancreatitis

A

Acute inflammation of pancreas causing severe pain, vomiting
chronic relapsing pain (chronic pancreatitis)
commonest cause alcohol > gallstones > pancreatic trauma, drugs, hypercalcamia / lipidaemia, familial

DEN303 - IHD (58 decks)

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