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Flashcards in Gastroenterology Deck (58):
1

what takes place in the gut?

digestion/absorption of nutrients
stomach - alcohol and water
duodenum - iron and B12
jejunum - folate
large intestine - water

2

what takes place in the pancreas?

exocrine portion - production of enzymes to digest food
endocrine - production of insulin

3

what takes place in the gall bladder?

concentration/storgae of bile
fat digestion and absorption

4

what takes place in the liver?

metabolism of nutrients and toxins
production of bile
protein synthesis

5

GI symptoms?

pain - localised/referred
dysphagia
dyspepsia - discomfort of upper tract
nausea/vomitting
diarrhoea
constipation
steatorrhoea
bleeding - haemaemesis, melanea - upper and lower tract
weight loss

6

investigations for upper GI tract?

endoscopy

7

investigations for lower GI tract?

sigmoidoscopy
colonoscopy

8

radiographs show?

plain
contrast - caused by barium swallow, meal, enema

9

ultrasound taken to look at?

especially biliary tract, liver

10

MRI taken to look at?

biliary tract, liver, pancreas
gut

11

antacids suppress acid - what are examples of antacids?

aluminium hydroxide
calcium carbonate - rennie
aligante based - gaviscon

12

gastric acid reduction caused by?

histamine receptor antagonists - H2 blockers
ranitidine, cimetidine

PPI's - omeprazole, lansoprazole

13

when do you treat the CNS with anti emetics? and what are some examples?

when there is chemical stimulation of the vomitting centre treat the CNS
domperidone
metoclopramide ondasteron

14

when to treat the gut? with what?

distension of the gut is causing sickness
anti histamines - cyclizine
ondansetron - serotonin antagonist

15

what is GORD?

gastro oseophageal reflux disease
excess acid at oseophageal sphinctor
= loss of tone
delayed gastric emptying

16

what is GORD associated with?

associated with obesity
lying flat
fatty foods
smoking

17

gord symptoms?
diagnosed by?

heart burn
endoscopy

18

how to treat gord?

lifestyle
drugs - antacids, PPI's
rarely surgery

19

complications caused by GORD?

stricture formation
cancer - via barretts oseophagus

20

what is peptic ulcer disease?

gastric/duodenal - gastric can become malignant
15-20% of population affected, more in elderly and men
caused by helicopter pylori
NSAIDS - esp gastric

21

symptoms of peptic ulcer disease?

epigastric pain
dyspepsia
vomitting
anorexia

22

complications from peptic ulcers?

bleeding - haematemesis, malaena
perforation

23

investigations for peptic ulcers?

endoscopy
biopsy if gastric
H.pylori - biopsy, breath test, serology

24

treatment of acute ulcer?

endoscopically stop bleeding
rarely surgery

25

treatment of non acute ulcer?

acid suppression with PPI
tx of h pylori - PPI/antibiotics

26

what is a hiatus hernia?

may cause heartburn
structural abnormality of the stomach leaving segment above diaphragm
treat with meds or surgery - flundoplication

27

dentally be cautious with what meds?

NSAIDS, corticosteroids

28

what might you see with oral ulceration that might indicate anaemia?

chronic blood loss

29

what might acid reflux cause?

NCTSL

30

what is coeliac disease?

multi symptom autoimmune disease not an allergy
sensitivity to gluten - wheat, rye, barley
small intestinal villous atrophy STVA

31

coeliac symptoms?

malabsorption - malaise, diarrhoea, steatorrhea, weight loss, iron/folate deficiency, protein deficiency

32

diagnosing coeliac disease?

atibodies - tissue transglutaminase antibody TTGA
endoscopy and biopsy

33

how to treat coeliac disease?

gluten free diet
osteoporosis prophylaxis

34

what to be aware of dentally when it comes to pt's with coeliac disease?

oral features of malabsorption - iron/folate
oral ulceration
bisphoshponates

35

types of inflammatory bowel disease?

crohns - entire GI tract
ulcerative colitis - large intestine

36

pathological appearance of crohns?

not continuous - skip lesions
transmural inflammation

37

pathological appearance of UC?

continuous
mucosal inflammation

38

symptoms of crohns?

malabsorption, abdominal pain, bleeding, abscess, fistula, sinus formation

39

symtopms of UC?

bloody diarrhoea
abdominal pain

40

extraintestinal symptoms of IBD?

autoimmune arthritis
skin lesions - erythema nodosum, pyodema gangrenosum
autoimmune hepatitis
DVT, PE
ocular inflammation

41

cancer result of what type of IBD?

long term complication of UC

42

how to diagnose IBD?

clinical
radiology - small bowel disease
colonoscopy/biopsy definitive
stool sample - rule out infective cause, faecal calprotection

43

treatment of IBD?

suppress the inflammation
with 5 aminosalicylic acid preps - sulfazalasine
corticosteroids - oral enema
immunosuppressants - azathioprine, methotraxate for crohns
biologics - anti TNF agents

44

IBD surgery options?

remove diseased bowel
colectomy in UC - curative
sections of bowel in crohns - not curative
abscess of drainage

45

parenteral nutrition/elemental diet causes?
antibiotics cause?

bowel resting/acute episodes
infective complications

46

dental aspects of IBD?

oral features of crohns and malabsorption
side effects of immunosuppressants/steroids

47

what is diverticulitis?

due to pouches/pockets
50% are over 50's
no symptoms usually, could be bleeding, pain from abscess formation/obstructions

48

what is functional GI disease?

symtpoms without demonstratable disease
80% of GI pt's
altered bowel smooth muscle tone?
?high cho diet in childhood

49

common symptoms of functional gi disease?

oseophageal - lump in throat/globus, regurgitation
gastric - dyspepsia, endoscopy if alarm symptoms and age over 40
IBS

50

treatment of functional GI disease?

reassurance, fibre, anti spasmodic
low dose -amitryptilines, SSRI's

51

types of liver disease?

acute inflammation - hepatitis
chronic inflammation - cirrhosis
cancer

52

causes of liver disease?

viruses hep a,b,c,d,e
iron overload - haemachromatosis
drugs
autoimmune - primary bilary cirrhosis
chronic active hepatitis
scleorsing cholangitis
diabetes
ayptogenic

53

liver. pancreas, biliary tract disease symptoms?

jaundice
ascites - fluid overload in belly
telangriectasia - red blood vessels on skin
renal failure
encephalopathy - confusion
variceal haemorrhage - life threatening upper gi tract bleed
coagulopathy
prone to infections

54

tx of liver, pancreas, biliary tract disease?

remove and trear underlying cause
support - liver can regenerate if no cirrhosis
liver transplant

55

what is dentally relevant to liver, pancreas and biliary tract disease?

coagulopathy/reduced platelets
possible infectious underlying cause - hepatitis, liability to infection
liver transplant pt's on immunosuppressants

56

gall bladder problems?

gall stones
cholecystitis - inflamm of gall bladder, cholangitis - inflamm of ducts = pain, jaundice, pancreatitis
treatment - endoscopic, open cholecystectomy

57

what is pancreatitis?

inflammation of the pancreas
caused by gall stones, alcohol, drugs
high amylase in blood gives diagnosis
treatment - support in hospital

58

GI bleeding commonly from?

oseophagus - 5%
varices - 15%
mallory weiss tear = secondary to vomitting - 10%
peptic ulcers - 50%
gastritis - 20%