Flashcards in Gastroenterology Deck (58):
what takes place in the gut?
digestion/absorption of nutrients
stomach - alcohol and water
duodenum - iron and B12
jejunum - folate
large intestine - water
what takes place in the pancreas?
exocrine portion - production of enzymes to digest food
endocrine - production of insulin
what takes place in the gall bladder?
concentration/storgae of bile
fat digestion and absorption
what takes place in the liver?
metabolism of nutrients and toxins
production of bile
pain - localised/referred
dyspepsia - discomfort of upper tract
bleeding - haemaemesis, melanea - upper and lower tract
investigations for upper GI tract?
investigations for lower GI tract?
contrast - caused by barium swallow, meal, enema
ultrasound taken to look at?
especially biliary tract, liver
MRI taken to look at?
biliary tract, liver, pancreas
antacids suppress acid - what are examples of antacids?
calcium carbonate - rennie
aligante based - gaviscon
gastric acid reduction caused by?
histamine receptor antagonists - H2 blockers
PPI's - omeprazole, lansoprazole
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
when to treat the gut? with what?
distension of the gut is causing sickness
anti histamines - cyclizine
ondansetron - serotonin antagonist
what is GORD?
gastro oseophageal reflux disease
excess acid at oseophageal sphinctor
= loss of tone
delayed gastric emptying
what is GORD associated with?
associated with obesity
how to treat gord?
drugs - antacids, PPI's
complications caused by GORD?
cancer - via barretts oseophagus
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
symptoms of peptic ulcer disease?
complications from peptic ulcers?
bleeding - haematemesis, malaena
investigations for peptic ulcers?
biopsy if gastric
H.pylori - biopsy, breath test, serology
treatment of acute ulcer?
endoscopically stop bleeding
treatment of non acute ulcer?
acid suppression with PPI
tx of h pylori - PPI/antibiotics
what is a hiatus hernia?
may cause heartburn
structural abnormality of the stomach leaving segment above diaphragm
treat with meds or surgery - flundoplication
dentally be cautious with what meds?
what might you see with oral ulceration that might indicate anaemia?
chronic blood loss
what might acid reflux cause?
what is coeliac disease?
multi symptom autoimmune disease not an allergy
sensitivity to gluten - wheat, rye, barley
small intestinal villous atrophy STVA
malabsorption - malaise, diarrhoea, steatorrhea, weight loss, iron/folate deficiency, protein deficiency
diagnosing coeliac disease?
atibodies - tissue transglutaminase antibody TTGA
endoscopy and biopsy
how to treat coeliac disease?
gluten free diet
what to be aware of dentally when it comes to pt's with coeliac disease?
oral features of malabsorption - iron/folate
types of inflammatory bowel disease?
crohns - entire GI tract
ulcerative colitis - large intestine
pathological appearance of crohns?
not continuous - skip lesions
pathological appearance of UC?
symptoms of crohns?
malabsorption, abdominal pain, bleeding, abscess, fistula, sinus formation
symtopms of UC?
extraintestinal symptoms of IBD?
skin lesions - erythema nodosum, pyodema gangrenosum
cancer result of what type of IBD?
long term complication of UC
how to diagnose IBD?
radiology - small bowel disease
stool sample - rule out infective cause, faecal calprotection
treatment of IBD?
suppress the inflammation
with 5 aminosalicylic acid preps - sulfazalasine
corticosteroids - oral enema
immunosuppressants - azathioprine, methotraxate for crohns
biologics - anti TNF agents
IBD surgery options?
remove diseased bowel
colectomy in UC - curative
sections of bowel in crohns - not curative
abscess of drainage
parenteral nutrition/elemental diet causes?
bowel resting/acute episodes
dental aspects of IBD?
oral features of crohns and malabsorption
side effects of immunosuppressants/steroids
what is diverticulitis?
due to pouches/pockets
50% are over 50's
no symptoms usually, could be bleeding, pain from abscess formation/obstructions
what is functional GI disease?
symtpoms without demonstratable disease
80% of GI pt's
altered bowel smooth muscle tone?
?high cho diet in childhood
common symptoms of functional gi disease?
oseophageal - lump in throat/globus, regurgitation
gastric - dyspepsia, endoscopy if alarm symptoms and age over 40
treatment of functional GI disease?
reassurance, fibre, anti spasmodic
low dose -amitryptilines, SSRI's
types of liver disease?
acute inflammation - hepatitis
chronic inflammation - cirrhosis
causes of liver disease?
viruses hep a,b,c,d,e
iron overload - haemachromatosis
autoimmune - primary bilary cirrhosis
chronic active hepatitis
liver. pancreas, biliary tract disease symptoms?
ascites - fluid overload in belly
telangriectasia - red blood vessels on skin
encephalopathy - confusion
variceal haemorrhage - life threatening upper gi tract bleed
prone to infections
tx of liver, pancreas, biliary tract disease?
remove and trear underlying cause
support - liver can regenerate if no cirrhosis
what is dentally relevant to liver, pancreas and biliary tract disease?
possible infectious underlying cause - hepatitis, liability to infection
liver transplant pt's on immunosuppressants
gall bladder problems?
cholecystitis - inflamm of gall bladder, cholangitis - inflamm of ducts = pain, jaundice, pancreatitis
treatment - endoscopic, open cholecystectomy
what is pancreatitis?
inflammation of the pancreas
caused by gall stones, alcohol, drugs
high amylase in blood gives diagnosis
treatment - support in hospital