Gastrointestinal System and Coeliac Disease

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Questions and Answers

What are the three components of the small intestine?

Cecum, Rectum, and Anal canal

Duodenum, Jejunum, and Ileum (correct)

Ileum, Jejunum, and Cecum

Duodenum, Jejunum, and Rectum

What is the dietary source of coeliac disease?

Sorbitol malabsorption

Lactose intolerance

Gluten sensitivity - wheat, barley, rye, and oats (correct)

Fructose malabsorption

What is the genetic source of coeliac disease?

The HLA C7 tissue type

The HLA A1 tissue type

The HLA B8 tissue type (correct)

The HLA D4 tissue type

What is a common gastrointestinal symptom of coeliac disease?

Diarrhea Signup and view all the answers

What is one of the extra-intestinal symptoms of coeliac disease?

Anaemia Signup and view all the answers

How is coeliac disease diagnosed?

Using antibodies to gliadin, endomysium, and transglutaminase (ttg) Signup and view all the answers

What is the primary treatment for coeliac disease?

Gluten restriction Signup and view all the answers

What is the increased risk of cancer in patients with coeliac disease?

Lymphoma and adenocarcinoma of the small bowel Signup and view all the answers

What is the consequence of vitamin K deficiency in coeliac disease?

Bleeding tendency Signup and view all the answers

Which inflammatory bowel disease is more common?

Ulcerative colitis Signup and view all the answers

What is the immune aetiology of inflammatory bowel diseases?

Defective immune system Signup and view all the answers

What is the protective effect of appendicectomy in inflammatory bowel diseases?

Protects against Ulcerative colitis Signup and view all the answers

What is the characteristic of Crohn's disease in terms of affected areas?

Affects anywhere from mouth to anus Signup and view all the answers

What is the characteristic of the wall of the bowel in Crohn's disease?

Thickened wall Signup and view all the answers

What is the microscopic feature of Crohn's disease?

Chronic inflammatory cells transmurally Signup and view all the answers

What are the two ways to improve the quality of life of a Crohn's patient?

Medical and surgical treatments Signup and view all the answers

What is the potential effect of long-term systemic corticosteroid therapy on dental treatment?

Increased risk of infection Signup and view all the answers

Which of the following is a specific dental complication that can occur as a result of Crohn's?

Cobblestones Signup and view all the answers

What is the diet used to combat orofacial granulomatosis?

Cinnamon free diet and Benzoates free diet Signup and view all the answers

What is the definition of ulcerative colitis?

Diffuse mucosal inflammation of the colon with backwash involvement of the terminal ileum Signup and view all the answers

What is the most common family history that predisposes ulcerative colitis?

Jewish Signup and view all the answers

What is the potential complication of ulcerative colitis?

Colorectal cancer Signup and view all the answers

What is the manifestation of ulcerative colitis that is more prevalent in Crohn's?

Uveitis Signup and view all the answers

What is the joint manifestation of inflammatory bowel disease that is more prevalent in Crohn's?

Type 1 Arthropathy (Pauci) Signup and view all the answers

In which inflammatory bowel disease do kidney stones occur?

Crohn's Signup and view all the answers

What is the bacteria that grows as a result of ulcerative colitis, and what does it cause?

Pyostomatitis vegetans, oral lesions Signup and view all the answers

What is the most common presentation of colon cancer on the right colon?

Anaemia Signup and view all the answers

What is the dental relevance of carcinoma in the colon?

Tooth decay and gum disease Signup and view all the answers

What is the characteristic feature of Osetomas?

Unexplained pain relieved by analgesics Signup and view all the answers

What can IBS mask?

Appendicitis and Endometriosis Signup and view all the answers

What is the treatment for Diverticular disease?

High fibre diet and maybe surgery Signup and view all the answers

What is a common symptom of IBS-C?

Hard, lumpy stools Signup and view all the answers

What is a common oral manifestation of ulcerative colitis?

Aphthous-like ulcer Signup and view all the answers

What is the purpose of pANCA serological tests in diagnosing IBDs?

To diagnose ulcerative colitis Signup and view all the answers

What is the recommended frequency for colonoscopy screening in patients with ulcerative colitis?

Every 2 years after 10 years of disease Signup and view all the answers

What is the name of the valve located in the colon?

Ileocaecal valve Signup and view all the answers

What is the prognosis for ulcerative colitis?

1/3 single attack, 1/3 relapsing attacks, 1/3 progressively worsen Signup and view all the answers

What is the purpose of cyclosporin in treating Crohn's disease?

To treat acute flares Signup and view all the answers

What is the name of the acronym used to remove infection in IBDs?

I CHOP Signup and view all the answers

What is the increased risk of colon cancer associated with?

Ulcerative colitis Signup and view all the answers

What is the purpose of aminosalicylates in treating ulcerative colitis?

To maintain remission Signup and view all the answers

What is the common dental complication associated with cyclosporin use in Crohn's disease?

Tenderness, swelling, or bleeding of the gums Signup and view all the answers

What is the common gastrointestinal symptom of coeliac disease associated with malabsorption?

Steatorrhea Signup and view all the answers

What is the type of anaemia commonly associated with coeliac disease?

Iron deficiency anaemia Signup and view all the answers

Which antibody is used first in the diagnosis of coeliac disease?

Antitransglutaminase antibodies Signup and view all the answers

What is the name of the canal that is one of the three components of the large intestine?

Anal canal Signup and view all the answers

What is the name of the part of the small intestine that is affected in coeliac disease?

All of the above Signup and view all the answers

What is the name of the procedure used to diagnose coeliac disease?

Endoscopic biopsy Signup and view all the answers

What is the percentage of people with coeliac disease that can be cured with gluten restriction?

95% Signup and view all the answers

What is the increased risk of cancer associated with coeliac disease?

All of the above Signup and view all the answers

What is the dental complication associated with coeliac disease in childhood?

Enamel defects in the permanent dentition Signup and view all the answers

What is the age at which Crohn's disease is more common?

26 Signup and view all the answers

What is the protective effect of appendicectomy in inflammatory bowel diseases?

Protective of Ulcerative colitis Signup and view all the answers

What is the characteristic feature of the wall of the bowel in Crohn's disease?

All of the above Signup and view all the answers

What is the microscopic feature of Crohn's disease?

All of the above Signup and view all the answers

What is the method of diagnosis for Crohn's disease?

All of the above Signup and view all the answers

What is the treatment used to improve the quality of life of a Crohn's patient?

Both medical and surgical treatment Signup and view all the answers

What is the consequence of vitamin B12 deficiency in coeliac disease?

All of the above Signup and view all the answers

What effect may long-term systemic corticosteroid therapy have on dental treatment?

Increased risk of infection Signup and view all the answers

Which of the following is a specific dental complication that can occur as a result of Crohn's?

Gingival enlargement Signup and view all the answers

What is the oral manifestation of ulcerative colitis that appears as benign, multiple small white and yellow pustules?

Snail track ulcers Signup and view all the answers

What is the diet used to combat orofacial granulomatosis?

Cinnamon-free and Benzoates-free diet Signup and view all the answers

What is the purpose of sigmoidoscopy in diagnosing IBDs?

To check sigmoid colon Signup and view all the answers

What is the definition of ulcerative colitis?

Diffuse mucosal inflammation of the colon with backwash involvement of the terminal ileum Signup and view all the answers

What is the blood investigation used to diagnose the type of anaemia in IBD patients?

Haematemics Signup and view all the answers

What is the potential aetiology of ulcerative colitis?

Dysregulated interaction between mucosal immunology and intestinal microflora Signup and view all the answers

What is the purpose of azathioprine in treating IBDs?

To maintain remission in Ulcerative colitis Signup and view all the answers

What is the complication/risk associated with ulcerative colitis?

Colorectal cancer Signup and view all the answers

What is the cutaneous manifestation of ulcerative colitis that appears as a haemorrhagic lesion?

Pyoderma Gangrenosum Signup and view all the answers

What is the eye manifestation that is more prevalent in Crohn's?

Uveitis Signup and view all the answers

What is the joint manifestation that is more prevalent in Crohn's?

Type 1 Arthropathy (Pauci) Signup and view all the answers

What is the dental complication associated with cyclosporin use in Crohn's disease?

Tenderness, swelling, or bleeding of the gums Signup and view all the answers

What is the name of the valve located in the colon?

Ileocaecal valve Signup and view all the answers

What is the liver/billary manifestation that is more prevalent in ulcerative colitis?

Sclerosing cholangitis Signup and view all the answers

What is the bacteria that grows as a result of ulcerative colitis?

Pyostomatitis vegetans Signup and view all the answers

What is the purpose of pANCA serological tests in diagnosing IBDs?

To diagnose IBDs Signup and view all the answers

What is the increased risk of cancer associated with?

Ulcerative colitis Signup and view all the answers

What is the treatment for inducing remission in Crohn's disease?

Enteral nutrition Signup and view all the answers

What is the characteristic feature of pain in Osetomas?

Relieved by the intake of analgesics Signup and view all the answers

What is the common feature of colon cancer presentation on both colons?

Obstruction Signup and view all the answers

What is the consequence of anaemia on dental health?

Both a and b Signup and view all the answers

What is the primary treatment for Diverticular disease?

High fibre diet Signup and view all the answers

What is the characteristic feature of IBS-C?

All of the above Signup and view all the answers

What is the relevance of Virchow's node to colon cancer?

Lymphatic drainage occurs here Signup and view all the answers

Study Notes

Gastrointestinal System Components

The small intestine consists of three components: Duodenum, Jejunum, and Ileum
The large intestine consists of three components: Cecum, Rectum, and Anal canal

Coeliac Disease

Causes:
- Dietary source: Gluten sensitivity (wheat, barley, rye, and oats)
- Genetic source: HLA B8 tissue type
Symptoms:
- Change of bowel habit (COBH)
- Gastrointestinal symptoms:
  - Diarrhea
  - Flatulence
  - Borborygmi
  - Weight loss
  - Weakness, fatigue
  - Abdominal pain
  - Secondary lactose intolerance
  - Steatorrhoea
- Extra-intestinal symptoms:
  - Anaemias (10-15%), especially Fe and B12 deficiency
  - Neurological symptoms (8-14%)
  - Skin disorders (10-20%)
  - Endocrine disturbances (infertility, impotence, amenorrhoea, delayed menarche)
Diagnosis:
- Using antibodies to gliadin, endomysium, and transglutaminase (ttg)
- Endoscopic biopsy
- Pillcam camera for non-invasive inspection
Treatment:
- Gluten restriction (cures 95%)
- Corticosteroids for the remaining 5%

Complications of Coeliac Disease

Increased risk of lymphoma and adenocarcinoma of the:
- Pancreas
- Oesophagus
- Small bowel
- Biliary tract
- T and B cell non-Hodgkin lymphoma
Malabsorption problems:
- B12, folate, ferritin deficiency leading to:
  - Glossitis
  - Angular cheilitis
  - Anaemia
  - Burning mouth
  - Smooth tongue
- Vitamin K deficiency leading to bleeding tendency
- Vitamin D deficiency leading to osteomalacia and rickets in children
Dental problems:
- Enamel defects in permanent dentition, like hypoplasia, if onset is in childhood

Inflammatory Bowel Diseases

Two main types: Crohn's disease and Ulcerative colitis
More common: Ulcerative colitis
Age of onset: Crohn's (26 years), Ulcerative colitis (34 years)
Gender ratio: Females: 1.2:1, Males: 1.2:1
Aetiology: Defective immune system, leading to autoimmunity
Hygiene: Crohn's occurs in good hygiene and developed countries, while Ulcerative colitis has no relation to hygiene
Protective factor: Appendicectomy is protective of Ulcerative colitis
Maternal act: Breastfeeding reduces the risk of developing IBD

Crohn's Disease

Definition: Lifelong condition where parts of the digestive system become inflamed
Areas affected:
- Any part of the digestive tract from mouth to anus
Phenotypes:
- Stricturing: gradual thickening of intestinal wall, leading to stenosis/obstruction
- Penetrating: intestinal fistulas between GI tract and other organs
- Non-penetrating: anal fissures, abscesses
Macroscopic changes:
- Thickened bowel
- Narrowed lumen
- Deep ulcers
- Mucosal fissures
- Cobblestone appearance
- Fistulae
- Abscesses
- Apthoid ulceration
Microscopic changes:
- Chronic inflammatory cells occurring transmurally
- Lymphoid hyperplasia
- Granulomas in Langhans cells
Diagnosis:
- Barium enema, showing rose thorn, skip lesion, or string sign
- Sigmoidoscopy, biopsy, colonoscopy
- Differential diagnosis includes TB and sarcoidosis
Treatment:
- Medical: glucocorticoids, immunomodulators, biologics
- Surgical: intestinal resection
Complications:
- Dental: Many dental patients are receiving long-term systemic corticosteroid therapy, which may have a profound effect on risk of infection, wound healing, and ability to handle stress
- Specific dental lesions:
  - Diffuse labial and buccal swelling
  - Cobblestones
  - Mucosal tags
  - Linear ulcers
  - Mucogingivitis
  - Granulomatous Cheilitis
  - Gingival enlargement
  - Oral ulceration
  - Staghorn calculus in submandibular ducts
- Non-specific dental lesions:
  - Aphthous ulcers
  - Angular cheilitis
  - Glossitis
  - Dental caries
  - Gingivitis/Periodontitis

Ulcerative Colitis

Definition: Diffuse mucosal inflammation of the colon with backwash involvement of the terminal ileum
Areas affected:
- Rectum is always involved
Conditions:
- Proctitis
- Left-sided colitis
- Pancolitis
- Backwash ileitis
Microscopic changes:
- Chronic inflammatory cells occurring on the lamina propria
- Goblet cell depletion
- Crypt abscess
Aetiology:
- Dysregulated interaction mucosal immunology
- Intestinal microflora
- Genetic predisposition (Jewish)
Symptoms:
- Painless
- Bloody diarrhoea with mucus
- Associated fevers and remissions to near normal
- Surviving mucosa
- Crypt distortion
- Loss of haustra
- Absence of goblet cells
Diagnosis:
- Colonoscopy and biopsy
- Exudates, ulcerations, loss of vascular pattern, friability, continuous granularity, superficial inflammation with loss of haustration
Treatment:
- High protein and high fibre diet
- 5-ASA (5-amino salicyclic acid)
- Sulphasalazine and mesalazine
- Thiopurines
- Corticosteroids
- Surgery
Complications:
- Colorectal cancer

Gastrointestinal System Components

The small intestine consists of three components: Duodenum, Jejunum, and Ileum
The large intestine consists of three components: Cecum, Rectum, and Anal canal

Coeliac Disease

Causes:
- Dietary source: Gluten sensitivity (wheat, barley, rye, and oats)
- Genetic source: HLA B8 tissue type
Symptoms:
- Change of bowel habit (COBH)
- Gastrointestinal symptoms:
  - Diarrhea
  - Flatulence
  - Borborygmi
  - Weight loss
  - Weakness, fatigue
  - Abdominal pain
  - Secondary lactose intolerance
  - Steatorrhoea
- Extra-intestinal symptoms:
  - Anaemias (10-15%), especially Fe and B12 deficiency
  - Neurological symptoms (8-14%)
  - Skin disorders (10-20%)
  - Endocrine disturbances (infertility, impotence, amenorrhoea, delayed menarche)
Diagnosis:
- Using antibodies to gliadin, endomysium, and transglutaminase (ttg)
- Endoscopic biopsy
- Pillcam camera for non-invasive inspection
Treatment:
- Gluten restriction (cures 95%)
- Corticosteroids for the remaining 5%

Complications of Coeliac Disease

Increased risk of lymphoma and adenocarcinoma of the:
- Pancreas
- Oesophagus
- Small bowel
- Biliary tract
- T and B cell non-Hodgkin lymphoma
Malabsorption problems:
- B12, folate, ferritin deficiency leading to:
  - Glossitis
  - Angular cheilitis
  - Anaemia
  - Burning mouth
  - Smooth tongue
- Vitamin K deficiency leading to bleeding tendency
- Vitamin D deficiency leading to osteomalacia and rickets in children
Dental problems:
- Enamel defects in permanent dentition, like hypoplasia, if onset is in childhood

Inflammatory Bowel Diseases

Two main types: Crohn's disease and Ulcerative colitis
More common: Ulcerative colitis
Age of onset: Crohn's (26 years), Ulcerative colitis (34 years)
Gender ratio: Females: 1.2:1, Males: 1.2:1
Aetiology: Defective immune system, leading to autoimmunity
Hygiene: Crohn's occurs in good hygiene and developed countries, while Ulcerative colitis has no relation to hygiene
Protective factor: Appendicectomy is protective of Ulcerative colitis
Maternal act: Breastfeeding reduces the risk of developing IBD

Crohn's Disease

Definition: Lifelong condition where parts of the digestive system become inflamed
Areas affected:
- Any part of the digestive tract from mouth to anus
Phenotypes:
- Stricturing: gradual thickening of intestinal wall, leading to stenosis/obstruction
- Penetrating: intestinal fistulas between GI tract and other organs
- Non-penetrating: anal fissures, abscesses
Macroscopic changes:
- Thickened bowel
- Narrowed lumen
- Deep ulcers
- Mucosal fissures
- Cobblestone appearance
- Fistulae
- Abscesses
- Apthoid ulceration
Microscopic changes:
- Chronic inflammatory cells occurring transmurally
- Lymphoid hyperplasia
- Granulomas in Langhans cells
Diagnosis:
- Barium enema, showing rose thorn, skip lesion, or string sign
- Sigmoidoscopy, biopsy, colonoscopy
- Differential diagnosis includes TB and sarcoidosis
Treatment:
- Medical: glucocorticoids, immunomodulators, biologics
- Surgical: intestinal resection
Complications:
- Dental: Many dental patients are receiving long-term systemic corticosteroid therapy, which may have a profound effect on risk of infection, wound healing, and ability to handle stress
- Specific dental lesions:
  - Diffuse labial and buccal swelling
  - Cobblestones
  - Mucosal tags
  - Linear ulcers
  - Mucogingivitis
  - Granulomatous Cheilitis
  - Gingival enlargement
  - Oral ulceration
  - Staghorn calculus in submandibular ducts
- Non-specific dental lesions:
  - Aphthous ulcers
  - Angular cheilitis
  - Glossitis
  - Dental caries
  - Gingivitis/Periodontitis

Ulcerative Colitis

Definition: Diffuse mucosal inflammation of the colon with backwash involvement of the terminal ileum
Areas affected:
- Rectum is always involved
Conditions:
- Proctitis
- Left-sided colitis
- Pancolitis
- Backwash ileitis
Microscopic changes:
- Chronic inflammatory cells occurring on the lamina propria
- Goblet cell depletion
- Crypt abscess
Aetiology:
- Dysregulated interaction mucosal immunology
- Intestinal microflora
- Genetic predisposition (Jewish)
Symptoms:
- Painless
- Bloody diarrhoea with mucus
- Associated fevers and remissions to near normal
- Surviving mucosa
- Crypt distortion
- Loss of haustra
- Absence of goblet cells
Diagnosis:
- Colonoscopy and biopsy
- Exudates, ulcerations, loss of vascular pattern, friability, continuous granularity, superficial inflammation with loss of haustration
Treatment:
- High protein and high fibre diet
- 5-ASA (5-amino salicyclic acid)
- Sulphasalazine and mesalazine
- Thiopurines
- Corticosteroids
- Surgery
Complications:
- Colorectal cancer

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Description

This quiz covers the components of the small and large intestine, as well as the causes and symptoms of coeliac disease, including dietary sources and genetic predispositions.