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?

    <p>Diarrhea</p> Signup and view all the answers

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

    <p>Anaemia</p> Signup and view all the answers

    How is coeliac disease diagnosed?

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

    What is the primary treatment for coeliac disease?

    <p>Gluten restriction</p> Signup and view all the answers

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

    <p>Lymphoma and adenocarcinoma of the small bowel</p> Signup and view all the answers

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

    <p>Bleeding tendency</p> Signup and view all the answers

    Which inflammatory bowel disease is more common?

    <p>Ulcerative colitis</p> Signup and view all the answers

    What is the immune aetiology of inflammatory bowel diseases?

    <p>Defective immune system</p> Signup and view all the answers

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

    <p>Protects against Ulcerative colitis</p> Signup and view all the answers

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

    <p>Affects anywhere from mouth to anus</p> Signup and view all the answers

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

    <p>Thickened wall</p> Signup and view all the answers

    What is the microscopic feature of Crohn's disease?

    <p>Chronic inflammatory cells transmurally</p> Signup and view all the answers

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

    <p>Medical and surgical treatments</p> Signup and view all the answers

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

    <p>Increased risk of infection</p> Signup and view all the answers

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

    <p>Cobblestones</p> Signup and view all the answers

    What is the diet used to combat orofacial granulomatosis?

    <p>Cinnamon free diet and Benzoates free diet</p> Signup and view all the answers

    What is the definition of ulcerative colitis?

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

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

    <p>Jewish</p> Signup and view all the answers

    What is the potential complication of ulcerative colitis?

    <p>Colorectal cancer</p> Signup and view all the answers

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

    <p>Uveitis</p> Signup and view all the answers

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

    <p>Type 1 Arthropathy (Pauci)</p> Signup and view all the answers

    In which inflammatory bowel disease do kidney stones occur?

    <p>Crohn's</p> Signup and view all the answers

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

    <p>Pyostomatitis vegetans, oral lesions</p> Signup and view all the answers

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

    <p>Anaemia</p> Signup and view all the answers

    What is the dental relevance of carcinoma in the colon?

    <p>Tooth decay and gum disease</p> Signup and view all the answers

    What is the characteristic feature of Osetomas?

    <p>Unexplained pain relieved by analgesics</p> Signup and view all the answers

    What can IBS mask?

    <p>Appendicitis and Endometriosis</p> Signup and view all the answers

    What is the treatment for Diverticular disease?

    <p>High fibre diet and maybe surgery</p> Signup and view all the answers

    What is a common symptom of IBS-C?

    <p>Hard, lumpy stools</p> Signup and view all the answers

    What is a common oral manifestation of ulcerative colitis?

    <p>Aphthous-like ulcer</p> Signup and view all the answers

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

    <p>To diagnose ulcerative colitis</p> Signup and view all the answers

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

    <p>Every 2 years after 10 years of disease</p> Signup and view all the answers

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

    <p>Ileocaecal valve</p> Signup and view all the answers

    What is the prognosis for ulcerative colitis?

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

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

    <p>To treat acute flares</p> Signup and view all the answers

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

    <p>I CHOP</p> Signup and view all the answers

    What is the increased risk of colon cancer associated with?

    <p>Ulcerative colitis</p> Signup and view all the answers

    What is the purpose of aminosalicylates in treating ulcerative colitis?

    <p>To maintain remission</p> Signup and view all the answers

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

    <p>Tenderness, swelling, or bleeding of the gums</p> Signup and view all the answers

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

    <p>Steatorrhea</p> Signup and view all the answers

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

    <p>Iron deficiency anaemia</p> Signup and view all the answers

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

    <p>Antitransglutaminase antibodies</p> Signup and view all the answers

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

    <p>Anal canal</p> Signup and view all the answers

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

    <p>All of the above</p> Signup and view all the answers

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

    <p>Endoscopic biopsy</p> Signup and view all the answers

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

    <p>95%</p> Signup and view all the answers

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

    <p>All of the above</p> Signup and view all the answers

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

    <p>Enamel defects in the permanent dentition</p> Signup and view all the answers

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

    <p>26</p> Signup and view all the answers

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

    <p>Protective of Ulcerative colitis</p> Signup and view all the answers

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

    <p>All of the above</p> Signup and view all the answers

    What is the microscopic feature of Crohn's disease?

    <p>All of the above</p> Signup and view all the answers

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

    <p>All of the above</p> Signup and view all the answers

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

    <p>Both medical and surgical treatment</p> Signup and view all the answers

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

    <p>All of the above</p> Signup and view all the answers

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

    <p>Increased risk of infection</p> Signup and view all the answers

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

    <p>Gingival enlargement</p> Signup and view all the answers

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

    <p>Snail track ulcers</p> Signup and view all the answers

    What is the diet used to combat orofacial granulomatosis?

    <p>Cinnamon-free and Benzoates-free diet</p> Signup and view all the answers

    What is the purpose of sigmoidoscopy in diagnosing IBDs?

    <p>To check sigmoid colon</p> Signup and view all the answers

    What is the definition of ulcerative colitis?

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

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

    <p>Haematemics</p> Signup and view all the answers

    What is the potential aetiology of ulcerative colitis?

    <p>Dysregulated interaction between mucosal immunology and intestinal microflora</p> Signup and view all the answers

    What is the purpose of azathioprine in treating IBDs?

    <p>To maintain remission in Ulcerative colitis</p> Signup and view all the answers

    What is the complication/risk associated with ulcerative colitis?

    <p>Colorectal cancer</p> Signup and view all the answers

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

    <p>Pyoderma Gangrenosum</p> Signup and view all the answers

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

    <p>Uveitis</p> Signup and view all the answers

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

    <p>Type 1 Arthropathy (Pauci)</p> Signup and view all the answers

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

    <p>Tenderness, swelling, or bleeding of the gums</p> Signup and view all the answers

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

    <p>Ileocaecal valve</p> Signup and view all the answers

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

    <p>Sclerosing cholangitis</p> Signup and view all the answers

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

    <p>Pyostomatitis vegetans</p> Signup and view all the answers

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

    <p>To diagnose IBDs</p> Signup and view all the answers

    What is the increased risk of cancer associated with?

    <p>Ulcerative colitis</p> Signup and view all the answers

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

    <p>Enteral nutrition</p> Signup and view all the answers

    What is the characteristic feature of pain in Osetomas?

    <p>Relieved by the intake of analgesics</p> Signup and view all the answers

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

    <p>Obstruction</p> Signup and view all the answers

    What is the consequence of anaemia on dental health?

    <p>Both a and b</p> Signup and view all the answers

    What is the primary treatment for Diverticular disease?

    <p>High fibre diet</p> Signup and view all the answers

    What is the characteristic feature of IBS-C?

    <p>All of the above</p> Signup and view all the answers

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

    <p>Lymphatic drainage occurs here</p> 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.

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