Gasteroenterology

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Questions and Answers

What is a distinctive characteristic of Crohn's disease in terms of its location within the gastrointestinal tract?

  • It can affect any part of the gastrointestinal tract. (correct)
  • It primarily affects the rectum.
  • It exclusively affects the mucosa of the colon.
  • It is limited to the small intestine.

Which of the following is a typical presentation of Crohn's disease?

  • Sudden onset of severe abdominal pain with bloody diarrhea.
  • Acute nausea and vomiting following meals.
  • Painless jaundice with progressive weight loss.
  • Chronic pain and diarrhea, potentially with remission and flare-ups. (correct)

An enterocutaneous fistula is a complication that can arise from Crohn's disease. What does this complication involve?

  • An abnormal connection between the intestine and the skin. (correct)
  • Inflammation of the esophagus leading to strictures.
  • The formation of ulcers in the lining of the stomach.
  • The development of polyps in the colon.

What systemic complication of Crohn's disease is most likely secondary to small bowel involvement?

<p>Malabsorption. (D)</p> Signup and view all the answers

Which of the following is considered a potential complication of IBD in pediatric patients?

<p>Failure of growth and development. (A)</p> Signup and view all the answers

Which blood test is used to monitor for complications of Crohn's disease, such as sclerosing cholangitis?

<p>Liver function tests (LFTs). (B)</p> Signup and view all the answers

Which laboratory test is most useful in differentiating between inflammation and irritable bowel syndrome (IBS)?

<p>Stool/fecal tests. (D)</p> Signup and view all the answers

During an endoscopy for suspected Crohn's disease, what characteristic finding in biopsies would suggest Crohn's?

<p>Granulomatous inflammation. (D)</p> Signup and view all the answers

What oral manifestation is especially associated with Crohn's disease?

<p>Aphthous ulceration. (D)</p> Signup and view all the answers

What is the primary difference between ulcerative colitis (UC) and Crohn's disease in terms of the layers of the intestinal wall affected?

<p>UC affects only the mucosa, while Crohn's can cause transmural inflammation. (A)</p> Signup and view all the answers

Which of the following statements best describes the distribution of Crohn's disease and ulcerative colitis (UC) in terms of gender?

<p>Crohn's disease is more common in females, while UC is more common in males. (B)</p> Signup and view all the answers

What is the typical concordance rate observed in IBD familial patterns, indicating the likelihood of the disease occurring in genetically related individuals?

<p>10-25%. (D)</p> Signup and view all the answers

Which of the following factors is considered a potential cause of inflammatory bowel disease (IBD)?

<p>Infections. (D)</p> Signup and view all the answers

Which category of drug therapies includes agents like anti-diarrheals and anti-spasmodics used in the treatment of IBD?

<p>Symptomatic Agents. (C)</p> Signup and view all the answers

What term is used to describe the characteristic pattern of lesions seen in Crohn's disease, where there are areas of inflammation interspersed with areas of healthy tissue?

<p>Skip lesions. (B)</p> Signup and view all the answers

Which of the following is a systemic complication associated with IBD related to inflammatory activity?

<p>Aphthous ulceration. (D)</p> Signup and view all the answers

Which of the following could cause extra-intestinal signs of IBD such as Uveitis?

<p>Inflammatory activity. (C)</p> Signup and view all the answers

What treatment is often prescribed for short-term management of IBD symptoms, such as inflammation?

<p>Short term steroids. (C)</p> Signup and view all the answers

What distinguishes Crohn's disease from ulcerative colitis in terms of the areas of the GI tract that are affected?

<p>Crohn's disease can affect any part of the GI tract, while ulcerative colitis is limited to the colon. (C)</p> Signup and view all the answers

Systemic complications of Crohn's are associated with small bowel involvement. State one such complication.

<p>Cholelithiasis (Gallstones). (A)</p> Signup and view all the answers

Which of the following is a common symptom of Crohn's disease?

<p>Fever. (D)</p> Signup and view all the answers

What is one of the main purposes of stool/faecal tests in evaluating IBD?

<p>Looking for bleeding. (D)</p> Signup and view all the answers

What effect can certain medications, like adalimumab and infliximab, used to treat IBD, have on the mouth and dental health?

<p>The possible effects are being investigated. (C)</p> Signup and view all the answers

What feature is unique to Crohn's disease?

<p>Granulomas. (A)</p> Signup and view all the answers

What does the presence of the extra-intestinal sign, erythema nodosum suggest?

<p>Exacerbated inflammatory activity. (B)</p> Signup and view all the answers

How does Crohn's disease typically spread through the gastrointestinal tract?

<p>It presents with skip lesions, affecting any part of the GIT. (B)</p> Signup and view all the answers

What is the primary distinction between ulcerative colitis and Crohn's disease based on the layer of the intestinal wall affected?

<p>Ulcerative colitis affects the mucosa, while Crohn's disease is transmural. (C)</p> Signup and view all the answers

What is suggested by a Crohn's disease biopsy that shows granulomas?

<p>A characteristic feature found in Crohn's disease. (D)</p> Signup and view all the answers

Which of the following is a possible cause for IBD?

<p>Specific bacterial infections (C)</p> Signup and view all the answers

Why might a doctor order routine blood work for an IBD patient?

<p>To search for signs and effects of Crohn's disease (A)</p> Signup and view all the answers

Which oral manifestation is most frequently observed in patients with IBD?

<p>Aphthous ulceration (D)</p> Signup and view all the answers

What should a clinician consider when a young patient presents with symptoms of IBD?

<p>Young patients have a higher incidence of IBD. (C)</p> Signup and view all the answers

How do environmental factors contribute to the development of IBD?

<p>They influence the likelihood, particularly in 'Westernised' societies. (C)</p> Signup and view all the answers

How would a doctor use stool tests to evaluate IBD?

<p>To identify bleeding and infections (C)</p> Signup and view all the answers

Which of the following best describes the genetic component of IBD?

<p>Genetic and environmental components are not fully worked out. (A)</p> Signup and view all the answers

Which factor is most likely to cause fistulae to form in individuals with Crohn's disease?

<p>Transmural inflammation (A)</p> Signup and view all the answers

What feature is unique to Crohn's disease and not found in ulcerative colitis?

<p>Skip lesions (C)</p> Signup and view all the answers

In IBD, what indicates that symptoms are related to inflammatory activity?

<p>Aphthous ulceration (B)</p> Signup and view all the answers

What is the typical pattern of Crohn’s disease based on gender?

<p>UC more common in males (C)</p> Signup and view all the answers

What is the possible result of IBD in children?

<p>Arthritis (A)</p> Signup and view all the answers

Which class of medications requires routine monitoring of potential effects, such as anaemia?

<p>Immunosuppressants (C)</p> Signup and view all the answers

Which of the following best describes the role of symptomatic agents in the management of IBD?

<p>Alleviating symptoms (B)</p> Signup and view all the answers

What is indicated by an elevation of faecal calprotectin levels?

<p>Intestinal inflammation (B)</p> Signup and view all the answers

What is the primary reason for performing an endoscopy in a patient suspected of having Crohn's disease?

<p>To directly visualize the intestinal mucosa and obtain biopsies (B)</p> Signup and view all the answers

What is the role of genetic factors in the familial patterns observed in IBD?

<p>Genetic influences are not fully resolved. (B)</p> Signup and view all the answers

Why is it important to understand the different presentations of Crohn's disease?

<p>The symptoms vary according to the part of the GIT affected. (D)</p> Signup and view all the answers

What is the concordance rate in IBD familial patterns?

<p>10-25% (D)</p> Signup and view all the answers

Which systemic complication is related to malabsorption?

<p>Gallstones (D)</p> Signup and view all the answers

Other granulomatous disorders include?

<p>OFG and Sarcoidosis (A)</p> Signup and view all the answers

Why would LFT's be useful when monitoring Crohn's disease?

<p>To evaluate the symptoms of sclerosing cholangitis (A)</p> Signup and view all the answers

What is the primary mechanism by which acid and pepsin contribute to the pathophysiology of GORD?

<p>They directly erode the oesophageal mucosa, causing inflammation and damage. (B)</p> Signup and view all the answers

How does the diaphragm contribute to the anti-reflux barrier in the human body?

<p>By acting as an 'external sphincter' to support the lower oesophageal sphincter. (D)</p> Signup and view all the answers

In the context of GORD, what is the role of saliva as an oesophageal defence mechanism?

<p>Saliva contains bicarbonate, which neutralizes acid in the oesophagus. (D)</p> Signup and view all the answers

Which dietary habit is most likely to increase the risk of GORD?

<p>Eating larger meals close to bedtime. (B)</p> Signup and view all the answers

Why are anticholinergics considered a risk factor for GORD?

<p>They relax the lower esophageal sphincter. (B)</p> Signup and view all the answers

What is the term used to describe excessive salivation that can occur as a symptom of GORD?

<p>Water brash (D)</p> Signup and view all the answers

What is the significance of 'alarm symptoms' in the context of managing dyspepsia?

<p>They warrant an urgent referral for endoscopy to investigate potential serious underlying conditions. (D)</p> Signup and view all the answers

What is the primary action of proton pump inhibitors (PPIs) in the management of GORD?

<p>To reduce the production of stomach acid. (A)</p> Signup and view all the answers

Which condition is typically associated with erosions in the lining of the gastrointestinal tract caused by gastric acid?

<p>Peptic Ulcer Disease (B)</p> Signup and view all the answers

How is Helicobacter pylori typically diagnosed?

<p>Through a urea breath test. (D)</p> Signup and view all the answers

Which combination of medications is typically used in the 'triple therapy' for the eradication of Helicobacter pylori?

<p>A PPI, clarithromycin, and amoxicillin (or metronidazole). (A)</p> Signup and view all the answers

What is the primary characteristic of coeliac disease?

<p>Intolerance to alcohol-soluble proteins in wheat, rye and barley, leading to GI malabsorption. (D)</p> Signup and view all the answers

Which of the following is commonly associated with coeliac disease?

<p>HLA DR3 (C)</p> Signup and view all the answers

Which skin condition is specifically associated with coeliac disease?

<p>Dermatitis herpetiformis (C)</p> Signup and view all the answers

Which antibody is typically elevated in individuals with coeliac disease?

<p>Alpha-gliadin and anti-endomysial antibodies (C)</p> Signup and view all the answers

What is a common finding on jejunal biopsy in individuals with coeliac disease?

<p>Villous atrophy (D)</p> Signup and view all the answers

What is the appropriate initial management strategy for a patient diagnosed with GORD?

<p>Lifestyle modifications and antacids as needed (D)</p> Signup and view all the answers

If a patient with dyspepsia presents with progressive difficulty swallowing, what course of action should be taken?

<p>Schedule an urgent referral for endoscopy. (A)</p> Signup and view all the answers

Which of the following complications is specifically associated with coeliac disease?

<p>T cell lymphoma (D)</p> Signup and view all the answers

What is the initial step in managing GORD, before considering drug treatment?

<p>Reducing risk factors through lifestyle changes (B)</p> Signup and view all the answers

Which of the following symptoms is a classic sign of upper gastrointestinal bleeding?

<p>Haematemesis and melaena (B)</p> Signup and view all the answers

What underlying condition should a clinician suspect when encountering dental erosion in a patient?

<p>Gastro-Oesophageal Reflux Disease (GORD) (B)</p> Signup and view all the answers

Which of these groups has the highest incidence of IBD?

<p>Jewish people (D)</p> Signup and view all the answers

What oral manifestation could suggest an underlying digestive issue?

<p>Soft tissue lesions (A)</p> Signup and view all the answers

A patient presents with heartburn and regurgitation, symptoms suggestive of GORD. However, they also report unintentional weight loss. What is the MOST appropriate next step?

<p>Immediately refer for endoscopy. (A)</p> Signup and view all the answers

A patient presents with anaemia suspected to be secondary to coeliac disease. What laboratory finding would MOST strongly support this diagnosis?

<p>Positive alpha-gliadin and anti-endomysial antibodies (A)</p> Signup and view all the answers

A patient who has been managing their GORD with over-the-counter antacids presents with new-onset epigastric pain. Which of the following conditions should be considered?

<p>Peptic Ulcer Disease (C)</p> Signup and view all the answers

A patient with coeliac disease adheres to a gluten-free diet. Which of the following findings on a subsequent jejunal biopsy would indicate that the dietary changes have been effective?

<p>Reversal of villous atrophy (C)</p> Signup and view all the answers

A patient with H. pylori infection is prescribed triple therapy consisting of a PPI, clarithromycin and amoxicillin. What information is MOST important to provide to the patient regarding the administration of these medications?

<p>The medications should be taken for the entire prescribed course to ensure eradication. (D)</p> Signup and view all the answers

What is the estimated percentage of the adult population in Western society experiencing GORD symptoms at least monthly?

<p>25% (D)</p> Signup and view all the answers

Besides acid, which other substance found in refluxed material significantly contributes to damage of the oesophageal mucosa in GORD?

<p>Pepsin (C)</p> Signup and view all the answers

Which of these factors can impair oesophageal clearance and potentially contribute to GORD?

<p>Hiatus hernia (C)</p> Signup and view all the answers

What dietary factor is most likely to exacerbate GORD symptoms?

<p>High fat content (C)</p> Signup and view all the answers

Why are anticholinergic medications considered a risk factor for GORD?

<p>They delay gastric emptying and reduce lower oesophageal sphincter pressure (B)</p> Signup and view all the answers

What term describes the excessive salivation sometimes experienced as a symptom of GORD?

<p>Water brash (D)</p> Signup and view all the answers

A patient with dyspepsia reports unintentional weight loss; what action is most appropriate?

<p>Refer for an urgent endoscopy (D)</p> Signup and view all the answers

Which condition is characterized by erosions in the gastrointestinal tract lining due to gastric acid, and can be caused by NSAID use?

<p>Peptic ulcer (A)</p> Signup and view all the answers

What method is commonly used to diagnose Helicobacter pylori infection, leveraging its ability to metabolize urea?

<p>Urea breath test (C)</p> Signup and view all the answers

What combination of medications typically constitutes triple therapy for the eradication of Helicobacter pylori?

<p>PPI, clarithromycin, and amoxicillin (B)</p> Signup and view all the answers

What is the primary characteristic of coeliac disease that leads to gastrointestinal symptoms?

<p>Intolerance to alcohol-soluble proteins found in wheat, rye and barley (C)</p> Signup and view all the answers

Which of the following conditions is closely associated with coeliac disease?

<p>Dermatitis herpetiformis (C)</p> Signup and view all the answers

Which antibody is typically found to be elevated in individuals with coeliac disease, indicating an immune response to gluten?

<p>Alpha-gliadin antibodies (C)</p> Signup and view all the answers

What is a typical finding on jejunal biopsy in individuals with active coeliac disease?

<p>Villous atrophy (B)</p> Signup and view all the answers

What is the recommended initial management strategy for a patient newly diagnosed with GORD?

<p>Lifestyle modifications and acid suppressants (A)</p> Signup and view all the answers

If a patient with dyspepsia presents with progressive difficulty swallowing, what is the recommended course of action?

<p>Refer for endoscopy (A)</p> Signup and view all the answers

Which of the following is a potential long-term complication specifically associated with coeliac disease?

<p>T cell lymphoma (D)</p> Signup and view all the answers

What initial lifestyle change is typically recommended for patients to manage GORD before considering drug treatment?

<p>Reduce risk factors (B)</p> Signup and view all the answers

What underlying condition should a clinician suspect when encountering dental erosion in a patient, as seen in the included image?

<p>GORD (B)</p> Signup and view all the answers

Based on the provided image and information, which ethnic group has the highest incidence of IBD?

<p>Jewish People (A)</p> Signup and view all the answers

What oral manifestation could suggest an underlying digestive issue, particularly in the context of IBD or coeliac disease as shown in the images?

<p>Angular Cheilitis (B)</p> Signup and view all the answers

A patient presents with heartburn and regurgitation, symptoms suggestive of GORD. However, they also report unintentional weight loss and progressive difficulty swallowing. What is the MOST appropriate next step?

<p>Refer for endoscopy (A)</p> Signup and view all the answers

Aside from genetic predisposition, what are the risk factors that heavily influence the development and severity of gastro-oesophageal reflux disease (GORD)?

<p>Diet, obesity and smoking (B)</p> Signup and view all the answers

In IBD, if a patient presents with aphthous ulceration, episcleritis, and erythema nodosum, what do these signs collectively indicate?

<p>The patient's symptoms are related to inflammatory activity. (A)</p> Signup and view all the answers

A young patient presents with symptoms suggestive of IBD. What crucial consideration should guide the clinician's approach?

<p>The patient's symptoms may indicate a higher incidence of IBD at a young age. (B)</p> Signup and view all the answers

Which of the following accurately describes the influence of environmental factors on IBD development?

<p>Environmental factors, like the 'westernised' diet, may increase the risk of IBD. (A)</p> Signup and view all the answers

In evaluating IBD, how would a doctor interpret elevated faecal calprotectin levels?

<p>The patient has intestinal inflammation. (D)</p> Signup and view all the answers

What would a biopsy during an endoscopy reveal in a patient with Crohn's disease?

<p>Characteristics that are specifically granulomatous. (C)</p> Signup and view all the answers

What systemic complication of Crohn's disease is more likely to occur due to small bowel involvement?

<p>Malabsorption (A)</p> Signup and view all the answers

In a child with IBD, what potential complication related to growth should be monitored?

<p>Failure of growth and development. (A)</p> Signup and view all the answers

What is the primary utility of Liver Function Tests (LFTs) in monitoring Crohn's disease?

<p>To monitor for complications, such as sclerosing cholangitis. (D)</p> Signup and view all the answers

A patient presents with soft tissue swellings in the mouth. What action is most appropriate?

<p>Inquire about GI symptoms (C)</p> Signup and view all the answers

A patient taking adalimumab reports oral discomfort. What is the MOST likely cause?

<p>Adalimumab, being an immunosuppressant, is likely the cause. (D)</p> Signup and view all the answers

According to the information, which ethnic group has the highest incidence of IBD?

<p>Jewish people (D)</p> Signup and view all the answers

In the pathophysiology of GORD, what is the role of Transient Lower Oesophageal Sphincter (LOS) relaxations?

<p>They allow gastric contents to reflux into the esophagus. (A)</p> Signup and view all the answers

How does a hiatus hernia affect oesophageal clearance?

<p>It can impair oesophageal clearance. (D)</p> Signup and view all the answers

What is the function of bicarbonate in saliva in relation to oesophageal defence mechanisms against GORD?

<p>Neutralizing acid. (A)</p> Signup and view all the answers

Which dietary habit is most likely to exacerbate GORD symptoms and increase the risk of reflux?

<p>Consuming larger meals, especially late at night. (C)</p> Signup and view all the answers

Why are medications with anticholinergic effects considered a risk factor for GORD?

<p>They relax the lower oesophageal sphincter. (D)</p> Signup and view all the answers

What is the term used to describe the symptom of excessive salivation often experienced by individuals with GORD?

<p>Water brash (C)</p> Signup and view all the answers

A patient with dyspepsia reports new onset of progressive difficulty swallowing. What should you do?

<p>Refer the patient for an urgent endoscopy. (C)</p> Signup and view all the answers

What is the MOST appropriate initial management strategy for a patient who has been newly diagnosed with GORD?

<p>Lifestyle modifications to reduce risk factors (A)</p> Signup and view all the answers

A patient is suspected of having upper gastrointestinal bleeding; what symptom would MOST strongly suggest this?

<p>Haematemesis (B)</p> Signup and view all the answers

A new patient presents with dental erosion of unknown cause. What underlying condition should a clinician FIRST suspect?

<p>Gastro-oesophageal reflux disease (GORD). (A)</p> Signup and view all the answers

What best describes the incidence and prevalence of GORD?

<p>GORD is common and the incidence increases with age. (D)</p> Signup and view all the answers

Why might a clinician advise GORD patients to reduce high fat foods?

<p>High fat foods may impede gastric emptying and reduce LOS pressure. (B)</p> Signup and view all the answers

Which diagnostic approach can best identify Helicobacter pylori?

<p>Urea breath test. (B)</p> Signup and view all the answers

In triple therapy for Helicobacter pylori eradication which drugs are most likely used?

<p>PPI, clarithromycin, and amoxicillin (A)</p> Signup and view all the answers

What is the key characteristic of coeliac disease that affects gastrointestinal function?

<p>Intolerance to gluten leading to villous atrophy. (A)</p> Signup and view all the answers

A patient is diagnosed with dermatitis herpetiformis. What co-existing condition is MOST strongly associated with this?

<p>Coeliac disease (C)</p> Signup and view all the answers

Which of the following is a serological marker typically elevated in the blood of individuals with coeliac disease?

<p>Anti-endomysial antibodies (B)</p> Signup and view all the answers

What is expected on jejunal biopsy in individuals suffering from coeliac disease?

<p>Villous atrophy (B)</p> Signup and view all the answers

What is an established management strategy which can help reduce the complications of coeliac disease?

<p>Follow a gluten-free diet. (B)</p> Signup and view all the answers

What long-term complication is specifically associated with coeliac disease, highlighting the need for strict dietary control?

<p>T cell lymphoma (B)</p> Signup and view all the answers

What is the primary cause of peptic ulcers?

<p>Erosions caused by gastric acid. (D)</p> Signup and view all the answers

In managing a patient with GORD, what is the initial step to take before considering drug treatment?

<p>Suggesting lifestyle modifications. (A)</p> Signup and view all the answers

Considering the information provided, what alarm symptom would warrant immediate referral?

<p>Acute gastrointestinal bleeding (D)</p> Signup and view all the answers

Why does GORD reduce life quality?

<p>Rarely life threatening but is frequently chronic and relapsing (D)</p> Signup and view all the answers

A patient asks about risks for GORD; what can you tell them?

<p>Smoking is a risk factpr. (C)</p> Signup and view all the answers

A patient with symptoms of dyspepsia also reports unintentional weight loss, what is the recommended course of action?

<p>Arrange for urgent endoscopy (D)</p> Signup and view all the answers

According to what you have learnt, what is the treatment for GORD

<p>PPI's (C)</p> Signup and view all the answers

How do the symptoms of GORD present?

<p>Heartburn and retrosternal discomfort (D)</p> Signup and view all the answers

If you ask a patient and they say they experience water brash; what can you expect?

<p>Excessive salivation (B)</p> Signup and view all the answers

A patient with IBD presents with episcleritis and uveitis. What aspect of the disease do these symptoms indicate?

<p>The symptoms relate to inflammatory activity. (A)</p> Signup and view all the answers

A young female patient is suspected of having Crohn's disease. What factor distinguishes Crohn's disease in females compared to males?

<p>There is no difference in Crohn's in terms of gender for paediatric patients. (A)</p> Signup and view all the answers

If a patient presents with soft tissue swellings of the mouth, what questioning is recommended to further investigate the issue?

<p>Ask about gastrointestinal symptoms. (A)</p> Signup and view all the answers

A 55-year-old patient is undergoing an endoscopy, and is found to have granulomas. What other test could be used to further investigate the granulomas?

<p>SACE test (A)</p> Signup and view all the answers

What is suggested by anaemia in IBD in the context of dental health, particularly in patients on immunosuppressant medications?

<p>It could be the cause or result of systemic issues, which can have an impact on dental health. (A)</p> Signup and view all the answers

What is a potential systemic complication of Crohn’s disease related to small bowel involvement?

<p>Amyloidosis (B)</p> Signup and view all the answers

A patient taking the immunosuppressant Infliximab reports oral discomfort. What is the MOST likely cause?

<p>The medication has caused an aphthous ulcer to form. (A)</p> Signup and view all the answers

A patient newly diagnosed with Gastro-Oesophageal Reflux Disease (GORD) reports experiencing excessive salivation. Which term accurately describes this symptom?

<p>Water brash (C)</p> Signup and view all the answers

What is the initial recommended management strategy for a patient newly diagnosed with Gastro-Oesophageal Reflux Disease (GORD), prior to considering drug treatment?

<p>Adjust medications and reduce risk factors. (D)</p> Signup and view all the answers

What is the primary reason for using a urea breath test in the diagnosis of Helicobacter pylori infection?

<p>To measure the bacteria's production of ammonia and carbon dioxide. (A)</p> Signup and view all the answers

Flashcards

Inflammatory Bowel Disease (IBD)

A group of inflammatory conditions affecting the colon and small intestine.

Ulcerative Colitis

Inflammation and ulceration primarily affecting the inner lining (mucosa) of the large intestine and rectum.

Crohn's Disease

A chronic inflammatory condition that can affect any part of the gastrointestinal tract, from the mouth to the anus.

Aphthous Ulceration

Ulcerations in mouth

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Episcleritis and Uveitis

Redness and inflammation of the sclera and uvea.

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Arthritis

Inflammation of joints

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Erythema Nodosum

Painful, red, and tender bumps typically on the shins.

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Pyoderma Gangrenosum

A rare inflammatory skin condition causing painful pustules or nodules that break down into ulcers.

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Fistulae

Abnormal passages or connections that develop between two organs or vessels that don't normally connect.

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Malabsorption

The malabsorption of nutrients from the bowel.

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Gallstones

Stones composed of digestive fluid

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Hydronephrosis

A condition where kidneys swell because urine can't drain properly.

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Amyloidosis

A rare disease that occurs when an abnormal protein, called amyloid, builds up in your organs

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Endoscopy

A test that uses a flexible tube with a camera to view the digestive tract.

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Orofacial Granulomatosis (OFG)

A group of oral soft tissue swellings.

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Concordance in IBD

A trend of similarity within families for a specific trait or condition.

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Symptomatic Agents

Medications used to alleviate symptoms, such as anti-diarrhoeals or anti-spasmodics.

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Uveitis

An inflammatory condition of the eye, often associated with redness and pain.

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FBC

Lab tests assessing blood components and levels

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LFTs

Laboratory tests used to evaluate liver function and health

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U and E

Laboratory tests to measure kidney fuction

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Faecal calprotectin test

A test that measures the levels of a protein released in feces.

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Enterocutaneous Fistulae

Openings on the skin from Crohn's Disease

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Proctocolitis

Inflammation of the rectum and colon, often caused by conditions like ulcerative colitis or Crohn's disease.

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Retrograde Flow

When gastric contents flow backward into the esophagus.

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Gastro-Oesophageal Reflux Disease (GORD)

A condition where reflux of gastric contents causes frequent symptoms or mucosal damage.

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Lower Oesophageal Sphincter (LOS) pressure

The pressure in the lower esophageal sphincter is decreased in GORD

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Oesophageal Clearance

Gravity and peristalsis removing acid.

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Hiatus Hernia

A condition where part of the stomach pushes up through the diaphragm.

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Bicarbonate in Saliva

Neutralizes acid in the esophagus.

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Acid Brash

Heartburn related to acid.

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Water Brash

Excessive salivation.

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Odynophagia

Pain on swallowing due to severe oesophagitis or stricture.

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Dental Erosion

Loss of tooth enamel due to acid exposure.

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GORD Management

This involves lifestyle changes such as PPI and reducing risk factors.

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Upper Gastrointestinal Bleeding

Bleeding in the upper digestive tract.

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Peptic Ulcer Disease

Sores in the lining of the stomach or duodenum.

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Gastritis

Inflammation of the stomach lining.

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Oesophagitis

Inflammation of the oesophagus.

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Helicobacter pylori

Infection of the stomach , diagnosed via breath test.

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Diagnosis with urea breath test

Diagnosed with urea breath test

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Triple Therapy

Lansoprazole (protein pump inhibitor), Clarithromycin and amoxicillin for one week.

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Coeliac Disease

Malabsorption due to gluten intolerance.

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Gluten intolerance

Intolerance to alcohol soluble proteins in barley, wheat and rye

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Villous atrophy

Leads to villous atrophy and malabsorption

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Dermatitis Herpetiformis

Skin conditions such as dermatitis herpetiformis are associated with coeliac disease

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Coeliac serology

Includes alpha- gliadin and anti-endomyseal antibodies

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IBD Incidence by Ethnicity

Most common in Jewish people (10 per 100 000). Second highest in non-Jewish Caucasians (4 per 100 000). Lowest in black people (c. 1.5 per 100 000)

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Urgent Referral Symptom

Acute gastrointestinal bleeding

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Dyspepsia referral trigger

Urgent referral for endoscopy for patients of any age with dyspepsia

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Coeliac antibodies

Alpha- gliadin and anti-endomyseal antibodies

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Coeliac biopsy result

Jejunal biopsy showing villous atrophy

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Coeliac age group

Occurs at any age- especially children , 50-60 years age group, slight female predominance

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GORD Symptoms

Heartburn, Retro sternal Discomfort, Acid brash, Water brash, Odynophagia

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GORD - Refluxed material

Acid and pepsin damage the oesophageal mucosa

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Causes of Upper Gastrointestinal Bleeding

Peptic Ulcer Disease, Gastritis, Varix Rupture, Oesophagitis, Duodenitis

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Symptoms of Upper Gastrointestinal Bleeding

General abdominal discomfort, Haematemesis and melaena, Classic signs and symptoms of shock, Changes in orthostatic vital signs

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Peptic Ulcers

Erosions in the stomach caused by gastric acid due to NSAID use, Alcohol/Tobacco, H. Pylori

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IBD oral signs

Frequent occurrence of oral manifestations.

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Ulcerative colitis effects

Intramural ulceration of the mucosa of the colon

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Crohn's Disease effects

Inflammation that can occur in any part of the GIT, with transmural involvement and skip lesions.

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Crohn's Disease: gender

Is more common in females than males (not in paediatric cases).

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UC: gender

More common in males than females.

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Causes of IBD

Infections, immunological, genetic, dietary, vascular, allergenic and psychogenic factors.

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IBD drug therapy

Involves symptomatic drugs, steroids, 5-ASA, immunosuppressives, antibiotics and biologics.

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Crohn's presentation

Chronic pain, diarrhoea, abdominal pain and intestinal obstruction.

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Systemic Crohn's complications

Consequences of small bowel involvement, such as malabsorption of nutrients.

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Paediatric Crohn's complications

Fever, anaemia, arthritis, and failure of growth and development.

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IBD blood tests

Hb, white cells, platelets, CRP, LFTs, urea, electrolytes, ferritin and vitamins.

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IBD stool tests

Faecal tests for bleeding/infection, and calprotectin levels.

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Coeliac associations

HLA DR3, autoimmune disease and dermatitis herpetiformis.

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Coeliac symptoms

Abdominal pain, steatorrhoea, bloating, weight loss and fatigue.

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Coeliac complications

Anaemia, T cell lymphoma risk, secondary lactose intolerance and other malignancies.

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IBD keys

Genes, environmental factors, oral and extra-intestinal features, presentations and complications.

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GI tract rule

Ask about GI symptoms!

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Study Notes

Inflammatory Bowel Disease (IBD)

  • IBD has frequent oral manifestations.
  • IBD has a higher incidence in younger patients.
  • Knowledge of the other features of IBD is useful.

Pathology of IBD

  • Ulcerative colitis affects the mucosa of the colon, causing ulceration that is intra-mural.
  • Crohn's Disease can affect any part of the GIT, causing transmural damage, fistulae, and "skip lesions."

Epidemiology of IBD

  • Crohn's is more common in females than males (excluding pediatric cases).
  • Ulcerative Colitis (UC) is more common in males than females.

Familial Patterns in IBD

  • Concordance rate of 10-25% is observed.
  • Genetic and environmental influences are not yet fully resolved.
  • More common in Westernized societies.

Causes of IBD

  • Causes of IBD can include:
    • Infections
    • Immunological origin
    • Genetic factors
    • Dietary/environmental factors Vascular/neuromotor issues
    • Allergenic responses
    • Psychogenic factors

Drug Therapies for IBD

  • Symptomatic agents such as anti-diarrhoeals and anti-spasmodics are used.
  • Short-term steroids like prednisolone can be utilized to reduce inflammation.
  • 5-ASA compounds (e.g., sulphasalazine) can be prescribed.
  • Corticosteroids and immunosuppressives can be prescribed
  • Antibiotics such as metronidazole may be effective.
  • Biologic agents ending in "mab" are also used.

Crohn's Disease Presentation

  • Presentation depends on the part of the GIT affected.
  • Chronic pain and diarrhoea are common.
  • Abdominal pain is almost always present.
  • Intestinal obstruction can occur.
  • Malabsorption is sometimes present.
  • Remission and flare-ups are characteristic.

Intestinal Complications of Crohn's Disease

  • Intestinal complications of Crohn's disease can include enterocutaneous fistulae:
    • These fistulae can occur through surgical scars or the umbilicus.

Systemic Complications of IBD

  • Relate to inflammatory activity.
  • Systemic complications of IBD can include:
    • Aphthous ulceration
    • Episcleritis and uveitis (eye)
    • Arthritis
    • Erythema nodosum
    • Pyoderma gangrenosum

Crohn's Disease

  • Symptoms vary according to the part of gastrointestinal tract affected.

Systemic Complications of Crohn's Disease

  • Secondary to small bowel involvement, systemic complications can include:
    • Malabsorption
    • Gallstones
    • Renal stones
    • Fistulae
    • Hydronephrosis
    • Amyloidosis

Pediatric Complications of IBD

  • These can include:
    • Fever
    • Anaemia
    • Arthritis
    • Failure of growth and development

Blood Tests for IBD

  • Recommended blood tests include:
    • FBC (Hb, white cells, platelets)
    • C-Reactive Protein (CRP)
    • LFTs (looking for complications of Crohn's such as sclerosing cholangitis)
    • Urea and electrolytes
    • Ferritin (iron stores) levels
    • Vitamin B12 and folate, and vitamin D levels
    • Trace elements

Other Tests for IBD

  • Stool/faecal tests (bleeding, infection)
  • Faecal calprotectin levels

Endoscopy for IBD

  • Endoscopy can be oral/rectal depending on nature of symptoms.
  • Checks are for polyps, strictures.
  • Biopsies- Crohn's characteristically GRANULOMATOUS
  • Also checks for other granulomatous disorders, OFG, sarcoidosis (SACE test)

Dental Aspects of IBD

  • OFG- oral soft tissue swellings
  • Aphthous ulceration
  • ?effects of medication e.g. immunosuppressant medication e.g. adalimumab, infliximab
  • Can cause Anaemia
  • Relevant systemic signs/symptoms

Ethnic and Racial Incidence of IBD

  • The rates of developing IBD are highest in Jewish people at a rate of 10 per 100,000.
  • The rates are second highest in non-Jewish Caucasians (4 per 100,000).
  • The lowest incidence is in black people (approximately 1.5 per 100,000).

Proctocolitis

  • Proctocolitis causes can include:
    • Ulcerative colitis
    • Crohn's disease
    • Radiation
    • Ischemia
    • Infections
    • Antibiotics
    • Other causes

Ulcerative Colitis Surgery

  • Indications for surgery for ulcerative colitis include:
    • Failure of medical treatment
    • Life-threatening haemorrhage
    • Toxicity (+/- perforation)
    • Suspected malignancy/severe dysplasia
    • Growth retardation/systemic complications

Gastro-Oesophageal Reflux Disease (GORD)

  • GORD involves the retrograde flow of gastric contents into the oesophagus.
  • GORD is only diagnosed when this reflux causes frequent, severe symptoms or mucosal damage.
  • GORD is a common disorder causing various symptoms.
  • GORD is not life-threatening but is chronic and relapsing, reducing quality of life.

Epidemiology of GORD

  • Approximately 25% of the adult population in Western society experience symptoms at least monthly.
  • 5% of adults experience daily symptoms.
  • The incidence of GORD increases with age.

Pathophysiology of GORD

  • GORD is multi-factorial.
  • An anti-reflux barrier is present.
    • Individuals with GORD typically have lower lower oesophageal sphincter (LOS) pressures.
    • The diaphragm acts as an "external sphincter."
  • Refluxed material can damage the oesophageal mucosa.
    • Acid and pepsin damage the oesophageal mucosa.
    • Damage is proportional to the amount of acid exposure.

Oesophageal Defence Mechanisms

  • Oesophageal clearance depends on gravity and peristalsis. Peristaltic dysfunction can impair clearance.
  • A hiatus hernia can impair oesophageal clearance.
  • Saliva contains bicarbonate, which neutralizes acid.
  • Commonly found in dry mouth patients.
  • Oesophageal mucosa contains mucus, bicarbonate, and prostaglandins which are protective.

Risk Factors for GORD

  • Genetic Factors.
  • Smoking.
  • Diet:
    • Obesity.
    • Larger meals, especially late at night.
    • High-fat content.
    • Caffeine.
    • Excess alcohol.
  • Pregnancy.
  • Hiatus hernia.
  • Drugs, such as:
    • TCAs, anticholinergics, nitrates, and Ca2+ blockers.

Symptoms of GORD

  • Heartburn
  • Symptoms are related to meals, lying down, stooping, and straining can be relieved by antacids.
  • Retrosternal discomfort.
  • Acid brash:
    • Includes regurgitation of acid or bile.
  • Water brash:
    • Includes excessive salivation.
  • Odynophagia:
    • Pain on swallowing indicates severe oesophagitis or stricture.

Dental Erosion

  • GORD sufferers can suffer from dental erosion.

"Alarm Symptoms" -Refer

  • Patients experiencing acute gastrointestinal bleeding should be referred immediately.
  • Urgent endoscopy referrals are necessary for patients of any age with dyspepsia, exhibiting signs of:
    • Chronic gastrointestinal bleeding
    • Progressive unintentional weight loss
    • Progressive difficulty swallowing
    • Persistent vomiting
    • Iron deficiency anaemia
    • Epigastric mass

Management of GORD

  • Reducing risk factors
  • Drug treatment, unless alarm symptoms are present
  • Proton Pump Inhibitors (PPIs) such as:
    • Omeprazole
    • Lansoprazole

Upper Gastrointestinal Bleeding

  • Causes of upper GI bleeding include:
    • Peptic ulcer disease
    • Gastritis
    • Varix rupture
    • Oesophagitis
    • Duodenitis
  • Signs and symptoms include:
    • General abdominal discomfort
    • Haematemesis and melaena
    • Classic signs and symptoms of shock
    • Changes in orthostatic vital signs
  • Treatment involves:
    • General treatment guidelines
    • Differentiating between life-threatening and chronic problems

Peptic Ulcers

  • Peptic ulcers are erosions caused by gastric acid.
  • Terminology is based on the portion of the tract affected.
  • Causes include:
    • NSAID use
    • Alcohol/tobacco use
    • H. pylori

Helicobacter pylori

  • H. pylori can be diagnosed through a urea breath test, as it converts urea to ammonia and carbon dioxide.
  • Diagnosis can sometimes require biopsy.
  • H. pylori is micro-aerophilic, gram-negative, and helical-shaped.
  • Eradication of H. pylori involves Triple Therapy:
    • Lansoprazole (a protein pump inhibitor) PLUS
    • Clarithromycin and amoxicillin (or metronidazole) for one week.

Coeliac Disease

  • A form of GI malabsorption.
  • Intolerance to alcohol-soluble proteins in barley, wheat, rye or oats.
  • Leads to villous atrophy and malabsorption.
  • Can occur at any age, but mainly in children, or adults betwen 50-60 years.
  • Slight female predominance.
  • Is associated with:
  • HLA DR3
  • Autoimmune disease
  • Dermatitis herpetiformis

Dermatitis Herpetiformis

  • Dermatitis Herpetiformis is associated with Coeliac disease, it is an itchy skin rash comprising of small blisters and bumps.

Symptoms of Coeliac Disease

  • Abdominal pain
  • Steatorrhoea
  • Bloating
  • Weight loss
  • Fatigue
  • Aphthous ulcers and angular cheilitis may be present.

Coeliac Disease Diagnostics

  • Alpha- gliadin and anti-endomyseal antibodies detected in the blood.
  • Jejunal biopsy to show villous atrophy (reverses on gluten free diet)

Coeliac Disease- Complications

  • Anaemia
  • T cell lymphoma risk
  • Secondary lactose intolerance
  • Other malignancies

IBD and GORD Summary

  • IBD has two main types, and is not the same as IBS.
  • IBD is related to genes and environmental factors.
  • IBD can affect the oral and extra-intestinal regions.
  • Has a wide range of presentations and complications.
  • GORD can be controlled using PPI's
  • Always ask about GI symptoms when dealing with soft tissue lesions or prescribing.
  • Always ask about the GI tract!

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