Podcast
Questions and Answers
What is a distinctive characteristic of Crohn's disease in terms of its location within the gastrointestinal tract?
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?
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 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?
What systemic complication of Crohn's disease is most likely secondary to small bowel involvement?
Which of the following is considered a potential complication of IBD in pediatric patients?
Which of the following is considered a potential complication of IBD in pediatric patients?
Which blood test is used to monitor for complications of Crohn's disease, such as sclerosing cholangitis?
Which blood test is used to monitor for complications of Crohn's disease, such as sclerosing cholangitis?
Which laboratory test is most useful in differentiating between inflammation and irritable bowel syndrome (IBS)?
Which laboratory test is most useful in differentiating between inflammation and irritable bowel syndrome (IBS)?
During an endoscopy for suspected Crohn's disease, what characteristic finding in biopsies would suggest Crohn's?
During an endoscopy for suspected Crohn's disease, what characteristic finding in biopsies would suggest Crohn's?
What oral manifestation is especially associated with Crohn's disease?
What oral manifestation is especially associated with Crohn's disease?
What is the primary difference between ulcerative colitis (UC) and Crohn's disease in terms of the layers of the intestinal wall affected?
What is the primary difference between ulcerative colitis (UC) and Crohn's disease in terms of the layers of the intestinal wall affected?
Which of the following statements best describes the distribution of Crohn's disease and ulcerative colitis (UC) in terms of gender?
Which of the following statements best describes the distribution of Crohn's disease and ulcerative colitis (UC) in terms of gender?
What is the typical concordance rate observed in IBD familial patterns, indicating the likelihood of the disease occurring in genetically related individuals?
What is the typical concordance rate observed in IBD familial patterns, indicating the likelihood of the disease occurring in genetically related individuals?
Which of the following factors is considered a potential cause of inflammatory bowel disease (IBD)?
Which of the following factors is considered a potential cause of inflammatory bowel disease (IBD)?
Which category of drug therapies includes agents like anti-diarrheals and anti-spasmodics used in the treatment of IBD?
Which category of drug therapies includes agents like anti-diarrheals and anti-spasmodics used in the treatment of IBD?
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?
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?
Which of the following is a systemic complication associated with IBD related to inflammatory activity?
Which of the following is a systemic complication associated with IBD related to inflammatory activity?
Which of the following could cause extra-intestinal signs of IBD such as Uveitis?
Which of the following could cause extra-intestinal signs of IBD such as Uveitis?
What treatment is often prescribed for short-term management of IBD symptoms, such as inflammation?
What treatment is often prescribed for short-term management of IBD symptoms, such as inflammation?
What distinguishes Crohn's disease from ulcerative colitis in terms of the areas of the GI tract that are affected?
What distinguishes Crohn's disease from ulcerative colitis in terms of the areas of the GI tract that are affected?
Systemic complications of Crohn's are associated with small bowel involvement. State one such complication.
Systemic complications of Crohn's are associated with small bowel involvement. State one such complication.
Which of the following is a common symptom of Crohn's disease?
Which of the following is a common symptom of Crohn's disease?
What is one of the main purposes of stool/faecal tests in evaluating IBD?
What is one of the main purposes of stool/faecal tests in evaluating IBD?
What effect can certain medications, like adalimumab and infliximab, used to treat IBD, have on the mouth and dental health?
What effect can certain medications, like adalimumab and infliximab, used to treat IBD, have on the mouth and dental health?
What feature is unique to Crohn's disease?
What feature is unique to Crohn's disease?
What does the presence of the extra-intestinal sign, erythema nodosum suggest?
What does the presence of the extra-intestinal sign, erythema nodosum suggest?
How does Crohn's disease typically spread through the gastrointestinal tract?
How does Crohn's disease typically spread through the gastrointestinal tract?
What is the primary distinction between ulcerative colitis and Crohn's disease based on the layer of the intestinal wall affected?
What is the primary distinction between ulcerative colitis and Crohn's disease based on the layer of the intestinal wall affected?
What is suggested by a Crohn's disease biopsy that shows granulomas?
What is suggested by a Crohn's disease biopsy that shows granulomas?
Which of the following is a possible cause for IBD?
Which of the following is a possible cause for IBD?
Why might a doctor order routine blood work for an IBD patient?
Why might a doctor order routine blood work for an IBD patient?
Which oral manifestation is most frequently observed in patients with IBD?
Which oral manifestation is most frequently observed in patients with IBD?
What should a clinician consider when a young patient presents with symptoms of IBD?
What should a clinician consider when a young patient presents with symptoms of IBD?
How do environmental factors contribute to the development of IBD?
How do environmental factors contribute to the development of IBD?
How would a doctor use stool tests to evaluate IBD?
How would a doctor use stool tests to evaluate IBD?
Which of the following best describes the genetic component of IBD?
Which of the following best describes the genetic component of IBD?
Which factor is most likely to cause fistulae to form in individuals with Crohn's disease?
Which factor is most likely to cause fistulae to form in individuals with Crohn's disease?
What feature is unique to Crohn's disease and not found in ulcerative colitis?
What feature is unique to Crohn's disease and not found in ulcerative colitis?
In IBD, what indicates that symptoms are related to inflammatory activity?
In IBD, what indicates that symptoms are related to inflammatory activity?
What is the typical pattern of Crohn’s disease based on gender?
What is the typical pattern of Crohn’s disease based on gender?
What is the possible result of IBD in children?
What is the possible result of IBD in children?
Which class of medications requires routine monitoring of potential effects, such as anaemia?
Which class of medications requires routine monitoring of potential effects, such as anaemia?
Which of the following best describes the role of symptomatic agents in the management of IBD?
Which of the following best describes the role of symptomatic agents in the management of IBD?
What is indicated by an elevation of faecal calprotectin levels?
What is indicated by an elevation of faecal calprotectin levels?
What is the primary reason for performing an endoscopy in a patient suspected of having Crohn's disease?
What is the primary reason for performing an endoscopy in a patient suspected of having Crohn's disease?
What is the role of genetic factors in the familial patterns observed in IBD?
What is the role of genetic factors in the familial patterns observed in IBD?
Why is it important to understand the different presentations of Crohn's disease?
Why is it important to understand the different presentations of Crohn's disease?
What is the concordance rate in IBD familial patterns?
What is the concordance rate in IBD familial patterns?
Which systemic complication is related to malabsorption?
Which systemic complication is related to malabsorption?
Other granulomatous disorders include?
Other granulomatous disorders include?
Why would LFT's be useful when monitoring Crohn's disease?
Why would LFT's be useful when monitoring Crohn's disease?
What is the primary mechanism by which acid and pepsin contribute to the pathophysiology of GORD?
What is the primary mechanism by which acid and pepsin contribute to the pathophysiology of GORD?
How does the diaphragm contribute to the anti-reflux barrier in the human body?
How does the diaphragm contribute to the anti-reflux barrier in the human body?
In the context of GORD, what is the role of saliva as an oesophageal defence mechanism?
In the context of GORD, what is the role of saliva as an oesophageal defence mechanism?
Which dietary habit is most likely to increase the risk of GORD?
Which dietary habit is most likely to increase the risk of GORD?
Why are anticholinergics considered a risk factor for GORD?
Why are anticholinergics considered a risk factor for GORD?
What is the term used to describe excessive salivation that can occur as a symptom of GORD?
What is the term used to describe excessive salivation that can occur as a symptom of GORD?
What is the significance of 'alarm symptoms' in the context of managing dyspepsia?
What is the significance of 'alarm symptoms' in the context of managing dyspepsia?
What is the primary action of proton pump inhibitors (PPIs) in the management of GORD?
What is the primary action of proton pump inhibitors (PPIs) in the management of GORD?
Which condition is typically associated with erosions in the lining of the gastrointestinal tract caused by gastric acid?
Which condition is typically associated with erosions in the lining of the gastrointestinal tract caused by gastric acid?
How is Helicobacter pylori typically diagnosed?
How is Helicobacter pylori typically diagnosed?
Which combination of medications is typically used in the 'triple therapy' for the eradication of Helicobacter pylori?
Which combination of medications is typically used in the 'triple therapy' for the eradication of Helicobacter pylori?
What is the primary characteristic of coeliac disease?
What is the primary characteristic of coeliac disease?
Which of the following is commonly associated with coeliac disease?
Which of the following is commonly associated with coeliac disease?
Which skin condition is specifically associated with coeliac disease?
Which skin condition is specifically associated with coeliac disease?
Which antibody is typically elevated in individuals with coeliac disease?
Which antibody is typically elevated in individuals with coeliac disease?
What is a common finding on jejunal biopsy in individuals with coeliac disease?
What is a common finding on jejunal biopsy in individuals with coeliac disease?
What is the appropriate initial management strategy for a patient diagnosed with GORD?
What is the appropriate initial management strategy for a patient diagnosed with GORD?
If a patient with dyspepsia presents with progressive difficulty swallowing, what course of action should be taken?
If a patient with dyspepsia presents with progressive difficulty swallowing, what course of action should be taken?
Which of the following complications is specifically associated with coeliac disease?
Which of the following complications is specifically associated with coeliac disease?
What is the initial step in managing GORD, before considering drug treatment?
What is the initial step in managing GORD, before considering drug treatment?
Which of the following symptoms is a classic sign of upper gastrointestinal bleeding?
Which of the following symptoms is a classic sign of upper gastrointestinal bleeding?
What underlying condition should a clinician suspect when encountering dental erosion in a patient?
What underlying condition should a clinician suspect when encountering dental erosion in a patient?
Which of these groups has the highest incidence of IBD?
Which of these groups has the highest incidence of IBD?
What oral manifestation could suggest an underlying digestive issue?
What oral manifestation could suggest an underlying digestive issue?
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?
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?
A patient presents with anaemia suspected to be secondary to coeliac disease. What laboratory finding would MOST strongly support this diagnosis?
A patient presents with anaemia suspected to be secondary to coeliac disease. What laboratory finding would MOST strongly support this diagnosis?
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?
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?
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?
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?
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?
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?
What is the estimated percentage of the adult population in Western society experiencing GORD symptoms at least monthly?
What is the estimated percentage of the adult population in Western society experiencing GORD symptoms at least monthly?
Besides acid, which other substance found in refluxed material significantly contributes to damage of the oesophageal mucosa in GORD?
Besides acid, which other substance found in refluxed material significantly contributes to damage of the oesophageal mucosa in GORD?
Which of these factors can impair oesophageal clearance and potentially contribute to GORD?
Which of these factors can impair oesophageal clearance and potentially contribute to GORD?
What dietary factor is most likely to exacerbate GORD symptoms?
What dietary factor is most likely to exacerbate GORD symptoms?
Why are anticholinergic medications considered a risk factor for GORD?
Why are anticholinergic medications considered a risk factor for GORD?
What term describes the excessive salivation sometimes experienced as a symptom of GORD?
What term describes the excessive salivation sometimes experienced as a symptom of GORD?
A patient with dyspepsia reports unintentional weight loss; what action is most appropriate?
A patient with dyspepsia reports unintentional weight loss; what action is most appropriate?
Which condition is characterized by erosions in the gastrointestinal tract lining due to gastric acid, and can be caused by NSAID use?
Which condition is characterized by erosions in the gastrointestinal tract lining due to gastric acid, and can be caused by NSAID use?
What method is commonly used to diagnose Helicobacter pylori infection, leveraging its ability to metabolize urea?
What method is commonly used to diagnose Helicobacter pylori infection, leveraging its ability to metabolize urea?
What combination of medications typically constitutes triple therapy for the eradication of Helicobacter pylori?
What combination of medications typically constitutes triple therapy for the eradication of Helicobacter pylori?
What is the primary characteristic of coeliac disease that leads to gastrointestinal symptoms?
What is the primary characteristic of coeliac disease that leads to gastrointestinal symptoms?
Which of the following conditions is closely associated with coeliac disease?
Which of the following conditions is closely associated with coeliac disease?
Which antibody is typically found to be elevated in individuals with coeliac disease, indicating an immune response to gluten?
Which antibody is typically found to be elevated in individuals with coeliac disease, indicating an immune response to gluten?
What is a typical finding on jejunal biopsy in individuals with active coeliac disease?
What is a typical finding on jejunal biopsy in individuals with active coeliac disease?
What is the recommended initial management strategy for a patient newly diagnosed with GORD?
What is the recommended initial management strategy for a patient newly diagnosed with GORD?
If a patient with dyspepsia presents with progressive difficulty swallowing, what is the recommended course of action?
If a patient with dyspepsia presents with progressive difficulty swallowing, what is the recommended course of action?
Which of the following is a potential long-term complication specifically associated with coeliac disease?
Which of the following is a potential long-term complication specifically associated with coeliac disease?
What initial lifestyle change is typically recommended for patients to manage GORD before considering drug treatment?
What initial lifestyle change is typically recommended for patients to manage GORD before considering drug treatment?
What underlying condition should a clinician suspect when encountering dental erosion in a patient, as seen in the included image?
What underlying condition should a clinician suspect when encountering dental erosion in a patient, as seen in the included image?
Based on the provided image and information, which ethnic group has the highest incidence of IBD?
Based on the provided image and information, which ethnic group has the highest incidence of IBD?
What oral manifestation could suggest an underlying digestive issue, particularly in the context of IBD or coeliac disease as shown in the images?
What oral manifestation could suggest an underlying digestive issue, particularly in the context of IBD or coeliac disease as shown in the images?
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?
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?
Aside from genetic predisposition, what are the risk factors that heavily influence the development and severity of gastro-oesophageal reflux disease (GORD)?
Aside from genetic predisposition, what are the risk factors that heavily influence the development and severity of gastro-oesophageal reflux disease (GORD)?
In IBD, if a patient presents with aphthous ulceration, episcleritis, and erythema nodosum, what do these signs collectively indicate?
In IBD, if a patient presents with aphthous ulceration, episcleritis, and erythema nodosum, what do these signs collectively indicate?
A young patient presents with symptoms suggestive of IBD. What crucial consideration should guide the clinician's approach?
A young patient presents with symptoms suggestive of IBD. What crucial consideration should guide the clinician's approach?
Which of the following accurately describes the influence of environmental factors on IBD development?
Which of the following accurately describes the influence of environmental factors on IBD development?
In evaluating IBD, how would a doctor interpret elevated faecal calprotectin levels?
In evaluating IBD, how would a doctor interpret elevated faecal calprotectin levels?
What would a biopsy during an endoscopy reveal in a patient with Crohn's disease?
What would a biopsy during an endoscopy reveal in a patient with Crohn's disease?
What systemic complication of Crohn's disease is more likely to occur due to small bowel involvement?
What systemic complication of Crohn's disease is more likely to occur due to small bowel involvement?
In a child with IBD, what potential complication related to growth should be monitored?
In a child with IBD, what potential complication related to growth should be monitored?
What is the primary utility of Liver Function Tests (LFTs) in monitoring Crohn's disease?
What is the primary utility of Liver Function Tests (LFTs) in monitoring Crohn's disease?
A patient presents with soft tissue swellings in the mouth. What action is most appropriate?
A patient presents with soft tissue swellings in the mouth. What action is most appropriate?
A patient taking adalimumab reports oral discomfort. What is the MOST likely cause?
A patient taking adalimumab reports oral discomfort. What is the MOST likely cause?
According to the information, which ethnic group has the highest incidence of IBD?
According to the information, which ethnic group has the highest incidence of IBD?
In the pathophysiology of GORD, what is the role of Transient Lower Oesophageal Sphincter (LOS) relaxations?
In the pathophysiology of GORD, what is the role of Transient Lower Oesophageal Sphincter (LOS) relaxations?
How does a hiatus hernia affect oesophageal clearance?
How does a hiatus hernia affect oesophageal clearance?
What is the function of bicarbonate in saliva in relation to oesophageal defence mechanisms against GORD?
What is the function of bicarbonate in saliva in relation to oesophageal defence mechanisms against GORD?
Which dietary habit is most likely to exacerbate GORD symptoms and increase the risk of reflux?
Which dietary habit is most likely to exacerbate GORD symptoms and increase the risk of reflux?
Why are medications with anticholinergic effects considered a risk factor for GORD?
Why are medications with anticholinergic effects considered a risk factor for GORD?
What is the term used to describe the symptom of excessive salivation often experienced by individuals with GORD?
What is the term used to describe the symptom of excessive salivation often experienced by individuals with GORD?
A patient with dyspepsia reports new onset of progressive difficulty swallowing. What should you do?
A patient with dyspepsia reports new onset of progressive difficulty swallowing. What should you do?
What is the MOST appropriate initial management strategy for a patient who has been newly diagnosed with GORD?
What is the MOST appropriate initial management strategy for a patient who has been newly diagnosed with GORD?
A patient is suspected of having upper gastrointestinal bleeding; what symptom would MOST strongly suggest this?
A patient is suspected of having upper gastrointestinal bleeding; what symptom would MOST strongly suggest this?
A new patient presents with dental erosion of unknown cause. What underlying condition should a clinician FIRST suspect?
A new patient presents with dental erosion of unknown cause. What underlying condition should a clinician FIRST suspect?
What best describes the incidence and prevalence of GORD?
What best describes the incidence and prevalence of GORD?
Why might a clinician advise GORD patients to reduce high fat foods?
Why might a clinician advise GORD patients to reduce high fat foods?
Which diagnostic approach can best identify Helicobacter pylori?
Which diagnostic approach can best identify Helicobacter pylori?
In triple therapy for Helicobacter pylori eradication which drugs are most likely used?
In triple therapy for Helicobacter pylori eradication which drugs are most likely used?
What is the key characteristic of coeliac disease that affects gastrointestinal function?
What is the key characteristic of coeliac disease that affects gastrointestinal function?
A patient is diagnosed with dermatitis herpetiformis. What co-existing condition is MOST strongly associated with this?
A patient is diagnosed with dermatitis herpetiformis. What co-existing condition is MOST strongly associated with this?
Which of the following is a serological marker typically elevated in the blood of individuals with coeliac disease?
Which of the following is a serological marker typically elevated in the blood of individuals with coeliac disease?
What is expected on jejunal biopsy in individuals suffering from coeliac disease?
What is expected on jejunal biopsy in individuals suffering from coeliac disease?
What is an established management strategy which can help reduce the complications of coeliac disease?
What is an established management strategy which can help reduce the complications of coeliac disease?
What long-term complication is specifically associated with coeliac disease, highlighting the need for strict dietary control?
What long-term complication is specifically associated with coeliac disease, highlighting the need for strict dietary control?
What is the primary cause of peptic ulcers?
What is the primary cause of peptic ulcers?
In managing a patient with GORD, what is the initial step to take before considering drug treatment?
In managing a patient with GORD, what is the initial step to take before considering drug treatment?
Considering the information provided, what alarm symptom would warrant immediate referral?
Considering the information provided, what alarm symptom would warrant immediate referral?
Why does GORD reduce life quality?
Why does GORD reduce life quality?
A patient asks about risks for GORD; what can you tell them?
A patient asks about risks for GORD; what can you tell them?
A patient with symptoms of dyspepsia also reports unintentional weight loss, what is the recommended course of action?
A patient with symptoms of dyspepsia also reports unintentional weight loss, what is the recommended course of action?
According to what you have learnt, what is the treatment for GORD
According to what you have learnt, what is the treatment for GORD
How do the symptoms of GORD present?
How do the symptoms of GORD present?
If you ask a patient and they say they experience water brash; what can you expect?
If you ask a patient and they say they experience water brash; what can you expect?
A patient with IBD presents with episcleritis and uveitis. What aspect of the disease do these symptoms indicate?
A patient with IBD presents with episcleritis and uveitis. What aspect of the disease do these symptoms indicate?
A young female patient is suspected of having Crohn's disease. What factor distinguishes Crohn's disease in females compared to males?
A young female patient is suspected of having Crohn's disease. What factor distinguishes Crohn's disease in females compared to males?
If a patient presents with soft tissue swellings of the mouth, what questioning is recommended to further investigate the issue?
If a patient presents with soft tissue swellings of the mouth, what questioning is recommended to further investigate the issue?
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?
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?
What is suggested by anaemia in IBD in the context of dental health, particularly in patients on immunosuppressant medications?
What is suggested by anaemia in IBD in the context of dental health, particularly in patients on immunosuppressant medications?
What is a potential systemic complication of Crohn’s disease related to small bowel involvement?
What is a potential systemic complication of Crohn’s disease related to small bowel involvement?
A patient taking the immunosuppressant Infliximab reports oral discomfort. What is the MOST likely cause?
A patient taking the immunosuppressant Infliximab reports oral discomfort. What is the MOST likely cause?
A patient newly diagnosed with Gastro-Oesophageal Reflux Disease (GORD) reports experiencing excessive salivation. Which term accurately describes this symptom?
A patient newly diagnosed with Gastro-Oesophageal Reflux Disease (GORD) reports experiencing excessive salivation. Which term accurately describes this symptom?
What is the initial recommended management strategy for a patient newly diagnosed with Gastro-Oesophageal Reflux Disease (GORD), prior to considering drug treatment?
What is the initial recommended management strategy for a patient newly diagnosed with Gastro-Oesophageal Reflux Disease (GORD), prior to considering drug treatment?
What is the primary reason for using a urea breath test in the diagnosis of Helicobacter pylori infection?
What is the primary reason for using a urea breath test in the diagnosis of Helicobacter pylori infection?
Flashcards
Inflammatory Bowel Disease (IBD)
Inflammatory Bowel Disease (IBD)
A group of inflammatory conditions affecting the colon and small intestine.
Ulcerative Colitis
Ulcerative Colitis
Inflammation and ulceration primarily affecting the inner lining (mucosa) of the large intestine and rectum.
Crohn's Disease
Crohn's Disease
A chronic inflammatory condition that can affect any part of the gastrointestinal tract, from the mouth to the anus.
Aphthous Ulceration
Aphthous Ulceration
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Episcleritis and Uveitis
Episcleritis and Uveitis
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Arthritis
Arthritis
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Erythema Nodosum
Erythema Nodosum
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Pyoderma Gangrenosum
Pyoderma Gangrenosum
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Fistulae
Fistulae
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Malabsorption
Malabsorption
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Gallstones
Gallstones
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Hydronephrosis
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Amyloidosis
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Endoscopy
Endoscopy
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Orofacial Granulomatosis (OFG)
Orofacial Granulomatosis (OFG)
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Concordance in IBD
Concordance in IBD
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Symptomatic Agents
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Uveitis
Uveitis
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FBC
FBC
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LFTs
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U and E
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Faecal calprotectin test
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Enterocutaneous Fistulae
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Proctocolitis
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Retrograde Flow
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Gastro-Oesophageal Reflux Disease (GORD)
Gastro-Oesophageal Reflux Disease (GORD)
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Lower Oesophageal Sphincter (LOS) pressure
Lower Oesophageal Sphincter (LOS) pressure
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Oesophageal Clearance
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Hiatus Hernia
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Bicarbonate in Saliva
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Acid Brash
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Water Brash
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Odynophagia
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Dental Erosion
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GORD Management
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Upper Gastrointestinal Bleeding
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Peptic Ulcer Disease
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Gastritis
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Oesophagitis
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Helicobacter pylori
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Diagnosis with urea breath test
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Triple Therapy
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Coeliac Disease
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Gluten intolerance
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Villous atrophy
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Dermatitis Herpetiformis
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Coeliac serology
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IBD Incidence by Ethnicity
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Urgent Referral Symptom
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Dyspepsia referral trigger
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Coeliac antibodies
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Coeliac biopsy result
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Coeliac age group
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GORD Symptoms
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GORD - Refluxed material
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Causes of Upper Gastrointestinal Bleeding
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Symptoms of Upper Gastrointestinal Bleeding
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Peptic Ulcers
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IBD oral signs
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Ulcerative colitis effects
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Crohn's Disease effects
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Crohn's Disease: gender
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UC: gender
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Causes of IBD
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IBD drug therapy
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Crohn's presentation
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Systemic Crohn's complications
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Paediatric Crohn's complications
Paediatric Crohn's complications
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IBD blood tests
IBD blood tests
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IBD stool tests
IBD stool tests
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Coeliac associations
Coeliac associations
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Coeliac symptoms
Coeliac symptoms
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Coeliac complications
Coeliac complications
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IBD keys
IBD keys
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GI tract rule
GI tract rule
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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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