Reihan D Gastroenterology.pdf

Gastroenterology (GIT) Dr. Muhammad Reihan, MBBS, MD Associate Professor Internal Medicine Department  Learning Objectives Knowledge & Understanding Describe common GIT diseases including signs and symptoms, clinical man...

Gastroenterology (GIT) Dr. Muhammad Reihan, MBBS, MD Associate Professor Internal Medicine Department  Learning Objectives Knowledge & Understanding Describe common GIT diseases including signs and symptoms, clinical manifestation, pathogenesis, management, and their significance to dental practice. Gastrointestinal diseases GASTROINTESTINAL DISEASE MANIFESTING ORAL LESIONS Crohn’s disease Inflammatory bowel diseases Ulcerative colitis Gastro-oesophageal Reflux and Peptic Ulcer Disorders Inflammatory bowel diseases Malabsorption Eating disorders Genetic disorders  Metastatic diseases to the jaw  INFLAMMATORY BOWEL DISEASES An inflammatory bowel disease (IBD) characterized by chronic mucosal inflammation of the rectum, colon, and cecum. Ulcerative colitis Common symptoms include bloody diarrhea, abdominal pain, and fecal urgency. Laboratory findings typically show elevated inflammatory markers (e.g., ESR, CRP) and elevated fecal calprotectin. Clinical manifestations Extra Intestinal Signs Erythema nodosum Retinitis Microcytic hypochromic anaemia Leucocytosis Oral manifestations of Ulcerative Colitis Major and minor Aphthous ulcers Commonly seen on buccal mucosa and mucobuccal fold Pyostomatitis vegetans : A purulent inflammation of the mouth may occur Most commonly seen on buccal and labial mucosa. Tongue is usually spared Ulcerative colitis patients also can develop hairy leukoplakia, a lesion more commonly associated with human immunodeficiency virus (HIV) disease  An inflammatory bowel disease (IBD) of unclear etiology. Unlike ulcerative colitis, CD is not limited to Crohn Disease the colon but can manifest anywhere in the gastrointestinal tract. Extra-intestinal manifestations may occur in the eyes, joints, mouth and skin.  Oral manifestations of Crohn disease Persistent Cobblestone diffuse Indurated linear and mucosal swelling of polypoid tag- deep ulcer architecture, the lips and like lesions in face, the vestibule Dental Management of Inflammatory Bowel Disease Frequent preventive and routine dental care to monitor oral health Diagnosis of oral inflammatory or granulomatous lesions Palliative rinses and topical steroid therapy symptomatic oral lesions sodium bicarbonate mouth rinses 0.05% Fluosinonide. If the lesion is disseminated to oropharynx , dexamethasone elixir 0.5mg/5ml gargle for 1 minute 4 times daily  An inflammatory process of the gastric Gastritis mucosa that can be caused by a variety of conditions, commonly H. pylori infection or the use of drugs such as NSAIDs.  Gastritis Patient- External related Immune- Non- Systemic Infectious mediated Other infectious diseases Etiology Bacterial Alcohol Crohn disease AMAG Ménétrier disease Lymphocytic Physiological Viral Medications Vasculitis gastritis stress Non-IgE Chemo- Mesenteric mediated Fungal Idiopathic therapy isch. food allergies Parasitic Radiation  Classification Acute Gastritis Chronic Atrophic Erosive  Classification Acute gastritis Inflammation of the gastric mucosa, predominantly by a neutrophilic infiltrate Chronic gastritis Inflammation of the gastric mucosa characterized by a predominantly mononuclear infiltrate and loss of the normal architecture of the tissue  Classification Atrophic gastritis Chronic inflammation of the gastric mucosa, which results in loss of the native glands. Inflammatory changes are replaced over time by fibrosis or metaplastic changes Erosive gastritis Multiple superficial erosions that do not extend beyond the muscularis mucosae and may occasionally cause bleeding  OralORALmanifestations of Peptic Ulcer MANIFESTATIONS OF PEPTIC ULCER DISEASE Bacterial disease Xerostomia Drug induced Fungal Disease Altered taste perception Mucosal pallor Anaemia Thrombocytopenia Gingival bleeding Mucosal Agranulocytosis Necrotizing stomatitis ulcerations  Peptic ulcer disease Dental Management of Peptic Ulcer Disease Gastroesophag Gastroesophageal reflux: regurgitation of eal reflux stomach contents into the esophagus disease GERD Gastroesophageal reflux disease (GERD) A condition in which reflux causes troublesome symptoms (typically including heartburn or regurgitation) and/or esophageal injury/complications  Etiology Risk factors for GERD Smoking Caffeine Alcohol consumption Stress Obesity Pregnancy Scleroderma Sliding hiatal hernia: ≥ 90% of patients with severe GERD Asthma  Clinical features Typical symptoms Retrosternal burning pain (heartburn) Regurgitation Dysphagia Atypical symptoms Pressure sensation in the chest Belching Features of; aspiration pneumonia Extraesophageal symptoms Chronic nonproductive cough Hoarseness Aggravating factors Lying down shortly after meals Certain foods/beverages  Clinical features Red flags in GERD Dysphagia, odynophagia Anemia and/or evidence of GI bleeding Unintentional weight loss Vomiting Signs of GI bleeding Presence of > 1 risk factor for Barrett esophagus: o Male sex o European descent o Age ≥ 50 years o Obesity o Symptoms ≥ 5 years  Diagnostics Red flags in GERD: Refer to gastroenterology for EGD before initiating treatment. EGD Indications Red flags in GERD Risk factors for Barrett esophagus No symptomatic improvement after PPI trial Esophageal pH monitoring Not a routine diagnostic test  Treatment Pharmacological therapy PPIs: standard dose of PPI Lifestyle changes Physical recommendations Weight loss in patients with obesity Elevate the head of the bed Reduce or avoid triggering substances Tobacco, alcohol, and/or caffeine  Oral manifestations of GERD Dysgeusia [altered taste] Erosion Mucosal erythema Esophagial stricture and Mucosal atrophy Xerostomia Fibrosis Dental Management of GERD NaHCO3 mouth rinses to minimize disguisia due acid reflux Topical fluoride application to ensure optimal mineralisation Salivary substitutes may be prescribed Patients should be advised to have adequate amount of fluid intake Note:- Cimetidine Toxic reaction to IV lidocaine Inhibits absorption of systemic antifungal drugs  DISORDERS DUE TO GASTROINTESTINAL MALABSORPTION (Celiac disease) PERNICIOUS ANEMIA Severe deficiency of Vitamin-B12 results in pernicious anemia Occurs due to atrophy of Gastric mucosa resulting in lack of intrinsic factor Macrocytic normochromic anemia Diagnosis Serum Vitamin B12 levels Serum methylmalonic acid and homocystien levels GENERAL SYMPTOMS PERNICIOUS ANEMIA  ORAL MANIFESTATIONS OF PERNICIOUS ANEMIA Inflamed “beefy red" tongue Glossitis and glossodynia Burning mouth  FOLIC ACID DEFICIENCY ANEMIA It is a macrocytic anemia caused due to folic acid deficiency Prevalent in patients whose diet devoid of leafy vegetables. Alcoholics and drug abusers Increased requirement of folate – Pregnant women and young children Anticancer drugs like Methotrexate, Azathioprine and 6- mercaptapurine leads to folate deficiency It causes severe anemia but without any neurological abnormalities  ORAL MANIFESTATION FOLIC ACID DEFICIENCY ANEMIA Mostly similar to those seen in pernicious anemia Angular cheilitis is more common than in pernicious anemia Recurrent Aphthous stomatitis {15%} Angular cheilitis Recurrent Aphthous ulcer DENTAL MANAGEMENT OF ANEMIA Patients at low risk (hematocrit > 30% ) Normal dental protocol Patients at high risk( hematocrit