Professional Documents
Culture Documents
MANAGEMENT OF
DISEASES OF THE
GASTROINTESTINAL
SYSTEM
INDEX
Introduction
Common gastrointestinal symptoms.
Investigations in Gastroenterology
Gastrointestinal diseases of dental interest:
Gastro-oesophageal reflux disease
Gastritis
Hiatus hernia
Peptic ulcer disease: Gastric Ulcer and Duodenal ulcer
Celiac disease
Inflammatory Bowel Disease (IBD): Crohns disease and Ulcerative colitis
Irritable bowel syndrome (IBS)
Malabsorption
INTRODUCTION
The primary structures of the
Abdominal Pain
Investigations In
Gastroenterology.
abdomen
Endoscopy:
This is performed to visualize of parts of the GI tract and also to take
biopsies of the involved tissues.
Gastroscopy:
Oesophagus, stomach and proximal duodenum can be investigated
with the gastroscope
Colonoscopy:
The large bowel and terminal ileum can be investigated using the
colonoscope.
Sigmoidoscopy:
Diseases of the rectum can be investigated with sigmoidoscope
Laparoscopy:
This is a method of inspecting the abdominal organs directly using a
fibreoptic system through one or more small incisions.
Investigations In Gastroenterology.
Radiology:
The whole of the GI tract can be investigated radiologically using a
contrast medium such as barium swallow, barium meal or enema.
Crosby capsule:
A device used for obtaining biopsies of small bowel mucosa. This is
used for jejunal biopsies in celiac disease.
Faecal fat collection:
Faeces collected for 3-5 days to quantitate the fat content ( in the
diagnosis of malabsorption)
Faecal occult blood:
Simple bed-side methods are used to detect haemoglobin in blood
in faeces.
Breath tests:
Urea breath test is used for the detection or absence of H. Pylori.
Lactose Hydrogen breath test is used for the detection of disaccharide
deficiency.
Investigations In Gastroenterology.
Pancreatic function tests:
ETIOLOGY / Predisposing
Factors
Obesity
big meals
tight clothing
fatty meals
alcohol
Smoking
pregnancy
hiatus hernia
drugs such as tricyclics (antidepressants) and
Symptoms
Dull retrosternal ache (heart burn) is often
Diagnosis/Investigations
Endoscopy With Or Without Biopsy
Barium Meal
Oesophageal Motility Studies
Resting ECG Is Helpful To Rule Out Ischemic
Heart Disease
ORAL HEALTH
CONSIDERATION
Oral adverse effects of medication for GERD and peptic ulcer
ORAL HEALTH
CONSIDERATION
A common
condition, regurgitation of gastric contents (pH 12) reduces the pH of the oral cavity below 5.5 & this acidic
pH begins to dissolve enamel. It is most commonly seen on
the palatal surfaces of the maxillary dentition.
GASTRITIS
Definition/Description: Gastritis is
ETIOLOGY
In majority of cases over-indulgence of
Anaemia Is Common.
Diagnosis/Investigations
No special investigations are necessary in
majority of cases.
When erosions are suspected, endoscopy is
recommended.
If pernicious anaemia is present
haematological examination is necessary.
Urea breath test, rapid urease test, culture
and histology tests for H. Pylori are
recommended particularly for chronic
gastritis.
ORAL HEALTH
CONSIDERATION
Patient with gastritis should not be given
HIATUS HERNIA
Definition/Description
Hiatus hernia is a protrusion of the stomach
through a hiatus in the diaphragm.
There are two types: sliding (most common)
and paraesophagealhernias.
In the sliding type the gastroesophageal
junction and a portion of the stomach are above
the diaphragm where as in paraoesophageal
hiatus hernia the gastroesophageal junction is
in the normal location but a part of the stomach
is adjacent to the oesophagus
ETIOLOGY
Exact cause of hiatus hernia is not known.
Stretching of the fascial attachments
asymptomatic.
Often hernias are noted as incidental
findings on x-rays.
Chest pain may be a feature in some
patients. Strangulation of hernia is a
complication.
Diagnosis/investigations
Chest x-rays and barium swallow confirm
Etiology
Old
No acid
no ulcer
Idiopathic Stress
Spicy food
New
Helicobacter Pylori
NSAID
Crohn s disease
Gasrtrinoma
Hyperparthyroidism
Duodenal Ulcer.
Pain Tends To Wax And Wane, Aggravates During Stress And
With The Use Of Drugs And Alcohol.
Signs Of Anaemia Due To Bleeding From The Ulcers May Be
Present.
Ingestion Of Food, Milk Or Antacids Provides Temporary Relief.
Protracted Vomiting A Few Hours After Meals Is A Sign Of
Gastric Outlet (Pyloric) Obstruction.
Black Tarry Stools (Melena) Due To Gastrointestinal
Haemorrhage And Weight Loss Are Other Features Of The
Peptic Ulcer Disease.
Diagnosis/Investigations
Endoscopy
barium meal
biopsy (to rule out gastric malignancy) are
ORAL HEALTH
CONSIDERATION
In peptic ulcer disease, oral signs and symptoms
CELIAC DISEASE
Definition/Description:
Celiac disease is also known as gluten
sensitive enteropathy.
It is characterised by the atrophy of the
jejunal mucosa due to its sensitivity to the
dietary gluten
ETIOLOGY
Gluten in the diet is the cause of Celiac
disease.
Gluten has two components: glutenin and
-gliadin.
The latter is antigenic.
Genetic predisposition to celiac disease
exists (HLA B8 and BR3).
Symptoms
Diarrhoea
Steatorrhoea
Weight Loss
Abdominal Pain
Anaemia
Muscle Wasting
Oral Mucosal Ulcers
Dental Enamel Hypoplasia
Delayed Eruption
Skin Pigmentation
Peripheral Oedema
Dermatitis Herpetiformis (Itchy Blistering Skin Disease).
Diagnosis/Investigations
Full Blood Count May Reveal Anaemia And
ORAL HEALTH
CONSIDERATION
In Celiac disease oral ulceration, glossitis,
Crohns disease
Ulcerative colitis
Changes confined to
the colon
Frequent rectum
involvement
Rare perianal
disease
Continous
inflammation
Superficial lining
mucosa inflammation
Rare presence of
fistulae and stenotic
complication
Rare presence of
abscess
Superficial ulcers,
friability
ETIOLOGY
Crohns disease
Ulcerative colitis
Unknown
at higher risk
Males and females are equally
affected.
Diagnosis/Investigations
Crohns disease
Ulcerative colitis
WBCs (increased)
ESR(elevated)
Colonoscopy
plain x-ray
ETIOLOGY
Psychological and stress related in most
cases.
Diagnosis/Investigations
Rectal examination
Barium Enema
Sigmoidoscopy.
ORAL HEALTH
CONSIDERATION
In irritable bowel syndrome psychogenic
MALABSORPTION
Definition/description: Malabsorption
ETIOLOGY
Gastrocolic Fistula
Gastrectomy
Biliary Obstruction
Chronic Liver Failure
Chronic Pancreatitis
Alcohol Abuse
Acute Intestinal Infections
Celiac Disease
Amyloidosis
Crohns Disease
Addisons Disease
Radiation Enteritis.
Diagnosis/investigations
If history suggests a specific cause (liver
GASTROINTESTINAL SYNDROMES
Eating Disorders: Anorexia and Bulimia
Gardners Syndrome
Plummer-Vinson Syndrome
Peutz-Jeghers Syndrome
Cowdens Syndrome
Diagnosis
The diagnosis of anorexia or bulimia is not always
Gardners Syndrome
Gardners syndrome consists of intestinal
polyposis (which represents premalignant
lesions) and multiple impacted
supernumerary (extra) teeth.
Plummer-Vinson Syndrome
Plummer-Vinson syndrome, originally described
Oral findings
Atrophic glossitis with erythema or fissuring
Angular cheilitis
Thinning of the vermilion borders of the lips
Leukoplakia of the tongue
Inspection of the oral mucous membranes will disclose
Peutz-Jeghers Syndrome
Peutz-Jeghers syndrome is characterized by multiple
intestinal
polyps throughout the gastrointestinal tract but
primarily in
the small intestine.
Malignancies in the gastrointestinal tract and elsewhere
in the body have been reported in approximately 10% of
patients with this syndrome.
Pigmentation (present from birth) of the face, lips, and
oral cavity is a hallmark of this syndrome.
Interestingly, the facial pigmentation fades later in life
although the intraoral mucosal pigmentation persists.
No specific oral treatment is necessary.
Cowdens Syndrome
Cowdens syndrome (multiple hamartoma and
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