1
Q
Name some of the problems that can be caused as a result of Haemorrhoids
A
- Bleeding: fresh red blood in toilet water, on toilet paper
- Pain, itching
- Problems with continence ( changing bowl)
- tenesmus
- Ulceration
2
Q
What is Tenesmus
A
feeling of needing to pass stools even when the bowl is empty
3
Q
What can be the possible aetiology for Haemorrhoids?
A
Increase in abdominal pressure due to
- Pregnancy
- Straining ( as result of not eating fibre rich diet)
4
Q
What kind of sensation does the rectum and anal skin have?
A
Rectum: non somatic sensation (visceral)
Anal skin: somatic sensation
5
Q
What is the somatic sensation
A
- Sensations arising from the skin — such as touch, pressure, cold, warmth, and pain
- And from the muscles, tendons, and joints — such as the position of the limbs and pain
- it involves the
6
Q
What is visceral sensation
A
- Nerve supply, supplying the internal organs and it feels changes such as pressure and not our usual sensations
7
Q
Explain the location, and sensation of the internal pile (Haemorrhoids)
A
- Location: Arise from the rectum
- Sensation: Pain free, only discomfort and tenesmus
8
Q
Explain the location, and sensation of the External pile (Haemorrhoids)
A
- Location: Pile arise from the Anal cushion
- Sensation: Pain, itching, discomfort
9
Q
What is the responsibility of the Anal cushion?
A
- It Contributes to continence (control movement of bowels)
and distinguishes between Solid vs liquid vs gas
10
Q
How does Haemorrhoids form?
A
- When the blood vessels in the anal cushion swell up (as result of stretching under pressure) , they form something like varicose veins and these are the Haemorrhoids
11
Q
Internal and External anal sphincter, which one of them contain voluntary and which one contain involuntary muscles
A
- Internal: Involuntary muscle with resting tone
- External: Voluntary muscle with resting tone (you don’t need to keep concentrating to keep it contracted)
12
Q
How to manage Haemorrhoids?
A
-Symptomatic: relieve itching (by providing haemorrhoid gel which is local anaesthetic)
- Hygiene
-Diet: High fibre diet, fluid intake, keep stool soft
- Surgery: In surgery, we put a rubber band around them, constrict the blood supply,
they become necrotic and fall off
13
Q
How do we distinguish the origin of the bleeding in the GI system?
- Stomach/ upper GI:
- Colon:
- Sigmoid/ Rectum:
- Rectum/ Anus:
A
- Stomach/ upper GI: Black coloured stool (blood gets digested with the food and produce a black colour)
- Colon: Mixed in with stool
- Sigmoid/ Rectum: Coating the stool
- Rectum/ Anus: fresh blood in the toilet paper, toilet water
14
Q
When we get abdominal pain, is somatic sensation or visceral sensation? why?
A
- The Parietal Peritoneum has a somatic sensation. But GI tract generally has a visceral innervation (the organs).
This is why when we get abdominal pain we can locate that the pain is coming from the abdominal area but we can’t tell which organ exactly is the source of pain
15
Q
What is the Parietal Peritoneum
A
the outer lining of the abdominal cavity and it has the somatic sensation.
16
Q
What organs can cause the abdominal pain in the UR, UL, LR and LL
A
- UR: Liver
- UL: Pancreases, Spleen
- LR: Appendix
- LL: Kidney, Colon
17
Q
What to ask if someone present with abdominal pain?
A
- Where is it?
- When is it? after meal? before?
- Associated nausea and vomiting?
- When did you last move your bowels?
- When did you last pee? they might have obstructed bladder which the pain present in suprapubic area and feeling of needing to pee
- When was your last menstrual period? as it can be pregnancy
18
Q
What does the phrase “ End arteries” mean?
A
- The area has No collateral blood flow or venous drainage
19
Q
What are the consequences of inflammation or obstruction in an area of End Arteries?
A
- Inflammation in this area can cause obstruction, meaning the blood can’t get to the area and so the area gets increasingly inflamed and necrotic
20
Q
what is the consequence of necrosis in the appendix?
A
necrosis in the appendix leads to leakage of the bowel content, causing Peritonitis
21
Q
How is the pain sensation in Appendicitis
A
- initially, it is poorly localised (can present as central pain) and it can be associated with diarrhoea/ constipation, malaise or anorexia
- when progresses, it become more localised to the lower right section of abdomen and the tenderness increases as it reaches the somatic peritoneal nociceptors
22
Q
- Give an example of viral gastroenteritis
- Symptoms of it:
- Management and treatment:
A
Noravirus
- Symptoms of it:
. Nausea/Vomiting
. Diarrhoea
. Malaise
. +/- fever - Management and treatment:
. It is a self limiting virus
. Hand hygiene: as it transfer by faecal-oral route
. treatment: rehydrate
23
Q
What is the source of Bacterial gastroenteritis?
A
- Raw/incompletely cooked food
- Dairy (unpasteurised)
- Poorly stored food (it the wrong temperature)
- Unwashed salad
24
Q
What Species of bacteria causes bacterial gastroenteritis?
A
- Salmonella
- E.coli
- Campylobacter
25
What are the symptoms of Bacterial Gastroenteritis?
- Nausea/vomiting
- Diarrhoea
- Adbominal pain
- Fever
- Dehydration
- Fluid and electrolyte balance
26
Which group of patients might need extra care if they get Bacterial gastroenteritis?
- Pregancy
- Infants
- Immunocompromised
- Elderly
27
What is GIT parasite and hits symptoms?
- Worms or part of worms that are found in stool
- patients get itchy anus especially at night
- Diarrhoea
- Vomiting
- abdominal pain
28
What is the treatment of GIT parasite?
- praziquantel
29
What diet increases/ decreases chance of colorectal cancer?
Increase:
- Red meat
- Dairy
Decrease:
- fish
- vegetable
- Nuts
30
What are the modifiable risk factors for Colorectal cancer?
- Alcohol
- Smoking
31
What are the two different methods used to see the severity of colorectal cancer
- Staging
- TNM system
32
What are the different stages of colorectal cancer?
- Tumour thickness
- node involvement
- Distant metastases
33
How can you use the TNM system in colorectal cancer?
TNM system divides the cancer to 4 stages based on its severity. T1 being the early stage and T4 the latest stage
34
What are the treatment options for colorectal cancer:
- Surgery
- Radiotherapy
- Chemotherapy
35
How to screen for colorectal cancer
Sample of stool taken and sent to the lab. they check for blood in stool as it is usually hidden
1. Faecal occult blood: not very effective as it shows any blood (even blood from food e.g stake, black pudding)
2. Faecal immunochemical test: detects only human blood. Therefore very accurate
OOOOOORRRRRRRR
- Colonoscopy: to check for bowel polyp
36
What are symptoms of colorectal cancer?
- Change in bowl habit ( more than 2/3 weeks)
- abdominal pain
- Anaemia: as result of loosing blood
- blood or mucus in blood
- weight loss
37
As dental professionals, what can we do to prevent/ detect colorectal cancer?
* Smoking cessation
* Alcohol reduction
* Ask about diet (tell them to eat their veggies!)
* Encourage patient to participate in all screening
programmes
* ASK about symptoms
* Refer to GP
38
GI 1: What does the gut have that allows for motility (moves food along)?
Layers of muscle running circumferentially and longitudinally that allow for peristaltic waves to push food along.
39
GI 1: What does liver produce? What does this substance do and where is it usually stored?
Liver produces bile salts that allow emulsification of fats, thus increasing absorption. Bile salts are stored in gall bladder and released in response to food in GI tract.
40
GI1: What things does pancreas secrete?
Secretes bicarbonate and enzymes (as inactive pro-enzymes). Also secretes insulin into circulation.
41
GI1: What is use of bicarbonate secreted by pancreas?
To neutralise acidic contents coming from stomach.
42
GI1: How does appendicitis happen?
Happens when appendix gets obstructed and gets necrotic, leading to pain, inflammation and infection.
43
GI1: Describe blood flow to the gut (what arteries?)
Arterial blood flows from aorta to mesenteric arteries which supplies the gut.
44
GI1: Whee does blood go from the gut?
Blood drains from gut into portal venous system and goes toward liver.
45
G1: What does liver hepatocytes do to blood before releasing it into systemic circlation?
Liver hepatocytes:
-filter the blood from any toxins, bacteria etc.
-metabolise drugs, nutrients (like vitamins).
46
GI1: What happens to gut during sympathetic nervous system (fight or flight response)?
Reduces gut motility and secretion.
Breakdown:
-BP inc.
-Pulse rate inc
-Vasoconstriction to pump as much blood as possible to muscles
-Decrease blood flow to gut = slow down gut function = reduce peristaltic waves and secretions
-
47
GI1: What happens to gut during parasympathetic nervous system (relaxed state)?
Promotes gut motility and gut secretion (peristaltic waves and secretions increase)
48
GI1: List symptoms/signs that are an indication of GI disorders.
-Nausea and vomiting
-Heartburn/epigastric pain
-Loss of appetite
-Abdominal pain
-Unintentional weight loss
-Malabsorption (vit. deficiency/ anaemia)
-Change in bowel habit
-Other bowel symptoms:
1) painful bowel motions
2) Blood or mucus in stool
3) Tenesmus (feeling of not having emptied bowel)
49
GI1: Describe what causes GORD to happen.
If Lower Oesophageul Sphincter gets weak, stomach contents can reflux back into lower oesophagus and even upper oesophagus, and if severe can get into pharynx and back into mouth.
50
GI1: List signs and symptoms of GORD.
*Reflux of acidic stomach contents into the oesophagus
*Heartburn
*Acid reflux
*Belching (burping)
*Erosion
*Inflammation of the pharynx and larynx (acid in pharynx and larynx can cause thickening, hoarse voice, feel of lump In throat)
51
GI1: List risk factors of GORD.
-Reduced tone of the lower oesophageal sphincter
-Increased intra-abdominal pressure (eg in pregnancy, overweight, if overweight/pregnant and lying flat)
-Decreased stomach pH-> v acidic. There are foods that cause that.
-Increased stomach contents (big meal)
-Lifestyle (stress, diet, caffeine, alcohol, smoking)
-Drugs (NSAIDS make GORD more likely, specific serotonin reuptake inhibitors for anxiety/depression)
52
GI1: How do you manage GORD?
1) Address risk factors:
-Lose weight
-Address diet
-Avoid very fatty + big meals
-Avoid caffeine
-Reduce alcohol consumption
-Smoke less
2) Neutralise stomach contents (eg with Gaviscon)
3) Surgery to tighten lower oesophageal sphincter (in really problematic GORD)
53
GI1: What is peptic ulcer disease?
Ulceration or inflammation of the stomach or duodenum.
54
GI1: Define an ulcer.
A pathological break in the epithelial lining.
55
GI1: How is peptic ulcer disease formed (what produces it)?
Produced by acid and enzymes in the stomach that have overcome the mucous defenses that normally protect stomach and duodenum against damage.
56
GI1:List causes of peptic ulcer disease.
Stress
Steroids
NSAIDS
SSRIs
H.Pylori microorganism
57
GI1: List symptoms of peptic ulcer disease.
Upper abdominal pain/burning- not chest pain
Bloating
Heartburn
Nausea and vomiting
Dark stools (severe!)
Unexplained weight loss (severe!)
58
GI1: How to manage peptic ulcer disease:
1) Confirm diagnosis via upper GI endoscopy. Investigate dark stools
2) Take biopsy if appropriate
3) Correct risk factors (stress, diet, medication)
4) Increase stomach pH- GIVE PPI (protein pump inhibitor), will inc. pH of stomach contents making it less acidic and less harmful
5) Eradicate H.pylori (if peptic ulcer is related to H.pylori) with antibiotics- amoxicillin. If allergic to amoxicillin, will give clindamycin and metronidazole.
59
GI1: What are the 2 main types of inflammatory bowel disease?
1) Ulcerative Colitis
2) Crohn's disease
60
GI1: True or False: Inflammatory bowel disease is the inflammation of the intestine.
True.
It affects the:
-small intestine (ileum)
-large intestine (colon)
-rectum
-anus
61
GI1: List common symptoms of IBD:
Abdominal pain
Change in bowel habit
Blood loss
Anaemia
Fever
Malaise (feeling unwell)
Arthritis
Skin lesions
Eye lesions
62
GI1: If a pt is anaemic and has IBD, what oral sign would they be presented with?
Recurrent aphthous stomatitis
63
GI1: List the 3 types of Ulcerative Colitis:
Proctitis - affects rectum only
Left-sided (distal) colitis- affecting rectum and descending colon
Total colitis- affecting whole colon including rectum
64
GI1: Where does ulcerative colitis start?
It starts at the anus/ rectum
65
GI1: True or false: Ulcerative colitis can affect the ileum.
False
66
GI1: What are symptoms common to ulcerative colitis?
-Tenesmus
-Relapsing/remitting disease
-Diarrhoea +/- blood, mucus
-Abdominal pain
-Fever, malaise, weight loss
67
GI1: What are 2 symptoms common to Crohn's Disease?
-Chronic inflammatory disease
-Abdominal pain
-Change in bowel habit (constipation/diarrhoea) +/- blood, mucus
68
GI1: What are 2 differences between Ulcerative colitis and Crohn's disease?
1) Ileum is never affected in ulcerative colitis but can be affected in Crohn's disease
2) smoking reduces risk of Ulcerative colitis but increases risk of Crohn's disease
69
GI1: What do we need to carry out to make diagnosis between ulcerative colitis and crohn's diisease?
Blood test
Endoscopy
Biopsy of gut
CT scan
70
GI1: How can IBD be treated?
-Anti-inflammatory drugs (eg steroids, methotrexate)
-Biological response modifiers
71
GI1: What are symptoms of coeliac disease?
-Abdominal pain
-Bloating
-Nausea/vomiting
-Steatorhoea (fatty stools)
-Skin and mouth vesicles -“Failure to thrive” (not growing enough, not gaining weight etc)
72
GI1: What causes Coeliac disease?
It is an autoimmune disease triggered by molecules in gluten, causing inflammation of small intestine.
73
GI1: What would you carry out to diagnose coeliac disease?
Blood tests
Biopsy of small intestine
74
GI1: How would you manage Coeliac disease?
Gluten-free diet
75
GI1: What are the risk factors of irritable bowel syndrome (IBS)?
Diet and lifestyle
76
GI1: What are the main symptoms of IBS?
-Abdominal pain (relieved by bowel movement)
-Altered bowel frequency
-Urgency or straining
Other symptoms:
-bladder symptoms
-lethargy
-fatigue
77
What qs to ask if someone presents with abdominal pain?
-Do you have any blood/mucus in your stool?
-Have you lost any weight
-Check for anaemia (pale conjunctiva)
78
GI 1 QUIZ: How is the mucosa of the stomach, small intestine and colon adapted to its function?
The mucosa of the stomach has columnar epithelial cells with goblet cells, gastric glands and pits. This is to secrete acid and enzymes and mucus (to resist low pH and enzyme damage)
The mucosa of small intestine has columnar epithelial cells with goblet cells, villi (and Brunner’s glands in duodenum). This is to aid absorption of nutrients, neutralise stomach acid and the mucus resists enzyme damage.
The mucosa of the colon has columnar epithelial cells with goblet cells to aid in absorption of water and secrete mucus to resist enzymes.
79
GI QUIZ: How is peristaltic movement in the gut produced and controlled?
Peristaltic movement produced by two layers of smooth muscle; one layer running longitudinally and other running circumferentially. The coordinated contraction and relaxation of this muscle is peristalsis. It is controlled by hormones and autonomic nervous system. The parasympathetic nervous system increases peristaltic movement while sympathetic nervous system decreases peristaltic movement.
80
GI QUIZ: What is Hischprung’s disease? How does the underlying cause of the disease produce it’s clinical features?
Hirschsprung’s disease is a disease characterised by stool being stuck in the bowel and cannot be excreted. The disease is caused due to an absence of nerve cells after the large intestine, before the rectum and anus. This causes a blockage leading to severe constipation and even serious bowel infection (enterocolitis) if not identified and treated.
81
GI QUIZ: Without prescribing any medication, how would you advise a patient who has GORD to manage their disease?
I would address their risk factors such as: losing weight, addressing their diet, avoiding big/fatty meals, avoiding caffeine, reducing alcohol consumption, reducing smoking. I would also advise use of aids, such as Gaviscon, that neutralise stomach contents.
82
GI QUIZ: How do protein pump inhibitors (PPIs) work?
They work by increasing the pH of the stomach contents, making the contents less acidic and less harmful.
83
GI QUIZ: What are Koch’s postulates? How would you prove that they apply to dental caries?
Koch’s postulates are criteria that help determine whether there is a causal relationship between a microbe and a disease.
84
GI QUIZ: A 17 year old patient attends with a history of 3 months of bloody diarrhoea, abdominal pain and weight loss. What diagnoses should you consider and how would they be investigated?
Should consider: Ulcerative colitis, Ctohn’s disease and Coeliac disease. They would be investigated by carrying out blood tests, endoscopy, biopsy of the gut and a CT scan.
CMS1
flashcards
Decks in class (23)
# Cards
-
1.INTRO, RISK ASSESSMENT AND EXAMINATION OF CLOTHED PATIENT6
-
Common neurological disorders109
-
KIDNEY (8)75
-
Cranial Nerves29
-
GI Disorders84
-
Cardiovascular72
-
Skin57
-
Respiratory 143
-
Respiratory 222
-
Bone and Joints 120
-
Bone and joint 263
-
Vaccination and population immunity12
-
Endocrine disorders19
-
Cancer Symposium (all 3 lectures)45
-
Diabetes & obesity69
-
Blood 238
-
Blood 125
-
Liver76
-
Mental Health49
-
Prolonged bleeding69
-
Immunology20
-
Hiv & hep42
-
STROKES AND SEIZURES29
