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Question 1
Primary dysfunction in GERD
Dysfunction of the lower esophageal sphincter
Question 2
List the risk factors for GERD.
- Obesity - Tobacco usage - Genetic disposition - Impaired salivary gland secretion - Overconsumption of acidic carbonated beverages - Hernias
Question 3
Risk associated with GERD
Adenocarcinoma of the esophagus
Question 4
List the typical symptoms of GERD.
Heart burn, regurgitation, and dysphasia
Question 5
What are the atypical symptoms of GERD?
Non-cardiac related chest pain, asthma, hoarseness, and pneumonia
Question 6
Oral findings of GERD
- Malodor - dysgeusia - tooth erosion
Question 7
What is Barrett's esophagus?
- lining of esophagus is replaced by tissue similar to stomach - often due to chronic acid reflux
Question 8
What are the risk factors for Barrett's esophagus?
Male, Caucasian, increased age, obesity, smoking, and a history of reflux or GERD.
Question 9
Difference between the superficial layer of epithelium in a normal esophagus and Barret's esophagus?
Normal: superficial layer of epithelium = non-keratinized squamous cells Barret's: replaced by columnar cells
Question 10
What are the two types of tumors that can occur in the esophagus?
Squamous cell carcinoma and adenocarcinoma
Question 11
What tumor comes from squamous epithelium?
Squamous cell carcinoma
Question 12
What tumor comes from glandular epithelium?
Adenocarcinoma
Question 13
Significance of tumor island in connective tissue of esophageal cancer?
- tumor island into the connective tissue = progression of cancer - key factor in determining the stage and treatment of esophageal cancer
Question 14
Damaging Forces of peptic ulcer disease?
Gastric acidity and peptic enzymes
Question 15
What are the 'Defensive Forces' in the context of peptic ulcer disease?
- Surface mucus secretion - bicarbonate secretion into mucus - mucosal blood flow - apical surface - paracellular transport - epithelial regenerative capacity - elaboration of prostaglandins
Question 16
What does chronic disease do with peptic ulcer
Chronic disease increase risk fpr lymphoma and carcinoma
Question 17
T/F: People with peptic ulcer disease can be asymptomatic
True
Question 18
What are the signs and symptoms of peptic ulcer disease?
Gastric: occur after eating, nausea/vomiting, and weight loss Duodenal: occur at night; hunger sensations; food, milk, antacids reduces pain
Question 19
What are the oral findings associated with peptic ulcer disease?
- Dark, red tongue with a yellow coating - Candidiasis - Signs of anemia in patients with H. pylori-induced ulcers
Question 20
What is pseudomembranous colitis
inflammation of intestinal lining with abdominal pain, diarrhea, and fever
Question 21
What is the cause of Pseudomembranous Colitis?
Clostridium difficile - Gram positive, anaerobic - produces endotoxins → inflammation + cellular apoptosis
Question 22
Which antibiotics are associated with Pseudomembranous Colitis?
Broad-spectrum antibiotics -- Clindamycin
Question 23
What is this a picture of?
pseudomembranous colitis
Question 24
What are the symptoms of Pseudomembranous Colitis?
Diarrhea, abdominal pain, fever, and tenesmus.
Question 25
Celiac disease etiology
- prevalent in US and western europe - hereditary predisposition
Question 26
What is the abnormal reaction to gliadin in celiac disease?
Gluten sensitivity - immunologic inflammatory reaction when wheat products are consumed
Question 27
What are the symptoms of malabsorption in celiac disease?
GI upset: pain and diarrhea
Question 28
What are the oral manifestations of celiac disease?
Resembles malnutrition - Aphthous ulcers (canker sore) - atrophic glossitis - risk of candidiasis - xerostomia - defects to the dentition
Question 29
What is an aphthous ulcer?
A small, painful ulcer on the inside of the mouth, commonly referred to as a canker sore
Question 30
What is the difference between IBS and IBD?
IBS: Irritable Bowel Syndrome - group of symptoms - stomach pain, diarrhea, and constipation IBD: Inflammatory Bowel Disease - group of inflammatory diseases - ex. Crohn's disease, ulcerative colitis
Question 31
When does IBS usually occur?
IBS: late adolescence/early adulthood IBD: before 30, sometimes later
Question 32
IBS vs IBD Increase risk of cancer?
IBS: No IBD: Yes
Question 33
IBS vs IBD Complications?
IBS: impaired quality of life IBD: joints, eyes, skin, kidneys, bones all effected
Question 34
What is Ulcerative Colitis?
Chronic inflammatory disorder - affects the inner lining of the large intestine → inflammation + ulcers
Question 35
Where does the mucosal ulceration in Ulcerative Colitis typically occur?
From the rectum to the more proximal portion of the large intestines
Question 36
What is the clinical presentation of Ulcerative Colitis?
Abdominal pain and bloody diarrhea
Question 37
What is the oral manifestation of Ulcerative Colitis?
Pyostomitis vegetans
Question 38
How many layers are involved in Ulcerative colitis
1 or multiple
Question 39
What is Crohn's Disease?
Chronic inflammatory disease that can affect any part of the gastrointestinal tract - most commonly: small intestine and colon
Question 40
How many layers does Crohn's Disease involve
All 4 can be involved
Question 41
What are 'skip lesions' in the context of Crohn Disease?
- areas of inflammation that skip over other areas of the colon - pattern of affected and unaffected segments.
Question 42
What are the clinical symptoms of Crohn Disease?
abdominal pain and bloody diarrhea
Question 43
Endoscopy of what disease
Crohn's
Question 44
Endoscopy of what disease
Ulcerative colitis
Question 45
Histology of what disease
Crohn's; circle is granulomatous inflammation
Question 46
Histology of what disease
Ulcerative colitis
Question 47
What is granulomatous inflammation
inflammation characterized by the formation of granulomas - collections of immune cells that surround/encapsulate foreign substances or dead tissue
Question 48
What is the difference between Crohn's disease and ulcerative colitis based on the histology shown?
Crohn's disease shows granulomatous inflammation, while ulcerative colitis does not.
Question 49
Indications for aminosalicylates - IBD
Ulcerative colitis – distal ileum and colon small role in Crohn’s disease
Question 50
Aminosalicylates dental considerations
CBC w/Diff, renal and liver function should be tested Oral inflammation (stomatitis)
Question 51
Corticosteroids Indication for IBD
Combo with other meds to reduce “flares” Periods of severe disease
Question 52
Corticosteroids dental considerations for IBD
- Risk of infections - poor wound healing - periodontal disease - potential adrenal crisis
Question 53
Immunomodulator indications for IBD
- Cases not responding to corticosteroids - Weaning patients off steroids - Limited use due to toxicity
Question 54
Dental considerations for immunomodulators
- Risk of infection and lymphoma - oral inflammation (stomatitis) - gingival hyperplasia (Cyclosporine)
Question 55
Antibiotic indications for IBD
Manage abscesses, maintain remission, and post intestinal surgery
Question 56
Antibiotics dental considerations - IBD
avoid alcohol
Question 57
Biologics indications for IBD
- Severe cases that fail to responds to other meds - IV infusion
Question 58
Biologics dental considerations for IBD
- Risk of lymphoma - Risk of progressive multifocal leukoencephalopathy
Question 59
Common IBD surgical procedures
• bowel resection • colectomy • proctolectomy • strictureplasty • fistulotomy
Question 60
What is the surgical removal of a portion of the small and/or large intestine called?
Bowel Resection
Question 61
What is the surgical removal of the entire colon (large intestine) called?
Colectomy
Question 62
What is the surgical removal of the entire colon AND rectum?
proctocolectomy
Question 63
What is the surgical widening of the intestinal passageway called?
Strictureplasty
Question 64
What is the surgical treatment of anal fistula
fistulotomy
Question 65
What is a colon polyp?
A protrusion into the lumen of the colon
Question 66
What are the two main types of colon polyps?
Hyperplastic and Adenomatous (dysplastic)
Question 67
What is the potential outcome of adenomatous polyps?
give rise to adenocarcinoma → screen via colonoscopy and polypectomy
Question 68
First hit of carcinoma pathophysiology
Germline or somatic mutations of cancer suppressor genes
Question 69
Second hit of carcinoma pathophysiology
Muscosa at risk • methylation abnormalities • inactivation of normal alleles
Question 70
What is the most common malignancy of the colon?
Adenocarcinoma
Question 71
What are carcinoids, and where are they most commonly found?
Carcinoids are rare, except for rectal carcinoids.
Question 72
Types of neoplasms
• adenocarcinoma • carcinoids • lymphoma • metastatic carcinoma
Question 73
What are hereditary colon cancers
A syndrome with mutations that can cause patients to develop cancer at a young age.
Question 74
What syndromes associated with FAP?
Gardner Syndrome
Question 75
What syndrome is associated with Hereditary Nonpolyposis Colon Cancer (HNPCC)?
Lynch syndrome
Question 76
What dental mods should be made for GI disorders?
• chair positioning • dry mouth products - fluoride to help • delay treatment for ppl with active GI upset • use nonNSAIDs analgesics • early screening for ppl with familial history of GI cancers • avoid antibiotics associated with pseudomembranous colitis