Clinical Introduction to the GI Tract

• coeliac disease

  
  

  show oral manifestations of coeliac disease?

  
• coeliac disease

  
  

  What is the dental relevance of coeliac disease?

  (it can cause enamel defects if started in childhood)

  
  

  can cause problems with malabsorption: B12, folate, Fe: ROU, glossitis, burning mouth, angular stomatitis, anaemia

  
  

  • If vitamin K is not absorbed it can lead to bleeding

  • if Vitamin D is not absorbed it can lead to osteomalacia and rickets in children

  • if Minerals are not absorbed it can lead to weakness
• coeliac disease

  
  

  What is coeliac disease?

  A genetic disease where there is hypersensitivity of the small intestine mucosa to the gliadin component of gluten. They also have villous atrophy and malabsorption
• inflammatory bowel diseases: drugs

  
  

  what are the effects of corticosteroids?

  • Immunosuppression:

  - Increased susceptibility to infections

  
  

  • Cardiovascular:

  - Hypertension

  - Myocardial infarction Cerebrovascular accidents Hypotensive crises

  
  

  • Metabolic:

  - Hypothalmic-pituitary-adrenal suppression Impaired glucose tolerance or diabetes Growth retardation

  - Loss of Na and K

  - Osteoporosis

  
  

  • Gastrointestinal:

  - Peptic ulceration

  
  

  • Neurological:

  - Mood changes

  -Psychosis

  - Cataracts

  
  

  • Dermatological

  -Acne

  -Striae

  -Bruising

  
  

  • Other:

  - Delayed wound healing

  - Poor quality tissues
• inflammatory bowel diseases: drugs

  
  

  what is an example of an immunosuppressive?

  corticosteroids

  - they reduce inflammation and suppress the immune system.
• inflammatory bowel diseases: drugs

  
  

  what are the effects of immunosuppressives?

  they suppress the immune system responses which makes patients more susceptible to infections so dentists need to be cautious
• inflammatory bowel diseases: oral manifestations

  
  

  what is staghorning?

  Granulomatous swelling in floor of mouth

  
• inflammatory bowel diseases: oral manifestations

  
  

  what is ulceration?

  small, painful patches or lumps inside your mouth.

  
• inflammatory bowel diseases: oral manifestations

  
  

  what is gingival enlargement?

  excessive growth of the gums

  
• inflammatory bowel diseases: oral manifestations

  
  

  what is cobblestoning in mouth?


  cells bulge out from the mucosal surface to a varying degree

  
• inflammatory bowel diseases: oral manifestations

  
  

  What are mucosal tags?

  deep linear ulcers in the fold between the cheek and gum.

  
• inflammatory bowel diseases: oral manifestations

  
  

  What is orofacial granulomatosis?

  persistent swelling in the lips, face or areas within the mouth.

  
  

  if a sample of the swollen tissue is examined under a microscope, small collections of inflammatory cells, called granulomas are often seen.

  
• inflammatory bowel diseases

  
  

  What are common presentations of Crohn's disease?


  • Intermittent abdominal pain, diarrhoea, abdominal distension

  (90%)

  • Fever (30%)

  • Anaemia and weight loss (50%)

  • Fresh blood or melaena (40%)

  • Fistulae and perianal sepsis (20%)

  • Clubbing (50%)

  • Uveitis, arthritis, skin rashes (erythema nodosum)
• inflammatory bowel diseases

  
  

  What is Crohn's disease?

  A chronic inflammatory bowel disease that affects the lining of the digestive tract

  - unknown cause

  - usually starts in teens or early twenties and has a second peak in old age
• inflammatory bowel diseases

  
  

  show ulcerative colitis orally manifested

  
• inflammatory bowel diseases

  
  

  What is ulcerative colitis?

  Inflammatory bowel disease:

  - can affect part/whole of the large intestine, leading to inflammation and even pseudopolyps.

  - It's common amongst 15-40 yr olds
• what is the dental relevance of inflammatory bowel diseases?

  - it causes oral manifestations

  - it can cause malabsorption: dentists need to know effects of it

  - patients with inflammatory bowel disease may take immunosuppressives (e.g. corticosteroids): dentists need to know the effects of these drugs
• what are inflammatory bowel diseases?

  when prolonged inflammation results in damage to the GI tract
• Give some examples of direct and indirect reasons for dental defects.

  • Direct:

  - Acid erosion (intrinsic)

  - Dietary acid (extrinsic)

  
  

  • Indirect:

  - Malabsorption

  - Medications to treat GI disease

  - GI disease (linear and chronologically)
• How can GI disease orally manifest?

  Either:

  • dentally (related to teeth)

  • mucosally (soft tissues affected)

  
  

  This can be either a direct (directly from GI tract) or indirect (indirectly from GI tract) effect of problems with the GI tract
• what s the first portion of the large intestine called?

  cecum
• what does the large intestine do?

  • Absorbing water

  • Absorbing vitamins

  • Reducing acidity

  • Defending from infections

  • Producing antibodies
• where is the bile produced in the liver stored?

  in the gallbladder

  (it is released when CCK (Cholecystokinin) is released)
• what does the liver do?

  It produces bile which neutralises stomach acid and emulsifies fat.
• what does the pancreas do?

  it is an exocirne and endocrine gland:

  
  

  • Exocrine- It releases high levels of amylase and other enzymes into the duodenum to help with the digestive process

  • Endocrine- Blood sugar regulation and serotonin release
• what does the small intestine do?

  - Digestion (via enzymes)

  - absorption (of nutrients and medication)
• what is the first part of the small intestine called?

  duodenum

  
  

  - it is the c-shaped segment that receives partially digested food from the stomach and begins absorption
• what is the fluid that comes from the stomach into the small intestines called?

  chyme
• How long is the small intestine?

  6 metres
• what valve opens to allow food to pass from the stomach to the small intestine?

  The pyloric sphincter (muscular valve)
• How does the stomach digest food?

  The stomach muscle contract periodically, churning food to enhance digestion.
• What lines the stomach?

  Ridges of muscle tissue called rugae
• What does the stomach do?

  Secretes acid and enzymes that digest food
• What affects saliva, gastric, pancreatic and bile secretions?

  
• What is the mneumonic 'I 8 10 Eggs At 12' used to remember?

  Diaphragmatic apertures (holes in the diaphragm):

  • Inferior vena cava- T8

  • Oesophagus- T10

  • Aorta- T12
• what is peristalsis?

  the process of food travelling through the oesophagus

  
  

  -involuntary contraction and relaxation of longitudinal and circular muscles
• what are the 4 layers of the fibromuscular tube of the oesophagus?

  - adventitia

  - muscle layer

  - submucosa

  - mucosa

  
• What is the oesophagus?

  - A fibromuscular tube with 4 layers (adventitia, muscle layer, submucosa, mucosa)

  - is 25cm in length with 2 sphincter

  - It transports food from the pharynx to the stomach and via peristalsis
• what is the purpose of the epiglottis?

  it closes over the trachea while eating so it prevents food from entering the airway
• What is the pharynx?

  It's part of both the digestive and respiratory systems.

  
  

  -> For the digestive system, its muscular walls function in the process of swallowing, and it serves as a pathway for the movement of food from the mouth to the oesophagus