Term
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Definition
| is a well-defined break in the gastrointestinal mucosa (greater than 3 mm in diameter) that results from chronic acid or pepsin secretions and the destructive effects of the host response to Helicobacter pylori |
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Term
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Definition
| proximal to acid and pepsin secretions |
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Term
| Where is the location of most ulcers? |
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Definition
| The first portion of the duodenum |
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Term
| Who are peptic ulcers most common in? |
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Definition
| elderly, rare in children |
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Term
| What medications can cause peptic ulcers? |
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Definition
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Term
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Definition
| is a microaerophilic, gram-negative, spiral-shaped motile bacillus with 4 to 6 flagella, only lives in humans |
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Term
| What does H. Pylori cause? |
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Definition
| inflammation that causes ulcer formation |
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Term
| What happens to untreated ulcers? |
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Definition
| they are treated by fibrosis. This can lead to pyloric stenosis, gastric outlet obstruction, dehydration, and alkalosis |
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Term
| What are the symptoms of active peptic ulcers? |
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Definition
| some are asymptomatic, most experience epigastric pain that is long-standing (several hours) and sharply localized |
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Term
| Changes in character of pain may indicate what? |
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Definition
| the development of complications |
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Term
| How is a peptic ulcer diagnosed? |
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Definition
| diagnosed primarily by fiberoptic endoscopy and laboratory testing for H. pylori |
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Term
| What are some nonendoscope labratory tests used to diagnose peptic ulcers? |
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Definition
-include urea breath test (UBTs) -serologic tests
-less commonly, H. pylori stool antigen tests |
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Term
| So people with peptic ulcers go to the doctor right away? |
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Definition
| not usually until it progresses |
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Term
| What provide the best results for persons with a peptic ulcer and H. pylori infection? |
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Definition
| Four-drug treatment regimens, including a PPI plus three antimicrobials, or a PPI plus a bismuth plus tetracycline and metronidazole |
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Term
| People undergoing peptic ulcer thearpy must not.. |
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Definition
| eat foods or take medications that are hard on the stomach |
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Term
| Is surgery used to treat ulcers anymore? |
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Definition
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Term
| Is a med con needed for an ulcer? |
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Definition
| If gastrointestinal symptoms are suggestive of active disease, a medical referral is needed |
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Term
| Can we treat patients with ulcers? |
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Definition
| yes, we just have to make sure they are comfortable |
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Term
| H. pylori is found where? |
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Definition
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Term
| Use of systemic antibiotics for peptic ulcer disease may result in... |
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Definition
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Term
| What are two less common oral lesions of ulcers? |
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Definition
| Vascular malformations of the lip and erosion of the enamel |
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Term
| What is inflammatory bowel disese? |
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Definition
| a term encompassing two idiopathic diseases of the gastrointestinal tract: ulcerative colitis and Crohn’s disease |
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Term
| What is ulcerative colitis? |
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Definition
| a mucosal disease that is limited to the large intestine and rectum |
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Term
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Definition
| a transmural process (involving the entire thickness of the bowel wall) that may produce “patchy” ulcerations at any point along the alimentary canal, from the mouth to the anus, but most commonly involves the terminal ileum |
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Term
| When is peak onset of IBD? |
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Definition
| 20-40 years old, chrons is 55-65 |
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Term
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Definition
| of unknown cause that are generally thought to be associated with immune dysfunction in response to environmental factors in genetically susceptible persons |
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Term
| Where does ulcerative colitis take place? |
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Definition
| starts in the colorectal region and may spread proximally to involve the entire large intestine and the ileum |
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Term
| Does ulverative colitis progress? |
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Definition
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Term
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Definition
chronic, relapsing idiopathic disease that is characterized by segmental distribution of intestinal ulcers (so-called skip lesions) interrupted by normal-appearing mucosa
*relapse(more common in tobacco users), remission* |
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Term
| What are the three symptoms of Ulcerative colitis? What is the onset like? |
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Definition
1.Attacks of diarrhea
2.Rectal bleeding (or bloody diarrhea)
3.Abdominal cramps
*onset may be sudden |
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Term
| What are the symptoms of crohn' disease? |
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Definition
| Initial manifestations of Crohn’s disease consist of recurrent or persistent diarrhea (often without blood), abdominal pain or cramping, anorexia, and weight loss |
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Term
| What are the three patterns of symptoms of crohns disease? |
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Definition
1.Disease of the ileum and cecum
2.Disease confined to the small intestine
3.Disease confined to the colon |
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Term
| How long is the delay from the disease tot he onset of symptoms in crohns disease? |
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Definition
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Term
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Definition
| based primarily on clinical findings, results of endoscopy and biopsy, and observations of histolopathologic examination of intestinal mucosa |
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Term
| What is ulerative colitis characterized by? |
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Definition
| characterized by friable, granular, erythematous, and eroded mucosa of the colon, with regions of edema and chronic inflammation seen on endoscopic and microscopic examinations |
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Term
| What is crohns disease characterized by? |
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Definition
| features patchy erosions and ulcerations, with noncaseating granulomas that can arise in any part of the gastrointestinal tract |
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Term
| Blood tests in IBD may show... |
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Definition
-anemia
-decreased levels of serum protein
-inflammatory activity
-elevated platelet count |
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Term
| Can ulcerative colitis or chrons disease be cured? |
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Definition
| no, but they can be managed by an array of drugs |
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Term
| What are the first line drugs? Second? Third? |
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Definition
1.Antidiarrheal and anti-inflammatory medications
2.Immunosuppressive agents and antibiotics
3.disease in persons who are refractory to steroid treatment include monoclonal antibody active against TNF and surgical resection to remove the diseased portion of the colon |
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Term
| What are the mainstay of treatment for ulcerative colitis and play a small role in management of Crohn’s disease? |
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Definition
| Drugs containing 5-aminosalicylic acid (5-ASA) (drugs—sulfasalazine, mesalamine, olsalazine, and balsalazide) |
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Term
| What induces remission of these patients? |
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Definition
| Corticosteroids often are combined with sulfasalazine |
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Term
| Who are Immunomodulator drugs used in? |
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Definition
| patients who have active disease that is unresponsive to corticosteroids and in corticosteroid-dependent patients to reduce the amount of steroid needed, and to limit dose-dependent adverse effects of steroids |
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Term
| Infliximab (anti-TNF monoclonal antibody) is used for... |
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Definition
| for severe disease that is refractory to other drugs, and for maintenance of remission(for crohns disease) |
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Term
| what have Antibiotics (metronidazole or ciprofloxacin) have been used for treatment of? |
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Definition
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Term
| Who is surgery reccomended for? |
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Definition
| severe cases of IBD that do not respond to corticosteroids, or to manage serious complications(70% of people with crohns get surgery)Whih |
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Term
| Which patients with IBD can receive care in the dental office? |
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Definition
-have less than 4 bowel movements per day with little or no blood
-no fever
-few symptoms
-sedimentation rate below 22 mm/hour |
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Term
| Which patients with IBD need a med con? |
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Definition
moderate to severe:
-6 or more bowel movements per day with blood
-fever
-anemia
-a sedimentation rate higher than 30 |
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Term
| What can some antibiotics cause in patients with IBD? |
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Definition
| can promote overgrowth of Clostridium difficile, leading to symptomatic flares and diarrhea |
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Term
| Why can use of steriods in patients with IBD be of clinical concern? |
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Definition
| because corticosteroids can suppress adrenal function and reduce the ability of the patient to withstand stress |
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Term
| Immunosuppressors (azathioprine and 6-mercaptopurine) are associated with development of... |
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Definition
| pancytopenia in approximately 5% of patients |
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Term
| what are some oral manesistatons of IBD? |
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Definition
-Aphthous ulcer like lesions
-Granularity or presence of irregular margins may be helpful in the diagnosis to distinguish from apthous ulcers |
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Term
| What are some unique oral lesions of Crohn's disease? |
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Definition
Features include atypical mucosal ulcerations and diffuse swelling of the lips and cheeks (orofacial granulomatosis)
-may precede diagnosis of disease by years |
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Term
| Use of sulfasalazine has been associated with... |
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Definition
| with toxic effects on bone marrow, resulting in anemia, agranulocytosis, or thrombocytopenia, which can manifest as a bald tongue, an oral infection, or bleeding, respectively |
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Term
| What may corticosteriod use result in? |
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Definition
| in osteopenia, which may involve the alveolar bone |
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Term
| What is Pseudomembranous Colitis? |
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Definition
| A severe and sometimes fatal form of colitis that results from the overgrowth of Clostridium difficile in the large colon |
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Term
| Where is C. Diffiile found? |
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Definition
| is a gram-positive, spore-forming anaerobic rod that has been found in sand, soil, and feces |
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Term
| Where is the risk of disease greater? |
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Definition
| Risk of disease increases in areas where spores are inhaled and when broad-spectrum antibiotics are in prolonged use(target normal flora of the colon) |
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Term
| What is the most common presenting manifestation of pseudomembranous colitis? |
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Definition
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Term
| What is Pseudomembranous colitis associated with? |
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Definition
| leukocytosis, leukocyte-laden stools, and a stool sample positive for C. difficile or one of its toxins, as determined by tissue culture |
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Term
| What are often visible on colonoscopy or sigmoidoscopy? |
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Definition
| Colonic yellow-white pseudomembranes that are 5 to 10 mm in diameter |
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Term
| What is the first line treatment of pseduo. colitis? |
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Definition
| discontinuing use of the inciting antimicrobial agent, along with introducing an antibiotic that will eradicate the toxin-producing C. difficile |
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Term
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Definition
1.mild-antibiotic
2.moderate-, oral metronidazole is recommended
3.unresponsive to metronidazole-Vancomycin or rifaximin |
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Term
| What systemic antibiotics are associated with a higher risk of pseudomembranous colitis in elderly, debilitated patients and in those with a history of pseudomembranous colitis? |
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Definition
| clindamycin, ampicillin, and cephalosporins |
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Term
| Should we care for patients with pseudo colitis? |
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Definition
| Elective dental care should be delayed until after pseudomembranous colitis has resolved |
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Term
| What can the antibiotics be associated with? |
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Definition
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