#9

Gastroesophageal reflux disease Peptic ulcer:

(GORD):
The problem is in gastric sphincter 2 types:
Can lead to barret esophagus → Stomach (gastric ulcer)
potentially malignant Duodenum(duodenal ulcer)
Risk factors: Causes:
Smoking ● 3/4pts→ H.pylori
Alcoholism
● Other causes:
Obesity
Stress Stress
drugs(steroids)
Signs and symptoms: Hyperparathyroidism
*** stomach pain
N,V chronic renal failure;lead to secondary
Angina like chest pain hyperparathyroidism
Chronic cough→ larynx irritation Clinical features:
**Epigastric pain
Diagnosis:
signs/symptoms Digestion pain
endoscopy→ esophagus mucosa Or Asymptomatic + anemia → in elderly
PH to eliminate helicobacter pylori Diagnisis:
Dental aspect: Endoscopy
● erosion→ palatal ant+ occlusal post -test H-pylori
● Xerostomia -CBC
● Palatal erythema
● Antihistamine Drug interaction Dental aspect:
with antifungal drugs -xserostomia
-erosion→ bcoz reflux
-signs of anemia: atrophic tongue, burning
sensation, angular chelitis, candidal infection
**NSAIDS -->contraindicated
Drug interactions in antibiotics:tetracyclin
/erethromycin with antiacids.
**amoxicyline is safe

Peptic ulcer + barret esophagus if not treated → may lead to Cancer

 Crohn Ulcerative colitis
Granulomatous inflammatory disease Inflammatory disease
Site mostly → illeum+ secum
Signs and symptoms: Signs and symptoms:
-Abdominal pain, malaise, weakness, fever, Abdominal pain
diarrhea, vomiting, Vomiting
-Symptoms associated with malabsorption Bleeding
Symptoms of anemia or
-affect any part of the GI and oral cavity malabsorption
-specific oral manifestations:
A. Mucosal tags Diagnosis Management
Same as crohn
B. Recurrent lip swelling
C. Fissured mucosa differences :
-there are patients have crohn's disease limited to Site → colon
No granuloma
the oral cavity, called oral crohn's disease.
Less oral manifestation less
Diagnosis: specific→ aphthous ulcer,
-Cinical findings non specific symptoms angular chelitis, candidal
-Malabsorption→ folic acid,iron,B12 defficiency infections, glossitis and
biostomatitis vigitans (rare).
-endoscopy,biopsy→ chronic
inflammation+granuloma+macrophages
management: ----
Treated with steroids → immunosuppressed ptns *chronic inflammation is a risk
Antibiotic prophylaxis factor for cancer
Polypharmacy → secondary hepatotoxicity
NSAID are contraindicated
nutritional support
-surgical removal of inflamed part

Crohn additional notes:

- if patient has done resection in bowel he may has bleeding tendency, why?
Because the intestine has bacteria responsible for absorption of vitamin K, and after
surgical resection of the bowel the absorption will decrease and this lead to increase in
bleeding tendency.
-Granuloma present in → Crohn, Sarcoidosis, TB

Coeliac Disease → wheat intolerance Pseudomembranous colitis

“gluten”
Mostly hospitalized elderly
Causes: Causes:
Gluten intolerance → atrophy of the Broad spectrum Antibiotics (mostly
intestine→ malabsorption. clindamycin, amoxicillin and tetracyclin
Signs and symptoms: may cause it) oral and IV
● non specific (abdominal pain, Bacteria (cluserdium difficle) → normally
malabsorption, nausea, vomiting..) present in the colon
● skin rash“ dermatitis herpetiformis”. Signs and symptoms:
Diagnosis: -watery diarrhea
At childhood -bloody diarrhea
clinical features
-fever
-endoscopy
-abdominal pain
-IGA antibody
Treatment: Diagnosis
Gluten free diet Mainly clinical; patient has diarrhea after
Dental aspect: taking antibiotic.
aphthous like ulcer -stool culture to roll out infectious causes.
enamel hypoplasia→ malabsorption at -sigmoidescopy (‫ )تنظير‬in chronic cases.
young age.
glossitis Treatment:
*dental treatment is not complicated Stop antibiotic
except if he has anemia. Supportive (fluids,electrolyte replacement)
Severe cases(metronidazol/vancomycin)

Dental aspect:
Candidiosis as a result to BS antibiotic