GASTRO INTESTINAL DISORDERS Dr.linda maher

GIT(GASTRO INESTINAL TRACT)  it is a tube with muscle walls throughout its length. it is lined by an epithelium. The salivary glands, liver and pancreas pour their secretions into the gut lumen

:FUNCTIONS OF GIT.  1\MOTILITY: mixing and propelling the food along the tract  2\DIGESTION: the process of secreting enzymes which break down the complex food materials into simple forms  3\ABSORBTION: conveying the end products of digestion to the bloodstream

GIT DISORDERS  Though the mouth is the entry of GIT,few GIT diseases directly affect the oral cavity.  Usually the lesions are secondary lesions which may be induced by factors such as malabsorption.

1\CELIAC DISEASE(gluten sensitive enteropathy)  Celiac disease is a permanent intolerance to gluten(the protein component of wheat)  AETIOLOGY:  malabsorption of gluten due to morphological abnormalities in the small intestinal mucosa(GENETICAL ABNORMALITIES)  CLINICAL FEATURES:  diarrhea, weight loss,skin rash and blisters

.  ORAL MANIFISTATIONS:  Malabsorption may lead to hematinic deficiencies (iron,folate ) causing recurrent Aphthus Ulcers and glossitis  DIAGNOSIS:  Biopsy of the small intestine  Blood investigations  TREATMENT:  1\correct iron, folate and b12 deficiencies  2\gluten free diet

2\INFLAMMATORY BOWL DISEASE  inflammatory bowel diseases are lifelong conditions resulting from aberrant inflammation of the mucosal lining of the gastrointestinal tract  Two forms:  1\ Crohn's disease, which may affect the gut anywhere, mainly the ileocaecal region.  2\ulcerative colitis, which is predominantly within the colon.

A\CRHON’S DISEASE  Gastro intestinal inflammatory disease that affects mainly the ileocaecal region causing thickening and ulcerations  AETIOLOGY:  Unknown  CLINICAL FEATURES:  Abdominal pain, variable constipation or diarrhea, obstructions and malabsorption may occur.  fistula  Joint pain

.  Orofacial manifestations:  1\Diffuse soft swelling of the lips  2\cobblestone thickening of the buccal mucosa with fissuring and hyperplastic folds  3\gingiva may be swollen and erythematous  4\some times painful mucosal ulcerations  5\glossitis due to iron, folate, or vitamin b12 deficiency can result from malabsorption

.  TREATMENT:  1\corticosteroids  2\sulfasalazine(anti inflammatory)  3\in very severe cases surgery may be indicated

B\ULCERATIVE COLITIS  The inflammation in ulcerative colitis may affect all or part of the large intestine  AETIOLOGY:  Unknown  CLINICAL FEATURES:  Rectal bleeding and diarrhea  Cramps and severe pain  red swollen nodules that are usually on the thighs and legs, may be present.  Anemia

.  ORAL MANIFISTATIONS:  oral changes that occur in ulcerative colitis cases are nonspecific and uncommon, with an incidence of less than 8%.  Uphthus ulcer may occur in patients with ulcerative colitis may result from nutritional deficiencies of iron, folic acid, and vitamin B12 due to poor absorption in the gut and/or blood loss directly related to the ulcerative colitis

.  DIAGNOSIS:  is made on the basis of careful history, physical examination, gastrointestinal radiography, and endoscopy.  TREATMENT:  Sulfasalazine

3\OROFACIAL GRANULOMATOSIS  Clinically and histologically identical to crohn’s disease  DIAGNOSIS:  By exclusion of crohn’s disease, sarcoidosis  AETIOLOGY:  Probable cause is a hypersensitivity reaction to certain foods

.  TREATMENT:  1\identify and avoid the irritant factor  2\intralesional steroids

4\GASTROEOSOPHAGEAL REFLUX  Gastro esophageal reflux disease (GERD) is one of the most commonly occurring diseases affecting the upper gastrointestinal tract  During gastro esophageal reflux, gastric contents passively move up from the stomach into the esophagus causing damage to the esophageal mucosa  AETIOLOGY:  lower esophageal sphincter incompetence (unknown cause)

.  CLINICAL FEATURES:  Heartburn is the cardinal symptom of GERD and is defined as a sensation of burning or heat that spreads upward from the epigastria to the neck.  Esophageal ulcerations  ORAL MANIFISTATIONS:  dysgeusia(bad taste),  dental sensitivity related to hot or cold stimuli,  dental erosion, and/or pulpitis( erosion of enamel by gastric acid especially the palatal aspect of teeth)

.  MANAGEMENT:  Significant success in preventing or reducing the symptoms seen with lifestyle modification  Weight loss (reduces the pressure difference between the abdomen and thorax)  Less fatty meal (fatty meal slow down gastric emptying and increase the reflux symptoms)  Sleeping with the head of the bed elevated  Simple antacids(e.g. proton pump inhibitor-H2 receptor antagonist)

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