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Gastrointestinal disease
 

Gastrointestinal disease

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Oral Diagnosis I

Oral Diagnosis I
Third Year

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    Gastrointestinal disease Gastrointestinal disease Presentation Transcript

    • Gastrointestinal Disease December 03, 2006 Dr. Suresh. C. S. BDS; MDS; MDSc (UK) Oral Diagnosis I
    • Gastrointestinal Disease Overview  The following gastrointestinal diseases are common and may affect the delivery of dental care:  Peptic ulcer disease  Inflammatory bowel disease  Pseudomembranous colitis
    • Peptic Ulcer Disease Definition  It is a well defined break in the gastrointestinal mucosa (greater than 3 mm in diameter)  They develop in regions of the gastrointestinal tract that are proximal to acid-pepsin secretions.
    • Peptic Ulcer Disease Incidence & Prevalence  It affects 15% of the population in industrial countries.  5-10% of the world population.  500.000 new cases occurs annually in US.
    • Peptic Ulcer Disease Etiology  Current evidence supports a complex interaction between aggressive & defensive factors that are potentially destructive & protective to the mucosa, respectively. Aggressive factors Defensive factors Helicobacter pylori Mucus gel Acid hypersecretion Bicarbonate Tobacco Prostaglandins NSAIDs Mucosa blood flow Psychological & physical stress
    • Peptic Ulcer Disease Signs & Symptoms  Most patients develop epigastric pain that is long standing and sharply localized (burning)  The discomfort of a duodenal ulcer manifests most commonly on an empty stomach (90 min. to 3h. after eating) & awakens the patient in the middle of the night  Melena indicate blood loss due to gastrointestinal hemorrhage
    • Peptic Ulcer Disease Medical Management  Anti-Secretory agents alone or accompanied with antimicrobial agents are recommended.
    • Peptic Ulcer Disease Dental Management  Careful review of medications (aspirin, NSAIDs, oral anticoagulant) and alcohol consumption that can result in gastrointestinal bleeding.  If symptoms are suggestive of active disease, a medical referral is needed.
    • Peptic Ulcer Disease Dental Management  If the patient is under medical control, the dentist should update current medications in the dental record and follow the guidelines outlined in the following material.  Good oral hygiene measures and periodic scaling and prophylaxis may help for reducing the spread of H. Pylori.
    • Peptic Ulcer Disease Oral Manifestations  Use of systemic antibiotics can result in candidiasis  Medications taken by the patient can 1- Alter taste perception. 2- Have a toxic effect on bone morrow and infrequently cause anemia. 3- Xerostomia.
    • Inflammatory Bowel Disease Definition  It describes two idiopathic diseases.  Ulcerative colitis  It is a mucosal disease limited to the large intestine and rectum.  Crohn’s disease  It may produce focal ulcerations along any point of the alimentary canal from the mouth to the anus.
    • Inflammatory Bowel Disease Incidence & Prevalence  In the average general dentistry practice having 2000 adult patients, approximately 5 adults are predicted to have IBD.
    • Inflammatory Bowel Disease Signs & Symptoms Ulcerative colitis Crohn’s disease  Attack of diarrhea Recurrent diarrhea  Rectal bleeding Abdominal pain  Abdominal cramps Anorexia Unexplained fever Malaise Arthritis Weight loss
    • Inflammatory Bowel Disease Medical Management  Ulcerative colitis & Crohn’s disease can be managed but not cured  Anti-inflammatory medications.  Immunosuppressive agents  Monoclonal AB  Surgical resection to remove the diseased portion of the colon
    • Inflammatory Bowel Disease Dental Management  Use of steroid drugs is of concern to the dentist because of corticosteroids can suppress adrenal function and reduce the ability of the patient to withstand stress.
    • Inflammatory Bowel Disease Oral Manifestations  Ulcerative colitis:  20% of patients are affected with aphthous like lesions.  Crohn’s disease:  Atypical mucosal ulcerations & diffuse swelling of the lips & cheeks.
    • Pseudomembranous Colitis  Definition:  It is a severe form and sometimes fatal form of colitis  Dental Management:  Dentist should be aware that use of certain systemic antibiotics (exp. lincomycin, clindamycin, ampicillin & cephalosporins) is associated with higher risk of pseudomembranous colitis (PC.) in elderly, debilitated pts. or with previous history of PC.