Gi disorders disorders of the mouth


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Gi disorders disorders of the mouth

  1. 1. DISORDERS OF THE MOUTH:<br />May be dental or GI in origin<br />Interferes with nutrition<br />Caused By<br />Poor dental hygiene<br />Infections<br />Inflammation<br />Cancer<br />
  2. 2. Peridontal disease<br />Infection of the tissues (the gums)<br />Attack just below the gum line <br />Cause the attachment of the tooth and its supporting tissues to break down.<br />Classified according to the severity <br />Two major stages are gingivitis and periodnoitis<br />Gingivitis may lead to more serious-peridonitis<br />
  3. 3. Candidiasis (Thrush, Moniliasis)<br />Fungus=Candida Albicans<br />Found in small amounts in human intestinal tract.<br />Normally kept in check, C. albicans can increase when balance is distrubed<br />Causes thrush<br />Also called Moniliaalbicans<br />
  4. 4. Those susceptible<br />Newborns<br />People with Diabetes Mellitus<br />People with leukemia<br />Patients taking antibiotics<br />People receiving Chemotherapy (Chemo Tx) or Radiation Therapy<br />Alcoholics<br />
  5. 5. Treatment:<br />Nystatin/mycostatin. Done as a swish and spit administration<br />1 – 4 ml drops for newborn<br />Nystatin or amphotericin B liquid or buccal tablets<br />Use topical anesthesia 1 hr. a.c.<br />GOOD hand hygiene & practices to stop spread in newborn nurseries <br />
  6. 6. Cancer of the Mouth:<br />Can occur anywhere on lips, tongue, pharynx, or oral cavity.<br />Increased risk with ANY tobacco use<br />Risk increase with sun-exposure<br />Heavy drinkers and alcoholics also at increased risk<br />Early detection important<br />
  7. 7. Squamouscell epitheliomas<br />Grows rapidly <br />Metastasize quickly to adjacent structures if not detected early<br />Tumors of this type largest % of oral cancers<br />Cancer of anterior tongue & floor of mouth often occur together<br />
  8. 8. Leukoplakia<br />Pre-cancerous ulcer is white, firmly attached patch on tongue or buccal mucosa<br />May appear on lips<br />Can be benign or malignant<br />Bx if lasting more than 2 weeks<br />S/Sx: asymptomatic, but may develop chewing or swallowing difficulties, toothache, earache, sore throat.<br />
  9. 9. Dx:Larnygoscopy, X-ray of jaw structures, Excisional Bx, Scraping & Cytology. Esp. important with hx of ETOH or tobacco abuse, dysphagia, male > 40yr. with above history.<br />Tx: Depend on the staging of the cancer. Surgical removal of tongue, mandible, laryngectomy, muscles, nodes. Radiation Tx.<br />Prognosis: Good if caught early, but survival <50%. Many complications.<br />
  10. 10. DISORDERS OF THE ESOPHAGUS:<br />Esophageal Cancer: Risk factors include ETOH & Tobacco Abuse, Achalasia, Chronic Irritation, Barrett’s Esophagus<br />Tx is often comfort and control, not cure<br />Cancers of bronchus, stomach, breast metastasize to this site<br />Can invade/extend to heart & lungs.<br />Usually men 55 -70 yr.<br />
  11. 11. Epithelial Neoplasm<br />Squamous cell or adenocarcioma that has invaded esophagus<br />Adenocarcioma is type in 30-70 %<br />Associated with ETOH and Tobacco Abuse<br />Usually at late stage when discovered<br />
  12. 12. S/Sx: Progressive dysphagia as though food is stuck, vomiting, hoarse voice, chronic cough, weight loss.<br />Diagnostic Tests: Barium swallow, Endoscopy, Biopsy, CT scan and/or MRI.<br />Treatment: Surgery, Radiation Tx, Chemotherapy. Surgery and Radiation Tx can be either a treatment or palliative measure. Surgery involves resection of esophagus and attachment to stomach/intestines.<br />
  13. 13. Treatment (cont.)<br /> Assess for esophotracheal fistula – aspiration and respiration problems will occur. Pt. may need GT tube placed if unable to swallow and maintain nutritional intake.<br />Poor prognosis related to late detection of tumor.<br />
  14. 14. Achalasia (Cadiospasm):<br />Inability of cardiac sphincter/LES to relax.<br />Little or no food enters the stomach. “Won’t go down.”<br />Distal end of the esophagus dilates and looses peristalsis.<br />Cause not known.<br />S/Sx:Dysphagia, Food Regurgitation, Weight Loss, Weakness, Decreased Skin Turgor.<br />
  15. 15. Tx: Diagnosed with X-rays and esophagoscopy Forceful dilation of narrowed areas. May do Cardiomyotomy – incision of muscle layer(s).<br />Meds: Used to decrease pressure in lower esphageal sphincter (LES)/cardiac sphincter; includes Anticholinergics, Nitrates, Calcium channel blockers.<br />Nutrition: Increase protein, High caloric diet, Increased fiber, HOB each HS, avoid constipation.<br />
  16. 16. EsophagealVarices: <br />Complication of Liver Disease.<br />Related to portal circulation hypertension. Dilation of veins of lower esophagus. VERY susceptible to rupture, bleeding, ulceration, hemorrhage.<br />May be painless bleeding<br />Medical emergency. <br />
  17. 17. Treatment: Goal is to stop the bleeding.<br />Vasopressin drip (ADH that elevates B/P)<br />Tube with inflatable balloon to compress ruptured veins - suction applied.<br />Gastric lavage with iced saline solution.<br />Endoscopic sclerotherapy.<br />To decrease portal HTN – shunt blood from portal vein to inferior vena cava.<br />
  18. 18. GERD (Gastroesophageal Reflux Disease):<br />Lower esophageal sphincter (LES) …leaks, causing digestive fluids and stomach acid to “back up”.<br />Irritates the esophagus<br />Damage the delicate lining on the inside of the esophagus<br />Frequent heartburn (pyrosis)…occurs after meals.<br />
  19. 19. Uncomfortable, rising, burning sensation behind the breastbone.<br />Regurgitation of gastric acid or sour contents into the mouth, difficult and/or painful swallowing, and chest pain.<br />Goals of Treatment:<br />Relieve GERD symptoms<br />Heal any damage to esophagus.<br />Most effective is to reduce amount of stomach acid going back up into esophagus.<br />
  20. 20. Signs and Symptoms:<br />Cough- Nocturnal, Wheezing, Hoarseness<br />Heartburn/Epigastric, Substernal, Retrosternal Burning Pain.<br />Regurgitation without nausea or erutation (belching).<br />Dysphagia or Odynophia.<br />Mild/Infrequent GERD – s/sx x2/week or less.<br />Mild cases are dx by classic symptoms and treated on that basis.<br />