Gi disorders disorders of the mouth
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Gi disorders disorders of the mouth

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Gi disorders disorders of the mouth Presentation Transcript

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