Knowledge is shared

1. Management of the patient with oral and
oesophageal disorders

2. INTRODUCTION
The GIT plays a vital role for one’s overall
health.It has high concentration of nerve tissue
in the body beside the brain.It is in the GIT
where toxins are inactivated and nutrients
absorbed.

3.  The bacteria of the GIT play a significant
role in maintaining good health by
producing vitamin B compounds and other
compounds that help regulate the immune
system.

4.  Oral problems are mainly caused by poor
oral health, infections and inflammation
from other causes.
 The problems interfere with ingestion as
the patient may have pain in the mouth.
 thereafter the nutritional intake and even
oral communication may be
compromised

5. PRINCIPLES OF THE MGT. OF GI CONDITIONS
The principles of the management of GI conditions is
centered on the following principal manifestations of GI
disorders:
Dysphagia – is difficulty swallowing and is the most
common symptom of esophageal disease.
The symptom may vary from an uncomfortable feeling that
a bolus is caught in the upper oesophagus to acute pain on
swallowing called odynophagia

6. Heartburn (Pyrosis) – common symptom of
gastroesophageal reflux disease (GERD) that causes
malfunction of the anti-reflux mechanism of the gastro-
esophageal junction Leading to water brash.
Anorexia (loss of appetite) – nonspecific symptom that
commonly accompanies both acute and chronic conditions

7. Nausea and vomiting – most common symptoms of GI
diseases, which often occur together but may occur
independently.
Nausea is a feeling of discomfort in the epigastrium with the
conscious desire to vomit and,
vomiting is a reflex action which results in the contents of
the stomach being ejected through the mouth.

8. Dyspepsia – a sensation of pain, discomfort or fullness in the
epigastrium, often accompanied by belching and nausea .
Abdominal pain – it’s management is a complex and
challenging process because of its varied aetiologies and the
nurse’s perception of pain.

9. Constipation – a decrease in frequency of bowel movements
from what is “normal” for the individual ; hard, difficult to
pass stools; a decrease in stool volume; and retention of feaces
in the rectum.
Diarrhoea – frequent passage of loose watery stools

10. Weight loss – important but rather unspecific symptom of GI
and other diseases.
Gastrointestinal bleeding – may present as haematemesis,
maleana, occult blood or signs and symptoms of haemorrhagic
shock such as restlessness, distended abdomen, falling blood
pressure, etc.

11. STOMATITIS

12.  STOMATITIS
• Stomatitis is a generalised inflammation of the
soft tissue of the mouth.
• There are various types of stomatitis namely;

13. 1.SIMPLE CATARRHAL STOMATITIS.
• This is inflammation of mucous membrane
of the mouth ,
• Characterised by increased flow of mucus
and exudates.it occurs commonly in
children

14. Causes
 Poor oral hygiene
 Hot foods and drink
 Micro- organisms such as bacteria
 Systemic infections
 Corrosion from strong acids or alkali

15. Signs and symptoms
 Dry mucus membrane due to reduced
saliva production as a result of inflamed
membranes.
 Low grade fever due to infection
 Sores in the mouth due to corrosion
 Pain in the mouth especially due to
inflammation.

16.  Red mucus membrane as a result of
inflammation
 Loss of appetite due to increased flow of
mucus.

17. Treatment
 Anti pyretics such as Panadol in order to
reduce temperature .
 Mouth wash with saline water
 Treatment of systemic condition if it is the
cause

18. 2.VINCENT STOMATITIS
 It is severe inflammation of gingival caused
by bacteria ,for instance ,normal flora and
spirochetes
Predisposing factors
 poor oral hygiene
 Immunosuppression
 local tissue damage

19. Signs and symptoms
 Pain in the mouth as a result of inflammation.
 Foul taste due to poor salivation
 Fever due to infection
 Redness of the mucous membrane as a result
of inflammation
 Bleeding from the gums due to ulceration.
 Halitosis due to microorganisms.

20. Diagnosis of Vincent stomatitis
 Physical examination which might reveal
inflamed mouth and gums
 History from the patient. Patient will say that
there is pain on swallowing.
 Dental x-ray in order to rule out toothache

21. Treatment
 Antibiotics such as penicillin
 Regular brushing
 Mouthwash with saline water
 Cleaning by dentists.

22. 3.Monilla stomatitis /Oral thrush
 It is an infection of the mouth caused by
candida albican which is fungus.
 Monilla stomatitis is also known as
candidiasis.
.

23. Predisposing factors
 Lowered immunity persons, for example HIV,
cancer and pregnancy.
 Prolonged use of antibiotics and steroids

24. Signs and symptoms
 Lesions in the mouth also referred to as
milk curd. This lesion can easily bleed if
tempered with.
 Pain on swallowing

25. Treatment
 Hydrogen peroxide and saline washes
 Oral hygiene
 Nystatin suspension or pastilles or
amphotericin lozenges.
 Fluconazole for oral pharyngeal candidiasis
 Clotrimazole tablets

26. 4. Herpetic stomatitis
 It is a contagious viral infection of the mouth
caused by herpes virus which causes ulcers and
inflammation.
 It is common in children and immune
suppresses people.
 Patient is usually contagious during the
vesicular and ulceration stage .

27. Causes
 Varicella zoster
 Herpes virus hominis
 Epstein-Barr virus

28. Signs and symptoms
 Blisters in the mouth, often on the tongue or
cheeks.
 .Decrease in food intake, even when the patient
is hungry
 Offensive smell.
 Dysphagia

29.  Fever which may occur 1 - 2 days before
blisters and ulcers appear.
 Irritability due to pain
 Swollen gums which are painful
 Ulcers in the mouth, often on the tongue or
cheeks.
 Drooling/salivating

30. Mediccal management
Investigations
 History taking
 Physical examinations

31. Treatment
 Antiviral - acyclovir.
 Liquid diet which are cool-to-cold, nonacidic
drinks.
 For severe pain give oral topical anaesthetic –
lidocaine. Give it with caution as it can cause
burns

32.  Parotitis
 This is the inflammation of one or both
parotid glands, causing blockage of the main
parotid duct, or one of its branches.

33. Causes
 Bacterial for example staphylococcal areus
 Mycobacterium, the bacteria that causes tuberculosis.
 autoimmune disease causes most cases of chronic
parotitis
 HIV
 Occasionally, drugs such as iodides which can cause
swelling of the glands

34. -
Signs and symptoms
 pain in the area of gland and ear due to
inflammation
 Dry mouth due to absence salivation
 Severe pain when swallowing due to swelling
of the gland.

35.  Purulent exudates from gland due infection
 Fever due to infection
 Erythema, sometimes ulcers due the
inflammatory process.

36. Diagnosis
History taking
Physical examination- Enlarged gland will be
seen on examination

37. Treatment
 Antibiotics to combat infection- amoxyl
500mg x7/7
 Analgesics to relive pain and reduce
temperature. Paracetamol 1000mg tds x3/7
 Mouth washes of Warm salty water rinses may
be soothing and keep the mouth moist.

38.  Warm compresses to relieve pain.
 Increase fluid intake
 If an abscess develops, drainage of the gland is
necessary

39. Achalasia

40.  Achalasia
 It is condition of the oesophagus which is
characterised
 by lack of peristaltic movement and
 failure of relaxation of lower oesophageal
sphincter.

41. It is a motor disorder characterised by,
Incomplete relaxation of the lower oesophageal
sphincter leading to, difficulties in passing of
food into the stomach.
 There is failure of the esophagogastric
(cardiac) sphincter to relax in order to allow the
passage of food into the stomach .

42.  There is lack of tone in the musculature and
normal peristalsis, particularly in the lower part
of the oesophagus resulting in ,
 accumulation and
 stagnation of food and fluids in the oesophagus
causing
 irritation and inflammation of the oesophagus.

43.  Food lodges in the oesophagus and passes into
the stomach slowly over time .
 Aspiration of oesophageal content into the
lungs may occur when client lies down.

44. The exact cause is unknown ,but it has been
associated with.
 degenerative changes or
 malfunctioning in the nerve plexus that
innervates the oesophageal muscle tissue.

45. Signs and symptoms
 Progressive dysphagia with a feeling that
something is stuck in the throat due to
stagnation/accumulation of food.
 Regurgitation of undigested food due failure
relaxation of oesophageal sphincter.

46.  Halitosis caused by regurgitation of previously
ingested food.
 Coughing when lying in a horizontal position.
 Chest pains or sub sternal pain due to spasms of
oesophagus.

47. Diagnosis
 Barium swallow will show dilatation of the
oesophagus, lack of peristalsis.
 Esophagoscopy – will show dilatation of the
lower oesophageal sphincter.
 It can also show changes associated with cancer
or presence of candida

48. .
 Oesophageal manometry – This will be done
to measure muscle contractions in different
parts of the oesophagus during the act of
swallowing.
 Manometry- reveals failure of the lower
oesophageal sphincter to relax with swallowing
and lack of functional peristalsis in the smooth
muscle oesophagus.

49.  Biopsy-shows hypertrophied muscles and
absence of certain nerve cells of the mesenteric
plexus which controls oesophageal peristalsis.

50. Treatment
 Medication-Calcium channel blockers
(nifedipine) and nitrates (nitro-glycerine) to
relax the lower oesophagus sphincter.
 Balloon (pneumatic) dilatation –dilation of
oesophagus using aballon at the point of
narrowing.

51.  Surgery - Heller myotomy or cardiomyotomy.

52.  Gastro oesophageal reflux
 This is a condition in which there is backflow
(reflux) of gastric and or
 Duodenal content into the oesophagus which is
not associated with either vomiting or belching.
.

53.  Gastro oesophageal reflux is a condition that
results from
 abnormal regurgitation of gastric contents into
the oesophagus.
 Due to the reflux of the gastric/stomach contents
there may be erosion of the mucosa.

54. Cause
 The cause is unclear though there are some
predisposing factors associated with changes in
the barrier between the stomach and the
oesophagus. The predisposing factors include;
 Abnormal relaxation of the lower oesophageal
sphincter.
 .

55.  Anatomical abnormalities such as hiatus hernia
(condition where the upper part of the stomach
and the Lower Oesophageal Sphincter move
above the diaphragm.
 Obesity-increasing body mass index is
associated with more severe gastroesophageal
reflux

56.  Zollinger-Ellison syndrome - results in
increased gastric acidity due to gastrin
production.
 Pregnancy
 Drugs such as anticholinergic, calcium channel
blockers, can lead to Hypocalcaemia, which
can increase gastrin production, leading to
increased acidity.

57. Certain life styles like ,
•Food such as sodas that contain
caffeine,Smoking,alcohol consumption

58. Signs and symptoms
Heartburn (dyspepsia) – burning sensation behind
the breastbone and usually occurs after meals. This
is accompanied by regurgitation.

59. Pain usually occurs 30-60 minutes after meals
originating from chest and radiates to the neck and
throat. Pain is caused by acid regurgitation.
Dysphagia (difficulties in swallowing).

60. Excessive salivation (also known as water brash)
Coughing, hoarseness, or wheezing at night.

61. Diagnosis
• Esophagoscopy -to identify the cause and examine the
oesophagus for damage.
• Barium swallow- to evaluate oesophageal damage as
well.

62. Continuous oesophageal pH monitoring to evaluate
degree of acid reflux.
Oesophageal manometry
A positive stool occult blood test may diagnose
bleeding from the irritation in the oesophagus.

63. Treatment
Life style changes
Avoid foods that often cause symptoms e.g.
Alcohol, Caffeine, Carbonated beverages,
Chocolate, Tomatoes.

64. Advise patient to lose weight if obese.
Advise patient to stop smoking
Eat slowly and chew food thoroughly to reduce
belching

65. Antacid -Magnesium trilisilicate to neutralise the
acid.
Proton pump inhibitors -Omeprazole decrease the
amount of acid produced the stomach.

66. H2 antagonists -Cimetidine to decrease acid
production in the stomach.
Surgery - Nissen fundoplication (repair lower
oesophageal sphincter and hiatus hernia)

67. Vagotomy (surgical removal of
vagus nerve branches that
innervate the stomach lining

68. Hiccup
A hiccup or hiccough is an oesophageal
contraction of the diaphragm that repeats several
times per minute.


69. It is spasm of the diaphragm resulting in a rapid,
involuntary inhalation that is stopped by the
sudden closure of the glottis and accompanied by a
sharp, distinctive sound.

70. Hiccups are caused by many central and
 peripheral nervous system disorders, all from
injury or irritation to the phrenic and vagus nerves,
as well as toxic or metabolic disorders

71. Causes.
Chemotherapy—which can include a huge
amount of different ,for instance diazepam.
Hiccups often occur after drinking carbonated
beverages or alcohol or ingesting spicy foods.

72. Prolonged laughter is also known to
cause hiccups.
Eating too fast can also cause the
hiccups.

73. Treatment
Ordinary hiccups are cured easily without medical
intervention.
However, there are a number of anecdotal
treatments for casual cases of hiccups.

74. Some of the common home remedies include
giving the afflicted a fright or shock.
Eating peanut butter, taking a teaspoon of vinegar,
drinking water, holding one's breath and altering
one's breathing patterns

75. •Hiccups are treated medically only in severe and
persistent cases (termed "intractable“).
•Sedatives such as Diazepam and chlorpromazine
are given.