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Disease Of The Mouth & Asophagus

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Disease Of The Mouth & Asophagus

  1. 1. <ul><li>Disease OF The Mouth </li></ul><ul><li>By Dr. Osman Bukhari </li></ul>
  2. 2. <ul><li>Functions OF the Mouth </li></ul><ul><li>-Mastication </li></ul><ul><li>-Swallowing </li></ul><ul><li>-Digestion </li></ul><ul><li>-Speech </li></ul><ul><li>Normal Oral Comensal Organism </li></ul><ul><li>-Fusiform bacilli </li></ul><ul><li>-Spirochetes </li></ul><ul><li>-Bacteria (e.g. Strept.viridians) </li></ul><ul><li>-Candida </li></ul>
  3. 3. <ul><li>*Troubles Occur with poor Oral hygiene & Immunosuppression. </li></ul><ul><li>*Bactraemia may have its source in the oral cavity specially following dental manipulations </li></ul>
  4. 4. <ul><li>Oral Ulcers associated with </li></ul><ul><li>1- ROU: </li></ul><ul><li>-Affect 30% of population </li></ul><ul><li>-Recurring shallow ulcers </li></ul><ul><li>-May be multiple </li></ul><ul><li>-Aetiology unknown? Autoimmune </li></ul><ul><li>-Precipitated by emotional stress </li></ul>
  5. 5. <ul><li>*Treatment </li></ul><ul><li>-Chlorhexidise Mouth wash </li></ul><ul><li>-Topical steroids </li></ul><ul><li>-Rarely systemic C/S & Azathiosprine </li></ul><ul><li>2-Syestamic disorders (Crohns, UC, SLE, Behcets, Immunodefiency ) </li></ul>
  6. 6. <ul><li>3-Dermatological disorders (Erythema </li></ul><ul><li>multiform, Lichen Planus, pemphigus </li></ul><ul><li>vulgaris,dermatitis herpetiformis ) </li></ul><ul><li>4- Viral Infection (Herpes simplex, </li></ul><ul><li>Coxsackie's virus, HIV.) </li></ul><ul><li>5- Bacterial disease (Syphilis, T.b) </li></ul><ul><li>6- Drugs (Cytotoxic drugs, antibiotics, </li></ul><ul><li>penicillanmine & gold) </li></ul>
  7. 7. <ul><li>7-Truma (ill fitting teeth, sharp teeth & teeth brushing) </li></ul><ul><li>8- Neoplasia (Squamous Ca) </li></ul><ul><li>9-Fungal infection (Candidiasis) </li></ul><ul><li>10- Leukoplakia (Idiopathic, alcohol, smoking & HIV) </li></ul><ul><li>11- Nutritional deficiency (malnutrition & mal- absorption, Niacin, B2,& B12) </li></ul>
  8. 8. Diseases of the esophagus
  9. 9. <ul><li>-25CM in Length from cricoid's cartilage to </li></ul><ul><li>LOS. </li></ul><ul><li>- Double muscle layer </li></ul><ul><li>*Upper striated </li></ul><ul><li>*Lower smooth </li></ul><ul><li>- Epithelial layer </li></ul><ul><li>*Upper Squamous </li></ul><ul><li>*Lower columnar </li></ul>
  10. 10. <ul><li>-Upper sphincter formed by Cricophayrygeus muscle </li></ul><ul><li>-Lower sphincter (L.O.S) : physiological zone of increased tone just above the gastro-esophageal Junction below the diaphragm </li></ul>
  11. 11. <ul><li>Symptoms & Sign </li></ul><ul><li>OF </li></ul><ul><li>Esophageal </li></ul><ul><li>Disease </li></ul>
  12. 12. <ul><li>1- Heart burn </li></ul><ul><li>2- Regurgitation </li></ul><ul><li>3- Dysphagia </li></ul><ul><li>4-Odynophagia </li></ul><ul><li>5- Loss of weight </li></ul><ul><li>6-Anaemia </li></ul>
  13. 13. <ul><li>Investigation </li></ul>
  14. 14. <ul><li>1- Ba swallow </li></ul><ul><li>2- Endoscopy </li></ul><ul><li>3- Manometry </li></ul><ul><li>4-24 hour PH monitoring </li></ul>
  15. 15. <ul><li>Dysphagia </li></ul><ul><li>Causes:- </li></ul><ul><li>1-Painful oral legions </li></ul><ul><li>2-Neuromuscular disease </li></ul><ul><li>-Motor neurone disease </li></ul><ul><li>-C.V.A </li></ul><ul><li>-Systematic sclerosis </li></ul><ul><li>-Dermatomyocystis </li></ul>
  16. 16. <ul><li>-Diffuse Esophageal spasms </li></ul><ul><li>-Diabetes Mellitus </li></ul><ul><li>-Chogas </li></ul><ul><li>-Myasthenia graves </li></ul>
  17. 17. <ul><li>3-Extrinsic pressure </li></ul><ul><li>-Pharyngeal pouch </li></ul><ul><li>-Goitre </li></ul><ul><li>-Ca bronchus </li></ul><ul><li>-Enlarged L-Node </li></ul><ul><li>-Aortic aneurysm </li></ul><ul><li>-Enlarged Lt Atrium </li></ul>
  18. 18. <ul><li>4-Intrinsic Esophageal disease: </li></ul><ul><li>-Ca esophagus </li></ul><ul><li>-Stricture (Benign or Malignant) </li></ul><ul><li>-Esophageal rings & webs) </li></ul><ul><li>-Plumer Vinsons </li></ul><ul><li>-Candida & Herpes simplex </li></ul><ul><li>5-Forign body </li></ul><ul><li>6-Globus hystercus </li></ul>
  19. 19. <ul><li>Gastro Esophageal Reflux </li></ul><ul><li>Disease (GROD) & Oesophagitis </li></ul><ul><li>-Transient gastro esophageal reflux is a </li></ul><ul><li>normal event in 30% of people without </li></ul><ul><li>symptoms </li></ul><ul><li>- Symptoms occur with prolonged </li></ul><ul><li>contact of gastric contents with </li></ul><ul><li>esophageal mucosa when anti reflux </li></ul><ul><li>mechanisms fail </li></ul>
  20. 20. <ul><li>Anti reflux mechanisms </li></ul><ul><li>1-Competent L.O.S which is tonically contracted & relaxes only during swallowing. Tone is increased with high intra abdominal & intra-gastric pressures. </li></ul>
  21. 21. <ul><li>2-Flap valve like intra-abdominal esophagus </li></ul><ul><li>3-Fundal mucosal folds </li></ul><ul><li>4-Diaphragmatic orifice </li></ul><ul><li>5-Secondry esophageal peristalsis clearing </li></ul><ul><li>refluxate & neutralizing acid by saliva </li></ul>
  22. 22. <ul><li>Factor associated with impaired efficiency of LOS & GORD:- </li></ul><ul><li>1 -Impaired efficiency of L.O.S & low tone </li></ul><ul><li>associated with H.H, systemic sclerosis & </li></ul><ul><li>following Cardioyotomy & dilatation </li></ul><ul><li>2-Low L.O.S tone due to dietary factor & habbits (Fatty meals, Caffeine, alcohol, </li></ul><ul><li>chocolate & smoking) </li></ul><ul><li>3-Decreased secondary esophageal peristalsis & clearance of refluxate </li></ul>
  23. 23. <ul><li>4-Impaired gastric emptying following GOL </li></ul><ul><li>obstruction, fatty meals, heavy meals, & </li></ul><ul><li>drugs like anti-cholinergic, CCB, & nitrates </li></ul><ul><li>5-High intra abdominal pressure with Ascitis, obesity, straining, heavy weight lifting, pregnancy & bending down </li></ul><ul><li>*When anti reflux mechanism fail persistence exposure of the lower esophagus to acid & pepsin results in esophagitis </li></ul>
  24. 24. <ul><li>Clinical feature </li></ul><ul><li>1-Heart burn: increased after heavy meals, </li></ul><ul><li>hot drink, lying flat &stooping </li></ul><ul><li>2-Water brush relieved by anti acids </li></ul><ul><li>3-Regurgitation + aspiration lead to </li></ul><ul><li>chocking, cough & nocturnal asthma </li></ul><ul><li>4-Odynophagia </li></ul><ul><li>5-Dysphagia : transient with spasm & </li></ul><ul><li>persistent if there is stricture </li></ul>
  25. 25. <ul><li>6 Haematemesis & iron deficiency anemia </li></ul><ul><li>7-A typical chest pain which may mimic angina if severe (due to spasm) </li></ul><ul><li>Diagnosis: </li></ul><ul><li>1-Clinical </li></ul><ul><li>2-Esophagoscopy (Oesophagitis, Stricture &excludes malignancy) </li></ul><ul><li>3-Radio isotope labelled Tc to demonstrate </li></ul><ul><li>reflux </li></ul><ul><li>4-24 hour PH monitoring, most accurate test for reflux . </li></ul>
  26. 26. <ul><li>Complications </li></ul><ul><li>1-Peptic stricture following long standing </li></ul><ul><li>Oesophagitis & ulceration </li></ul><ul><li>2-Barretts esophagus (20%). It is pre </li></ul><ul><li>malignant </li></ul><ul><li>3-Iron deficiency anemia </li></ul><ul><li>Treatment </li></ul><ul><li>1-Avoid precipitating factor e.g. </li></ul><ul><li>Alcohol & smoking </li></ul>
  27. 27. <ul><li>2-Reduction of weight & avoid heavy meals </li></ul><ul><li>3-Raise foot of bed (15cm) </li></ul><ul><li>4-Anti acids, H.R.A & P.P.I in severe cases </li></ul><ul><li>5-Prokinetics (Cisapride & metoclopride) </li></ul><ul><li>6-Diltation for stricture </li></ul><ul><li>7-Surgry (Repair of H.H & Fundoplication) if </li></ul><ul><li>there is no response to medical treatment or </li></ul><ul><li>if the patient is unwilling to take it or if major symptoms of oesophagitis is trouble- some </li></ul>

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