The document discusses diseases of the upper and lower digestive tract. The upper tract includes the esophagus, stomach, and duodenum. Gastroesophageal reflux disease (GERD) and hiatal hernia are common upper tract diseases described. In the lower tract, duodenal ulcers, inflammatory bowel diseases like ulcerative colitis and Crohn's disease, and their signs, symptoms, and oral health considerations are outlined. Crohn's can involve any GI part and cause complications like strictures, while ulcerative colitis only impacts the colon.
Peptic ulcers are sores that develop in the lining of the stomach, lower esophagus, or small intestine. They're usually formed as a result of inflammation caused by the bacteria H. pylori, as well as from erosion from stomach acids. Peptic ulcers are a fairly common health problem.
Peptic ulcers are sores that develop in the lining of the stomach, lower esophagus, or small intestine. They're usually formed as a result of inflammation caused by the bacteria H. pylori, as well as from erosion from stomach acids. Peptic ulcers are a fairly common health problem.
In this slide, you can understand the concept of Nausea and vomiting normally called "puke.''
Difference between Nausea and vomiting.
Causes of Vomiting.
Diet in Vomiting
Treatment in Vomiting.
Treatment of Vomiting in Pregnancy.
PPT download link.
https://drive.google.com/open?id=1beZMVQ75fdiGJlJDbGJKK3MGio6zgpLfTu9flkBSutk
Video Link:
https://youtu.be/ZvUiGpjt3zc
Angina also known as angina pectoris is a medical condition characterized by chest pain usually left sided due to inadequate blood supply (ischemia) to the heart muscles due to obstruction (like presence of blood clot), narrowing or contraction (vasospasm) of the supplying coronary arteries.
Heart failure (HF) is a common cardiovascular condition with increasing incidence and prevalence. Unlike western countries where heart failure is predominantly a disease of elderly, in India it affects younger age group. Heart failure is a chronic condition in which the heart cannot pump enough blood and oxygen to support other organs in your body.
CHRONIC RENAL FAILURE (CRF) or CHRONIC KIDNEY DISEASE (CKD)
Chronic or irreversible renal failure is a progressive reduction of functioning of renal tissue such that the remaining kidney mass can no longer maintain the body’s internal environment.
This PPT covers the Pathophysiology of Peptic ulcer. It includes factors causing peptic ulcer, factors causing peptic ulcer, diagnosis and complications of peptic ulcer.
In this slide, you can understand the concept of Nausea and vomiting normally called "puke.''
Difference between Nausea and vomiting.
Causes of Vomiting.
Diet in Vomiting
Treatment in Vomiting.
Treatment of Vomiting in Pregnancy.
PPT download link.
https://drive.google.com/open?id=1beZMVQ75fdiGJlJDbGJKK3MGio6zgpLfTu9flkBSutk
Video Link:
https://youtu.be/ZvUiGpjt3zc
Angina also known as angina pectoris is a medical condition characterized by chest pain usually left sided due to inadequate blood supply (ischemia) to the heart muscles due to obstruction (like presence of blood clot), narrowing or contraction (vasospasm) of the supplying coronary arteries.
Heart failure (HF) is a common cardiovascular condition with increasing incidence and prevalence. Unlike western countries where heart failure is predominantly a disease of elderly, in India it affects younger age group. Heart failure is a chronic condition in which the heart cannot pump enough blood and oxygen to support other organs in your body.
CHRONIC RENAL FAILURE (CRF) or CHRONIC KIDNEY DISEASE (CKD)
Chronic or irreversible renal failure is a progressive reduction of functioning of renal tissue such that the remaining kidney mass can no longer maintain the body’s internal environment.
This PPT covers the Pathophysiology of Peptic ulcer. It includes factors causing peptic ulcer, factors causing peptic ulcer, diagnosis and complications of peptic ulcer.
Immense research on Gastrointestinal disorders is seen due to its prevalence in majority countries in the world. thus its essential to understand how to tackle with it through natural medicine to avoid side effects of alopathy
Medical considerations in dental treatment of patients with liver disease. Main types of liver disease, clinical manifestations, lab tests, treatment considerations.
Planning is making current decisions in the light of their future effects.
Health planning is a process culminating in decisions regarding the future provisions of health facilities and services to meet health needs of the community.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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2. Introduction
The digestive tract is a long muscular tube that moves
food and accumulated secretions from the mouth to
the anus.
the GI tract includes all structures between
the mouth and the anus.
The tract itself is divided into upper and lower tracts.
The upper gastrointestinal tract consists of
the esophagus, stomach, and duodenum.
The lower gastrointestinal tract includes most of
the small intestine and all of the large intestine.
The exact demarcation between the upper and lower
tracts is the suspensory ligament of the duodenum
(also known as the Ligament of Treitz)
3.
4. ▼ Diseases of the Upper Digestive Tract
Gastroesophageal Reflux Disease
is a chronic symptom of mucosal damage caused by
stomach acid coming up from the stomach into
the esophagus.
Although this can occur normally, it may be attributed
to GERD if it is associated with symptoms.
GERD is usually caused by changes in the
barrier between the stomach and the esophagus
including abnormal relaxation of the
lower esophageal sphincter, which normally
holds the top of the stomach closed.
5. In healthy patients, the "Angle of His’’—the angle at which the
esophagus enters the stomach—creates a valve that prevents
duodenal bile, enzymes, and stomach acid from traveling back
into the esophagus where they can cause burning and
inflammation of sensitive esophageal tissue.
Factors that can contribute to GERD:
Hiatal hernia .
Obesity .
Zollinger-Ellison syndrome, which can be present with increased
gastric acidity due to gastrin production.
Hypercalcemia, which can increase gastrin production, leading
to increased acidity.
Obstructive sleep apnea
Gallstones, which can impede the flow of bile into
the duodenum, which can affect the ability to neutralize gastric
acid.
6. Signs and symptoms
Heartburn is the cardinal symptom of GERD and is
defined as a sensation of burning or heat that spreads upward
from the epigastrium to the neck.
Chest pain is another important symptom that is related to
disorders of the esophagus.
Dysphagia is also a common presenting complaint that
may serve to prompt the dentist to refer the patient to the
patient’s physician.
Regurgitation is the expulsion of material from the
pharynx, or esophagus.
7. Other symptoms include
Pain with swallowing/sore throat (odynophagia)
Increased salivation (also known as water brash)
Nausea
Coughing
8. Oral Health Consideration
Patients who experience GERD complain of dysgeusia
(foul taste), dental sensitivity related to hot or cold stimuli,
dental erosion, and/or pulpitis. Dental thermal sensitivity is
generally due to erosion of enamel by gastric acid. if the
erosion is severe, irreversible pulpal (nerve) damage may
result that requires root canal therapy.
Dental management should provide topical fluoride
applications using custom-made occlusive tray delivery in
order to ensure optimal dental mineralization and reduction
of thermal sensitivity.
The dentist can restore tooth structure destroyed by gastric
acid in order to provide comfort and esthetics and to
minimize further hard tissue damage.
9. Medical therapy can affect the dental management of
patients with GERD in a number of ways. Patients taking
cimetidine (Tagament) or other H2 receptor antagonists may
experience a toxic reaction to lidocaine (or other amide local
anesthetics) if the anesthetic is injected intravascularly.
Soft tissue changes such as esophageal stricture and fibrosis may
complicate intubation if the patient requires general anesthesia
for an oral maxillofacial procedure.
10. Erythema and mucosal atrophy
may be present as a result of chronic exposure of
tissues to acid. Mild sodium bicarbonate rinses may
again be useful if mild signs of stomatitis are present.
11. Hiatal Hernia
The esophagus passes through the diaphragmatic hiatus and into
the stomach just inferior to the diaphragm. The hiatus causes an
anatomic narrowing of the opening into the stomach and thus
helps prevent reflux of stomach contents into the esophagus.
Some patients have a weakened or enlarged hiatus, perhaps due
to hereditary factors. It may also be caused by obesity, exercising
(eg, weight lifting).
When a weakened or enlarged
hiatus occurs, a portion of the
stomach herniates into the
chest cavity through this
enlarged hole, resulting in
a hiatal hernia.
12. Signs and Symptoms
chest pain, which may radiate in patterns similar to those of
myocardial infarction pain.
Infants with hiatal hernia usually regurgitate blood stained
food and may also have difficulty in breathing and swallowing.
Adult patients may experience chronic acid reflux into the
esophagus.
chronic esophageal inflammation may produce scarring, resulting
in esophageal narrowing. This narrowing causes dysphagia.
Heartburn is exacerbated when bending forward or lying down.
13. Types of Hiatal hernia
Hiatal hernias are classified into three major types :
1) sliding type is the most common. Characterized by an
upward herniation of the cardia and GE junction.
2) Fixed hernia characterized by an upward herniation of
the gastric fundus. Cardia and GE jn are in normal place
14. 3) The complicated type is the most serious and least
common form of hiatal hernia.This form includes a
variety of herniation patterns of the stomach, including
those in which the entire stomach moves into the chest.
15. Oral Health Considerations
If a hiatal hernia is treated with medications that cause
xerostomia(dry mouth), the dose or drug type may need to
be altered by the patient’s physician. Various treatment
modalities for dry mouth, such as artificial saliva, alcohol-free
mouthwashes, or increased fluid intake, may need to be
prescribed.
If reflux into the oral cavity is present, oral manifestations
that are the same as those of GERD may be present.
16. ▼ Diseases of the Lower Digestive Tract
Disorders of the Intestines
1. Duodenal Ulcer Disease
A duodenal ulcer represents a break through the mucosa into
the submucosa or deeper. The base of the ulcer is necrotic
tissue consisting of pus and fibrin. When the ulcer
erodes into an adjacent blood vessel, there is
hemorrhage. If erosion continues through
the serous outer layer of the duodenum,
adjacent organs or perforation into the
peritoneal cavity occurs. When conditions
are favorable, the ulcer heals, with
granulation tissue and new epithelium. If the ulcer is present
for prolonged periods, it becomes associated with scar tissue
and possible deformity.
17. Etiologic factor
The most common primary cause is H. pylori infection.
aspirin, ibuprofen, and other NSAIDs.
Less commonly, factors such as stress, parathyroid disease,
malignant carcinoid, and chronic lung disease have been
associated with duodenal ulcers.
The ulceration is usually located in
the first part of the duodenum
because the acidic chyme ordinarily
becomes alkaline after pancreatic
secretions enter the intestines in the second part of the
duodenum.
18. Signs and Symptoms
Epigastric pain: perceived as a burning sensation, usually occurs when the
stomach is empty or when not enough of a meal remains in the stomach. In
contrast to the symptoms of Duodenal ulcers, the pain of Gastric ulcer is
aggravated by food.
bloating and abdominal fullness.
Hematemesis : When an ulcer perforates and hemorrhages, the patient often
vomits gross blood.
The blood loss can lead to iron
deficiency anemia.
duodenal perforation, which leads
to acute peritonitis.
Melena.
19. Dental management
If a patient presents with symptoms of epigastric pain, as
described previously, the dentist should refer this person to
the primary care physician for diagnostic workup.
Dentist should avoid administering drugs that exacerbate ulceration
and cause gastrointestinal distress such as aspirin and other NSAIDs.
Instead, acetaminophen products should be recommended.
antacids contain calcium, magnesium, and aluminum salts that bind
antibiotics, such as erythromycin and tetracycline, dentists should
remember that administering one of these drugs within 1 hour of
antacid therapy may decrease the absorption of the antibiotic as much
as 75 to 85 % .
erythromycin and tetracycline should be taken 1 hour before or 2 hours
after ingestion of antacids.
Exogenous steroid administration is likely to exacerbate the ulcer
because of the increased production of acid caused by the steroid and
should be avoided.
20. Its good to prescribe penicillin V instead of penicillin G
(because of the destruction of penicillin G by gastric acid)
Hyposalivation and dry mouth (xerostomia) are common
complaints in patients taking anticholinergic drugs.
Patients who wear either complete or partial dentures are
particularly troubled by oral dryness. Denture adhesives
and artificial saliva may aid in the retention of their dental
prostheses.
Cimetidine and rantidine, drugs commonly prescribed for
duodenal ulcer patients, have occasionally been associated
with thrombocytopenia and may compete with antibiotics
or antifungal medications.
21. Inflammatory Bowel Diseases
Inflammatory bowel disease (IBD) is a general classification of
inflammatory processes that affect the large and small intestines.
Ulcerative colitis and Crohn’s disease together make up IBD.
Inflammatory bowel diseases fall into the class of autoimmune
diseases, in which the body's own immune system attacks
elements of the digestive system.
22. Ulcerative Colitis
The inflammation in ulcerative colitis may affect all or part of
the large intestine. Macroscopically, the mucosa may have a
granular appearance if the disease is mild. When fulminant,
the disease may include stripping of the mucosa, with areas of
sloughing, ulceration, and bleeding .Ulcerative colitisi restricted
to the colon and the rectum. Microscopically, ulcerative colitis
is restricted to the mucosa (epithelial lining of the gut), while
Crohn's disease affects the full thickness of the bowel wall.
23. Signs and Symptoms
The hallmark of ulcerative colitis is rectal bleeding and diarrhea,
sometimes nocturnal diarrhea (Typically, the diarrhea is severe,
possibly five to eight bowel movements in 24 hours).
pain that is in both abdominal quadrants and that is crampy in
nature and exacerbated prior to bowel movement.
Erythema nodosum, characterized by red swollen nodules that are
usually on the thighs and legs, may be present.
.
24. Joint symptoms occur in up to 20% of patients with the
disease, usually affecting the ankles, knees, and wrists.
Anemia is commonly associated with ulcerative colitis. It is
most likely caused by blood loss and is typically a microcytic
hypochromic anemia of iron deficiency.
Eye changes such as uveitis, corneal ulcers, and retinitis may cause
pain and photophobia.
25. Oral Health Considerations
The oral changes that occur in ulcerative colitis cases are nonspecific and
uncommon.
Aphthous stomatitis the appearance of these lesion may be coincidental.
Pyoderma gangrenosum.
Pyostomatitis vegetans, a purulent inflammation of the mouth.
hairy leukoplakia
26. Oral manifestations of anemia may be noted in patients
with ulcerative colitis, especially in undiagnosed or poorly
controlled disease. The oral manifestations include pallor,
angular cheilitis and glossitis.
27. Dental management
Chronic use of glucocorticosteroids can also result in adrenal suppression
Patients undergoing surgery may require supplemental glucocorticosteroids
before and after the procedure because their own adrenal response to stress is
blunted.
Prior to dental procedures, blood studies that include hemoglobin,hematocrit,
and a red blood cell count should be undertaken to rule out the presence of
anemia.
Patients on azathioprine might be expected to have changes in white and red
blood cell counts also Suppression of the liver can be expected so consultation
with the patient’s physician will help the dentist determine the patient’s liver
function.
Patients who have extensive bowel surgery may suffer from malabsorption
of vitamin K, vitamin B12, and folic acid. Before any surgical procedures are
completed, these patients should be evaluated for both macrocytic and
microcytic anemia and bleeding disorders from insufficient levels of
vitamin K (fibrin clot formation).
28. Crohn’s Disease
Crohn’s disease is an inflammatory disease of the small or
large intestine. The inflammation involves all the layers of
the gut (tansmural) and affect any part of the gastrointestinal
tract from mouth to anus. Most commonly involves the terminal
ileum.
characterized by segmental
Distribution of intestinal ulcers
(skip lesions) interrupted by
normal-appearing mucosa.
29. Recent epidemiologic evidence suggests that there are two
forms of Crohn’s disease :
a nonperforating form that tends to recur slowly .
perforating or aggressive form that evolves more rapidly.
Patients with the aggressive perforating type are more prone
to develop fistulae and abscesses, whereas the more indolent
nonperforating type tends to lead to stenotic obstruction.
33. Another manifestation
recurrent or persistent diarrhea (often without blood)
abdominal cramps
anorexia
Weight loss
Unexplained fever
malaise
34. Oral Health Considerations
Most oral manifestations of Crohn’s disease occur in patients with
active intestinal disease, and their presence frequently correlates
with disease activity.
Recurrent aphthous ulcers are the most common oral
manifestation of Crohn’s disease.
pyostomatitis vegetans, cobblestone mucosal architecture, and
minor salivary gland duct pathology represent granulomatous
changes that constitutethe hallmark of Crohn’s disease
35. Less often, Crohn’s disease patients develop diffuse swelling
of the lips and face, inflammatory hyperplasias of the oral
mucosa.
increased incidence of bacterial and fungal infections and
dental caries are multifactorial but appear to be related to the
patient’s altered immune status or diet.
36. Dental management of patients with IBD should include
frequent preventive and routine dental care to monitor oral
health and to prevent the destruction of hard and soft tissue.
Depending on the results of the consultation with the
patient’s physician, the following laboratory studies may be
indicated before surgical procedures are performed: (1)
complete blood count; (2) hematocrit level; (3) hemoglobin
level; (4) platelet count; (5) coagulation studies (prothrombin
time/INR, and partial thromboplastin time); (6) liver
function test; and (7) blood glucose level.
37. if the lesions are symptomatic Palliative sodium bicarbonate
mouthrinses (one-half teaspoon of baking soda in 8 ounces
of water) may be used.
Moderate-potency topical steroid preparations, such as
0.05% fluocinonide, desoximetasone, and triamcinolone, can
be topically applied to the lesions, four times daily.
Ointments and creams are useful when the lesions are
localized and direct topical application is possible.
In cases when lesions are disseminated or oropharyngeal in
distribution, dexamethasone elixir 0.5 mg/5 mL can be used
as a rinse or gargle for 1 minute, four times daily.