HOSA Patho - Digestive

Cephalic phase

• Thought, sight, and smell of food prepares stomach

• Medulla oblongata sends parasympathetic impulses along vagus nerve to stimulate gastric secretion

• Gastrin stimulates gastric glands

Gastric phase

• Stomach distention and food stimulate gastric secretion

• Brain receives signals from stomach distention along vagus nerve to stimulate more gastric juice secretion

Intestinal phase

• Regulates entry of chyme through pyloric sphincter

• Chyme in duodenum stimulates intestinal hormones to inhibit gastric secretions

• Medulla oblongata also inhibits gastric secretions

Missing teeth

Permanent teeth are missing

Missing teeth

• Malocclusion: altered bite

• Temperomandibular jaw disease

• Bolting (irregular chewing)

• Nutrient losses

Missing teeth

• Dental decay

• Congenital

• Dental injury

• Impacted and prevented from erupting

Missing teeth

• Permanent or removable prosthesis

• Orthodontics (dental implant)

Impacted third molar

• Pain

• Impacting of back teeth

Impacted third molar

• Develop at 8-10 yrs, erupt at 18-21 yrs

• Bone structure

• Adjacent teeth blocking

• Erupt at angle creating space for food to be trapped

• Hard to clear → decay

Impacted third molar

• Antibiotics

• Analgesics

• Extraction

Pericoronitis

Inflammation of soft tissues surrounding crown of a partially erupted tooth

Pericoronitis

• Gum around tooth red and swollen

• pain when biting

• Foul smell from mouth

Pericoronitis

• Food trapping in spaces between teeth

• Infection around partially erupted tooth

Pericoronitis

• Antibiotics

• Analgesics

Dental caries

• White spots on tooth surface

• Toothache

• Hypersensitivity

• Unpleasant taste in mouth

• Inflammation

• Abscess

Dental caries

• Cavity-causing bacteria break down sugars into acid plaque

• Deminerelization (acid plaque erodes enamel)

• Stomach acid can exacerbate

Dental caries

• Remove diseased part of tooth

  • Fill with dental amalgam, composite material, porcelain

• If pulp decay: root canal to remove pulp tissue and fill

• Tooth extraction at worst

• Dental implant

Discouloured teeth

• Slightly yellow to brown teeth

• Brown spots, patches, dark lines

Discouloured teeth

• Age (yellow)

• Smoking (brown)

• Wine, coffee, tea, blueberries

• Drugs (tetracycline during childhood)

• Antibacterial mouthwash

• Pertussis (patches)

• Measles (patches)

• Excess flouride (white/brown spots)

• Hereditary

Discouloured teeth

• Superficial: reduced by polishing by rotary polisher

• Deep in enamel: bleaching, capping, crowning

• Cosmetic whitening

Gingivitis

Inflammation of the gums

Ginvitis

• Gums red, soft, and shiny

• Gums bleed easily

• Toothache

• Can lead to periodontitis

• Loss of health teeth (severe)

Ginvitis

• Plaque

• Vitamin deficiencies

• Glandular disorders

• Blood diseases

• Viral infections

• Certain meds

• Pregnant people and diabetics more susceptible

Ginvitis

• Removal of plaque

• Antibacterial mouthwash

• Local anesthesia for thorough cleaning

• Oral antibiotics

• Treatment for loosened teeth

Periodontitis

Destructive gum and bone disease around teeth

Periodontitis

• unpleasant taste in mouth

• Halitosis

• Increased sensitivity

• Abscess

• Pain during chewing

• Loose, falling out teeth

Periodontitis

• End result of gingivitis

• Bacteria destroy bone and teeth

• Smoking

• Meds

• Chemo

• Diabetes

• HIV

• Stress

• Poor nutrition

• Pregnancy

Periodontitis

• Measure depth of pockets

• Radiography to determine condition of bone

Periodontitis

• Conservative: cleaning root surfaces of teeth

• Antibiotics

• Periodontal surgery

• Bone/gum tissue graft

Oral tumours

• Small, pale lumps on mouth, gums, cheeks, palate

• Grow slowly over years

• Not painful until advanced stages

Oral tumours

• Idiopathic

• Tobacco smoking

Oral tumours

• Monitored

• Excision if irritable

Malocclusion

Malposition and contact of maxillary and mandibular teeth

Malocclusion

• Faulty bite

• Protrusion/recession of jaw

• Turned/twisted jaw

• Crowding

• Difficuly with mastication

Malocclusion

• Hereditary

• Early loss of primary teeth

• Thumb sucking

• Airway problems (deviated septae, enlarged tonsils, allergies)

• Shifting of teeth to fill spaces

Malocclusion

• Braces

• Extraction

• Surgical removal of portions of jaw

• Combined crowns of bridges to replace missing teeth

Temporomandibular joint syndrome

• Limited jaw movement

• Clicking sounds during chewing

• Pain/aches in and around ears and jaw joints

• Unilateral and bilateral pain

• Headaches

• Dizziness

• Pressure

• Tittanus

• Draining sensation

• Deafness

• Sinus/muscle pain

• Inadequate chewing

Temporomandibular joint syndrome

Inflammation, disease, and dysfunction of TMJ

Temporomandibular joint syndrome

• Unbalanced activity of jaw muscles due to bruxism, malocclusion, rheumatoid/degenerative arthritis, clenching, gum chewing, neoplasia

Temporomandibular joint syndrome

• NSAIDs

• Anti-grinding devices

• Plastic bite plate for aligning

• Hydrocortisone for arthritis

• Worn teeth restorations

• Physical therapy

• Stress counselling

• Muscle relaxants

• Joint restructuring/replacement

Tooth abscesses

Pus-filled sac that develops in tissue surrounding base of the root

Tooth abscesses

• Persistent aches and throbs

• Pain when swallowing/chewing

• Glands in face/neck become swollen and tender

• Fever

• General malaise

Tooth abscesses

• Decaying/dying tooth

• Tooth structure loss

• Dental nerve exposed to bacteria

• Dead pulp and invading bacteria can affect surrounding tissues and jaw bone

Tooth abscesses

• Antibiotics

• Root canal

• Dental crown/filling

• Apicectomy

• Extraction

Mouth ulcers

Lesions on mucous membrane exposing sensitive underlying tissues

Mouth ulcers

• Pale yellow spots with red borders

• Aphthous: clusters lasting 3-4 days

• Traumatic: single and larger, last one week or longer

Aphthous ulcers

• Stress

• Illness

Traumatic ulcers

• Injury

• Burn

• Toothbrush

Mouth ulcers

• Acute: mechanical trauma, viral/bacterial infection, stress

• Can be signs of tumour, anemia, leukemia

Mouth ulcers

• Antiseptic mouth wash

• Rinsing with warm saltwater

• Avoid spicy and salty

• Topical analgesics

• Steroid mouthwash

• Oral agents

Herpes simplex

Contagious, recurrent viral infection that affects skin/mucous membranes

• Cold sores

Herpes simplex

• Cold sore blisters inside lips and mouth (painful ulcers that last few hours or days)

• Red and swollen gums

• Prodrome: tingling and numbness around mouth

• Vesicles, rupture, scabbing after 2 weeks

• Can cause lesions near eye

Herpes simplex

• Common: herpes type 1

• Sun, wind, stress, nicotine, stimulants

• Dormant virus

• Recurrent

Herpes simplex

• No treatment if mild

• Antiviral ointment/medication

Thrush

Candidiasis of oral mucosa

Thrush

• Sore, slightly raised, pale yellow patches in mouth

• Burning sensation in mouth

• Pain on contact

• Light bleeding

• Yeast smell in breath if severe

• Common in young chidren, elderly, immunodeficient

Thrush

• Candida albicans fungus

• Lowered resistance or prolonged antibiotic treatment

• Cancer

• Chemo

• Diabetes

• Glucocorticoids

Thrush

• Antifungal meds

• Coat prothesis in water with bleach or dental cleaner

Necrotizing periodontal disease

Infection affecting gum and anchoring structure of teeth

Necrotizing periodontal disease

• Painful ulceration of gums between teeth

• Painful, red, swollen gums

• Bleeding ulcers

• Greying gums

• Metallic taste

• Bad breath

• Fever

• Enlarged lymph nodes

Necrotizing periodontal disease

• Anaerobic, opportunistic bacteria

• Poor oral hygiene

• Secondary to gingivitis

• Associated with HIV/AIDs

• Stress

• Poor nutrition

• Leukemia

• Oral contraceptives

Necrotizing periodontal disease

• Antibiotics

• Hydrogen peroxide mouthwash

• Professional cleaning

• Gingivectomy

Oral leukoplakia

Hyperkeratosis (epidermal thickening) of buccal mucosa, palate, lower lip

Oral leukoplakia

• White plaque thickening and hardening part of mucus membrane of mouth

• Develops over weeks and can vary in size

• No symptoms but visual

• Sensitivity to hot/highly seasoned food

• more in elderly

Oral leukoplakia

• Sometimes idiopathic

• Chronic irritation

• Irritation and heat from tobacco

• Premalignant

Oral leukoplakia

• Eliminate irritation

• Smooth rough tooth or denture

• Cessation of smoking

Oral cancer

• Most common on lip

• White, patchy lesion

• Oral ulcer that fails to heal

• Pain in lip or tongue

• Dysphagia

• Odynophagia (painful swallowing)

• Weight loss

• Bleeding

• Loosening of teeth

Oral cancer

• Sun exposure

• Smoking

• Betel nut chewing

• HPV

• Poor oral hygiene

• Periodontal disease

Oral cancer

• Diagnosis often delayed due to lack of pain

• Brush or excisional biopsy

• Serum alkaline phosphatase

• Liver fucntion test

Oral leukoplakia

• Early: surgery with or without radiotherapy

• Neck dissection of nodal metastases

• Irration

• Speech and swallowing therapy

Oral cancer

Squamous cell carcinoma (90%) or adenocarcinoma (10%) of lips, cheek mucosa, anterior tongue, floor of mouth, hard palate, gingiva

Gastroephageal reflux disease

Regurgitation of stomach and duodenal contents into esophagus (GERD)

Gastroephageal reflux disease

• Often at night

• Heartburn

• Coughing spell and wheezing

• Vomiting in mouth

• Dysphagia

• Esophagitis

• Bleeding

• Esophageal stricture

• Erosion of tooth enamel

Gastroephageal reflux disease

• Overeating

• pregnancy

• Weight gain

• Relaxation of LES or more abdominal pressure

• Hiatal hernia

• Meds

• Coffee and alcohol

Gastroephageal reflux disease

• Barium swallow for gross changes

• Esophagoscopy

• Biopsies

• pH monitoring

• Scanning tests

Gastroephageal reflux disease

• Elevating head

• Light evening meal

• Antacids

• Weight loss

• Limiting alcohol and smoking

• H2-receptor antagonist

• proton pump inhibitor

• Anti-reflux surgery

Esophageal varices

Dilated/twisted submucosal veins at distal end of esophagus

Esophageal varices

• Preceding retching

• Dyspepsia

• May produce no symptoms until rupture

  • Leads to massive hemorrhage → hypovolemic shock

• Higher mortality than any other upper Gi bleed

Esophageal varices

• Alcoholic gastritis or withdrawl

• Increased venous pressure (venous return to liver impeded)

• Alcoholic cirrhosis

Esophageal varices

• History of hepatic disease

• Radiography

• Endoscopic examination

Esophageal varices

• Replace blood volume

• Maintain fluid and electrolyte intake

• Endoscopic sclerotherapy and ligation of bleeding varices

• Emergency variceal decompression if bleeding uncontrollable

Esophagitis

Inflammation and tissue injury of esophagus

Esophagitis

• Heartburn

• Hematemesis (internal bleeding and vomiting)

• Pain

• Inability to speak

• Perforation of esophagus

• GI manifestation of HIV

Esophagitis

• Corrosion from ingestion of caustic substance

• Reflux

• Erosive: antibiotics without enough water

• Hiatal hernia

Esophagitis

• Mild: bland diet, antacids

• Medication to reduce gastric acid

• Small a

Esophageal cancer

SCC in squamous epithelium or adenocarcinoma in columnar epithelium near esophagogastric hunction

Esophageal cancer

• Dysphagia

• Weight loss

• Retrosternal discomfort

• Burning sensation

• Iron-deficiency anemia

• Hoarseness

• Late stage: transesophageal fistula

Esophageal SCC

• High in Asia, Africa, Iran

• Smoking, alcohol, betel nut, N-nitroso containing foods, history of head or neck cancer, underlying esophageal disease

Esophageal adenocarcinoma

• Mostly in Caucasian males

• Barret’s esophagus, GERD, smoking, obesity

• Near gastroesophageal junction

Esophageal cancer

• Barium study

• Biopsy

• CT scan to evaluate malignancy and possibility of surgical resection

• Endoscopic ultrasonography if no metastasis

Esophageal cancer

• Chemoradiotherapy before surgery

• Radiation or endoscopic stent for dysphaiga

Gastric and duodenal peptic ulcers

Ulcers in stomach or upper intestinal tract

Gastric and duodenal peptic ulcers

• Asymptomatic if gastric

• Lesions

• Deep sores

• Heartburn

• Epigastric pain

• Uncomfortable fullness

• Blood in vomit/stool

• Radiating pain

• Hemorrhage of small intenstine/stomach into abdominal cavity

Gastric and duodenal peptic ulcers

• Most common: duodenal ulcer

• Middle-aged men

• Helicobacter pylori bacteria

• NSAID use

• Chronic gastritis

• Ulcerogenic drugs

• Increase of gastric juice

Gastric and duodenal peptic ulcers

• Biopsy to rule out cancer

Gastric and duodenal peptic ulcers

• Rest

• Medication

• Lifestyle and diet changes

• Surgery

• Small, frequent, bland meals

• Histamine receptor blocker

• Proton pump inhibitor

Gastritis

Inflammation of lining of stomach

Gastritis

• Epigastric pain

• Indigestion

• Feeling of fullness

• Loss of appetite due to nausea, belching, fatty food intolerance

• Bleeding in vomit and stool

Gastritis

• Helicobacter pylori

• Lack of gastric acid (B12 deficiency)

• Aspirin and anti-inflammatory meds

• Poison

• Alcohol

• Smoking

• Infection disease

• Stress

• Mechanical injury

• Allergic reaction

Gastritis

• Gastroscopy

• Radiography

• Blood count/serum tests

• Fecal occult blood tests