DS Diseases

Xerostomia

Decrease in saliva production

Missing teeth

• Alters bite (occlusion) leading to jaw pain called temporomandibular joint disorder 

• Causes bolting (inadequate chewing) of food 

• Leads to loss of nutrient value and digestive disturbances

• Four main causes of missing teeth

  • Dental decay most common

  • Tooth loss/dental injury

  • Congenitally missing

  • Impacted from erupting by root of another tooth  

Impacted third molar

impacted third molar is malpositioned, prevents normal eruption

• Third molars aka wisdom teeth: last teeth in the back of the mouth and can become impacted (pressed together)

  • Causes pain

• No symptoms until teeth emerge

• Caused by lack of room to erupt due to bone structure or blockage 

  • Sometimes erupt at an angle, creating space where food can be strapped

    • Causes pain, swollen gum

Dental caries (dental decay)

Infection resulting in erosion of tooth surface

• First seen as white spots on tooth surface

• Major symptoms is a mild toothache

  • Hypersensitivity to sweets and temperature extremes

• If untreated, an unpleasant taste arises from bacteria and food

• Pulp of gum becomes inflated and pain becomes persistent 

• Caused when bacteria in the mouth break down sugars present in foods

  • Converts them into acid plaque 

  • Acid plaque erodes the calcium in tooth’s enamel (demineralization) causing cavity to form 

Gingivitis

 Inflammation and swelling of gums

• Gums become red, soft, shiny

  • Bleed easily even with gentle brushing

• Not treated → leads to destruction of gums and periodontitis 

• Second most common cause of toothache

• Caused by plaque 

  • Sticky deposit of mucus, food, bacteria that builds up in base of tooth 

Periodontitis

Destructive gum and bone disease around one or more teeth

• End result of gingivitis that was treated too late

• Pockets that form between teeth in gingivitis deepen, exposing the root 

  • Causes unpleasant taste and bad breath (halitosis)

• Teeth become very sensitive

• Caused by plaque and unchecked gingivitis 

Temporomandibular joint disorder

Symptom related to inflammation, disease, or dysfunction of TMJ

• Limited jaw movement and chewing pains near ears and joints 

• Sinus pain 

• Reduced ability to open jaw interferes with chewing and prevents adequate cleaning

• Caused by unbalanced activity of jaw muscles caused by

  • Bruxism (teeth grinding)

  • Malocclusion

  • Poor fitting dentures 

Abscess

Pus-filled sac that develops in tissues surrounding base of root

• Aches and throbs 

  • Extremely painful when eating food

• Glands in neck/face become swollen and tender 

• Fever 

• Caused by a decaying or dying tooth or when the tooth structure loss (ex. From fracture) exposes dental nerve to bacteria in mouth

  • Dead pulp, along with bacteria, can infect tissue and jaw to form an abscess 

Ulcers (canker sores)

Lesion on mucous membrane, exposing underlying sensitive tissue

• Aphthous ulcers: occur during stress or illness

  • Occur in clusters, 3-4 days

• Traumatic ulcers: occur during injury, burns, rough dentures, toothbrushes

  • Single, large, week or more

• Pale yellow spots with red borders

• Caused by mechanical trauma (braces), viral/bacterial infections, stress, illness 

Thrush

Candidiasis of the oral mucosa and involves the mouth, tongue, palate, and gums 

• Fungal infection of short duration that produces sore, raised, pale-yellow patches

• Burning sensation 

• Caused by fungus Candida albicans 

  • Normally present in small numbers in mouth

    • Can multiply out of control 

    • Occurs during decreased resistance of microbes (antibiotics treatment) 

Herpes simplex (cold sores)

Contagious viral infection affecting skin and mucous membranes 

• Blisters inside mouth

• Prodrome (tingling/numbness) before blisters form

• Heals within 2 weeks

• Caused by Herpes simplex virus type 1, sun exposure, stress

• No cure

Necrotizing periodontal disease

Infection affecting gums and anchoring structure of teeth

• Rare, painful ulceration and disease of gums

  • Between teeth 

• Primary symptom is painful, red, swollen gums with ulcers that bleed

• Gums can appear grayish 

  • Metallic taste 

• Caused by anaerobic opportunistic bacteria 

  • Poor oral hygiene and gingivitis 

• Seen commonly in HIV/AIDS

Oral leukoplakia

Hyperkeratosis or epidermal thickening of buccal mucosa, palate, lower lip

• Leukoplakia aka white plaque thickens and hardens

• Mucous membrane becomes hard and is sensitive 

• Caused by chronic irritation or friction 

Gastroesophageal reflux disease (GERD)

Clinical manifestations of stomach and duodenal contents into esophagus occurring at night

• Similar to heartburn when mild

• Belching, burning sensation in chest and mouth 

• Coughing spell and wheezing caused by irritation 

• Vomitus may regurgitate into the mouth 

• Chronic GERD leads to dysphagia (difficulty swallowing)

• Lining of esophagus becomes enflamed 

• Caused by overeating, pregnancy, weight gain

  • Relaxation of lower esophageal sphincter

Esophageal varices

Dilated submucosal veins that develop in patients with portal hypertension, can result in serious upper GI bleeding

• Superficial veins lining esophagus become dilated and twisted 

• Don’t cause symptoms until rupture causes hemorrhage

• Caused by increased pressure within veins 

  • Occurs when venous return to liver is impeded

•  Vomiting blood, black poop

Esophagitis

Inflammation and tissue injury of esophagus 

• Main symptom is burning chest pain (heartburn), follows eating/drinking

• Corrosive esophagitis is severe inflammation resulting from ingestion of chemical 

  • Causes tissue damage 

• Caused by reflux of acid contents resulting from defect of LES

Ulcerative colitis

Chronic inflammatory disease affecting mucosa and submucosa of rectum and colon 

• Serious bowel issues

• Bloody diarrhea, cramping, poop urgency 

  • As disease progresses, 10-20 poops per day

• Caused by genetics 

Irritable Bowel Syndrome

• Chronic abdominal pain, bloating, diarrhea, constipation, feeling of incomplete bowel movement

• Unknown cause, no cure

Esophageal cancer

• Esophagus is lined for most of its length with squamous epithelium 

  • Leads to SCC Squamous Cell Carcinoma

• Adenocarcinoma develops in columnar epithelium near esophagogastric junction 

• Dysphagia, weight loss, burning sensation 

Peptic ulcers

• Should the protective mucous membrane break down, the lining is prone to ulceration 

  • Internal surface lesions can be acute/chornic, single/cluster, shallow/deep

• When peptic ulcer occurs in stomach (gastric ulcer), no symptoms 

• Most common is duodenal ulcer (first part of small intestine)

  • Heartburn, pain

  • Some have said frequent eating relieves discomfort

• Caused by Helicobacter pylori infection, most common human bacterial infection 

• Also caused by use of NSAIDs (ibuprofen) 

Gastritis

Inflammation of lining of the stomach 

•  Mucosal layer of stomach normally acts as physical barrier against injury

• When the lining becomes inflamed..

  • Pain, indigestion, feeling of fullness, discomfort

• When gastric mucosa is inflamed…

  • It bleeds (seen in vomit and stool)

• Caused by H. pylori like peptic ulcers

Gastric cancer

• Asymptomatic 

  • Progression lead to weight loss and pain 

  • Anorexia

• Japan has highest rate of gastric cancer

• H. pylori is known carcinogen and cause 

Acute appendicitis

Inflammation of appendix (narrow pouch, 3.5 in long, extends from first part of large intestine, no known function)

• Discomfort around navel

  • Within a few hours, localizes in lower right quadrant

• Caused by obstruction of appendiceal lumen leading to bacteria growth

  • Caused by lymphoid hyperplasia, fecaliths, parasites

• As bacteria multiply, they invade appendix wall and appendix is compromised 

Hiatal hernia

Defect in diaphragm that causes segment of stomach to slide into thoracic cavity

• LES muscle at the junction of esophagus and stomach malfunctions

  • Allows contents of stomach to be regurgitated into esophagus 

• Heartburn, chest pain

• Caused by congenital defect in diaphragm 

Abdominal hernia

Organ protrudes through an abnormal opening in abdominal wall

• Results from weakness in muscles and membranes of abdominal wall 

• Inguinal canal is a common site for hernias

• Sharp pain in groin 

• Caused when abnormal opening develops in weak area or from congenital malformation 

Chron Disease

Chronic inflammatory disorder of GI tract 

• All layers of bowel wall are swelling and inflamed 

• Chronic diarrhea, RLQ abdominal pain, weight loss, nausea

• Tender abdomen, vomit, bloody poop

• No clear cause 

• Damages bowel and hinders nutrient absorption 

Colorectal cancer

Cancer in colon or rectum

• Third leading cause of death in the world

• Early stages have vague symptoms 

  • Abdominal pain, diarrhea, bloody poop

• Later symptoms

  • Abdominal distention (swelling), pallor, ascites (fluid in abdominal cavity)

Gastroenteritis

Acute inflammation of lining of stomach and intestine 

• When normal bacteria flora and acid secretions fail to protect stomach and intestines from toxins and disease-causing bacteria, they become filled with products of inflammation → gastroenteritis

• Bloody stool, dehydration

• Common syndrome is traveler’s diarrhea

  • Anorexia, abdominal cramping, loose stools, nausea, vomiting

• Traveler’s diarrhea caused by eating disease-causing bacteria from contaminated food 

Diverticulosis

Progressive condition, defects in muscular wall of large bowel

• Small, bulging pouches (diverticula) of the mucosa penetrate the weak points of muscular layer of large intestine 

  • Can be several dozen

• Occurs in distal part of colon since pressure is higher there

• No symptoms or inflammation

• Cause is unclear

  • May be a low fiber diet  

Diverticulitis

Infection of one or more diverticula 

• Fecal matter becomes trapped in diverticula causes inflammation 

• Abdominal pain in lower left quadrant, constipation, mass felt, bloody poop

Pseudomembranous enterocolitis

Acute inflammation with plaquelike necrotic debris and mucus adhered to damaged superficial mucosa of small/large intestines

• Enterocolitis 

  • Bowel mucosa has membranous appearance

  • Greenish, foul smelling watery diarrhea (30 stool per day)

  • Fever and weakness 

• Caused by usage of antibiotics

  • Reduces body’s protective natural intestinal flora 

  • Allows development of infection with Clostridioides difficile

    • Produces powerful toxins that cause bowel wall to become inflamed 

    • Cause dead tissue to form called pseudomembrane

Peritonitis

inflammation of peritoneum

• Large membrane that lines abdominal cavity and folds over visceral organs is normally transparent and stable

• When irritated, it becomes hyperemic and edematous as fluid accumulates

• Caused by infection of bloodborne organisms or organisms in GI

  • Can occur as a result of surgery when bacteria enter 

Short bowel syndrome

Small bowel fails to absorb nutrients because of inadequate absorptive surface

• Insufficient amount of functioning small bowel to absorb nutrients that body needs

• Diarrhea, abnormal stools

• Weight loss, weakness

• Caused when length of intact small bowel is altered by disease or surgery

  • Chron disease, interstitial infarction, radiation enteritis, volvulus, tumor resection, trauma 

Hemorrhoids

Varicose dilations of a vein in the anal canal

• Tumorlike lesions in anal area caused by dilated veins

• Painless

  • Rectal pain, itching, protrusion, bleeding

• Mucous discharge from rectum 

• Caused by veins in the rectal/anal area becoming varicose, swollen, and tender from blockage

• Large, firm lump indicates thrombosis of external hermorrhoids 

• Any condition that increases pressure on veins exacerbates condition

  • Straining, constipation, pregnancy 

Liver Cirrhosis

Chronic degenerative disease that is irreversible, slow deterioration of liver, replaces normal liver cells with hard, fibrous scar tissue (hobnail liver)

• As the liver is destroyed..

  • Loss of appetite, weight, nausea, vomiting 

• Bleed and bruise more easily 

• Caused by chronic alcoholism, malnutrition, hepatitis, chemicals 

Viral hepatitis

Systemic infection, mild inflammation of liver to severe destruction of hepatic cells

• Common cause of acute hepatitis

  • Can lead to chronic hepatitis

Hepatitis A

• Highly contagious 

• Transmitted by fecal-oral route from contaminated food, water, poop

Hepatitis B

• Symptoms similar to flu 

• Worse than Hep A

• Transmitted through percutaneous and permucosal routes

  • When virus enters body, it quickly destroys liver cells

• Contact with blood, semen, vaginal secretions, saliva

• Many result from sexual contact or blood exchange from needles 

Hepatitis C

• Most common bloodborne infection

• Resemble Hep A symptoms 

  • Less severe and without jaundice 

• Results in a gradual liver disease 

  • Causes necrosis, fibrosis, and cirrhosis of liver 

• Transmitted via blood and bodily fluids 

Liver cancer

Tumor of liver that arises in setting of chronic liver disease 

Hepatoblastoma: childhood cancer in a normal liver

• No symptoms other than those with chronic liver disease 

• Ascites, hepatomegaly, splenomegaly, jaundice

• Caused by HBV infection

Cholelithiasis (gallstones)

Abnormal presence of calculi or gallstones in the bile 

• Asymptomatic until bile ducts become obstructed 

• Colicky pain (sharp abdominal pain) signal obstruction 

• Pain in right upper quadrant of abdomen 

• Nausea, vomiting, clay poop, jaundice 

• Gallstones form in gallbladder from insoluble cholesterol and bile salts

  • Vary in size 

Cholecystitis

Acute or chronic inflammation of gallbladder associated with obstruction of cystic duct from gallstones 

• Acute colicky pain in upper right quadrant of abdomen 

• Nausea, vomiting, fever, clay stools, jaundice, dark urine

• In some cases, acutely inflamed gallbladder ruptures causing peritonitis

Acute and chronic pancreatitis

Inflammation of pancreas 

• Pancreas functions as both exocrine and endocrine organ

• Pancreas becomes edematous, inflamed, hemorrhagic, necrotic

• Acute pancreatitis 

  • Sudden onset of severe abdominal pain that radiates to the back

  • Nausea, tachycardia, tender upper abdomen

• Chronic pancreatitis

  • Back pain, anorexia, nausea, weight loss

  • Advanced: malabsorption, diabetes, depression

• Acute caused by “escape” of activated pancreatic enzymes from acinar cells (cells of tiny lobules of gland) into surrounding tissues

• Chronic caused by repeated acute episodes and alcoholism 

Pancreatic Cancer

Usually adenocarcinoma in head of pancreas, mostly in exocrine cells

• Abdominal pain, weight loss, jaundice, nausea, fatty poop (steatorrhea)

  • On examination, patient has ascites, abdominal tenderness, palpable gallbladder 

  • Risk factors include smoking, obesity, diabetes

Malabsorption syndrome

Group of disorders where intestinal absorption of dietary nutrients is impaired 

• Abdominal discomfort, chronic diarrhea, fatty stools

• Caused by defective mucosal cells in small intestine and malfunctioning intestinal enzymes

Celiac disease

Disease of small intestine characterized by malabsorption, gluten intolerance, and damage to intestinal lining

• Cramps, diarrhea, farting, large smelly stools

• End result is malabsorption and malnutrition

• Caused by a toxic or an immunological reaction to gluten

  • Triggers inflammatory response, damaging lining