medical

1. Disorders of Gastro Intestinal System

2. Review of anatomy and physiology of GIT
The GI tract is a 23- to 26-foot-long pathway that extends from
the mouth through the esophagus, stomach, and intestines to
the anus.
The esophagus is located in the mediastinum in the thoracic
cavity, anterior to the spine and posterior to the trachea and
heart.
It passes through the diaphragm at an opening called the
diaphragmatic hiatus.
The remaining portion of the GI tract is located within the
peritoneal cavity.

3. UPPER GIT
Consists of structures that aid in the ingestion and digestion of food.
includes the mouth, esophagus, stomach, duodenum
Hypothalamus
is responsible for notifying the body that it is satisfied or
has received sufficient food

4. Cont.…
Lower GIT
Consists of the small and large intestines
Digestion is completed in the small intestine , and most
nutrients are absorbed in this part of the GIT
The large intestine serves primarily to absorb water and
electrolytes and to eliminate the waste products of digestion
through the feces

5. Mouth
Salivation
the “thought” of food initiates saliva production
a.) Serous secretions;-contain ptyalin for starch digestion –
produced by parotid and submaxillary glands
b.) Mucous secretions- for lubrication of food – produced by the
buccal, sublingual and submaxillary glands

6. Cont.…
Mastication
chewing of food
teeth - for initial breakdown of food to small particles
it helps prevent excoriation of the lining of the tract and
increase rate of digestion

7. Cont.…
Major Structures in the Mouth
teeth – to grind the food
salivary glands – moisten food and mucous
membranes and begin carbohydrate digestion

8. Esophagus
 is a hollow tube, the upper 1/3 is composed of skeletal muscles, the
rest is smooth muscle
lined with mucous membrane – secretes mucoid substance for
protection
the bolus of food arrives at the cardiac sphincter of the
stomach w/in 5-10 secs. after ingestion
the lower esophageal sphincter (LES) prevents reflux of food in the
stomach back into the lower esophagus

9. Cont.…
Swallowing(deglutition)
3phases:
1.) tongue forces the bolus of food into the pharynx
2.) the food moves into the upper esophagus
3.) the food moves down into the stomach
* Food is prevented from passing into the trachea by closing of the
epiglottis.

10. Stomach
 Made up of 5 layers of smooth muscle 2
types of contractions:
1.) tonus contractions – continuous contractions
2.) rhythmic contractions – may be slow ( q2-3 mins.) or fast
– responsible for the mixing of food and peristaltic movement
Vagus nerve – supplies the nervous stimulation for the stomach

11. Cont.…
movement of food through the stomach and intestines is by
peristalsis the alternate contraction and relaxation of the muscle
fibers that pushes the food in a wave-like motion
chyme – food in the stomach
- is pumped through the pyloric sphincter into the duodenum
chyme – food in the stomach
- is pumped through the pyloric sphincter into the duodenum

12. Cont.…
Digestive Function of the Stomach:
Pepsin – needed for protein digestion
HCL acid – aids in pre-digestion of food

13. Intestines
Small Intestine
2.5 cm.(1 inch) wide and 6 meters (20 feet) long–fills most of
the abdomen
3 parts :
a) duodenum – which connects to the stomach (10 inches)
b) jejunum – middle portion (8 feet long)
c) ileum – with connects to the large intestine (12 feet long)

14. Cont.….
Large Intestine
6 cm. (2 ½ in.) wide and 1.5 meters (5 feet long)
3 parts :
a.) cecum – which connects to the small intestines
b.) colon – 4 parts (ascending, transverse, descending,
sigmoid colon)
c.) rectum – 17-20 cm. (7-8 inches) long, anal canal

15. Cont.…
ileocecal valve – prevents backward flow of fecal contents
from the large intestine to the small intestine
vermiform appendix – has no function , near the ileocecal
valve anus – anal opening, is controlled by a smooth muscle
internal sphincter and a striated muscle external sphincter
chyme is propelled toward the anus by peristalsis, also mixes
the intestinal contents
in the colon, the feces is pushed forward by mass movements
stimulated by gastrocolic reflexes initiated when food enters
the duodenum from the stomach.

16. Cont.…
Defecation reflex
 when feces enter the rectum and cause distention of wall of
the rectum - send impulses to the sacral segment of the spinal
cord – then back to the colon, sigmoid and rectum - initiate
relaxation of the internal anal sphincter -relaxation or

17. cont…
Secretion and Digestion
 major portion of digestion occurs in the small intestines by the action of
pancreatic and intestinal secretions (enzymes) and bile
a.) Carbohydrate digestion
start in the mouth  Ptyalin – breakdown polysaccharides to
disaccharides
intestinal enzymes (maltase, lactase, sucrase)
🡲 breakdown disaccharides to monosaccharides (glucose, galactose
fructose)
b.) Protein digestion
- start in the stomach  pepsin – breakdown of proteins to polypeptides
- small intestines  trypsin – breakdown of polypeptides into peptides and
amino acids
c.) Fat digestion
- fats require emulsification into small droplets before it can be broken down
into glycerol and fatty acids

18. cont.…
Absorption
• the intestinal wall has many folds which are covered by fingerlike
projections called (villi) -increase the absorptive area of the small intestines
• in the center of the villi are capillaries, veins, small arteries for absorption of nutrients into
the blood vessel system
• 90% of absorption occurs within the small intestines by active transport or diffusion
• amino acids, monosaccharides, Na+, Ca++ are transported by active transport w/ the
expenditure or use of energy
• other nutrients, fatty acids and H2O – diffuse passively across the cell membrane
• reabsorption of H2O, electrolytes and bile occurs mainly in the ascending colon

19. cont.…
• GIT role in Fluid and Electrolytes Balance


GIT secretions contain electrolytes
severe fluid and electrolyte imbalance may occur with excessive losses
of gastrointestinal fluids
Ex. 1.) Na+ and K+ deficits : vomiting, diarrhea, gastric suctioning, intestinal
fistula
2.) Ca++ & Mg++ deficits: malnutrition, malabsorption, intestinal fistula 3.)
Metabolic alkalosis : loss of gastric acid by suctioning or persistent
vomiting
4.) Metabolic acidosis : loss of bicarbonate-rich intestinal secretions by severe
diarrhea or fistula
• Other functions of the GIT
• the GIT supports bacterial growth and has a role in antibody formation
• intestinal bacteria synthesize Vit. K  required for production of clotting
factors II (Prothrombin), VII, IX,X

20. Summary of Anatomy and physiology of GIT

21. Assessment of the GIT
Nursing History : Subjective Data
1.General Data
a. presence of dental prosthesis, comfort of usage
b. difficulty eating or digesting food
c. nausea or vomiting
d. weight loss
e. pain – may be caused by distention or sudden contraction of
any part of the GIT
specify the area, describe the pain

22. Cont.….
2.Specific data if symptoms are present
situations or events that effect symptoms
onset, possible cause, location, duration, character
of symptoms
relationship of specific foods, smoking or alcohol to
severity

23. Cont.….
3. Normal pattern of bowel elimination
a. frequency and character of stool
b. use of laxatives, enemas

24. Cont.…
Recent changes in normal patterns
 changes in character of stool (constipation, diarrhea, or alternating
constipation and diarrhea)
 changes in color of stool
 melena - black tarry stool (upper GI bleeding)
 hematochezia – fresh blood in the stool (lower GI bleeding)
c. drugs /medications being taken
d. measures taken to relieve symptoms

25. Physical Examination : Objective Data
a.) Mouth and Pharynx
1. lips – color, moisture, swelling, cracks or lesions
2. teeth – completeness (20 in children, 32 in adults), caries,
loose teeth, absence of teeth impair adequate chewing
3. gums – color, redness, swelling, bleeding, pain (gingivitis)
4. mucosa – color (light pink)

26. Cont.….
 examine for moisture, white spots or patches, areas of bleeding,
or ulcers
 white patches – due to candidiasis (oral thrush)
 white plaques w/in red patches may be malignant lesions
 tongue – color, mobility, symmetry, ulcerations / lesions or nodules
 pharynx – observe the uvula, soft palate, tonsils, posterior pharynx
 signs of inflammation (redness, edema, ulceration, thick
yellowish secretions), assess also for symmetry of uvula and
tonsil.

27. Cont.…
b.)Abdomen
 assess for the presence or absence of tenderness, organ enlargement,
 masses, spasm or rigidity of the abdominal muscles, fluid or air in the
abdominal cavity.
 Anatomic Location of Organs
 RUQ – liver, gallbladder, duodenum, right kidney, hepatic flexure of colon
 RLQ- cecum, appendix, right ovary and fallopian tube
 LUQ – stomach, spleen, left kidney, pancreas, splenic flexure of colon
 LLQ – sigmoid colon, left ovary and tube

28. Cont.…
1. Inspection
 assess the skin for color, texture, scars, striae, engorged
veins, visible peristalsis (intestinal obstruction), visible
pulsations (abdominal aorta), visible masses (hernia)
 assess contour (flat, protuberant, globular)
 abdominal distension, measure abdominal girth or
circumference at the level of umbilicus or 2-5 cm. below

29. Cont.…
2. Auscultation
 presence or absence of peristalsis or bowel sounds
 Normoactive – every 5-20 secs.
 Hypoactive – 1 or 2 sounds in 2 mins.
 Absent – no sounds in 3-5 mins.
 peritonitis, paralytic ileus,
 Hyperactive – 5-6 sounds in less than 30 sec.
 diarrhea, gastroenteritis, early intestinal obstruction

30. Cont.…
3.Percussion
done to confirm the size of various organs
to determine presence of excessive amounts of air or fluid
Normal tympany
dullness or flatness – area of liver and spleen, solid structure.
Tumor

31. Cont.…
4.Palpation
to determine size of liver, spleen, uterus, kidneys – if
enlarged determine presence and chac. of abdominal masses
determine degree of tenderness and muscle rigidity
(rebound or direct).

32. Cont.…
c.) Rectum
perineal skin and perianal skin
assess for presence of pruritus, fissures, externa
hemorrhoids, rectal prolapse

33. Diagnostic Tests
1. Stool examination (fecalysis)
 Stool for occult blood
o GI bleeding
o No red meat, turnips, horseradish, steroids, NSAIDS, iron
 Stool for Ova and parasites
 proper collection of specimen should not be mixed with water or
urine, should be sent immediately to the laboratory

34. Cont.…
2. CEA (Carcinoembryonic antigen)
 (+) colon cancer and other forms of cancer
 it is useful as in indicator of the effects of therapy
 CEA - recurrence or spread of tumor
 effectiveness of therapy
 A blood sample is withdrawn or sent to laboratory

35. Cont.…
3. Exfoliative Cytology
 Detect malignant cells
 Liquid diet
 UGI: NGT insertion – saline lavage
 LGI: laxative, enema, proctoscope

36. Radiologic Tests
 visualization of the GIT by barium swallow, upper GI
series or barium enema
 Barium – is a radiopaque substance that when
ingested or given by enema in solution, outlines the
passage ways of the GIT for viewing by x-ray or
fluoroscopy

37. Cont.….
1. Barium swallow/UGIS
 for identification of disorders of esophagus, stomach, duodenum –
esophageal lesions, hiatal hernia, esophageal reflux, tumors, ulcers,
inflammation
 Pt. swallows a flavored barium solution and the radiologist observes
the progress of the barium through the esophagus and take x-ray films
 NPO for 6-8 hrs.
 Post procedure:
o Increase fluid intake
Laxative
o Stool – white for 24-72 hrs.
o Observe for: impaction, distended abdomen.

38. Cont.…
2. Barium Enema/LGIS
 Purpose: to visualize the colon to detect tumors, polyps,
inflammation, obstruction
 Prep.
o low residue diet (1-2 days), clear liquid diet (evening meal)
o Laxative, cleansing enema in AM
 Post
o Laxative or enema
o Same as UGIS

39. Other analysis
a.) Gastric analysis
 to quantify gastric acidity Normal 1-5 mEq / L
gastric acid : gastric cancer, pernicious anemia
gastric acid : duodenal ulcer Normal gastric
acid : gastric ulcer

40. Cont.…
 NPO for 12 hours
an NGT is inserted and gastric contents are aspirated, connected to suction

41. Cont.…
b.)Biopsy
 Upper GI biopsy – biopsy of the oral cavity or tongue, or any lesion or
ulcerated area
 - local anesthesia assess site for bleeding , give oral
 hygiene
 Biopsy of stomach - done during endoscopy
 Rectal biopsy–biopsy of lesions, polyps, tumors of the lower sigmoid
colon, rectum and anal canal during sigmoidoscopy
 monitor for signs of bleeding

42. Cont.…
Endoscope
 directly visualize the GIT by the use of a fiberscape
 fiberscope – has a thin, flexible shaft that can pass through and
around bends in the GIT, transmit light and the image can be seen in
the monitor
Colonoscopy
 to visualize the colon
 useful to identify tumors, colonic cancer, colonic polyps
 not done when there is active bleeding or inflammatory disease

43. DISORDERS OF GASTRO INTESTINAL SYSTEM

44. Achalasia
Absent or ineffective peristalsis of the distal esophagus accompanied by
failure of the esophageal sphincter to relax in response to swallowing.
Narrowing of the esophagus just above the stomach results in a
gradually increasing dilation of the esophagus in the upper chest.
Achalasia may progress slowly and occurs most often in people 40
years of age or older

45. Cont.…
Cause is unknown
S/S
gradual onset of dysphagia for both fluids and solids
loss of weight
substernal chest pain and heartburn (pyrosis)
regurgitation of esophageal contents onto pillow at night

46. Cont.…
Diagnostic tests : Barium swallow, esophagoscopy
Medical Mgt:
Medications–Nitrates, Nifedipine –to decrease LES
pressure
Forceful dilation of the LES by pneumatic dilators
a balloon is inserted and inflated for 1 min., 2-3 times

48. Cont.…
Nursing mgt
 Encourage pt. To drink fluids with meals and use the valsalva
Maneuver (bearing down with a closed glottis) while swallowing
To help push the food
 Advise soft diet
 Elevate head during sleepingto prevent regurgitation
After esophageal surgery, monitor for signs of esophageal
perforation as evidenced by chest pain, shock, dyspnea and fever

49. Gastritis
 Gastritis(inflammation of the gastric or stomach mucosa) is a common GI
problem.
 Gastritis may be acute, lasting several hours to a few days, or chronic,
resulting from repeated exposure to irritating agents or recurring episodes of
acute gastritis.

50. Cont.…
 Gastritis is an inflammation of the stomach lining due to either erosion or
atrophy.
 Erosive causes include stresses such as physical illness or medications such
as nonsteroidal anti-inflammatory drugs (NSAIDs).
 Atrophic causes include a history of prior surgery (such as gastrectomy),
alcohol use, or Helicobacter pylori infection.

51. Pathophysiology
 In gastritis, the gastric mucous membrane becomes edematous
and hyperemic (congested with fluid and blood) and undergoes
superficial erosion .
 It secretes a scanty amount of gastric juice, containing very little
acid but much mucus.
 Superficial ulceration may occur and can lead to hemorrhage.

52. Cont.…
Risk factors
 Bacterial infection: Helicobacter pylori (H. pylori), Salmonella,
Streptococci, Staphylococci.
 Family member with H. pylori infection
 Family history of gastritis
 Prolonged use of NSAIDs, corticosteroids (stops prostaglandin
synthesis)
 Excessive alcohol use
 Bile reflux disease
 Advanced age

53. Cont.…
Smoking
Caffeine
Excessive stress
Exposure to contaminated food or water

54. SIGNS AND SYMPTOMS
The patient with acute gastritis
may have
 abdominal discomfort and
distension
 headache
 tiredness
 nausea
 anorexia
 vomiting
 hiccupping.
 heartburn after eating
 belching
 a sour taste in the mouth

55. Cont.…
 Epigastric tenderness on palpation due to gastric irritation
 Bleeding from irritation of the gastric mucosa
 Hematemesis—possible coffee ground emesis due to partial digestion
of blood
 Melena—black, tarry stool

56. Laboratory Tests
Noninvasive tests
 CBC to check for anemia (in women, Hgb less than 12 g/dL and RBC
less than 4.2 cells/mcL; in men, Hgb less than 14 g/dL and RBC less
than 4.7 cells/mcL)
Serum and stool antibody/antigen test for presence of H. pylori .
Diagnostic Procedures
■ Upper endoscopy
A small flexible scope is inserted through the mouth into the esophagus,
stomach, and duodenum to visualize the upper digestive tract.
This procedure allows for a biopsy, cauterization, removal of polyps,
dilation, or diagnosis.

57. INTERPRETING TEST RESULTS
Hemoglobin and hematocrit decrease.
Anemia (iron deficiency) due to chronic, slow blood loss.
 Fecal occult blood positive.
Helicobacter pylori may be positive.
 Upper endoscopy shows inflammation, allows biopsy

58. Medical TREATMENT
Administer antacids
anti acid syrup or MTS
Administer histamine 2 blockers:
ranitidine, famotidine, cimetidine
Administer proton pump inhibitors:
omeprazole and pantoprazole
Eradicate Helicobacter pylori infection if present.
triple treatment

59. Nursing Care
Monitor fluid intake and urine output.
Administer IV fluids as prescribed.
Monitor electrolytes (diarrhea and vomiting may deplete
electrolytes and cause dehydration).
 Assist the client in identifying foods that are triggers.
Provide small, frequent meals and encourage the client to
eat slowly.

60. Cont.…
 Advise the client to avoid alcohol, caffeine, and foods that may cause
gastric irritation.
 Assist the client in identifying ways to reduce stress.
 Monitor for indications of gastric bleeding (coffee-ground emesis; black,
tarry stools).
 Monitor for findings of anemia (tachycardia, hypotension, fatigue,
shortness of breath, pallor, feeling light-headed or dizzy, chest pain).

61. Gastric and Duodenal Ulcers(PUD)
 Normally, the gastric and duodenal mucosa is protected from acid and pepsin
by mucusand bicarbonate(base) that are secreted by surface epithetical cells.
Peptic ulcer
 is a sharply defined break or ulceration in the protective mucosal lining of the
lower esophagus, stomach or duodenum which may involve the submucosa
and muscular layers
 such breaks may expose the submucosal layers to gastric acid secretions and
pepsin and cause Autodigestion
 True ulcers extend through the muscularis mucosa and damage blood
vessels, causing bleeding or may lead to perforation of the GIT wall

62. Cont.…
Peptic ulcers include:
 Gastric ulcers that occur on the inside of the stomach
 Duodenal ulcers that occur on the inside of the upper
portion of your small intestine (duodenum)

63. Pathophysiology
Peptic ulcers occur mainly in the gastroduodenal mucosa because
this tissue cannot withstand the digestive action of gastric acid
(HCl) and pepsin. The erosion is caused by the increased
concentration or activity of acid-pepsin, or by decreased resistance
of the mucosa. A damaged mucosa cannot secrete enough mucus to
act as a barrier against HCl.

65. Cause of PUD
The most common causes of peptic ulcers are infection
with the bacterium Helicobacter pylori (H. pylori).
long-term use of nonsteroidal anti-inflammatory drugs
(NSAIDs) .
It’s a common misconception that coffee and
spicy foods can cause ulcers.

66. SIGNS AND SYMPTOMS
Epigastric area pain:
 Worse just after eating as acid increases with gastric ulcer
Worse when stomach is empty (with duodenal ulcer); may
awaken during the night due to pain

67. Cont.…
Bleeding from ulcer causes:
Hematemesis (vomiting bloody fluid—red,
maroon); more likely with gastric ulcer
Coffee-ground emesis (partially digested blood)
Melena (tarry stool) more likely with duodenal
ulcer

68. Cont.…
Perforation of ulcer causes:
Sudden, sharp pain
Tender, rigid, board-like abdomen
Knee-chest position reduces pain
 Hypovolemic shock

69. MEDICAL DIAGNOSIS
CBC
STOOL EXAMINATION
UPPER GI ENDOSCOPY
ABDOMINAL X-RAY

70. INTERPRETING TEST RESULTS
Anemia due to bleeding.
Stool for occult blood positive due to bleeding.
H. pylori testing positive.
Upper GI or barium swallow shows areas of ulceration—not
done if perforation suspected.
 Upper endoscopy shows ulcer.
Abdominal x-rays show free air in perforation

71. MEDICAL TREATMENT
 Administer antacids
 Administer histamine-2 blockers:
• famotidine, ranitidine, nizatidine
 Administer proton pump inhibitors:
• omeprazole and pantoprazole
 Treat H. pylori infection if present with combination therapy:
• Proton pump inhibitor plus clarithromycin plus amoxicillin or
• Proton pump inhibitor plus metronidazole plus clarithromycin or

72. NURSING INTERVENTION
 Monitor vital signs.
 Monitor intake and output.
 Assess abdomen for bowel sounds, tenderness, rigidity, rebound pain,
guarding.
 Monitor stool for change in color, consistency, blood.
 Teach patient about home care:
 Diet modification to avoid acidic foods, caffeine, alcohol.
 Eat more frequent, small meals.
 Avoid nonsteroidal anti-inflammatory medication.
 Stop smoking

73. Gastroenteritis
 An acute inflammation of the gastric and intestinal mucosa which is most
commonly due to bacterial, viral, protozoal, or parasitic infection.
 It may also be caused by irritation due to chemical or toxin exposure or
allergic response.
 Symptoms may be self-limiting or may need prescription medication to
resolve the illness.
 Older or debilitated patients may have more severe symptoms or require
hospitalization due to dehydration.

74. CAUSES
Viruses
such as caliciviruses, rotaviruses, astroviruses and adenoviruses.
Bacteria – such as the Campylobacter bacterium
Parasites – such as Entamoeba histolytica, Giardia lamblia and
Cryptosporidium
Bacterial toxins – poisonous by products caused by bacteria can
contaminate food
Chemicals – lead poisoning, for example, can trigger
gastroenteritis.

75. SIGNS AND SYMPTOMS
Nausea and vomiting due to gastric irritation
Diarrhea—watery, soft, may be mixed with mucous or
blood
Abdominal pain due to intestinal irritation
Abdominal distention
Fever due to infection

76. Cont.…
Anorexia due to gastric irritation
Malaise due to infection
Headache due to viral illness
Signs of dehydration—dry, flushed skin and mucous
membranes, decreased urine output, tachycardia, poor skin
turgor, orthostatic blood pressure changes

77. Medical diagnosis
CBC
BUN AND CREATE ANALYSIS
STOOL EXAMINATION

78. INTERPRETING TEST RESULTS
CBC may show leukocytosis or eosinophilia (parasites).
 Electrolytes show imbalance due to GI loss.
BUN and creatinine elevated due to dehydration.
 Stool for ova and parasites show positive with parasitic
infection.

79. Nursing intervention
Monitor intake and output.
Replace fluids lost.
Administer antiemetic medication for symptom relief

80. Cont.…
Administer antidiarrheal medications for symptom relief:
• loperamide
• diphenoxylate
• kaolin-pectin
• bismuth subsalicylate
Need to allow organism one way out of gastrointestinal
system (either antiemetic or antidiarrheal.

81. PREVENTION
Wash hands thoroughly with soap and water after activities
Wash your hands thoroughly with soap and water before preparing food
or eating
Use disposable paper towels to dry your hands rather than cloth towels.
Make sure foods are thoroughly cooked
Clean the toilet and bathroom regularly, especially the toilet seat, door
handles and taps

82. Stomatitis
DEFINITION: Stomatitis is an inflammation of the mucous lining
of the mouth , which may involve the cheeks, gums ,tongue ,lips ,
and roof or floor of the mouth. The word“ stomatitis “ literally
means inflammation of the mouth

83. Oral cavity consist of
1. Lips
2. Gums
3. Tongue
4. Salivary glands
5. teeth

84. CAUSE
S
1. Chemotherapy
2. Radiotherapy
3. Loose-fitting dental prosthetics
4. Trauma
5. Poor dental hygiene
6. Smoking
7. Dehydration
8. Medication
9. Burns

85. Sign & symptoms
1. Pain or discomfort in the mouth.
2. The presence of open sores or ulcers in the mouth.
3. Fever
4. Irritability and restlessness
5. Blisters in the mouth
6. Swollen gums , which may be irritated and bleed.
7. Drooling.
8. Dysphagia.
9. Foul-smelling breath.

86. Management of Stomatitis
1. Medical management :- bismuth salicylate , sucralfate, antacids
• Water –Soluble lubricants from mouth and lips
• Topical analgesics, such as benzamine hydrochloride
• Topical anesthetics, such as lidocaine viscous
• Oral or parenteral analgesics, including opioids if needed, for
pain not controlled with above
• Topical corticosteroids.
2. Other management :-
• Antiseptic mouth wash
• Avoid excessive brushing
• Denture hygiene measures

87. Nursing Management
Maintain integrity of the oral mucosa.
• Instruct the client to brush and floss his teeth and massage his
gums several times daily.
• Advise the client to use gauze or a sponge tooth to clean the oral
mucosa when pain prevents the use of a toothbrush.
• Recommend the use of water, saline, or a dilute solution of
hydrogen peroxide instead of toothpaste or mouthwash.

88. Cont.…
Promote adequate food and fluid intake.
• Advise the client to eat a bland diet.
• Suggest that the client consume lukewarm, or cold food and
fluids, which may minimize discomfort and result in
increased intake.

90. Prevention /Management
1. Good oral hygiene
2. Regular dental visit
3. Good health practices
4. Brush twice a day after meal and snack
5. Use soft brush or electric toothbrush
6. Use electric brush and floss daily
7. Stop smoking

91. Complication
1. Discomfort
2. Airway obstruction
3. Dysphagia
4. Dysphonia
5. Recurrent oral infection
6. Abscess
7. Oral cancer

92. DENTAL PLAQUE AND CARIES
 Tooth decay is an erosive process that begins with the action of bacteria on
fermentable carbohydrates in the mouth, which produces acids that dissolve tooth
enamel.
 The extent of damage to the teeth depends on the following:
The presence of dental plaque
The strength of the acids and the ability of the saliva to neutralize them
 The length of time the acids are in contact with the teeth
The susceptibility of the teeth to decay

93.  Dental plaque is a thick, gelatin-like substance that adheres to the teeth.
 The initial action that causes damage to a tooth occurs under dental
plaque.
 Dental decay begins with a small hole, usually in a fissure (a break in the
tooth’s enamel) or in an area that is hard to clean.
 Left unchecked, the affected area penetrates the enamel into the dentin.

94.  Because dentin is not as hard as enamel, decay progresses more
rapidly and in time reaches the pulp.
 When the blood, lymph vessels, and nerves are exposed, they become
infected and an abscess may form, either within the tooth or at the tip
of the root.
 Soreness and pain usually occur with an abscess.

95. Cont.…
 The dentist can determine by x-ray studies the extent of damage and
the type of treatment needed.
 Treatment for dental caries includes fillings, dental implants, and
extractions. If treatment is not successful, the tooth may need to be
extracted.
 In general, dental decay is associated with young people, but older
adults are subject to decay as well, particularly from drug-induced or
age-related oral dryness (see the accompanying Gerontologic
Considerations box).

96. Medical diagnosis
by x-ray studies the extent of damage and the type of
treatment needed.
CBC

97. Sign and symptom
The patient’s face may swell
 Pulsating pain
 may feel tenderness
 pain when eating or drinking something hot
 cold or sweet.
grey, brown or black spots appearing on your teeth
bad breath
unpleasant taste in your mouth

98. Medical treatment
Treatment for dental caries includes
fillings,
dental implants
extractions. If treatment is not successful, the
tooth may need to be extracted.
Antibiotics
Analgesics

99. Prevention
Measures used to prevent and control dental caries include
practicing effective mouth care,
Reducing the intake of starches and sugars (refined
carbohydrates),
applying fluoride to the teeth or drinking fluoridated water,
refraining from smoking,
controlling diabetes, and
using pit and fissure sealants

100. Cont…
Brush teeth using a soft toothbrush at least two times
daily.
 Hold toothbrush at a 45-degree angle between the brush
and the gums and teeth.
A small brush is better than a large brush. Gums and
tongue surface should be brushed.
Floss at least once daily.

101. Cont…
Use an antiplaque mouth rinse.
 Visit a dentist at least every 6 months, or when you have a
chipped tooth, a lost filling, an oral sore that persists longer
than 2 weeks, or a toothache.
Avoid alcohol and tobacco products, including smokeless
tobacco.
Maintain adequate nutrition and avoid sweets.
 Replace toothbrush at first signs of wear, usually every 2
months.

102. Disorders of the Salivary Glands
 The salivary glands consist of the parotid glands, one on each side of the
face below the ear; the submandibular and sublingual glands, both in
the floor of the mouth; and the buccal gland, beneath the lips.
 About 1200 mL of saliva are produced daily.
 The glands’ primary functions are lubrication, protection against
harmful bacteria, and digestion.

103. PAROTITIS
 Parotitis(inflammation of the parotid gland) is the most common
inflammatory condition of the salivary glands, although inflammation can
occur in the other salivary glands as well.
 Mumps (epidemic parotitis), a communicable disease caused by viral
infection and most commonly affecting children, is an inflammation of a
salivary gland, usually the parotid.

104.  Elderly, acutely ill, or debilitated people with decreased salivary flow
from general dehydration or medications are at high risk for parotitis.
 The infecting organisms travel from the mouth through the salivary duct.
The organism is usually Staphylococcus aureus (except in mumps).
 The onset of this complication is sudden, with an exacerbation of both
the fever and the symptoms of the primary condition.
 The gland swells and becomes tense and tender.
 The patient feels pain in the ear, and swollen glands interfere with
swallowing.
 The swelling increases rapidly, and the overlying skin soon becomes red
and shiny

105. Cont…
 Preventive measures are essential and include advising the patient to have
necessary dental work performed before surgery.
 In addition, maintaining adequate nutritional and fluid intake, good oral
hygiene, and discontinuing medications (e.g., tranquilizers, diuretics) that can
diminish salivation may help prevent the condition.
 If parotitis occurs, antibiotic therapy is necessary.
 Analgesics may also be prescribed to control pain.
 If antibiotic therapy is not effective, the gland may need to be drained by a
surgical procedure known as parotidectomy.
 This procedure may be necessary to treat chronic parotitis.

106. SIALADENITIS
 Sialadenitis (inflammation of the salivary glands) may be caused by
dehydration, radiation therapy, stress, malnutrition, salivary gland calculi
(stones), or improper oral hygiene.
 The inflammation is associated with infection by S. aureus, Streptococcus
viridans, or pneumococcus.
 In hospitalized or institutionalized patients the infecting organism may be
methicillin-resistant S. aureus (MRSA) (McQuone, 1999).
 Symptoms include pain, swelling, and purulent discharge.
 Antibiotics are used to treat infections.
 Massage, hydration, and corticosteroids frequently cure the problem.
 Chronic sialadenitis with uncontrolled pain is treated by surgical drainage of
the gland or excision of the gland and its duct.