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  1. 1. Disorders of Gastro Intestinal System
  2. 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. 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. 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. 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. 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. 7. Cont.… Major Structures in the Mouth teeth – to grind the food salivary glands – moisten food and mucous membranes and begin carbohydrate digestion
  8. 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. 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. 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. 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. 12. Cont.… Digestive Function of the Stomach: Pepsin – needed for protein digestion HCL acid – aids in pre-digestion of food
  13. 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. 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. 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. 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. 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. 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. 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. 20. Summary of Anatomy and physiology of GIT
  21. 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. 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. 23. Cont.…. 3. Normal pattern of bowel elimination a. frequency and character of stool b. use of laxatives, enemas
  24. 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. 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. 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. 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. 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. 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. 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. 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. 32. Cont.… c.) Rectum perineal skin and perianal skin assess for presence of pruritus, fissures, externa hemorrhoids, rectal prolapse
  33. 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. 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. 35. Cont.… 3. Exfoliative Cytology  Detect malignant cells  Liquid diet  UGI: NGT insertion – saline lavage  LGI: laxative, enema, proctoscope
  36. 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. 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. 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. 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. 40. Cont.…  NPO for 12 hours an NGT is inserted and gastric contents are aspirated, connected to suction
  41. 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. 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
  44. 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. 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. 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
  47. 47. 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
  48. 48. 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.
  49. 49. 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.
  50. 50. 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.
  51. 51. 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
  52. 52. Cont.… Smoking Caffeine Excessive stress Exposure to contaminated food or water
  53. 53. 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
  54. 54. 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
  55. 55. 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.
  56. 56. 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
  57. 57. 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
  58. 58. 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.
  59. 59. 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).
  60. 60. 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
  61. 61. 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)
  62. 62. 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.
  63. 63. 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.
  64. 64. 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
  65. 65. 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
  66. 66. Cont.… Perforation of ulcer causes: Sudden, sharp pain Tender, rigid, board-like abdomen Knee-chest position reduces pain  Hypovolemic shock
  68. 68. 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
  69. 69. 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
  70. 70. 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
  71. 71. 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.
  72. 72. 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.
  73. 73. 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
  74. 74. 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
  76. 76. 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.
  77. 77. Nursing intervention Monitor intake and output. Replace fluids lost. Administer antiemetic medication for symptom relief
  78. 78. 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.
  79. 79. 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
  80. 80. 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
  81. 81. Oral cavity consist of 1. Lips 2. Gums 3. Tongue 4. Salivary glands 5. teeth
  82. 82. 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
  83. 83. 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.
  84. 84. 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
  85. 85. 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.
  86. 86. 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.
  87. 87. 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
  88. 88. Complication 1. Discomfort 2. Airway obstruction 3. Dysphagia 4. Dysphonia 5. Recurrent oral infection 6. Abscess 7. Oral cancer
  89. 89. 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
  90. 90.  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.
  91. 91.  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.
  92. 92. 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).
  93. 93. Medical diagnosis by x-ray studies the extent of damage and the type of treatment needed. CBC
  94. 94. 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
  95. 95. 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
  96. 96. 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
  97. 97. 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.
  98. 98. 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.
  99. 99. 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.
  100. 100. 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.
  101. 101.  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
  102. 102. 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.
  103. 103. 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.

Notas del editor

  • sympathetic nervous system is a network of nerves that helps your body activate its “fight-or-flight” response..
    It could be called your “automatic” nervous system, as it is responsible for many functions that you don’t have to think about to control.
    This can include control of your heart rate, blood pressure, digestion, urination and sweating, among other functions.
    Your sympathetic nervous system is best known for its role in responding to dangerous or stressful situations.
     In response to danger or stress, your sympathetic nervous system may affect your:
    Eyes: Enlarge your pupils to let more light in and improve your vision.
    Heart: Increase your heart rate to improve the delivery of oxygen to other parts of your body.
    Lungs: Relax your airway muscles to improve oxygen delivery to your lungs.
    Digestive tract: Slow down your digestion so its energy is diverted to other areas of your body.
    Liver: Activate energy stores in your liver to an energy that can be used quickly.
    The word “vagus” means wandering in Latin. This is a very appropriate name, as the vagus nerve is the longest cranial nerve. It runs from the brain stem to part of the colon.
    Motor functions of the vagus nerve include:
    stimulating muscles in the pharynx, larynx, and the soft palate, which is the fleshy area near the back of the roof of the mouth
    stimulating muscles in the heart, where it helps to lower resting heart rate
    stimulating involuntary contractions in the digestive tract, including the esophagus, stomach, and most of the intestines, which allow food to move through the tract
  • chyme: mixture of food with saliva, salivary enzymes, and gastric secretions that is produced as the food passes through the mouth, esophagus, and stomach