8. Digestive System Pathologies Flashcards
Oral Thrush
- A fungal infection of the mouth which is not contagious and a sign of low immunity.
- Risk of spread (systemic candidiasis).
Oral Thrush: Causes
- Candida albicansis a fungus seen in cases of compromised immunity (cancer patients, diabetics, HIV/AIDs).
- After broad-spectrum antibiotics (destroys healthy microflora and allows for opportunistic fungal growth) or immune suppressant drugs (e.g. steroids).
- Nutritional deficiencies (iron, zinc, vit. B12).
Oral Thrush: Signs and Symptoms
- White patches (plaques) on the oral mucosa.
- “Cottage cheese” consistency that can be wiped/brushed off.
- Red/raw appearance to the underlying tissue (with cracksin corners of mouth).
- Loss of taste or an unpleasant taste.
Oral Thrush: Treatment
Antifungals
Mouth Ulcer
• Areas of ulceration within the oral cavity
that are generally painful (loss of the
mucosal layer).
Mouth Ulcer: Causes
- Physical trauma and hot food/liquids.
- Nutritional deficiencies: Iron, zinc, folate and vitamin B12.
- Stress (“fight or flight” - causes poor mucosal blood flow).
- GIT pathologies such as Crohn’s disease.
Mouth Ulcers: Treatment
• Treat the cause. Correct nutritional status,
improve immunity, probiotics.
Cold Sores
- A viral infection that lays dormant & activates when immunity is low.
- The virus remains dormant in sensory ganglion (nerves) –often the trigeminal nerve.
- When immunity is low, the virus migrates along the nerve to the skin or mucosa around the mouth –causing tingling/burning sensation.
Cold Sores: Causes
- Herpes simplex virus (normally Type I).
* Triggers include stress, steroid use, trauma, local infections, sunlight exposure.
Cold Sores: Signs and Symptoms
- Tingling, itching, burning sensation around the mouth.
* Small fluid-filled sores then appear most commonly on the lower lip.
Cold Sores: Treatment
• Antiviral creams (acyclovir).
Absess
- A localised pocket of pus surrounded by inflammation (can occur anywhere).
- A defensive reaction of the tissue to prevent spread of infection elsewhere.
Absess: Signs and Symptoms
- Pain, redness, local swelling.
* Fever, malaise
Absess: Treatment
Antibiotics
Drainage
Gingivitis and Periodontal Disease
• Gingivitis is a bacterial infection of the gums.
• If left untreated, gingivitis may progress to
periodontal disease (pathology of the bone
around teeth).
Gingivitis and Periodontal Disease: Symptoms
Bleeding and receding gums
Gingivitis and Periodontal Disease: Causes
- Plaque build up, poor dental hygiene, dental amalgams.
- Longterm steroid medication use.
- Diabetes mellitus.
- Smokers.
- Poor nutrition (high in refined sugars, low anti-oxidant).
Anglar Stomatitis
- Fissuring and dry scaling of the surface of the lips and angles of the mouth.
- Commonly seen in elderly where it is predisposed by changes to facial muscles (sagging).
- Also seen in those immuno-compromised.
Angular Stomatitis: Causes
- Vitamin B deficiencies: Riboflavin (B2) & folic acid (B9).
- Iron deficiency.
- Candida albicans (opportunistic) and staphylococcus.
Xerostomia
- Dry mouth due to reduced/absent flow saliva.
* A common complaint in the elderly(20%).
Xerostomia: Signs and Symptoms
- Dry mouth
- burning sensation
- halitosis (bad breath)
- Speech & swallowing interference.
Xerostomia: Causes and Complications
CAUSES:
• Drugs (antidepressants e.g. Amitriptyline).
• Sjögren’s syndrome (AI attack on exocrine glands).
• Stress (sympathetic dominance)&anxiety, dehydration, renal failure, menopause, alcohol, smoking, radiotherapy.
COMPLICATIONS:
• Candidiasis, gingivitis, tonsillitis, pharyngitis.
Cleft Lip
- Malformation of the lip in embryonic development.
- Can be unilateral or bilateral, complete or incomplete.
- Causes: Genetic defects, environmental (maternal disease, dietary factors). Teratogens(chemotherapy, radiation, alcohol, excess vitamin A, anticonvulsant medications, smoking, substance abuse).
Cleft Palate
- Malformation of the hard palate in embryonic development
- Caused difficulty in speech, feeding and hearing
- Causes: Genetic defects, environmental (maternal disease, dietary factors). Teratogens(chemotherapy, radiation, alcohol, excess vitamin A, anticonvulsant medications, smoking, substance abuse).
Oral Cancer
- Carcinoma of the oral mucosa, lip or tongue.
* Accounts for 1 in 50 of all cancer cases.
Oral Cancer: Causes
- Smoking (including pipes, chewing tobacco).
* Alcohol, HPV infection.
Oral Cancer: Signs and Symptoms
- Red or white patches on oral mucosa or tongue.
* Difficulty eating and breathing.
Oral Cancer: Treatment
• Allopathic: Surgery, chemotherapy, radiotherapy
Salivary Calculi
- Metabolic imbalance affecting mineral concentration resulting in stone formation in one of the salivary glands.
- Calculi can abrade the gland wall causing inflammation, fibrosis and blockage.
Salivary Calculi: Causes
- Dehydration. Abnormal calcium metabolism.
* Sjögren’s syndrome, chronic salivary duct infections.
Salivary Calculi: Signs and Symptoms
• Intermittent pain and swelling of the affected gland, particular when eating –“mealtime syndrome”. May be a palpable mass.
Tonsillitis
- Inflammation of the tonsils.
* Common in children, although can affect adults.
Tonsillitis: Signs, Symptoms and Complications
SIGNS & SYMPTOMS:
• Red, sore & painful tonsils, pus, fever over 38oC, coughing, headache.
COMPLICATIONS:
• Middle ear infections & abscess.
Tonsillitis: Treatment
Rest & hydrate, antibiotics
Tonsillectomy if repeated infections.
Sjogren’s Syndrome
Immune system attacking salivary system
Gastro-Oesophageal Reflux Disease: GORD
• The lower oesophageal sphincter relaxes and acid regurgitates from the stomach into the oesophagus.
GORD: Signs and Symptoms
- Retrosternal pain “heartburn”(can mimic a cardiac pathology) –aggravated by lying down.
- Belching.
GORD: Causes
- Obesity.
- Hiatus hernia (stomach pushed into thorax).
- Pregnancy (high intra abdominal pressure).
- Trigger foods -spicy, fatty foods, alcohol, caffeine, carbonated beverages, onions, chocolate.
- Stress.
GORD: Complications
•Damage to oesophageal mucosa increasing the risk of ulcers, Barrett’s oesophagus (pre-cancerous oesophageal cell changes) & cancer.
GORD: Treatment
• Antacids (some contain aluminium).
Hiatus Hernia
- Part of the stomach protrudes (herniates) into the thoracic cavity through an opening in the diaphragm.
- Estimated to affect 1/3 of people over 50.
Hiatus Hernia: Signs and Symptoms
• Often asymptomatic or GORD.
Hiatus Hernia: Causes
• Increased abdominal pressure: Heavy lifting, hard coughing/sneezing, pregnancy, childbirth, violent vomiting, straining with constipation, obesity, heredity, smoking, drug abuse, stress.
Hiatus Hernia: Complications
• Can cause gastro-oesophageal reflux disease (GORD).
Hiatus Hernia: Treatment
- Treat the cause.
- Manual therapy –visceral manipulation.
- Eating smaller, more frequent meals, avoiding foods & drinks that exacerbate symptoms.
- Avoiding lying down for three hours after eating.
Oesophageal Cancer
• A common aggressive tumour with a poor prognosis.
Oesophageal Cancer: Signs and Symptoms
- Few early symptoms, later obstruction may occur.
- Dysphagia(red flag!). - Difficulty swallowing
- Anorexia & melaena (due to bleeding in oesophagus) - black tarry stool .
Oesophageal Cancer: Causes and Risk Factors
- Chronic irritation, alcohol, smoking.
- GORD & Barrett’s oesophagus.
- Obesity, low fruit & veg diet, age
Acute Gastritis
- Acute inflammation of the stomach mucosa causing breakdown of the stomach lining.
- Insufficient mucous production (due to reduction of prostaglandin synthesis), which protects mucosa from erosion.
- Acute inflammation characterised by neutrophil infiltrate -> acute infection or inflamm. condition
Acute Gastritis: Causes
- Helicobacter pylori.
- NSAIDs(lower prostaglandin levels = reduces gastric mucosal barrier).
- Alcohol, food poisoning, stress.
Acute Gastritis: Signs and Symptoms
- Epigastric pain usually worse with food intake.
* Nausea/vomiting, loss of appetite
Acute Gastritis: Complications
• Bleeding and anaemia
Chronic Gastritis
- Chronic stomach mucosal inflammation for more than 4-6 weeks.
- Lymphocytes and macrophages in lamina propria.
- Prolonged low grade inflammation resulting in fibrosis and hence loss of elasticity and peristalsis.
- May be associated with ulcers.
Chronic Gastritis: Causes
- Autoimmune.
- Bacterial (H pylori).
- Chronic irritation (e.g. Long term NSAIDs).
Chronic Gastritis: Signs and Symptoms
- Few symptoms: Epigastric discomfort, feeling full and discomfort with heavy meals.
- Nausea and poor appetite.
Chronic Gastritis: Complications
- Anaemia: Megaloblastic, iron, pernicious.
* Gastric carcinoma.
Peptic Ulcer
- Ulcer of the GI mucosa (stomach, duodenum).
- Tissue erosion can be superficial or penetrate down to the submucosa or muscularis.
- Commonly affects the proximal duodenum and lesser curvature of the stomach.
Peptic Ulcer: Signs and Symptoms
- Gastric: epigastric pain, 30-60 mins after eating, less often at night.
- Duodenal: epigastric pain 2-3 hours after eating and at night.
- Pain mostly when stomach is empty.
- Burping, nausea, reaction to irritating food (alcohol, coffee, spicy food, fatty/fried food etc.)
Peptic Ulcer: Causes
- Helicobacter pylori(80%).
- NSAIDs (10%): disrupts mucous barrier, lowers stomach bicarbonate, disrupts blood flow.
- Stress(SNS dominance) can often cause ischaemia (resulting in defective tissue repair).
- Chronic gastritis.
Dumping Syndrome
- Loss of control of gastric emptying.
- Duodenum is filled with undigested food.
- Water drawn out from surrounding vessels causing sudden and urgent diarrhoea.
- Presence of carbohydrates -> elevated serum glucose -> excessive insulin release from the pancreas = reactive hypoglycemia(2-3 hrs later).