GI diseases pt 1

Question 1

order of the digestive tract?

Answer 1

mouth ➡ pharynx ➡ esophagus ➡ stomach ➡ small intestine ➡ colon/large intestine

Question 2

accesory organs of GI system?

Answer 2

liver, gallbladder, pancrease

Question 3

Process of digestion

Answer 3

1. starts at mouth where saliva moistens and breaks down food
2. food moves through pharynx, larynx and esophagus to stomach (spincter at end of esophagus to prevent regurgitation)
3. food in stomach where it is broken town by gastric juice (has enzymes + hydrochloric acid) (stomach is covered in layer of mucus for protection)
4. Chyme passes from stomach to small intestine through sphincter muslce (plyloric sphincter) before passing through duodenum where chyme is broken down through bile to digest fat
5. nutrients are absorbed into blood capillairies in intestial wall
6. water and mineral are absorbed from large intestine before being excreted

Question 4

how does food move in GI tract?

Answer 4

persistalsis

Question 5

What are intestinal secretions from?

Answer 5

pancreas (enters through pancreatic duct)

Question 6

What is bile?

Answer 6

made i nliver, stored in gallbladder, enters duodenum through common bile duct, breaks down fat

Question 7

How to identify infectious disease in digestive organs?

Answer 7

culture and immunodiagnostic methods by analyzing stool (feces)

Question 8

What are the purpose of blood test in GI diseases?

Answer 8

can test liver enzymes to detect luver abnormalities and liver infections

Question 9

How to identify malabsorption syndrome?

Answer 9

biopsy of the intestine’s lining

Question 10

What is stomatitis?

Answer 10

inflammation of the oral tissue that may apeear as pathces, ulcers, redness, bleeding or necrosis

Question 11

what is cause of stomatitis

Answer 11

usually viruses but can sometimes be bacteria and fungi or a sign of systemic infection

strepotocci is common cause of oral and throat bactteial infeciton that results in red, swollen mucosa, canker sores, small circular lesions with red border

Question 12

What causes gonorrhea and what does that cause?

Answer 12

NEISSERIA GONORRHOEAE

causes painful ulcerations in the mouth and throat

Question 13

what causes syphilis and what does syphilis cause?

Answer 13

Treponema pallidum

causes oral chancres (small sores) and ulcerations

Question 14

What is herpes simplex 2?

Answer 14

STI transmitted by genital-oral contact

causes vesicles that rupture to form ulcers on the inside or outside of the mouth

Question 15

what is herpes simplex 1?

Answer 15

aka cold sores

contagious, recurrent viral infection that affects skin and mucous membranes, transmitted oral-oral contact through saliva, mouth to genitals

herpes lesions = difficulty eating, drinking and swallowing

lessons after 2 weeks as virus moves to nerve tissue known as ganglia

recur bc virus can lie dormant

Question 16

What is candida albicans?

Answer 16

aka candidiasis or thrush

fungus found in mouth in low levels but can grow excessively in newborns or those with immune deficiency or follow long antibiotic or corticosteroid treatment

forms painless white patches that resemble cheese curds, removing patches = raw, damaged mucosal surface (cause burning sensation in mouth and become painful when rubbed by dentures, toothbrushes, or food when eating, light bleeding) and smell of yeast in breath

diagnose by dentist, physician or healthcare provider through oral exam and lab analysis of a sample taken from a lesion + blood tests

treat with antifungal meds for 14 days (mostly nystatin, fluconazole as suspension or an oral tablet)

Question 17

What is cancer of the mouth?

Answer 17

malignant tumor originating within the oral tissue, most often a squamous cell carcinoma

mouth and throat cancer rank 11th among the leading causes of cancer death worldwide

mostly appear in floor of mouth, tongue, and lower lip (aggressive form occurs on upper lip)

begin as single, small, pale lumos, in or on mouth, which may or may not bleed easily or cause pain

if benign then assess and may be excised if they r subject to chronic irritation

Question 18

risk factors of mouth cancer?

Answer 18

tobacco, smokeless tobacco, and alcohol

Question 19

treatment for cancer of the mouth?

Answer 19

surgical removal, radiation if on floor of mouth

Question 20

how does esophageal disease manifest itself?

Answer 20

as dysphagia (difficult/ painful swallowing)

Question 21

What is cancer of the esophagus?

Answer 21

malignant tumor in esphagus

2 types: esophagus is lined for most of its length with squamous epithelium so SCC or adenocarcinoma in columnar epithelium near esophagogastric junction

6th leading cause of cancer death wordwide

cancer narrows esophageal lumen (= dysphagia)

Question 22

risk factors for esophageal cancer/

Answer 22

common in men over 60

risk factors for SCC r highest in Asia, Africa and Iran , tobacco and alc use, betel nut chewing, drinking of very hot beferages (over 149F), eating of foods containing N-nitroso compounds (pickled vegetables), diet low in fruit and vegetables, history of head and neck cancer

risk factors of adenocarcinoma predominantly affects Caucasians and males and having barrett esophagus

Question 23

symptoms of esophageal cancer?

Answer 23

retrosternal discomfort or burning sensation
iron deficiency anemia
horaseness
tracheaesophagela fistula
coughing or frequent pneumonias occuring when saliva, liquid or food spills into lungs
dysphagia
vomiting
bad taste in mouth
bad breath
wt loss

Question 24

diganosis for esophageal cancer?

Answer 24

via ct, endoscopy, barium study, staging with CT, PET, endoscopic ultrasonogrpahy (EUS)

cancer frequently metastasizes to adjacent organs (usually lungs + liver + bone + adrenal gland and remotely though lymph vessels) = poor prognosis

Question 25

What are esophageal varices + s/s and etiology?

Answer 25

varicose (enlarged) veins that develop in esophagus i pt with underlying portal hypertension and may result in serious upper GI bleeding

s/s r preceding retching, dyspepsia atributable to alcoholic gastritis or withdrawal, acutal varices ahve no symptoms until rutpture cause massive hemorrhage in which pt experiences hematemesis or melena and signs of hypovolemic shock

mainly affects thosewho abuse alc and ppl with liver cirrhosis (cirrhosis is chief cause)

caused by increased pressure within veins

Question 26

how does cirrhosis = esophageal varices?

Answer 26

destruction and scarring of tissue from cirrhosis impaires blood flwo through liver which elevates pressure in the veins of the abd and esophagus = esopphageal vins dilate and become knotting (may hemorrhage)

Question 27

how to diagnose and treat esophageal varices?

Answer 27

diagnosis - radiographic exam, endoscopy (particularly esophago-gastro-duodenoscopy (EGD))

treat - may try meds and surgery (endoscopic scleortherapy and ligatin of vleeding varices and emergency portal decompression) but prognosis for esophageal varices is poor

Question 28

What is esophagitis + risk factors, s/s and etiology?

Answer 28

inflammation of the lining of the esophagus

risk factors r old age, obesity, and pregnancy

main s/s r heartburn after eating/ drinking, vomitting of blood and reflux

corrosive esophagitis is severe inflammation of esophagus resulting from ingestion of caustic chemical (alkali or acid) or causes tissue damage

most often cause is reflux of acid content of stomach resultingfrom a defect of LES

Question 29

What is GERD (everything but s/s)?

Answer 29

gastroesophageal reflux disease

clinical manifestions of regurgitation fo stomach and duodenal content into esophagus, frequently at night (mild episodes = hearburn)

may be caused by incompetent cardiac sphincter, hiatal hernia, meds that inhibit sphincter or induce excess acid secretion, weight gain

diagnose with Barium swallow, esopagoscopy or esophagogastroduodenoscopy (EGD) and biopsy

treat - elevating head of bead abt 6 in using multiple pillows, light evening meal 4 hous before bedtime, antacids, wt loss, histamine 2 receptor antagonist, ranitidine or famotidine or proton pump inhibitor, inhibit acid secretion and alllows for healing of espohagus, antireflux surgery

Question 30

How to diagnose and treat Esophagitis/ GERD?

Answer 30

diagnose - history, s/s, barium fluoroscopy, measure esopahgeal pH and/or EGD

treatment - nonirritating diet, antacids, acid reducing meds, sleep with head elevated, avoid eating 2-3 hours before sleeping

Question 31

What is hiatal hernia + s/s, etiology?

Answer 31

defect of diaphragm that allows protrusion of part of the stomach through the diaphragm at the point where the esophagus joins the stomach

either congenital defect or increased intra-abd pressure associated with obesity

LES malfunctions and allows contents of stomach to be regurgitated into esophagus which can irritate lining of esophaus causing:

may have indigestion, heartburn, SOB, difficulty swallowing, chest pain

Question 32

How to diagnose and treat hiatal hernia?

Answer 32

dianose - chest xray or EGD, barium radiographic studies, endoscopy, measurement of reflux pH and examination of reflux contents in blood

treat - aim to reduce symptoms using cholinergic drugs (strengthen cardiac sphincter and reduce reflux after eating), avoiding irritants like spicy foods and caffeine, frequent small meals, lose weight, aboid increasing intraabdominal pressure, avoid lying down for 4 houyrs after meal, elevating head of bed

may need surgery but hiatal hernias usually come back after surgery

Question 33

What is gastritis? + etiology and s/s

Answer 33

inflammation of lining of the stomach frequently accompanines by vomiting of blood

acute gastritis can be caused by aspirin, excessive coffee, tobacco, alc or infection, H. pylori, mechanical injury, stress, allergic reaction to foods

s/s r epigastric pain, indigestion, feeling of fullness after meals, nausea, bleching, fatty food intolerance (= loss of appetite), inflamed and swollen gastric mucosa, bleed and blood can be seen in pt vomit and stool

Question 34

What is a major cause for hemorrhagic gastritis?

Answer 34

acute alchoholism (chronic alc use stimulates acid secretion = irritating mucoosa)

Question 35

how to diagnose and treat gastritis?

Answer 35

diagnose - EGD w/ biopsy, gastroscopy, blood counts and serum tests, fecal occult blood test

treat - curing H. pylori infection w/ antibiotics, avoiding known irritants and treating infections, may need meds to block gastric secretion and/ or surgery if bleeding, antacids, monitor and treat with meds to contrict bv if they habe bleeding, antiemetics, bland diet, vitamin and mineral supplements

Question 36

What is chronic atrophic gastritis?

Answer 36

degenerative condition in which the stomach lining does not secrete intrinsic factor (needed for absorption of B12) and hydrochloric acid (protein digestion)

little can be done to treat this disease

Question 37

causes of chronic atrophic gastritis

Answer 37

stomach cancer, chronic alcoholism, or chronic exposure to certain irritants
such as alcohol, aspirin, and certain foods

Question 38

What are peptic ulcers?

Answer 38

lesions of stomach and small intestine where necrotic (dead) tissue forms in mucous membrane as a result of inflammation and is sloughed off, leaving a hole

stomach ulcers - gastric ulcers small intestines - duodenal ulcers

most common peptic ulcer is duodenal ulcer

Question 39

Approximately ___% of peptic ulcers are duodenal ulcers,
which occur most frequently in ________________

Answer 39

80

most frequent in men between ages 20 and 50

Question 40

What are the 4 main cause of peptic ulcers?

Answer 40

1. infection with Helicobacter pylori
2. use of nonsteroidal antiinflammatory drugs
3. inherited disorder of excessive acid secretion
4. pepsin, hydrochloric acid of stomach, intestinal juice and bile irritate gastric mucosa = nectrotic

Question 41

S/s of peptic ulcers/

Answer 41

• 1st signs r heartburn and indigestion and epigastric pain that is described as gnawing, dull, aching or hunger like
• uncomfy fullness after eating = avoid eating = loss of wt and predispotion to dehydration
• pain from hydrochloric acid on exposed surface of lesion (intensified by peristalsis)
• nausea, vomiting, abd pain, massive GI bleeding (in some cases)
• occult b (hidden) or frank (obvious) blood is found in vomitus or stool
• if lesion invades deeply and perforates, causing hemorrhage and leakage of content of stomach or intestine into abdominal caivty
• pt may be observed guarding painful area by clutching the somtach, frequnt eating helps ands most intense pain after 2 hr after meal
• complication is hemorrhage

Question 42

What is hematemesis?

Answer 42

bloody vomitus, a possible complication of ulcer, if it hits an artery or blood appears in stool (called melena)

Question 43

what is a serious ulcer complication?

Answer 43

perforation, where ulcer breask through intestinal or gastric wall = sudden and intense abd pain

immediate surgical repair is needed

Question 44

What is peritonitis +s/s?

Answer 44

inflammation of the lining of the abd cavity usually results when digestive contents enter cavity bc it contains numerous bacteria

s/s r paralytic ileus, hyperemic and edematous as fluid accumulates in peritoneal, causing abscess and adhesions, profuse sweating, abdominal pain, N&V, weakess, fever and abd tenderness, distention, examinatio nof abd reveal tenderness to direct touch and rebound

caused by primary infection by bloodborme organims or organisms originiating in GI or genital tract or secondary if source of infeciton is conatmination by GI secretions resulting from perforation of GI tract or intrabdominal organs, noninfective secreitons can cause aseptic peritonitis, bacterial invasion

Question 45

how to diagnose peptic ulcer?

Answer 45

diagnose - test for H. Pylori, endoscopy, xray detection of blood in stool, blood test for elevated levels of white blood cells and Hgb and reduced Hct, gastric content analysis, barium radiography of upper GI tract t odetect abn appearance and function, upper GI tract endoscopy, buiopsy, serum albumin and transferrin level

Question 46

how to treat peptic ulcers?

Answer 46

treatment is aimed at promoting healing, prevent complications and recurrences and provide pain relief

meds - acid reducers (more effective than antacids and mucosal barriers) and antibiotics to eradicate H. Pylori and reduce rate of ulcer relapse (ex r H2 receptory blocking agents to control gastric secretion) coating agents to protect mucosa and PPIs, to supress secretion of gastric acid)

Question 47

What is gastroenteritis?

Answer 47

inflammation of the stomach and intestines

Question 48

what are the symptoms of gastroenteritis?

Answer 48

anorexia, nausea, vomiting, and diarrhea

abrupt w/ rapid loss of fluid and electrolytes

presence of mucus, pus, blood in stool

common syndrome of gastroenteritis called traveler’s diarrhea (characterized by vary degrees of anorexia, abd crampings, frequent loose stools, nausea and profuse vomiting, fever, weakness)

if viral then called sotmach flu (chemical or food poisoning, allegic reactions to food and some drug reactions)

Question 49

possible causes of gastroenteritis?

Answer 49

(when normal bacterial flora, acid secretions and by healthy motility of GI tract fail to get rid of:

bacterial or viral infections (in travler’s diarrhea it’s from contaminated food or water)
chemical toxins
lactose intolerance or other food allergy

Question 50

how to treat gastroenteritis/ food poisoning?

Answer 50

replaces fluid and nutritional requirements, including the lost
salts.

Antispasmodic medications can control the vomiting and diarrhea + antidiarrheal and antiemetic

Question 51

What cause gastroenteritis and food poisoning?

Answer 51

food contaminated with human or animal feces may microrganisms

Question 52

what is Escherichia coli?

Answer 52

normally found in human or animal inestines

can cause diseases like traveler’s diarrhea, hemolytic uremic syndrome in which toxins cause potentially fatal sutdown of kideny

Question 53

what is salmonella?

Answer 53

bacteria invades intestinal mucosa

causes sudden, colicky abd pain, nausea, vomiting and sometimes blood diarrhea and fever after 6-48 hrs for 2 weeks

identified with stool culture

associated with contaminated eggs and poultry

Question 54

how to treat salmonella?

Answer 54

replenishing water, electrolytes, and nutrients

may need antibiotics and antidiarrheal medications

Question 55

what is vomitting?

Answer 55

sign not disease

protective response to presence of irritant, infection, distention or blockage which send message to medulla which tell diaphragm and abd muscles to squeeze stomach which opens spinchter for gastric content to be regurgitated

Question 56

what is cancer of the stomach + risk factors?

Answer 56

malignant tumor of the stomach tissue

accountrs for less than 1% of all cancers

9th leading cause of cancer in men (more prevalent among men over age 40 than among women)

h. pylori infection increases risk through damagin mucosal cells

jpan has highest incidience og gastric cancer in world (H. pylori s a known carcinogen, barret esophagus i main risk factor + diet high in salt, smoking, previous gastric surgery, prior abdn radiation exposure, genetic predisposition, history of gastric ulcer)

Question 57

What does a stomach tumor do?

Answer 57

may project into lumen or invade stomach wall

either way, lumen narrows to point of obstruction so remainder of stomach becomes extremely dilated and pain results from pressure on nerve endings

Question 58

s/s of carcinoma of the stomach?

Answer 58

bc pain isnt early symptom it takes a while to diagnose

early s/s r loss of appetite, heartburn, general stomach distress, blood in vomit or feces, pernicious anemia gastric mucosa fiails to secrete intrinsic factors, wt loss, persistent abd pain, nausea, dysphagia, melena, anorexia

Question 59

etiology of carcinoma of the stomach?

Answer 59

unknown but related to consumption of preserved, salted, cured foods and a diet low in fresh fruits and vegetables

Question 60

how to diagnose cancer of the stomach?

Answer 60

EGD, gastric analysis by means of a stomach tube to determine absence of hydrochloric acid (achlorhydria), biopsy, CT, EUS, laparoscopy

Question 61

xWhat are the general categoires of disease

Answer 61

• erosion of tissue
• inflammtation
• nfection
• benign and malignant tumors
• obstruction
• interference with blood or nerve supply
• malnutrition
• malabsorption syndrome

Question 62

What is xerostomia/

Answer 62

• decrease in saliva production
• may be caused by dehyradtioon, meds (prescription or OTC), or less often by Sjogren disease

Question 63

What is perdontal disease a risk factor for?

Answer 63

• peridontal disease and increase in systemic of cross-reactive protein have been recognzed as risk factors for CV disease 9arteriosclerosis), diabetes, pancreatic cancer

Question 64

structure of tooth

Answer 64

1) enamel
2) dentin
3) pulp
4) gingiva (gum)
5) cementum
6) periodontal tissue
7) nreve
8) artery and vein
9) root
10) crown

Question 65

structure of tooth

Answer 65

1) enamel
2) dentin
3) pulp
4) gingiva (gum)
5) cementum
6) periodontal tissue
7) nreve
8) artery and vein
9) root
10) crown

Question 66

What does missing teeth do (s/s, diagnosis, treatment, etiology)?

Answer 66

• loss of permanent teeth can alter bite (how teeth come together = occlusion), can lead to jaw pain called temproomandibular joint diosrder, bolting (inadequate chewing), digestive distrubances (gastritis or constipation) and loss of nutrient value of food
• 4 main caues: dental decay (mostly from periodontal disease in adults), tooth loos from age or dental injury, congenitally missing, or impacted and prevented from erpting by the root of an adjacemnt tooth
• diagnose with oral exam and radiographs
• treat with placement or permanent or reovable prosthetis or dental implant

Question 67

What does missing teeth do (s/s, diagnosis, treatment, etiology)?

Answer 67

• loss of permanent teeth can alter bite (how teeth come together = occlusion), can lead to jaw pain called tempromandibular joint diosrder, bolting (inadequate chewing), digestive distrubances (gastritis or constipation) and loss of nutrient value of food
• 4 main caues: dental decay (mostly from periodontal disease in adults), tooth loos from age or dental injury, congenitally missing, or impacted and prevented from erpting by the root of an adjacemnt tooth
• diagnose with oral exam and radiographs
• treat with placement or permanent or reovable prosthetis or dental implant

Question 68

What is an impacted third molar?

Answer 68

• aka wisdom teeth (lasth teeth in back of mouth)
• is malpositioned and can become impacted (pressed together) and cause pain by preventing normal eruption
• wisdom teeth begin developing btwm 8 an 10 and emerge betwn 17 and 21 (in some ppl one or more of these teeth nerve erupt)
• no s/s util wisdom teeth erupt and bc they r in back of mouth they are difficult to clean, resulting in decay and pain
• they become impacted when they dont have enough room to reupt bc bone structure or adjacemtn teeth block eruption, sometime they erupt in an angle, creating a spae in which food can become trapped
• diagnose with radiographic studies to determine positio nand examination
• most likley antibiotic to clear up infection, analgesics, and surgical extraction

Question 69

s

Question 70

What is dental caries?

Answer 70

• aka dental decay
• infection resulting in erosion of the tooth surface
• caused by bacteria in mouth breaking down sugars (sucrose, glucose and fructose, lactose, simple carbs) in food and converting them into acid plaque which erodes calcium in tooth’s enamel (demineralization), causing formation of cavity, it can also be caused by other disorder such as stomach acid from GERD, episodes of purging in bulimia
• diagnose with examination and radiographs to determine extent
• treatment with removing disease portion and filling cavity with dental amalgam composite materia, can do root canal procedure (infected pulp tissue is removed and then canals in roots of tooth r filled, treated with antibiotics) or tooth extraction which is replaced with a dental impant

Question 71

s/s of dental caries?

Answer 71

• first manifest as white spot on tooth, accompanies with mild toothache, hypersensitivity to sweets and temp extremes in foods or beverages, if left untreated then unpleasant taste in mouth from accumulation of food and bacteria, eventually pulp of gum becomes inflamed, persistent pain, stabbing pain in jaw, tooth continues to decay, an abscess may form

Question 72

What are discolored teeth?

Answer 72

• colors of teeth range from slight yellow to brown and gray, some have brown spots, patches and dark lines
• caused by aging, smoking, death tooth, red wine, coffee, tea, foods such as blueberrues, certain drugs in large quantiites uring childhood, antibacterial mouthways, severe attacks of pertusis (whooping cough) and measles in children, naturally occuring fluoride in excessive amouts
• diagnose with oral exam, history for illnesses, meds and trauma
• treat depend if discoloration is superficial or deep, if superficial remove or reduced by polishing with rotatrry polisher, deeper discoloration is treated by dentist-provided bleaching, capping, crowning, cosmetic whitening

Question 73

What is gingivitis?

Answer 73

• inflammation and swelling the gum
• gums r normally pale pink and firm become red, soft and skinny, bleed easily, even w/ gentle tooth brushing
• if gingivitis is not treated it leads to destruction of gums and periodontitis and can cause loss of healthy teeth
• it’s the second most common cause of toothache
• diagnosed with symptoms
• treat with removal of plaque and calculus, antibacterial mouthwash, local anesthesia to thoroughly clean teeth and exposed teeth roots (procedure called root planing and subgingival curettage)

Question 74

causes of gingivitis?

Answer 74

• common cause of gingivitis is plaque (sticky deposit of muscle, food particles, and bacteria that builds up from incorrect technique when brushing or flossing)
• as gums become swollen, plaques
  cause a pocket to form btwn gums and teeth where food gets trapped
• other causes r vitamin deficiencies, glandular disorders, blood diseases, viral infections, use of certain meds

Question 75

What is periodontitis?

Answer 75

• aka periodonal disease
• destructive gum and bone disease around 1 or more teeth
• periodontitis is the end result of gingivitis that was treated too late or not at all
• pockets that form btwn teeth and gums in gingivitis gradually deepen, exposing root where plaque develop and = halitosis (more sensitive tto temp extremes in foods, pain while chewing and absecess)
• caused by plaque biofilm and unchecked gingivitis which is result of poor oral hygein and lack of professional dental periodontal care (factors include smoking, certain meds, chemo, diabetes, HIV infection, stress, poor nutrrition, hormonal meds and prgenancy)

Question 76

diagnose and treat periodontal disease?

Answer 76

diagnose - to determine stage meaure depth of pockets and radiographs (rveals condition of underlying bone)

treat - conservative treatment including thorough cleaning of root surfaces of teeth (procedure called scaling and root planin SRP) and curettage), multiple daily session of brushing and flossing of teeth, antibiotic, periodontal surgery (called respective periodontal surgery, requires dentist to trim the gum to reduce depth of pockets and to remove any damaged bone, may graft bone and/or gum tissue)

Question 77

What is malocclusion?

Answer 77

• specific angles of malposition and contact of maxillary and mandibular teeth
• relationship of upper and lower teeth when mouth is closed to called occlusion or bite; faulty bite is called malocclusion
• signs of malocclusion include protrusion or recession of jaws and teeth that r turned or twisted out of position because of crowding
• generally from genetic, could be from oral habits (thumb/ finger sucking), airway problems (deviated septae, enlarged tonsil or allergies)
• diagnose with visual exam and radiographic studes
• treat with bracs, extractio nof one or more teeth, surgcial removal of portion of jaws , combining crowns or bridges

Question 78

What is temporomandibular joint disorder?

Answer 78

• symptom complex related to inflammation, disease or dysfunction of tempromandibular joint (TMJ)
• synovial joints btwn condyles of mandible and temproal bone is known as temporomandibular joints
• caused by unbalanced activity of jaw muscle (including bruxism (grinding of teeth), malocclusion, poorly fitting dentures, rheumatoid, degenerative or traumatic arthritis, and neoplastic disease, emotional stress (with accompanying clenching and grindign of teeth and habitual gum chewing)

Question 79

s/s of temporomandibular joint disorder?

Answer 79

• draining sensation may be present in one or both ears
• deafness
• sinus pain from muscle pain from superior or deep masseters
• jaw movment is markedly limited
• pt hearing clicked sounds during chewing or expieriences severe pain or aching in or around the ear and jaw joints and pain si worse iwth chewing
• pain and limitation of movmeemtn can be unilateral but is uusally bilateral with 1 side feeling more pain
• headache
• dizziness
• feeling of pressure
• tinnitus
• prevents adequate cleaning of teeth and treatment of cavity
• prevent making of dentures, crowns or implants bc of inability to take impressions

Question 80

how to diagnose and treat temporomandibular joint disorder?

Answer 80

diagnose - oral exam, pt history, radiographic studies, CT< MRI, history of previosus trauma to jaw or fractured facial bones, assessment of child or elder abuse

treatment - aimed at cause of condition or disease, immobilization of mandible, NSAIDs, special applicances to prevent them from grinding their teeth, splint to better align jaw, intraarticular injections of hydrocortisone, adjust occlusion by grinding surfaces of teeth, orhtrodontic and/or comprehensive restorative dental care, physical therapy, strtess counseling, use of muscle relaxants, TMJ arthroscopy, joint restructure and joint replacement

Question 81

What is tooth abscesses?

Answer 81

• pus-filled sac that develops in tissue surrounding base of root
• aches or throbs persistently and can be exremely painful when biting and chewing food, glands in neck and face on affected side may become swollen and tender, fever also can evelop, along with a feeling of general malaise
• forms when a tooth is decayed or dying or when tooth structure loss, exposes dental nerve to bacteria from the mouth

Question 82

diagnose and treat tooth abscesses

Answer 82

diagnose - based on s/s and swelling in neck or face must be treated immediately

treat - antibiotic therapy, root canal therapy (entails removal of infected dental pulp and cleanising, shaping and definitive filling of root canal system of tooth), restorative procedures such as dental crown or filling, r requried to seal root canal system from oral environment, apicectomy (incision in gum and remove bone that covers the tip of root and infected tissue)

Question 83

etiology of mouth ulcers?

Answer 83

for aphthous ulcers no viral cause but also rsult of mechanical trauma (braes, excessive brushing, etc.), viral and bacterial infections, stress, illness, r certain meds used in chemo (may be first sign of tumro in mouth, anemia, or leukemia)

Question 84

how to diagnose and treat mouth ulcers?

Answer 84

diagnose - blood tests, biopsy

treat - antiseptic mouthwashes, rinsing with war salt water, avoiding spicy or acidic foods and hot foods or drinks, topical analgesics such as benzocaine and soothign agents to reduce painful irritation, steroid mouthwash and topical ororal antivral agents

Question 85

s/s of herpes simplex (cold sore) blisters

Answer 85

• develop on lips and inside mouth
• producing painful ulcers that last a few hours or days
• exposure to strong sun, wind, stress, nicotine, and stimulants (caffeine and chocolate)
• ulcers also can form on the gums, causing them to become red and swollen
• tingling and numbness around the mouth precede their appearance (prodrome) followed by appearance of vesicles (blisters), their rupture and scabbing and finally healing of scabs (pathogenesis can often last 14 days)

Question 86

What is necrotizing periodontal disease?

Answer 86

• formerly called acute necrotizing ulcerative gingivitis (trench mouth)
• common infection affecting gums and anchoring structure of teeth
• rare, painful ulceration and disease of gums, particularly betwen teeth and is smoetiems called Vincet angina
• primary symptom is painful, red, swollen gums with ulcers that bleed (can apear grayis in areas of decomposing tissue, metallic taste in mouth and bad breath, fever and enlarged lymph nodes)
• caused by necrotizing periodontal disease, results from poor oral hygience and bacteiral infection secondary to gingivitis
• most often association with HIV/AIDS, stress, poor nutrition, throat infections, smoking and serious illnesses such as leukemia
• diagnose with throat culture and blood work
• threat with antibiotics and hydrogen peroxide mouthwash (may do minor surgery called gingivectomy)

Question 87

What is oral leukoplakia?

Answer 87

• hyperkeratosis or epidermal thickening of buccal mucosa, palate or lower lip
• s/s r leukoplakia (white plaque) is thickening and hardening of a part of mucous membrane in mouth, first asymptomatic but as tehy progress mucous membrane becomes rough, hard, whitish gray and is sensitive to hot or highly seasoned foods
• more common in older adults, result from chronic irritation such as friction caused by habitual cheek biting, dentures or a rough tooth that rubs an area raw , can also be reaction to heat from tobacco smoke or local irritation from chewing tobacco
• diagnose with oral exam, biopsy (3% of case, oral leukoplakia progresses to oral cancer)
• treatment is consisting eliminatng source of irritation, rough tooth or denture may be smooth, giving up smoking

Question 88

What is oral cancer?

Answer 88

• include squamous cell carcinoma (SCC) and adenocarcinoma of lip, cheekc mucosa, anterior tongue, floor of mouth, hard palate and upper and lower gingivae
• appears as a white, patchy lesion or an oral ulcer (if on lip or tongue ulcer is likely to be associated with pain, dysphagia, odynophagia, wt loss, bleeding, or referred pain in ear or jaw
• over than 90% r SCCs, most commonly lip (15x higher in ppl who smoke and drink and accounts for 80% of oral cancer)
• betel chewing, HPV, poor oral hygeine, and periodontal disease r risk facotrs
• diagnose in dental office, confirmed with fine-needle aspiration biopsy, staging of oral cancer with CT, MRI, PET, chest x-ray and measurement of serum alkaline phosphatase and liver function
• treat eoth surgery, with or ithout radiotherapy, laser therapy, neck dissection to detect nodal metastases

Question 89

s/s of GERD?

Answer 89

• belching
• burning sensation in chest and mouth
• coughing spell and wheezing
• vomitus regurigtate into mouth
• dysphagia
• erosive espohagitis with bleeding
• acid gastric fluid (pH < 4)
• reflux of bile or alkaline pancreatic secretion
• eroded tooth enamel
• scar tissue
• ulceration of mucosa and pulmonary aspiration
• subtype of GERD is laryngopharyngeal reflux (LPR) which may present as a chronic nonproductive cough
• hoarseness or frequent clearing of throat

Question 90

s/s of GERD?

Answer 90

s/s r belching, burning sensation in chest and mouth, coughing spell and wheezing, vomitus regurigtate into mout, dysphagia, erosive espohagitis with bleeding, acid gastric fluid (pH < 4), reflux of bile or alkaline pancreatic secretion, eroded tooth enamel, scar tissue, ulceration of mucosa and pulmonary aspiration, subtype of GERD is laryngopharyngeal reflux (LPR) which may present as a chronic nonproductive cough, hoarseness or frequent clearing of throat

Question 91

What is acute appendicitis?

Answer 91

• inflammation of appendix (narrow pouch that is about 35 in long and etends from 1st part of large intestien (cecum))
• s/s r abdominal pain, vague discomfort, localized pain in RLQ, as condition worsens, pt becomes nauseated and may vomit, run a fever and has diarrhea or constipation
• obstruction of narrow appendical lumen is cause obstruction can be caused by lymphoid hyperplasia, fecaliths, parasites, foeign bodies, Crohn disease, and priamry or metastatic cancer)
• diagnose with phyical exam and reported s/s + maximal tenderness of abd at McBurney point (rebound tenderness on the opposite sute may be a sign of peritoneal irritation), CBC and urinalysis, lab finds for elevated WC count

treat - appendectomy, antibiotic therapy,

Question 92

What is abdominal hernia _ etilogy, s/s, diagnose and treat ?

Answer 92

• condition in which organ protruedes thorugh abd opening in abd wall
• s/s r from weakness in muscles and mebmranes of abd wal that allows organ or part of organ to herniate (common in inguinal canal in which loop of bowel protrudes in inguinal canal and in males may progress to fill coratal sac) (severe pain = hernia may be trapped or strangulated)
• caused by abnormal opening develos in weak area or congential amlformation, trauma or increased intraabd pressure from heavy lifting or pregnancy (hernia occasional develops in site of previosu surgical scar)
• diagnos with palpation, Valsalva maneuver, radiographic sutdies f abd and WBC count
• treat based on type of hernia, if simply then wear devise calle dtruss, herniorrhaphy is treatment of choice in children and healthy adults

Question 93

What is intestinal obstruciton + s/s?

Answer 93

• mechanical or functional blockage of intestines
• occurs when contents of intenstine cant move ofrward bc partial or complete blcokage of bowel
• s/s r severe pain, N&V, bloated and painful abd w/o passage of stool or gas, electrolyte imbalanace, elevated WBC count, hyperactive or absnet bowel sounds

Question 94

etiology of intestinal obstruction?

Answer 94

• neoplasm
• foreign bodies
• fecal impaction
• stricutres from Crohn dsease
• compression of bowel
• volvulus
• intussuception
• strangulated hernia
• adhesion
• mechanical obbstruction can lead to blood supply being blocked, resulting in issue death, risk of perforation, spillage of intestinal contents into abd cavity
• paralytic condition of smal bowel called ileus can occur after abdominal surgery, when persitalsis and bowel sounds r absent
• normal peristalsis also can be inhibited by use of certain meds or disease conditons, such as peritonitis

Question 95

What is pesudeomembranous enterocolitis?

Answer 95

• acute inflammation with a plaquelike necrotic debris and mucus adhered to damaged superficial mucosa of small and large intestines
• often related to use of broad-spectrum antibiotics (undergoing antibiotics therapy during previous 6 weeks) which decreases body’s protective natural intestinal flora nd allow development of bacterial infectin with Clostridoides difficile and the products of inflammation and dead tissue form a coating that is called a pseudomembrane (more common in helathcare faciliites so hospitalized pt r most at risk)

Question 95

s/s of pesudeomembranous enterocolitis?

Answer 95

• mild to severe greenish, flou-smelling watery diarrhea (up to 30 stools per day)
• concentrated urine
• decrease turgor in skin
• irritation around anal area
• fecal inconteinence
• blood and mucus in stools
• fever
• weakness
• report abdominal cramping
• tenderness
• N&V
• dehydration (dry mouth, lightheadness and dizziness)

Question 96

diagnose and treat pseudomembranous enterocolitis?

Answer 96

diagnose - stool or rectal biopsy reveal C.difficle, elevated WBC, reduced blood protein (serum albumin) level, serum electrolyte levels r abnormal, abdominal radiographs show distended colon

treat - discontinuing the broad-spectrum antibiotics and substituting it with emtronidazole or vancomycin, cholestyramine, drugs that slow bowel activity are not recommend because they boost retention of toxin, theraby increasing damage to bowel,monitoring fluid and electrolyte balance with oral or IV supplement

Question 97

What is short bowel syndrome?

Answer 97

• small bowel fails to absorb nutrients bc of inadequate absoprtive surface
• s/s r based on amt of missing or damaged bowel, signficant signs of malnutrition, including pathologic changes in other organs and body systems
• s/s r diarrhea, abnornal stools, loose wt, feel weak, tried, dizzy, brittle hair and nails, rashes
• caused by extensive resection of small intestine (crohn disease, itnestinal infarction, radiation enteritis, volvulus, tumor resection and trauma)

Question 98

dignose and treat short bowel syndrome?

Answer 98

diagnose - pt history (presence of bowel isease or surgy to reduce lenght or function of part of small bowel), blood tests (abnormal electrolyte levels, pH distrurbance, anemia, increased fat in stool)

treat - prescription drugs for infection, diarrhea, vitamin and mineral deficiency and pain, oral or IV food supplements, surgery, postoperative parenteral hyperalimentation

Question 99

How to diagnose and treat peritonitis/

Answer 99

diagnose - elevated WBC count, abnormal serum electrolyte levels, gaseous distention of bowel evident on radiographic exam of bad, radiographic studies, CT, aspiration of peritoneal shows cloudy peritoneal fluid

treat - clinical manifestion of peritontiis and source mus t be indentifies then broad-specturm antibiotics, analgesics, antiemetic, NPO, surgeyry for perforation

Question 100

What is malnurttion?

Answer 100

• disorder of nutrition caused by primary deprivation of pprotein energy(seen in poverty or self-imposed starvation) or secondary to deficiency disease (cancer or diabetes)
• distrubs body’s metabolic processes, distrubring normal phytsical structures and biological function, appetite may decrease or increase, resutlign in emaciation or obesity, loss of energy, diarrhea, drastic weight change, skin lesion, loss of hair, poor nails, generalized edema, delayed healing, greasy stools from loss of fat, muscle wasting, enlarged lgands and hepatomegaly

Question 101

etiology of malnutrtion?

Answer 101

• 2 distinct syndromes:
• Kwashiorkor: deficieny of protein in presence of adequate energy (typically seen in weaning infants at birth of a sibling ni sareas where food contaiing protein is insufficienctly abudnance, usually occurs from IONCREASED METABOLIC ACUTE ILLNESSES SUCH AS TRAUMA, BURNS AND SEPSIS)
• Marasmus (extreme malnutrition and emaciation), caused by combined protein and energy deficiency, most commonly seen where adequate quantities of food r not available, usually occurs from chronic disease such as COPD, CHF, caner or AIDS)

Question 102

HOW TO DIAGNOSE AND TREAT MALNUTRTION?AND TREAT MALNUTRTION?

Answer 102

DIAGNOSE - COMPLETE PHYSICAL WITH SPECIAL ATTENTION TO wt, measurement of body fat and muscle mass, blood protein level, CBC, and 24 hours urine test from urea nitrogen, mineral deficiency, anemia, abnormal protein metabolism

treat - feeding through NG tube, combination of dietary modifications with appropariate supplelements of proteins, vitamin, and mineral,s control diarrhea nad infections, special counselling or psychiatric interventions

Question 103

What is hypervitaminosis?

Answer 103

• toxiciity resuilting from excess of any vitamin (esp fat-soluble vitamin A and D which r stored in fat tissue)
• symptoms r irritabiltiy, loss of hair, anorexia, enlargement of liver and spleen, jaundice, skin changes, psychiatric disorder
• can cause increased presure in brain, tinutis, pruritus, wswelling of optic nerve and abn bone growth if chronic in infants and chidren