upper GI tract disorders Flashcards
congenital defects of the upper tract
cleft lip and cleft palate
cleft lip and cleft palate causes
multifactorial; environmental and genetic and problems arise in the second or third month of gestation
cleft lip
may be unilateral or bilateral and results from failure of the maxillary processes to fuse with the nasal elevations, or failure of the upper lip to fuse
cleft palate
failure of the hard and soft palate to fuse, creating an opening between the oral cavity and the nasal cavity
problems associated with cleft palate
feeding problems, risk of aspirating fluid in respiratory passages, and speech developments
treatment for cleft palate
surgery and speech therapy
aphthous ulcers
canker sores/ aphthous stomatitis; cause is unclear there are contributing possible factors
factors contributing to aphthous ulcers
minor injury to the mouth, toothpastes, food sensitivities, lack of vitamins, allergic response, H pylori, hormonal shifts, emotional stress, celiac, IBDs, bechat disease, a faulty immune system, and HIV
what ingredient in toothpaste causes aphthous ulcers?
sodium lauryl sulfate
foods that may cause aphthous ulcers
chocolate, coffee, strawberries, eggs, nuts, cheese, or spicy and acidic foods
what lack of vitamins may cause aphthous ulcers
B12, zinc, folate, or ion
what do aphthous ulcers appear as?
small, shallow, painful lesions occurring on the moveable mucosa, the buccal mucosa, the floor or the mouth, the soft palate, or the lateral borders of the tongue
example of resident flora of the oral cavity
viridans streptococci and staphylococcus aureus
risk of infection in the oral cavity
resident flora are normally harmless but can cause opportunistic infections such as candidiasis or secondary infections when there are open lesions; may also enter the bloodstream and travel to the heart (bacterial endocarditis)
what medication may help with oral cavity infections?
amoxicillin
oral candidiasis
fungal infection caused by candida albicans which are part of the normal flora of the mouth; common in those who have received broad-spectrum antibiotics, chemo, or glucocorticoids, or those who have diabetes or are immunosuppressed
initial infection of AIDs
oral candidiasis
what does oral candidal infection appear as?
a red, swollen area or irregular patches or white curd like material on the mucosa of the tongue of the mouth
treatment for candidal infections
nystatin, a topical antifungal agent
what is herpes virus caused by and transmission?
the herpes simplex virus type 1 (HSV-1) and is transmitted by kissing or close contact
why does herpes not persist early on?
it remains dormant in a sensory ganglion, often in the trigeminal nerve
herpes simplex signs
burning or stinging at the site, following by vesicles/blisters as thee virus reproduces and causes necrosis of the host cell, leaving a shallow, painful ulcer
when is herpes simplex activated?
via stress, trauma, or another infection
treatment for herpes simplex
no cure but treated with antiviral medications such as acyclovir, valtrex, and famvir
where may herpes simplex travel to?
the eyes, causing conjunctivitis and keratitis
what is syphilis caused by?
the spirochete treponema pallidum
stages of syphilis
initial stage is a painless ulcer on the tongue, lips, or palate, followed by a red macules or papules on the palate, and a rash
another name for tooth decay and cavities
dental caries
dental caries
is an infection involving any number of bacteria found in the oral cavity
primary microorganisms causing dental caries
streptococcus mutans and lactobacillus
how do dental caries form
from the bacteria acting on sugars in ingested food to create large quantities of lactic acid that dissolves the minerals in the tooth enamel
pulpitis
infection of the internal structures of the teeth and can be caused when dental caries are untreated
risk for developing dental caries
sugars and acids such as carbonic acid in soda, dry mouth, plaque formation, and periodontal disease
dry mouth name
xerostomia
how does fluroide work?
is decreases the solubility of the minerals in the enamel (replaces hydroxyapatite) and enhances the remineralization process
hypocalcification
excessive fluoride ingestion and can result in a deficient calcification of tooth enamel
periodontitis
the infection and damage to the periodontal ligament and bone by microorganisms and the subsequent loosening and possible loss of teeth
how many categories of periodontal disease are there?
8; range from mild gingival disease to severe periodontitis
what is the periodontium
the gingivae and the anchoring structures (alveolar bone, cementum, and the periodontal ligament
what is periodontal disease caused by?
poor oral hygiene but can be aggravated by some systemic diseases and medications
gingivitis
the inflammation of the gingia which causes the gingival tissue to become red, soft, swollen, and bleed easy
causes of gingivtis
accumulated plaque, in which the microbes secrete substances that enable them to adhere to the tooth surface and its plaque
what is plaque?
a mass of bacteria and debris adhering to the teeth
what is tartar?
aka calculus; is calcified plaque, which is even more irritating to the tooth due to its hard, rough surface
how improper brushing cause gingivitis?
can create extensive grooving on the tooth surface, increasing plaque retention and tooth sensitivity
dark line of the gingival margin
indicative of lead poisioning
overgrowth of gums
may occur from hormonal changes associated with pregnancy and the use or oral contraceptives
gingival hyperplasia
occurs with the long-term use of drugs such as phenytoin or cyclosporine
necrotizing periodontal disease
aka trench mouth; an infection caused by anaerobic opportunistic bacteria in those who tissue resistance is decreased
causes of necrotizing perodontal disease
stress, smoking, disease, or nutritional deficets
appearance of necrotizing periodontal disease
lower jaw teeth are affected, showing white necrotic areas surrounded by red and swollen areas that are painful and bleed easy
periodontitis
a more serious more of periodontal disease that develops when there is an increase in activity of gram-negative anaerobic bacteria as they enter the plaque and secrete enzymes
common microbes in periodontal disease
porphyromonas gingivalis, actinobacillus actinomyectem comians and bacteroides forsythus
what is periodontitis caused by?
poor oral hygiene cancer, smoking, diabetes mellitus, and HIV infection
what does periodontal disease result in?
inflammation around the tooh and beneath the gingival margin, forming a pocket around the tooth; mucosa is also red, swollen, and bleeds easily
hyperkeratosis and example
thickening on the skin in certain areas; ex. leukoplakia
leukoplakia
a whitish plaque or epidermal thickening of the mucosa that occurs on the buccal mucosa, palate, lower lip, or tongue
common cancer of the oral cavity
squamous cell carcinoma
squamous cell carcinoma risk population
common in smokers, those over 40, those with alcohol abuse, and those with a preexisting leukoplakia
squamous cell carcinoma
malignant tumors inside the oral cavity; poor prognosis because they are hidden and painless; common around the floor of the mouth and the lateral borders of the tongue
what does squamous cell carcinoma appear as?
a whitish thickening and then develops into a nodular mass or an ulcerative lesion
kaposi carcoma
common in AIDS patients; lesion is a brownish or purple lesion, usually on the palate which eventually becomes a nodular mass
lip cancer
usually on the lower lip, it obvious, accessible, and has a good prognosis; common in pipe smokers
sialadenitis
inflammation of the salivary glands, most commonly affecting the parotid gland by infectious agents and tumors
mumps
aka infectious parotitis; is a viral infection leading to marked, usually bilateral, swelling of the glands
noninfectious parotitis
develops in debilitated or elderly patients who lack adequate fluid intake and mouth care
most frequent malignant tumor of the salivary gland
mucoepidermoid carcinoma which occurs primarily in the parotid glands
dysphagia and causes
is difficulty swallowing; many causes such as a neurological deficit, a muscular disorder, or a mechanical obstruction
neurologic causes for dysphagia
infection, stroke, brain damage, and achalasia (failure of the lower esophageal sphincter to relax)
results of achalasia
an accumulation of food in the lower esophagus, causing inflammation and reflux of the food; increased risk of esophageal carcinoma in chronic conditions
mechanical obstructions causing dysphagia
congenital atresia, stenosis, esophageal diverticula, and tumors
congenital atresia
a developmental defect in which the upper and lower esophageal segments are separated, causing reflux of feeding, leading to aspiration
stenosis of the esophagus
the narrowing of the esophagus which can be developmental or acquired
causes of esophagus stenosis
usually is secondary to fibrosis from chronic inflammation, ulcers, or radiation therapy, or from scar tissue from chemicals
esophageal diverticula
outpouchings of the esophageal wall that either result from congenital defects or inflammation; food will accumulate here and obstruct the flow of food, causing irritation, inflammation, and scar tissue
signs of esophageal diverticula
dysphagia, foul breath, chronic cough, and hoarseness, and sometimes bleeding
esophageal cancer
primary cancer is squamous cell carcinoma which forms in the distal esophagus; can grow into the lumen and cause dysphagia; prognosis is quite poor
what is esophageal cancer associated with?
chronic irritation like alcohol, smoking, or inflammation
hiatal hernia
occurs when part of the stomach protrudes through the opening (hiatus) in the diaphragm into the thoracic cavity
two types of hiatal hernia
sliding and rolling or paraesophageal
sliding hernia
more common and occurs when a portion of the stomach and the gastroesophageal junction move above the diaphragm; standing in slides back down but occurs in a supine position
rolling or paraesophageal hernia
occurs when part of the fundus of the stomach moves up through an enlarged or weak hiatus in the diaphragm; can cause vessels to be compressed, leading to ulceration
risks associated with hernias
food can lodge in the pouch, causing inflammation of the mucosa, a reflux of food up the esophagus, and dysphagia; chronic conditions can cause fibrosis and stricture (narrowing of a passage)
factors increasing risk for developing a hiatal hernia
shortening of the esophagus, weakness of the diaphragm, and pregnancy due to increased abdominal pregnancy
signs of hiatal hernia
heartburn or pyrosis (burning sensation following by a sour taste in the mouth), belching, and discomfort eating, lying down, or coughing
why is dysphagia common in hiatal hernia’s?
because of the inflammation caused in the esophagus or the mass of food collected in the pouch that compresses the esophagus
how to reduce discomfort from hiatal hernia’s?
frequent, small meals and avoiding a recumbent position (horizontal) after meals
GERD
gastroesophageal reflux disease; involves the periodic flow of gastric contents into the esophagus and is often in conjunction with hiatal hernia; severity depends on the position of the lower esophagus sphincter
how does GERD occur?
a decrease in LES pressure or an increase in intra abdominal pressure which causes gastric contents to reflux back into the esophagus
what is the result of frequency reflux og gasric acid?
inflammation and ulceration of the mucosa, and eventually fibrosis and stricture in the esophagus
how to prevent GERD
reducing caffeine, fatty foods, alcohol, smoking, and certain drugs
diagnosis of GERD
includes an upper endoscopy, ambulatory acid probe test, esophageal manometry, and X-ray of the upper digestive tract
treatment for GERD
antacids that neutralize stomach acids such as Tums or mylanta, medications to reduce acid production like H2 receptor blockers (nizatidine or cimetidine), proton pump inhibitors (lansoprazole), medication to strengthen the LES
gastritis
an inflammation of the stomach; can be acute or chronic
acute gastritis
the gastric mucosa is inflamed and appears red, edematous, and sometimes ulcerating and bleeding, which can be a result of poor circulation
what may cause acute gastritis
infection from microorganisms such as bacteria and/or viruses, allergies, ingestion of spicy foods, excessive alcohol, ingestion of aspirin, ingestion of toxic substances, or chemotherapy or radiation
basic signs for gastrointestinal irriation
anorexia, nausea, or vomiting are most common; can also be pain, cramps, or fever and headache that occur with infection
treatment for acute gastritis
heals on its own within a day or two; electrolyte and fluid replacement is good when diarrhea or vomiting occurs, and antimicrobial drugs may be used for infections
food or water-borne illnesses
may involve a large number of cases, sometimes infecting communities
rotavirus
cause serious infection including vomiting and diarrhea, sometime along with ulcers
where are outbreaks of gastroenteritis common?
daycare centres and institutions
clostridium difficile
common in those on broad-spectrum antibiotics when bacteria like E coli are killed off; it is a gram-positive bacteria and is common in hospitals
Escherichia coli
a normally harmless microbe that can adhere to the mucosa and secrete enterotoxin, causing gastroenteritis or ‘travelers diarrhea’; has five forms
5 forms of escherichia coli infection
enterotoxigenic E coli, enteroinvasive E coli, enteropathogenic E coli, enteroaggregative E coli, and enterohemorrhagic E coli
enterotoxigenic E coli
causes diarrhea in infants and travelers; the organism produces enterotoxins
enteroinvasive E coli
causes severe diarrhea and fever; the organism does not produce enterotoxins
enteropathogenic E coli
similar to enteroinvasive, but enterotoxins are produced and it is similar to shigella
enteroaggregative E coli
produces persistent diarrhea and a hemolysin that causes UTIs; produces an enteroaggregative heat-stable toxin
enterohemorrhagic E coli
damage to the mucosa blood vessels can affect blood vessels in the kidneys; present in cows and infection is due to food and water contaminated with particular strains
what strain causes enterohemorrhagic E coli
O157:H7
what is enterohemorrhagic E coli commonly caught from?
ground beef, unpasteurized milk, or contamination from other oral fecal routes
what do the strains of enterohemorrhagic E coli release?
O157:H7 release verocytotoxins that are similar like Shiga-like toxins
general effects of E coli
diarrhea (can progress to bloody diarrhea), cramps, hemolysis of blood cells leading to anemia, acute renal failure, and neurologic effects such as seizures
chronic gastritis
characterized by atrophy of the mucosa of the stomach, with loss of the secretory glands; loss of parietal cells cause achlorhydria and lack of secretion of intrinsic factor
what infection is often associated with chronic gastritis?
H pylori
what individuals often display chronic gastritis?
chronic peptic ulcers, alcohol abuse, the elderly, and some includes with autoimmune disorders such as pernicious anemia
signs of chronic gastritis
mild epigastric discomfort, anorexia, or intolerance for spicy and fatty foods
increased risk for those with chronic gastritis
peptic ulcers and gastric carcinoma
treatment for chronic gastritis
antibiotics and proton pump inhibitors
where are peptic ulcers found?
commonly occur in the proximal duodenal but are also found in the antrum of the stomach or lower esophagus
peptic ulcers
usually appear as single, small, round cavities with smooth margins that penetrate the submucosa; surrounding tissues are damaged due to acid from the gastric wall
effects of peptic ulcers
ulcers may erode into a blood vessel wall, causing bleeding and sometimes hemorrhages
mucosal of the stomach
tightly packed epithelial cells that can regenerate quickly and are covered by a thick layer of HCO3- rich mucous
causes of gastric ulcers
impaired mucosal defences and H pylori
causes of duodenal ulcers
increased acid secretion and H pylori
relationship of H pylori and peptic ulcers
major significance of developing ulcers due to the microorganism secreting cytotoxins and the enzymes protease, phospholipase, and urease which all damage the mucosa
how might the mucosa lining of the GI tract be damaged?
H pylori, an inadequate blood supply due to vasoconstriction, excessive glucocorticoids, aspirin, NSAIDS, alcohol, chronic gastritis, increased gastric secretion, increased pepsin-acid, and rapid gastric emptying
how does stress contribute to gastric ulcers?
by reducing mucosal blood flow and increasing glucocorticoid effects; as well by stimulating stressful coping mechanisms like smoking, caffeine, and alcohol
healing of peptic ulcers
isolating the causes is difficult so healing takes a long time and ulcers may reoccur; granulation tissue breaks down and scar tissue may develop
complications of peptic ulcers
may cause a hemorrhage, perforation, chemical peritonitis, and obstruction of the GI tract
perforation
occurs when the ulcer erodes completely through the wall, allowing chyme to enter the peritoneal cavity; results in chemical peritonitis
chemical peritonitis
inflammation of the peritoneal membrane and other structures in the abdominal caivty
general causes of peptic ulcers
H pylori, genetic factors (O blood group), older individuals, and though taking NSAIDs
signs and symptoms of gastric ulcers
epigastric burning after meals and at night, heartburn, nausea, vomiting, and weight loss
diagnostic tests for peptic ulcers
fiberoptic endoscopy or barium x-ray
treatment for peptic ulcers
combination of drugs including antimicrobial drugs to treat H pylori, reduce acid secretion, inhibit the proton pump, and a coating agent; also reducing exacerbating factors such as caffeine partial gastrectomy may also be required
examples of drugs to treat peptic ulcers
helidac treats acid secretion, tetracycline treats H pylori, cimetidine treats H2 receptors, and omeprazole reduces gastric secretions
stress ulcers causes
result from traumas such as burns or head injuries or those with serious systemic problems such as hemorrhage or sepsis
curling ulcers
ulcers in the presence of burns
cushing ulcers
ulcers in those with head injuries; increased vagal stimulation of acid secretion occurs
first indicator of stress ulcers
hemorrhages
where does gastric cancer occur?
occurs in the mucous membrane, often in the antrum and pyloric areas
most common gastric cancer
adenocaricoma
adenocarcinoma
cancer that starts in the glands lining organs
early gastric carcinoma
effects the mucosa and submucosa
advanced gastric carcinoma
involves the muscularis layer; eventually it spreads and involves the serosa, lymph nodes, liver, and ovaries
prognosis for gastric cancer
is poor due to not being detected early on
causes of gastric carcinoma
H pylori, diet, food preservatives such as nitrates and smoked foods, and genetic factors (A blood group)
signs of gastric carcinoma
initial signs are anorexia, indigestion, epigastric discomfort, weight loss, fatigue, and fullness; iron-deficiency anemia also occurs
treatment for gastric carcinoma
gastric resection, chemo, radiation therapy, and B12 injections after gastrectomy
dumping syndrome
occurs when control of gastric emptying is lost and occurs often after gastric resection or a partial gastrectomy; the storage stage in the stomach is lost
effects of dumping syndrome
hypoglycemia, cramps, nausea, diarrhea, along with dizziness, weakness, rapid pulse, and sweating
dumping syndrome and osmosis
the hyperosmolar chyme draws fluid from the vascular system into the chyme; this can cause dizziness, weakness, rapid pulse, and sweating
why does hypoglycemia occur with gastric dumping?
the rapid emptying leads to initial high blood glucose levels, but these drop very quickly; causes tremors, sweating, and wekaness
treatment for dumping syndrome
small meals that are high in protein and low in simple carbs; fluids should be taken between meals rather than with meals
pyloric stenosis
narrowing and obstruction of the pyloric sphincter usually due to scar tissue
signs of pyloric stenosis
regurgitation of food, projectile vomiting lacking bile, small and infrequent stoll,s and failure to gain weight
treatment for pyloric stenosis
surgery to remove the obstruction
