disease of the mouth & asophagus
TRANSCRIPT
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Disease OF The Mouth
By Dr. Osman Bukhari
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Functions OF the Mouth -Mastication -Swallowing -Digestion -Speech Normal Oral Comensal Organism -Fusiform bacilli -Spirochetes -Bacteria (e.g. Strept.viridians) -Candida
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*Troubles Occur with poor Oral hygiene & Immunosuppression.
*Bactraemia may have its source in the oral cavity specially following dental manipulations
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Oral Ulcers associated with
1- ROU:
-Affect 30% of population
-Recurring shallow ulcers
-May be multiple
-Aetiology unknown? Autoimmune
-Precipitated by emotional stress
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*Treatment
-Chlorhexidise Mouth wash
-Topical steroids
-Rarely systemic C/S & Azathiosprine
2-Syestamic disorders (Crohns, UC, SLE, Behcets, Immunodefiency )
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3-Dermatological disorders (Erythema
multiform, Lichen Planus, pemphigus
vulgaris,dermatitis herpetiformis )
4- Viral Infection (Herpes simplex,
Coxsackie's virus, HIV.)
5- Bacterial disease (Syphilis, T.b)
6- Drugs (Cytotoxic drugs, antibiotics,
penicillanmine & gold)
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7-Truma (ill fitting teeth, sharp teeth & teeth brushing)
8- Neoplasia (Squamous Ca)
9-Fungal infection (Candidiasis)
10- Leukoplakia (Idiopathic, alcohol, smoking & HIV)
11- Nutritional deficiency (malnutrition & mal- absorption, Niacin, B2,& B12)
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Diseases of the esophagus
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-25CM in Length from cricoid's cartilage to
LOS.
-Double muscle layer
*Upper striated
*Lower smooth
-Epithelial layer
*Upper Squamous
*Lower columnar
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-Upper sphincter formed by Cricophayrygeus muscle
-Lower sphincter (L.O.S) : physiological zone of increased tone just above the gastro-esophageal Junction below the diaphragm
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Symptoms & Sign
OF
Esophageal
Disease
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1- Heart burn
2- Regurgitation
3- Dysphagia
4-Odynophagia
5- Loss of weight
6-Anaemia
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Investigation
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1- Ba swallow
2- Endoscopy
3- Manometry
4-24 hour PH monitoring
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Dysphagia
Causes:-
1-Painful oral legions
2-Neuromuscular disease
-Motor neurone disease
-C.V.A
-Systematic sclerosis
-Dermatomyocystis
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-Diffuse Esophageal spasms
-Diabetes Mellitus
-Chogas
-Myasthenia graves
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3-Extrinsic pressure
-Pharyngeal pouch
-Goitre
-Ca bronchus
-Enlarged L-Node
-Aortic aneurysm
-Enlarged Lt Atrium
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4-Intrinsic Esophageal disease:
-Ca esophagus
-Stricture (Benign or Malignant)
-Esophageal rings & webs)
-Plumer Vinsons
-Candida & Herpes simplex
5-Forign body
6-Globus hystercus
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Gastro Esophageal Reflux Disease (GROD) & Oesophagitis -Transient gastro esophageal reflux is a
normal event in 30% of people without symptoms
- Symptoms occur with prolonged contact of gastric contents with esophageal mucosa when anti reflux mechanisms fail
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Anti reflux mechanisms
1-Competent L.O.S which is tonically contracted & relaxes only during swallowing. Tone is increased with high intra abdominal & intra-gastric pressures.
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2-Flap valve like intra-abdominal esophagus
3-Fundal mucosal folds
4-Diaphragmatic orifice
5-Secondry esophageal peristalsis clearing
refluxate & neutralizing acid by saliva
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Factor associated with impaired efficiency of LOS & GORD:-
1-Impaired efficiency of L.O.S & low tone
associated with H.H, systemic sclerosis &
following Cardioyotomy & dilatation
2-Low L.O.S tone due to dietary factor & habbits (Fatty meals, Caffeine, alcohol,
chocolate & smoking)
3-Decreased secondary esophageal peristalsis & clearance of refluxate
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4-Impaired gastric emptying following GOL
obstruction, fatty meals, heavy meals, &
drugs like anti-cholinergic, CCB, & nitrates
5-High intra abdominal pressure with Ascitis, obesity, straining, heavy weight lifting, pregnancy & bending down
*When anti reflux mechanism fail persistence exposure of the lower esophagus to acid & pepsin results in esophagitis
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Clinical feature
1-Heart burn: increased after heavy meals, hot drink, lying flat &stooping 2-Water brush relieved by anti acids 3-Regurgitation + aspiration lead to chocking, cough & nocturnal asthma 4-Odynophagia 5-Dysphagia : transient with spasm & persistent if there is stricture
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6 Haematemesis & iron deficiency anemia 7-A typical chest pain which may mimic angina if
severe (due to spasm) Diagnosis: 1-Clinical 2-Esophagoscopy (Oesophagitis, Stricture
&excludes malignancy) 3-Radio isotope labelled Tc to demonstrate reflux 4-24 hour PH monitoring, most accurate test for
reflux .
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Complications 1-Peptic stricture following long standing Oesophagitis & ulceration 2-Barretts esophagus (20%). It is pre malignant 3-Iron deficiency anemia
Treatment 1-Avoid precipitating factor e.g. Alcohol & smoking
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2-Reduction of weight & avoid heavy meals
3-Raise foot of bed (15cm)
4-Anti acids, H.R.A & P.P.I in severe cases
5-Prokinetics (Cisapride & metoclopride)
6-Diltation for stricture
7-Surgry (Repair of H.H & Fundoplication) if
there is no response to medical treatment or
if the patient is unwilling to take it or if major symptoms of oesophagitis is trouble- some