Lecture 11: Oral Cavity and Digestive Tract (Exam 3) Flashcards
What Disorders were focused on in the oral cavity?
Cavities
Gingivitis
Xerostomia
What disorders were focused on in the esophagus?
Varices
Atresia/Fistulae
Reflux esophagitis
- Gastroesophageal reflux disease (GERD)
-Barrett’s Esophagus
What disorders were focused on in the stomach?
Gastritis (Acute v. Chronic)
-NSAIDS
-H. Pylori
-Autoimmune
What disorders were focused on in the intestines?
Duodenal Ulcer
Obstructions
Celiac disease
Inflammatory Bowel Disease
-Acute (infectionious)
-Chronic (Ulcerative Colitis, Crohn’s)
Hemorrhoids
What is Dental Caries?
Cavities
- oral bacteria convert sugar into acid
-S. mutans implicated in plaque formation
-Acids destroy the enamel and dentin of the teeth
-hydroxyapatite crystals are solubilized
-Fluorapatite crystals are more resistant
What is an example of a biofilm in the oral cavity?
plaque is a biofilm
What is the clinical perspective of cavities?
cells that make enamel are lost after the tooth erupts so enamel cannot be regenerated
-exposes pulp and nerves to cold/heat from food
-Treatment: fill
-Prevention: cleaning
What is gingivitis?
-Inflammation of the gingiva layer
- Gingiva is the oral mucosa (often parakeratized-keratinized)
-immediately around teeth
Caused by: oral bacteria forming a biofilm (plaque) on the teeth
-plaque beneath the gum line leads to gingival infections (gingivitis)
Consequences:
- gingival erythema and edema
-bleeding
-changes in contour
-loss of soft tissue around the teeth
-periodontitis (eventual loss of teeth)
What salivary glands were focused on?
Parotid (serous)
Submandibular (mixed gland)
-predominantly serous
-some mucous
Sublingual (mixed gland)
-under tongue
-predominantly mucous
-some serous
What proteins are found in saliva?
alpha-amylase to break down carbohydrates
-lysozyme to attack bacteria
Glycoproteins
-mucins (lubrication)
-conjugated antibodies
Ions/Water
-INcluding bicarbonate ion (buffering)
IgA
-polymerized
What is Xerostomia?
-dry mouth
-decrease in saliva production by salivary glands
-usually, side effects of medication
-a feature of autoimmune disorder Sjogren Syndrome
-Major complication of radiation therapy
Symptoms
Dry mouth atrophy of tongue papilla (with fissuring and ulcerations)
Complications:
increase rates of dental caries
increased risk of candidiasis (oral thrush)
Dysphagia (difficulty swelling )
Dysarthria (difficult speaking)
How is the esophagus developed?
Trachea and esophagus develop as one tube
-Trachea buds off foregut (lung buds)
-Must separate (failure=fistula)
During development, the esophagus fills in
-recanalizes to be an open tube
-Failure= atresia
Associated with defects in neighboring structures
-Heart defects
-genitourinary malformations
-neurologic disease
What is esophageal atresia?
-the lack or limitation of a space or lumen (usually. developmental)
-results in mechanical obstruction of the space or tube
-In the esophagus, most commonly associated with a fistula
-Symptoms:
-Regurgitation while feeding
-incompatible with life unless repaired (surgery
Treatment: surgery
-feeding tube will not be able to reach the stomach
What is an esophageal fistula?
-abnormal opening between tubes
Three types of fistula, but common is tracheal esophageal fistula with atresia
-Symptoms:
Aspiration, suffocation, pneumonia
-Severe fluid/electrolyte imbalances
-Struggling to breathe while eating
Treatment: surgery
-feeding tube may be able to reach the stomach (imaging may be required)
What is Cardiovascular esophageal disorder?
Portal Hypertension
-reduced/blocked blood flow in the liver increases pressure within the portal vein
-Portal vein drains from the GI tract
Increased pressure causes distension of blood vessels
-Channels form to relieve pressure
-Esophagus is the location of potential connection
What are esophageal Varices?
distention of blood vessels increases the likelihood of rupture
-Walls thin as pressure increases
-remember hypertension
Rupture can cause fatal hemorrhage
-Even if the patient survives, loss of liver perfusion will cause damage that can seriously compromise function
What are esophageal Varices?
distention of blood vessels increases the likelihood of rupture
-Walls thin as pressure increases
-remember hypertension
Rupture can cause fatal hemorrhage
-Even if the patient survives, loss of liver perfusion will cause damage that can seriously compromise function
What is Reflux esophagitis?
-also known as GERD (Gastroesophageal Reflux Disease)
-movement of stomach (or pancreatic) contents into the esophagus
-damage to the esophageal mucosa produces inflammation
What are the symptoms of GERD?
Heartburn: recurrent burning sensation in the chest due to mucosal injury
-worsens after ingestion of foods that decrease the tone of the lower esophageal sphincter (LES)
-Recurrence of disease produces additional damage
-Scarring affects the tonicity of LES
Describe the Lower Esophageal Sphincter?
tonically contracted smooth muscle ring
-prevents backflow of stomach contents
-relaxes during swallowing to allow food into the stomach
Responds to NT
-Nitric Oxide
-Vasoactive intestinal peptide (VIP)
What are the causes of Heartburn?
-foods and other factors (eg mint, coffee
-impaired reflexive esophageal contractions after LES relaxation
-increased gastric volume/pressure
-increased acid production
-gastric obstruction
-Alkaline injury
-Hiatal hernia
How does mucosal inflammation affect the esophagus?
-acid damages epithelium and underlying tissue
-infiltration of granulocytes
-intraepithelial eosinophils
-Neutrophils are signs of more advanced disease
-Development of bleeding ulcers and exudate
-Edema
-Hemorrhage
What is the progression of Heartburn
initial lesion produces scarring that increases the likelihood of additional reflux
Can produce:
-stricture
-pain
-obstruction
-perforation
or Barrett’s esophagus
-pre-cancerous
