GIT - Prob 1

GIT – Problem 1
Anastasia Wibianto
405130125
LO 1
ANATOMY & HISTOLOGY OF CAVITY &
ESOPHAGUS
Mouth Anatomy
• The oral cavity represents the first part of the
digestive tube: entrance of the alimentary tract and
to initiate the digestive process by salivation and
propulsion of the alimentary bolus into the pharynx.
• The oral cavity is oval shaped and is separated into
the oral vestibule and the oral cavity proper.
– Lips anteriorly, the cheeks laterally, the floor of the mouth
inferiorly, the oropharynx posteriorly, and the palate
superiorly.
Mouth Anatomy
Schematic representation of oral cavity and floor of mouth. A: philtrum; B: upper labial
frenulum; C: opening of Stensen's duct; D: labial commissure; E: hard palate; F: soft palate; G:
intermaxillary commissure; H: base of tongue; I: lateral border of tongue, dorsal view;
J: tip of tongue, dorsal view; K: tip of tongue, ventral view; L: lateral border of tongue, ventral
view; M: ventral surface of tongue; N: lingual frenulum; O: floor of mouth;
P: opening of Wharton's duct; Q: vestibular gingiva; R: vestibule.
Mouth Anatomy
• The oropharynx begins superiorly at the
junction between the hard palate and the soft
palate, and inferiorly behind the circumvallate
papillae of the tongue. The bony base of the
oral cavity is represented by the maxillary and
mandibular bones.
Oral Cavity & Pharynx
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2597750/figure/F1/
Development
Sagital section of the head and neck in (A) infant and (B) adult human.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2597750/
Esophagus Anatomy
• A long muscular tube that connects the pharynx to
the stomach. (adult: 25 cm; at birth: 8-10 cm;
adolescent: 19 cm)
• Upper border:
– Adult: lower border of the cricoid cartilage (vert C6)
– Newborn: vert C4-C5
• Lower border
– Adult: cardiac orifice of the stomach (vert T11)
– Newborn: vert T9
http://emedicine.medscape.com/article/1948973-overview
Esophagus Anatomy
• The esophagus has been subdivided into 3 portions,
as follows:
– The cervical portion extends from the cricopharyngeus to
the suprasternal notch
– The thoracic portion extends from the suprasternal notch
to the diaphragm
– The abdominal portion extends from the diaphragm to the
cardiac portion of the stomach.
Esophagus Anatomy
• 3 constrictions in its vertical course:
– First constriction: 15 cm from the upper incisor teeth,
where the esophagus commences at the cricopharyngeal
sphincter; this is the narrowest portion of the esophagus
and approximately corresponds to the 6th cervical vert.
– Second constriction: 23 cm from the upper incisor teeth,
where it is crossed by the aortic arch and left main
bronchus
– Third constriction: 40 cm from the upper incisor teeth,
where it pierces the diaphragm; the lower esophageal
sphincter (LES) is situated at this level
Esophagus Anatomy
http://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/articles/image_article_collections/anatomy_pages/Esophagus.jpg
Esophagus Blood Supply
• The cervical portion is supplied by the inferior
thyroid artery
• The thoracic portion is supplied by bronchial and
esophageal branches of the thoracic aorta
• The abdominal portion is supplied by ascending
branches of the left phrenic and left gastric arteries.
Esophagus Nerve Supply
• Recurrent laryngeal branches of the vagus nerve
supply the striated muscle in the upper third of the
esophagus, and cell bodies for these fibers are
situated in the rostral part of the nucleus ambiguus.
• Motor supply to the nonstriated muscle is
parasympathetic. These fibers reach the esophagus
through the vagus and its recurrent laryngeal
branches. They synapse in the esophagus wall in the
ganglia of submucosal plexus (Meissner) and
myenteric plexus (Auerbach).
HISTOLOGY
Histology of Lips
http://classconnection.s3.amazonaws.com/340/flashcards/550340/jpg/lip1306729121652.jpg
Tongue: Filiform Papillae
http://www.siumed.edu/~dking2/erg/images/GI053b.jpg
Tongue: Fungiform Papillae
http://www.vetmed.vt.edu/education/curriculum/vm8054/Labs/Lab17/IMAGES/FUNGIFORM%20COMPOSITE.jpg
Tongue: Circumvallate Papillae
http://www.e-histology.or.kr/data/ColorAtlas/0610/610_18_0.jpg
Esopaghus
http://legacy.owensboro.kctcs.edu/gcaplan/anat2/histology/esophagus3.jpg
LO 2
PHYSIOLOGY OF CAVITY & ESOPHAGUS
Physiology of Swallowing
• Swallowing apparatus consists of the pharynx,
cricopharyngeus (upper esophageal
sphincter), body of the esophagus, and lower
esophageal sphincter.
4 Main Stages
1. Oral Preparatory Stage, in which the food is
chewed (masticated), mixed with saliva, and
formed into a cohesive ball (bolus)
2. Oral Stage, in which the food is moved back
through the mouth with a front-to-back
squeezing action, performed primarily by the
tongue
http://calder.med.miami.edu/pointis/tbifam/swal1.html
4 Main Stages
3. Pharyngeal Stage, which begins with the
pharyngeal swallowing response:
– The food enters the upper throat area (above larynx)
– The soft palate elevates
– The epiglottis closes off the trachea, as the tongue moves
backwards and the pharyngeal wall moves forward
– These actions help force the food downward to the
esophagus
4 Main Stages
4. Esophageal Stage, in which the food bolus
enters the esophagus (the tube that
transports food directly to the stomach). The
bolus is moved to the stomach by a
squeezing action of the throat muscles
(peristaltic).
LO 3
BIOCHEMISTRY OF CAVITY &
ESOPHAGUS
Digestion
• A natural process of breaking down food into
absorbable forms to our body
• Regulated by mechanical and chemical stimuli,
extrinsic control by the central nervous
system, and local intrinsic control (plexus)
• Occurs with the presence of hydrolase enzyme
along the digestive tract
Mouth
• Mechanical and chemical digestive process by
teeth, saliva, and enzymes:
– α-amylase: secreted by salivary gland, needs Ca2+
to break carbohydrate to mono-/disaccahrides
– lipase: secreted by serous Von Ebner gland to
break short or medium chain triglycerides to 1,2-
diacylglycerol + fatty acid
– mucin: glycosylated protein secreted by
epithelium cells of salivary gland to lubricate food
Mouth
• Mechanical and chemical digestive process by
teeth, saliva, and enzymes:
– Lysozyme: as non-specific antiseptic by
hydrolyzing bacterial cell wall
– IgA: secreted by plasma cells in lamina propria and
is the only antibody which is made in digestive
tract
– Haptocorrin (R-factor): coded by TCN1 gene, a
glycoprotein to protect vit B12 from HCl
Esophagus
• Mechanical process (peristaltic movements)
which started after swallowing process in
oropharynx and ended in the stomach or
gaster
LO 4
SWALLOWING DISORDERS (DYSPHAGIA
& ODYNOPHAGIA)
Swallowing Disorders
• Dysphagia: sense of difficulty with the passage of
food from the pharynx to the stomach.
– Can be divided into oropharyngeal or esophageal
dysphagia
– Further subdivisions: mechanical causes or neuromuscular
causes.
• Globus: a subjective feeling of fullness in the throat
not related to eating.
• Odynophagia: presence of pain on swallowing that
may or may not accompany dysphagia.
Vahabzadeh B, Early DS. Common gastrointestinal complaints. Available from:

https://www.inkling.com/read/washington-manual-outpatient-internal-medicine-1st/chapter-24/dysphagia-and-odynophagia
Globus
• Present between meals, and swallowing of solids or large
liquid boluses may give temporary relief.
• Dysphagia and odynophagia are not present.
• Frequent dry swallowing and emotional stress may worsen
the globus sensation.
• Psychological factors may be important in the genesis of the
globus sensation. The most commonly found psychiatric
diagnoses include anxiety, panic disorder, depression, hypo-
chondriasis, somatization, and introversion
http://www.ualberta.ca/~loewen/Medicine/GIM%20Residents%20Core%20Reading/DYSPHAGIA,%20G
ERD,%20BARRETTS%20ESOPHAGUS/dysphagia,%20heartburn%20Slezinger.pdf
Odynophagia
• This symptom may range from a dull retrosternal ache on
swallowing to a stabbing pain with radiation to the back so
severe that patients cannot eat or even swallow their own
saliva
• Usually reflects a severe inflammatory process that involves
the esophageal mucosa or, in rare instances, the esophageal
muscle.
• Dysphagia also may be present, but pain is the dominant
complaint
• Infrequent complaint with GERD patients; when present
usually is associated with a severe ulcerative esophagitis
Odynophagia
Mechanisms of Dysphagia
• Failed peristaltic contractions due to: nerves disorder, low-
amplitude peristaltic activity that is insufficient for clearing
the esophagus in elderly, motility disorders
• Mechanical narrowing of esophageal lumen; Symptoms also
vary with the degree of luminal obstruction, associated
esophagitis, and type of food ingested
• GERD: difficulty swallowing in this situation usually results
from intermittent acid-induced motility disturbances
sometimes associated with mild to moderate esophageal
inflammation
• Abnormal sensory perception within the esophagus
Diagnostic Alogarithm
Diagnosis: Clinical Presentation
• History:
– Onset
• Progressive difficulty in swallowing solid foods, whereas liquids pass with
ease, indicates mechanical obstructive cause such as malignancy or
benign stricture.
• Dysphagia involving solids and liquids is consistent with esophageal motor
dysfunction, such as achalasia or diffuse esophageal spasm, but can be
seen in advanced obstruction.
• Intermittent dysphagia for solids, usually meat or bread, can result from
mucosal abnormality of the lower esophagus known as Schatzki ring.
• Hoarseness preceding dysphagia usually is of laryngeal origin; however,
when it follows, the onset of dysphagia involvement of the recurrent
laryngeal nerve by cancer should be considered.

• History:
– Location
• Symptoms located in the lower part of the sternum are most likely due to
abnormality in the distal esophagus. Otherwise, subjective localization of
dysphagia is infrequently helpful.
• Hiccups can reflect a lesion in the distal esophagus caused by
diaphragmatic irritation, or gastric or esophageal distention from
aerophagia.

• History:
– Characteristics
• Unintended weight loss may suggest carcinoma, particularly in those with
heavy tobacco and alcohol use, and those with long-standing acid reflux.
• Tracheobronchial aspiration may occur in those with tracheoesophageal
fistula, brainstem neuromuscular diseases, achalasia, or severe
gastroesophageal reflux.
• Previous chronic heartburn associated with dysphagia is usually present in
peptic strictures. These individuals may describe chronic antacid use.
• Chest pain may occur in those with severe reflux, accounting for half of
the noncardiac chest pain.
• Odynophagia is frequently related to esophageal infections or pill ulcers.

• Physical Examination:
– Oral pharyngeal examination looking for evidence of thrush or lesions
of pemphigus or epidermolysis bullosa.
– Examination of the neck may reveal structural defects such as
thyromegaly, spinal deformity, and neck masses.
– Skin examination is important for features of collagen vascular disease
including scleroderma or CREST syndrome (Calcinosis, Raynaud
phenomenon, Esophageal dysmotility, Sclerodactyly, and
Telangiectasias), which is associated with dysphagia and impaired
peristalsis.

Differential Diagnosis

Differential Diagnosis
• Infections including candidal, herpetic, or other viral
esophagitis must be considered in patients who
describe odynophagia, are debilitated, or
immunosuppressed.
• Acute odynophagia can be secondary to esophagitis
or ulcers from pills such as tetracycline, potassium
tablets, bisphosphonates, ferrous sulfate, quinidine,
and nonsteroidal anti-inflammatory agents (NSAIDs).

Diagnostic Testing
• When esophageal dysphagia is suspected, endoscopy is the initial
test to visualize the mucosa directly with biopsy of suspicious
lesions.
• Barium swallow can be used in cases with high risk for sedation,
patient anxiety, and anticoagulation concerns to identify structural
defects.
• Modified barium swallow is used to evaluate real-time swallowing
mechanisms to identify oropharyngeal dysmotility and aspiration.
• Laryngoscopy can identify oropharyngeal lesions.
• Esophageal manometry is the test of choice when esophageal
motor disease is suspected.

Treatment
• Gastroesophageal reflux disease should be treated with
proton pump inhibitors.
• Esophageal strictures or rings can be treated with endoscopy
by bougienage (the passage of dilators with or without
guidewire assistance) or balloon dilators.
• Achalasia can be treated with the following:
– Pneumatic dilatation via fluoroscopic and endoscopic visualization.
– Heller myotomy (surgical procedure that dissects the smooth muscle
of the hypertensive lower esophageal sphincter).
– Botulinum toxin injection can be used for those at high risk for other
interventions.

Treatment
• Odynophagia may be treated symptomatically with opioid
analgesic agents or topical viscous lidocaine.
• Pill ulcers (drug-induced esophagitis) are generally self-
limited.
• Infectious causes of odynophagia should be treated with
appropriate antimicrobials.

LO 5
THE DISEASE OF ORAL CAVITY
MOUTH ULCERS
Mouth ulcers
• Sores or open lesions in the mouth
• Causes: Canker sores, Gingivostomatitis,
Herpes simplex (fever blister), Leukoplakia,
Oral cancer, Oral lichen planus, Oral thrush,
Histoplasmosis
• General symptoms: open sores, pain or
discomfort
http://umm.edu/health/medical/ency/articles/mouth-ulcers
Mouth ulcers
• Signs and tests: Based on its appearance and
location. Blood tests or a biopsy of the ulcer to
confirm the cause.
• Treatment – to relieve symptoms & treat the cause:
– Gentle, thorough oral hygiene.
– Topical (rubbed on) antihistamines, antacids, or
corticosteroids to sooth the ulcers.
– Avoid hot or spicy foods, which often increase the pain of
mouth ulcers.
Mouth ulcers
• Complications
– Cellulitis of the mouth, from secondary bacterial
infection of ulcers
– Dental infections (tooth abscesses)
– Oral cancer
– Spread of contagious disorders to other people
CANDIDIASIS
Oral Candidiasis
• Also known as “thrush" or oropharyngeal
candidiasis
• A fungal infection that occurs when there is
overgrowth of a yeast called Candida.
• Can also grow in esophagus and develop
esophageal candidiasis
http://www.cdc.gov/fungal/diseases/candidiasis/thrush/definition.html
Symptoms of Oral Candidiasis
• White patches or plaques on the tongue and
other oral mucous membranes (most
common)
• Redness or soreness in the affected areas
• Difficulty swallowing
• Cracking at the corners of the mouth (angular
cheilitis)
People at Risk
• Age: <1 month, elderly
• Groups of people with weakened immune
systems: HIV/AIDS, Cancer treatments, Organ
transplantation
• Diabetes
• Corticosteroid use
• Dentures
• Broad-spectrum antibiotic use
Treatment
• Topical: clotrimazole troches and nystatin suspension
• Systemic: fluconazole or itraconazole may be necessary for
oropharyngeal infections that do not respond to these
treatments.
• Candida esophagitis is typically treated with oral or
intravenous fluconazole or oral itraconazole. For severe or
azole-resistant esophageal candidiasis, treatment with
amphotericin B may be necessary.
LEUKOPLAKIA
Leukoplakia
• White patch or plaque that cannot be rubbed off, cannot be
characterized clinically or histologically as any other condition,
and is not associated with any physical or chemical causative
agent except tobacco.
Etiology of Leukoplakia
• Most cases = idiopathic.
• In other cases, may depend on extrinsic local
factors and/or intrinsic predisposing factors.
• Factors most frequently blamed: tobacco use,
alcohol consumption, chronic irritation,
candidiasis, vitamin deficiency, endocrine
disturbances, and possibly a virus.
• Smoking: the combustion end-products brought
about by burning tobacco and heat (eg, tobacco
tars and resins) are irritating substances capable
of producing leukoplakic alterations of the oral
mucosa.
– Chronic exposure  benign keratosis in the hard
palate, called stomatitis nicotina  pale mucosa due
to slight increase in keratinization  the palatal tissue
is keratinized more heavily  nodules appear
(hyperplasia of the underlying glands, retention of
saliva, and fibrosis)
• Alcohol: May irritate the mucosa.
• Dental problems: Malocclusion; chronic cheek
biting; ill-fitting dentures; and sharp, broken-
down teeth that constantly irritate the
mucosa.
• Syphilitic glossitis have a higher prevalence.
• Candida albicans: common oral fungus.
• Deficiency of vitamins A and B: inciting factor.
Epidemiology of Leukoplakia
• International Frequency: <1%
• Mortality/Morbidity: potentially malignant,
transformation rate in various studies and
locations ranges from 0.6 to 20%.
• Sex: male-to-female ratio of 2:1.
• Age: fifth to seventh decade of life, ± 80% of
patients >40 yo.
3 Stages of Leukoplakia
• Earliest lesion: nonpalpable, faintly translucent,
white discoloration.
• Next: localized or diffuse, opaque white, fine
granular, and slightly elevated plaques with an
irregular outline develop.
• Late: lesions progress to thickened, white lesions,
showing induration, fissuring, and ulcer formation.
2 Main Groups of Leukoplakia
• Most common: uniformly white plaques (homogenous)
prevalent in the buccal mucosa, which usually have low
premalignant potential.
• Far more serious: speckled or verrucous leukoplakia, stronger
malignant potential, consists of white flecks or fine nodules
on an atrophic erythematous base. A combination of or a
transition between leukoplakia and erythroplasia, which is flat
or depressed below the level of the surrounding mucosal red
patch, is uncommon in the mouth, and carries the highest risk
of malignant transformation.
Diagnosis of Leukoplakia
• Biopsy:
– The plaque may show hyperorthokeratosis
(granular cell layer, nuclei lost in the keratin layer)
or hyperparakeratosis (No granular cell layer,
nuclei retained in the keratin layer).
– Acanthosis, which refers to the abnormal
thickening of the prickle cell layer (spinous layer),
may also be observed.
Treatment of Leukoplakia
• Medical care: surgical exicision, cryotherapy ablation and
carbon dioxide laser ablation
• Diet: discontinue the use of alcohol
• Medication:
– High-dose induction followed by low-dose systemic isotretinoin 
stabilization of the majority of lesions, preventing malignant changes,
no toxicity.
– Beta-carotene produced sustained remissions of leukoplakia, with a
durable response for at least 1 year.
– Both of these drugs have been used in experimental trials and must be
investigated in more depth.
LUDWIG’S ANGINA
Definition
• Ludwig's angina is an infection of the floor of the mouth
under the tongue. It is due to bacteria.
Alternative name:
• Submandibular space infection
• Sublingual space infection
MedlinePlus. Ludwig’s Angina. Updated 3/22/2013. Reviewed by

A.D.A.M. Health Solution, Ebix, Inc.
Causes
• Ludwig's angina is a type of skin infection that occurs on the
floor of the mouth, under the tongue. It often develops after
an infection of the roots of the teeth (such as tooth abscess)
or a mouth injury.
• This condition is uncommon in children.

Patophysiology
• Ludwig’s angina starts from a dental infection. Periodontal
infections are commonly caused by streptococcus and
staphylococcus organisms which are present in the mouth
even when the person is healthy.
• The bacteria travel and spread, it reaches the submandibular
and sublingual areas causing inflammation and swelling.
Because of the inflammatory response, the body produces
chemical mediators responsible for pain, erythema and
swelling. The infection and inflammation extends to adjacent
tissues such as the pharynx and neck. Patients typically
breathe through the mouth as a result of swelling of the
airways which causes airway obstruction.
swelling at submandibular region in ludwigs angina condition
Symptoms
The infected area swells quickly. This may block the airway or prevent from swallowing
saliva.
Symptoms include:
• Breathing difficulty
• Confusion or other mental changes
• Fever
• Neck pain
• Neck swelling
• Redness of the neck
• Weakness, fatigue, excess tiredness
Other symptoms that may occur with this disease:

• Difficulty swallowing
• Drooling
• Speech that is unusual and sounds like the person has a "hot potato" in the mouth
• Earache

Diagnosis
• Your health care provider will do an exam of your neck and
head to look for redness and swelling of the upper neck,
under the chin.
• The swelling may reach to the floor of the mouth. Your tongue
may be swollen or out of place.
• You may need a CT scan of the neck.
• Bacterial Culture. Fluid samples from the affected areas are
taken to determine specific microorganisms that cause the
infection. Almost half of the cases are caused by
streptococcus bacteria

Treatment
• Tracheostomy is a surgery that creates an opening through
the neck into the windpipe. It can restore breathing.
• Antibiotics are given to fight the infection. Antibiotics taken by
mouth may be continued until tests show that the bacteria
have gone away.
• Dental treatment may be needed for tooth infections that
cause Ludwig's angina.
• Surgery may be needed to drain fluids that are causing the
swelling.
• Steroid therapy

Prognosis
• Ludwig's angina can be life threatening. However, it can be
cured with getting treatment to keep the airways open and
taking antibiotic medicine.

Complication
• Airway blockage
• Generalized infection (sepsis)
• Septic shock

PAROTITIS
Parotitis
• Parotitis causes swelling in one or both of the
parotid glands (serous salivary glands that are
inside each cheek over the jaw in front of each
ear).
Etiology of Parotitis
• Varying depending on whether the condition is
chronic or acute:
– Bacterial infection due to staphylococcus, streptococcus, or
haemophilus
– Viral infection due to mumps or AIDS
– A blockage may block saliva flow and lead to a bacterial
infection. Causes include:
• Salivary stone in the parotid gland
• Mucus plug in a salivary duct
• Tumor—usually benign
– Sjogren’s syndrome—an autoimmune disease
Etiology of Parotitis
• Varying depending on whether the condition is
chronic or acute:
– Sarcoidosis
– Malnutrition
– Radiation treatment of head and neck cancer can lead to
parotid gland inflammation
– Other conditions can cause the parotid glands to become
enlarged, but not infected, including:
• Diabetes
• Alcoholism
• Bulimia
Risk Factors of Parotitis
• Factors that increase your chances of getting
parotitis include:
– Dehydration • Malnutrition
• Alcoholism
– Recent surgery
• Bulimia
– Increased age
– Depression
– Medical conditions, such as:
– Use of certain
• HIV-positive or AIDS
medications
• Sjogren’s syndrome
• Diabetes – Poor oral hygiene
Symptoms of Parotitis
• Infectious parotitis
– Acute bacterial parotitis: The patient reports
progressive painful swelling of the gland and
fever; chewing aggravates the pain.
– Acute viral parotitis (mumps): Pain and swelling
of the gland last 5-9 days. Moderate malaise,
anorexia, and fever occur. Bilateral involvement is
present in most instances.
• Infectious parotitis
– HIV parotitis: Nonpainful swelling of the gland
occurs; otherwise, patient is asymptomatic.
– Parotitis in tuberculosis: Chronic nontender
swelling of one parotid gland occurs, or a lump is
noted within the gland. Symptoms of tuberculosis
are found in some cases.
• Chronic punctate (autoimmune) parotitis
– Sjögren syndrome: Recurrent or chronic swelling
of one or both parotid glands with no apparent
cause is noted, frequently associated with
autoimmune disease, discomfort is modest in
most cases and is related to dry mouth and eyes.
• Diseases of uncertain etiology Recurrent
parotitis of childhood:
– Repetitious episodes of unilateral or bilateral
mumps like episodes in a young child are
indicative.
– Sarcoidosis: Chronic nontender swelling of parotid
gland occurs.
• Diseases of uncertain etiology Recurrent
parotitis of childhood:
– Chronic nonspecific parotitis: Most commonly,
patients experience episodes of painful parotid
inflammation that last for hours to weeks with
relative asymptomatic periods between. Pain
varies from mild to incapacitating.
Created by Samuel Freire da Silva, M.D. in homage to The Master And Professor
Delso Bringel Calheiros. Image obtained from Dermatology Atlas
Treatment of Parotitis
• Sialogogues, local heat, gentle massage of the
gland from posterior to anterior, and
hydration provide variable symptomatic relief.
• Culture of pus and sensitivity studies guide
antibiotic selection.
• Treatment of the primary disease (eg, HIV,
rheumatoid arthritis) is all that is required.
Treatment of Parotitis
• Intermittent irrigation of the ductal system
with saline, steroid solution, and/or an
antibiotic to treat the infection and
mechanically remove inspissated mucous or
pus from the ducts.
GLOSSITIS
Definition
• Glossitis is a problem in which the tongue is swollen and
changes color, often making the surface of the tongue appear
smooth.
• Geographic tongue is a type of glossitis.
• Alternative names: Tongue inflammation; Tongue infection;

Smooth tongue; Glossodynia; Burning tongue syndrome
MedlinePlus. Glossitis. Updated 3/22/2013. Reviewed by ADAM, Health

Solution. https://www.nlm.nih.gov/medlineplus/ency/article/001053.htm
Causes
Glossitis is often a symptom of other conditions, such as:
• Allergic reactions to oralcare products, foods, or medicine
• Dry mouth due to Sjogren syndrome
• Infection from bacteria, yeast or viruses (including oral herpes)
• Injury (such as from burns, rough teeth, or bad-fitting dentures)
• Skin conditions that affect the mouth
• Irritants such as tobacco, alcohol, hot foods, spices, or other
irritants
• Hormonal factors
At times, glossitis may be passed down in families.

Symptoms
• Problems chewing, swallowing, or speaking
• Smooth surface of the tongue
• Sore, tender, or swollen tongue
• Pale or bright red color to the tongue
• Tongue swelling
Rare symptoms or problems include

• blocked airway
• Problems speaking, chewing, or swallowing

Diagnosis
• Finger-like bumps on the surface of the tongue (called
papillae) that may be missing
• Swollen tongue (or patches of swelling)
• The health care provider may ask questions about your health
history and lifestyle to help discover the cause of tongue
inflammation.
• It may need blood tests to rule out other medical problems.

http://healthool.com/glossitis/
Treatment
• Good oral care. Brush your teeth thoroughly at least twice a
day and floss at least once a day.
• Antibiotics or other medicines to treat infection.
• Diet changes and supplements to treat nutrition problems.
• Avoiding irritants (such as hot or spicy foods, alcohol, and
tobacco) to ease discomfort.

Prognosis
• Glossitis goes away with if the cause of
problem is removed or treated.

Prevention
• Good oral care (thorough tooth brushing and flossing
and regular dental checkups) may help prevent
glossitis.

CARIES DENTIST
Definition
• Caries dentist or dental cavities are holes (or
structural damage) in the teeth.
MedlinePlus. Dental cavities. Updated 2/25/2014. Reviewed by

Verimed Healthcare Network.
Patophysiology
• Tooth decay is a common disorder, usually occurs in children
and young adults, but can affect any person.Tooth decay is a
common cause of tooth loss in younger people.
• Bacteria are normally found in your mouth. These bacteria
change foods -- especially sugar and starch -- into acids.
Bacteria, acid, food pieces, and saliva combine in the mouth
to form a sticky substance called plaque. It is most common
on the back molars.
• Plaque that is not removed from the teeth turns into a
substance called tartar or calculus. Plaque and tartar irritate
the gums, resulting in gingivitis and periodontitis

Patophysiology
• Plaque begins to build up on teeth within 20 minutes after
eating. If it is not removed, tooth decay will begin.
• The acids in plaque damage the enamel covering your teeth,
and create holes in the tooth (cavities). Cavities usually do not
hurt, unless they grow very large and affect nerves or cause a
tooth fracture.
• An untreated cavity can lead to a tooth abscess. Untreated
tooth decay also destroys the inside of the tooth (pulp) or
worse case removal of the tooth.

Symptoms
There may be no symptoms. If symptoms occur, they may
include:
• Tooth pain or achy feeling, particularly after sweet, hot, or
cold foods and drinks
• Visible pits or holes in the teeth

Diagnosis
• Most cavities are discovered in the early stages during routine
dental checkups.
• A dental exam may show that the surface of the tooth is soft.
• Dental x-rays may show some cavities before they are visible
to the eye.

Treatment
• Fillings
Fill teeth by removing the decayed tooth material with a drill and replacing it
with a material such as silver alloy, gold, porcelain, or composite resin.
Porcelain and composite resin more closely match the natural tooth
appearance.
• Crowns
Crowns or "caps" are used if tooth decay is extensive and there is limited
tooth structure, which may cause weakened teeth. A crown is fitted over the
remainder of the tooth.
• Root canals
A root canal is recommended if the nerve in a tooth dies from decay or injury.
The center of the tooth, including the nerve and blood vessel tissue (pulp), is
removed along with decayed portions of the tooth. The roots are filled with a
sealing material.

Treatment & Prognosis
• Treatment often saves the tooth. Treatment is less painful and
less expensive if it is done early.
• You may need numbing medicine (lidocaine) and prescription
pain medicines to relieve pain during or after dental work.
• Nitrous oxide with local anesthetic or other medicines may be
an option if you are afraid of dental treatments.

Complication
• Discomfort or pain
• Fractured tooth
• Inability to bite down on tooth
• Tooth sensitivity
• Tooth abscess

Prevention
• Oral hygiene is necessary to prevent cavities. This consists of
regular professional cleaning (every 6 months), brushing at
least twice a day, and flossing at least daily. X-rays may be
taken yearly to detect possible cavity development in high-risk
areas of the mouth.
• Fluoride is often recommended to protect against dental
caries. People who get fluoride in their drinking water or by
taking fluoride supplements have less tooth decay.
• Dental sealants can prevent some cavities. Sealants are thin
plastic-like coatings applied to the chewing surfaces of the
molars. This coating prevents the buildup of plaque.

ORAL CANCER
Definition
• Cancer is defined as the uncontrollable growth of cells that
invade and cause damage to surrounding tissue.
• Oral cancer appears as a growth or sore in the mouth that
does not go away which includes cancers of the lips, tongue,
cheeks, floor of the mouth, hard and soft palate, sinuses, and
pharynx (throat), can be life threatening if not diagnosed and
treated early.
WebMD Medical Reference

Reviewed by Michael Friedman, DDS on February 17, 2015
Symptoms
• Swellings/thickenings, lumps or bumps, rough spots/crusts/or eroded
areas on the lips, gums, or other areas inside the mouth
• The development of velvety white, red, or speckled (white and red)
patches in the mouth
• Unexplained bleeding in the mouth
• Unexplained numbness, loss of feeling, or pain/tenderness in any area of
the face, mouth, or neck
• Persistent sores on the face, neck, or mouth that bleed easily and do not
heal within 2 weeks
• A soreness or feeling that something is caught in the back of the throat
• Difficulty chewing or swallowing, speaking, or moving the jaw or tongue
• Hoarseness, chronic sore throat, or change in voice
• A change in the way your teeth
• Dramatic weight loss
• Earpain

Risk Factors
• Excessive consumption of alcohol. Oral cancers are about six
times more common in drinkers than in nondrinkers.
• Family history of cancer.
• Excessive sun exposure, especially at a young age.
• Human papillomavirus (HPV). Certain HPV strains are etiologic
risk factors for oropharyngeal Squamous Cell Carcinoma
(OSCC)
• Smoking. The smoker are six times more likely than
nonsmokers to develop oral cancers.

Diagnosis
• Oral cancer screening exam by dentist. Seeing an abnormal
tissue, look for any sores.
• Oral brush biopsy if the mouth looks suspicious. This test is
painless and involves taking a small sample of the tissue and
analyzing it for abnormal cells.

Treatment
• Oral cancer is treated the same way many other cancers are
treated -- with surgery to remove the cancerous growth,
followed by radiation therapy and/or chemotherapy (drug
treatments) to destroy any remaining cancer cells.

Prevention
• Don't smoke or use any tobacco products and drink alcohol in
moderation (and refrain from binge drinking).
• Eat a well balanced diet.
• Limit your exposure to the sun. Repeated exposure increases
the risk of cancer on the lip, especially the lower lip. When in
the sun, use UV-A/B-blocking sun protective lotions on your
skin as well as your lip
• Conduct a self exam at least once a month.
• See your dentist on a regular schedule.

THE DESEASE OF ESOPHAGUS
REFLUX ESOPHAGITIS
Definition
Gastroesophageal reflux:
• Gastroesophageal refers to the stomach and esophagus.
Reflux means to flow back or return. Therefore,
gastroesophageal reflux is the return of the stomach's
contents back up into the esophagus.
• Gastroesophageal reflux disease, or GERD, is a digestive

disorder that affects the lower esophageal sphincter (LES), the
ring of muscle between the esophagus and stomach.

Reviewed by Melinda Ratini, DO, MS on June 21, 2013
Causes
• Dietary and lifestyle choices may contribute to GERD.
• Certain foods and beverages, including chocolate,
peppermint, fried or fatty foods, coffee, or alcoholic
beverages, may trigger reflux and heartburn
• Studies show that cigarette smoking relaxes the LES. Obesity
and pregnancy can also play a role in GERD symptoms.

Symptoms
• Heartburn, also called acid indigestion, usually feels like a
burning chest pain beginning behind the breastbone and
moving upward to the neck and throat.
• Vomiting
• Dysphagia
• Coughing
• Other respiratory problems

Diagnosis
• Upper GI series X-ray shows the esophagus, stomach, and
duodenum (the upper part of the small intestine). While an
upper GI series provides limited information about possible
reflux.
• Endoscopy is an important procedure for individuals with
chronic GERD.
• For patients in whom diagnosis is difficult, doctors may
measure the acid levels inside the esophagus through pH
testing. Testing pH monitors the acidity level of the esophagus
and symptoms during meals, activity, and sleep.

Treatment
• Lifestyle and dietary changes.
• Avoiding foods and beverages that can weaken the LES is
often recommended. These foods include chocolate,
peppermint, fatty foods, coffee, and alcoholic beverages.
Foods and beverages that can irritate a damaged esophageal
lining, such as citrus fruits and juices, tomato products, and
pepper, should also be avoided if they cause symptoms.
• Eating meals at least 2 to 3 hours before bedtime may lessen
reflux by allowing the acid in the stomach to decrease and the
stomach to empty partially.
• Stopping smoking is important to reduce GERD symptoms.
(weaken LES)

Treatment
• Antacids can help neutralize acid in the esophagus and
stomach and stop heartburn.
• For chronic reflux and heartburn, the doctor may recommend
medications to reduce acid in the stomach. These medicines
include H2 blockers, which inhibit acid secretion in the
stomach. H2 blockers include: cimetidine (Tagamet),
famotidine (Pepcid), nizatidine (Axid), and ranitidine (Zantac).
• bethanechol (Urecholine) and metoclopramide (Reglan). will
increase the strength of the LES and quicken emptying of
stomach contents.

Surgery
• A small number of people with GERD may need surgery
because of severe reflux and poor response to medical
treatment. However, surgery should not be considered until
all other measures have been tried. Fundoplication is a
surgical procedure that increases pressure in the lower
esophagus. Endoscopic procedures that involve making the
LES function better or using electrodes.

Complication
• Esophagitis may cause esophageal bleeding or ulcers. Some
people develop a condition known as Barrett's esophagus.
This condition can increase the risk of esophageal cancer.

ACHALASIA
Achalasia
• A primary esophageal motility disorder characterized
by the absence of esophageal peristalsis and
impaired LES relaxation in response to swallowing.
The LES is hypertensive in about 50% of patients.
These abnormalities cause a functional obstruction
at the gastroesophageal junction.
• Signs and symptoms: Dyphagia (most common),

regurgitation, chest pain, heart burn, weight loss
http://reference.medscape.com/article/169974-overview
Pathophysiology of Achalasia
• LES pressure and relaxation are regulated by
excitatory (eg, acetylcholine, substance P) and
inhibitory (eg, nitric oxide, vasoactive intestinal
peptide) neurotransmitters.
• Persons with achalasia lack nonadrenergic,
noncholinergic, inhibitory ganglion cells, causing an
imbalance in excitatory and inhibitory
neurotransmission. The result is a hypertensive
nonrelaxed esophageal sphincter.
Diagnosis of Achalasia
• Physical examination & laboratory
studies are non-contributory
• Imaging studies:
– Barium swallow: The esophagus appears
dilated, and contrast material passes
slowly into the stomach as the LES opens
intermittently. The distal esophagus is
narrowed and has been described as
resembling a bird's beak.
https://globalgenes.org/raredaily/september-achalasia-awareness-month-
will-spread-awareness/
Diagnosis of Achalasia
• Other tests:
– Esophageal manometry is the criterion standard in helping
to diagnose the classic findings of achalasia. Findings
include:
• Incomplete relaxation of the LES in response to swallowing
• High resting LES pressure
• Absent esophageal peristalsis
– Prolonged esophageal pH monitoring is important for the
following reasons: To rule out (GERD) and to determine if
abnormal reflux is being caused by treatment
Treatment of Achalasia
• Goal: relieve symptoms by eliminating the outflow
resistance caused by the hypertensive and
nonrelaxing LES  food bolus can travel through the
aperistaltic body of the esophagus by gravity.
• Calcium channel blockers (nifedipine) and nitrates
(isosorbid dinitrate) are used to decrease LES
pressure, used primarily in elderly patients who have
contraindications to either pneumatic dilatation or
surgery.
Treatment of Achalasia
• Endoscopic treatment includes an intrasphincteric
injection of botulinum toxin to block the release of
acetylcholine at the level of the LES.
• Pneumatic dilatation via fluoroscopic and
endoscopic visualization.
• Laparoscopic Heller myotomy is considered by many
to be the appropriate primary treatment of patients
with achalasia
ESOPHAGEAL ATRESIA
Definition
• Esophageal atresia is a disorder of the digestive system in
which the esophagus does not develop properly. The
esophagus is the tube that normally carries food from the
mouth to the stomach.
• Alternative name: Tracheoesophageal fistula
MedlinePlus. Esophageal atreesia. Updated 9/1/2013. Reviewed by

ADAM, Editorial Team.
Epid & Causes
• Esophageal atresia occurs in about 1 out of 4,000 births.
• Esophageal atresia is a congenital defect, which means it occurs before
birth. There are several types. In most cases, the upper esophagus
ends and does not connect with the lower esophagus and stomach.
The top end of the lower esophagus connects to the windpipe. This
connection is called a tracheoesophageal fistula (TEF). Some babies
with TEF will also have other problems, such as heart or other
digestive tract disorders.
• Other types of esophageal atresia involve narrowing of the esophagus,
and may also be associated with other birth defects.

MedlinePlus. Esophageal atreesia. Updated 9/1/2013. Reviewed by ADAM, Editorial Team.
Symptoms
• Bluish coloration to the skin (cyanosis) with attempted
feedings
• Coughing, gagging, and choking with attempted feeding
• Drooling
• Poor feeding

Diagnosis
• Before birth, an ultrasound performed on the pregnant
mother may show too much amniotic fluid, which can be a
sign of esophageal atresia or other blockage of the digestive
tract.
• The disorder is usually detected shortly after birth when
feeding is attempted and the infant coughs, chokes, and turns
blue.
• An x-ray of the esophagus shows an air-filled pouch and air in
the stomach and intestine. If a feeding tube has been
inserted, it will appear coiled up in the upper esophagus.

Treatment
• Esophageal atresia is considered a surgical emergency.
Surgery to repair the esophagus should be done quickly after
the baby is stabilized so that the lungs are not damaged and
the baby can be fed.
• Before the surgery, the baby is not fed by mouth. Care is taken
to prevent the baby from breathing secretions into the lungs.

Prognosis
• An early diagnosis gives a better chance of a good
outcome.

Complication
• The infant may breathe saliva and other fluids into the lungs,
causing aspiration pneumonia, choking, and possibly death.
Other complications may include:
• Feeding problems
• Reflux (the repeated bringing up of food from the stomach)
after surgery
• Narrowing (stricture) of the esophagus due to scarring from
surgery
• Prematurity may complicate the condition.


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Vahabzadeh B, Early DS. Common gastrointestinal complaints. Available from:

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Vahabzadeh B, Early DS. Common gastrointestinal complaints. Available from:

Vahabzadeh B, Early DS. Common gastrointestinal complaints. Available from:

Vahabzadeh B, Early DS. Common gastrointestinal complaints. Available from:

Vahabzadeh B, Early DS. Common gastrointestinal complaints. Available from:

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• Alternative names: Tongue inflammation; Tongue infection;

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MedlinePlus. Glossitis. Updated 3/22/2013. Reviewed by ADAM, Health

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MedlinePlus. Dental cavities. Updated 2/25/2014. Reviewed by

MedlinePlus. Dental cavities. Updated 2/25/2014. Reviewed by

MedlinePlus. Dental cavities. Updated 2/25/2014. Reviewed by

MedlinePlus. Dental cavities. Updated 2/25/2014. Reviewed by

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MedlinePlus. Dental cavities. Updated 2/25/2014. Reviewed by

WebMD Medical Reference

WebMD Medical Reference

WebMD Medical Reference

WebMD Medical Reference

WebMD Medical Reference

WebMD Medical Reference

• Gastroesophageal reflux disease, or GERD, is a digestive

WebMD Medical Reference

WebMD Medical Reference

WebMD Medical Reference

WebMD Medical Reference

WebMD Medical Reference

WebMD Medical Reference

WebMD Medical Reference

WebMD Medical Reference

• Signs and symptoms: Dyphagia (most common),

• Alternative name: Tracheoesophageal fistula

MedlinePlus. Esophageal atreesia. Updated 9/1/2013. Reviewed by

MedlinePlus. Esophageal atreesia. Updated 9/1/2013. Reviewed by

MedlinePlus. Esophageal atreesia. Updated 9/1/2013. Reviewed by