390 likes | 472 Views
Diseases of the Mouth & Salivary Glands. Causes of Oral Ulceration. Aphthous : Idiopathic Pre-menstrual Infection : Fungal e.g. Candidiasis Bacterial e.g. Vincent ’ s angina, Syphilis Viral e.g. herpes simplex GIT diseases: Crohn ’ s disease Celiac disease
E N D
Diseases of the Mouth & Salivary Glands
Causes of Oral Ulceration • Aphthous: • Idiopathic • Pre-menstrual • Infection: • Fungal e.g. Candidiasis • Bacterial e.g. Vincent’s angina, Syphilis • Viral e.g. herpes simplex • GIT diseases: • Crohn’s disease • Celiac disease • Dermatological conditions: • Lichen planus dermatitis herpetiformis • Pemphiguserythemamultiformi • Pemphegoid
Causes of Oral Ulceration - cont. • Drugs: • Hypersensitivity e.g. Steven’s Johnson syndrome NSAID losartan ACE inhibitor cytotoxic • Systemic diseases: • SLE • Behcet’s disease • Neoplasia: • Carcinoma • Leukemia • Kaposi’s Sarcoma
Chronic oral candidiasis Acute oral candidiasis
Angular Stomatitis & atrophic glossitis in patient with IDA Angular Stomatitis
Gastro-Esophageal Reflux Disease
Definitions • Gastro-Esophageal Reflux Disease (GERD): • It is a chronic disorder which describes any symptomatic or histopathologic alteration resulting from episodes of gastro-duodenal reflux into the esophagus and/or adjacent organs more than twice/week for more than 2 months
ERD Erosive Reflux Disease 1/3 NERD Non Erosive Reflux Disease 2/3 Definitions
Symptoms • Typical: • Heartburn • Acid regurgitation • > 2x/week • > 4 to 8 weeks
Esophageal: Non-cardiac chest pain Non-obstructive dysphagia Globus hystericus Pulmonary: Asthma Chronic cough Hemoptysis Bronchitis Bronchiectasis Recurrent pneumonia Symptoms-Atypical
Otorhinolaryngological: Hoarseness Throat cleaving laryngitis Sinusitis Otolagia Oral Etching of dental enamel Halitosis Symptoms-Atypical
Increasing Prevalence: • 197615% • 198844%
Pathogenesis • Transient lower esophageal sphincter (LES) relaxation • Hypotensive LES • Delayed Esophageal clearance • Delayed gastric emptying • Salivary function • Tissue resistance
1-History • Age • Alarm features • Dysphagia • Odynophagia • Weight loss • GI bleeding • Nausea &/or vomiting • Family history of cancer • Nocturnal reflux
Indications: Age over 40 years-old Alarm features Atypical symptoms Useful in: Grading Hiatus hernia Ulcer or stenosis Barrett’s Esophagus Endoscopy -ve endoscopy is seen in 2/3 of GERD
24 hrs pH Recording • Indications: • Atypical symptoms • NERD who do not respond to PPI • When esophagitis is not demonstrated in the pre-operative endoscopic examination . IMPEDANCE testing
Symptoms Antacids/Alginates Proton pump inhibitor Full dose Good response Poor response Proton pump inhibitor Maintenance dose Reconsider diagnosis Consider pH Monitoring H2 receptor Antagonists Normal Fundoplication Antacids
Behavioral modifications in the treatment of GERD • Elevation of the headboard of the bed (15 cm) • Ingestion of the following foods in moderation & based on symptom correlation: fatty foods, citrus, coffee, chocolate, alcoholic & carbonated beverages, mint, tomato-based products.
Behavioral modifications in the treatment of GERD • Special care with at risk medications: anticholinergics, theophylline, tricyclic antidepressants, Ca channel blockers, B-Adrenergic agonists, alendronate. • Avoidance of lying down for 2 hrs after meals • Avoidance of large meals • Drastic reduction in, or cessation of, smoking. • Reduction of body weight if overweight
Surgical treatment • Indications: • No response to medical treatment including atypical symptoms. • Continuous maintenance treatment is required especially in patients younger than 40 year old. • Financial impediment
Complications • Barrett’s esophagus • Stenosis • Ulcer • Bleeding