Upper GI Disorders
What structures make up the upper GI
from mouth to stomach
identify aphthous ulcers (physical description and clinical manifestion)
Up to 66% of the population is affected
can be single or multiple, they are rounded, flat, painful
they interupt eating, drinking, and oral hygiene
risk factors associated with acquiring xerostomia
can be caused by many different diseases and side effects of many medications
Key points to remember:
Stomatitis patient care:
patients are at risk of aspiration; have suction equipment at the ready, keep head of bed elevated
ensure medications are given as ordered, especially pain meds and antibiotics
Leukoplakia manifests as...
raised white clocks
Define stomatitis
it is an inflammatory condition that affect the oral mucosa, dentation (the arrangement of teeth, jaw, and bones)
Common cause of stomatitis
candidiasis (oral fungal infection, aka thrush)
Clinical manifestations of xerostomia
thickened or no saliva
Key points to remember:
Stomatitis patient self care
educate patient, make sure theyre using a soft bristle toothbrush, no alcohol-based mouth wash as it can be an irritant to them, encourage dentist visits regularly
Leukoplakia risk factors include
over 40 y.o.
2x as likely in men
Risk factors associated with stomatitis
viral, bacterial, and fungal infections
irritants such as alcohol, tobacco, and mouthwash
radiation therapy (usually starts 7-14 days after starting treatment; chemotherapy cause stomatitis, this usually peaks 6-12 days after last dose)
allergies to metal, medications, dental materials, cosmetics, foods
vitamin deficiencies
chronic kidney disease and inflammatory bowel disease can be linked to stomatitis
risk factors for candidiasis
radiation, chemotherapy, long term antibiotics, steroids, side affects of some meds, diabetes, poor oral hygiene
complications of xerostomia
difficulty eating, talking, swallowing, and tasting
Oral cancer epidemiology
Rises in cases in north america and western europe
70% of new cases are related to HPV
men are effected 2 to 4 times more likely than women, increases with age
malignancies of the lips are most common, these are related to the sun, alcohol consumption, pipe smoking and cigarette smoking
outcomes regarding lower lip are less favorable because they grow more rapidly and metastasize
Another type of pre-malignant lesion from oral cancer
erytheplakia (less common)
clinical manifestions of stomatitis
inflammation and ulcerations of the lining of the mouth (lips, pharynx, tongue, gums, esophogus, roof and floor of the mouth, the buechel mucosa, and along the GI tract
most common is tongue and buechal mucosa
sores are very painful and put patient at risk of bleeding
its often an open ulceration
clinical manifestation of candidiasis (thrush)
redness that can crack in the corners of the mouth, red smooth area near the middle of the tongue or a white coating on the tongue
treatment of stomatits
frequent assessments (especially is at risk of previous causes), oral mouth rinses
patients undergoing, chemo or radiation therapy need to be assessed more carefully and frequently as they are the most susceptible and good dental care pertinent to these patients
due to pain during eating and swallowing (ordinand dysphagia is painful swallowing), consult dietary to adjust their diet
Locations of Oral cancer
bottom of mouth
Clinical manifestations of erytheplakia
appear on the mucosal surface of the floor of the mouth, tongue, or palate, these lesions are red. there is increased vascularity and are velvety in appearance
complications of stomatitis
Risk of infections due to open sores, inadequate nutrition
may have recurrent aphthous ulcers (most common lesions in the oral cavity)
what is xerostomia and what does it increase the risk of?
dryness of the mouth
increases risk of candidiasis, which increases risk of stomatitis
Key points to remember:
Stomatitis assessments
thorough assessment;
vital signs, temperature can indicate an infection, an increased pulse and decreased blood pressure indicate a volume deficent.
physically look into mouth using flashlight; this inspection can indicate is treatment is effective or not
diet and nutrition, due to painful eating and swallowing, keep track of I&Os, keep a food log, consult dietary as needed to make adjustments, daily weight, if inadequate oral intake of fluids, they may need IV fluids
Type of pre-malignant lesion from oral cancer
leukoplakia is the most prevalent pre-malignant lesion, it is from long term irritation
Cancers of the oral cavity signs/symptoms
usually asymptomatic during early stages
as disease progresses you will see oral bleeding, raised area on the lips or in the mouth, oral ulcers with poorly defined margins, white or red patches in the mouth, pain with speaking, difficulty eating, weight issues, and suddenly poor fitting dentures.