1. DISORDERS OF THE MOUTH: May be dental or GI in origin Interferes with nutrition Caused By Poor dental hygiene Infections Inflammation Cancer

2. Peridontal disease Infection of the tissues (the gums) Attack just below the gum line Cause the attachment of the tooth and its supporting tissues to break down. Classified according to the severity Two major stages are gingivitis and periodnoitis Gingivitis may lead to more serious-peridonitis

3. Candidiasis (Thrush, Moniliasis) Fungus=Candida Albicans Found in small amounts in human intestinal tract. Normally kept in check, C. albicans can increase when balance is distrubed Causes thrush Also called Moniliaalbicans

4. Those susceptible Newborns People with Diabetes Mellitus People with leukemia Patients taking antibiotics People receiving Chemotherapy (Chemo Tx) or Radiation Therapy Alcoholics

5. Treatment: Nystatin/mycostatin. Done as a swish and spit administration 1 – 4 ml drops for newborn Nystatin or amphotericin B liquid or buccal tablets Use topical anesthesia 1 hr. a.c. GOOD hand hygiene & practices to stop spread in newborn nurseries

6. Cancer of the Mouth: Can occur anywhere on lips, tongue, pharynx, or oral cavity. Increased risk with ANY tobacco use Risk increase with sun-exposure Heavy drinkers and alcoholics also at increased risk Early detection important

7. Squamouscell epitheliomas Grows rapidly Metastasize quickly to adjacent structures if not detected early Tumors of this type largest % of oral cancers Cancer of anterior tongue & floor of mouth often occur together

8. Leukoplakia Pre-cancerous ulcer is white, firmly attached patch on tongue or buccal mucosa May appear on lips Can be benign or malignant Bx if lasting more than 2 weeks S/Sx: asymptomatic, but may develop chewing or swallowing difficulties, toothache, earache, sore throat.

9. Dx:Larnygoscopy, X-ray of jaw structures, Excisional Bx, Scraping & Cytology. Esp. important with hx of ETOH or tobacco abuse, dysphagia, male > 40yr. with above history. Tx: Depend on the staging of the cancer. Surgical removal of tongue, mandible, laryngectomy, muscles, nodes. Radiation Tx. Prognosis: Good if caught early, but survival <50%. Many complications.

10. DISORDERS OF THE ESOPHAGUS: Esophageal Cancer: Risk factors include ETOH & Tobacco Abuse, Achalasia, Chronic Irritation, Barrett’s Esophagus Tx is often comfort and control, not cure Cancers of bronchus, stomach, breast metastasize to this site Can invade/extend to heart & lungs. Usually men 55 -70 yr.

11. Epithelial Neoplasm Squamous cell or adenocarcioma that has invaded esophagus Adenocarcioma is type in 30-70 % Associated with ETOH and Tobacco Abuse Usually at late stage when discovered

12. S/Sx: Progressive dysphagia as though food is stuck, vomiting, hoarse voice, chronic cough, weight loss. Diagnostic Tests: Barium swallow, Endoscopy, Biopsy, CT scan and/or MRI. Treatment: Surgery, Radiation Tx, Chemotherapy. Surgery and Radiation Tx can be either a treatment or palliative measure. Surgery involves resection of esophagus and attachment to stomach/intestines.

13. Treatment (cont.) Assess for esophotracheal fistula – aspiration and respiration problems will occur. Pt. may need GT tube placed if unable to swallow and maintain nutritional intake. Poor prognosis related to late detection of tumor.

14. Achalasia (Cadiospasm): Inability of cardiac sphincter/LES to relax. Little or no food enters the stomach. “Won’t go down.” Distal end of the esophagus dilates and looses peristalsis. Cause not known. S/Sx:Dysphagia, Food Regurgitation, Weight Loss, Weakness, Decreased Skin Turgor.

15. Tx: Diagnosed with X-rays and esophagoscopy Forceful dilation of narrowed areas. May do Cardiomyotomy – incision of muscle layer(s). Meds: Used to decrease pressure in lower esphageal sphincter (LES)/cardiac sphincter; includes Anticholinergics, Nitrates, Calcium channel blockers. Nutrition: Increase protein, High caloric diet, Increased fiber, HOB each HS, avoid constipation.

16. EsophagealVarices: Complication of Liver Disease. Related to portal circulation hypertension. Dilation of veins of lower esophagus. VERY susceptible to rupture, bleeding, ulceration, hemorrhage. May be painless bleeding Medical emergency.

17. Treatment: Goal is to stop the bleeding. Vasopressin drip (ADH that elevates B/P) Tube with inflatable balloon to compress ruptured veins - suction applied. Gastric lavage with iced saline solution. Endoscopic sclerotherapy. To decrease portal HTN – shunt blood from portal vein to inferior vena cava.

18. GERD (Gastroesophageal Reflux Disease): Lower esophageal sphincter (LES) …leaks, causing digestive fluids and stomach acid to “back up”. Irritates the esophagus Damage the delicate lining on the inside of the esophagus Frequent heartburn (pyrosis)…occurs after meals.

19. Uncomfortable, rising, burning sensation behind the breastbone. Regurgitation of gastric acid or sour contents into the mouth, difficult and/or painful swallowing, and chest pain. Goals of Treatment: Relieve GERD symptoms Heal any damage to esophagus. Most effective is to reduce amount of stomach acid going back up into esophagus.

20. Signs and Symptoms: Cough- Nocturnal, Wheezing, Hoarseness Heartburn/Epigastric, Substernal, Retrosternal Burning Pain. Regurgitation without nausea or erutation (belching). Dysphagia or Odynophia. Mild/Infrequent GERD – s/sx x2/week or less. Mild cases are dx by classic symptoms and treated on that basis.