Stomatitis: Types and Causes

• Disturbances in Ingestion is the topic

Stomatitis

• Stomatitis is an inflammation of the mucosal membranes of the mouth.
• Severe stomatitis can lead to painful ulcerations, bleeding, and secondary infections.
• Development and classification into infectious and non-infectious stomatitis depends on several factors.

Herpetic Stomatitis

• Herpes simplex V-1 virus causes this condition.
• The virus causes a corrosive impact on tissues and a breakdown of infected cells.
• The infection begins as pin-head-sized vesicles that may eventually rupture and cause an ulcer.
• The ulcers frequently have a yellow-gray covering layer, and are painful, uneven in form, and distinctive.
• After the lesions heal, the virus enters a latent stage, traveling through the nerves to the nerve cells, and may reactivate and create symptoms if the person's immune system becomes compromised.
• Causes encephalitis linked to herpetic stomatitis through interactions between HSV-1 and Toll-like receptor 2 (TLR2).

Zoster Stomatitis

• Varicella zoster virus is the cause.
• Zoster stomatitis vesicles cluster on one side of the hard palate.
• The buccal mucosa, gingival tissue, and tongue are other tissues that contain vesicles.

Gangrenous Stomatitis or Noma

• Gangrenous stomatitis, also known as noma, is a focally damaging infection caused by the bacteria Bacteroides, Fusobacterium, and Borrelia vincentii.
• Another name for gangrenous stomatitis is Noma or "cancrum oris".
• Acute infection of the orofacial region's tissues affects people with impaired immune systems more often.
• There is a small, painful ulcer inside the mouth, typically affecting the gums or the inner cheeks.
• Ailments also includes fever, swelling, and foul-smelling breath.
• Management includes antibiotics, surgery, oral care/pain management, nutritional support, and hygiene and sanitation

Acute Necrotizing Ulcerative Gingivitis or Trench Mouth

• Trench mouth, also referred to as Vincent's angina, manifests as gingival necrosis, severe oral pain, and ulceration.
• An abrupt development of poor breath as well as ulceration and destruction of the gum tissue in the area in between the teeth, differentiates is as its own disease.
• Leukocytes, erythrocytes, fibrin, bacteria, and necrotic tissue can be found in the scrapings from necrotic ulcers.
• Other symptoms may include a fever and lymphadenopathy.
• It is linked to vitamin B and C deficiencies
• Symptoms of trench mouth include swollen, bleeding gums, painful ulcers on the gums, a grayish film on the gums, bad breath, a fever, and general malaise.
• Improving oral hygiene and antibiotics treat this condition.

Candidal Stomatitis

• Oral candidiasis is another name for candidal stomatitis.
• It can happen alone or in conjunction with systemic candidiasis in people with impaired immune systems.
• The virus's invasion may exhibit hyperplastic or erythematous symptoms or glossitis.
• Antifungal medications can come in the form of topical treatments via oral gels, lozenges, or mouthwashes, and systemic treatments: via oral antifungal pills being prescribed to treat the infection throughout the body.
• Good oral hygiene and managing underlying conditions is paramount

Aphthous Stomatitis

• Clear pathophysiology is lacking.
• It is thought to be related to the immune system's cell-mediated arm, which appears due to an increase of certain cytokines and T cells.
• It presents as round ulcers with a grayish foundation.
• The recurrence of aphthous ulcers is extremely frequent.
• Injuries or irritations, stress, hormonal changes, diet, and nutrition can cause Stomatitis.

Gastro-esophageal Reflux Disease (GERD)

• It's typical to experience some gastroesophageal reflux (the overflow of stomach or duodenal contents into the esophagus).
• The main cause is the lower esophageal sphincter's relaxation or inefficiency
• Clinical manifestations include pyrosis, dyspepsia, regurgitation, dysphagia, or odynophagia (pain when swallowing), Hypersalivation and esophagitis
• Signs could resemble a heart attack.

GERD Causes

• Incompetent LES
• Pyloric stenosis
• Motility disorder
• Diagnostics can include Endoscopy, 24 to 36 hr pH monitoring or Barium Swallow
• Symptoms: include Pyrosis, Dysphagia, Odynophagia, Sore throat, Dental erosions, Regurgitation or Hypersalivation
• The backward flow of GI contents injures the Esophageal mucosa
• Management: includes Elevating head of bed, avoiding eating or drinking 2 hours before bedtime, Eating a low-fat diet, Avoiding overeating or Caffeine, tobacco, beer, milk, Weight control or Medications

Hiatal Hernia

• When the esophagus' passageway through the diaphragm enlarges, the upper portion of the stomach tends to push up into the lower area of the thorax and a hiatus (or hiatal) hernia occurs.
• Women are more likely than men to have a hiatal hernia.
• Two types exist: paraesophageal (rolling) and sliding hernia.

Types of Hiatal Hernias

• Sliding Hernia (Type 1): occurs when the upper stomach and gastroesophageal junction have moved up and slide in and out of the thorax
• Rolling or Paraesophageal hernia occurs when all or part of the stomach pushes through the diaphragm next to the gastroesophageal junction Causes
• Esophageal muscle weakness caused by aging, congenital defects, obesity, trauma, persistent and intense pressure lead to esophageal muscle support decreasing.
• The protrusion of the stomach leads to the diagnois of Hiatal Hernia and can be diagnosed with a Barium swallow or Plain film.
• Medical management includes Medications: that act as Antacids, Antiemetics, Histamine H2 receptors or Proton pump inhibitors, or Surgical Procedures that result in Nissen fundoplication
• Nursing Management focuses on Relieving pain, Modifying the diet, or Promoting lifestyle changes
• Symptoms include heartburn, swallowing difficulty, dyspnea, chest pain abdominal pain, nausea and vomiting or belching.

Esophageal Diverticula

• An outpouching of mucosa and submucosa through a weakened area of the musculature.
• The Zenker's diverticulum, the most prevalent kind of diverticulum is three times more common in men than in women.
• It is also known as a pharyngoesophageal pulsion diverticulum or pharyngeal pouch.
• It takes place in the midline of the neck posteriorly through the cricopharyngeal muscle and people older than 60 are afflicted by it
• Diverticula can have hereditary causes or can arise from problems with the sphincters at either end Clinical manifestations of Esophageal Diverticula
• dysphagia, a sour taste in the mouth, a feeling of fullness in the neck, regurgitation of undigested food, gurgling noises after eating, nocturnal coughing, halitosis, or weight loss.

Esophageal Diverticula Causes

• Sac-like out pouching due to Esophageal weakness occurs in one or more layers of the esophagus
• Can lead to Food trapped in a diverticulum, Local abscess, or Esophageal perforation
• Excision and re anastomosis of esophageal mucosa, along with myotomy of the cricopharyngeal muscle, can repair the area.
• Nursing Care emphasizes care of the client with an NG tube, while making sure they are comforted and in no pain
• Observations of incision for evidence of leakage should be done using with liquids and dietary changes.

Achalasia

• Absent or inadequate peristalsis in the distal esophagus, resulting in the esophageal sphincter's inability to relax in response to swallowing.
• Esophageal dilatation in the upper chest eventually widens due to esophageal narrowing directly above the stomach.
• It can develop slowly, usually affects those who are 40 years of age or older.
• Researchers suspect it may be caused by a loss of nerve cells in the esophagus, viral infection or autoimmune responses or an inherited genetic disorder or infection.
• Causes: poorly understood due to the exact nature not being known, theories about what causes it exist.
• May lead to dysphagia, food regurgitation, non-cardiac chest or epigastric pain, heartburn, or secondary pulmonary complications
• It can be diagnosed with Xray, Barium Swallow, CT Scan, Endoscopy, or Esophageal manometry

Treatments for Achalasia

• Nursing Management focuses on the patient eating slowly and drinking fluids with meals
• Medical Managements can include Oral Calcium Channel Blockers, Botox, Pneumatic Dilation or Esophagomyotomy (Heller Myotomy) that cuts the affected muscle of the esophagus to allow a better passage of food and liquids from it into the stomach.

Nausea and Vomiting

• Vomiting is an automatic response that causes the stomach's contents to leave the body through the mouth
• They sense that you might vomit but aren't really vomiting, a sensation referred to as nausea
• Causes are often Chemotherapy, Gastroparesis, General anesthesia, Intestinal obstruction or Migraine or Morning sickness, Motion sickness, Viral gastroenteritis (stomach flu) or Vestibular neuritis
• Management and treatment consist of oral rehydrating solution to help Pregnant experiencing women with morning sickness eat some crackers, while Avoiding solid food until the vomiting episode has passed and taking Anti Emetics

Gastrointestinal Bleeding

• Symptom of a disorder in the digestive tract
• It may occur either in the upper or lower gastrointestinal tract
• The stool may look black or tarry.

Upper GI Bleeding

• Peptic Ulcer, Esophageal varices, Mallory-Weiss tears all lead to a bleeding upper GI tract.

Lower GI Bleeding

• Diverticular disease
• Inflammatory bowel disease (IBD)
• Tumors
• Colon polyps
• Hemorrhoids
• Anal fissures or Proctitis can all cause bleeding in the lower GI

Signs and symptoms, Diagnosis and Managements of GI Bleeding

• Signs and symptoms of Gastrointestinal Bleeding Manifest via- Hematemesis, Melena, Hematochezia, or Rectal bleeding, usually with stool
• It is tested for with Fecalysis, Upper endoscopy, Colonoscopy, Flexible sigmoidoscopy or Imaging tests
• Management can include Removal of polyps during a colonoscopy, administering of a Proton Pump Inhibitor (PPI) or Blood transfusions

Peptic Ulcer Disease

• Occurrence may also be known as a gastric, duodenal, or esophageal ulcer
• An excavation (hallowed area) known as a peptic ulcer can develop in the mucosal wall of the stomach, the pylorus, the duodenum, or the esophagus
• The mucous membrane erodes a specific region may penetrate all the way through the muscle layers or the peritoneum
• People between the ages of 40 and 60 are most likely to have it
• Familial tendency, Blood type, Stress, Type A personality, Alcohol, Caffeine, Fatty, spicy highly acidic foods, NSAIDs, H. Pylori or Zollinger-Ellison Syndrome (ZES)

Clinical Manifestations of Peptic Ulcers

• Dull gnawing pain or burning sensation at the mid epigastrium or at the back occurs, along with hematemesis (vomiting blood) or the passage of melena (black tarry stool).
• Severe, sharp upper abdominal pain has been reported, which may be referred to the shoulder along with extreme abdominal tenderness, nausea or vomiting or Hypotension

Complications of Peptic Ulcers

• Hemorrhage (15-20%)
• coffee ground emesis
• melena
• hematochezia or Perforation which leads to Sudden onset of severe abdominal pain, Diffuse abdominal tenderness along with a Boardlike abdomen, or distention
• obstruction which manifests as Fullness, Nausea or profuse vomiting of undigested food
• Assessment and diagnostics can include Upper endoscopy or Biopsy of the gastric mucosa , as well as a Urea breath test

Pathogenesis of Peptic Ulcers

• ASA & NSAIDs, H. Pylori gastritis and Hypersecretory states can lead to alterations in mucosal defense mechanisms
• These altercations can exacerbate Acid and pepsin secretion to lead to Ulceration

Comparison Between Gastric and Duodenal Ulcers

• GASTRIC ULCERS*
• *-**Predisposing Factors include Salycylates, Cigarette Smoking, Genetic inclinations and high levels of Stress
• Common at 40-60 years old
• There is a Severe Epigastric Pain that occurs Immediately after eating and is Not Relieved by Antacids
• The diagnosis is performed using, Upper GI series
• DUODENAL ULCERS*
• There high Acid Oversecretion rates due to Increased Gastrin Released
• common among 20 - 45 year olds
• Severe Epigastric Pain happens 2 to 3 hours after meals, that is Relieved by food or antacid (also present commonly with Night pain is common)

Medical Management of Peptic Ulcers

• Using the Vaccine HELIVAX that was approved by the FDA in 2003, can help with prevention and treatmen
• Care can include Dietary modification which reduces Stress, requires Rest, as well as the Cessation of Smoking
• The use of Pharmacologic Therapy, via Antibiotics & Bismuth salts, Antacids or H2 - receptors antagonist, as well as Proton pump inhibitors or Cytoprotective agents

Gastritis

• Inflammation of the gastric mucosa.
• It can be acute, lasting a few hours to a few days, or chronic, brought on by recurrent episodes of acute gastritis or persistent exposure to irritants.
• Causes: Consumption of food that is irritating, too seasoned, or infected with pathogenic bacteria; usage of Aspirin and other NSAIDs; excessive alcohol consumption and radiation therapy

Risk Factors for Gastritis

• Maligant or benign stomach ulcers, along with the bacteria Helicobacter Pylori, can all contribute to chronic gastritis and long-lasting stomach inflammation.
• In some cases, autoimmune conditions like pernicious anemia or dietary elements like coffee and dairy can contribute
• Symptoms can include abdominal discomfort, headache, nausea, anorexia, vomiting, or hiccupping
• Diagnosis is performed through endoscopic and histologic analysis
• Tests can be done to find H. Pylori

Nursing Management for Gastritis

• Reducing Anxiety
• Promoting Optimal Nutrition
• Promoting Fluid Balance
• Relieving Pain

Celiac Disease (Sprue)

• Malabsorption disorder caused by an autoimmune response to the consumption of products that contain protein gluten and may manifest at any age if the host is genetically predisposed.
• Risk factors can include if women are afflicted twice as often as men or if a familial risk component is present in the host.
• Those with heightened risk may include patients with Type 1 diabetes, Down syndrome, and Turner syndrome.

Causes and Symptoms

• Genetic inclination, gastrointestinal infections and the presence of gut bacteria are causes.
• It could also only happen after a surgical proceedure, during a pregnacy, during childbirth, during a viral infection or severe emotional stress.
• Symptoms include Anemia, usually from iron deficiency and Loss of bone density (osteoporosis) or softening of bone (osteomalacia)
• Also, may have Itchy, blistery skin rash (dermatitis herpetiformis), Mouth ulcers, Headaches, Fatigue or Joint pain.
• Findings includes medical history, signs, symptoms assessment, along with risk factors, serologic tests and endoscopic biopsy

Pathogenesis For Celiac Disease

• An autoimmune response to gluten products leads to epithelial cells lining the small intestines becoming inflammed causing mucosal villi becoming denuded.
• There is Loss of function in the host and of ability to to absorb both micronutrients and macronutrients
• Treatment consits of nutritional management consults that lead to specific dietary and pharmaceutical targets, along with guidance and support.
• This may lead to a need for systemic nutritional deficits.

Lactose Intolerance/Deficiency

• There is an inability to fully digest the sugar (lactose) in milk meaning that lactose in the food moves into the colon instead of being processed and absorbed.

Types Of Lactose Tolerance

• Primary Lactose Intolerance (the most common type), is caused when you start life producing enough lactase, only for it to fall off by adulthood.
• Secondary occurs when the small intestine production of Lactase decrease for various Reasons, such as: in illness, after injury or by a surgery involving the small intestines
• Congenital or Developmental Lactose Tolerance in born kids, happens due to a general lack of lactase that is passed from generation to generation

Risks and Symptoms

• Risk Factors include Increasing age, an Ethnicity, birth circumstances, Diseases in the small intestine, or Certain cancer treatments
• Symptoms -Include Diarrhea , general Nausea, with varying amounts of Vomiting in a normal case, plus stomach cramps and gas
• There is a high correlation between digestive issues after lactose consumption-Hydrogen breath test results, coupled with more precise Lactose tolerance tests are used to find it
• The pathogenesis stems from the small intestines being unable to produce lactase and absorb it throughout the Colon leading to Lactose which is undigested being pushed into the Colon where normal flora exist.