Stomatitis Notes PDF

Introduction  You have finished looking at the common investigations and procedures which are done in GIT disorders.  We will now look at the management of patients with oral and oesophageal disorders, these include:  Simple Catarrhal Stomatitis, vincent’s...

Introduction  You have finished looking at the common investigations and procedures which are done in GIT disorders.  We will now look at the management of patients with oral and oesophageal disorders, these include:  Simple Catarrhal Stomatitis, vincent’s stomatitis, hepatic stomatitis, monilia stomatitis/ oral thrush, parotitis, achalasia, gastroesophageal reflux, hiccup.  OBJECTIVES Define stomatitis Describe the different types of stomatitis and its management Discuss oesophageal disorders and its management.  STOMATITIS Definition Stomatitis is a generalized inflammation in the mouth. Types of stomatitis There are different types of stomatitis and these are: Simple Catarrhal Stomatitis, vincent’s stomatitis, hepatic stomatitis, monilia stomatitis/ oral thrush, parotitis,  Simple Catarrhal Stomatitis  Simple catarrhal stomatitis is inflammation of the mucous membranes of the mouth with increased flow of mucus and exudates.  more in children than in adults. Causes Micro-organisms such as bacteria. Poor oral hygiene/neglected mouth. Hot foods/drinks. Wounds caused by foreign bodies in the mouth. Corrosion from strong acids or alkali. Systemic infection  Signs and symptoms Low grade fever. Dry mucus membrane. Sores in the mouth. Pain in the mouth especially when eating. Red mucus membrane. Loss of appetite and craving for cold drinks.  Treatment Antipyretics such as panadol. Mouth wash with antiseptics. Soft diet. Treat the existing condition if cause is systemic condition  VINCENT’S STOMATITIS Definition It is a severe inflammation of the mouth and gums. Vincent’s stomatitis is also considered as severe gingivitis. Cause Bacteria Poor oral hygiene Immunosuppresion  Signs and symptoms Pain in the mouth. Swelling of the affected parts. Bleeding from the gums. Redness of the mucous membrane. Bad taste Halitosis Fever due to infection Diagnosis Physical examination will reveal: Mouth and gum swelling Inflamed gums: Gum redness  Dental x-rays History taking Treatment Oral antibiotics such as penicillin, erythromycin. Antiseptic mouthwash Hydrogen peroxide rinses Regular brushing Professional dental cleaning.  HEPATIC STOMATITIS It is a contagious viral infection of the mouth that causes ulcers and inflammation. It is common in children Causes Herpes virus hominis Epstein-Barr virus Varicella zoster  Signs and symptoms Blisters in the mouth, often on the tongue or cheeks. Decrease in food intake, even when the patient is hungry Dysphagia Drooling Fever which may occur 1 - 2 days before blisters and ulcers appear. Irritability Pain in mouth Swollen gums Ulcers in the mouth, often on the tongue or cheeks -- these form after the blisters pop.  Diagnosis Diagnosis History taking Physical examinations Treatment Antiviral - acyclovir. Liquid diet which are cool-to-cold, nonacidic drinks. For severe pain give oral topical anaesthetic – lidocaine. Give with caution because it can interfere with swallowing and can possibly cause burns on the mouth or throat MONILIA STOMATITIS/ ORAL THRUSH It is a mouth infection which is caused by a yeast-like fungus (Candida albicans) Predisposing factors It commonly occurs in people with: Lowered immunity Prolonged use of antibiotics such as tetracycline and chloramphenicol because the normal floras of the mouth which usually keep fungi at bay are destroyed by antibiotics.  Signs and symptoms Lesion on the mucous membrane and on the gums which easily bleed when tempered with. Treatment Hydrogen peroxide and normal saline mouthwashes Clotrimazole tablets dissolved in the mouth five times/day Nystatin suspension or pastilles or amphotericin lozenges Fluconazole for oropharyngeal candidiasis Oral hygiene  PAROTITIS  Parotitis is inflammation of one or both parotid glands. Causes Bacterial infection- staphylococcus aureus. Mycobacterium, the bacteria that causes tuberculosis. Mumps virus. HIV Blockage of the main parotid duct, or one of its branches. Systemic infection Signs and symptoms Swollen and painful gland which is seen at the jaw angle.  Dry mouth Severe pain when swallowing. Purulent exudates from gland. Erythema Ulcers Fever Diagnosis History taking Physical examination- Enlarged gland will be seen on examination  Treatment Antibiotics Mouth washes Warm salty water rinses may be soothing and keep the mouth moist. Warm compresses Increase fluid intake If an abscess develops, drainage is necessary.  oesophageal disorders and its management. ACHALASIA It is a gastrointestinal tract condition which is characterised with lack of peristaltic movement in the esophagus and failure of relaxation of lower esophageal sphincter. resulting in the accumulation and stagnation of food and fluids in the esophagus causing irritation and inflammation of the esophagus.  Cause  The exact cause is unknown but it has been associated with degenerative changes or malfunctioning in the nerve plexus that innervates the esophageal muscle tissue  Signs and symptoms Progressive dysphagia. Regurgitation of undigested food. Weight loss, Halitosis caused by regurgitation of previously ingested food. Coughing when lying in a horizontal position. Chest pains that may increase after eating.  Diagnosis Barium swallow will show dilatation of the esophagus, lack of peristalsis. Esophagoscopy – will show dilatation of the lower esophageal sphincter. It can also show changes associated with cancer or presence of candida Oesophageal manometry – This will be done to measure muscle contractions in different parts of the esophagus during the act of swallowing. Manometry reveals failure of the lower oesophageal sphincter to relax with swallowing and lack of functional peristalsis in the smooth muscle oesophagus.  Biopsy, the removal of a tissue sample during endoscopy shows hypertrophied muscles and absence of certain nerve cells of the mesenteric plexus (network of nerve fibres that controls oesophageal peristalsis). Treatment Medication - include calcium channel blockers such as nifedipine and nitrates such as nitroglycerin to relax the lower esophagus sphincter. Balloon (pneumatic) dilatation – This procedure is done to dilate the esophagus at the point of narrowing. It involves inserting a balloon into the esophagus inside the lower esophageal sphincter to stretch the lower sphincter.  Surgery - Heller myotomy or cardiomyotomy (surgical division of the muscle of the lower end of the esophagus.  GASTROESOPHAGEAL REFLUX This is a condition in which there is backflow (reflux) of gastric and or duodenal content into the esophagus which is not associated with either vomiting or belching. is a GIT condition that results from abnormal regurgitation of gastric contents into the esophagus.  Cause It is usually caused by changes in the barrier between the stomach and the oesophagus, including Abnormal relaxation of the lower oesophageal sphincter. Anatomical abnormalities such as hiatus hernia( condition where the upper part of the stomach and the Lower Esophageal Sphincter move above the diaphragm).  Predisposing factors  The following factors can increase the chance of developing gastroesophageal reflux: Obesity: increasing body mass index is associated with more severe gastresophageal reflux. Zollinger-Ellison syndrome, which can be present with increased gastric acidity due to gastrin production. Pregnancy Smocking Hypocalcaemia, which can increase gastrin production, leading to increased acidity. Food such as sodas that contain caffeine, chocolates, spicies, acidic foods like oranges, fat foods. Alcohol consumption  Hiatus hernia Nasogastric tube placement for more than 4 days. Signs and symptoms Heartburn – burning sensation behind the breastbone and usually occurs after meals. This is accompanied by regurgitation. Pain – this originates in the chest and radiates to the neck and throat. Pain is caused by acid regurgitation. Dysphagia(difficulties in swallowing).  Less-common symptoms include: Odynophagia Nausea Coughing, hoarseness, or wheezing at night. Belching Flatulence  Diagnosis Esophagoscopy is often used to identify the cause and examine the oesophagus for damage. Barium swallow to evaluate esophageal damage as well. Continuous oesophageal pH monitoring to evaluate degree of acid reflux. Oesophageal manometry A positive stool occult blood test may diagnose bleeding from the irritation in the oesophagus.  Treatment  Life style changes Avoid foods that often cause symptoms e.g. Alcohol, Caffeine, Carbonated beverages, Chocolate, Citrus fruits and juices, Tomatoes.  Advise patient to lose weight if obese.  Raise head of the bed 6-8 inches and patient should avoid lying down 3 hours after taking a meal.  Advise patient to stop smoking  Eat slowly and and chew food thoroughly to reduce belching. Antiacid such as magnesium transilicate to neutralise the acid. Proton pump inhibitors are thethe most potent acid inhibitors e.g. omeprazole Proton pump inhibitors (PPIs) decrease the amount of acid produced the stomach.  Surgery - Nissen fundoplication – procedure to repair lower esophageal sphincter Repair a hiatus hernia Vagotomy (surgical removal of vagus nerve branches that innervate the stomach lining).  HICCUP Definitions A hiccup or hiccough is an esophageal contraction of the diaphragm that repeats several times per minute. A spasm of the diaphragm resulting in a rapid, involuntary inhalation that is stopped by the sudden closure of the glottis and accompanied by a sharp, distinctive sound.  Causes Hiccups are caused by many central and peripheral nervous system disorders, all from injury or irritation to the phrenic and vagus nerves, as well as toxic or metabolic disorders. Chemotherapy—which can include a huge amount of different drugs—has been associated with hiccups. Hiccups often occur after drinking carbonated beverages or alcohol or ingesting spicy food Prolonged laughter is also known to cause hiccups. Eating too fast can also cause the hiccups.  Treatment Ordinary hiccups are cured easily without medical intervention. However, there are a number of anecdotal treatments for casual cases of hiccups. Some of the common home remedies include giving the afflicted a fright or shock. Eating peanut butter, taking a teaspoon of vinegar, drinking water, holding one's breath and altering one's breathing patterns.  Hiccups are treated medically only in severe and persistent cases (termed "intractable“). Sedatives such as Diazepam and chlorpromazine are given  SUMMARY We have now finished discussing the conditions of the mouth and the esophagus, we talked about stomatitis which we defined as generalized inflammation in the mouth. We went on to mention the different types of stomatitis which are, Simple Catarrhal Stomatitis, vincent’s stomatitis, hepatic stomatitis, monilia stomatitis/ oral thrush, parotitis, achalasia, gastroesophageal reflux and hiccup  ASSIGNMENT State the common manifestations (signs and symptoms) of GIT conditions  REFERENCES 1. Phipps, W.J. et al., (2007). Medical-Surgical Nursing, C.V Mosby co., St Louis 2. Lewis, S.H., Heitkemper, M.M. & Dirksen, S.R. (2004). Medical Surgical Nursing: Assessment and Management of Clinical Problems. Mosby. St Louis.