Upper GI (Oral Cavity & Oesophagus) PDF Lecture Notes, Jan 2024

Jan 01, 2024 Copyright (C) 2020. School of Health Sciences. IMU For internal circulation in the IMU University ONLY Inspire Empower Elevate  At this end of this l...

Jan 01, 2024 Copyright (C) 2020. School of Health Sciences. IMU For internal circulation in the IMU University ONLY Inspire Empower Elevate  At this end of this lesson, you will be able to: Lesson Outcomes Describe the normal anatomy and physiology of the upper gastrointestinal tract: oral cavity, esophagus and stomach Explain the aetiology, pathophysiology and clinical manifestations of oral infections and impaired taste, dysphagia, gastroesophageal reflux disease, gastritis, peptic ulcer disease and gastric surgery 2  Definition/ Terminology (1) Digestion: The process by which food is converted into substances that can be absorbed and assimilated by the body. This process is accomplished in the alimentary canal by the mechanical and enzymatic breakdown of foods into simpler chemical compounds. Absorption: Occurs when nutrients are taken into body often via bloodstream Excretion: Removal of waste product passing through anus  Definition/ Terminology (2) Enzyme A catalyst is a substance that accelerates (speeds up) a chemical reaction without being permanently changed or consumed itself. Digestive enzyme A digestive enzyme serves as a catalyst, aiding in digestion. Enzymes are manufactured in the salivary glands of the mouth, in the lining of the stomach, in the pancreas, and in the walls of the small intestine. Stages In Digestive Process 6 GI SYSTEM https://youtu.be/08VyJOEcDos Components of Digestive Systems MAIN: OTHER ACCESSORY ORGANS: Mouth Teeth Pharynx Tongue Esophagus Salivary Glands Stomach Gall Bladder Small intestine Liver Large intestine Pancreas ORAL CAVITY & OESOPHAGUS NORMAL ANATOMY AND PHYSIOLOGY AETIOLOGY, PATHOPHYSIOLOGY AND CLINICAL MANIFESTATIONS – ORAL INFECTIONS, IMPAIRED TASTE, DYSPHAGIA AND GASTROESOPHAGEAL REFLUX DISEASE 9 Oral cavity and In the mouth, teeth, jaws and the oesophagus – tongue begin the mechanical Anatomy & breakdown (tearing, grinding, chewing, mashing, mixing) of food into smaller Physiology (1) particles to facilitate swallowing and increase surface area. The presence of food in the oral cavity triggers a nervous reflex that causes the salivary glands to deliver saliva through ducts to the oral cavity. 10  Oral cavity and oesophagus – Anatomy & Physiology (2) Saliva contains a slippery glycoprotein (carbohydrate–protein complex) called mucin, which protects the lining of the mouth from abrasion and lubricates food for easier swallowing. Saliva also contains buffers that help prevent tooth decay by neutralizing acid in the mouth. Antibacterial agents in saliva kill many of the bacteria that enter the mouth with food 11 Oral cavity and oesophagus – Anatomy & Physiology (3) Chemical breakdown of starch by production of salivary amylase from the salivary glands. Starch & glycogen → polysaccharides disaccharide maltose Salivary amylase The tongue manipulates food during chewing and swallowing. The tongue tastes food then shape food into a ball called a bolus. Click HERE for video: During swallowing, the tongue pushes a bolus to the back of the oral cavity and into pharynx. With peristalsis, food will be moved throughout oesophagus, and then reach stomach. https://youtu.be/eLvfzyZNnVw  Oral Infection - Aetiology, Pathophysiology & Clinical Manifestations Glossitis Angular stomatitis, chelosis Gingivitis with gingival bleeding Deficiency of riboflavin, niacin, Deficiency of riboflavin, niacin, biotin, Deficiency of vitamin C biotin, vitamin B6, vitamin B9, vitamin B6, and iron Inflammation of the gums vitamin B12, iron and zinc An inflammatory lesion at corner of the surrounding the teeth Inflammation or infection of the mouth, and often occurs bilaterally (on May also present with gingival tongue both corners) bleeding Manifests as swollen tongue with a Manifests as deep crack or splits. In change in colour (Papillae may be severe cases, the splits can bleed when atrophied – atrophic glossitis/ slick the mouth is opened and shallow tongue) ulcers or a crust may form  Impaired Taste - Aetiology & Pathophysiology Dysgeusia Condition of altered or impaired sense of taste Ageusia Inability to taste or “mouth blindness” Affected by many clinical conditions Patients undergoing treatment for cancer relate changes in taste and smell Diseases of the tongue and palate Nervous system diseases (transmission of sensory) Certain medications (e.g. methotrexate used for cancer and autoimmune diseases)  Upper GIT disorders – Gastroesophageal Reflux Symptoms or complications resulting from the reflux of stomach contents up into the esophagus or beyond, into oral cavity or lung Impaired lower esophageal sphincter (LES) function Gastroesophageal Reflux Disease (GERD) - Clinical Manifestations Prolonged erosive disease ❑ Oesophagitis ❑ S carring ❑ Oesophageal ❑ S t r icture erosions ❑ Dysphagi a ❑ Ulceration Long-standing reflux ❖ B ar rett’s oesophagus (cells lining distal oesophagus become abnormal/ premalignant) Presence of gastric mucosa in the lower oesophagus ❖ 5 -15% with GERD develop Barrett’s oesophagus Gastroesophageal Reflux Primary medical treatment objectives: Disease (GERD) - Medical & – INCREASE LES COMPETENCE, REDUCTION OF Surgical Treatment ACID SECRETION, IMPROVE CLEARANCE Medications Medical Diagnosis: Presence of 1. Proton pump inhibitors - ↓ acid production by gastric parietal cells associated symptoms and their 2. H2 receptor antagonists & antacids relief after prescription and use of a proton pump inhibitor 3. Prokinetic agents – promote gastric emptying (PPI), and further diagnosis Others (Lifestyle) endoscopy (biopsy/ barium X- To reduce weight if obese, and to reduce tobacco as it: rays optional) ↓LES pressure, hence compromises GI integrity ↑risk of oesophageal/other cancers 18 Gastroesophageal Those unresponsive to primary treatment: Reflux Disease Fundoplication (fundus of stomach is wrapped (GERD) around lower oesophagus to limit reflux - Medical & Surgical Treatment Other treatment options: Partial fundoplications Roux-en-Y gastric bypass 19 Expandable device around the LES 20  POP QUIZ https://forms.office.com/r/ ajyxhJ1E21 If you encounter issue to scan the code or click the link, please go to Elearn portal and access under Quiz KNOWLEDGE CHECK # 1 Copyright reserved  2020, IMU. All rights  References 1. Marieb, E. N. and Hoehn, K. (2018) Human Anatomy and Physiology, 11th edition, Hoboken, New Jersey: Education, Inc. 2 Nelms, M. N., Sucher, K. and Lacey, K. (2020) Nutrition Therapy and Pathophysiology, 4th edition, Boston, MA, USA: Cengage Learning. ISBN: 9780357041710,2018965075 3.Krause and Mahan Nutrition care process , 2023 Janice Raymond Kelly Morrow 978-0-323-81025-8 16th Edition ,Elsevier, Inc.. 4. Nieman DC (2019). Nutritional Assessment. 7t editionh. McGraw Hill, New York Inspire Empower Elevate  Thank you. 1 Dr. Yang wai Yew ,A/P Dr Snigdha Misra and Dr Megan Chong for sharing their previous slides IMU Education Sdn Bhd No. 126, Jalan Jalil Perkasa 19 199201005893 (237397-W) Bukit Jalil, 57000 Kuala Lumpur, Malaysia 603 8656 7228 Insert footnotes here (if any). Formerly known as International Medical University. imu.edu.my