GASTROINTESTINAL SYSTEM BLOCK

PROBLEM 1
ALMIRA NABILA VALMAI
405130193

1. Anatomy of digestive system

LO

LO 1

ANATOMY OF DIGESTIVE
SYSTEM

Bibir & pipi

Pipi

Dens

Dens

Vaskularisasi Dens

Palatum &
Lidah

Otot Penggerak
Lidah

Otot
Penggerak
Lidah

Otot
Penggerak
Lidah

Vaskularisasi &
Persarafan Lidah

Kelenjar
Lidah

LO 2

PHYSIOLOGY OF
DIGESTIVE SYSTEM

The Digestive System

The primary function of the digestive
system is to transfer nutrients,
water, and electrolytes from the food
we eat into the bodys internal
environment.
There are four basic digestive
processes : motility, secretion,
digestion, and absorption.

 The digestive system consists of the

digestive tract plus the accessory
digestive organs.
The accessory digestive organs
include the salivary glands, the
exocrine pancreas, and the biliary
system , which is composed of the
liver and gallbladder.
The digestive tract wall has four
layer. From the innermost layer
outward, they are the mucosa, the
submucosa, the muscularis externa,

 Four factors are involved in

regulating digestive system
function :
1. Autonomous smooth muscle
function
2. Intrinsic nerve plexuses
3. Extrinsic nerves
4. GI hormones

Mouth
Entry to the digestive tract is through
the mouth or oral cavity. The opening
is formed by the muscular lips.
The palate , which forms the arched
roof of the oral cavity, separates the
mouth from the nasal passages.
The tongue, which forms the floor of
the oral cavity, is composed of
voluntarily controlled skeletal muscle.

 The first step in the digestive process

is mastication, or chewing, the
motility of the mouth that involves
the slicing,tearing, grinding, and
mixing of ingested food by the teeth.
Saliva, the secretion associated with
the mouth, is produced largely by
three major pairs of salivary glands
that lie outside the oral cavity and
discharge saliva through short ducts
into the mouth.

 The most important salivary proteins are

amylase, mucus, and lysozyme. They
contribute to the functions of saliva, which
are as follows :
1. Saliva begins digestion of dietary starches
through action of the enzyme salivary
amylase.
2. Saliva facilitates swallowing by moistening
food particles, there by holding them
together.
3. Saliva exerts some antibacterial action by
a fourfold effect-first, by lysozyme.

4. Saliva serves as a solvent for molecules

that stimulate the taste buds.
5. Saliva aids speech by facilitating
movements of the lips and tongue.
6. Saliva plays an important role in oral
hygiene by helping keep the mouth and
teeth clean.
7. Saliva is rich in bicarbonate buffers,
which neutralize acids in food and acids
produced by bacteria in the mouth.

 Salivary secretion is continuous and

can be reflexly increased.
On average, about 1 to 2 liters of
saliva are secreted per day.
Salivary secretion may be increased
by two types of salivary reflexes,
simple and conditioned.

Pharynx and Esophagus

The motility associated with the
pharynx and esophagus is
swallowing.
Swallowing actually is the entire
process of moving food from the
mouth through the esophagus into
the stomach.
The two stages of swallowing : the
oropharyngeal stage and the
esophangeal stage.

LO 3
HISTOLOGY OF DIGESTIVE SYSTEM

DIGESTIVE SYSTEM
Two groups of organs compose the
digestive system:
Gastrointenstinal (GI) tract or alimentary
canal mouth, most of pharynx,
esophagus, stomach, small intestine,
and large intestine
Accessory digestive organs teeth,
tongue, salivary glands, liver,
gallbladder, and pancreas
diFiore Atlas of Histology, 247

Histologic organization:
Mucosa:
Epithelium, lamina propria, muscularis mucosa
Submucosa:
connective tissue, vessels, and Meissners plexuses,
some times mucous glands
Muscularis externa: 2-3 layers of smooth muscle (plus
skeletal muscle in esophagus), myenteric (Auerbach)
plexus in between muscle layers
Serosa and adventitia: Outermost layer of loose
connective tissue and blood vessels. Call serosa if
covered my mesothelium; adventitia otherwise

mucosa

submuco

muscula

serosa

ORAL CAVITY
Inner surface of the lips, cheeks, soft
palate, surface of tongue, and floor of the
mouth
Nonkeratinized stratified squamous epithelium
Lamina propria
Submucosa

Gingiva and hard palate

Keratinized stratified squamous epithelium
Lamina propria

Tongue: specialized mucosa with papillae

THE LIP

THE TONGUE

Junquiera, L. C. (2013) Basic Histology text & Atlas, 13rd edn.

McGraw Hill, New York.

TONGUE PAPILLAE

There are four types:

fungiform

filliform

foliate

circumvall
ate

TASTE BUD

TEETH

ESOPHAGUS
Mucosa: non-keratinizing stratified
squamous
Submucosa: contains mucous glands
Increased mucous glands at lower esophagus
(GE junction) to protect esophagus from
gastric juices

Muscularis externa: inner circular and

outer longitudinal
Contains skeletal muscle fibers

Esophagus

Squamous
mucosa

Submuco
sa

Musculari
s Externa

Mucosa

Adventitia /
Serosa

Muscularis
mucosa

Lower esophagus

Upper esophagus

LO 4

BIOCHEMISTRY

Mouth
DIGESTION & ABSORPTION OF CARBOHYDRATES
Amylases Catalyze the Hydrolysis of Starch
The hydrolysis of starch by salivary and pancreatic amylases
catalyze random hydrolysis of (14) glycoside bonds, yielding
dextrins, then a mixture of glucose, maltose, and isomaltose (from
the branch points in amylopectin).
Disaccharidases Are Brush Border Enzymes
The disaccharidasesmaltase, sucrase-isomaltase (a
bifunctional enzyme catalyzing hydrolysis of sucrose and
isomaltose), lactase, and trehalaseare located on the brush
border of the intestinal mucosal cells where the resultant
monosaccharides and others arising from the diet are absorbed. In
most people, apart from those of northern European genetic origin,
lactase is gradually lost through adolescence, leading to lactose
intolerance. Lactose remains in the intestinal lumen, where it is a
substrate for bacterial fermentation to lactate, resulting in
discomfort and diarrhea.

LO 5

MOUTH INFECTION

a. Cleft lip and palate

Cleft lip and cleft palatebirth
defects that occur when a babys lip
or mouth do not form properly during
pregnancy

Sumber: http://www.cdc.gov/ncbddd/birthdefects/cleftlip.h

 Etiology:
- Changes in theirgenes
- A combination of genes and other
factors, such as things the mother
comes in contact with in her
environment, or what the mother
eats or drinks, or certain medications
she uses during pregnancy.

Sumber: http://www.cdc.gov/ncbddd/birthdefects/cleftlip.h

 Diagnosis: Routine ultrasound (during pregnancy)

Management & Treatment
Vary depending on the severity of the cleft; the
childs age and needs; and the presence of
associated syndromes or other birth defects, or
both.
- Surgery (cleft lip) first few months of life and is
recommended within the first 12 months of life.
- Surgery (cleft palate) first 18 months of life or
earlier if possible.
- Special dental or orthodontic care or speech
therapy.

Sumber: http://www.cdc.gov/ncbddd/birthdefects/cleftlip.h

b. Micrognathia &
macrognathia
1. Micrognathia a severely deficient jaw, most
commonly affects the mandible.
Types:
- Apparent micrognathia: this is not due to abnormality
of small jaw, in terms of size but rather due to an
abnormal positioning or abnormal relation of one jaw
to another, which produces illusion of micrognathia
- True micrognathia: it is due to small jaw. It is again
classified as:
a. Congenital
b. Acquired

Sumber: Textbook of Oral Medicine 3th edition, 2014

Etiology
Congenital:
- Congenital abnormalities: in
many instances, it is associated
with other congenital
abnormalities, particularly
congenital heart disease and
Pierre Robin syndrome (cleft
palate, micrognathia and
glossoptosis)
- Forceps delivery trauma: the use
of forceps on either side of the
head. If the joint, in this area,
called the temporomandibular
joint, is badly bruised, the
mandible does not develop

Acquired:

Ankylosis
Mouth breathing
Agenesis of condyle
Posterior positioning

Sumber: Textbook of Oral Medicine 3th edition, 2014

 Signs and Symptomps

- Short upper jaw
- Abnormal alignment of teeth

Sumber: Textbook of Oral Medicine 3th edition, 2014

 Management:
- Orthognathic surgery: recommended
treatment modality for micrognathia.
This surgery is followed by
orthodontic appliance to correct
malocclusion

Sumber: Textbook of Oral Medicine 3th edition, 2014

2. Macrognathia refers to the condition of

abnormally large jaws. It is also called as
megagnathia.
Etiology:
- Pituitary gigantism: there is generalized
increase in the size of entire skeleton
- Pagets disease of bone: overgrowth of
cranium and maxilla occurs
- Acromegaly: progressive enlargement of
mandible owing to hyperpituitarism in adults
Sumber: Textbook of Oral Medicine 3th edition, 2014

 Clinical features:
- prognathism: mandibular protrusion or proganthism is common
occurrence, which is due to disparity in the size of maxilla to
mandible and posterior positioning of maxilla in relation to the
cranium
- Mandible: mandible is measurably larger than normal. Increased
mandibular body length
- Gummy smile: in certain patients with congenital abnormalities,
there may be elongation of maxilla. There is much show when
the patient smiles, so that there is so-called gummy smile.
This is due to the upper jaw being too long
- Ramus: large ramus which forms less step angle with body of
mandible
- Chin: there is prominent chin button
Sumber: Textbook of Oral Medicine 3th edition, 2014

 Management:
- Osteotomy: resection of portion of
mandible to decrease the length,
followed by orthodentic treatment

Sumber: Textbook of Oral Medicine 3th edition, 2014

3. Leukoplakia
Leukoplakia patches on the tongue, in the mouth, or on the inside of
the cheek.

Etiology:
Rough teeth
Rough places on dentures, fillings, and crowns
Smoking or other tobacco use (smoker's keratosis), especially pipes
Holding chewing tobacco or snuff in the mouth for a long period of time
Drinking a lot of alcohol
The disorder is most common in elderly persons.
A type of leukoplakia of the mouth called hairy leukoplakia is caused by
the Epstein-Barr virus. It is seen mostly in persons withHIV/AIDS. It may
be one of the first signs of HIV infection. Hairy leukoplakia can also
appear in other people whose immune system is not working well, such
as after a bone marrow transplant.

Sumber: https://www.nlm.nih.gov/medlineplus/ency/article/001046.h

 Symptoms:
- Patches in the mouth usually develop on the tongue
(sides of the tongue with hairy leukoplakia)and on the
insides of the cheeks.
- Leukoplakia patches appear:
Usually white or gray
Uneven in shape
Fuzzy (hairy leukoplakia)
Slightly raised with a hard surface
Unable to be scraped off
Painful when the mouth patches come into contact with
acidic or spicy food

Sumber: https://www.nlm.nih.gov/medlineplus/ency/article/001046.h

 Exams and Tests

Abiopsy of the lesion
Treatment
The goal of treatment is to get rid of the leukoplakia patch. Removing the
source of irritation may cause thepatch to disappear.
- Treat dental causes such as rough teeth, irregular denture surface, or
fillings as soon as possible.
- Stop smoking or using other tobacco products.
- Do not drink alcohol.
- If removing the source of the irritation does not work, the doctor may
suggest applying medicine to the patch or using surgery to remove it.
- For hairy leukoplakia, taking antiviral medicine usually causes the patch
to disappear. The doctor may also suggest applying medicine to the
patch.

Sumber: https://www.nlm.nih.gov/medlineplus/ency/article/001046.h

 Prognosis
- Leukoplakia is usually harmless.Patches inthe mouthoften clear up
in a few weeks or months after the source of irritation is removed.
- Insome cases, the patches may be an early sign of cancer.

When to Contact a Medical Professional

Call for an appointment with your health care provider if you have
anypatches that look likeleukoplakia or hairy leukoplakia.
Prevention
Stop smoking or using other tobacco products. Do not drink alcohol,
or limit how many drinks you have. Have rough teeth treated and
dental appliances repaired promptly.
Alternative Names
Hairy leukoplakia; Smoker's keratosis

Sumber: https://www.nlm.nih.gov/medlineplus/ency/article/001046.h

Mouth Ulcers
Definition

Canker sores or mouth ulcers are normally small

lesions that develop in your mouth or at the base of
your gums. They are annoying and can make eating,
drinking, and talking uncomfortable. (*)

Etiology

Canker sores, Gingivostomatitis, Herpes simplex (fever

blister), Leukoplakia, Oral cancer, Oral lichen planus,
Oralthrush. (**)

Sign &
Symptoms

A painful sore or sores inside your mouth -- on

thetongue, on the soft palate (the back portion of the
roof of your mouth), or inside your cheeks
A tingling or burning sensation before the sores appear
Sores in your mouth that are round, white or gray, with
a red edge or border
In severe canker sore attacks, you may also
experience: Fever, Physical sluggishness, Swollen
lymph nodes (***)

Types of Mouth Ulcers

Simple canker sores.These may
appear three or four times a year and
last up to a week. They typically
occur in people between 10 and 20
years of age.
Complex canker sores.These are
less common and occur more often in
people who have previously had
them.

 Mouth ulcers also can be a sign of

conditions that are more serious and
require medical treatment, such as:
celiac disease (a condition in which the
body is unable to tolerate gluten)
inflammatory bowel disease (IBD)
Bechets disease (a condition that causes
inflammation throughout the body)
a malfunctioning immune system that
causes your body to attack the healthy
mouth cells instead of viruses and bacteria
HIV/AIDs

Treatments of Mouth Ulcers

TREATMENTS
using a rinse of
saltwater and baking
soda
covering mouth ulcers
with baking soda paste
using over-the-counter
benzocaine products like
Orajel or Anbesol
applying ice to canker
sores
using mouth rinse that
contains a steroid to
reduce pain and swelling

placing damp tea bags on

your mouth ulcer
cauterizing or burn sealing
the tissue with a chemical
cauterizer like silver
nitrate
taking nutritional
supplements like folic
acid, vitamin B6, vitamin
B12, and zinc
trying natural remedies
such as chamomile tea,
echinacea, myrrh, and
licorice
using oral steroids

Mouth Ulcers
Complication

Prevention

Cellulitis of the mouth,

from secondary bacterial
infection of ulcers
Dental infections (tooth
abscesses)
Oral cancer
Spread of contagious
disorders to other people

There are steps you can take to reduce

the occurrence of mouth ulcers.
Avoiding foods that irritate your mouth
can be helpful. That includes :
Acidic fruits like pineapple, grapefruit,
oranges, or lemon, as well as nuts,
chips, or anything spicy. Instead,
choose whole grains and alkaline
(nonacidic) fruits and vegetables.
Try to avoid talking while you are
chewing your food. Reducing stress and
maintaining good oral hygiene and
brushing after meals
Soft bristle toothbrushes and
mouthwashes that contain sodium
lauryl sulfate.

Oral Candidiasis
Definition A condition in which candida albicans accumulates
on the lining of your mouth. (*)
Symptom -Creamy white lesions on your tounge, inner cheeks,
s
and sometimes on The roof of your mouth, gums,
and tonsils
- A cottage cheese-like appearance
- Redness or soreness
- Slight bleeding
- Cracking and redness at the corner of your mouth
- A cottony feeling in your mouth
- Loss of taste (**)
-Some health conditions HIV/AIDS, cancer, DM,
Risk
Factors
vaginal yeast
Infections
- Undergoing chemotherapy or radiation treatment
for cancer
- Wearing dentures

Diagnosis

Limited to your mouth looking at the lesions

In your esophagus throat culture (swabbed with
sterile cotton), endoscopic exam (*)

Treatment - Patient with late-stage HIV infection amfotericin

B
- Practice good oral hygiene
- Try warm saltwater rinses. (**)
Preventio
n

Rinse your mouth

Brush your teeth at least twice a day and floss daily
Clean your dentures
See your dentist regularly
Watch what you eat
Maintain good blood sugar control if you have DM
Treat any vaginal yeast infections (***)

Glossitis
Definition

Glossitis is a problem in which the tongue is swollen

and changes color, often making the surface of the
tongue appear smooth. (*)

Etiology

Allergic reactions to oralcare products, foods, or

medicine
Dry mouth due to Sjogren syndrome
Infection from bacteria, yeast or viruses (including
oral herpes)
Injury (such as from burns, rough teeth, or badfitting dentures0
Skin conditions that affect the mouth
Irritants such as tobacco, alcohol, hot foods, spices,
or other irritants
Hormonal factors. (*)

Sign &
Symptoms

Problems chewing, swallowing, or speaking

Smooth surface of the tongue
Sore, tender, or swollen tongue

Treatmen
ts

Good oral care. Brush your teeth thoroughly at

least twice a day and floss at least once a day.
Antibiotics or other medicines to treat infection.
Diet changes and supplements to treat nutrition
problems.
Avoiding irritants (such as hot or spicy foods,
alcohol, and tobacco) to ease discomfort. (*)

Prognosis Good oral care (thorough tooth brushing and

flossing and regular dental checkups) may help
prevent glossitis(*)

Angina Ludwig
Ludwigs angina
Ludwig's angina is an infection of the floor of the
mouth under the tongue. It is due to bacteria.
Causes
Ludwig's angina is a type of skin infection that
occurs on the floor of the mouth, under the tongue.
It often develops after an infection of the roots of
the teeth (such as tooth abscess) or a mouth injury.
This condition is uncommon in children.

 Symptoms
The infected area swells quickly. This may block the airway or
prevent you from swallowing saliva.
Symptoms include:
-Breathing difficulty
-Confusion or other mental changes
-Fever
-Neck pain
-Neck swelling
-Redness of the neck
-Weakness, fatigue, excess tiredness
Other symptoms that may occur with this disease:
-Difficulty swallowing
-Drooling
-Earache
-Speech that is unusual and sounds like the person has a "hot
potato" in the mouth

Exams and Tests

health care provider will do an exam of neck and
head to look for redness and swelling of the
upper neck, under the chin.
The swelling may reach to the floor of the
mouth. Your tongue may be swollen or out of
place.
need a CT scan of the neck. A sample of the
fluid from the tissue may be sent to the lab to
test for bacteria.

Treatment
If the swelling blocks the airway. A breathing tube through your
mouth or nose and into the lungs to restore breathing. need to
have surgery called a tracheostomy that creates an opening
through the neck into the windpipe.
Antibiotics are given to fight the infection. Antibiotics taken by
mouth may be continued until tests show that the bacteria
have gone away.
Dental treatment may be needed for tooth infections that
cause Ludwig's angina.
Surgery may be needed to drain fluids that are causing the
swelling.

Prognosis
Ludwig's angina can be life
threatening. However, it can be cured
with getting treatment to keep the
airways open and taking antibiotic
medicine.
Prevention
Visit the dentist for regular checkups.
Treat symptoms of mouth or tooth
infection right away.

Parotitis
Parotitis is the name given to
inflammation and infection of the
largest of the salivary glands known
as the parotid glands. Inflammation
results in swelling of the tissues that
surround the salivary glands,
redness, and soreness.

etiologi

Infection
Drugs
Radiation
and various diseases
The signs and symptoms of parotitis : can
vary among individuals. Some people with
parotitis may not realize they have a disease,
while others may have severe swelling and
pain.

prevention
practicing good oral hygiene, drinking plenty of
fluids, washing your hands, and receiving the
MMR vaccine to prevent mumps.
Seek immediate medical care for serious
symptoms such as a high fever and difficulty
breathing or swallowing.
Seek prompt medical care if you are being
treated for parotitis but mild symptoms recur or
are persistent.

Caries dentis/ dental

cavities
Dental cavities
Dental cavities are holes (or
structural damage) in the teeth.

Sign & Symptoms

There may be no symptoms. If
symptoms occur, they may include:
Tooth pain or achy feeling,
particularly after sweet, hot, or cold
foods and drinks
Visible pits or holes in the teeth

Exams and Tests

Most cavities are discovered in the
early stages during routine dental
checkups.
A dental exam may show that the
surface of the tooth is soft.
Dental x-rays may show some
cavities before they are visible to the
eye.

Treatment
Treatment may involve:
Fillings
Crowns
Root canals

Prognosis

Need numbing medicine (lidocaine)

and prescription pain medicines to
relieve pain during or after dental
work.
Nitrous oxide with local anesthetic or
other medicines may be an option

Complications

Discomfort or pain
Fractured tooth
Inability to bite down on tooth
Tooth abscess
Tooth sensitivity

prevention
Oral hygiene is necessary to prevent
cavities. This consists of regular
professional cleaning (every 6
months), brushing at least twice a
day, and flossing at least daily.

Achalasia
Definition
a primary motor disorder of the esophagus characterized by insufficient lower esophageal
sphincter relaxation and loss of esophageal peristalsis
Classification
Divided into 2 parts:
primary achalasia -> neurotropic virus (nukleus dorsalis vagus,ganglia misentrikus)
secondary achalasia-> chagas diseases,interluminary tumor
Common symptoms
Difficulty in swallowing(dysphagia), chest pain and regirgitation of food and liquids
Complication
Lung problems,weight loss,(> the risk of cancer)
Diagnose
X-ray(chest xray: mediastinum hipertrophy ), endoscopy, esophageal manometry(LES
increases,abnormality of sphingtr relaxation,no peristaltic)
Farmacology treatments
Oral
medications:
nitrat
(isosorbid
dinitrat),calcium
channel
blockers(nifedipin&verapamil),tingtur beladona,atrofin sulfat -> (<LES pressure) & (>emptying
esophagus).
LES dilatation-> businasi hurst,esofagomiotomi distal,injection of muscle relaxing-> botulinum
toxin directly to the esophagus
Non-farmaco treatments
Drinking liquid foods, drinking more water with meals and drinking carbonated beverages
DD : adenokarsinoma gaster to esophagus,karsinoma paru&pankreas,sarkoma sel retikulum

Atresia
Definition
Absence of a normal opening, or failure of structure to be tubular, it can affect many structures in the
body
Causes
congenital defect
Symptomps
Bluish coloration to the skin (cyanosis) with attempted feedings, coughing, gagging, choking with
attempted feeding, drooling, poor feeding
Diagnose
USG on the pregnant mom: show too much amniotic fluid or other blockage of digestive tract, after birth
when feeding is attempted and the infant cough,chokes,turns blue, Xray: shows an air filled pouch and
air in the stomach&intestine
Treatment
Surgery to repair esophagus, before the surgery, the baby is not fed by mouth
Complication
Feeding problems, reflux, Narrowing of the esophagus due to scarring from surgery

Esophagitis Corrosive
Corrosive Esophagitis is an inflammation of the
esophagus caused by injury fuel because the
chemicals that are corrosive, such as strong
acids, strong bases and organic substances.
Ingested chemicals that can be toxic or corrosive.
Chemicals corrosive will cause damage to the
canal path,
whereas chemical substances that are toxic only
cause symptoms of poisoning when it has been
absorbed by the blood.

Etiology Esophagitis
Corrosive
Corrosive esophagitis most often caused by
swallowing cleaning agent household, usually by
children. The most damaging substances are sodium
hydroxide, or which cause lysis of tissue and often
penetrate the esophageal wall. Duct cleaning fluids
can damage the esophagus or creating lesions.
Type and the amount of chemicals ingested
determines the severity and location damage. These
chemicals may damage limited to the mucosa,
submucosa, even the entire lining of the esophagus.
Symptoms worsened by alcohol use, smoking,
poor lifestyle and obesity.

Pathophysiology Esophagitis
Corrosive
Strong bases
Ingestion strong base causes tissue necrosis melt
(liquefactum necrosis), a process that involves
the saponification of fats and dissolving protein.
Emulsification cell death and destruction caused
by the structure cell membrane.
Hydroxyl ions (OH-) derived from reacting with
alkaline substances collagen tissue that causes
swelling and shortening tissue (contractures),
thrombosis in capillaries, and heat production
by network

 The most commonly affected tissue on the first

contact by a strong base is the oropharynx
squamous epithelial layers, hypopharynx, and
esophagus.
Esophageal is the organ most frequently affected
and the most severe level damage when ingested
strong base than the stomach, Within 48 hours of
going on tissue edema can cause airway
obstruction,
furthermore within 2-4 weeks can be formed
stricture.

 Strong acids
Tissue damage due to strong acids are
ingested necrosis
clot (coagulation necrosis), a process of
protein denaturation superficial which will
lead to clot, crusts or scabs that can protect
underlying tissues from damage.
Stomach is the organ most
often affected in the case of swallowing
strong acid, in 20% of cases the small
intestine also can be exposed

Corrosive Esophagitis Clinical Overview

Corrosive esophagitis according to the
degree of burns inflicted can
divided into clinical forms are:
Esophagitis corrosive without ulceration
Esophagitis corrosive to mild ulceration
ulcerative oesophagitis corrosive medium
corrosive Esophagitis severe ulceration
without complications
corrosive ulcerative oesophagitis severe with
complications

 Based on the course of their illness corrosive

esophagitis is divided into 3 phases:
The acute phase
This situation lasted for 1-3 days, the anamnesis
was found dyspnea, dysphagia, pain and burning
in the mouth, chest pain and stomach, nausea and
vomiting, and hematemesis.
On physical examination can found:
1. Burns on the mouth, lips, and pharynx are
sometimes accompanied bleeding.
2. The signs of impending airway obstruction such
as: stidor, Tachypnoea, hiperpnu, cough
3. Other signs such as fever, drooling, the white
membrane on palate, laryngeal edema,
laryngospasm, signs of peritonitis.

 latent phase
Lasts for 2-6 weeks, at this phase of the patient's
complaints is reduced, the temperature Weight,
patients feel has been cured, it can swallow
properly, but the actual process is still running by
forming scar tissue(cicatricial)
Chronic Phase
After 1-3 years will occur again because of
dysphagia have formed a network scarring,
resulting in esophageal stricture. Other symptoms
that can arise is
fistula, hipomotilitas gastrointestinal tract, and
increased risk of gastrointestinal cancer

physical examination
Influx corrosive substances through the
mouth can be seen with bad breath or vomit.
The presence of vaginal discharge burns in
the mucosa of the mouth or on the lips and
gray chin showed caustic or corrosive
materials due to both strong acidsand a
strong base.
Severe corrosive damage due to alkali (base)
of the esophagus is more powerful heavier
than due to strong acids, the greatest
damage when PH> 12, but concentration
also depends on the material

supporting investigation
Examination of radiological
Photos thorac and abdomen
b. CT-Scan

Laboratory tests
Complete blood count, electrolytes, liver
function, blood urea and creatinine for see
signs of systemic poisoning
Examination of the amount of urine and
urinalysis to help keep fluid balance.

Examination of the endoscope with

esofagoskopi

therapy
Management aims to prevent corrosive
esophagitis stricture formation. Divided
corrosive esophagitis therapy in the acute
phase and phase chronic. In the acute
phase, carried out general maintenance
and special treatment in the form of
medical therapy and esofagoskopi.
Chronic phase there has been a stricture,
sondilatation with the help esofagoskop.

Complications
shock, coma, laryngeal edema, aspiration
pneumonia, esophageal perforation,
mediastinitis, and death.

Esophageal varices are

abnormal, enlarged veins in the lower part of the
esophagus the tube that connects the throat
and stomach. Esophageal varices occur most
often in people with serious liver diseases.
Esophageal varices develop when normal blood
flow to the liver is obstructed by scar tissue in
the liver or a clot. Seeking a way around the
blockages, blood flows into smaller blood vessels
that are not designed to carry large volumes of
blood. The vessels may leak blood or even
rupture, causing life-threatening bleeding.

Causes

Scarring ( cirrhosis) of the liver is the most

common cause of esophageal varices. This
scarring cuts down on blood flowing through
the liver. As a result, more blood flows through
the veins of the esophagus.
The extra blood flow causes the veins in the
esophagus to balloon outward. Heavy bleeding
can occur if the veins break open.
Any type of chronic liver disease can cause
esophageal varices.
Varices can also occur in the upper part of the
stomach.

Symptoms
People with chronic liver disease and esophageal
varices may have no symptoms.
If there is only a small amount of bleeding, the only
symptom may be dark or black streaks in the stools.
If larger amounts of bleeding occur, symptoms may
include:
Black, tarry stools
Bloody stools
Light-headedness
Paleness
Symptoms of chronic liver disease
Vomiting blood

Exams and Tests

Bloody or black stool (in a rectal exam)

Low blood pressure
Rapid heart rate
Signs of chronic liver disease or cirrhosis
Tests to find the source of the bleeding and
determine if there is active bleeding include:
Esophagogastroduodenoscopy (EGD), which
involves-the use of a camera on a flexible tube to
examine the upper gastrointestinal system
Insertion of a tube through the nose into the
stomach (nasogastric tube) to look for signs of
bleeding

Treatment
To treat acute bleeding:
The health care provider may inject the varices directly with a
clotting medicine, or place a rubber band around the bleeding
veins. This procedure is done using a small lighted tube called
an endoscope.
A medication that tightens blood vessels (vasoconstriction)
may be used. Examples include octreotide or vasopressin.
Rarely, a tube may be inserted through the nose into the
stomach and inflated with air. This produces pressure against
the bleeding veins (balloon tamponade).
Once the bleeding is stopped, varices can be treated with
medicines and medical procedures to prevent future bleeding
including:
Drugs called beta blockers, such as propranolol and nadolol
that reduce the risk of bleeding.

Prognosis
Bleeding often comes
back with or without
treatment. Bleeding
esophageal varices are
a serious complication
of liver disease and
have a poor outcome.
Placement of a shunt
can result in a decrease
of blood supply to the
brain, leading to mental
status changes or
encephalopathy.

Possible Complications
Encephalopathy
(sometimes called
hepatic
encephalopathy)
esophageal stricture
after surgery or
endoscopic therapy
Hypovolemic shock
Infection (pneumonia,
bloodstream infection,
peritonitis)
Return of bleeding after
treatment

Gastroesophageal reflux
Definition
Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents leak
backwards from the stomach into the esophagus. This can irritate the esophagus and cause
heartburn and other symptoms.
Causes
Stomach contents back into the esophagus. Reflux may cause symptomps, harsh stomach
acids can also damage the lining of the esophagus
Risk Factors
Alcoholic, obesity, preganancy, sclerodema, smoking
Can also be caused by certain medicines, such as : antiholigernics,beta-blockers for high blood
pressure,dopamine active for parkinsons dss, progestin for abnorm menstrual, sedative for
insomnia/anxiety, tricyclic antidepressant.
Symptoms
Feeling that food is stuck the breastbone, heartburn/burning pain in the chest, nausea after
eating (symptomps may get worse when you lie down and eat,may be worse at night)
Diagnoses
Upper endoscopy, esophageal monometry
Farmaco treatment
Antacid, Proton pump inhibitors (PPIs)& H2 blockers: decrease the amount of acid, endoscopy
Non farmaco treatment
Maintaining a healthy body weight
Compications
Asthma, cancer, bronchospasm, chronic cough/hoarseness, dental problems, ulcer in the
esophagus, stricture