• TUTOR : dr.

Roro
• Ketua : SURAJ SINGH SANDHU 405140258
• Sekre : SIMRAN JEET KAUR 405140100
• Penulis : STEFANUS ANDREW SUSANTO 405140149
ANGGOTA
• INTAN SARI 405140013
• ALBERT EDO RAHMADI SINOOR 405140023
• WENNY DAMAYANTI 405140049
• MELANIE SALIM 405140076
• SANDRA SUDARGO 405140165
• AYU SARASWATI 405140204
• MUHAMMAD FAHMI ROSYADI 405140220
• IVANA 405140259
Step 1 – Unfamiliar Terms
• Odynophagia = sakit di mulut/esofagus saat menelan
• Regurgitation = naiknya makanan dr kerongkongan/lambung tanpa
disertai rasa mual/ kontraksi perut yang sangat kuat
• Belch mengeluarkan gas dari mulut secara bersuara
• Heartburn rasa panas atau rasa tertekan dibawah esofagus akibat
iritasi oleh zat2 tertenttu
Step 2 - Questions
1. Kenapa orang tersebut sulit menlan ?
2. Apa ada hubungan keluhan pasien dgn riwayat hipertensi?
3. Apa ada hubungan keluhan pasien dengan kebiasaan merokok?
4. Mengapa cairan berbusa dan makanan yg tidak dicerna keluar dari
mulutnya? Mengapa setelah makan malam?
5. Mengapa org tsb sering batuk dimalam hari danbb menurun ?
6. Mengapa pasien tidak bisa bersendawa?
7. Mengapa mulutunya banyak ulkus ?
8. Pemeriksaan penunjang lain apa yang diperlukan?
Step 3 - Brainstorming
1 &4. Makanan berbusa  makanan sudah tercampur dengan gastric juicenya, saat
tidur/ bungkuk melawan gaya gravitasi sehingga makanan akan refluks ke atas,
selain itu terdapat kelainan di LES, gangguan motilitas esofagus, prosuksi savila
menurun
2&3. Merokok menurukan produksi saliva tidak nafsu makan krn pengecapan
menurun sehingga bb menurun ditambah konsumsi obat hipertensi
5. Karena makanan yang tidak dapat dicerna masuk ke dalam sal nafas  refleks
batuk
6. -
7. Karena terjadi erosi karena asam lambung dan pepsin dan juga bisa karena
penyakit sistemik
8. X ray, barrium swalllow, ph monitoring, laringoskopi, manometri,EGD
Step 4 – Mind Map
Laki – laki 60 thn

-Disfagia
- Batuk malam hari
-Sulit bersendawa
-Regurgitasi
-Bb menurun
-Ulkus pada mulut
Learning Objectives
1. Anatomi upper GIT
2. Fisiologi upper GIT
3. Histologi Upper GIT
4. Biokimia saliva dan digestive enzime
5. Definisi dan etiologi disfagia dan odenophagia
6. Patolofisiologi disfagia dan odenophagia
7. Epidemiologi disfagi dan odenophagia
8. Kelainan dimulut,esofagus,
Learning Objective 1
Describe the anatomy of upper gastrointestinal tract
(Oral Cavity & Oesophagus)
 Anatomy of Upper GI Tract
• Upper Gastrointestinal Tract:
Esophagus - Gaster - Duodenum - Proximal Jejunum - Treitz
ligament

• Lower Gastrointestinal Tract:

Treitz ligament - Distal Jejunum – Ileum –Colon - Anus
 Oral Cavity (mouth)
• Entrance to the GI tract.
• Initial site of digestion:
• mechanical digestion (via mastication)
• chemical digestion (via enzymes in saliva).
• Bounded anteriorly by the teeth and lips
• Bounded posteriorly by the oropharynx.
• Superior boundary is formed by the hard and soft palates.
• Floor, or inferior surface, of the oral cavity
• the tongue
• the mylohyoid muscle covered with mucosa.
• Teeth:
• Primary: 2I 1C 2M x 2 = 20
2I 1C 2M
• Permanent: 2I 1C 2PM 3M x 2 = 32
2I 1C 2PM 3M Source : Loukas M, Tubbs R, Abrahams P, Carmichael S. Gray's anatomy. Philadelphia: Elsevier; 2016.
Source : Loukas M, Tubbs R, Abrahams P, Carmichael S. Gray's anatomy review. Philadelphia: Elsevier; 2016.
Source : Loukas M, Tubbs R, Abrahams P, Carmichael S. Gray's anatomy. Philadelphia: Elsevier; 2016.
Source : Sleisenger M, Feldman M, Friedman L, Brandt L. Sleisenger and Fordtran's gastrointestinal and liver disease. Philadelphia, PA: Saunders/Elsevier; 2016.
Functional Anatomy: Throat & Esophagus

• Pharynx: oropharynx & laryngopharynx; muscular wall propels

food to the esophagus
• Esophagus:
• Muscular 25cm tube from laryngopharynx to stomach
• Passes through the diaphragm at the esophageal hiatus
• Gastroesophageal (cardiac) sphincter: A physiologic
sphincter that helps keep esophagus closed when empty
Functional Anatomy: Esophagus
• Esophagus (continued)
• Wall has all 4 GI tract tunics:
• Epithelial layer changes at the junction with the stomach from stratified
squamous epithelium to simple columnar epithelium
• Esophageal mucous glands lubricate food bolus
• Muscularis externa
• Superior 1/3 of muscularis externa is skeletal muscle
• Middle 1/3 is mixed skeletal & smooth
• Lower 1/3 is smooth muscle
• Adventitia: external covering
Functional Anatomy: Stomach
• Cardiac region: narrow, receives food bolus
• Fundus: bulge that extends supero-laterally to the cardia, reaches the diaphragm
• Body: mid-portion
• Pyloric antrum : funnel shaped portion narrows to form the;
• Pyloric canal
• Pylorous 
• Pyloric sphincter 
• small intestine
• Rugae
• longitudinal mucosal
folds
• volume about 4L

Figure 23.14a
Learning Objective 2
Describe the histology of upper gastrointestinal tract
Labium oris / Lips
• 3 layers:
• Pars cutanea/outer layer:
1. Stratified keratinizing squamous cell epithelium
2. Hair follicle with sebaceous and sweat glands
3. Orbicularis oris muscle
• Pars Intermedia
• Pars oral mucosa:
1. Stratified nonkeratinizing squamous cell epithelium
2. Tunica propria
a. Labialis glands
3. Orbicularis oris muscle
4. Labialis artery
5. Small chorium
Pars cutanea
Stratified keratinizing
squamous cell epithelium

Hair follicle with sebaceous and

sweat glands

Orbicularis
oris muscle
Pars intermedia and pars oral mucosa
Stratified nonkeratinizing squamous cell
epithelium
Pars oral mucosa
Pars Intermedia
Tunica propria

Labialis glands
Orbicularis oris muscle
Labialis artery
 Circumvalata papillae

A. Circumvalata
papillae:
1. Secondary
papillae
2. Taste bud
B. Ebneri glands
Parotid Glands

1. Pars terminalis (serous)

2. Secretory duct
3. Intercalaris duct
4. Intelobular tissue
Submandibular
glands

1. Pars terminalis
(mucoserous)
2. Secretory duct
3. Excretory duct
Sublingual glands

1. Pars terminalis
(mucoserous)
2. Secretory duct
Teeth
esophagus
A. Tunica mucosae
1. Stratified nonkeratinizing
squamous cell epithelium
2. T. propria
3. T. muscularis mucosae
B. Tunica submucosae
4. Oesephagus glands
5. Excretory duct
C. Tunica muscularis
6. T. Musc. Circular
7. T.Musc. Longitudinal
D. Tunica adventitia
 LO 3

Physiology of Upper GIT.

General aspects
• Primary function of the digestive system
• To transfer nutrients, water, and electrolytes from the food we eat into the
body’s internal environment
• Ingested food is essential as an energy source, or fuel, from which the cells
can generate ATP to carry out their particular energy-dependent activities
4 basic digestive processes
• Motility
• Refers to the muscular contractions that mix and move forward the contents of
the digestive tract
• It also maintains a constant low level of contraction known as tone (preventing
its walls from remaining permanently stretched following distension)
• 2 basic types of phasic digestive motility
• Propulsive movement
• Push the contents forward through the digestive tract
• Mixing movement
• Mixing food with the digestive juices, these movements promote digestion of the food
• Facilitate absorption by exposing all parts of the intestinal contents to the absorbing surfaces of
the digestive tract
• Secretion
• Digestive juices are secreted into the digestive tract lumen by exocrine glands
along the route, each with its own specific secretory product
• Secretion consists of water, electrolytes, spesific organic constituents 
digestive processes (enzyme, bile salts, mucus)
• On appropriate neural or hormonal stimulation, the secretions are released
into the digestive tract lumen.
• Normally, the digestive secretions are reabsorbed in one form or another
back into the blood after their participation in digestion
• Digestion
• Biochemical breakdown of the structurally complex foodstuffs of the diet into
smaller, absorbable units by the enzymes produced within the digestive system
• Most ingested carbohydrate is in the form of polysaccharides (most common: starch)
• Meat contains glycogen, the polysaccharide storage form of glucose in muscle
• A lesser source of dietary carbohydrate is in the form of disaccharides
• The simplest form : glucosa, fructosa, galactosa
• Dietary proteins consist of various combinations of amino acids held together by peptide
bonds
• Most dietary fats are in the form of triglycerides, which are neutral fats, each consisting of
a glycerol with three fatty acid molecules attached
• Absorption
• The small absorbable units that result from digestion, along with water,
vitamins, and electrolytes, are transferred from the digestive tract lumen into
the blood or lymph.
Digestive tract & accessory digestive glands

• 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 is essentially a tube about 4.5 m (15 feet) in
length in its normal contractile state
• mouth; pharynx (throat); esophagus; stomach; small intestine (consisting of
the duodenum, jejunum, and ileum); large intestine (the cecum, appendix,
colon, and rectum); and anus
Saliva

• Functions:
• Action of salivary amylase (breaks polisaccharides  (maltose)
• Moistioning food particles, holding them together, lubrication (mucus)
• Antibacterial action (lysozyme  breaking down bacterial cells wall, IgA
antibodies, lactoferrin  binds iron, rinsing away material (food for bacteria))
• Solvent for the molecules  stimulate taste buds
• Aids speech
• Oral hygiene  keeps mouth & teeth clean
• Rich in bicarbonate buffers  neutralize acids in food
• Autonomic influence on salivary secretion
• Parasympathetic stimulation  dominant role in salivary secretion, produce a prompt,
abudant flow of saliva that rich in enzymes
• Sympathetic stimulation  produces a much smaller volume of thick saliva that thick in
mucus
• Stress situation  mouth feels dry
• Nerveous about giving a speech  mouth feels dry
Pharynx & esophagus
• Motility associated with pharynx & esophagus is swallowing  moving
food out of the mouth into the esophagus
• Swallowing  all or none reflex
• During swallowing, food is prevented from entering the wrong track :
Bolus from mouth  pharinx  esophagus
In esophagus, bolus is controlled by:
- Position of the tounge pressing the palatum
- Uvula
- No respiration
- Elevation of the larynx
- Contraction of the muscles of pharynx
Swallowing  all or none reflex
• Initiated when a bolus voluntarily forced by tongue to the rear of the
mouth into the pharynx  stimulates pharyngeal pressure receptor
 afferent impulses  swallowing center (medula oblongata) 
reflexly activates the muscles involved of swallowing
• Swallowing initiated voluntarily but once begun it cannot be stopped
Oropharyngeal stage of swallowing
• Last about 1 second  moving the bolus from the mouth through the pharynx &
into the esophagus
• Esophagus  fairly straight muscular tube, extends between the
pharynx and stomach
• Guarded at both ends by sphincters (pharyngoesophageal & gastroesophageal
sphincter)

• Esophagus is exposed to subatmospheric intrapleural pressure (respiratory

activity), a pressure gradient exists between the atmosphere & the esophagus
• During a swallow, pharyngoesophageal sphincter remain closed (neurally
induced contraction)  prevent large volume of air from entering esophagus
• If large volumes of air enters the digestive tract  eructation
Esophageal stage of swallowing
• Swallowing center  primary peristaltic wave (sweeps from the
beginning to the end of esophagus, forcing the bolus ahead of it through
the esophagus to the stomach)
• Peristaltis (ringlike contractions of the circular smooth muscle that progresively
forward, pushing the bolus into a relaxed area ahead of contraction)
• 5-9 s
• Secondary peristaltic waves
• More forceful peristaltic, mediated by the intrinsic nerve plexuses at the level of
distention
Sherwood L. Introduction to human physiology. 8th ed. United
States: Brooks/Cole-Cengage Learning; 2013.
Sherwood L. Introduction to human physiology. 8th ed. United
States: Brooks/Cole-Cengage Learning; 2013.
Sherwood L. Introduction to human physiology. 8th ed. United
States: Brooks/Cole-Cengage Learning; 2013.
 LO 4

Biochemistry of Saliva and Digestive Enzyme

ENZYMES IN MOUTH
• Saliva contains : 99% water and 1% mixture of ion, amylase, lipase, mucin, IgA
• KHCO3 (potassium bicarbonate)  buffer, neutralize acids, keeps dentin and
enamel intact.
1. Lingual lipase (not important for human)
• Triglyceride lipase
glycerides + free fatty acids
2. Amylase
• Produced by salivary gland for carbohydrate metabolism. Needs calcium in order to work
• Polysaccharides amylase monosaccharides

3. Mucin
• Coats food so it can enter stomach easily
 ENZYMES IN MOUTH
4. Lysozyme
• Nonspecific antiseptic
• Hydrolyse bacterial cell wall
5. IgA  the only antibody produced by digestive tract
• Produced by the plasma cell (5-8 g/day)
6. Haptocorrin (R factor)
• Helps absorption of vit B
B12
Food Haptoco
• A glycoprotein, coded by TCN1 Bile
gene salt B12-IF absorbed,
separates
contain rrin-B12 B12 from comple with help
from cubilin
• Minerals
• Macrominerals and trace elements are mainly absorbed from the
small intestine, but the large intestine may also take part in the
absorption processes.
• Active calcium absorption is subjected to regulatory mechanisms
that are mediated by vitamin D, parathyroid hormone and
calcitonin.
• Phosphorus is less well studied and seems to be regulated by similar
mechanisms.
• Magnesium is absorbed without homeostatic regulation so that the
blood magnesium levels have a higher variation.
• Sodium, potassium and chloride are mainly absorbed in the small
intestine and the absorption rates normally exceed 90 per cent.
• The absorption rates of zinc, iron and manganese are subjected to
regulatory mechanisms. Active transport systems have been
demonstrated for manganese and copper. Other elements are
absorbed by passive diffusion.
• Vitamins
• Lipid-soluble vitamins (A, D, E and K) are
dissolved in mixed micelles, and passively
absorbed across the MVM.
• Water-soluble vitamins, most notably B
vitamins, are absorbed by passive diffusion,
facilitated transport or active transport.
Learning Objective 5
Dysphagia and Odynophagia
Definiton
• Sensation of “sticking” or obstruction of the passage of food through the
mouth, pharynx, or esophagus ~ swallowing difficulty
• Aphagia  complete esophageal obstruction
• Odynophagia  painful swallowing
• Globus pharyngeus  sensation of a lump lodged in the throat
• Phagophobia  fear of swallowing, and refusal to swallow may occur in
hysteria, rabies, tetanus, and pharyngeal paralysis due to fear of aspiration
Epidemiology
• Dysphagia is an important danger sign, though studies /
epidemiological data is still small, as previous studies have estimated
the prevalence of dysphagia between 16-22%. It is the second most
frequent indication of patients undergoing endoscopy in the United
States. Reported 5-8% of the population aged> 50 years and over and
16% in the elderly. The problem is mainly the type of oropharyngeal
dysphagia often occurs in 60% of the inhabitants home / nursing
home
Classification of Dysphagia

• Dysphagia is classified into two major groups, namely:

• Oropharyngeal dysphagia arises from abnormalities in the oral cavity, pharynx,
and esophagus
• Esophageal dysphagia arises from abnormalities in the corpus of the esophagus,
the lower esophageal sphincter, or cardia gastric
Etiology
Adults Oropharyngeal dysphagia can be caused by:
• Stroke
• Parkinson's disease
• Neurological disorders
• Oculopharyngeal muscular dystrophy
• Xerostomia
• dental problems
• Esophageal dysphagia arises from abnormalities in the corpus of the
esophagus, the lower esophageal sphincter, or gastric cardia. Usually
caused by:
 esophageal stricture
 esophageal malignancy
 Achalasia
 Scleroderma
Pathophysiology

• Dysphagia caused by a large food bolus or narrowing of the lumen is

called: mechanical dysphagia
• Lumen of the esophagus in adults can inflate up to 4 cm
• If the esophagus is not able to dilate more than 2.5 cm in diameter,
the symptoms of dysphagia can occur
• Dysphagia caused by incoordination or weakness contraction called
peristalsis: dysphagia motor
Signs and Symptoms
Oral or pharyngeal dysphagia
• Coughing or choking when swallowing
• The difficulty at the start swallowing
• Food sticking in throat
• Weight loss
• Recurrent pneumonia
• Voice changes (wet voice)
• Nasal Regusgitasi
Esophageal dysphagia
• Sensation of food stuck in the throat or chest
• Oral or pharyngeal regurgitation
• Recurrent pneumonia
 Diagnosis
• X-ray with a contrast material (barium X-ray)
can see changes in the shape of the esophagus and can assess the muscular activity
• Dynamic swallowing study
Swallow foods of different consistencies that have been coated with the barium. This test
provides a visual image of these foods as they travel trough your mouth and down your throat.
Helpful for diagnosing oropharyngeal dysphagia and aspiration
• Endoscopy
• Esophageal muscle test (manometry)
A small tube is inserted into your esophagus and connected to a pressure recorder. This allows
measurement of the muscle contractions of your esophagus as you swallow
• Water swallow test
Assessment of your swallowing abilities
Complication
• Malnutrition and dehydration
Dysphagia make it difficult to take in enough food or fluids to stay adequately nourished
and hydrated
• Respiratory problem
• Coughing and choking
There is a risk of food, drink or saliva going down the “wrong way”. It can block the airway,
making it difficult to breath and causing you to cough an choke
• Aspiration pneumonia
Is a chest infection that can occur if you accidently inhale something, such as small piece of
food, which causes irritation in the lungs or damage them
Complication
• In children,
If children with long term dysphagia are not eating enough, they may not get
the essential nutrients they need affect their physical and brain
development
Stressful meal times  behavioural probelms
Treatment
• Oropharyngeal dysphagia
• Exercise
• Exercises may help coordinate your swallowing muscles or restimulate the nerves that
trigger the swallowing reflex
• Learning swallowing techniques
• Learn simple ways to place food in your mouth or to potition your body and head to help
you swallow succesfully
Treatment
• Esophageal dysphagia
• Esophgeal dilation
• For achalasia and esophageal stricture. Using endoscope with a special balloon attached
to gently stretch and expand the width of your esophagus or pass a flexible tube or tubes
to stretch the esophagus
• Surgery
• For esophageal tumor, achalasia, pharingeal diverticula
• Medications
• For dysphagia associated with GERD can be treated with prescription oral medications to
reduce stomach acid
Treatment
• Severe dysphagia
• Special liquid diet
• To maintain a healthy weight and avoid dehydration
• Feeding tube
Lifestyle and Home Remedies
• Change your eating habits
Eating smaller, more-frequent meals
• Try foods with different textures
Thin liquids, such as coffee and juice are a problem for some people
Sticky foods, such as peanut butter or caramel can make swallowing difficult
• Avoid alcohol, tobacco and caffeine
Can make heartburn worse
ETIOLOGY
REFLUX ESOPHAGITIS
ESOPHAGEAL ATRESIA
PAROTITIS

LEUKOPLAKIA

DENTAL CARIES

MALIGNANCY

DYSPHAGIA
ANGINA LUDWIG

ACHALASIA

ORAL CANDIDIASIS
GLOSITIS
MOUTH ULCER
 Candidiasis (Oral Trush)
A fungal infection that occurs when there is overgrowth of a yeast
called Candida
Etiology :
• C. albicans (most)
• C. krusei (severed immunocompromised)
• C. glabrata (radiation theraphy)

Risk factor :
• Oral hygiene
• Hyposalivation
• Use of immunosuppressants or antimicrobial
• Impaired immunity
http://emedicine.medscape.com/article/1075227-overview
 Candidiasis (Oral Trush)
Sign and Symptomps:
• The most common symptom
of oral thrush is white patches
or plaques on the tongue and
other oral mucous
membranes.
• Redness or soreness in the
affected areas
• Difficulty swallowing
• Cracking at the corners of the
mouth (angular cheilitis)
Candidiasis - Treatment

PHARMACOLOGY
• Oral fluconazole (200 mg on the first NON-PHARMACOLOGY
day, followed by 100 mg daily) for 7– • avoid high sucrose diets
14 days is the preferred treatment.
Patients refractory to fluconazole • good oral hygiene practice
often respond to itraconazole.
• Amphotericin B (10–15 mg IV
infusion for 6 h daily to a total dose
of 300–500 mg) is used in severe
cases.
Parotitis/ mumps
• Mumps is an illness caused by the mumps virus. It starts with
• Fever
• Headache
• Muscle aches
• Tiredness
• Loss of appetite

https://medlineplus.gov/mumps.html
• After that, the salivary glands under the ears or jaw become swollen
and tender. The swelling can be on one or both sides of the face.
Symptoms last 7 to 10 days. Serious complications are rare.
• You can catch mumps by being with another person who has it. There
is no treatment for mumps, but the measles-mumps-rubella (MMR)
vaccine can prevent it.
• Before the routine vaccination program in the United States, mumps
was a common illness in infants, children and young adults. Now it is a
rare disease in the U.S

https://medlineplus.gov/mumps.html
 Aphthous Ulcers

• Recurrent aphthous ulcers / stomatitis

• The most common lesions at the oral mucosal.
• Most acute ulcers are painful and self-limited
• Types of Recurrent Aphthous Ulcers :
• Minor aphthous ulcer (80%)
- small ulcer 2-4 mm
• Major aphthous ulcer
- bigger ulcer, and appear at tongue or palate
• Herpetiform ulcer
- occurs common in young women, 1-2 mm, numerous (10 –
100)
Buku Ajar Ilmu Penyakit Dalam. Jilid II. Edisi 6.
Harrison’s Principles of Internal Medicine. 18 th Edition. Vol 1.
Aphthous Ulcers
Etiology
• The causes of aphthous ulcer remain unknown.
• There is associated with celiac disease and inflammatory bowel syndrome
Predisposing factors :
• Genetic
• Trauma
• Infection
• GIT disorders
• Atopic or food allergy Buku Ajar Ilmu Penyakit Dalam. Jilid II. Edisi 6.
Kubar V, et al. Robbins and Cotran Pathologic Basis of Disease. 8 th Edition.
Aphthous Ulcers

Laboratory Study DDx

• Complete blood cell count
• Hemoglobin test
• White blood cell count with
differential
• Iron studies
• Serum vitamin B12
measurements
• Hematinic deficiency
• Celiac disease
• Crohn disease
• Behcet syndrome
• Sweet syndrome
• HIV infection

Medscape.com
Aphthous Ulcers

Treatment

• Vitamin B12 used orally

• Topical corticosteroid
- Hydrocortisone hemisuccinate pellets (Corlan), 2.5mg, 4x/day
- Triamcinolone acetonide in carboxymethyl cellulose paste,
4x/day
- Betamethasone sodium phosphate 0.5mg tablet dissolved in
15 mL water to make a mouth rinse, 4x/day for 4 min each times

Medscape.com
Achalasia

Achalasia is a primary
esophageal motility disorder
characterized by the absence
of esophageal peristalsis and
impaired relaxation of the
lower esophageal sphincter
(LES) in response to
swallowing

https://www.nlm.nih.gov/medlineplus/ency/article/000267.htm
Achalasia

SYMPTOMS DIAGNOSIS
• Backflow (regurgitation) of food • esophageal manometry
• Chest pain, which may increase • upper GI x-ray
after eating or may be felt in the
back, neck, and arms
• Cough
• Difficulty swallowing liquids and
solids
• Heartburn
• Unintentional weight loss
https://www.nlm.nih.gov/medlineplus/ency/article/000267.htm
Achalasia

Treatment :
• Injection with Botox
• long-acting nitrates or calcium channel blockers.
• Widening (dilation) of the esophagus at the location of the
narrowing. (Esophagogastroduodenoscopy)

• Surgical treatment includes the following:

• Laparoscopic Heller myotomy, preferably with anterior (Dor; more
common) or posterior (Toupet) partial fundoplication
• Peroral endoscopic myotomy (POEM)

https://www.nlm.nih.gov/medlineplus/ency/article/000267.htm
Ludwig’s Angina
• infection of the floor of the mouth under the tongue
• Causes : infection of the roots of the teeth or mouth injury

https://www.nlm.nih.gov/medlineplus/ency/article/001047.htm
Ludwig’s Angina

SYMPTOMS
• Breathing difficulty
• Confusion or other mental • Difficulty swallowing
changes • Drooling
• Fever • Speech that is unusual and
• Neck pain sounds like the person has a
• Neck swelling "hot potato" in the mouth
• Redness of the neck
• Weakness, fatigue, excess
tiredness
https://www.nlm.nih.gov/medlineplus/ency/article/001047.htm
Ludwig’s Angina
DIAGNOSIS
• Physical exam of neck to look
for redness and swelling of the
upper neck, under the chin.
• The swelling may reach to the
floor of the mouth. Tongue may
be swollen or out of place.
• CT scan of the neck may be
needed.  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 mouth or nose
and into the lungs to restore breathing.
Tracheostomy may be needed.
• Antibiotics
• 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.
Ludwig’s Angina
• 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.
• Possible Complications
• Airway blockage
• Generalized infection (sepsis)
• Septic shock
• Prevention :
• Visit the dentist for regular checkups.
• Treat symptoms of mouth or tooth infection right away.
Leukoplakia
The WHO first defined oral leukoplakia :
whitish patch or plaque that cannot be characterized clinically or pathologically as any other
disease, and is not associated with any physical or chemical causative agent, except the use of
tobacco.
Leukoplakia

ETIOLOGY PREDISPOSING FACTOR

• most cases are idiopathic
• Tobacco use
• alcohol consumption
• chronic irritation
• Candidiasis
• vitamin deficiency
• endocrine disturbances
• virus
Leukoplakia

SYMPTOMS DIAGNOSIS
• White or gray • Biopsy
• Slightly raised with a hard surface
• Unable to be scraped off
• Painful when the mouth patches
come into contact with acidic or
spicy food

Nodular leukoplakia of the soft palate

 GERD
Gastroesophageal reflux disease occurs when the amount of gastric juice that
refluxes into the esophagus exceeds the normal limit, causing symptoms with or
without associated esophageal mucosal injury (esophagitis)
 GERD - Etiology
• Excessive retrograde movement of acid-containing gastric secretions
or bile and acid-containing secretions from the duodenum and
stomach into the esophagus is the etiologic effector of GERD.
• A functional (frequent transient LES relaxation) or mechanical
(hypotensive LES) problem of the LES is the most common cause of
GERD.
• Transient relaxation of the LES can be caused by
• foods (coffee, alcohol, chocolate, fatty meals)
• medications (beta-agonists, nitrates, calcium channel blockers,
anticholinergics)
• hormones (eg, progesterone)
• nicotine.
 GERD – symptoms
Typical esophageal symptoms include the following:
• Heartburn
• Regurgitation
• Dysphagia
• Abnormal reflux can cause atypical (extraesophageal) symptoms, such as the
following:
• Coughing and/or wheezing
• Hoarseness, sore throat
• Otitis media
• Noncardiac chest pain
• Enamel erosion or other dental manifestations
 GERD - Pharmacotherapy
The goals of pharmacotherapy are to prevent complications
and to reduce morbidity in patients with GERD.
• Antacids
• H2 receptor antagonists
• proton pump inhibitors
• prokinetic agents
Caries dentis

Symptoms :
• Toothache
• Tooth sensitivity
• Mild to sharp pain when eating or drinking something
sweet, hot or cold
• Visible holes or pits in your teeth
• Brown, black or white staining on any surface of a tooth
• Pain when you bite down

Pathophysiology :
• Plaque forms
• Plaque attacks
• Destruction continues
Caries Dentis
Risk factor :
• Tooth location
• Certain foods and drinks
• Frequent sipping or snacking
• Bedtime infant feeding
• Inadequate brushing
• Not getting enough fluoride
Complication :
• Pain that interferes with daily living
• Weight loss or nutrition problems
from painful or difficult eating or
chewing
• Tooth loss, which may affect
appearance, as well as confidence
and self-esteem
• In rare cases, a tooth abscess that
can cause serious or even life-
threatening infections
Caries Dentis

Treatment : Prevention :
• Fluoride treatment • Brushing teeth
• Fillings • Rinse the mouth
• Crowns • Have a visit to the dentist
• Root canals regulary
• Tooth extraction • Eat tooth healthy food
• Avoid frequent snacking and
sipping
Cleft Lip
Risk factor :
• Family history
• Race
• Sex (male : cleft lip
wth/without cleft palate)
• Exposure with certain
substances during pregnancy
• Diabetes
• Obese during pregnancy
Complication:
• Difficulty feeding
• Ear infection and hearing loss
• Dental problems
• Speech difficulties
• Challenges of coping with a
medical condition
Cleft Lip
Treatment :
• Cleft lip repair - within the
first 12 months of age
• Cleft palate repair - by the
age of 18 months, or earlier if
possible
• Follow-up surgeries -
between age 2 and late teen
year
Treatment for complication :
• Feeding strategies
• Speech therapy
• Orthodontic adjustment
• Monitoring (dental health
and ear infection)
• Hearing aids (for hearing loss)
• Psychologist therapy
Odynophagia
• This symptom may range from a dull retrosternal ache on swallowing to a
stabbing pain with radiation to the back so severe that patients cannot eat or
even swallow their own saliva
• Usually reflects a severe inflammatory process that involves the esophageal
mucosa or, in rare instances, the esophageal muscle.
• Dysphagia also may be present, but pain is the dominant complaint
• Infrequent complaint with GERD patients; when present usually is associated with
a severe ulcerative esophagitis

http://www.ualberta.ca/~loewen/Medicine/GIM%20Residents%20Core%20Reading/DYSPHAGIA,
%20GERD,%20BARRETTS%20ESOPHAGUS/dysphagia,%20heartburn%20Slezinger.pdf
Odynophagia

http://www.ualberta.ca/~loewen/Medicine/GIM%20Residents%20Core%20Reading/DYSPHAGIA,
%20GERD,%20BARRETTS%20ESOPHAGUS/dysphagia,%20heartburn%20Slezinger.pdf
• Conclusion:
We have studied Anatomy,physiology,histology,biochemistry of Upper
GI Tract

• Suggestion: while sleeping put a pilllow over 2

• Do not lie down after eating
 REFERENCES
• Tortora GJ, Derrickson B. Principles of anatomy & physiology. 13th ed. John Wiley
& Sons (Asia); 2011.
• Anatomi berorientasi klinis. Jakarta: Penerbit Erlangga.
• Netter FH. Atlas of human anatomy. 6th ed. Philadelphia: Saunders Elsevier; 2014.
• Sherwood L. Introduction to human physiology. 8th ed. United States:
Brooks/Cole-Cengage Learning; 2013.
• Matsuo K, Palmer BJ. Anatomy and physiology of feeding and swallowing. Phys
Med Rehabil Clin Am. 2008 Nov;19(4):691-707.
• Eroschenko VP. Atlas histologi diFiore: dengan korelasi fungsional. Ed 11. Jakarta:
EGC; 2008.
 REFERENCES
• Kumar V, Abbas AK, Fausto N. Robbins and cotran pathologic basis of disease. 7 th
ed. Philadelphia: Saunders Elsevier; 2005.
• McPhee SJ, Papadakis MA, editors. Current medical diagnosis & treatment. 49th ed.
New York: The McGraw-Hill Companies; 2010.
• Malagelada JR, Bazzoli F, Elewaut A, Fried M, Krabshuis JH, Lindberg G, et al.
Dysphagia. World Gastroenterology Organisation Practice Guideline; 2007.
• Medscape :
• http://reference.medscape.com/article/169974-overview#showall
• http://emedicine.medscape.com/article/135959-overview#showall
• http://emedicine.medscape.com/article/935858-overview#showall
• http://emedicine.medscape.com/article/1610393-overview#showall
• http://emedicine.medscape.com/article/2212409-overview#aw2aab6b2b7