GASTROINTESTINAL SYSTEM BLOCK PROBLEM 1

ALMIRA NABILA VALMAI405130193

LO

1. Anatomy of digestive system

2. Physiology of digestive system

3. Histology of digestive system

4. Biochemistry

5. Mouth infection

ANATOMY OF DIGESTIVE SYSTEMLO 1

Bibir & pipi

Pipi

Dens

Dens

Vaskularisasi Dens

Palatum & Lidah

Otot Penggerak Lidah

Otot Penggerak

Lidah

Otot Penggerak Lidah

Vaskularisasi & Persarafan Lidah

Kelenjar Lidah

PHYSIOLOGY OF DIGESTIVE SYSTEMLO 2

The Digestive System

• The primary function of the digestive system is to transfer nutrients, water, and electrolytes from the food we eat into the body’s 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, and the serosa.

• 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.

HISTOLOGY OF DIGESTIVE SYSTEMLO 3

diFiore Atlas of Histology, 247

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

• 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 submucosa muscularis 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

circumvallate

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

Muscularis Externa

Submucosa

Adventitia / Serosa

Mucosa

Muscularis mucosa

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sop

hag

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BIOCHEMISTRY LO 4

Mouth • DIGESTION & ABSORPTION OF CARBOHYDRATESAmylases Catalyze the Hydrolysis of StarchThe hydrolysis of starch by salivary and pancreatic amylases catalyze random hydrolysis of α(1→4) glycoside bonds, yielding dextrins, then a mixture of glucose, maltose, and isomaltose (from the branch points in amylopectin).Disaccharidases Are Brush Border EnzymesThe disaccharidases—maltase, sucrase-isomaltase (a bifunctional enzyme catalyzing hydrolysis of sucrose and isomaltose), lactase, and trehalase—are 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.

MOUTH INFECTIONLO 5

a. Cleft lip and palate

• Cleft lip and cleft palatebirth defects that occur when a baby’s lip or mouth do not form properly during pregnancy

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

• Etiology:- Changes in their genes- 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.html

• Diagnosis: Routine ultrasound (during pregnancy) • Management & TreatmentVary depending on the severity of the cleft; the child’s 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.html

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. Congenitalb. 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- Paget’s disease of bone: overgrowth of cranium and

maxilla occurs- Acromegaly: progressive enlargement of mandible

owing to hyperpituitarism in adultsSumber: 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 with HIV/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.htm

• 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.htm

• Exams and TestsA biopsy of the lesion

• TreatmentThe goal of treatment is to get rid of the leukoplakia patch. Removing the source of irritation may cause the patch 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.htm

• Prognosis - Leukoplakia is usually harmless. Patches in the mouth often clear up in a few

weeks or months after the source of irritation is removed.- In some 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

any patches that look like leukoplakia 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.htm

Mouth UlcersDefinition 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, Oral thrush. (**)

Sign & Symptoms

A painful sore or sores inside your mouth -- on the tongue, on the soft palate (the back portion of the roof of your mouth), or inside your cheeksA tingling or burning sensation before the sores appearSores in your mouth that are round, white or gray, with a red edge or borderIn 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)– Bechet’s 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

• using topical pastes

• 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• Cellulitis of the mouth, from

secondary bacterial infection of ulcers

• Dental infections (tooth abscesses)

• Oral cancer• Spread of contagious

disorders to other people

Prevention• 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. (*)

Symptoms -Creamy white lesions on your tounge, inner cheeks, 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 (**)

Risk Factors -Some health conditions HIV/AIDS, cancer, DM, vaginal yeast Infections- Undergoing chemotherapy or radiation treatment for cancer- Wearing dentures-Taking antibiotics or oral or inhaled corticosteroids (***)

Diagnosis Limited to your mouth looking at the lesionsIn 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. (**)

Prevention - 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 (***)

GlossitisDefinition 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 syndromeInfection from bacteria, yeast or viruses (including oral herpes)Injury (such as from burns, rough teeth, or bad-fitting dentures0Skin conditions that affect the mouthIrritants such as tobacco, alcohol, hot foods, spices, or other irritantsHormonal factors. (*)

Sign & Symptoms

Problems chewing, swallowing, or speakingSmooth surface of the tongueSore, tender, or swollen tonguePale or bright red color to the tongueRare symptoms or problems include: blocked airway, Problems speaking, chewing, or swallowing (*)

Treatments 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

• Ludwig’s 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 productionby 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

necrosisclot (coagulation necrosis), a process of protein denaturation superficial which will lead to clot, crusts or scabs that can protectunderlying tissues from damage.

– Stomach is the organ mostoften 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 candivided 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 phaseThis 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, cough3. Other signs such as fever, drooling, the white membrane on palate, laryngeal edema, laryngospasm, signs of peritonitis.

• latent phaseLasts 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 PhaseAfter 1-3 years will occur again because of dysphagia have formed a network scarring, resulting in esophageal stricture. Other symptoms that can arise isfistula, 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

TreatmentTo 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 esophagusRisk Factors Alcoholic, obesity, preganancy, sclerodema, smokingCan also be caused by certain medicines, such as : antiholigernics,beta-blockers for high blood pressure,dopamine active for parkinson’s 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 monometryFarmaco treatment Antacid, Proton pump inhibitors (PPIs)& H2 blockers: decrease the amount of acid, endoscopyNon farmaco treatmentMaintaining a healthy body weight Compications Asthma, cancer, bronchospasm, chronic cough/hoarseness, dental problems, ulcer in the esophagus, stricture