1) Explain/Define the cheilitis. (Define cheilitis).
=> Chilitis is a medical condition in which infection and inflammation of the lips occurs.
=> Chelitis is mainly due to dryness due to any infection, allergic condition, and any disease condition.
=> Cheilitis causes redness, swelling dryness, and cracks in the lips.
There are 6 (six) different types of cheilitis.
1) cheilitis exfoliative (cheilitis exfoliative),
2) Allergic contact cheilitis (allergic contact cheilitis),
3) Actinic cheilitis (actinic cheilitis),
4) Cheilitis Grandularis
5) Angular chelitis,
6) Plasma cell chelitis
•••••••>
1) explain/define cheilitis exfoliative,
=> Exfoliative cheilitis is an inflammatory condition of the lips in which the lips are covered by a crust.
=> Outerpart of lips in exfoliative cheilitis
There is continuous peeling and shedding of vermillions.
=> This affects only one lip (only affect the one lip mainly lower lip) mainly affects the lower lip.
2) Explain the etiology of exfoliative cheilitis. (State the cause of exfoliative cheilitis)
Due to infection.
Due to any bacterial infection.
Due to any fungal infection.
lip licking or biting.
Due to psychological factor.
Due to any anxiety.
Due to any stress.
Due to any psychological condition.
Due to coming in contact with any allergens.
Due to coming into contact with any irritating substance.
Due to any autoimmune disease condition.
Due to deficiency of certain vitamins and minerals.
3) Explain the clinical manifestation/ sign and symptoms of exfoliative chelitis.
The skin of lips is continuously peeling and shedding.
Redness and inflammation are seen in the lips.
Lips become dry,
cracking of the lip’s skin,
Burning sensation in the lips.
Discomfort.
Pain in the lips,
There is difficulty in eating.
Difficulty occurs in speaking.
Tingling sensation occurs in the lips.
There is itching and dryness in the lift.
fissuring,
ulceration,
An unpleasant appearance is seen.
3) Explain the diagnostic evaluation of exfoliative chelitis.
history tacking and physical examination,
swab of the infection,
biopsy,
Patch test if any Allergic condition to the patient.
psychological assessment of patients.
4) Explain the treatment of exfoliative chelitis.
Ask the patient to apply keratolytic lip balm to the lips.
Ask the patient to apply sun screen.
Ask the patient to apply antifungal cream.
Ask the patient to apply topical and systemic steroids.
Ask the patient to apply antibiotics.
Ask the patient for cryotherapy.
Ask the patient to apply topical tacrolimus and calendula officinalis (marigold)ointment 10%.
If the patient has cheilitis caused by a fungal infection, provide antifungal treatment.
If the patient has any psychological disorder then antipsychotic medication prov
2) Explain/define Allergic contact chelitis
=> Allergic contact cheilitis is mainly infection and inflammation of the lips due to coming in contact with any allergic substance, it is called allergic contact cheilitis.
=> Allergic contact cheilitis is mainly seen due to type four (type:=4 hypersensitivity reaction) hypersensitivity reaction after coming in contact with any allergen.
2) Explain the Etiology/cause of Allergic contact chelitis.
Allergic contact cheilitis is more common in women than in men.
Allergic contact dermatitis occurs after any person comes in contact with that allergen.
Due to application of lipstick and lip cosmetic products to the lips.
Because of certain types of toothpaste.
Due to use of certain dental care products like mouth wash, denture cleaner etc.
Due to coming into contact with certain types of metal objects.
because of food,
Due to medication,
Due to rubber and latex,
nail varnishes,
Because of the medication.
3) Explain the clinical manifestation/sign and symptoms of Allergic contact chelitis.
Write the signs and symptoms of allergic contact chilitis.
Eczema-like changes on the vermilion margin or skin around the mouth.
Redness in the lips.
Swelling in the lips.
itching on lips.
Lips become dry.
Burning sensation in the lips.
cracking on the lips.
scaling,
Burning sensation in the lips,
Pain in the lips,
lip pigmentation,
4) Explain the diagnostic evaluation of Allergic contact chelitis.
Write the diagnostic evaluation of allergic contact dermatitis.
history taking and physical examination.
patch test.
(ROAT := Repeated open application test).
blood test.
5) Explain the treatment of the patient with Allergic contact chilitis.
Avoiding things that the patient is allergic to.
Ask the patient to use corticosteroid ointment.
Provide antihistamine medication to the patient.
Ask the patient to apply a moisturiser.
Administer oral antihistamine medication to the patient.
Ask the patient to follow up properly.
3) Explain/Define Actinic chelitis
=> Actinic chelitis is known as
“Farmer’s lip
(Pharmacy Leap)”
or “sailor’s lip”
(Sailor’s Leap) is called.
=> Actinic cheilitis mainly
Sun exposure
It is caused due to coming in (sun exposure).
=> Thickening whitish discolouration is seen mainly in the lip in actinic cheilitis.
Actinic cheilitis mainly affects lover lips more.
2) Explain the etiology/cause of actinic chelitis.
Actinic cheilitis is more common after the age of 50.
Mainly due to exposure to ultra violet radiation.
Due to use of tobacco.
Because of using lip balm.
Due to poor oral hygienic condition.
Because of dentures.
Because of the prosthesis.
Because of fair skin.
Due to geographic location (speciall in high level of sun exposure area).
Age.
Because of a weak immune system.
3) Explain the clinical manifestation/sign and symptoms of the patient with actinic chelitis.
Actinic cheilitis mainly affects the lower lips.
Redness.
scalling.
chopping.
Dryness and scaling of lips.
cracking and fissure in lips.
Swelling of the lips.
white and grayish color change in the lips.
Bernig Sensation.
Sensitivity to sunlight.
4) Explain the treatment of the patient with the actinic chelitis.
Instruct the patient to use a chemotherapeutic agent (5-flurouracil).
Ask the patient to use a topical immuno modulator.
Advise the patient for cryotherapy.
If the condition is very severe, surgically affected tissues are removed.
Abnormal cells are destroyed using laser therapy.
The patient should avoid sun exposure.
4) Explain / define cheilitis grandularis
=> Ciliitis gledularis is a condition in which swelling and eversion of the lower lips occurs.
=> Chiliitis grandularis mainly affects the lips and often the face as well.
=> Chilitis grandularis is a chronic inflammatory condition of the lips.
=> Cheilitis glandularis is mainly an acquired disorder of unknown cause mainly characterized by swelling,ulceration,
crusting,
mucous gland hyperplasia,
And the formation of abscess in the sinus tract.
2) Explain the etiology/cause of chelitis grandularis.
the exact cause is unknown.
Due to chronic irritation (Due to contact with the chronic irritant materials from the environment).
Due to obstruction of salivary gland.
Due to any bacterial and viral infection.
Due to genetic factors.
Due to any autoimmune diseases.
Due to chronic sun exposure.
3) Explain the clinical manifestation/sign and symptoms of the patient with chelitis grandularis.
Write the symptoms and signs.
Swelling of the lips.
Gradual cheilitis mainly involves swelling of the forehead, eyelids and scalp.
excessive dryness of lips,
cracking and fissuring on the lips,
Pain in the lips.
Inflammation of the lips.
scallening and peeling of the lips.
Burning sensation in lips.
Ulceration in the lips.
4) Explain the diagnostic evaluation of the patient with chelitis grandularis.
history taking and physical examination.
assessment of the skin appearance.
biopsy.
blood test.
culture or swab.
patch test.
5) Explain the management of the patient with chelitis grandularis.
If the patient has any chelitis grandularis caused by an allergic condition, avoid that allergen.
Provide the patient with topical corticosteroids.
Provide antibiotic to the patient.
Provide anti-inflammatory medicine to the patient.
Administration of corticosteroid injection (sulfasalazine, clofazimine) to the affected area.
Surgical reduction of the affected area.
Ask the patient to apply a topical moisturiser.
Provide topical corticosteroids to reduce inflammation.
An irritating substance such as toothpaste
Avoid mouthwash.
Ask the patient to maintain good oral hygiene.
Ask the patient to drink plenty of fluids to maintain hydration status.
Ask the patient to avoid spicy and acidic food.
Providing education to patients for regular follow up.
5) Explain/define Angular chelitis
=> Angular cheilitis is called “PERLECHE”.
=> Angular cheilitis is an inflammatory condition that occurs mainly in the labial commissure or above the corner of the mouth or on both sides.
=> Angular cheilitis causes deep cracks and splints.
=> Bleeding occurs from these splints if there is a severe condition.
2) Explain the Etiology/cause of Angular chelitis.
Due to bacterial infection.
Due to fungal infection.
Due to being immunocompromised.
Due to any head and neck radiation exposure.
Due to ion deficiency.
Due to vitamin B 12 deficiency.
Due to folate deficiency.
3) Explain the clinical manifestation/sign and symptoms of patient with Angular chelitis.
cracking or fissuring at the corner of the mouth.
Redness.
ulceration.
drainage of pus.
tissues softness and tenderness.
4) Explain the management of the patient with Angular chelitis
Ask the patient to apply a topical antibiotic.
Ask the patient to apply a topical anti-fungal.
6) Define/explain plasma cell chelitis
(Explain plasma cell cheilitis)
=> Plasma cell cheilitis is a condition in which infection and inflammation of the lip occurs.
=> In the lips because of it
erosive,
Ulcerative,
fissuring,
Bleeding,
Crusting,
Erythematous-like signs and symptoms are seen.
[6:55 pm, 20/1/2024] Pankhaniya Deepali. Team: 1) Define/explain parotitis.
=> Parotid gland
(parotid gland) means salivary gland (salivary gland).
=> Parotid gland is the largest salivary gland.
=> Parotid gland below the ear
(below the ear) and
Located near the jaw
(near the jaw).
=> Salivary gland (parotid gland) plays an important role in the production of saliva in the mouth that saliva
Plays an important part in the cleansing of the mouth.
=> Parotitis means salivary gland
Parotid gland (salivary gland / parotid gland) infection and inflammation is called parotitis.
=> Inflammation is mainly seen in one or both parotid glands.
=> Redness, soreness and swelling are also seen in the tissue around the salivary gland due to inflammation.
=> Due to inflammation in the salivary gland, the functional ability of the salivary gland is reduced due to which infection is created in the mouth.
=> Thus, the salivary gland in the mouth
If infection and inflammation occurs in (parotid gland), it is called “parotitis”.
2) Explain the type of parotitis.
1) Acute bacterial parotitis.
(Acute Bacterial Parotitis)
2) chronic recurrent parotitis.
(Chronic Recurrent Parotitis),
3) viral parotitis
(viral parotitis),
4) Recurrent parotitis in children
(Recurrent parotitis
in children)
•••••••>
1) Acute bacterial parotitis.
(Acute Bacterial Parotitis)
=> Acute bacterial parotitis is mainly sudden and painful inflammation of one or both parotid glands.
=> Redness, pain, swelling, tenderness are seen due to it.
=> Acute bacterial parotitis is mainly any
Primarily seen in •>dehydrated patients, •>any postoperative patients, •>following any radiotherapy, and •>individuals with compromised immune systems.
2) chronic recurrent parotitis.
(Chronic Recurrent Parotitis),
=> In chronic recurrent parotitis, repeated episodes of swelling of the parotid gland occur after eating.
=> Chronic recurrent parotitis is mainly due to blockage of salivary gland mainly due to blockage or stricture of any duct.
3) viral parotitis
(viral parotitis),
=> Viral parotitis is mainly due to infection and inflammation of one or both parotid glands due to any viral infection.
=> The most common viral parotitis is caused by mumps.
(Mumps is highly contagious
is an infection that comes from the paramyxovirous family. )
=> Viral parotitis mainly causes inflammation of both parotid glands.
4) Recurrent parotitis in children
(Recurrent parotitis
in children)
=> Recurrent parotitis in children is mainly caused by Streptococcus bacteria.
=> This condition is mainly due to dilatation and ballooning of the duct (ectacia:= dilatation and distance of the hollow organ).
=> These are mainly self-limiting and surgery is sometimes required.
2) Explain the etiology/cause of parotitis.
Due to bacterial infection.
Due to poor oral hygiene.
Due to infection.
Due to certain types of medication.
Due to radiation.
Due to any viral infection.
Obstruction in salivary gland
Due to (obstruction).
Certain medications that cause dry mouth such as antihistamines and cancer treatments.
Sjograne syndrome (sjograne syndrome:= *Sjograne syndrome is an autoimmune degenerative disorder in which the secretion of the lacrimal gland and salivary gland is not produced, due to which dryness occurs in the oral cavity and eyes)
Due to coming into close contact with a person who has a mumps infection.
due to dehydration.
A person who has MMR (mumps,
meseals and Rubbella) if the vaccine is not taken.
due to dehydration.
Due to autoimmune disease.
Due to traumatic and ductal abnormality.
due to ductal obstruction.
3) Explain the clinical manifestation/sign and symptoms of parotid gland.
Swelling,
to be in pain,
bed test,
Dry mouth.
Bad test in the mouth.
There is difficulty in opening the mouth.
Face pain.
Fever.
Mouth pain.
Redness on the side of the mouth.
Difficulty in bridging.
Difficulty in swallowing.
sore throat.
Getting high fever.
Difficulty swallowing.
Swelling.
redness and warmth.
Dry mouth.
5) Explain the diagnostic evaluation of the patient with the parotitis.
history taking and physical examination.
assess the salivary gland fluid.
assess the blood test.
x-rays.
Computed Tomography.
MRI (Magnetic resonance imaging).
6) Explain the management of the patient with parotitis.
Providing antibiotic medicine to the patient.
Provide antiviral medication if the patient has parotitis due to a viral infection.
If there is an abscess in the parotid side, it is surgically aspirated.
Rinsing the mouth with salt water to moisten the mouth (1/2 teaspoon of salt in 1 cup of water).
Ask the patient to drink lots of fluids.
Ask the patient to use sugar-free lemon drops to increase the flow of saliva.
Ask the patient to maintain good oral hygiene.
Ask the patient to brush properly twice a day.
Advise the patient to take small amounts of food.
Advise the patient to take soft food in frequent amounts.
Advise the patient to take liquid food.
Ask the patient to intake plenty of water.
Ask the patient to avoid smoking.
Ask the patient to maintain oral hygiene.
Properly immunizing the patient against mumps, measles, and rubella (MMR).
Ask the patient to perform proper hand hygiene before and after defecation.
Ask to avoid irritating foods such as coffee, spicy food, and hot drinks and hot food.
Advise the patient to avoid spicy food.
To moisten the patient’s mouth
Using Lukewarm saline solution.
Advise the patient to use sugar-free lemon drops to increase the production of saliva.
Advise patient to take semi-solid diet.
[9:26 am, 21/1/2024] Pankhaniya Deepali. Team: 1) Define/explain stomatitis.
=> Infection and inflammation in the mucous membrane of the mouth is called stomatitis.
=> This infection can also be extended in the buccule mucousa, lips and palette.
=> Stomatitis causes discomfort, pain and soreness in the mouth.
2) Explain the types/classification of stomatitis.
There are total five types of stomatitis:
1) Acute herpetic stomatitis.
2)Aphthous stomatitis
(Aphthous stomatitis).
3) Angular stomatitis
4) Nicotic stomatitis.
5) Eosinophilic stomatitis (Eosinophilic stomatitis)
••••••>
1) ##Acute herpetic stomatitis (Acute herpetic stomatitis).
=> Acute herpetic stomatitis is mainly caused by herpes simplex virus.
=> Painful sore (painful sore) and ulcer (ulcer) occur in the mouth in acute herpetic stomatitis.
=> A cute herpetic stomatitis is mainly short lived and easily recognized
(easily recognized) and it is quite severe and generalized in the neonate
(generalised) and fetal.
(Aphthous stomatitis).
=> The cause of aphthous stomatitis is mainly unknown.
=> Aphthous stomatitis mainly heals spontaneously and there is no scar formation, it heals within 10 to 14 days.
=> Recurrent, small pain in the mouth, full ulcer.
3) Angular stomatitis
=> Angular stomatitis causes inflammation and soreness at the corner of the mouth.
=> Angular stomatitis is mainly caused by nutritional deficiency and fungal infection.
4) Nicotic stomatitis.
=> Nicotine stomatitis is mainly
tobacco
Caused by the consumption of
=> This causes inflammation in the mouth and changes in the appearance of the palate.
5) Eosinophilic stomatitis (Eosinophilic stomatitis)
=> Eosinophilic stomatitis is mainly seen due to increase in eosinophil count.
=> It is mainly caused due to any allergic reaction and due to certain disease conditions.
3) Explain the etiology/cause of the stomatitis.
State the cause of stomatitis.
=> Due to medication.
=> Due to drooling in the mouth.
=> Due to poor nutritional habit.
=> Due to stress.
=> Due to bacterial and viral infections.
=> Due to less amount of sleep.
=> Due to sudden weight loss.
=> Due to taking certain types of food like potatoes, citrus fruits, coffee, chocolate, cheese and nuts etc.
=> Due to immune system week.
=> Due to hormonal changes.
=> Due to low amount of B12, Iron and folate.
=> Due to genetic abnormality.
=> Due to autoimmune diseases.
=> Caused by herpes simplex virus.
=> Due to any injury in mouth cavity.
=> Due to some type of allergy (sensitivity to food, fluid, and certain medication).
=> Due to chemotherapy.
=> due to radiation therapy.
=> Due to taking tobacco.
=> Due to consumption of alcohol.
4) Explain the clinical manifestation/sign and symptoms of stomatitis.
Sore is painful.
There is a burning sensation in the mouth.
Tingling sensation occurs in the mouth.
Gums become swollen.
Bleeding from the gums.
There is tenderness in the mucus membrane.
Papulovesicular ulcer appears in the mouth.
Redness is seen in the mouth.
Lesions appeared in the mouth.
Single or multiple small, round ulcer with whitish center and red border.
Inflammation occurs in the mouth.
There is difficulty in eating and drinking.
Bad breath (halitosis).
Fever.
There is swelling in the lymph node.
Cracking and dryness occurs in the mouth.
5) Explain the diagnostic evaluation of stomatitis.
history taking and physical examination.
biopsy.
blood test.
cultures.
imaging studies.
x-rays.
ct scan.
patch test.
assess the stomatitis is related to the food.
6) Explain the treatment of stomatitis.
Ask the patient to avoid hot beverages.
Ask the patient to avoid hot food.
Advise the patient to avoid spicy, salty and citrus foods.
Provide analgesic medicine if the patient is in pain.
Advise the patient to rinse with cold water.
Advise the patient to drink plenty of water.
Advise the patient to rinse the mouth with salt water.
Advising the patient to maintain proper dental hygiene.
Advise the patient to apply topical anesthetic such as ligbocaine and xylocaine (not provide to the children under 6 years of age.).
The patient is given a topical coti course thyroid such as triamcinolone
Giving advice to apply (triamcinolone).
Advise the patient to apply lidex gel.
Ephthasol to the patient
Giving advice to apply (Aphthasole) anti inflammatory paste.
Advise the patient to use peridex mouthwash.
If the patient has sore mouth, provide folate and vitamin B12.
Provide the patient with an anti-inflammatory drug such as a corticosteroid.
Provide an antiviral agent (5% acyclovir ointment) to the patient.
Advise the patient to apply ice on the lesion.
Asking the patient to consume citrus fruits and fresh fruits such as apples, grapes, pineapple, peaches, papaya etc.
Advise the patient to rinse the mouth properly with warm water.
Advise the patient to avoid alcoholic mouthwash.
Advise patient to take liquid diet, clear liquids, and bland diet.
Advise the patient to take whole grains, cereals, raw and lightly cooked vegetables and seeds.
Advise patient to take high fiber diet like fruits, vegetables, salad without salt.
Advise the patient to take vitamin C rich diet like lemon water daily.
Advising the patient to avoid tea, coffee, junk food, ice cream, hot diet, breakfast, spicy food that irritate the mouth.
Pickle to the patient,
Refined processed food, condiments,
Giving advice to avoid meat and soft drinks.
Advise the patient to gargle properly to prevent infection.
Advise the patient to maintain proper oral hygiene.
Advise the patient to take proper rest and sleep.
Advise the patient for multi-vitamin medication such as vitamin B complex and becasole capsule.
Advise the patient to brush the teeth gently to prevent bleeding from the gums.
Take proper care not to swallow the medicine applied on the ulcer.
Advise the patient to maintain proper oral hygiene.
[12:33 pm, 21/1/2024] Pankhaniya Deepali. Team: 1) Explain/define Glossotis.
=> Glossitis means infection and inflammation of the tongue is called glossitis.
=> Due to infection and inflammation in the tongue, the tongue becomes swollen and its color changes.
=> Finger like projections in the tongue called papillae due to glossitis
(finger like projection it’s called papillae) is lost from the surface of the tongue due to which the tongue looks smooth.
2) Explain the type of Glossitis.
There are 9 types of glossitis:
1) Benign migratory glossitis.
(benign migratory glossitis),
2) Acute infective glossitis.
(Acute Infective Glossitis),
3) Chronic Atrophic Glossitis/Hunter Glossitis
,
(Chronic Atrophic Glossitis/Hunter’s Glossitis)*
4) Median rhomboid glossitis
(median rhomboid glossitis),
5) Allergic or contact Glossitis.
(Allergic or Contact Glossitis),
6) Plaque-induced glossitis.
(Plaque induced glossitis),
7) Papillary Atrophy Glossitis.
(papillary atrophy glossitis),
8) Herpetic geometric glossitis
(herpetic geometric glossitis),
9) Idiopathic Glossitis
•••••>
(benign migratory glossitis),
=> Desquamation of filliform papillae on dorsal part of tongue in benign migratory glossitis
(peeling/shedding) occurs.
=> In this
Pinkies – Red
(pinkish-red)
A central lesion and yellowish lines or bands are seen which changes in a few days.
=> Because this glossitis keeps changing in few days
•>Erythema migrans
(Migraines in Eridhe),
•>Glossitis migrans
(glossitis migrans),
•>Glossitis areata exfoliativa
(Glossitis areata exfoliativa),
Pityriasis linguae
is called
(Acute Infective Glossitis),
=> A cute infectious glossitis is caused by a bacterial infection.
=> Acute infective glossitis mainly
It is seen due to poor oral hygiene and compromised immunity.
=> Its onset is rapid.
=> Symptoms of acute infective glossitis include pain, swallowing and difficulty in swallowing.
(Chronic Atrophic Glossitis)
=> Chronic atrophic glossitis is also called Hunter Glossitis.
=> In Hunter glossitis, the papillae of the tongue are lost, so the tongue has a smooth and shiny appearance.
=>Hunter glossitis is mainly caused by Iron and
Occurs due to deficiency of vitamin B12.
=> Pain and burning sensation occurs in Hunter glossitis.
=> Hunter’s glossitis also spreads to other parts of the oral cavity.
=> Beefy red color and shiny appearance of tongue is seen in hunter glossitis.
=> Small ulcer in Hunter Glossitis spreads on the surface so it is also called Atrophic Glossitis.
(median rhomboid glossitis),
=> In median rhomboid glossitis, a reddish lesion of diamond shape is seen in the center of the tongue.
=> Median rhomboid glossitis is mainly caused by yeast (candida).
Caused by infection.
=> Median rhomboid glossitis is a congenital disorder.
=> Mainly Rhomboid reddish, smooth and shiny lesion along with some opalescent spots are seen in the central part of the tongue.
(Allergic or Contact Glossitis),
Allergic contact glossitis is a condition of glossitis mainly due to allergic reaction to certain foods, medications and oral care products.
(Plaque induced glossitis),
=> Plaque induced glossitis is mainly seen due to inadequate oral hygiene.
=> Plaque induced glossitis is mainly seen due to accumulation of plaque in the tongue.
(papillary atrophy glossitis),
=> Papillary atrophy Glossitis is a filiform papilla mainly on the surface of the tongue.
(filliform papillae) is seen due to loss.
=> Therefore bald (smooth) and depapillated appearance of tongue is seen.
(herpetic geometric glossitis),
=> In herpetic geometric glossitis
Painful,
•>longitudinal, •>crossed, and
Branched fissure is found on the dorsum (posterior) surface of the tongue.
=> In idiopathic glossitis there is infection and inflammation of the tongue but its cause is unknown, it is called idiopathic glossitis.
=> In idiopathic glossitis, there is redness, swelling and changes in the color of the tongue.
3) Explain the Etiology/cause of Glossitis.
Due to any bacterial and viral infection (including oral herpes simplex).
due to poor hydration.
Due to mechanical irritation.
Due to less amount of saliva in the mouth.
If there is any injury in the mouth like burn.
Due to any trauma to the mouth.
rough edges of the teeth.
Due to exposure to any irritant such as tobacco, alcohol,
Hot food and spicy food etc.
Continuous colonization of any microorganism on the tongue
Due to (colonisation).
Any toothpaste, mouthwash, breath freshener, dyes in candy, plastic dentures,
due to medication.
Due to some kind of dish order viz
•> Iron deficiency Anemia,
•> Pernicious Anemia,
•>Vitamin B deficiency,
Oral lichen planus,
•>Erythema multiforme,
•>Aphthous ulcer,
•> Pemphigus vulgaris,
Syphilis,
And
•>other yeast infections.
Due to dry mouth.
Inherited
(inherited).
Due to poor oral hygiene.
4) Explain the clinical manifestation/sign and symptoms of Glossitis.
There is inflammation and swelling of the tongue.
A smoother appearance of the tongue is seen.
The color of the tongue is a dark “beefy” red color.
Pale color due to Pernicious Anemia.
Tongue is sore and tender.
Ulceration is seen in the tongue.
There is difficulty in chewing.
swallowed
(Swallowing) is a problem.
There is difficulty in speaking.
fiery red, due to deficiency of B Vitamin.
Tongue is sore and tender.
White patches are seen in the tongue.
5) Explain the diagnostic evaluation of the patient with the Glossitis.
history taking and physical examination.
blood test.
microbiological test.
biopsy.
Allergic testing.
imaging studies.
ct scan test.
salivary gland test.
6) Explain the treatment of the patient with Glossitis.
Advise the patient to maintain good oral hygiene.
Advise the patient to brush teeth properly twice a day.
If the patient has anemia and nutritional deficiency, provide dietary supplements.
Advise the patient to avoid hot and spicy food, alcohol and tobacco.
Provide corticosteroids to reduce inflammation of the patient’s tongue.
Provide antibiotic to the patient.
Provide antifungal to the patient.
Provide anti-fungal treatment to the patient.
Provide iron, vitamin B12 and folate to the patient.
Provide a balanced diet to the patient to prevent nutritional deficiency.
Advise the patient to avoid very hot and very cold items.
Advise the patient to avoid coffee, tea, spicy and salty food.
Advise the patient to avoid cigarette smoking.
Advise the patient to have adequate liquid intake.
Advise the patient to avoid things that have allergens.
Advise patients to maintain good oral hygiene.
Advise the patient to use a soft brush.
Advise patient to rinse mouth thouraly.
Minimize products that are irritating.
Advise patient to use topical emollient (glycerine).
Advise the patient to brush properly twice a day.
Advise the patient to apply topical corticosteroids.
Advise to rinse the mouth properly with Santni mouth wash.
Inform the doctor if the patient is allergic to any medication.
Advise the patient for regular mouth check-ups.
Advise the patient to follow up regularly.
[8:44 pm, 21/1/2024] Pankhaniya Deepali. Team: 1) Define/explain the Gingivitis.
= Gingivitis is a common and mild form of gum disease.
=> that in which
Infection and inflammation of gums/gingiva occurs.
=> Gingivitis is mainly plaque
due to build up of
=> Redness, swelling, pain, irritation in the gums due to gingivitis.
2) Explain the types of Gingivitis.
1) Acute Necrotizing Ulcerative Gingivitis (ANUG)
2) Chronic Gingivitis
3)Paque induced Gingivitis.
(Plaque induced gingivitis),
4) Non plaque induced gingivitis (Non plaque induced gingivitis)
••••••>
1) Acute Necrotizing Ulcerative Gingivitis (ANUG)
=> Acute necrotizing gingivitis is mainly seen due to impaired immune system and malnutrition.
=> Foul smelling from mouth due to acute gingivitis
(halitosis) comes fever and gums are full of pain.
=> Acute Gingivitis is mainly seen more in smoker. Less common in non-smokers.
2) Chronic Gingivitis
=>Chronic Gingivitis is mainly the most common type of gingivitis.
=> That gingivitis is caused by poor oral hygiene
=>Chronic Gingivitis is mainly seen for long time.
3)Paque induced Gingivitis.
(Plaque induced gingivitis),
=> Plaque induced gingivitis is primarily plaque in the gums.
is seen due to the formation of
4) Non plaque induced gingivitis (Non plaque induced gingivitis)
= >Non plaque induced gingivitis is mainly any disease condition, Hormonal changes,
And some diseases are caused by the condition.
It is mainly caused by viral infection, fungal infection, or genetic origin.
3) Explain the Etiology/cause of Gingivitis.
Due to plaque deposition.
Due to injury to the gums.
Due to vigorous brushing.
general illness.
Due to poor dental hygiene.
Due to hormonal changes during pregnancy.
Because of smoking.
Due to uncontrolled diabetes.
Because of dentures.
Due to certain types of medication.
Ex:=phenytoin,
Calcium channel blocker.
Birth control pills.
Due to taking birth control pills.
Due to poor oral hygiene.
Due to bacterial growth.
Because of smoking.
Due to use of tobacco.
Due to autoimmune disorders.
Due to hormonal changes.
4) Explain the clinical manifestation/sign and symptoms of the Gingivitis.
Gums become swollen.
Bright red or purple colored gums.
Bleeding from the gums.
Gums that tender when touched.
Halitosis
(halitosis:= bed breath).
Fever.
Gums are swollen and have shieny appearance.
gingival Edema.
Ulceration.
Redness occurs in games.
Gums are tender.
Sensitivity increases.
5) Explain the Diagnostic evaluation of Gingivitis.
history taking and physical examination.
x-rays.
Biopsy.
blood test.
culture.
patch testing.
6) Explain the management of the patient with Gingivitis.
Advise the patient to maintain proper oral hygiene.
Advise patient to gargle with saline solution.
Provide antibiotic to the patient.
Provide non steroidal anti inflammatory drug to the patient.
Provide xylocaine to relieve the patient’s pain.
Advise patient to clean mouth with antibacterial mouthwash.
If there is plaque formation in the oral cavity, remove it.
Scaling the patient,
Advise for root planning curratage.
Advise the patient to use chlorhexidine or hydrogen peroxide mouth wash to treat the gingivitis condition.
Provide antibiotic therapy to the patient.
Ex:= Amoxicillin, cephalexin.
Advise the patient to maintain oral hygiene.
Advise the patient for daily teeth brushing.
If there is formation of plaque in the patient’s oral cavity, remove it.
If dentures are fitted, maintain their proper hygienic condition.
Advise patient to maintain blood glucose level.
Avoiding the use of certain types of medication.
Ex:=phenytoin,
Calcium channel blocker.
Birth control pills etc.
Advise the patient to use a soft brush for brushing.
Advise the patient to avoid cigarette smoking.
Advise the patient to take proper nutrition like green leafy vegetables, vitamin-E, and vitamin-C.
Advise the patient to clean the mouth regularly.
Consult a dentist for proper mouth brushing and flushing technique.
[9:45 am, 22/1/2024] Pankhaniya Deepali. Team: 1) Define/explain pyorrhea/periodontitis.
Define periodontitis.
=> Pyorrhea is also known as periodontitis.
=> Periodontitis is a condition in which inflammation occurs due to infection in the bones and ligaments that support the teeth.
=> Pyorrhea is a serious gum infection that destroys the soft tissue and bone that supports the teeth.
=> Tooth loss due to periodontitis and other health conditions viz
heart attack,
Heart attack, stroke, and other serious health problems also arise.
=> Periodontitis is mainly seen due to poor oral hygienic condition.
2) Explain the types/classification of pyorrhea/periodontitis.
•••> There are mainly five types of pyorrhea. This type is mainly given based on the severity of the disease.
1) Gingivitis,
2) Aggressive periodontitis (aggressive periodontitis),
3) chronic periodontitis
(chronic periodontitis),
4) Periodontitis as a manifestation of systemic disease. (Periodontitis as a manifestation of systemic disease.)
5) Necrotizing periodontal disease
•••••••>
=> Gingivitis is the initial stage of gum disease in which the gums become infected and inflamed.
=> Gingivitis disease is reversible if proper oral hygiene is maintained.
=> Aggressive periodontitis develops more rapidly.
=> Aggressive periodontitis is a very severe condition,
=> Bones and tissues supporting the teeth in aggressive periodontitis rapidly.
is lost.
(chronic periodontitis),
=> Chronic periodontitis is the most common type of periodontitis.
=> In chronic periodontitis, attachment of bone and tissues from the teeth is lost while supporting the teeth.
=> Chronic periodontitis develops progressively and gradually.
=> Periodontitis also due to certain types of systemic diseases
condition arises.
Ex:= heart disease,
Respiratory disease,
Diabetes mellitus etc.
=> Necrotizing periodontal disease is a condition in which •>gingival tissues, •>periodontal ligaments, and •>alveolar bone are lost.
=> This condition mainly occurs in individuals who have systemic conditions such as •>HIV infection,
Malnutrition,
And •>immuno suppressant is found in excess in the person.
3) Explain the etiology/cause of pyorrhea/periodontitis.
When gingivitis is not properly treated.
Due to the formation of plaque in the teeth.
Due to the accumulation of tartar in the teeth.
hereditary,
Because of smoking.
Due to poor oral health habits.
Due to hormonal changes in females.
Due to diabetes.
AIDS infection,
Certain Drugs (like:=
•>antidepressant,
•>antihistamine,
•>Anti-seizure,
•>Calcium channel blocker,
•>Drugs that suppress the immune system. ),
Because of cancer.
Due to older age.
Due to reduced immunity.
Due to poor nutrition.
Due to substance abuse.
4) Explain the clinical manifestation/sign and symptoms of the patient with the pyorrhea/periodontitis.
State the symptoms and signs of a patient with pyorrhea.
Gums are soft and bleed easily.
Gums are swollen, bright red, and purple in color.
There should be more space between the gums.
gums that pull away from the teeth.
Teaches to look longer than normal length.
Finding pus between teeth and gums.
Bad breath (halitosis) coming from the mouth.
loose teeth.
Bleeding while brushing the teeth.
Bleeding when flossing the teeth.
metallic from the mouth
Test coming.
Inflammation of the gums.
Gums become red, swollen and tender.
gums pain.
5) Explain the diagnostic evaluation of the patient with pyorrhea.
history taking and physical examination.
Dental X Ray.
periodontal probing.
bite assessment.
plaque and tartar analysis.
Gingival crevicular fluid analysis.
6) Explain the management of the patient with pyorrhea/periodontitis.
medical management #
Advising the patient to maintain daily routine oral hygiene.
1) Scaling
=> By scaling, tarture, plaque and bacteria on the surface of the teeth are removed.
=> Scaling is mainly done using instruments and ultrasonic devices.
2)Root planning
(Route Planning)
=> In root planing, the root surface is smoothed due to which plaque and tartar are removed.
Route planning is done to avoid build up.
3) Antibiotic
=> Providing topical and oral antibiotics to the patient to prevent bacterial infection.
4) Antimicrobial mouth rinse
(antimicrobial mouth rinse)
=> Providing anti microbial mouth wash to the patient to prevent the growth of bacteria in the mouth. (Ex:=chlorhexidine
(chlorhexidine)).
5)Antiseptic” CHIP” (antiseptic chip) :=
=> Antiseptic “chip” contains a small piece of gelatine,
=> that chlorhexidine
(Chlorhexidine) filled,
=> It mainly controls bacterial growth, and peridontal pocket size
Reduces (peri dental pocket size),
=> This medicine is mainly placed in the pocket after route planning and this medicine is released slowly.
6) Antibiotic gel
=> Mainly doxycycline in this gel
(Doxycycline) is an antibiotic,
=> This medicine controls the growth of bacteria,
=> This is mainly placed in the pocket after scaling and root planning and slowly releases medicine from it.
7) Antibiotic microspheres
=> Mainly minocycline antibiotic in antibiotic microsphere
(minocycline Antibiotic) which controls the growth of bacteria and also reduces the size of periodontal pocket.
=> It is mainly placed in the pocket after scanning and route planning from which the medicine is slowly released.
8) Enzyme suppressant
=> Doxycycline in enzyme suppressant
A low dose of (doxycycline) is provided.
=> Some enzymes break down the tissues of the gums. By providing this medicine, the response from the body to that enzyme is held. And the breakdown of gum tissue is prevented.
=> This is mainly taken orally (as a pill).
9) Oral antibiotics
=> Oral antibiotics are mainly taken in capsule or tablet form.
=> Oral antibiotics are mainly used for short term in people who have acute and locally persistent periodontal infection.
=> If the patient has advanced periodontitis, surgical management is done in the condition where the gum tissue does not respond to non-surgical treatment and good oral hygiene.
1) Flap surgery (pocket reduction surgery).
Flap Surgery/Pocket Reduction Surgery.
=> In this procedure, the periodontist makes a tiny incision in the root of the gums.
=> Hence the gum tissues are lifted towards the back and the root is properly exposed hence scaling and
Route planning can be done more effectively.
=> This procedure generally takes one to three hours and is mainly performed by providing local anesthesia.
2) soft tissue graft
(Soft Tissue Graft)
=> When any
When the patient’s gums are lost due to periodontal disease, the teeth appear longer than their normal length.
=> Then replacement of the damaged one is done.
=> Roof of mouth in soft tissue graft
(palate)
A small amount of tissue is removed from or tissue from any donor is attached to the affected site.
=> Through this procedure, further recession of the gums can be reduced and the exposed root can be covered.
3) Bone grafting
=> This procedure is mainly done when the bone surrounding the teeth has been destroyed due to periodontitis.
=> In bone graft, patient’s own bone or synthetic and donated bone is used.
=> By doing bone grafting the tooth can be held in its place due to which the loss of the tooth can be prevented.
=> Bone grafting provides a platform for natural bone growth.
4) Guided tissues regeneration
=> This procedure provides a platform for regrowth of bone which has been destroyed due to bacteria.
=> In this procedure, the dentist places a special piece of biocompatible fabric (special pieces of biocompatible fabric) between the bone and the teeth.
=> This material prevents the unwanted tissue from moving into the healing area so the bone can grow properly.
5) Enamel matrix derivative application
=> Enamel matrix derivative application consists of a specialized gel applied to the root of the diseased tooth.
=> This gel contains SAM protein which is present in tooth enamel which is responsible for stimulating healthy bone and tissue growth.
Explain the nursing management of the patient with the pyorrhea:=
Write the nursing management of a patient with pyorrhea.
Advise the patient to maintain proper oral hygiene.
Advise patient athletes to brush properly twice a day.
Advise the patient to brush properly.
Advise patient to wash mouth properly with antiseptic mouth wash chlorhexidine glucomate.
Advising the patient for regular dental checkup.
Advise the patient to brush properly after taking a meal.
Advise the patient to use a soft toothbrush.
Advise the patient to take a well balanced diet.
Advise the patient to take a diet rich in calcium and vitamin C.
[3:19 pm, 22/1/2024] Pankhaniya Deepali. Team: 1) Define/explain dental caries.
=> Dental caries a
An infectious microbiological disease that causes dissolution and destruction of the calcified tissue of the teeth.
=> Due to dental caries, small shallow holes are formed in the teeth.
=> Dental caries
Tooth DK in (dental caries).
(tooth decay) and formation of cavities.
=> Dental caries is mainly caused by the growth of any bacteria in the mouth, which leads to the formation of acid in the oral cavity, which destroys/breaks down the hard tissues around the teeth.
=> Due to this, cavities are formed in the tooth.
2) Explain the etiology/cause of dental caries.
1) Due to bacterial infection.
Streptococcus mutans ( Streptococcus
mutans)
2) Due to high intake of sugar and carbohydrates in diet.
Due to high intake of carbohydrates.
3) Due to poor oral hygiene
Due to not brushing properly.
4) Due to reduced salivary flow.
Due to reduced salivary flow in the mouth.
5) Due to genetic factor
The condition of dental caries is seen due to genetic abnormality.
6) Poorly fluoridated
Because of (fluoridated) water
Due to fluoride, the teeth are strengthened too much, while the amount of fluoride is less, the formation of KV occurs in the teeth.
7) Lack of dental care
Due to not taking proper care of the teeth, the condition of dental caries is seen.
8) Due to accumulation of food particles in the mouth.
9) Due to bacterial infection.
10) Due to the formation of plaque in the mouth.
11) Due to poor oral hygiene.
12) Autoimmune disorders
(autoimmune disorder).
13) Due to dehydration of the mouth.
14) Due to taking some kind of cancer meditation.
3) Explain the clinical manifestation/sign and symptoms of the patient with the dental caries.
1) Tooth sensitivity
=> When sensitivity through any hot, cold, acidic, spicy beverages food is an early sign of dental caries.
2) Toothache
(toothache) or pain
=> Pain is seen in the tooth due to the formation of cavity in the tooth.
3) Visible Cavity:=
=> Formation of small cavities in the mouth. Which is visible
4) Tooth discoloration
=> Tooth a white brown and black discoloration occurs.
5) Bad breath (halitosis)
=> Persistent bed breath is seen due to bacterial activity.
6) Pain when chewing
=> Chewing on the affected side causes pain in the teeth.
7) Pus (Abscess) formation
=> When a serious condition occurs, pus accumulates around the teeth, causing pain and swelling in the teeth.
8) Visible holes and breaks in teeth.
=> Due to the formation of teeth caries, the structure of the teeth breaks down, which leads to the formation of holes in the teeth.
4) Explain the diagnostic evaluation of the patient with dental caries.
history taking and physical examination.
Dental X-rays.
cavity detection tools.
tooth sensitivity evaluation.
Dye or staining agent.
visual or tactile examination.
assessment of the symptoms.
5) Explain the treatment of the patient with the dental caries.
Teeth damage can be prevented by treatment.
1) Fluoride medication:=
=> Fluoride is a type of mineral that prevents the formation of hollow cavities in the teeth.
=> So provide fluoride medication.
2)Dental fillings (Dental fillings): =
=> If cavity formation has occurred in small and moderate mounts, the dentist removes the decayed part of the tooth and fills the teeth with some materials.
Material like:=
Ex:= Amalgume,
Composite resin,
Glass ionometer
3) crowns
=> If the formation of a large cavity in the teeth
If there is, a crown is placed on the teeth.
=> By placing the crown on the teeth, the structure of the remaining teeth can be prevented from being destroyed.
4) Root canal therapy
(Root Canal Therapy)
=> A root canal is done when the tooth decay has reached the nerve of the tooth.
=> In this mainly infected pulp (nerve) is removed,
And root canal is cleaned. And it is sealed to prevent further infection.
5) Dental bonding
=> Dental bonding is mainly used to treat the formation of minor cavities in the teeth.
=> Tooth colored resin material is applied in this.
=> It is provided shape and made hard by special light.
6) Preventive treatment
(Preventive Treatment)
=> Fluoride treatment and dental sealants mainly prevent teeth from further decay.
7) Dental extraction
(Dental Extraction)
=> Teeth extraction is done when teeth are severely decayed.
8) Nutritional Diet
and oral hygiene education.
=> Advising the patient to maintain proper oral hygiene.
=> Giving advice to the patient for proper brushing, flossing.
=> Giving advice to the patient to avoid sugary food, acidic food and beverages.
9) Regular dental check up:=
=> Giving advice to the patient to get teeth checked up regularly.
[3:47 pm, 22/1/2024] Pankhaniya Deepali. Team: 1) Explain/Define Halitosis.
=> Bed breath for halitosis
is called
=> In halitosis, an unpleasant odor is present when the breath is exhaled.
=> Halitosis is mainly seen due to dental decay, poor dental care, any gum disease, and bacterial infection.
2) Explain the etiology of the patient with halitosis.
1) Due to consumption of certain types of food.
Ex:= due to Onion,Garlic,Fish,Cheese,Spices etc.
2) Due to tobacco product:=
=> Bad breadh comes from the mouth due to gum disease due to smoking.
3) Poor dental hygiene:=
=> If the mouth is not cleaned properly, bed bread can come from the mouth.
4) Oral disease :=
=> Gingivais
dental decay,
Halitosis is also seen due to Ulceration etc.
5)other cause:=
=> Due to chronic rhinosinusitis.
=> Due to tonsillitis.
=>gastro esophageal reflux disease (GERD),
=> Due to lower respiratory tract infection.
=> Due to renal failure.
=> Due to nasal infection.
=> Due to renal infection.
=> Due to diabetes mellitus (smell of acetone breath).
3) Explain the diagnostic evaluation of the halitosis.
history taking and physical examination.
Halimeter test.
gas chromatography.
4) Explain the management of the patient with the halitosis.
Advise the patient to maintain daily oral hygiene.
Advising the patient for proper diet intake.
Advise the patient to chew sugar frwe chew gum.
Advise the patient to stop smoking and alcohol.
Advise the patient to visit the dentist regularly.
Advise the patient to properly cleanse the tongue.
Advise the patient to brush twice a day.
Advise the patient to maintain proper oral hygiene after meal.
Advise patient to gargle with proper mouth wash.
Advise the patient to properly clean dentures if they have applied them.
Advise the patient to have plenty of fluid intake.
Advise the patient to intake high fiber foods and citrus foods.
Advise the patient to take low amount of carbohydrate and high fat and high protein diet.
1) Explain/define Dysphagia.
=> Dysphagia is a medical term for difficulty in swallowing.
=> Dysphagia can be mainly due to oesophageal disorder and also due to oesophageal disorder.
=>specific cause of dysphagia including:=
1) Neuromotor malfunction
(neuromotor dysfunction),
2) Mechanical obstruction
(Mechanical obstruction),
3) Cardiovascular Abnormality
4) Neurological disease (Neurological disease).
••>There are three classifications of dysphagia.
1) oropharyngeal dysphagia (oropharyngeal dysphagia),
2) Esophageal dysphagia
(esophageal dysphagia),
3) functional dysphagia
(Functional Dysphagia)
•••••>
1) oropharyngeal dysphagia (oropharyngeal dysphagia),
=> The condition is seen mainly due to any abnormality in the oral cavity and pharynx.
=> Condition of dysphagia is seen due to problem in tongue and throat also.
=> Oropharyngeal dysphagia can also be due to the following reasons
•>Tonsillitis
(Tonsillitis),
•>Peritoncillure abscess
(peritonschilar abscess),
•>Stomatitis
(stomatitis),
Tongue cancer
2) Esophageal dysphagia
(esophageal dysphagia),
=> Esophageal dysphagia is mainly due to a problem in the structure of the esophagus or any disease condition of the esophagus.
•>like:=
1) Narrowing of the esophagus.
(due to narrowing of esophagus). ,
2) Obstruction of the esophagus
(due to obstruction in esophagus),
3) weak muscles contraction
(due to wick muscle contraction)
(Functional Dysphagia)
=> In functional dysphagia, dysphagia is not seen mainly due to any organic cause. But it is mainly seen due to impaired muscle contraction due to any neurological disorder.
3) Explain the etiology/cause of dysphagia.
Achalasia
(Achalasia := Achalasia is a condition in which peristalsis of the smooth muscles of the esophagus
(peristalsis := a wave like movement) moment is impaired and relaxation is impeded in the lower sphincter in the esophagus.).
Esophageal tumor.
Esophageal stricture (narrowing).
Gastroesophageal Reflux Disease (GERD).
Due to foreign body.
Due to any allergy to (eosinophilic esophagitis).
scleroderma (scar tissues formed and cause hardening and stiffening of the tissues).
Neurological disorders (stroke, Parkinson’s disease, Alzheimer’s disease).
4) Explain the clinical manifestation/sign and symptoms of the patient with the dysphagia.
Pain in swallowing.
Difficulty in swallowing.
Pulmonary aspiration.
Sensation as if any food is stuck in the throat.
coughing.
chocking.
drooling of the saliva.
Weight loss.
Regurgitation of food
(back flow of food) to happen.
Frequent heart burn.
hoarseness of voice.
gagging while swallowing.
Difficulty swallowing.
5) Explain the diagnostic evaluation of the patient with the dysphagia.
history taking and physical examination.
barium swallow.
fluoroscopy.
X Ray.
ct scan.
MRI.
Endoscopy.
Ultrasonography.
Esophagal muscle test (monometry).
6) Explain the treatment of the patient with the dysphagia.
Patients with dysphagia have difficulty swallowing, so advise the patient about swallowing therapy, exercise, and dietary changes.
Educate the patient about dilatation if he has an esophageal stretcher.
Inserting a fitting tube to feed the patient.
Balloon dilation of patient’s esophagus.
If there is a problem in the esophageal sphincter, laparoscopic myotomy (making an incision at the lower sphincter of the esophagus to reduce the pressure.)
Provide antacid medicine if the patient has gastroesophageal reflux disease (GERD).
If the patient has the condition of dysphagia, then all the emergency equipment like suction, oxygen and face mask should be kept at the patient’s bed side.
Giving advice to change the patient’s eating habit, providing the patient with small amounts of food at small intervals and giving advice to eat slowly.
Provide high Fowler position with support of the patient on chair or pillow in sitting position.
Advise the patient to identify the food that causes dysphagia in the patient and give advice to avoid those foods like coffee, butter, spicy food etc.
Provide proper mouth care to the patient before and after taking meal, if there is secretion present in the mouth, remove it by suction.
Advise the patient to avoid tea, coffee, soft drinks, tobacco, alcohol which are acid forming foods and heart burn.
Providing a calm and comfortable environment to the patient.
Advising the patient to avoid sticky food like peanut butter, chocolate, milk.
Advise the patient to use a straw to ingest any liquid.
Asking the patient to avoid talking while taking his meal.
Advising the patient to intake semi solid food so that the patient does not have difficulty in swallowing.
[12:21 pm, 23/1/2024] Pankhaniya Deepali. Team: 1) define/explain Achalasia.
=> Achalasia is a type of medical condition.
=> Achalasia is a medical condition in which there is an inability of the lower oesophageal sphincter.
=> In which the lower esophageal sphincter cannot be relaxed, due to which liquid and food from the esophagus properly enters the stomach.
Cannot be transferred.
=> In Achalasia (Achalasia) peristalsis moment of esophagus (A wave like movement is impaired).
=> In achalasia
Esophagus is narrowing just above the stomach due to which the esophagus is a
Incomplete emptying occurs and food cannot be properly transferred to the stomach.
2) Explain the etiology/cause of the patient with Achalasia.
nerve damage
(due to new damage).
autoimmune factore.
genetic predisposition (genetic
predisposition).
viral infection (viral infection).
autoimmune disease
(autoimmune disease).
3) Explain the clinical manifestation/sign and symptoms of the patient with the Achalasia.
Difficulty in swallowing.
Chest pain.
Heart burn.
Discomfort in taking liquid and solid food.
Aspiration of gastric contents is done.
Regurgitation (back flow of stomach contents).
Chest pain.
4) Explain the diagnostic evaluation of the patient with the Achalasia.
history taking and physical examination.
X rays.
Gastrointestinal examination.
barium swallow.
Endoscopy.
Esophageal monometry.
5) Explain the management of the patient with the Achalasia.
1) Calcium channel blocker and nitrates
(Calcium channel blockers and nitrates).
= >Calcium channel blockers help relax the lower oesophageal sphincter so that the food content can reach the stomach properly.
2) Botulinum toxin injection
=> Botulinum toxin injection is given directly into the lower esophageal sphincter due to which the temporary lower oesophageal sphincter relaxes.
=> But its effect is for short duration so it needs to be provided repeatedly.
3)Dilatation (pneumatic balloon dilatation)
=> In this procedure, a balloon is inflated in the narrowed esophagus.
=> Due to this, the esophagus dilates and the food container is emptied at the same time.
=> But this procedure is also temporary, the esophagus needs to be dilated repeatedly.
=> Surgical management involves cutting the lower oesophageal sphincter.
=> And the obstruction is removed by cutting the narrowing esophagus.
=>Heller’s myotomy
(Hellers myotomy)
=> In this procedure the lower esophageal sphincter is surgically cut.
=> Antireflux procedure with it
Fundoplication is also done to prevent gastroesophageal reflux.
Advise patient to take clear fluid, soft diet which is easy to swallow food.
Advise patient to take high fiber food.
Giving advice to the patient to take liquid diet (liquid diet) and bland diet (bland diet).
Advise the patient to take high fiber food like fruits and vegetables.
Advise patient to take vitamin C rich diet.
Advise the patient to avoid spicy food and items containing pickles and spices.
Advising the patient to avoid tea, coffee, junk food, ice cream and hot diet.
Encourage the patient to drink plenty of fluids to prevent dehydration.
Advise the patient to take proper rest and sleep so that the pain and discomfort can be relieved.
Provide antibiotic medicine to prevent patientn from infection.
Monitoring the patient’s weight daily.
Provide calcium channel blocker medicine to patient to relieve muscle contraction.
Providing Analgesic Medicine to relieve the pain level of the patient.
Advise patient to take regular follow up.
Explain/define the gastroesophageal reflux disorder.
=> In gastroesophageal reflux disorder, gastric and duodenal contents flow back into esophagus in excessive amount.
=> Because incompetent
(being disabled) •>oesophageal sphincture / •>pyloric stenosis/ •>esophageal motore disorder causes back flow of stomach contents (acid) in esophagus. It causes irritation and inflammatory conditions.
2) Explain the etiology/cause of gastro oesophageal reflux disorder.
Due to neuromuscular development delay.
Hiatal hernia
(This is a condition in which a part of the stomach crosses the diaphragm and comes upwards.)
Being a cerebellar defect.
Due to esophageal sphincter loss.
Abdominal pressure due to increase due to obesity, constipation.
Due to taking fatty food.
Due to smoking, chocolate, caffeine, alcohol, obesity pregnancy delays stomach emptying.
Broncho pulmonary
Dysphasia.
Due to certain types of medication.
(like:= theophylline).
Due to lower esophageal sphincter dysfunction.
Due to delayed gastric emptying.
Due to pregnancy.
Due to certain food and lifestyle changes.
3) Explain the clinical manifestation/sign and symptoms of the patient with gastroesophageal reflux disease.
Burning sensation.
heartburn.
Regurgitation
(back flow of food into the esophagus).
Indigestion (dyspepsia).
Abdominal bloating.
Odynophagia (pain on swallowing).
Passing bloody and black stools.
Burping (burping).
Hypersalivation occurs.
Chest pain.
Difficulty in swallowing (dysphagia).
Hiccups that don’t let up.
Nausea.
hoarseness.
Esophagitis
(oesophagitis).
Loss of appetite.
Weight loss.
Discomfort in the upper abdominal area.
Nozia.
hoarseness.
whizzing sound,
dry cough,
chronic sore throat.
4) Explain the diagnostic evaluation of the patient with the gastroesophageal reflux disease.
=> history taking and physical examination.
=> Barium swallow.
=> Endoscopy.
=> Bilirubin monitoring.
=>Esophageal histology finding.
=> Esophago gastroduodenoscopy
(EGD).
=>Esophageal monometry.
=> PH monitoring of the esophagus.
=> biopsy.
5) Explain the management of the patient with the gastroesophageal reflux disease.
provide antacid to the patient.
Ex:=antacids such as maalox,
Mylanta,
Gelusil,
Rolaids,
Tums.
provide proton pump inhibitor to the patient.
Provide proton pump inhibiting medicine when patient has severe symptoms.
Ex:=proton pump inhibitor drugs are:=
•>omeprazole (prilosec),
•>lansoprazole
(prevacid),
•>Rabeprazole
(Aciphex),
•>pantoprazole
(protonix),
•>Ex omeprazole (Nexium).
provide Acid suppressants to the patient.
provide prokinetic agents to the patient.
1)procedures:=
=> In this surgical intervention, the surgeon wraps the top part of the stomach and the lower part of the esophagus.
=> Due to this valve like structure forms.
=> Stomach content can be prevented from coming into the esophagus by doing this procedure.
2)Approaches:=
1) Laproscopic fundoplication (laparoscopic fundoplication)
=> This procedure is a minimally invasive procedure in which a small incision is made. And cameras and special instruments are placed.
=> It mainly results in fast recovery and post-operative complications are less than open surgery.
2)open fundoplication:=
=> Open surgery is also done in some cases.
3) Types of fundoplication
A) Nissan fundoplication
=> This is a most common type of fundoplication in which the fundus part of the stomach is completely wrapped around the esophagus.
B) partial fundoplication (partial fundoplication)
=> In this procedure the part of stomach is partially wrapped.
=> This is a procedure in which the lower part of the stomach (pylorus/pylorus) is widened due to which the stomach can be completely emptied into the duodenum.
do the gastrotomy
(surgically opening into the stomach).
Complete medical history and physical examination of the patient.
To provide complete information to the patient about gastero esophageal reflux disease, its cause, its signs and symptoms and its treatment.
Advise the patient to make proper dietary modification such as to avoid fatty and spicy food.
Advise the patient to maintain proper body weight.
Advise the patient to take soft drinks like tea, coffee, alcohol in small quantities.
Advising the patient to avoid smoking, cigarettes, fatty and spicy food, milk, onion, garlic.
Advise the patient not to lie down directly after eating.
Advise the patient to take food with low fat, high protein and high fiber and green leafy vegetables.
Advise the patient to make lifestyle modifications including maintaining proper weight and giving advice to avoid smoking and tobacco.
Instruct the patient to take proper medication such as antacids and
Advise to take proton pump inhibitor medicine.
Advise the patient to lie down only after two hours after eating.
Advise the patient to take food three hours before lying down so that acid reflux can be prevented.
Advising the patient on proper fluid intake.
Advising the patient to take diet in small and frequent amounts.
Some medications cause acid reflux so advise the patient to drink water properly before taking that medicine.
Advise the patient to walk after every meal.
To advise the patient to take medicine properly.
Provide proper emotional support to the patient.
Providing proper health education to patients.
[5:53 am, 24/1/2024] Pankhaniya Deepali. Team: # #1) explain/define Esophagus *cancer.
=> Cancer of esophagus occurs in this.
=>And from the lining of the esophagus and its muscles and lymph nodes also get involved and cancer develops.
=> Esophageal cancer involves abnormal and uncontrollable growth of epithelial cells in the esophagus.
and tumor formation
And it creates cancer of esophagus.
2) Explain the types of esophageal cancer.
=> Esophageal cancer
There are two main types.
1) Adenocarcinoma of the esophagus
(of the esophagus in adenocarcinoma).
2) squamous cell carcinoma of the esophagus
(Squamous Cell Carcinoma of the Esophagus)
••••>
1) Adenocarcinoma of the esophagus
(of the esophagus in adenocarcinoma).
=> In esophageal carcinoma, it is found in the lower part of the esophagus and near the stomach.
=> United States
Adeno carcinoma is the most common type of esophageal cancer in the United States.
2) squamous cell carcinoma of the esophagus
(Squamous Cell Carcinoma of the Esophagus)
=> This type of cancer is mainly found in the upper 2/3 of the esophagus.
=> In squamous cell carcinoma, it is mainly found in less amount in American
=> But esophageal cancer is the most common type in the whole world.
1) Gender more in men 👨🦼
2) Race
Esophageal cancer is more common in African and American ethnicities.
3)Age:= Occurs more in persons above 50 years of age.
4) use of alcohol and tobacco,
5) GERD ( Gastero esophageal reflux disease := Gastero esophageal reflux disease),
6)hot,spicy dietary intake (due to excessive spicy fried food),
7) Exposure to nitrosomine in food/Environments.
8) Obesity.
9) Due to acid reflux.
10) Chronic peptic ulcer.
11) Diet low in fruits and vegetables.
12) Human papilloma virus.
13) iron deficiency.
14) Barrett esophagus.
15) Due to medical history of head and neck.
16) Due to undergoing any radiation therapy.
17) celiac disease.
18) Due to thermal injury.
19) Ecclesia.
Dysphagia (difficulty in swallowing),
feeling of lump in throat.
(feeling like a lump in the throat),
painfully and difficulty in swallowing
Regurgitation of undigested food
(undigested food comes back into the mouth),
loss of appetite
(loss of appetite),
loss of weight
(weight loss),
Food getting stuck in the esophagus.
Lose too much weight.
Pain in the throat and in the part behind the breastbone and between the shoulder blades.
hoarseness and chronic cough.
coughing up blood.
Heart burn.
Nausea.
Vomiting.
Regurgitation of food (back flow of the food).
Ct scan,
MRI,
PET (Positron Emosin Tomography),
barium swallow.
gastroesophagoscopy
(gastroesophagoscopy).
biopsy.
De bulking surgery,
chemotherapy and radiation therapy combination
7) Explain the nursing management of the patient with the esophageal cancer.
To check patient’s vital sign.
Providing emotional support to the patient.
Maintain hygienic condition.
Give the patient high calorie and high protein rich food.
To meet all the needs of the patient.
If the patient gets any kind of adverse effect, see about it.
To maintain the nutritional status of the patient.
Maintaining the patient’s fluid level.
To clear all the doubts of the patient and his family members.
Providing psychological support to the patient and his family members.
If the patient is not able to take food orally, provide total parenteral nutrition.
If the patient is unable to swallow, insertion of an esophageal stent that allows the esophagus to remain patent.
Provide intravenous fluid to the patient.
Monitoring the patient’s arterial blood gas level.
Advise the patient to avoid overeating Advise the patient to take small amounts of food.
If the patient has nausea, vomiting, cough, difficulty in swallowing, advise to report immediately.
To provide a calm and comfortable environment to the patient.
) explain/define Esophageal stricture.
=> Esophagus is gradually narrowing or tightening in esophageal stricture.
=> Difficulty in swallowing occurs due to this.
=> Esofacial stricture is mainly due to the buildup of scar tissues in the esophagus.
=> Scarring develops in the esophagus when the lining of the esophagus is damaged.
=> When this scarring develops, the esophagus becomes stiff, while continuous stiffness builds up in the esophagus, causing difficulty in swallowing.
2) Explain the etiology/cause of the patient with the esophageal stricture.
Due to gastro esophageal reflux disease.
caustic ingestion (acid or alkali).
Due to prolonged nasogastric tube use.
Malignancy
(malignancy).
Due to injection of any toxic chemical.
due to radiation therapy.
Due to ingestion of any corrosive substance (household cleaning agents).
due to chronic and severe viral and bacterial infections.
•>candida.
•>herpes simplex virus (HSV).
•>cytomegalovirus
(CMV).
•>Human immunodeficiency virus (HIV).
Due to injury from use of endoscope.
In an immunosuppressed patient who has received a transplant.
Due to scar formation by previous surgery.
due to esophageal cancer.
medication induced stricture.
•>Non steroidal anti inflammatory drug (NSAID).
•>phynytoin.
•>potassium chloride.
•>quinidine.
•>tetracycline.
•>Acorbic acid.
idiopathic
Eosinophilic esophagitis
(idiopathic eosinophilic esophagitis).
Due to extrinsic compression.
Due to squamous cell carcinoma.
3) Explain the clinical manifestation/sign and symptoms of the patient with the esophageal stricture.
Difficulty in swallowing.
Discomfort with swallowing.
A feeling that food is stuck in the esophagus.
Regurgitation of food.
Weight loss.
Heart burn.
Bitter and acid test in mouth.
Choking (choking).
Coughing.
Shortness of breath.
Frequent burping or hiccups.
Pain in swallowing.
4) Explain the diagnostic evaluation of the patient with the esophageal stricture.
history taking and physical examination.
Barium swallow.
Endoscopy Examination.
Complete blood cell count (complete blood cell count).
liver profile.
complete metabolic panel.
imaging studies.
Barium esophagram.
Chest radiograph (posterior anterior and lateral).
X rays.
ct scan.
Endoscopic ultrasound.
5) Explain the management of the patient with the esophageal stricture.
Provide proper antibiotic medicine to the patient.
Esophageal dilatation (pneumatic dilator).
Provide the patient with proton pump inhibitor medicine.
Ex:= omeprazole,
Lansoprazole,
Rabeprazole.
Advising the patient for lifestyle modification.
Advise the patient to avoid fatty food, spicy food, alcohol chocolate, and peppermint.
Advise the patient to take food in small amounts and in frequent amounts.
Advise the patient to avoid eating in a hurried manner.
Advise the patient to eat two to three hours before going to bed.
Advising the patient to lose weight.
[10:44 am, 24/1/2024] Pankhaniya Deepali. Team: 1) Explain/define Esophageal varices.
=> In esophageal varices, the vein located in the lower part of the esophagus enlarges abnormally.
=> Esophageal varices
(Esophageal varices)
It is mainly seen in excess in the person with liver disease (most common in the patient with the liver cirrhosis).
=> Esophageal varices develop when the normal blood flow to the liver is slowed down.
=> Due to this, the blood flow backs into the smaller blood vessels nearby.
=> It mainly occurs in the vessels of the esophagus due to which the blood vessels dilate.
Esophageal varices develop
=> Esophageal varices often rupture. It then creates life threatening bleeding.
2) Explain the etiology/cause of esophageal varices.
Liver failure.
Liver cirrhosis.
Portal hypertension.
Portal vein thrombosis.
Increst portal blood flow fistula.
Portal vein obstruction.
cirrhosis due to varices cause.
Idiopathic portal hypertension.
Acute hepatitis.
Schistosomiasis.
Congenital hepatic fibrosis.
Myelosarcosis.
Budd chiary syndrome.
Constrictive pericarditis (constrictive pericarditis).
Liver disease.
malnourishment.
Due to ingesting alcohol.
Physical exercise.
Sarkardian rhythm.
Increases intra-abdominal pressure.
Aspirin intake (Aspirin intake).
Non-steroidal anti-inflammatory drug (NSAID).
Bacterial infection.
3) Explain the clinical manifestation of the patient with the clinical manifestation/sign and symptoms of the patient with the esophageal varices.
=> Gastrointestinal bleeding.
=> Hematemesis (blood in vomit).
=> Abdominal pain.
=> Dysphagia
(dysphagia::= difficulty in swallowing).
=> Odynophagia
(odynophagia:= pain in swallowing).
=> Confusion.
=> symptom of Anemia and shock.
=> Blood coming in vomiting.
=> Abdominal pain.
=> Ascites (Acities:= accumulation of fluid in the stomach).
=> Hepatic encephalopathy (hepatic encephalopathy).
=> Paleness/pallor
=> Hypotension
(Hypotension/Shock).
=> Urine output will be reduced.
=> Melina (malaena).
=> Glasgow Coma Scale reduction.
=> sign of sepsis.
4) Explain the diagnostic evaluation of the patient with the esophageal varices.
history taking and physical examination.
complete blood count (CBC).
hemoglobin level assessment.
assess the platelet count.
assess the international normalized ratio (INR).
renal function test
Liver function test.
Computerized Tomography (ct scan assessment).
7) Explain the management of the patient with the digestive and gastro intestinal disorder.
1) Endoscopic band ligation
(endoscopic band ligation)
=> In endoscope ligation, rubber is tied around the bulged vein and bleeding is stopped.
=> Endoscopic band ligation is considered as the first line treatment for esophageal varices.
2) balloon tamponade
=> In the balloon tamponade procedure, a balloon is inserted through the nose and the bleeding from the varices is stopped.
3)Sclerotherapy
=> In sclerotherapy, injection is introduced at the building side and due to this the blood clots and the bleeding is also stopped.
4) Drug therapy
(Drug Therapy)
=> In drug therapy, drugs are provided to reduce blood pressure.
Ex:= terlipressin,
Vasopressin,
Nitroglycerine,
Octerotides.
Somatostatin.
5) Transjugular intrahepatic portosystemic shunting (TIPS)
6) Distal splenorenal shunt (DSRS). ,
7) Esophageal Transection.
8) Liver transplantation.
Advise the patient to stop drinking alcohol.
Advising the patient to take a healthy diet.
Advise the patient to take fruits and vegetables.
Advise the patient to avoid fatty and spicy food.
Advise the patient to maintain his body weight.
Advise the patient to maintain properly.
[8:37 pm, 24/1/2024] Pankhaniya Deepali. Team: 1) define/explain hiatus hernia.
=> Hiatus hernia is a condition,
In which the esophagus enters the abdominal cavity from the chest cavity through the opening of the diaphragm (its called hiatus), the part of the stomach protrudes from the abdominal cavity into the chest cavity from the space (hiatus). It is called a hiatus hernia.
=> Hiatus hernia is more common disease of gastero intestinal track.
2) Explain the types of hiatus hernia.
=> There are total four types of hiatus hernia.
1) Sliding hiatus hernia
(Sliding Hieter’s Hernia),
2)Fixed hiatus hernia
(fixed hiatus hernia),
3) Complicated hiatus hernia (complicated hiatus hernia),
4) Rolling/para esophageal hernia (Rolling or paraesophageal hernia)
••••>
1) Sliding hiatus hernia
(Sliding Hieter’s Hernia),
=> In sliding hiatus hernia, the upper most part of the stomach, gasteroesophageal sphincter protrudes into the chest cavity.
2)Fixed hiatus hernia
(fixed hiatus hernia),
=> In fixed hernia, the uppermost part of the stomach protrudes into the chest cavity.
=> This type of hernia is not serious and has few symptoms.
3) Complicated hiatus hernia (complicated hiatus hernia),
=> Complicated hiatus hernia is the most complex form of hernia.
=> In this hernia, the whole stomach protrudes into the chest cavity.
=> Many types of symptoms are seen in this type of hernia and the patient has many difficulties.
=> This type of hernia is not common.
4)Rolling/para esophageal hernia (Rolling or paraesophageal hernia)
=> In rolling/paraesophageal hernia, the junction where esophagus and stomach are connected remains normal.
=> But parts of the stomach protrude into the chest cavity.
3) Explain the classification of the hiatus hernia.
••••••>
=> In this type of hernia, the gastroesophageal junction and also the stomach is displaced into the chest cavity.
=> This type of hernia is symptomatic and asymptomatic.
=> In this type of hernia, mainly the hernia is placed in the abdominal cavity.
There is a need for surgical intervention.
=> In this type of hernia, the stomach protrudes into the chest cavity and the gastroesophageal junction is in its normal position.
=> This type of hernia is mainly due to tissue a week of diaphragm muscles.
=> This is mainly a combination of type one and type two hernias
(its a combination of type 1 and type 2 hernia).
=> In this type of hernia, the gastroesophageal junction and the fundus part of the stomach protrude into the chest cavity.
=> This type of hernia is massive.
Therefore it is called giant esophageal hernia.
=> Displacement of other organs of abdomen also occurs in this type of hernia.
Ex:=•> omentum,
•> Transverse
colon,
Mesocolon,
•> Spleen.
4) Explain the etiology/cause of the patient with the hiatus hernia.
white flour
(flour), and their products like cakes, pastries, biscuits,
Due to excessive consumption of white bread.
Aging. (Mainly seen more in old age person due to the muscles of diaphragm.).
Refined sugar.
Due to trauma and surgery.
Due to obesity.
poor nutrition.
Genetic
due to abnormality.
Because of smoking.
Due to pregnancy.
chronic straining.
Due to disorder of connective tissues.
5) Explain the clinical manifestation/sign and symptoms of the hiatus hernia.
Heart burn.
sense of fullness after eating.
indiagetion.
Retrosternal pain.
Nausea.
Vomiting.
Regurgitation
(back flow of food).
Anemia.
Difficulty in swallowing.
Chest pain.
belching or hiccups.
6) Explain the diagnostic evaluation of the patient with the hiatus hernia.
history taking and physical examination.
upper GI barium.
chest x rays studies.
gastroscopy.
Barium swallow.
fluoroscopy.
Upper intestinal endoscopy.
7) Explain the management of the patient with the hiatus hernia.
Provide antacid medicine to the patient.
Ex:=
•> maalox,
Mylanta,
Gelusil,
•>Tums.
Advise the patient to avoid alcohol and smoking.
Administer prokinetic medication to the patient.
Ex:=
•>reeglan,
•>Bethanacol,
Provide proton pump inhibitor medicine to the patient.
Ex:=
•>prilosec
(omeprazole),
•>Prevacid
(esomeprazole),
Administer histamine blocker medicine to the patient.
Ex:=
zantac
(ranitidine),
Tagmet
(cimetidine),
Pepcid
(famotidine).
1) Nissen fundoplication
=> This is a laparoscopic procedure in which the upper part of the stomach is wrapped around the lower esophageal sphincter, due to which gastric reflux can be prevented.
2) Laproscopic hiatal hernia repair,
=> This is a minimally invasive procedure in which the hernia is replaced using stitches and mesh through a laparoscope.
=> This surgery mainly has less healing time than traditional open surgery.
3) Toupet fundoplication
=> Troupet fundoplication is essentially similar to Nischen fundoplication but only partially wraps the fundus around the esophagus.
4) Paraesophageal hernia
=> In paraesophageal hernia, the stomach protrudes into the chest cavity and is placed back in the normal position in the abdominal cavity.
5) Hill procedures
=> Heel procedure lower esophagus is fixed in place (diaphragm) due to which its upward moment and hernia can be prevented.
To collect the patient’s history properly.
To monitor patient’s vital signs properly.
Advise patient to take soft diet like porridge, khichdi etc.
Serving food to the patient in an attractive manner.
Advise the patient to take food in small and frequent amounts.
Advise patient to take bland diet.
Provide antacid medicine to the patient.
Assess the patient’s skin color and turgor.
Advise the patient to take clear fluid, coconut water.
Advise the patient to maintain oral hygiene.
Provide intravenous fluid to the patient.
Provide antiemetic medicine to the patient.
Assessing the patient’s pain level.
Assess the duration and location of the patient’s pain.
To provide comfort measures to the patient.
Advise the patient to take proper waste and sleep.
Place the patient in semi-fowler position.
If the patient is in pain, provide analgesic medicine.
Assessing the patient’s daily routine activity.
Advising the patient to rest and sleep properly.
Advising the patient on proper diversional therapy like music, newspaper, sports etc.
Advising the patient to take a properly balanced diet.
Providing multi vitamin medicine to the patient.
1) Define/explain gastritis.
=> Gastritis is mainly made up of two words.
★ “Gastro” meaning:= “stomach”
★ “Itis” meaning := “inflammation”
=> Gastritis means inflammation, infection, irritation and erosion in the mucosal lining of the stomach.
=> Gastritis means infection and inflammation of the stomach mucosal lining.
2) Explain the types of gastritis.
There are total seven types of gastritis. :=>
1) Acute gastritis (acute gastritis),
2) chronic gastritis (chronic gastritis),
A) erosive gastritis
(Erosive Gastritis),
B) Non-erosive gastritis
(nonerosive gastritis),
3) Acute stress gastritis
(Acute Stress Gastritis),
4) Atrophic gastritis
(atrophic gastritis),
5) H. pylori
(helicobacter pylori) associated gastritis.
(Helicobacter pylori associated gastritis),
6) Autoimmune gastritis
(autoimmune gastritis),
7) chemical gastritis
(Chemical Gastritis),
••••••>
1) Acute gastritis (acute gastritis),
=> Acute gastritis is the most common type of gastritis condition.
=> Acute gastritis mainly develops suddenly and in short term.
=> In acute gastritis, inflammation occurs in the lining of the stomach and it is mainly sudden and due to this bleeding is also seen in the mucosal lining of the stomach.
=> This bleeding is mostly seen for less than 24 hours.
=> Acute gastritis is mainly caused by Helicobacter pylori bacteria.
=> A cute guest is mainly caused by spoiled food, dead fish, animal, bone, plastic, good, chemicals, drug, toxic, plant, and virus viral infection.
=> Acute gastritis is mainly caused by non-steroidal anti-inflammatory drugs, alcohol, and viral and bacterial infections.
2) chronic gastritis (chronic gastritis),
=> Chronic gastritis is mainly seen more in older people’s.
=> Long time (gradual) inflammation occurs in the mucousal lining of the stomach in chronic gastritis.
=> Chronic gastritis is mainly spread by bacteria called Helicobacter pylori (H. Pylori).
=> In chronic gastritis, the sphincter located mainly above the stomach cannot perform its function properly, due to which the acid from the stomach comes into the esophagus, due to which conditions like chest pain, heart burn are seen.
=> Chronic gastritis is mainly caused by an infection, pernicious anemia, and irritant substances.
A) erosive gastritis
(Erosive Gastritis),
=> Erosive gastritis mainly occurs due to erosion of the mucosal lining of the stomach.
=> Erosive gastritis is mainly caused by any irritant substance
Like alcohol, non steroidal anti inflammatory drug (NSAID) etc.
=> In erosive gastritis mainly there is weight loss, lesion in mucosal lining of stomach, abdominal pain.
B) Non-erosive gastritis
(nonerosive gastritis),
=> Non erosive gastritis is mainly due to histological abnormalities and mainly Helicobacter pylori infection.
(H. Pylori).
=> In non-erosive gastritis mainly the body accidentally identifies the stomach as a foreign protein and the infection causes the body to produce antibodies against it.
occurs and causes severe damage to the mucosal lining of the stomach, causing the condition of nonerosive gastritis to arise.
3) Acute stress gastritis
(Acute Stress Gastritis),
=> Acute stress gastritis is mainly caused by any severe illness and injury.
=> Acute stress gastritis is mainly in patients who,
•> In the intensive care unit (icu).
•>Patient who has respiratory failure, •>Neurological trauma,
•> severe burn, ,
•> Peritonitis (infection and inflammation of the peritoneum layer of the stomach),
Due to all these reasons, the condition of acute stress gastritis arises.
4) Atrophic gastritis
(atrophic gastritis),
=> Atrophic gastritis is a chronic form of gastritis in which the mucosal lining of the stomach becomes very thin/atrophy and the cells of the stomach which produce digestive acid and enzymes are lost. happens
=> This type is mainly autoimmune
Caused by (autoimmune disorder).
5) H. pylori
(helicobacter pylori) associated gastritis.
(Helicobacter pylori associated gastritis),
=> This type of gastritis is mainly caused by bacteria called Helicobacterium pylori.
=> Helicobacter pylori bacteria cause both acute gastritis and chronic gastritis.
6) Autoimmune gastritis
(autoimmune gastritis),
=> Auto immune
Gastritis is mainly caused due to Autoimmune disease in which mainly the body’s own immune system attacks the normal/healthy cells of the body due to which the condition of gastritis also occurs.
7) chemical gastritis
(Chemical Gastritis),
=> Chemical gastritis is mainly caused by prolonged use of any irritant substance.
=> Chemical gastritis occurs due to taking alcohol, corrosive chemicals, non-steroidal anti-inflammatory drug (NSAID).
3) Explain the etiology/cause of the patient with the gastritis.
The condition of gastritis mainly arises when the protective layer of the stomach has become week.
Due to benign and malignant ulcers in the stomach.
Due to any medication, medical and surgical condition.
Due to social habit,
Due to chemicals,
Due to infection,
Due to pernicious anemia (Anemia occurs due to deficiency of vitamin B12).
Due to bacterial infection such as Helicobacter pylori bacteria.
Due to regular use of certain types of drugs.
Ex:= NSAID Drug,
Ibuprofen,
Naproxen,
Due to alcohol and smocking.
Because of the older age.
Due to taking hot drinks and spicy food.
Due to injury,
Due to infection,
Due to any major surgery,
Due to excessive intake of cocaine substance.
due to bile reflux disease.
Due to other disease conditions such as HIV, Chron’s disease
Parasitic infection
4) Explain the clinical manifestation/sign and symptoms of the patient with the gastritis.
Abdominal discomfort.
Burning sensation.
to have a headache.
Indigestion.
nausea,
vomiting,
Feeling of fullness in upper abdomen after eating.
Loss of appetite.
Abdominal bloating.
Heart burn.
Sour taste in the mouth.
hiccups,
Symptoms of Vitamin B12 Deficiency.
Passing black, tarry stool.
Getting a fever.
Weakness.
Stomach cramping.
pallor, sweating and rapid heart beat.
Difficulty in breathing.
Large amount of blood in vomiting.
5) Explain the diagnostic evaluation of the patient with the gastritis.
history taking and physical examination.
Complete Blood Count Test (CBC Test).
Helicobacter pylori test (H. Pylori test).
Liver and kidney function test.
Urine Analysis
(Urine analysis).
Esophagogastroduodenoscopy
(esophagogastro
duodenoscopy).
Fecal occult blood test (fecal occult blood test).
Double contrast barium study.
X ray (x ray) of upper digestive system.
Gallbladder and pancreas test.
Double contrast barium study.
Endoscopy.
Histological examination of tissues obtained by biopsy.
6) Explain the medical management of the patient with the gastritis.
=> Antibiotic medication is mainly used to treat infections caused by bacteria called Helicobacter pylori.
Ex:=
•> Amoxicillin,
•>Tetracycline,
Metronidazole,
•>Clarithromycin.
2) Provide antacid medicine to the patient.
=> Antacid medicine mainly neutralizes the acid content of the stomach so provide antacid medicine to the patient.
Ex:=
Aspirin,
•>Sodium bicarbonate and megnasia.
3) Provide antiemetic medicine to the patient.
=> Anti-emetic medicine is mainly used to treat the condition of nausea and vomiting of the patient.
Ex:= ondancetrone.
4) Provide proton pump inhibitor to the patient.
=> Proton pump inhibitors reduce the production of acid mainly from the cells in the stomach that produce acid.
Ex:=
•>Omeprazole
(prilosec),
•>Lansoprazole
(prevacid),
•>Rabeprazole
(Acifex),
•>Esomeprazole
(Nexium),
•>Pantoprazole
(protonix).
5) Provide histamine 2 (H2) blocker to the patient.
=> Histamine blockers mainly help in reducing the amount of acid released in the digestive track and it relieves gastric pain and helps in healing.
Ex:=
•>Ranitidine (Zantac),
•>Famotidine (Pepcid),
•>Cimetidine (Tagamet),
•>Nizatidine (Axid).
6) Provide cytoprotective agent to the patient.
Cytoprotective agent medication mainly helps to protect the tissues of stomach and small intestine.
Ex:=
•>sucralfate
(carafate),
•>Subsalicylate
(pepto bismol).
7) Explain the nursing management of patients with gastritis.
Complete assessment and physical examination of the patient.
Assessing the signs and symptoms of the patient’s disease condition.
To assess the patient’s vital signs.
To auscultate the patient’s bowel sounds.
Palpate the abdomen.
1) Impaired nutritional status less than body requirement related to acid regurgitation as evidenced by intake output chart.
To collect a complete history of the patient.
To monitore patient’s vital sign hourly.
Advise patient to take soft diet like dalia, khichdi etc.
Serving food to the patient in an attractive manner.
Advise the patient to take small, frequent and non-irritating diet.
Anchoring the patient to maintain daily body weight.
Advise patient to take bland diet.
Provide antacid medicine to the patient.
2) Imbalance fluid level less than body requirement related to vomiting as evidence by assessing the skin turgor of the patient.
To monitor patient’s vital signs.
Assess the patient’s skin color and turgor.
Advise the patient to take clear liquids, juice, and coconut water.
Advise the patient to maintain oral hygiene.
Providing intravenous fluid to the patient.
Provide the patient with antiemetic medicine such as ondancetrone.
3) Disturbed sleeping pattern related to abdominal pain as evidenced by observing the restlessness condition of the patient.
Assessing the patient’s sleep pattern.
To provide a calm and comfortable environment to the patient.
Advise the patient to do daily routine activities in small amounts.
To provide a quiet environment to the patient.
Advise the patient to read a book and pray at bed time.
4) Acute pain related to disease condition as evidence by verbalise with the patient.
Assessing the patient’s pain level.
Assess the duration and location of the patient’s pain.
Advise the patient to take comfort measures such as deep breathing exercises.
Advise the patient to rest and sleep in a quiet environment.
Provide semi fowler position to the patient every hour.
Advise the patient to do moderate daily routine activities.
Provide analgesic medicine to the patient.
5) Activity intolerance related to Anemia as evidenced by weakness.
Assessing the patient’s daily routine activity.
Advise the patient to exercise in small amounts.
Advise to take proper rest.
Advise the patient for mind diversional therapy like music, magazine reading.
Advise the patient to take a balanced diet.
Provide vitamin supplements to the patient.
1) Define/explain peptic ulcer.
=> “peptic ulcer” is a compound word of two words.
1) “peptic”
2) “ulcer”
•••••>
1) “peptic”
=> “peptic” come from the Latin word “pepticus”
=> “pepticus” Which come from the Greek word “peptikus”
=> “peptikus” Which comes from the Greek word “peptein”
2) *”ulcer” Which comes from the Latin word “ulcus”
=> “ulcus” meaning a sore or a wound, an ulcer (a sore or a wound).
=> Peptic ulcer means that erosion or excavation (hollow area) forms in the mucosal lining of the stomach and the first part of small intestine (duodenum), it is called peptic or duodenal ulcer.
=> In peptic ulcer mucosal lining of stomach and first part of small intestine
(mucosal lining of the duodenum).
Sore and open sore develop mainly due to excessive secretion of acidic contents in the stomach and are called peptic and duodenal ulcers.
•> If peptic ulcer is in “stomach” it is called “gastric ulcer”.
•> If the peptic ulcer is in the “first part of the small intestine (duodenum)” then it is called “duodenal ulcer”.
•> If the peptic ulcer is in the just upper part of the stomach i.e. in the “esophagus” then it is called “esophageal ulcer”.
2) Explain the types of peptic ulcer.
•> There are two types of peptic ulcer.
1) Acute peptic ulcer (acute peptic ulcer),
2) Chronic peptic ulcer
•••••••>
1) Acute peptic ulcer (acute peptic ulcer),
=> Acute peptic ulcer is mainly superficial with erosion of the superficial mucosal layer.
=> Healing of acute peptic ulcer is done within a short time but if it is not treated, bleeding, perforation is seen in it.
2) Chronic peptic ulcer
=> Chronic peptic ulcer is deep, sharp edges and clean base.
=> Mucosa and submucosa in chronic peptic ulcer
(submucosa) is also involved.
=> If this ulcer penetrates into the stomach, it also affects the organ (pancreas) near the stomach.
3) Explain the etiology/cause of the patient with the peptic or duodenal ulcer.
H.pylri (by Helicobacter pylori bacteria),
Due to regular use of pain relieving mediation.
Ex:=
Aspirin,
Ibuprofen,
•>Non steroidal anti •>inflammatory drug.
Ibuprofen,
•>Naproxen etc.
Due to excessive production of stomach acid.
Due to hereditary factor.
Because of smoking.
Due to consumption of alcohol.
Due to taking excessive stress.
Due to excessive use of irritating things like tea, coffee, spices, tobacco.
Due to old age.
Due to anxiety, worry.
4) Explain the clinical manifestation/sign and symptoms of the patient with the peptic ulcer.
Inflammation in the first part of the stomach and interstitial (duodenum).
Abdominal bloating (bloating).
Abdominal burning.
Pain in upper middle part of abdomen.
nausea,
vomiting,
heartburn,
Abdominal fullness.
belching (belching).
Weight loss.
Passing bloody, black, terry stool (hematochazia).
bloody vomiting (hemetemesis).
Gastero intestinal bleeding.
Severe abdominal pain.
feeling of abdominal fullness.
5) Explain the diagnostic evaluation of the patient with the peptic or duodenal ulcer.
blood test:=
To detect the presence of helicobacter pylori bacteria in blood.
stool test.
Breathe test.
upper gastro intestinal x rays.
Barium swallow.
Endoscopy.
6) Explain the management of the patient with the peptic or duodenal ulcer.
The main goal of treatment is to eradicate Helicobacter pylori bacteria.
Provide acid suppression medicine to the patient.
1) Provide proton pump inhibitor medication to the patient.
=> Proton pump inhibitors reduce the production of acid in the stomach and play an important role in the healing of stomach ulcers.
Ex:=
omeprazole,
•>Lansoprazole,
Pantoprazole.
2) Administer H2 receptor antagonist medicine to the patient.
=> H2 receptor antagonist medicine reduces the production of acid in the stomach.
Ex:=
•> Ranitidine,
Famotidine,
3) Provide antibiotic medication to the patient.
=> If the peptic ulcer is mainly caused by bacteria called Helicobacter pylori, provide antibiotic medicine along with proton pump inhibitor medicine to treat it.
Ex:=
Amoxicillin,
Clarithromycin.
4) Provide cytoprotective agent to the patient
=> Cytoprotective agents protect the cells and tissues in the lining of the stomach and intestines.
Ex:=
•>sucralfate
(carafate)
•>Subsalicylate ( pepto bismol).
5) Provide Antacid medicine to the patient.
=> Antacid medicine mainly neutralizes the acid in the stomach and prevents heart burn.
Ex:=
Aspirin,
•>Sodium bicarbonate,
•>Citric acid,
Alumina,
•> Megnesia,
•>Calcium carbonate.
6) Provide education about the life style modifications to the patient.
=> Giving advice to the patient to avoid spicy food, caffeine and acidic food.
=> Giving advice to the patient to avoid smoking.
=> Advise patient to avoid consumption of alcohol.
=> Giving advice to avoid the patient’s stress level.
=> Advising the patient to take regular follow up.
1) vagotomy
(vagotomy)
=> In vagotomy, the vagus nerve is cut which is responsible for the secretion of stomach acid.
=> The aim of this surgery is to reduce the production of stomach acid and improve the healing of the ulcer.
2) Antrectomy
(Entrectomy)
=> In an antrectomy procedure, the lower part of the stomach (antrum) is removed which is mainly responsible for producing a hormone that increases the production of stomach acid.
3) pyloroplasty (pyloroplasty)
=> In pyloroplasty, the lower part of the stomach (pylorus) and the beginning part of the small intestine (duodenum) are widened due to which the food content in the stomach can pass into the intestine properly and the condition of ulcer can be reduced.
4) Gastrectomy
(gastrectomy)
=> In gastrectomy procedure, stomach is partially (partial gastrectomy) and completely
(completely gastrectomy) is removed and the esophagus is directly attached to the small intestine.
4)Billroth 1
(Billroth one) (gasteroduodenoostomy)
=> In this procedure, a new opening is formed between the stomach and the small intestine.
=> Remove lower part of stomach and anastomose remaining portion of stomach with duodenum of small intestine.
(anastomosis) is done.
5) Billroth 2
(Billroth to)
=> In this procedure the part of stomach along with jejunum (middle portion of the small intestine).
7) ## Nursing management ##
1) Pain related to gastric mucosa irritation.
Assessing the patient’s pain level.
Providing Mind Divergent Therapy to the patient.
Provide the prescribed analgesic medicine to the patient.
Advise the patient to avoid beverages and caffeinated food.
Advise the patient on relaxation techniques.
2) Altered nutritional status less than body requirement related to the therapeutic regimens.
Assessing the patient’s nutritional status.
Advise the patient to take liquid and semi-solid food.
Advise the patient to avoid hot, spicy and caffeinated foods.
Provide bland diet to the patient.
Provide antacid medicine if the patient is suffering from heart burn.
If the patient is vomiting, provide antiemetic medicine.
3) Anxiety related to the disease condition
Assessing the patient’s anxiety level.
To provide complete information to the patient about his disease condition, its causes and its treatment.
To clear all the doubts of the patient.
To provide a comfortable environment to the patient and his family members.
Communicating with the patient properly in simple language.
Providing psychological support to the patient.
4) Risk for gastro intestinal bleeding related to the surgery.
To monitor patient’s vital signs.
Monitoring the patient’s hemoglobin level.
Assess the patient for any conditions like dizziness and nosia.
Monitor the patient’s stool test.
Monitoring the patient’s urine output.
If the patient is bleeding, take immediate measures to stop it.
Continuously monitoring the patient.
[9:21 am, 25/1/2024] Pankhaniya Deepali. Team: ## 1) Define/explain cancer of stomach ##
Stomach cancer is also called gastric cancer.
=> It develops in any part of the stomach and in stomach cancer there is abnormal and uncontrollable growth of stomach cells and formation of tumor and mass like structures.
=> This tumor is a
Can be both benign (non cancerous) and malignant (cancerous).
=> About 85% of gastric cancers are adenocarcinomas
(Adenocarcinoma).
=> And it mainly develops on the stomach lining (mucosa).
=> 40%: = As many stomach cancers occur in the lower part of the stomach (pylorus := pylorus).
=> 40%: = As much as stomach cancer in the middle part of the stomach (body). happens
=> 15%: = As many cases occur in the upper part of the stomach (cardia).
=> And this stomach cancer is a metastasis i.e. transferred and in the body
Liver,
Lungs,
•>bone (bone), and
•>Spreads in brain, etc.
=> And mainly that
Periosteum (periosteum) i.e. also spreads in the abdominal cavity.
Age:= seen after 40 years of age.
Gender:= Males are more affected than females.
Region:= More common in Japanese people.
Diet := It can also be caused due to less intake of fruits and vegetables.
Smocking,
alcohol,
Hereditary factors,
cronic infection in the stomach (due to chronic infection in the stomach),
Stomach surgery,
H. pylorus infection (Helico bacterium pylori),
High consumption of red meat 🍖,
(due to eating too much meat),
Pernicious Anemia
(due to vitamin B 12 deficiency),
Gastric ulcer,
Hereditary,
Obesity,
Hormonal factors,
Etc.
3) Explain clinical manifestation/sign and symptoms of the patient with the stomach cancer
There is pain in the part of the stomach.
Difficulty in swallowing.
Nausea and vomiting occur.
Weight is reduced.
Even after eating a little, the stomach feels very bloated.
There is blood in vomiting (hemetemesis).
There is blood in the stool
(hematochezia),
Gastrointestinal bleeding,
Conditions like indigestion and gas (heart burn) occur.
Anorexia (loss of appetite)
Diarrhea (loss of watery stool),
Constipation
(difficulty in passing stool),
Iron deficiency anemia.
History tacking and physical examination,
biopsy,
Endoscopy,
USG,
X Ray,
ct scan,
MRI,
5) Explain the management of the patient with the stomach cancer.
chemotherapy,
radiation therapy,
gastrectomy,
-> Total gastrectomy,
-> sub total gastrectomy
esophageal gastrectomy
Billiroth :- I (gasteroduodenostomy),
Billroth:=II
(gasterojejunostomy),
Emergency management:=
To check the patient’s vital sign after 15 minutes.
Checking the patient’s blood pressure every 15 minutes.
Setting up two intra venous lines to the patient and preparing blood transfusion.
Administering oxygen to the patient.
To check the patient’s bowel sound.
To see whether the patient has vomiting and diarrhea.
Catheterizing the patient to check urine intake output.
To check the skin color of the patient.
Maintaining intake output chart of patient.
Put the patient in fowler position to avoid aspirating mucus.
Insertion of Nasogastric tube (N.g tube) in the patient.
Start feeding the patient with a clear liquid diet.
preoperative and
Postoperative nursing management :=
Preoperative nursing management:=
Explaining the procedure to the patient and his family members.
Setting up an intravenous line to the patient.
Catheterizing the patient.
Maintaining patient’s intake output chart.
Setting up a blood transfusion to the patient.
To carry out all laboratory investigations of the patient.
Administer oxygen to the patient.
Proper shaving should be done on the operation part of the patient.
Cleaning or painting the patient with savlon and spirit on the operation side.
To mentally and physically prepare the patient for surgery.
To check patient’s vital signs.
Providing psychological support to the patient and his family members.
Post operative nursing management:=
Close observation of the patient after the operation.
Patient Nadar 15 minutes to check vital signs.
Provide intravenous fluid to the patient by parenteral route.
To check the patient’s bowel sound.
Administering proper antibiotics to the patient.
Providing psychological support to the patient.
Advising the patient’s family members to ensure that the patient does not do very hard work.
Ask the patient to rest.
Providing work and comfortable environment to the patient.
To balance the nutritional and food status of the patient.
Ask the patient to do a small amount of activity.
[11:56 am, 25/1/2024] Pankhaniya Deepali. Team: 1) Explain/Define Gasteroenteritis.
=>#Gastro meaning:= stomach.
=>#enter meaning:= intestine.
=> #itis meaning := inflammation (inflammation).
=> Gastroenteritis involves inflammation of the gastrointestinal tract.
=> In which there is also involvement of stomach and small intestine due to which acute diarrhea
(Acute Diarrhea)
The condition of
=> Gastroenteritis is a condition that causes infection, irritation and inflammation in the stomach and intestines.
2) Explain the Etiology/cause of the patient with the Gasteroenteritis.
1) Due to viral infection.
•>Rotavirous
(rotavirus),
•>Norovirus
(norovirus),
•> Adenovirus,
•>parvovirous
(parvovirus),
•>Astrovirous
(Astro virus).
2) Due to bacterial infection.
•>Escheresia coli ( Escherichia coli),
•>salmonella
(Salmonella),
•>shingella (Singella),
•> campylobacter
( Campylobacter ),
•>vibrio,
•> Clostridium difficile
( Clostridium difficile),
3) Due to parasites.
•> Giardia lamblia,
•>cytosporidium
(Cytosporidium),
•>entamiba histolytica
(Entamoeba histolytica),
4) Due to toxins and chemicals.
•> Due to contaminated food and water intact.
•>Due to ingestion of contaminated chemicals.
5) Non-infectious cause
•> Due to certain types of medication,
•> Due to food allergy,
•>reaction to certain substance,
6) Poor hygiene factors.
•> Due to not washing hands properly.
•> Due to poor hygienic condition.
3) Explain the clinical manifestation/sign and symptoms of the patient with the Gasteroenteritis.
nausea,
vomiting,
Abdominal discomfort,
Abdominal cramps (cramps).
Diarrhea.
Loss of appetite.
swollen abdomen
Abdominal pain.
to come up with a fever.
Abdominal bloating (filling about abdomen is full and tight due to the gas).
Diarrhea.
Blood in vomit (hematemesis).
Blood in the stool.
(hematochazia).
Dehydration.
Muscle aches.
feeling tired
4) Explain the diagnosis evaluation of the patient with the gastroenteritis.
history taking and physical examination.
complete blood count.
stool examination.
imaging studies.
clostridium difficile
Testing.
Electrolyte Testing.
kidney function test.
5) Explain the management of the patient with the Gasteroenteritis.
Maintain patient’s hydration status.
Provide intravenous fluid to the patient.
Providing antibiotic medicine to the patient.
Antidiarrheal to the patient
Provide antidiarrheal medicine.
Provide antiemetic medicine to the patient.
Ex:=
•>promethazine
(phenargan),
•>Prochlorperazine
(compazine),
•>Ondancetrone
(zofran),
1)Fluid replacement:=
Advising the patient on proper fluid intake.
Advise patient to ingest oral rehydration solution if electrolyte imbalance is present.
Properly maintain the patient’s hydration status.
To monitor patient’s vital signs.
2) Maintain nutritional status of the patient.
Advise to intake diet in small amount of tuition.
Advise the patient to consume easily digestible food.
Ex:=
bananas,
Rise,
Toast, etc.
Advise the patient to avoid fatty and spicy food.
Maintain intake output chart of patient.
3)isolation precaution (if Gasteroenteritis is infectious) :=
If the gasteroenteritis is infectious, keep the patient isolated.
Advise the patient to maintain proper hand hygiene.
4) medication administrations :=
Advising the patient to take the prescribed medicine properly.
Providing antiemetic medicine to treat the patient’s vomiting.
If the patient has a condition of diarrhea, provide antidiarrheal medicine.
5) Comfort measures:=
=> Provide comfort measures if the patient is in pain.
=> Providing mind diversional therapy to the patient.
6) Educational and discharge planning.
=> Advise the patient for proper hand washing technique.
=> Advised the patient for proper food technique.
=> Advise patient for hand washing technique.
=> Giving advice to provide proper emotional support to the patient.
=> To provide a clean and comfortable environment to the patient.
[8:39 am, 26/1/2024] Pankhaniya Deepali. Team: 1)#Define/explain tracheoesophageal fistula.
=> Fistula means Abnormal connection between any two organs is called fistula.
=> Tracheoesophageal fistula in trachea/wind pipe and esophagus
Abnormal connection occurs between (esophagus/the tube that carries food from mouth to the stomach). It is called tracheoesophageal fistula.
=> Tracheoesophageal fistula is mainly a congenital abnormality but it occurs late in life.
If it occurs in late life, it is due to any surgical procedure.
2) Explain the etiology/cause of the patient with the tracheoesophageal fistula.
Due to congenital defect.
Due to traumatic and blunt injury.
Due to environmental factors.
Due to tumor formation.
due to pressure necrosis by a tracheostomy tube.
gastric acid regurgitation through distal fistula.
3) Explain the clinical manifestation of the patient with the tracheoesophageal fistula.
Excessive secretion after birth.
in neonate:=
•>Chocking,
•> Coughing,
Vomiting,
•>Cyanosis during •>feeding,
White frothy bubbles of mucous are present in the mouth and nose of the neonate.
cyanosis,
Abdominal distension.
to cough.
poor feeding.
Respiratory distress.
Inability to pass nasogastric tube.
3) Explain the diagnostic evaluation of the patient with the esophageal fistula.
history taking and physical examination.
ultra sound,
chest x rays,
nasogastric tube insertion,
barium mill,
electrocardiogram,
echocardiogram,
5) Explain the management of the patient with the tracheoesophageal fistula.
1) Immediate management:=
=> Keep the infant at 30 degree angle so that gastric content can be prevented from being reflexed.
2) Keep the naso gastric tube in the esophagus and suction the secretion in the esophagus so that aspiration can be prevented.
3) Washing out the pouch with normal saline so that the tube is not blocked by mucus.
4) Provide supportive therapy to the patient.
5) Full filling of the nutritional requirement of the patient.
6) Provide Indra Winners fluid to the patient.
7) Provide antibiotic medicine to the patient.
8) Provide respiratory support to the patient.
9) Advise the patient to maintain a neutral environment.
10) To correct the fistula by surgical intervention to the patient.
Advise the patient to increase fluid intake.
Provide intravenous fluid to the patient.
Provide respiratory support to the patient.
Provide oxygen to the patient properly.
To monitor patient’s vital sign continuously.
Provide ventilatory support to the patient.
Do not give anything by mouth to the patient.
Keeping the agent in semi fowler position.
Provide emotional support to the patient and his family members.
To report immediately if any kind of complication occurs to the patient.
To provide all the information about the disease to the family members of the patient.
1) Explain/define peritonitis.
=> peritoneum
(Peritoneum is a serous membrane that covers the viscera of the abdominal cavity and provides support to the abdominal organs)
=> Localized and generalized infection and inflammation in this peritoneum is called peritonitis.
••{ peritonitis :=
Infection and inflammation of the peritoneum layer of the abdomen its called peritonitis. }••
=> Peritonitis is mainly caused by any bacterial and fungal infection. Due to this, the most common symptom is severe abdominal pain.
2) Explain the etiology/cause of peritonitis.
The most common cause of peritonitis is any bacterial or viral infection.
1) infection (due to infection):=
bacterial infection,
Fungal infection.
2) Perforated organ
In this, infection can also occur due to perforation of any organ of the abdominal cavity.
3) Intra abdominal inflammatory condition:
=> Diverticulitis,
=> Pancreatitis,
=> Inflammatory bowel disease.
4) Trauma
(due to trauma)
=> Due to trou in admon.,
5) Post operative complication
=> As a complication of surgery in any abdominal cavity.
6)Activities
(due to ascites)
=> Due to accumulation of fluid in abdominal cavity.
7) other organ inflammation
=> Peritonitis occurs due to the spread of inflammation in other organs of the body in the abdominal cavity.
8) Due to intra abdominal abscess (pus).
9) Due to peritoneal dialysis.
10) Rupture appendix.
11) Due to peptic ulcer.
12) Due to liver cirrhosis.
13) Due to any pelvic inflammatory disease.
14) Due to inflammation in fallopian tubes.
3) Explain the type of peritonitis.
1) primary peritonitis
(primary peritonitis),
2) secondary peritonitis
(Secondary Peritonitis)
•••••>
1) primary peritonitis
(primary peritonitis),
=> When infection and inflammation occurs in the peritoneum through any blood or lymph infection, it is called primary peritonitis.
=> This type of peritonitis is seen only in rare conditions.
2) secondary peritonitis
(Secondary Peritonitis)
=> When infection and inflammation occurs in the peritoneum layer by bacteria and enzymes in the biliary and gastro intestinal track, it is called secondary peritonitis.
=> This type of peritonitis is most common.
4) Explain the clinical manifestation/sign and symptoms of the patient with the peritonitis.
Abdominal pain.
Abdominal tenderness.
Abdominal Bloating (filling of fullness or tightness in abdomen due to gas accumulate in abdominal cavity).
rebound tenderness (when
Even when the abdomen is palpated by the hand and the pressure given by the hand is released from that place, the pain and tenderness of the patient increases, it is called rebound tenderness.)
fever and chills.
Nausea.
Vomiting.
Do not bring hunger.
Temperature and pulse rate increase.
Electrolyte imbalance.
Leukocytes count increase.
Breathing difficulty.
skin turned pale and cold.
Heart rate increase.
shock.
4) Explain the diagnostic evaluation of the patient with the peritonitis.
history taking and physical examination.
Blood test.
Complete blood count test.
Blood culture.
Electrolyte and kidney function tests.
Abdominal ultrasound.
abdominal x ray.
abdominal ct scan.
Laparoscopy
(leproscopy).
peritoneal fluid culture.
Exploratory surgery.
rectal and pelvic examination.
5) Explain the management of the patient with peritonitis.
Maintain patient’s fluid and electrolyte balance.
Provide isotonic solution to the patient to prevent hypovolemia.
If the patient is in pain, provide analgesic medicine.
If the patient has a complaint of nausea and vomiting, provide antiemetic medicine.
If there is a complaint of abdominal distension, then intestinal intubation and suction are done, due to which abdominal distention is relieved and intestinal function is promoted.
Provide adequate amount of oxygen to the patient.
Providing broad spectrum antibiotic medicine to the patient.
Ex:=
•>Cifoxitine with the aminoglycocide.
•>Penicillin G.
•> Clindamycin with aminoglycoside.
Surgery to remove infected tissue.
Provide intravenous fluids to the patient to normalize if electrolyte disturbance has occurred.
Advise the patient to maintain oral hygiene to prevent infection.
During childhood
Advising on proper immunization of Mums, Measles and Rubella (MMR).
Advise the patient to wash hands properly before and after defecation.
Advise the patient to avoid irritant food like caffeine, spicy food, and hot food.
Advise the patient to intake plenty of fluids to reduce dryness of the mouth.
Patients smoking,
Giving advice to stop alcohol and cigarettes.
It is advised to use lukewarm saline solution to moisten the mouth.
Advising the patient to use sugar free lemon drops helps to increase saliva production and reduce swallowing.
Advising the patient on semisolid diet intake.
Advise a hit application to reduce swelling in the patient’s cheeks.
Advise the patient to take fiber rich diet.
Providing psychological support to the patient.
To inform the patient properly about the disease, its cause, its treatment.
To clear all the doubts of the patient and his family members.
Advise patient to take medicine regularly.
Advising the patient for proper follow up.
[5:34 pm, 26/1/2024] Pankhaniya Deepali. Team: 1) Explain/define helminthiasis.
=> Helminthiasis is also called worm infection.
=> When the body is infected by parasitic worms it is called helminths.
=> Helminths are classified as:=
•> Tapeworm
(cestodes),
•> Round worm
(nematodes),
•> Fluckes
(treamatodes).
=> This 🪱 worm 🪱 mainly lives in the gastro intestinal track but also in other organs of the body.
Spreads and causes physiological changes and damage.
=> Helminthiasis is primarily in the body’s intestines, liver, lungs, blood stream. affects etc.
=> STH
(Soil Transmitted Helminthiasis / Soil Transmitted Helminthiasis)
and schistosomiasis is the most important group of helminthiasis.
2) Explain the types of 🪱 worm infestation.
There are four types of worm infestation.
1) Ascariasis
(ascariasis)
(Roundworm infection)
=> Round worm mainly contaminates food and due to this food affects intestines and lungs.
=> Includes round worm infections such as lymphatic filariasis.
2) Tape worm infection
(Tape worm infection.)
=> Tape worm infection is mainly caused by eating uncooked food.
=> Tapeworm infections include cysticercosis.
3) Enterobiasis
(Enterobiasis)
(pinworm infection)
(Pine Vomit Infection)
Pinworm mainly infects the cecum and its eggs are mainly present on the perianal skin.
4) Hook worm infection
(hookworm infection)
=> Larvae of hook worm mainly
Skin,
Lungs,
And
•>Affects small intestine, •>esophagus.
3) Explain the etiology/cause of helminthiasis.
=> Helminthiasis is mainly caused by parasitic worms.
1) Contaminated food or water
=> Due to ingestion of food infected/contaminated by helminths.
=> Due to poor sanitation.
2) Soil contamination.
=> Due to contact with soil contaminated with helminths and ingestion of contaminated vegetables.
3) fecal oral transmission
=> Helminths are spread through fecal oral root mainly due to unhygienic conditions.
4) consumption of undercooked or raw food
(due to intake of undercooked and raw food)
=> Certain types of helminths like tapeworms are mainly spread by ingesting undercooked food or raw food.
5) contact with the infected animals
=> Some types of helminths are mainly spread by direct contact with any infected animal.
6) vectore born transmission
=> Some types of helminths are mainly transmitted by vectors.
4) Explain the clinical manifestation/sign and symptoms of the patient with the helminthiasis.
low grade fever,
Blood in sputum,
Make a wheezing sound.
Dyspnoea
(shortness of breath).
Chest pain.
Epigastric pain.
Vomiting.
Abdominal distension.
perineal itching during night.
irritability.
restlessness.
Insomnia.
Blood in the stool
(hematochazia).
Anemia.
Weight loss.
feeling tired
5) Explain the diagnostic evaluation of the patient with the helminthiasis.
history taking and physical examination.
Stool examination microscopically.
Complete blood count test.
Serological testing.
6) Explain the medical management of the patient with the helminthiasis.
1) Deforming treatment
(Deforming treatment.)
=> Tab mebendazole to the patient in this treatment
A single dose of (vermox) is provided for three days.
=> This dose is repeated every two weeks.
=> Provide tab. Albendazole to the patient.
=> Provide Oxamniquine to the patient.
=> If the patient has anemic condition then tab. Ferrous sulphate 200 mg should be provided three times a day.
In surgery, the affected part of the intestine is removed.
(Mass Deworming of Children)
=> Dewarming medication twice a year to children in areas where worm infestation is high.
(Albendazole) is provided.
=> Education is provided to children to do proper hand washing.
=> Children are advised to brush properly.
Providing education for proper hand hygiene of patients.
To provide education to patients for safe drinking water and safe food preparation.
Advise the patient to maintain cleanliness while doing food preparation.
=> Giving advice to maintain clinliness even while eating food.
=> Advise the patient to maintain proper environmental sanitation.
=> Giving advice to the patient to maintain personal hygiene.
Advise a balanced diet to prevent nutritional deficiencies.
Giving advice for high protein diet, low carbohydrate and fibrous food intake.
Advise the patient to take small and frequent amounts of food.
Advise green leafy vegetable intake to prevent anemia.
Advise the patient to have plenty of fluid intake.
The patient should be properly treated with antihelminthic medicine such as albendazole,
Administer mebendazole.
Advising the patient for regular checkup.
Advise the patient to report any complications immediately.
Advising the patient to take regular follow up.
Advising the patient to take medication properly.
Team: 1) Define/explain constipation.
=> Constipation is a condition in which bowel movements are infrequent or
•>Difficulty in bowel emptying or •>Difficulty in passing stool, or •>Incomplete bowel evacuation/emptying.
=> The condition of constipation is mainly due to the hardening of feaceas,
2) Explain the etiology/cause of the constipation.
1) Dietary factors
=> Due to low intake of fiber rich diet.
=> Due to less fluid intake.
=>Due to excessive consumption of processed food.
2) Lack of physical activity
(due to less physical activity)
=> Due to sedentary lifestyle and lack of physical activity.
3) Dehydration
=> Constipation may occur due to low intake of fluids, hard stool and difficulty in passing stool.
4) certain medication
(due to certain types of medication)
Ex:=
•> Antihypertensive,
•> Antidepressant,
•>Antacid,
•>Opioids (narcotics),
Diuretics,
•> Antihistamine,
•>Antispasmodic,
•> Anticonvulsant,
•>Calcium channel blocker,
•>Pain reliever,
All these medications can also cause constipation.
5) Neurological conditions
(Neurological condition)
=> Multiple sclerosis, parkinson disease can also cause constipation.
6) Hormonal changes
(due to hormonal changes)
=> Due to hormonal fluctuation due to pregnancy and age.
7) Metabolic or muscular
=>
•>Hypercalcemia, •>Hypothyroidism, •>Diabetes mellitus, •>Cystic fibrosis,
•> myotonic dystrophy,
Celiac disease,
etc. also causes condition of constipation.
8) structural or functional disorder (due to structural and functional disorder)
=>
Colon cancer,
•>Anal fissure,
•>Spinal cord lesion, •>Pregnancy,
•> Descending perineum syndrome,
•>Stroke.
9) psychological factore (due to psychological factor)
=> Due to sress, anxiety, fear.
10) Due to lead poisoning.
11) Due to connective tissue disorders.
12) Due to appendicitis.
13) Ignorance to the urge of defecation.
14) Due to obstruction.
3) Explain the clinical manifestation/sign and symptoms of the patient with the constipation.
Abdominal discomfort.
Abdominal distension.
Abdominal pain.
Anorexia (lack of appetite).
straining to pass stool.
headache
Nausea.
Feeling of fullness.
restlessness.
Indigestion.
Anismus
Anesmus: Uncoordinated contraction of the anal sphincter during straining.
fecal impaction:=
=> Hard mass feeling in the rectum.
Infrequent bowel movements.
Difficulty in passing stool.
Passing hard and dry stools.
4) Explain the diagnostic evaluation of the patient with constipation.
history taking and physical examination.
Barium enema.
Colonoscopy.
Sigmoidoscopy.
Abdominal X Ray
Anorectal manometry.
Rectal examination.
5) Explain the complications of the patient with the constipation.
Getting hemorrhoids.
Perforation occurs.
Hypotension.
Fecal impaction.
Anal fissure (fissure).
Abdominal pain.
Diverticulosis.
Megacolon.
Bowel perforation.
6) Explain the treatment of the patient with constipation.
Advise patient to have high fiber diet intake.
Advising the patient to take fruits and vegetables.
Advise the patient to drink six to eight glasses of water daily.
If impaction of stool is done, provide enema to the patient.
Like:=
soap water enema,
Tap water enema,
Phosphate enema.
Provide medication therapy to improve bowel motor function.
Ex:= prokinetic agent (cisatride or metoclopramide).
provide bulk forming drug to the patient ex:=methyl cellulose psyllium.
provide stool softener to the patient ex:= Docusate.
Provide lubricant to the patient.
Ex:= mineral oil.
Providing stimulants to the patient.
Ex:= phenol phthalein.
Providing saline and osmotic solution to the patient.
Ex:=
milk of magnesia,
Sodium Phosphate lactulose.
serotonin type a Receptor partial agonist (tegaserod) provide to the patient.
1) Advice about taking adequate nutritional diet :=
Advise the patient to have an adequate balance diet to prevent nutritional deficiency.
Advise the patient to avoid cigarettes, smoking, alcohol.
Advise patient to avoid irritating food like tea, coffee, spicy food, hot food.
Advise patient to intake adequate amount of water.
Advise patient to take high fiber food.
Advise the patient to intake fruits and vegetables like apple, papaya, orange etc.
Ask the patient to avoid taking sleep immediately after meal.
Advise the patient to adopt good hand hygiene habits to prevent infection.
Advise patients to wash hands properly before and after meals to prevent infection.
Giving advice to minimize the use of irritant products and dairy products.
Advise the patient to maintain personal and environmental hygiene.
Advising patients to maintain oral hygiene.
Advise the patient that physical activity and exercise increase the peristalsis movement, so exercise properly.
Advise the patient to do walking, yoga and meditation due to which constipation is relieved.
Provide proper laxative and enema to the patient.
Suppository administration to the patient to relieve constipation.
Advising the patient to follow up regularly.
Advising the patient to take medication properly.
[12:02 pm, 27/1/2024] Pankhaniya Deepali. Team: 1) Define/explain Diarrhea.
=> Diarrhea is not any disease but acts as a symptom.
=> Diarrhea is a symptom of digestive system disease.
=> In diarrhea, stool frequency, its fluid content, and volume increases.
=> Diarrhea is a condition in which liquefied and more loose stool is passed more than three times in a day is called diarrhea.
=> Diarrhea is mainly caused by any bacterial, viral and parasitic infection.
2) Explain the types of diarrhea.
=> There are total seven types of diarrhea.
1) Acute Diarrhea,
=> The onset of acute diarrhea is sudden and of short duration.
=> Acute diarrhea is mainly observed for a few hours and days only.
=> Acute diarrhea is mainly due to viral, bacterial, and parasitic infections and food poisoning.
2) Chronic Diarrhea,
=> The time duration of cronic or diarrhea is very long.
=> If Diarrhea is mainly persistent for more than two weeks then it is called cronic diarrhea.
=> Chronic diarrhea mainly
•>Irritable bowel syndrome (Irritable bowel syndrome),
Inflammatory bowel disease
•> It is seen due to malabsorption disorder.
3) Persistent Diarrhea
(persistent diarrhoea),
=> If there is a condition of continuous diarrhea for more than a few weeks, it is called persistent diarrhea.
=> Persistent diarrhea mainly
Infection
•> Inflammatory bowel disease (Inflammatory Bowel Disease) and
•>cetain medication
Caused by (certain types of medication).
4) Traveller’s Diarrhea
(traveler’s diarrhoea),
=> Traveller’s diarrhea is a condition of traveler’s diarrhea mainly when any individual comes in contact with contaminated food and water while travelling.
=> It is mainly caused by bacterial, parasites infection.
5) Inflammatory Diarrhea (Inflammatory Diarrhea),
=> Inflammatory diarrhea is a condition of inflammatory diarrhea mainly due to infection and inflammation in the gastrointestinal tract.
=> This mainly,
•>Crohn’s disease
(Chron’s disease) •>Seen in the condition of ulcerative colitis (ulcerative colitis).
6) Osmotic Diarrhea (Osmotic Diarrhea),
=> Osmotic diarrhea is mainly due to poor amount absorption of water by intestine.
=> Due to this, water goes into the bowel. And loose watery stool (loss watery stool) is passed.
This condition is mainly seen due to lactose intolerance and malabsorption.
7) Secretory Diarrhea
(secretory diarrhea)
=> Secretory diarrhea is mainly due to the secretion of fluid in more amount in the intestine or due to any infection or some type of medication.
3) Explain the Etiology/cause of the patient with Diarrhea.
1) Infection
(due to infection)
=> viral
Ex:=Rotavirous.
=>Bacteria
Ex:=
•>E.coli,
•>Shingella,
Salmonella,
Campylobacter species,
•>Closridium difficile
=>paracitic infection
•>Gardia lamblia,
•>erytosporidium,
2) food born illness
(Food Bone Illness)
=> Due to intake of contaminated food and water.
=> Due to lack of cleanliness while preparing food.
3) certain medication
(of certain types of medication)
=> Some types of antibiotics, antacids and cancer drugs also cause diarrhea condition.
4)Diatory factore (Dietary factor)
=> Due to consumption of some types of food and beverages in excessive amount, the condition of diarrhea also occurs.
Ex:=
•>high fatty food,
•>Spicy food,
Caffeinated drinks can also cause diarrhea.
5) Inflammatory bowel disease
=> Crohn’s disease and ulcerative colitis cause infection and inflammation in the digestive tract, causing the condition of diarrhea.
6) Irritable bowel syndrome
=>Irritable bowel syndrome also causes the condition of chronic diarrhea.
7) Malabsorption disorder