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Pornchanok Srimongkon http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001311/figure/ A000265.B1090/?report=objectonly

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Outline Structure and functions of the digestive system. Diseases within the oral cavity. Stomach and small intestine diseases. Colon and rectal diseases.

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GI tract GI tract Teeth Tongue Esophagus Stomach Small and large intestine Rectum Anus Hepatobiliary Hepatobiliary liver gall bladder pancreas Mucosa, gland Structure and functions of the digestive system.

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Oropharynx Salivary gland Salivary gland Parotid Submanibular gland Sublingual gland A = Nasopharynx B = Uvula C = Hypopharynx D = LarynxLarynx E = Tongue F = Oropharynx Structure and functions of the digestive system.

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Chewing or Mastigation Functions Functions Grind food into smaller Lubricate Amylase enzyme The chewing 50-80 kg./molar! Structure and functions of the digestive system.

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Peristalsis Structure and functions of the digestive system. http://www.ksbrhospital.com/site/SP/index.php?p=22 http://www.healthcentral.com/acid-reflux/h/antacid- pills-relieve-gas-in-intestines.html

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Apthous ulcer Angular stomatitis Oral thursh Dental caries, tooth decay Gingivitis

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1. Apthous ulcer Unknown causes Pain 2-3 days Oral Mucosa Autoimmune Related to Stress, Constipation, Indigestion, Menstruate, chronic fever Duration up to 2 wk http://dentyomarajconference.blogspot.com/2012/02/blog-post_13.html

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Treatment Treatment Avoid eating spicy foods. Wash out mouth with salt water. Fix the cause. Drug use Drug use Pain Pain: Paracetamol, NSAIDs ex. Ibuprofen Steroid cream Steroid cream to reduce the inflammation and promote healing: triamcinolone paste http://www.plazathai.com/show-342547.html http://www.thairx.com/dmdrug.asp?did=knlor http://www.aussietip.com/forum/topics/0425795337-sms- 1?commentId=1004284%3AComment%3A951210&xg_source=activi ty 1. Apthous ulcer

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2. Angular stomatitis Cause: lack of vit B2 (riboflavin) Other causes: Dermatitis, hypersaliva Bean, milk, meat, yolk, liver, greens Tx Tx: find the cause Vit B2 3 times/day for 3 days http://dental.anamai.moph.go.th/oralhealth/PR/E-book/elderly/keld03.html http://drcarebear.exteen.com/20110609/entry-1

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3. Oral thrush Candida albicans Fungal infection Baby and child with poor nutrition (lack of immunization) Poor in oral hygiene broad spectrum antibiotics immunodeficiency Adults who take broad spectrum antibiotics or immunodeficiency Candida albicans Fungal infection Baby and child with poor nutrition (lack of immunization) Poor in oral hygiene broad spectrum antibiotics immunodeficiency Adults who take broad spectrum antibiotics or immunodeficiency http://www.edentalhealth.com/oral-thrush/

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Treatment: Clean, to brush the teeth Baby: entering the water after milk feeding Drug use: Gentian violet solution apply 3-4 times a day for 5-7 days Clotrimazole troche Nystatin solution Ketoconazole tab 2 weeks 3. Oral thrush

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4. Dental caries, tooth decay Garbage from sugar and carbohydrate Bacteria Bacteria form it to acid http://www.kroobannok.com/blog/11268 http://www.cashewthai.com/?name=knowledge&file=readknowledge&id=13 Symptoms: Toothache, tooth pain Pulp inflammation Purulent

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4. Dental caries, tooth decay Suggestions: Avoid eating sugary foods or cold. Brush the teeth and tongue properly. Use dental floss. Suggestions: Avoid eating sugary foods or cold. Brush the teeth and tongue properly. Use dental floss. Drug use: Paracetamol or NSAIDs (Ibuprofen) for pain Antibiotics use for purulent

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5 Gingivitis Poor oral hygiene Calcium plaque Bacteria release toxin induce gingivitis, swollen gums, bleeding without pain Shorten gum, loose the teeth, bad breath, pus http://www.mayoclinic.com/health/medical/IM01745

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Treatment: See the dentist for scrape plaque Prevention: Brush the teeth properly. See the dentist to check up every 6 months http://www.umm.edu/patiented/articles/gingivitis_000438.htm 5 Gingivitis

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Dyspepsia Peptic ulcer Gastroesophageal reflux disease: GERD Nausea and vomiting

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1.Dyspepsia Symptoms Symptoms : stomachache, abdominal discomfort Abdominal colic, burning stomach, bloating, burping frequently, nausea, vomiting Divided into 3 groups: 1. Ulcer-like dyspepsia Stomachache, know the specific position Nocturnal pain or empty stomach The pain should relieves after take some food

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2. Reflux-like dyspepsia Heartburn, belching Causes: overeating, overweight, tightness wearing suit 1.Dyspepsia http://www.medicinenet.com/gastroesophageal_reflux_disease_gerd/article.htm

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3. Dysmotility-like dyspepsia Caused by abnormal bowel movements. Symptoms: Bloated distension after eating. With air or gas in the stomach. Nausea Vomiting 3. Dysmotility-like dyspepsia Caused by abnormal bowel movements. Symptoms: Bloated distension after eating. With air or gas in the stomach. Nausea Vomiting 1.Dyspepsia

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Risk factors of dyspepsia : Risk factors of dyspepsia : Eating difficulty digested food (high-fat diet) Food or drinks that cause gas in the stomach. (soft drink, nuts) The talk between Dining. Gum chewing Sleep immediately after eating. Diseases: Gallstones in the gallbladder, cirrhosis 1.Dyspepsia

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1.Dyspepsia: Alarm symptoms Age > 40 years Awakening pain Weight loss (>5% within 1 mo or >10% within 6 mo) History of GI bleeding Chronic vomiting Dysphagia Jaundice Anemia Age > 40 years Awakening pain Weight loss (>5% within 1 mo or >10% within 6 mo) History of GI bleeding Chronic vomiting Dysphagia Jaundice Anemia Hepatomegaly, splenomegaly, lymphadenopathy Fever Abnormal excretion habits. Palpation of the abdominal mass. Family history of GI cancer Hepatomegaly, splenomegaly, lymphadenopathy Fever Abnormal excretion habits. Palpation of the abdominal mass. Family history of GI cancer

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Treatment Treatment: lifestyle modification Avoid: smoking, chewing gum, alcohol, tea, coffee and soft drink consumption Dining on time, avoid spicy and difficulty digested food Do not sleep immediately after dining Chewing food thoroughly, do not talk while eating Lose weight Relaxing and exercise 1.Dyspepsia

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Drug use Drug use: duration 2 wk then + 4 weeks (total 6-8 wk) Ulcer-like dyspepsia Ulcer-like dyspepsia: Antisecretory drugs: Cimetidine, Omeprazole Reflux-like dyspepsia Reflux-like dyspepsia: Antisecretory drugs + prokinetic drugs (domperidone/metoclopramide) + simethicone Dysmotility-like dyspepsia Dysmotility-like dyspepsia: Prokinetic drugs (domperidone/metoclopramide) + simethicone 1.Dyspepsia

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Causes: 2.Peptic ulcer Protecting factors: Sodium bicarbonate Mucosa Blood circulation Protecting factors: Sodium bicarbonate Mucosa Blood circulation Damaging factors: Pepsin hormone Hydrochloric acid Helicobactor pyroli infection Damaging factors: Pepsin hormone Hydrochloric acid Helicobactor pyroli infection

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2.Peptic ulcer http://www.hopkins-gi.org/GDL_Disease.aspx?CurrentUDV=31&GDL_Cat_ID=83F0F583-EF5A-4A24-A2AF- 0392A3900F1D&GDL_Disease_ID=80AD1118-6659-4B04-B560-71B95E3B7FA9 http://www.rayur.com/peptic-ulcer-definition-causes-sign-symptoms-diagnosis-and-treatment.html 2.1 Gastric ulcer 2.2 Duodenal ulcer

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Symptoms: stomachache, Middle abdominal pain, colic distension, bloating, burning, indigestion, nausea, vomiting Chronic and related to meal Alarm symptoms: Bloody stool Hematemesis severe pain > 6 hr Severe anemia 2.Peptic ulcer

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Risk factors: smoking, alcohol consumption, stress, not dining on time, some medications (aspirin, ibuprofen) Treatment: Lifestyle modification: Dining on time. Avoid Caffeine, alcohol, smoking, spicy food, some medication Enough rest, reduce stress Drug use: antacid, antisecretory drug 2.Peptic ulcer

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Antacid Antacid: Neutralization HCl acid in the stomach Aluminium, Magnesium, Calcium carbonate and Sodium bicarbonate 1-2 tablespoon 3 times after meals and bedtime 2.Peptic ulcer

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Antisecretory drugs Antisecretory drugs: cimetidine, ranitidine, omeprazole Anti-gastric acid secretion The stomach is healed 2.Peptic ulcer

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Causes Causes: A condition in which the stomach contents (food or liquid) leak backwards from the stomach into the esophagus This action can irritate the esophagus, causing heartburn and other symptoms. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001311/figure/A000265.B19609/?report=objectonly 3. Gastroesophageal reflux disease (GERD)

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Risk factors Risk factors: Alcohol (possibly), coffee, mint Hiatal hernia Obesity Pregnancy Smoking Sleep immediately after eating Tightness wearing (in the middle of the body) http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001311/ 3. Gastroesophageal reflux disease (GERD)

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Call for any of the following symptoms: Bleeding Weight loss Hoarseness Loss of appetite Frequent vomiting Feeling filled up quickly when eating Choking (coughing, shortness of breath) Trouble swallowing (dysphagia) pain with swallowing (odynophagia) 3. Gastroesophageal reflux disease (GERD)

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More common symptoms: Feeling that food is stuck behind the breastbone Heartburn or a burning pain in the chest (under the breastbone) Heartburn Increased by bending, stooping, lying down, or eating More likely or worse at night Relieved by antacids Nausea after eating Less common symptoms: Bringing food back up (regurgitation) Cough or wheezing Difficulty swallowing Hiccups Hoarseness or change in voice Hoarseness Sore throat http://www.i-am-pregnant.com/encyclopedia/Pregnancy/Heartburn 3. Gastroesophageal reflux disease (GERD)

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Change your eating habits. Eat several small meals instead of two or three large meals. After you eat, wait 2 to 3 hours before you lie down. Late-night snacks aren't a good idea. Chocolate, mint, and alcohol can make GERD worse. Spicy foods, foods that have a lot of acid (like tomatoes and oranges), and coffee can make GERD symptoms worse in some people. 3. Gastroesophageal reflux disease (GERD)

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Do not smoke or chew tobacco. If you have GERD symptoms at night, raise the head of your bed 6 in. (15 cm) to 8 in. (20 cm) Do not wear tight clothing around your middle. Lose weight if you need to. Losing just 5 to 10 pounds can help. http://www.teluguone.com/vanitha/content/good-food-to-avoid-heart-burn-74-2416.html 3. Gastroesophageal reflux disease (GERD)

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Drug use: Antacid Antacid: every hour or as needed Antisecretory drugs Antisecretory drugs: 4 wks Histamine receptor antagonist: cimetidine, ranitidine Proton pump inhibitors: omeprazole 3. Gastroesophageal reflux disease (GERD)

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Nausea is an unpleasant, queasy feeling in the throat or stomach that may result in vomiting. Vomiting is emptying the stomach as a result of strong gagging and retching that leads to throwing up. Vomiting can come in waves as the natural movement (peristalses) is reversed, and involuntary contractions in the walls of the stomach and esophagus force the stomach contents out. 4. Nausea and Vomiting

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Nausea and vomiting are not diseases, but they are symptoms of many conditions such as: Motion sickness or seasickness Early stages of pregnancy Medication-induced vomiting Intense pain Emotional stress (such as fear) CNS causes: Bulimia or other psychological illnesses Ingestion of toxins or excessive amounts of alcohol 4. Nausea and Vomiting

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Ulcers (acute gastritis) Gallbladder disease Food poisoning Overeating Heart attack Infections (such as the "stomach flu") A reaction to certain smells or odors Concussion or brain injury, Brain tumor Some forms of cancer 4. Nausea and Vomiting

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The nausea makes it difficult to drink fluid, making the dehydration worse, which then increases the nausea. Intravenous fluids may be provided to correct this issue and break the cycle 4. Nausea and Vomiting http://drugline.org/ail/pathography/1655/ Dehydration: increased thirst and dry lips or mouth

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http://survivalscoop.blogspot.com/2010/08/signs-of-dehydration-why-you-need-water.html http://www.full-timer.com/recognizing-and-treating-dehydration/

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Management : Liquid diet: Small amounts but often. ORS (Oral Rehydrate Salt) Relaxing Pregnancy: morning sickness Drink soda, ginger soup with cracker in the morning Sit for 10-15 minutes before getting out of bed. 4. Nausea and Vomiting

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Diarrhea Constipation Parasite Hemorrhoids

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Diarrhea Diarrhea describes bowel movements (stools) that are loose and watery. Caused by Increased secretion of fluid into the intestine Reduced absorption of fluid from the intestine Rapid passage of stool through the intestine. Very common and usually not serious. http://www.charlestongi.com/charleston_gi_conditions.php?id=7

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Definition: Stool > 3 times /day Watery stool > 1 time/day Bloody or mucous > 1 time/day http://www.webmd.com/digestive-disorders/understanding-diarrhea-basics Diarrhea

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Symptoms of uncomplicated diarrhea include: Abdominal bloating or cramps Thin or loose stools Watery stool Sense of urgency to have a bowel movement Nausea and vomiting In addition to the symptoms described above, the symptoms of complicated diarrhea include: Blood, mucus, or undigested food in the stool Weight loss Fever Diarrhea

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Acute diarrhea 4 weeks Causes: stress, cancer, abnormal absorption, lactase enzyme deficiency, chronic diseases (diabetes or hyperthyroidism) Diarrhea http://amy-amirah.blogspot.com/2010/12/kitchen-and-health.html

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Watery diarrhea Watery diarrhea Causes: enterotoxin from Vibrio cholera, enterotoxigenic E.coli Food poisoning: Staphylococcus aureus, Bacillus cereus Heat durable 6-24 hr after eating Nausea stomachache with no fever Symptoms will go away by themselves within 24 hours. Mucous bloody or invasive diarrhea Mucous bloody or invasive diarrhea Causes: Shigella, Salmonella Stomachache, fever, N/V Diarrhea

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Treatment: Prevent dehydration and electrolyte replacement (Oral rehydration solution: ORS) Sugar 2 tablespoons + salt teaspoon + water 750 ml Soft drink 375 ml + salt teaspoon Maintain and fix the cause of the diarrhea Antidiarrheals drugs Others: Others: Select low fat foods eg. Lean meat, white rice, bread Drink plenty of liquids Diarrhea

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Drug use in Diarrhea: 1. Antiperistalsis: loperamide (Imodium) Reduce the amount of stool. Avoid using in elderly and child Dont use in bloody mucous stools, fever Over using: Distension, bloating, abdominal cramps, pain Diarrhea http://leominnick.typepad.com/blog/2012/07/imodium-thailand.html http://china.mims.com/resources/portal/common/document/mi ms/mimsau.htm

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Diarrhea Drug use in Diarrhea: 2. Anticholinergics: hyoscine, dicyclomine Reduce abdominal pain Not reduce the amount of stool. Side effects (with high dose): Palpitations, dry mouth, dry throat http://www.mims.com/resources/portal/common/document/mims/mimsau.htm http://www.drugexp.com/buscopan-sugarcoated-tablets-10mg-p- 516.html

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Diarrhea Drug use in Diarrhea: 3. Adsorbents : activated charcoal, kaolin, pectin Absorb toxins from the bowel Use within 24-48 hours Mass stools Safe Black stools http://www.desiccantpacks.net/activated-carbon/http://www.efirstaid.com.sg/product_info.php?products_id=194

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Diarrhea Drug use in Diarrhea: 4. Colonic microflora: probiotics eg. Lactobacillus acidophilus Adjust to acidic pH in the gut Inhibit bacterial growth Prevent germ adhesion and poliferation Improve the immunization But delay effect http://www.visualphotos.com/image/1x3745780/lactobacillus_acidophilus_lactobacillus

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Diarrhea Prevention: 1. Cooked food should be clean. 2. Wash your hands before eating and defecation. 3. Defecate into a toilet

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Constipation Constipation is defined medically as fewer than three stools per week and severe constipation as less than one stool per week. Caused by the slow movement of stool through the colon. medications, poor bowel habits, low fiber diets, abuse of laxatives, hormonal disorders, and diseases primarily of other parts of the body that also affect the colon.

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Lifestyle modification

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Treatment : Find the cause and fix it. Stage 1: Toilet training habits Exercise High fiber diet Drink 7-8 glasses of water/day Stage 2: laxatives Bulk-forming laxatives Stimulant laxatives Osmotic/saline laxatives Stool softener/surfactant laxatives Stage 3: surgery Constipation

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Laxatives : 1. bulk-forming (1 st line) eg. Prune, basil seeds Increase water, osmotic pressure and stool in the intestine. Safe and low side effect Side effect: Distension, flatulence. Do not use: Gastrointestinal obstruction. Constipation Onset: 2-3 days

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Laxatives : 2. stimulant laxative eg. senna, bisacodyl Increase water and electrolyte onto large intestine. osmotic pressure and stool in the intestine. Stimulate myenteric plexus movement Addict, bowel movement dysfuction Constipation Onset: 6-8 hours

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Laxatives: 3. Osmotic/saline laxatives Lactulose, glycerin suppository (onset 30 mins), Milk of Magnesia (MOM) Safe for use in baby Avoid MOM in kidney disease Constipation

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http://drugline.org/drug/medicament/10777/

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Laxatives: Stool softener/surfactant laxatives anionic surfactant: Reduces surface tension in fecal, then water leak into the stool to make it soft. Docusate, mineral oil Slow onset (24-72 hr) Constipation

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Prevention: Do not suppressed your stool Exercise regularly to stimulate bowel movement 7-8 glasses of water/ day Vegetables, fruits Constipation

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http://www.siamhealth.net/public_html/Disease/infectious/parasite/ascaris.htm Parasite: Ascaris

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http://board.postjung.com/500440.html Parasite : Pin worm, Enterobius vermicularis, enterobiasis

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Enterobiasis

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http://www.siamhealth.net/public_html/Disease/infectious/parasite/HOOKWORM.htm Parasite: Hookworm

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http://www.med.cmu.ac.th/dept/parasite/public/Hookworm.htm Parasite: Hookworm

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Parasite http://www.bangkokhealth.com/index.php/health/health-general/food-nutrition/584- %E0%B8%9E%E0%B8%A2%E0%B8%B2%E0%B8%98%E0%B8%B4%E0%B8%95%E0%B8%B1%E0%B8%A7%E0%B8%88%E0%B8 %B5%E0%B9%8A%E0%B8%94.html Gnathostoma spinigerum

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Parasite: tape worm

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Parasite Treatment: Albendazole : Zentel Mebendazole : Fugacar, Benda Niclosamide : Yomesan

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Parasite infection Prevention: Short fingernails Wash your hands Clean the toilet frequently Defecate in the toilet Eat clean food Wash fresh fruits and vegetables thoroughly before eating. Wear the shoes Washing clothes thoroughly Prevention: Short fingernails Wash your hands Clean the toilet frequently Defecate in the toilet Eat clean food Wash fresh fruits and vegetables thoroughly before eating. Wear the shoes Washing clothes thoroughly

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Hemorrhoid Hemorrhoids are enlarged veins located in the lower part of the rectum and the anus. They become swollen because of increased pressure within them, usually due to straining at stools and during pregnancy because of the pressure of the enlarged uterus. Divided into 2 groups: External hemorrhoid Internal hemorrhoid http://diseasespictures.com/hemorrhoids/

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http://www.pain-relief-treatments.com/hemorrhoid-pain-relief.html Hemorrhoid

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Causes: increased pressure Hemorrhoids are associated with constipation and straining at bowel movements. Pregnancy is also associated with hemorrhoids. Other conditions, for example chronic liver disease, may also cause increased venous pressure and may be associated with hemorrhoid formation.

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symptoms The most common symptom and sign is painless bleeding. There may be bright red blood on the outside of the stools, on the toilet paper, or dripping into the toilet. The bleeding usually is self-limiting. There may be other reasons to have bleeding including inflammatory bowel disease, infection, and tumors

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Hemorrhoid Treatment: Self-Care at Home Warm Sitz Baths Sitting in a few inches of warm water three times a day for 15- 20 minutes may decrease the inflammation. Dry the anus. Dietary Changes Increased fluid intake and dietary fiber decrease the potential for constipation lessen the pressure on the rectum and Activity Suggestions Should not sit for long periods of time and may benefit from sitting on an air or rubber donut. Exercise is helpful in relieving constipation and in decreasing pressure on the hemorrhoidal veins

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Hemorrhoid treatment:

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