Kuliah sistemik 16

8/20/2019 Kuliah sistemik 16

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Manifestasi

KelainanSistem Pencernaan

Di Rongga Mulut

Suhartini, drg., M.BiotechBagian Biomedik

Fakultas Kedokteran Gigi Univ. Jember

Februari, 20!


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"en#akit sistemik

Meru$akan $en#akit #angmem$engaruhi sistem tubuh secaraumum

Mani%estasi $en#akit adalah tanda dange&ala #ang muncul $ada tubuh manusiaakibat suatu $en#akit


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PENYAKIT

$erubahan dalam individu #angmen#ebabkan $arameter kesehatanmereka berubah diluar batas'batas

normal

"atologi"atogenesis"ato(siologi

)tiologiMani%estasiKom$likasi

"rognosis


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Kelainan Gastrointestinal *G+Meru$akan kelainan #ang mengenai $ada G+

-ract. *eso$hagus, lambung, usus, accessoriesorgans of digestion


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Jenis Kelainan GI

Tract.

- $roses digesti dan

absor$si- "erubahan sekresi

- sistem imun- aliran darah- neo$lastik

- $engaruh genetik


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Kelainan GI tract. yangermanifestasi !i rongga mulut

+nammator# bo/eldiseases

"e$tic Ulcerdisease

)ating disorders

Mal absor$tion

Gastro'oeso$hageal reu

disorder

Metastatic diseases to thea/

Genetic disorders

Ulcerative 1olitis1rohns 3isease

"ernicious anemiaFolic acid de(cienc#anemia

Bulimia

4noreia

Gardners s#ndrome"eut5'Jeghers

s#ndrome

Malignant neo$lasma o% liverand G+-


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In"ammatory

o#el !iseases"en#akit inamasi #ang melibatkan saluran$encernaan

-erdiri dari 6

Ulcerative 1olitis1rohns 3isease


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Ulcerative 1olitis

-"en#akit kronis #ang ter&adi karenainamasi $ada usus besar7kolon- karakteristik 6 eksaserbasi dan remisi

- Ge&ala 6 diare berdarah, n#eri $erut, dandemam- )tiologi 6 belum diketahui secara $asti"en#ebabn#a meli$uti herediter, %aktor

genetik, %aktor lingkungan, ataugangguan sistem imun.


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Peran!ingan antara usus normal !an usus

!enganulcerative colitis


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Mani%estasiklinis


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Mani%estasi di 8onggaMulut

4$htous ulceration or su$er(cialhemorrhagic ulcers

4ngular stomatitis

"#ostomatitis vegetans

"#ostomatitis gangrenosum


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1rohns 3isease

• chronic inammation o% thegastrointestinal tract most commonl#involving the intestine

• it most o%ten a9ects the end o% thesmall intestine or the beginning o%the large intestine


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:hat is 1rohns 3isease

• +t is believed that the disease occurs/hen the immune s#stem mistakesmicrobes that are normall# %ound in

the intestines %or %oreign or invadingmicrobes and then activates theimmune res$onse to attack these

mistakenl# invading microbes


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+ncidence

• +nterestingl#, the incidence o%1rohns disease has had a stead#increase in the last ;0 #ears

• +n the US, it is estimated that < out o%00,000 $eo$le have 1rohns disease


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:ho is most likel# to have 1rohnsdisease=

• 1aucasians are the most likel# todevelo$ 1rohns 3isease

• Je/ish individuals are 2'> times morelikel# to have the disease

• ?is$anics and 4sians are among theleast likel# to develo$ the disease/ith a rise in 4%rican 4mericans


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)tiolog#

• -he etiolog# o% 1rohns disease isunkno/n, but research has beenconducted to determine genetic

relationshi$s


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)tiolog#' Genetic theor#

• -he (rst gene %or 1rohns 3isease /asrecentl# identi(ed and is a result o% amutation or alteration *gene K@3271483

• -his mutation a9ects the bodies abilit# torecogni5e bacteria as harm%ul


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)tiolog#' +nammator# 1ell -heor#

• 4nother theor# im$lies that thecause ma# be related to -'cell and7@rmacro$hage abnormalities and the

interaction bet/een both

• -he result is an anti'inammator#and $ro'inammator# imbalance


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Signs and S#m$toms

• More common

• $ersistent diarrhea

• abdominal cram$s

• %ever

• malaise

• rectal bleeding

• loss o% a$$etite

• $ess common

• /eight loss

• anemia

• obstruction, $er%oration, orhemorrhage o% the intestine

• (ssures

• abscesses

• (stula• toic megacolon

• se$sis


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?emorrhage o% intestine

1rohnAs disease $ortion o% smallintestine sho/ingmulti%ocal areas o%thickening o% the /alland narro/ing o% the

lumen.

Ulcerative colitis asegment o% colonsho/ing su$er(cial,hemorrhagic mucosaland submucosalulceration.


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etraintestinal mani%estations o% 1rohns3isease

• More common

• &oint $ain

• skin rash

• oral ulcers

• gall stones

• liver disease

• e#e $roblems• gro/th retardation

in children

• %t&er less common

• anemia

• blood clots

• kidne# stones• nerve damage

• lung disease

• $ancreatitis

• $ericarditis

• menstrual irregularities

• severe gingivitis

• osteo$orosis


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1ommon @ralMani%estations

• ?#$ertro$h# and s/elling o% li$s

• gingival so%t tissue s/elling *resembles e$ulis(ssuratum

• cobblestone a$$earance o% buccal mucosa and

$alate• dee$ ulcers *#ello/7/hite, a$$ear linear /ithin

the vestibule and on the gingiva

• 4$thous'like ulcerations

• "#ostomatitis vegetans *er#thematous, thickenedoral mucosa /ith multi$le $ustules, andsu$er(cial erosions


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the hallmark o% 1rohnAs disease in oral6

"ersistent linear and dee$ ulcer1obblestone

mucosal architecture,

di9use s/elling o% the li$s and %ace,

+ndurated $ol#$oid tag'like lesions in thevestibule

"#ostomatitis vegetans,


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1rohnAs disease dee$ crateri%ormulcer /ith rolledborder and necroticcenter as /ell asangular cheilitis.

1rohnAs disease mucosalh#$er$lasia and

(ssuring /ithlinear ulceration*courtes# o% 3r.Mark Kernstein.


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1rohnAs disease mucosal edema,a$htha%orm ulcers and militar#

granulomas *1ourtes# o% 3r. MarkBernstein.

Ulcerative colitis similara$$earing ulcers o% the buccal

mucosa *courtes# o% Universit# o%@klahoma School o% 3entistr#.


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Pe'tic (lcer

!isease -er&adi ulserasi $ada bagian e$itel darilambung *gastric ulcer mau$un

duodenum *duodenal ulcer

Ge&ala umum 6 e$igastric $ain' relieved b# %ood *duodenal' aggravated b# %ood *gastric

gastrointestinal bleeding obstruction or $er%oration


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Mani%estasi @ral

3rug+nduced

4granuloc#tocis

4naemia

erostomia

Bacterial

disease

Fungaldisease4ltered

taste$erce$tion

Mucosal $allor

tromboc#to$eni

Gingivalbleeding

Mucosalulceration

Cecroti5ing stomatitits


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Mal

asor'tion"ernicious anemiaFolic acid de(cienc#anemia

Mani%estasi di @ral 6 glossitis, angularcheilitis, stomatitis a$thous


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Gastro)oeso'&ageal

re"u* !isor!erGastroeso'&ageal re"u* !isease +GERD, is oneo% the most commonl# occurring diseases a9ecting

the u$$er gastrointestinal tract /here in Gastriccontents *ch#me $assivel# move u$ %rom the

stomach into the eso$hagus

Ge&ala umum 6 heartburn, eso$hagitis,eso$hagial ulcers, d#s$hagia


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Eating

!isor!ers-ulimia, kelainan cara makan #ang terlihatdari kebiasaan makan berlebihan #ang ter&adisecara terus menerus, dan memuntahkann#aAnore*ia,kelainan cara makan denganmembiarkan rasa la$ar atau mengurangimakan dengan sangat drastis

%RA$ MANIESTATI%NS % EATINGDIS%RDERS

)rosion o% lingual sur%aces o% anterior teeth, +ncreased risk o% caries,

$eriodontal disease"arotid gland s/elling

-eeth sensitive to thermal changes


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Gar!ner/ssyn!rome

Genetic

!isor!ers' meru$akan gangguan #ang &arang ter&adidan diturunkan secara genetic sebagai si%atdominan autosomal dan dicirikan denganratusan $oli$ diseluruh usus besar.' oral 6 multi$le im$action o% su$ernumerar#

teeth


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Peut0)Jeg&er/ssyn!rome

Manifestasi oral 6 'oral and $erioral$igmentasi' Freckling o% skin

around the li$s andvermilion 5one o% theli$

ACCESSORIES ORGANS OF GI Tract


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ACCESSORIES ORGANS OF GI Tract.


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-he Diver

• +s located in the u$$er right Euadranto% the abdomen

• -he liver isessential

%or li%e


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Fungsi 6 . %ungsi metabolis 6 metabolisme

karbohidrat, lemak, $rotein men&adi$roduksi energi

2. %ungsi $ertahanan tubuh 6 detoksi(kasi

5at beracun dan %agositosis

. $engaturan dalam $eredaran darahHber%ungsi mengalirkan darah ke &antung

>. membentuk garam em$edu

;. men#im$an 5at mineral, vitamin,liko en


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1e'ati

tis


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:hat +s ?e$atitis=• ?e$atitis means inammation o% the liver

– ?e$at *liver I itis *inammation ?e$atitis

• iral he$atitis means there is a s$eci(c

virus that is causing #our liver to iname*s/ell or become larger than normal


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+nammation

Walls ofscartissue

begin toform

Healthy liver cellsbecome trappedby a wall of scartissue


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?e$atitis

• 1an have man# causes – drugs

– toins

– alcohol

– viral in%ections *4, B, 1, 3, )

– other in%ections *$arasites, bacteria

– $h#sical damage


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iral ?e$atitis

; t#$es6A2 %ecal'oral transmission

-2 seual uids L blood to blood 32 blood to blood

D2 travels /ith BE2 %ecaloral transmission

VaccinePreventable

4da$ted %rom 1orneil, 200


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Source of

virus

feces blood/

blood-derivedbody fluids

blood/


blood/


feces

Route of

transmission

fecal-oral percutaneous

permucosal

percutaneous

permucosal

percutaneous

permucosal

fecal-oral

Chronic

infection

no yes yes yes no

Prevention pre/post-

eposure

immuni!ation

pre/post-

eposure

immuni!ation

blood donor

screenin"#

ris$ behavior

modification

pre/post-

eposure

immuni!ation#

ris$ behavior

modification

ensure safe

drin$in"

%ater

-#$e o%

?e$atitisA B C D E


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Signs and S#m$toms

• +ndividuals ma# have one or more o%the %ollo/ing s#m$toms, /hile otherse$erience no s#m$toms6

–

Tiredness –Nausea –Muscle or joint pain –Trouble sleeping –Loss of appetite

–

Weight loss –Abdominal pain –Itchiness –Depression –Dark urine


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Signs and S#m$toms

• 4 %e/ ma# have s$eci(c liverrelated s#m$toms initiall#6 – "ale stool

– Jaundice *#ello/ing o% the skin ore#es


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?e$atitis -erms

• Acute 1e'atitis6 Short'termhe$atitis. – Bod#s immune s#stem clears the virus

%rom the bod# /ithin ! months

• 3&ronic 1e'atitis2 Dong'termhe$atitis.

– +n%ection lasts longer than ! monthsbecause the bod#s immune s#stemcannot clear the virus %rom the bod#


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?e$atitis 4 – +n%ection o% the liver caused b# ?e$atitis

4 virus?e$atitis 4 "athogenesis

• )ntr# into mouth

• iral re$lication in the liver

• irus $resent in blood and %eces 0'2 da#s a%terin%ection

• irus ecretion ma# continue %or u$ to /eeksa%ter onset o% s#m$toms

1 titi -


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1e'atitis -

N is a serious disease caused b# a virus that in%ectsthe liver

– 1an cause li%elong in%ection, cirrhosis *liverscarring, liver cancer, liver %ailure and death

• :ho is at highest risk=

– +n&ection drug users

– Se $artners o% those /ith ?e$ B – Se /ith more than one $artner

– Men /ho have se /ith men

– Diving /ith someone /ith chronic ?e$ B

– 1ontact /ith blood – -rans%usions, dial#sis


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• ?o/ do #ou get it= – 3irect contact /ith blood or bod#

uids o% an in%ected $erson• sharing in&ection eEui$ment

• se

• bab# %rom in%ected mother duringchildbirth

• ?e$atitis B is not s$read b# %ood,/ater or casual contact


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• :ho should get ?e$atitis Bvaccine= – 4ll babies, at birth

– 4ll children '2 /ho have not hadvaccine

– "eo$le at risk• MSM

• Multi$le se $artners

• +n&ection drug users

• "eo$le /ith &obs /here e$osure to bloodmight ha$$en


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?e$atitis 1

– ?e$ 1 is a liver in%ection caused b# avirus

– 4lso kno/n as non 4, non B he$atitis

1e'atitis A - 3


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' A Kirus - Kirus 3 KirusSym'tomsof Initial

Infection

• Some $eo$le have no s#m$toms *es$eciall# ?1

• )#es or skin ma# turn #ello/ *&aundice

•

Doss o% a$$etite

• Causea, vomiting, %ever, stomach or &oint $ain

• Fatigue *can last /eeks or months

• 3ark urine L $ale bo/el movements

3&ronic

Infection

+Infection forlife,

Co chronic disease 0O 1hronic

1an cause6Diver cell damage1irrhosisDiver cancer

P;O 1hronic

1an cause6Diver cell damage1irrhosisDiver cancer

1o# is it

S'rea!4

• Fecal7 oral

• 1ontaminated%ood and /ater

• @ral74nal seualcontact

• Blood and bod#

uid contact• Se*

• Ceedles

• Mother to bab#

• ?uman bite

• Blood and bod# uid

contact• Ceedles

• Mother to bab#

• Se* +minimal,

5accine Qes Qes Co


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. ter&adi diskolorisasi $ada gigi sulung$ada atresia bilier gigi akan ber/arnahi&au,sedangkan $ada he$atitisneonatal ber/arna kuning

Keadaan ini disebabkan olehde$ositn#a bilirubin $ada email dandentin #ang sedang dalam taha$$erkembangan.

Mani%estasi @ral


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2.Men#ebabkan oral h#giene buruk,halitosis

. Kom$likasi $ada gangguan endokrin,candidiasis>.Sirosis hati da$at men#ebabkan hi$er$igmentasi $adamulut.

;.-imbul ulcer karena berkurangn#a 5at 5atvitamin dan gi5i dalam rongga mulut.

!."roses mastikasi terganggu


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"revention

• Cever share drug eEui$ment – Stra/s, bills, needles, s#ringes, /ater,

(lter, cooker, $i$es etcR

• Cever share tooth brushes or an#$ersonal h#giene articles that haveblood on them

• "ractice sa%er se


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"revention

• 4l/a#s make sure ne/ L sterili5ed o%dental eEui$ment

• 3o not touch dirt# n other

eEui$ment /ithout $ro$er eEui$mentor %ollo/ing $ro$er $rocedures

3i t C dl " ti


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3irt# Ceedle "recautions

. ?andle onl# i% #ou have $ro$er eEui$ment• Sturd# $air o% gloves, tongs or $liers and a $uncture

$roo% container *heav# $lastic or metal

2. "lace needle in $uncture $roo% container• 3o not touch needle /ith bare hands and do not tr# toreca$ needle i% ca$ $resent

. 1an dis$ose container in garbage but better

i% it is taken to health clinic or needleechange


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Kuliah sistemik 16

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