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Surgery- UGIT > Anatomical Pathology of the Oesophagus, salivary glands and mouth. > Flashcards

Anatomical Pathology of the Oesophagus, salivary glands and mouth. Flashcards

1
Q

What is another name for aphtous ulcers?

A

Canker sores.

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2
Q

Name 4 triggers of aphrours sores?

A

Stress
IBD
Fever
Certain foods

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3
Q

Give a brief description of how aphtous sores look and how are they treated?

A
  • Common
    • 5mm diameters, painful shallow ulcers.
    • Round with grey-white exudate and erythematous rim.

Cancerous sores are self limiting

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4
Q

Name 2 Ulcerative and Inflammatory lesions:

A

Candidiasis

Herpes stomatitis

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5
Q

Name Ulcerative and Inflammatory lesions linked to AIDS:

A 
Kaposi sarcoma 
Candida Herpes 
Hairy leukoplakia 
Leukoplakia 
Erythroplakia
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6
Q

What is Candidiasis?

A

This is an ulcerative and inflammatory lesion caused by thrush.
It is a normal inhabitant of the mouth aggravated by:
- Anaemia
- Antibiotics
- Glucocorticosteroids
- Immunodeficiency
- Cancer
If it spreads, it becomes life threatening.
When scraped off, an erythematous base is found.

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7
Q

What is hepes stomatitis?

A

This is an ulcerative inflammatory disease that is also known as Herpes simplex virus- 1
- it is spread through person-person transmission (kissing)
- Remains dormant in nerves and is
- Reactivated by cold exposure, sun, respiratory infection or trauma
The vesicles are small and filled with clear fluid, rupture hollow and are painful.
In immunocompromised may develop into encephalitis and hepatic gingivostomastitis.

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8
Q

What is hairy Leukoplakia?

A

Hairy leukoplakia is an ulcerative inflammatory disease.
It presents as a white patch on the side of the tongue with a corrugated or hairy appearance (Due to epithelial thickening).
- It is caused by Epstein-Barr virus (EBV).
- Usually occurs in persons who are immunocompromised: (HIV/AIDS)

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9
Q

What is hairy Kaposi Sarcoma?

A

Purple raised lesions

Common in patients with HIV/AIDS

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10
Q

What is Leukoplakia?

A

Leukoplakia is an ulcerative inflammatory disease:
In this condition, thickened white patches form on the gums, insides of the cheeks, the bottom of the mouth and, sometimes, the tongue. Patches can’t be scraped off.
- Typically seen in older men
- Can become cancerous: squamous cell carcinoma

Associated with use of tobacco (pipe, smokeless tobacco), chronic friction due to ill-fitting dentures or jagged teeth, alcohol abuse, irritant foods

For most people, stopping tobacco or alcohol use clears the condition.

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11
Q

What is Erythroplakia

A

Erythroplakia appears as abnormal red lesions on the mucous membranes in your mouth. The lesions typically occur on your tongue or on the floor of your mouth.

  • Lesions can’t be scraped off.
  • Dysplasia of epithelium
  • High chance of becoming malignant
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12
Q

What is the most common cancer of the mouth and what are it’s risk factors?

A

Squamous cell carcinoma

  • Leukoplakia
  • Erythroplakia
  • HPV 16 and 18
  • Smoking
  • Excessive drinking
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13
Q

Name the 3 major salivary glands:

A

Parotid gland
Sub-mandibular gland
Sub lingual gland
- There are many salivary glands distributed within the oral active

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14
Q

What is xeromastia?

A

Dry mouth condition due to a decrease/ lack of saliva.

- Usually a result of Sjogren syndrome. (Inflammatory enlargement the salivary glands)

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15
Q

What causes xeromastia ?

A 
Radiation therapy 
Xeromastia may be a result of the use of medications
   - Anticholinergic
   - Antidepressant/antipsychotic
   - Diuretics 
   - Antihypertensive drugs
   - Sedatives 
   - Muscle relaxants 
   - Analgesic and antihistamine drugs
Sjogren syndrome. (Inflammatory enlargement the salivary glands)
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16
Q

Name 3 complications of xeromastia:

A

Candidiasis
Increase in dental carries
Difficulty swallowing and speaking

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17
Q

What is sialadenitis?

A

Sialadenitis is an infection of the salivary glands causing inflammation.
Usually caused by:
- A virus, bacteria or autoimmune disease.
- Most common form is mumps
- Another form is sjogren syndrome
Wide-spread inflammation of salivary glands and mucous secreting glands
May include involvement of lacrimal glands producing dry eyes.
>Keratoconjunctivitis sicca

The parotid (in front of the ear) and submandibular (under the chin) glands are most commonly affected.

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18
Q

What is a Mucocele, how is one formed and how is one treated?

A

This is the most common lesion of the salivary glands.

  • Blockage or rupture of Salivary gland ducts
  • With leakage of saliva into surrounding connective tissue and stroma.
  • Most commonly found on lower lip due to falling.
  • Swelling and blue hue

Complete excision of the cyst and it’s accompanying minor salivary glands.

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19
Q

What is a Ranula?

A

Epithelial lined cyst that forms when the sub-lingual gland has been damaged.

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20
Q

What is a “plunging ranula”?

A

Epithelial lined cyst that forms when the sub-lingual gland has been damaged.
It sits through the connective tissue stroma connecting the 2 bellies of mylohyoid muscle.

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21
Q

Explain non-specific sialidenitis and sialithiasis:

A

Non-specific sialidenitis is caused by one or other bacterial infection due to the formation of stones- sialithiasis which block salivary gland ducts

  • Staph Aureus
  • Streptococcus viridans
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22
Q

Which major salivary gland has a higher incidence of tumor formation?

A

Parotid gland
- Note: 15%-30% of those are malignant

However 10% of all oral tumors are sublingual or submandibular.
- Of those: 40% of submandibular, 50% of minor salivary glands and 90% of sublingual tumors are cancerous.

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23
Q

What is a pleomorphic adenoma?

A

Common benign salivary gland neoplasm
There’s a mixture of ductal (epithelium) and myoepithelium.
Epithelial elements are dispersed throughout the matrix with varying amounts of:
- myxoid
- Hyaline
- Osseous tissue
- Chondroid (cartilaginous)

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24
Q

What does a pleomorphic adenoma look like?

A
  • Round, well demarcated mass that doesn’t exceed 6cm
    • Cut gray-white surface with myxoid nd blue translucent areas of chondroid.
    • Painless
    • Mobile
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25
Q

What is it called when a carcinoma forms inside a pleomorphic adenoma?

A

Carcinoma Ex pleomorphic adenoma
Or
Malignant mixed tumor

Note that tumors involve lymph node

26
Q

What is another name for a Warthrin tumor?

A

Papillary cystadenoma lymphomatosum

27
Q

What is a wathrin tumor?

A

This is the 2nd most common oral neoplasm (first is squamous carcinoma)

  • Arises almost exclusively in the parotid gland.
  • More common in men
  • 10% multifocal, 10% bilateral
  • Smokers have 8 times more risk.
28
Q

How do Warthrin tumors look?

A

Round to oval encapsulated masses, 2 to 5 cm in diameter.

- Pale gray surface punctuated by narrow cystic or cleft like spaces filled with mucinous or serous secretions

29
Q

Where does the oesophagus extend to and from?

A

Extends from the pharynx to the cardia of the stomach.

30
Q

What kind of Sphincters are found in the esophagus?

A

At the upper end - cricopharyngeal sphincter, containing striated muscle under voluntary control

Lower end - functional sphincter

31
Q

Define Atresia:

A

Atresia is a condition in which an orifice or passage in the body is closed or absent.

32
Q

What is Diverticulosis?

A

A condition in which small, bulging pouches develop in the digestive tract.

33
Q

What is heterotopic tissue?

A

heterotopia is the presence of a particular tissue type at a non-physiological site, but usually co-existing with original tissue in its correct anatomical location. In other words, it implies ectopic tissue, in addition to retention of the original tissue type.

34
Q

What is hiatus hernia?

A

This is a condition in which part of the stomach pushes up through the diaphragm muscle.

35
Q

What is achalasia?

A

This is a condition in which the muscles of the lower part of the oesophagus fail to relax, preventing food from passing into the stomach.

36
Q

What are esophageal varices?

A

Abnormal veins in the lower part of the tube running from the throat to the stomach.
Oesophageal varices usually develop when blood flow to the liver is blocked. Seen in patients with advanced liver disease.

37
Q

What are Mallory-Weis tears?

A

Severe prolonged vomiting can cause Mallory-Weis tears.
In this condition there are tear in the mucous membrane, or inner lining, where the esophagus meets the stomach.
- Can cause significant bleeding
- Depending on severity, surgery might be needed.

38
Q

What is Barrett’s esophagus?

A

A condition in which there is an abnormal (metaplastic) change in the mucosal cells lining the lower portion of the esophagus, from normal stratified squamous epithelium to simple columnar epithelium with interspersed goblet cells that are normally present only in the small intestine

39
Q

What is the result of the uncommon condition in which contractility of lower oesophageal sphincter (LOS) is lost and there is increased tone of sphincter and how is it diagnosed?

A

Results in slowing or retention of food bolus with increasing obstruction and dilatation of the oesophagus

Diagnosed with a venogram
- Appear as tortuous dilated veins in submucosa of distal oesophagus and proximal stomach

40
Q

Name 2 causes of the uncommon condition in which contractility of lower oesophageal sphincter (LOS) is lost and there is increased tone of sphincter

A
  • Cirrhosis- Associated with alcoholic liver disease

- Schistosomiasis

41
Q

What is eosinophilic esophagitis?

A

Also known as allergic oesophagitis

This is an allergic inflammatory condition of the esophagus that involves eosinophils, a type of white blood cell.

42
Q

What is reflux oesophagitis?

A

This is a chronic disease in which inflammation of the lining of the esophagus is seen.
It occurs when stomach acid or bile flows into the food pipe and irritates the lining.

43
Q

What is acute esophagitis?

A

Inflammation of the esophagus associated with ulcerations due to:

  • Viral or fungal infections
  • Ingestion of corrosive substances
44
Q

Give a few causes of epithelium damage in the esophagus:

A
  • Alcohol
    • Corrosive acids or alkali’s
    • Excessive hot fluids
    • Heavy smoking
    • Infections: viral (CMV, HSV) and bacterial (candida, aspergillosis)
    • Pill induced esophagitis : Medicinal pills Get lodged in the esophagus, and dissolve there instead of in the stomach.
45
Q

Is the stratified squamous epithelium of the esophagus resistant to the abrasion of food or acid.

A

The stratified squamous epithelium of the esophagus is resistant to the abrasion of food.
- It is sensitive to acid

46
Q

What prevents stomach acid reflux?

A

Constant lower esophagus sphincter tone

47
Q

What is the clinical condition for reflux into the esophagus causing esophagitis?

A

Gastro-esophageal Reflux Disease (GERD/ GORD)

48
Q

What are clinical signs of GORD?

A

Dysphasia
Heart burn
Chest pain

49
Q

What conditions contribute to GORD?

A

Conditions that lower esophageal sphincter tone and increase abdominal pressure lead to GORD:

  • Alcohol or tobacco use
  • Obesity
  • CNS Depressants
  • Pregnancy
  • Hiatus hernia
50
Q

How does GORD present histologically?

A
  • Basal cell hyperplasia
    • Eosinophils
    • Neutrophils
    • Plasma cells
    • Anaemia
    • Lymphocytes
51
Q

True or false: most patients that suffer from GORD are atopic:

A 
True 
Most patients are atopic:
  - Atopic dermatitis 
  - Asthma
  - Allergic rhinitis 
  - Moderate peripheral eosinophilia
52
Q

What symptoms do GORD patients present with?

A

Food impaction
Dysphasia
Feeding intolerance

53
Q

What is dysphasia?

A

Difficulty swallowing

May be due to a tumor

54
Q

What is trismus?

A

Difficulty opening the mouth due to pain.

Involved the muscles of mastication

55
Q

What is stridor?

A

Obstruction to air enters and exhaling of air

- Usually involving the larynx

56
Q

What are 2 ways that salivary glands are infected?

A
  • Virally

- Bacterially

57
Q

Name 3 causes for ductal obstruction in salivary glands:

A

Tumors
Stones
Trauma .

58
Q

Name 4 benign tumors of the salivary glands:

A

Pleomorphic adenoma’s
Monomorphic adenoma’s
Lymphoepithelial cysts
Connective tissue disease

59
Q

Name 4 malignant tumors of the salivary glands:

A

Malignant pleomorphic adenoma’s
Adenoid cystic carcinoma
Muco epidermoid carcinoma
Lymphoma

60
Q

What is the function of saliva

A

The digestive functions of saliva include moistening food, and helping to create a food bolus, so it can be swallowed easily. Saliva contains the enzyme amylase that breaks some starches down into maltose and dextrin. Thus, digestion of food occurs within the mouth, even before food reaches the stomach.

Surgery- UGIT (9 decks)

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