ch 14 Flashcards
what are aphthous ulcers
thin exudate (white), red rim
idiopathic self-limiting
cause stress, fever, certain foods
what is another name for aphthous ulcer
canker sore
recurrent aphthous stomatitis
what are the signs of Herpes simplex virus
1-3 vesicles (blister like)
itching, burning, tingling and pyrexia (fever)
self limiting
what is primary HSV
in young children
80% asymptomatic
10-20% acute herpetic gingivostomatitis (this is when there is a breakout all over the face)
what is HSV in adults
if it gets reactivation then it is called recurrent herpetic stomatitis
(dormant in trigeminl ganglion)
what is HSV-1 and HSV-2
HSV-1 orofacial
HSV-2 genital
what are some of the things that could trigger HSV
uv light pyrexia cold trauma URTI pregnancy
what is it called if HSV spreads to the nervous system (brain and spinal cord)
encephalitis
what is another name for oral candidiasis and what will cause this
thrush
Candida albicans
what does oral candidiasis look like
gray-to-white shit in the mouth
may be scraped off
what % of newborns have oral candidiasis
37%
what is fibroma
submucosal fibrotic mass near the bite line
caused by chronic irritation
what is pyogenic granuloma
caused by hormonal factors, irritation vascular mass (red-to-purple), gingival
what is leukoplakia
raised, white patch
DX of exclusion
caused by inflammation
biopsy to rule out CA (SCC)
what is Erythroplakia
looks like leukoplakia
50% pre-cancerous
red, velvety area
what is hairy leukoplakia
associated with EBV and people with AIDS
what is verrucous leukoplakia
associated with HPV
warty appearance
commonly transformation into SCC
when is oral cancer normally DX
in advanced stages
if you have oral cancer what is it most likely to be
Squamous cell carcinoma (95%)
painful
multiple primary tumors
what are the risk factors for oral cancer
alcohol
tobacco
>30 years old
HPV-16
what does SCC look like
whitish-gray or red
mimics leukoplakia or erythoplakia
if you have SCC where is it most likely to metastasis to
the cervical lymph nodes
what could give you a better prognosis if you have SCC
HPV-16
what is the most common gland that gets salivary gland disease
parotid gland
what are some of the signs of salivary gland disease
xerostomia (dry mouth)
dysphagia, dysarthria (difficulty swallowing and speaking)
what is sialadenitis
inflammation and enlargement of the salivary glands
MC cause is mumps (MC viral cause of parotids)
what is a mucocele
blockage/rupture of salivary gland
this will cause inflammation
what % of salivary gland neoplasms happen in the parotid gland and what % of those are malignant
65-80% and
15-30% malignant
the bigger the gland the higher % of incidents and lower % of malignant
what % of salivary gland neoplasms happen in the submndibular gland and what % of those are malignant
10% and
40% malignant
what % of salivary gland neoplasms happen in the sublingual and minor salivary gland and what % of those are malignant
10-25%
50-90% malignancy
what is a pleomorphic adenoma
it is a benign tumor in the parotid gland
it accounts for 60% of the parotid gland
risk for malignant development
what is achalasia
this is located at the inferior part of the esophagus has the triad 1 incomplete LES relaxation 2 increased LES tone 3 esophageal aperistalsis
what are the signs of when you have achalasia
Dysphagia (difficult swallowing)
regurgitation
what are primary and secondary Achalasia cause by
Primary: is idiopathic (MC),
secondary: is inflammation near auerbach’s plexus
what is Esophageal varices
it is when you have PORTAL HTN that will cause the blood to shunt blood to ESOPHAGEAL VENOUS PLEXUS
90% of the time this is caused by liver cirrhosis
could rupture and bleed out
what is esophagitis
this is a common and all it is is esophageal inflammation
symptoms do not correlate degree of inflammation
what is GERD
idiopathic inflammation of the lower esophagus
heartburn “SOUR BRASH “
what will cause chemical esophagitis and what is it
acute inflammation that is caused by tobacco, alcohol, pill-induced
what will cause infectious esophagitis
severely debilitated or immunosuppressed (AIDS)
what is mallory-weiss tear
longitudinal tears at the gastroesophageal junction caused by forceful vomiting
risks: alcoholics, bulimia, acute illness
what is a hiatal hernia
this is when some part or the stomach protrudes through the esophageal hiatus.
what is a axial(sliding) hiatal hernia
MC 95%
bell shaped dilation
what is a non-axial (rolling) hiatal hernia
this is when a separate portion of the stomach protrudes
look at the pick on page 7 of the paper copy
how common is a hiatal hernia
20% of all adults
70% of those >70 years old
90% are asymptomatic
GERD like symptoms
what is Barrett esophagus
intestinal metaplasia of the esophagus (the stomach cells have started to grow out through the esophagus)
pre-cancerous lesion
what are you at risk for if you have Barrett esophagus
esophageal adenocarcinoma (30-100x)
what does a Barrett Esophagus look like
red, velvety mucosa
bands (tongues) that extend superiorly
what is a adenocarcinoma and what are the risk factors
it is esophageal tumors,
risks: US, Barrett esophagus, GERD, Caucasians, Males (7X)
what is squamous cell carcinoma in the esophageal tumors
it is the most common esophageal cancer in the world about 90%
what are some of the features of adenocarcinoma
inverse relationship with fruits vegetable intake
has a early invasion of the lymphatics (DX late)
DX in the late stage
where in the esophagus is esophageal adenocarcinoma
the distal 1/3
who is at risk to getting squamous cell carcinoma in the esophagus
> 45 year olds, males(4X) and african americans
what is the prognosis of squamous cell carcinoma in the esophagus
poor <10% 5 year survival rate
where is the squamous cell carcinoma in the esophagus located
in the middle 1/3
this will also cause strictures (narrowing)
what are some of the signs of acute gastritis
TRANSIENT mucosal inflammation (pain) epigastric pain nausea vomiting anorexia
what can cause Acute gastritis
NSAIDs (aspirin) the more you take the worse the inflammation gets
what are acute peptic ulceration associated with
severe physiological stress and NSAIDs
what is cushing ulcers
it is a acute peptic ulceration
caused by intracranial disease
what are some of the signs of acute peptic ulcerations (cushing ulcers)
vomiting up of “coffee-ground” hematemesis
how does chronic gastritis compared to acute gastritis
less severe, more prolonged
what are the causes of chronic gastritis
helicobacter pylori (MC) additional factors upset mucosal balance
what do you have a great risk of getting if you have chronic gastritis
stomach cancer
(MC) gastric adenocarcinoma
who is at the greatest risk of having a H. pylori infection
poor childhood sanitation/hygiene
what is the effects does a chronic gastritis have with a H pylori infection
increase in acid production
where are you most likely to get a peptic ulcer disease (PUD)
proximal duodenum (MC (4X)) gastric antrum
what is the lifetime risk of getting a PUD
10% males
4% females
what are the causes of PUD
NSAIDs
H. pylori (MC) (70-90%)
what is a gastric polyps
mass projecting above surrounding mucosa (into the lumen)
what is the only way to determine the type of gastric polyps
with a biopsy
what gastric polyps are the most concerning and why
gastric adenomas because 30% transition into adenocarcinomas
what is the most common type of gastric carcinomas
gastric adenocarcinomas (90%)
what do gastric carcinomas (adenocarcinomas) resemble
chronic gastritis
when it comes to gastric carcinomas (adenocarcinomas) when are the symptoms developed and what is the outcome
MC Dx. late and <20% 5 year survival rate
what are the 4 intestinal obstructions
herniation
adhesions
intussusception
volvulus
what is a herniation
abdominal wall defect allows intestinal protrusion (inguinal/umbilical), edema, strangulation
what is an adhesions
inflammatory fibrosis, adherent intestinalsegments, may create closed loops
what is a Intussusception:
telescoping of the proximalbowel into the distal segment
what is a Volvulus:
twisting a loop of bowel, possible infarction
what is Meckel diverticulum
Congenital, blind-ended outpouching of the small intestine
has the rule of two (this means if he is asking a question about this just pick anything with a 2 in it)
what is Hirschsprung disease
Lack of ganglia in distal intestines causing Failure to pass meconium (the first poop when you are a new born)
what is Ischemic bowel disease
cutting of the blood to the intestine causing infarction
what will cause a Thrombosis Ischemic bowel disease
atherosclerosis, vasculitis, dissecting aneurysm, inflammation (CA),hypercoagulability, cirrhosis
what will cause a Arterial embolism Ischemic bowel disease
myocardial infarction (muralthrombus), angioplasty, endarterectomy
what will cause a Non-occlusive ischemia Ischemic bowel disease
heart failure, shock, dehydration, vasoconstrictive meds
what are the signs of acute Ischemic bowel disease
sudden/severe abdominal pain (rigidity), nausea, vomiting, bloody diarrhea (melanotic)
• Hours: shock/vascular collapse
what are the signs of chronic Ischemic bowel disease
abdominal distention & G.I. bleeding
who is at the greatest risk for Ischemic bowel disease
elderly
what is Angiodysplasia
Tortuous/abnormal dilations
• Submucosal & mucosal blood vessels
where is the most common place to get Angiodysplasia
Cecum or ascending colon
what is the cause of Angiodysplasia
Idiopathic
who usually gets hemorrhoids and what are some of the risk factors for them
>50 years old ↑ intra-abdominal pressure (Valsalva's) Liver cirrhosis (portal HTN)
where are the internal and external hemorrhoids
internal ↑ anorectal line (columnar cells)
External: below anorectal line (squamous cells)
what are some of the signs of hemorrhoids
may bleed with bowel movement
irritates surrounding tissues
perianal pruritus (itching)
what is the cause of diarrheal diseases
intestinal inflammation that cause diarrhea that might cause malabsorption
what Steatorrhea poop
bulky, frothy, greasy, yellow/gray
what is dysentery
painful, bloody, small volume diarrhea
what are the features of malabsorption
- Weight loss, muscle wasting (cachexia)
- Abdominal distension
- Borborygmus
- Flatulence
what are the the consequences of malabsorption
Anemia (iron, B12, folate), vitamin deficiencies, osteopenia, tetany (↓ Ca++), amenorrhea, impotence, infertility, hyperkeratosis, edema, peripheral neuropathies (Vit. B12)
what is Celiac disease
Immune-mediated reaction to gluten (gliadin)
Non-infectious malabsorption
what will Celiac disease do to the small intestine
Loss of mucosal & brush border surface area called Villous atrophy
in the US what % have celiac disease and who is most likely to get it
1% of US
Caucasians
30-60
what are some of the signs of celiac disease
steatorrhea
bloating/destention
what can celiac disease cause on the skin
dermatitis herpetiformis
what do you need to know about Environmental enteropathy
Recurring, acute: diarrhea, fever, malaise
responds to antibiotics
villus flattening
MC age 2-3 years
what is infectious enterocolitis
microbial infections that will cause inflammation and diarrhea
major global heath problem
cholera
cause vibrio cholerae
massive chloride ion secretion
“rice water stool
hypotension/shock
campylobacter enterocolitis
AKA traveler's diarrhea (E.coli) cause campylobacter jejuni MC bacterial enteric pathogen in the US enterotoxins self-limited colitis
pseudomembranous colitis
AKA antibiotic-associated colitis
cause clostridium difficile
risk hospitalization
Viral gastroenteritis
50% of all gastroenteritis
children: rotavirus
adult: norovirus
parasitic disease
Cause Giardia lamblia
resists cold and chlorine
“beaver fever”
alters SI enzymes
what is Irritable bowel syndrome
altered bowel habits
no cellular abnormalities
MC 20-40 females
NO INFLAMMATION
what is inflammatory bowel disease
idiopathic
crohn disease
ulcerative colitis
what is crohn disease
skip lesions
MC in ileum
transmural (throughout the wall)
what is ulcerative colitis
starts in the rectum effects the mucosa and submucosa 20-25 year olds smoking inhibitory stringy and bloody
what is a adenomas polyps
onset >40 years of age
50% of all US adults >50 years old
could turn into adenocarcinomas
what is familial adenomatous polyposis
numerous adenomas
100% chance of CA by age 30
