Chapter 14 Flashcards
What percent of the population is affected by Aphthous Ulcers
40%
What age group are Aphthous Ulcers most common to occur
0-20 (women = higher risk)
What diseases are Aphthous Ulcers associated with
Celia disease
Inflammatory bowl disease (IBD)
Behcet disease
A shallow ulceration of the oral cavity that is covered by a thin exudate and is surrounded by Erythema
Aphthous Ulcers
What is another name for Aphthous Ulcers
Canker sores
What causes Oral herpes
HHV1 (HSV-1)
what causes Genital Herpes
HHV2 (HSV-2)
Primary herpes infections typically occur in what age group
2-4 years old
10-20% of Primary herpes infections manifest as what?
Acute herpetic gingivostomatitis
What can tigger HHV1 outbreaks
UV light Trauma Allergies URTI Pregnancy menstruation immunosuppresion
What are common locations for HHV 1 infections
Lips Nasal orifices Buccal mucosa Gingiva Hard palate
How long does it take for a HHV1 lesion to resolve
7-10 days
How can Herpes be treated
Antiviral medication
What is the most common fungal infection of the oral cavity
Oral Candidiasis (thrush)
What causes Oral Candidiasis (Thrush)
Candida ablicans
What factors determine the severity of Oral Candidiasis
Strain
Immunosuppression
Oral micobiota
What are the three forms of Oral Candidiasis
Pseudomembranous
Erythematous
Hyperplastic
What form of Oral Candidiasis is most common and is known as Thrush
Pseudomembranous
What is Characteristic of Oral Candidiasis
Grey-white plaques that can be scraped off (redness underneath plaques)
What can happen to someone that has AIDS and Oral Candidiasis
It can spread down esophagus
What is formed due to chronic irritation as a result of tissue hyperplasia
Fibromas
Where are fibromas most likely to form
Along the bite line of the cheek
What is a richly vascular lesion on the gingiva, most commonly found in pregnant women
Pyogenic Granuloma
How can one remove a Pyogenic Granuloma
Wait till it recesses
Surgical removal
What is a white patch in the oral cavity that cannot be scraped off.
Leukoplakia
What percent of the world has Leukoplakia
3%
what percentage of leukoplakias are malignant
25%
What is a red velvety patch in the oral cavity called
Erythroplakia
Which is most likely to cause cancer Leukoplakia or Erythroplakia
Erythroplakia
What are some predisposing factors for developing Leukoplakia or erythroplakia
Smoking
age 40-70
Males 2:1
95% of cancers of the oral cavity are what type of cancer
Squamous Cell Carcinoma
What is the long term survival rate of someone that survived Squamous Cell Carcinoma of the oral cavity
50%
What is unique about oral cancer
There are multiple tiny primary tumors that develop around the same time
What is a common cause of Squamous cell Carcinoma
years of chronic exposure to carcinogens (tabacco, alcohol)
Do people that have Oral HPV-6 tumors have a better prognosis than those who have squamous cell carcinoma
No, HPV cancers have a better prognosis
What are the two most common locations for Oral Squamous cell Carcinoma
Ventral surface of the tongue
Floor of mouth
What is Xerostoma
Dry Mouth
What autoimmune disease has Xerostoma as a major feature
Sjogrens
What are some complications of Xerostoma
Cavities
Tongue Fissure
Difficulty swallowing
What inflammatory condition is caused by trauma, viral or bacterial to the salivary glands
Sialadenitis
What is the most common inflammatory lesion of the salivary glands
Mucocele
What causes Mucocele
Damage or blockage of the salivary glands
What percent of Salivary gland tumors arise from the parotid gland; what percent of them are malignant
65%-80% of all salivary tumors
15%-30% are malignant
What percent of Salivary gland Tumors arise from the submandibular gland; what percent of them are malignant
10% of all salivary tumors
40% are malignant
What percent of Salivary gland tumors arise form the sublingual gland; what percent of them are malignant
10% of all salivary tumors
70-80% are malignant
Describe a parotid gland neoplasm
Encapsulated (mobile growth) growth that is localized to the parotid gland
What percent of parotid gland tumors are pleomorphic adenomas; what percent of them will turn into cancer
60% of parotid tumors
2%-10% will become cancerous
What is the name of a pleomorphic adenoma that has become malignant
Carcinoma ex pleomorphic adenoma
What is the 5-yr survival rate for a carcinoma ex pleomorphic adenoma
50%
What are the 4 categories of esophageal lesions
Mechanical
Functional
Ectopia
Esophageal varices
What falls under the category of Mechanical esophageal lesions
Atresia
Fistula
Stenosis
What falls under the category of Functional esophageal lesions
Aperistalis
Achalasia
What is the triad for Achalasia
Incomplete Lower Esophageal sphincters relaxation
Increased Lower Esophageal tone
Esophageal aperistalsis
What are complications of Achalasia
Regurgitation
Chest pain (heart burn)
wt loss
What causes Primary Achalasia
Idiopathic
possible loss of innervaiton
What causes secondary Achalasia
Chages disease
Polio
Inflammation pf Auerbachs’ plexus
What causes Esophageal varrices
Portal vein congestion/hypertension
secondary to liver cirrhosis
Where are esophageal varrices likely to occur
Lower 1/3 of esophagus
What is Esophagitis
Esophageal inflammation due to injury to esophageal mucosa
What is the most common cause of Esophagitis
Reflux esophagitis
What causes Reflux Esophagitis
unknown, most likely dysfunction of LES
Obesity
smoking
pregnancy
What is the most common outpatient GI complaint
GERD/heart burn
What causes Chemical/acute esophagitis
Tobacco Alcohol hot liquids chemotherapy irradiation
What causes infectious esophagitis
Fungal infxn
HHV
Cytomegalo virus
What is the most common laceration of the esophagus
Mallory-weiss tear
What causes Mallory-weiss tear
Forceful vomiting (alcoholics, bulimics)
inadequate LES relaxation
Gastopharyngeal junctions
What type of esophageal laceration makes up 50% of upper GI bleeds
Mallory-Weiss tear
What is the most common hiatal hernia
Axial (asymptomatic)
“bell shaped”
What type of hiatal hernia is prone to strangulation/obstructions and is likely symptomatic
Non-axial
How is at a higher risk of developing a hiatal hernia
Elderly
What esophageal condition shows metaplasia of cells in the distal esophagus
Berrets Esophagus
What is a risk for patients experiencing Berrets Esophagus
Development of esophageal cancer
What groups are at a higher risk of developing Berrets esophagus
Males
Caucasians
Obese
40-60 y/o
What type of cancer is likely to develop from berrets esophagus
Esophageal adenocarcinoma
What is a benign smooth muscle tumor of the esophagus
Leiomyoma
What esophageal tumor makes up 50% of all esophageal tumors
Adenocarcinoma
What makes someone have a higher risk of developing adenocarcinoma
GERD
Berrets Esophagus
Tobacco
Obesity
What is the most common esophageal tumor world wide
Squamous cell carcinoma
Where are the majority of Esophageal adenocarcinomas located
Distal 1/3 of the esophagus
What is the prognosis for Esophageal adenocarcinomas; what is the reason
25% 5yr survival
Due to late symptom development and lymphatic invasion
What part of the esophagus is a Squamous cell carcinoma likely to develop?
Middle 1/3
What esophageal cancer is prominent in underdeveloped or poverty stricken areas
Squamous cell carcinoma
What is the most common stomach infection
Heliobacter pylori
What is the most common cause of stomach mobidity
Gastritis
What is inflammation of the gastric mucosa called
Gastritis
Which form of gastritis has transient inflammation with possible erosion/ulceration
Acute Gastritis
What is Acute gastritis associated with
NSAIDS/Salicylism
Trauma
Alcoholics
how do you treat Acute gastritis
meds that decrease gastric activity
What gastric problem is associated with shallow Ulcerations of the stomach/duodenum and is caused by highly traumatic injury
Acute peptic ulcer
How can acute peptic ulcers be a problem?
They are likely to perforate and place the patient in the ICU if bad enough
Which form of gastritis is more severe
Acute
What ulcers are associated with Chrionic gastritis
Peptic ulcers caused by heliobacter pylori
What are some complications of Chronic gastritis
Peptic ulcer disease
Gastric Adenocarcinoma
What type of gastritis is common in the elderly
Autoimmune gastritis
What is a complication of Autoimmune gastritis
Pernicious anemia
Where do Peptic ulcers develop
Gastric Antrum
Proximal Duodenum
70-90% of Peptic ulcers are caused by H. pylori. What percent of H.pylori infections develop into Peptic Ulcer Disease
5-10%
how is the appearance of peptic ulcer diseases described
Solitary “punched out” lesions
What is the most common type of Gastric Polyp
Hyperplastic growth/inflammation
Which gastric polyp is most concerning
Gastric Adenoma
What percent of Gastric Adenomas become adenocarcinomas
30%
What are the majority of stomach cancers
Gastric Adenomas
What increases the risk of a gastric adenomas
Inflammation
H.pylori
EBV
What part of the GI track are most likely to have an obstruction
Small intestine
What are the most common type of GI obstructions
Herniation
Adhesion
Intussusception
Volvulus
Out pouching of the small intesting, most common in males
Meckel Diverticulum
Congenital disease where the rectum and sigmoid colon lack nervous innervation which causes obstructions/ dilation of proximal bowels
Hirschsprung Disease
Condition that is common in elderly and obease that is caused by a lack of blood or a decrease of BP to the bowels
Ischemic Bowel Disease (Ischemic Colitis)
What can cause Ischemic Bowel Disease
Thrombis
Arterial embolism
Non-occlusive ischemia
Which form of ischemic Bowel disease has episodic bloody diarrhea and mimics IBD
Chronic
Which form is Ischemic Bowel disease has sudden/severe abdominal pain, nausea, vomiting and frank blood in stool
Acute
Which form of Ischemic Bowel disease can cause hypovolemic shock
Acute
What are small vascular lesions of the submucosal and mucosal vessels
Angiodysplasia
What is the most common location for angiodysplasia
Cecum or ascending colon
What is the most likely cause of Angiodysplasia
Constipation
What is the most common vascular disorder of the GI tract
Hemorrhoids
What causes hemorrhoids
Increase interabdominal pressure Liver Cirrhosis (portal htn)
What are the two type of hemorrhoids and their location
Internal: above anorectal line
External: below anorecetal line
What are the most common malabsorption diseases in the US
Pancreatic insufficiency
Celiacl disease
Crohn disease
What is it called when there are excessive fats in feces
Steatorrhea
What is it called when there is bloody diarrhea
Dysentery
What are some features of malabsorption
WT loss + muscle wasting Abdominal distension flatulence anorexia vit + mineral deficiency
Non-infectious malabsorption due to an immune-mediated reaction to gliadin
Celiac disease
Which immune-mediated malabsorptive condition will have atrophy of the villous
Celiac disease
Name for celiac disease manifesting on the skin
Dermatitis herpetiformis
Which malabsorptive condition is most likely seen in children between the ages of 2-3 that have recently visited a tropical area
Environmental Enteropthy
Which malabsorptive condition has cycles of mucosal injury, malnutrition and inflammation
Environmental enteropathy
Which malabsorptive disease has a decrease of lactase at the S.I brush boarder, causing cramps, gas and diarrhea
Lactase Deficiency
What GI disease kills 12,000 children a year and
Infectious enterocolitis
What does the cholera toxin do
Opens CFTR which causes chloride ion secretions
What percent of cholera cases result in death
50-70%
What is the most common cause of Traveles Diarrhea
Enterotoxigenic E. Coli
What is the most common bacterial enteric pathogen in the US
Campylobacter jejuni
Which enteric pathogen is associated with Snakes, Lizzards and Slamanders
Salmonella
What is the condition associated with a C. Diff infection
Pseudomembranous Colitis
Who is at a higher risk of developing a C.Diff infection
Elderly
immunosuppressed
GI disease that has pseudomembranes inside of the colon
Pseudomembranous colitis
What causes over half of reported gastroenteritis infections
Rotavirus (children)
Norovirus (adults)
What is the most common parasitic infection, what causes it
Giardiasis
Giardia lamblia
Condition in which there are blind pouches in the colon wall, mainly in the sigmoid colon
Sigmoid diverticulitis
What are some risks of sigmoid diverticulitis
Perforation –> hemorrhage
how can one develop sigmoid diverticulitis
Decrease fiber in diet which will cause constipation and straining
Sigmoid diverticulits affects how many people over the age of 60
50%
Who is most likely to develop irritable bowel syndrome
20-40 year old females
What are symptoms of IBS
Bloating, diarrhea, constipation
Who is at risk of developing an inflammatory bowel disease
Women
White
Which inflammatory bowel disease is a T cell autoimmune reaction that causes transmural inflammation (Cobblestone)
Crohns Disease
What are the symptoms of Crohns disease
Melena
Mild Diarrhea
Fever
Abdominal pain
Where are the most common locations for Crohns disease inflammation
Terminal ileum
Ileocecal valve
Cecum
Which inflammatory bowel disease affects the superficial mucosa and always begins in the rectum and preceeds proximally
Ulcerative Colitis
Which disease is smoke inhibitory for:
Crohns disease
Ulcerative colitis
Ulcerative Colitis
Which inflammatory bowel disease has relapsing episodes of Abdominal cramping along with pseudopolyps
Ulcerative Colitis
What is the stool like of a patient with Ulcerative Colitis
Bloody and mucoid
What is a benign mass in the colon that is always treated as Pre-malignant
Adenomas
What do Adenomas has a chance to turn into
Adenocarcinomas
Which GI tract disease has numerous adenomas and is treated with prophylactic colectomy
Familial Adenomatous Polyposis
at What age is Familial adenomatous polyposis likely to develop
Teenagers
What are the two types of Tumors of the GI tract
Adenocarcinomas
Carcinoid tumor
What is the most common malignancy of the GI tract
Colorectal adenocarcinoma
Who is at risk of developing Colorectal adenocarcinoma
Males in developed nations between that age of 50-70
How is the Stool of a patient with Colorectal adenocarcinoma described
Occult blood (black)
Where do Colorectal adenocarcinomas metastasis to
Liver
Lymph nodes
Lungs
Bone marrow
What region of the GI tract are Neoplasms most likely to occur
Duodenum
What is the most common acute abdominal condition
Appendicitis
Who is at a higher risk of developing Appendicitis
Males
What is the most common cause of appendicitis
Obstruction that causes ischemia and inflammation
What type of tumor is the appendix most likely to have
Carcinoid tumor