Chapter 17 Flashcards
What term describes an excess of bilirubin in the bloodstream that causes a yellowish discoloration of the skin and mucosa?
Jaundice
What are the causes of juandice?
There are numerous, some are physiologic, many are pathologic
Sickle cell, liver infection, toxins, cancer, Gilbert syndrome
What is Glibert syndrome?
It is an inherited, innocuous (not harmful) impaired processing of bilirubin by the liver
What structures accumulate bilirubin in jaundice and why?
Sclera, lingual frenum and soft palate because these structures have more elastin, which has a high affinity for elastin
What are some other symptoms due to hyperbilirubinemia that may occur with jaundice?
Fever, abdominal pain, anorexia, fatigue
What term describes a group of conditions characterized by the deposition of an extracellular, proteinaceous substance?
Amyloidosis
What are the classifications of amyloidosis?
Organ limited
Systemic primary
Systemic secondary
Systemic heredofamilial
What are the characteristics of organ-limited amyloidosis?
Is in no association with a systemic condition. Can occur in a variety of organs but is rarely seen in the oral cavity. May have a submucosal amyloid nodule
What is systemic primary amyloidosis associated with?
Myeloma
20% are associated with multiple myeloma
Who does systemic primary amyloidosis typically affect?
Older adults, males more than females
What are the initial signs of systemic primary amyloidosis?
Initial signs are nonspecific, but eventually carpal tunnel syndromem mucocutaneous lesions, hepatomegaly and macroglossia
What do skin lesions in systemic primary amyloidosis appear as and where do they occur?
Smooth-surface, firm, waxy papules and plaques that most commonly affect the eyelid, neck and and lip
What is systemic secondary amyloidosis associated with?
Usually Hemodialysis
but can develop as a result of a chronic inflammatory process (TB, sarcoidosis, osteomyelitis)
What does systemic secondary amyloidosis affect?
Spares the heart but affects the liver, kidney and spleen
Why is systemic secondary amyloidosis due to TB, sarcoidosis or osteomyelitis uncommon?
Because these are usually treated with ABX before the disease progresses to amyloidosis
Why does systemic secondary amyloidosis associated with hemodialysis?
Because the protein (amyloid) is not removed by dialysis so it accumulates in the plasma and eventually deposits in the bones and joints
What is systemic heredofamilial amyloidosis?
It is an uncommon but significant form of the disease. It is autosomal dominant and causes polyneuropathies, cardiomyopathy, cardiac arrythmias, CHF, and renal failure
What is the treatment of amyloidosis?
In most instances, there is no effective therapy available. Most patients with the systemic form succumb to cardiac failure, arrythmias or renal disease within months to a few years of the dx
What are the main causes of vitamin deficiencies in the US today?
Due to malabsorptions, eating disorders, “fad diets”, and alcoholism
What is Vitamin A called and what is it for? What does a deficiency lead to?
Retinol
It is essential for vision
may lead to blindess
What is Vitamin B1 called and what is it for? What does a deficiency lead to?
Thiamine
It maintains proper functioning of neurons
May lead to beriberi
What is Vitamin B2 called and what is it for? What does a deficiency lead to?
Riboflavin
IT is necessary for cellular oxidation reduction reactions
Can lead to oral alterations like angular cheilitis and glossitis
What is Vitamin B3 called and what is it for? What does a deficiency lead to?
Niacin
It acts as a coenzyme for oxidation reduction reactions
It can lead to pellagra which is dermatitis, dementia, and diarrhea
What is Vitamin B6 called and what is it for?
Pyroxidine
It is a cofactor associated with enzymes that participate in amino acid synthesis
What is Vitamin C called and what is it for? What does a deficiency lead to?
Ascorbic acid
It is necessary for the proper synthesis of collagen
Can lead to scurvy
What is Vitamin D considered and what does a deficiency leadt to?
Is it considered a hormone
It is necessary for calcium absorption from the gut
Can lead to RIckets/Osteomalacia
What is Vitamin E called and what is it for?
alpha-tocopherol
It is an antioxidant
What is vitamin K for and what does a deficiency lead to?
It is necessary for proper clotting (Factors 2, 7, 9, 10)
Bleeding disorders
What is the most common cause of anemia in the US and the world?
Iron deficiency anemia
What is the cause of iron deficiency anemia?
Excessive blood loss, increased demand for RBCs (excercise), decreased uptake/absorption of iron
Who is commonly affected by iron deficiency anemia?
20% are women of childbearing years from chronic blood loss (menorrhagia)
What are the oral manifestations of iron deficiency anemia?
Angular cheilitis and atrophic glossitis
What are the laboratory findings in iron deficiency anemia?
Hypochromic microcytic RBCs
What is Plummer Vinson SYndrome?
Iron deficiency anemia, glossitis, dysphagia
Why is Plummer Vinson SYndrome significant?
It has been associated with a high frequency of both oral and esophageal squamous cell carcinoma – it is considered a premalignant process, and have anywhere from 5-50% of developing a malignancy
Who is most commonly affected by Plummer Vinson Syndrome?
Women of Scandinavian or Northern European background between the ages of 30-50
What do patients with Plummer Vinson SYndrome often complain of?
A burning sensation with the tongue and oral mucosa
What other oral sign might there be in Plummer Vinson syndrome (besides the glossitis, and burning tongue and dysphagia)
Angular cheilitis (Duh they have an iron deficiency)
What is present in the esophagus in Plummer Vinson Syndrome?
Abnormal bands of tissues called esophageal webs
What is another sign of Plummer Vinson Syndrome?
Alteration of the growth pattern of the nails – spoon shaped = koilonychia
And brittle nails
How is Plummer Vinson syndrome treated?
Dietary iron supplementation (may need an injection if they cannot absorb iron), and periodic evaulation for oral, pharyngeal and esophageal carcinoma
What is caused by the poor absorption of Vitamin B 12 and what is the name of Vitamin B 12?
Pernicious anemia
Cobalamin
Why are patients with pernicious anemia unable to absorb vitamin b12?
Many patients lack intrinsic factor because of autoimmune destruction of the parietal cells of the stomach
What is the oral manifestation of pernicious anemia?
Atrophic glossitis or a werid metallic taste
What are the laboratory findings in pernicious anemia?
Megaloblastic anemia
What term descriebs an excessive production of growth hormone before the closure of the epiphyseal plates?
Gigantism
What is an oral finding in patients with gigantism?
Generalized macrodontia
What is usually the cause of gigantism and excessive growth hormone?
A pituitary adenoma
What term describes an excessive production of growth hormone after the closure of the epiphyseal plates?
Acromegaly
What are some oral findings in patients with acromegaly?
Increased growth of the mandible (prognathism) with diastema formation and macroglossia
What term describes decreased levels of thyroid hormone?
Hypothyroidism
What is the term for hypothyroidism in infants?
Cretinism
What is the term for hypothyroidsin in adulthood?
Myxedema
What vasculature structures are mainly affected in Diabetes Mellitus?
Arteries so a decrease in tissue perfusion results
What leukocyte is also impaired in patients with diabetes mellitus?
Neutrophil dysfunction
What are the oral manifestations associated with diabetes mellitus?
Periodontal disease (more frequent and rapid), delayed healing, increased probability of infection, enlargement and erythema of the attached gingiva, oral candidiasis (30%), zygomycosis, xerostomia (30%), diabetic sialadenosis
What is Crohn’s disease?
An inflammatory and immunologically mediated condition of unknown causes with manifestations anywhere along the GI tract
When does Crohn’s disease usually become evident?
During teenage years
What usually precedes GI lesions in Crohn’s disease and how often?
ORal lesions precede the GI lesions 30% of the time
What are some of the GI signs of Crohn’s?
Abdominal cramping, diarrhea, pain, nausea, fever, weight loss and malnutrition may develop
What are the oral lesions observed in Crohn’s disease?
Oral lesions are non specific! Can be diffuse nodular swellings, cobblestone appearance of the oral mucosa, linear ulcerations of the buccal vestibule (usually mandibular), pyostomatitis vegetans
How is Crohn’s treated?
Usually with a sulfa drug, or systemic prednisome in more severe cases
