Chapter9 pathology Flashcards
Endocrine disorders
-hyperpituitarism
-Hyperthyroidism
-hypothyroidism
-hyperparathyroidism
-Diabetes mellitus
-Addisons disease
Hyperpituitarism
Most common cause benign pituitary adenoma
#1 cause is excessive production of growth hormone from the anterior pituitary gland
Gigantism
- Increase in growth hormone during development
- Before closure of the long bone
- Excessive growth of the whole skeleton, in proportion
Acromegaly
- after closure of the epipysis
- Enlargement of hands and feet
-sensitive to light
-elongated mandible
-slow insidious onset
Hyperthyroidism (Thyrotoxicosis)
- Goiter or hyperplasia of gland maybe the cause
- Graves’ disease is a common disease
- Excess production of the thyroid hormone
- leads to increased metabolism
Hyperthyroidism oral manifestation
- premature loss of primary teeth
- Early eruption of permanent
- dental caries/ periodontal disease
- osteoporosis in mandible/ maxilla
- burning tongue
Hypothyroidism- cretinism
- Decreased output of thyroid
- decreased metabolism
- may have enlarged tongue
- Causes of hypothyroidism: development disturbances, autoimmune disease, Iodine deficiency, Drugs and pituitary problems
- Cretinism is the infancy and children version (delayed exfoliation)
Hypothyroidism- myxedema
- In older children and adults
- systemic edema is common
-more severe than Cretinism - edema in the gingiva and tongue, fatigue, weakness, and dry lips
Hyperparathyroidism
- parathyroid glands are concerned with control of calcium metabolism by mobilizing it into the bloodstream and maintaining normal calcium level
- affects only calcified structures that re forming during the period of dysfunction of those that have a readily mobile source of calcium
-caused by benign tumor of the parathyroid
Primary Hyperparathyroidism
- hyperplasia of thyroid gland caused by either benign tumor or malignant tumor
- elevated calcium sometimes leads to kidney stones
- low levels of phosphorus
- Browns tumor lesion identical to entrap giant cell granuloma (seen in both primary and secondary hypothyroidism)
- browns tumor seen in secondary hyperparathyroidism
Secondary hyperparathyroidism
- over production of parathyroid hormone (PTH) in response to long term decreased levels of serum calcium often associated with chronic renal disease (kidney disease)
- Secondary presents “ground glass”
T/F- Gigantism occurs after the closure of the long bone epiphysis
False
T/F A goiter maybe associated with hyperthyroidism
True
T/F Hypothyroidism in adults is called Cretinism.
False
Cause of diabetes
- Inadequate release of insulin from the beta cell of the pancreas
- Decrease in insulin prevents the glucose in the bloodstream to move into the fat and skeletal muscle cells
- blood has abnormal high levels of glucose (hyperglycemia)
Type 1
- 5-10% this type with usual onset in 20’s
-3 P’s: Polydipsia, Polyphagia, and polyuria - difficult to control insulin levels and there are major complications to body organ (eyes,kidneys, and nerves)
-Controlled usually with multiple injection of insulin throughout the day or by an insulin pump ( Allows for better control blood sugar)
Type 2
- 90% of people
- gradual onset
- Organ complication are less common than type 1
- Weight gain and metabolic rate are contributing factors
- some still need insulin
Oral manifestation
- Vascular system most affected/ slow wound healing
-advanced periodontitis - Nodular, fiery red, hyperplastic gingivitis
- secondary candida lesions from altered oral flora
-severe periodontal with hyperplastic and erythematous gingiva - xerostomia
-chronic gingivitis - gingival abscess
Diabetes and acanthosis nigricans
- skin disorder
- associated with type 2 diabetes
- useful indicator in screening
Modifications for diabetes
- Most common cause of death in diabetes is a heart attack
- Best to treat after breakfast
- May need to snack around 10am and 3pm
- Recall every 3-4 months
- stress management
- avoid chronic use of NSAID’s and steroid
- New drug by Etta, subcutaneous injection for type 2
Addison Disease
- insufficient production of adrenal steriods
- increases relapse of ACTH
- causes increase in release of melanocytes
- main oral manifestation is oral macules
- Bronzing on the skin
- Treatment is steroid administration
How Addison disease works
anemia
Reduction in oxygen carrying capacity of blood
- Iron deficiency anemia
- Pernicious Anemia
- folic acid/ Vitamin B12 deficiency anemia
thalassemia
- inherited disorder of hemoglobin synthesis
Sickle cell anemia
Inherited disorder of abnormal hemoglobin creating sickle shaped cell, due to decreased oxygen
Celiac sprue
Sensitivity of dietary gluten
Aplastic anemia
Decrease in circulation blood cells
polycythemia
Abnormal increase in circulating RBC
All anemias
- Reduction in he oxygen carrying capacity f the blood
- skin and mucosal pallor, weakness and fatigue
- Angular cheilitis
-erythema and atrophy of oral mucosa - loss of fungiform and filliform papillae
- circumvallate and foliage papillae not affected
- Do Not administer aspirin or ibuprofen
- main issue is poor wound healing
iron deficiency anemia (Plummer-vision syndrome)
- insufficient iron in the bone marrow for RBC production
-RBC are microcytic and hypochromatic - causes: menstruation, low iron intake, poor absorption of iron and pregnancy
- treatment: iron supplement
Pernicious anemia “red beefy tongue”
- Autoimmune disease
- pernicious anemia called megaloblastic anemia and presents with macro cystic RBC that have nucleus
- caused by a deficiency of intrinsic factor, released from the parietal cells of the stomach
-intrinsic factor in needed for proper Vitamin B12 absorption
Folic Acid and Vitamin B12 deficiency
-caused by malnutrition or increased metabolic requirements
- same oral signs as pernicious anemia
- Vitamin B12 anemia can be detected by the schilling test
- Treat with dietary supplements
- lack of folic acid may lead to spin bifida
Thalassemia
- inherited disorders of hemoglobin synthesis
- prominent cheekbones, depressed, nasal bridge
- prominent premaxilla, protrusion of anterior teeth
- “ hair on end” skull pattern
- Abnormal thickened trabecular bone pattern “salt and pepper” bone appearance
Thalassemia major
- severe hemolytic anemia from damaged RBC’s
Thalassemia minor
Mild and asymptomatic
Sickle cell anemia blood smear
- abnormal hemoglobin in RBC leads to lack of oxygen in cells and they take a sickle cell shape from lack of oxygen
Celiac sprue
- caused by disorders in the RBC and hemoglobin/ injury to the intestinal mucosa
- chronic sensitivity to dietary gluten
- oral symptoms: glossitis, burning tongue, atrophy of tongue papilla and mucosal ulcers
Aplastic anemia
- Decrease in a blood cells (RBC, WBC, and Platelets)
-Secondary aplastic anemia- severe depression of bone marrow due to drug or chemical agent
Primary aplastic anemia
-chemotherapy radioactive isotopes, radium and radiant energy, unknown cause
Polycythemia Vera
-neoplastic proliferation of the bone marrow stem cell that results in a abnormal high number of circulating RBC
- Impaired blood flow, poor circulation and vascular stasis Unknown cause
Secondary polycythemia
- caused by a physiologic response to decreased oxygen triggers an increase in erythropoietin form the Kidneys
- carbon monoxide, pulmonary disease, heart disease and high altitudes
Relative polycythemia
Decreased plasma volume not an increase in RBC
-causes diuretics, vomiting, diarrhea and excessive sweating
- increased problems with heart, strokes and heart attacks
Agranulocytosis
- reduction in circulating neutrophils (leukopenia)
-Causes problems with the development of neutrophils and with accelerated destruction of neutrophils - same disease as cyclic neutropenia except there is no cycle
Agranulocytosis oral manifestations
- ulcerations
- angular cheilitis
- necrotizing ulceration
- infection and gingival enlargement
-rapid loss of supporting bone- tooth loss - treatment: transfusions, antibiotics, control infection, remove cause
Hemostasis
- Stoppage of blood flow
Defect in hemostasis
- abnormalities in platelets or coagulation factors
Normal platelet count
150,000-400,000
Abnormal platelet count (platelet deficiency purpura)
<100,000 = thrombocytopenia
<20,000. = spontaneous bleeding
-reddish-blue or purple mucosa or skin
- blood oozing from margins
Normal Bleeding time
1-6 min
Abnormal bleeding time
5-10 min
Normal prothrombin time
11-16 seconds
Abnormal prothrombin time
16> seconds
Normal Partial thromboplastin time
25-40 seconds
Abnormal partial thromboplastin time
> 50 seconds
Thrombocytopenia purpura
- reddish- blue or purple
- severe reduction of circulating platelets
- safe for minor dental TX >50,000
Nonthrombocytopenic Purpura
-Most common cause: drugs that affect platelet function ( Indomethacin, Naproxen, Ibuprofen, aspirin)
-Von Willebrand disease (worst case)
- Spontaneous bleeding petechiae, ecchymosis, and hemorrhagic blister
Hemophilia X linked inheritance
-severe problem in blood coagulation
- Type A is most common
-plasma proteins deficient specifically Factor VIII
Treatment replace missing cascade factor
Hemophilia Manifestations
-swollen knees
Gingival hemorrhage after routine curettage
Echymosis and petechiae
Primary Immunodeficiency
- genetic origin
-B-cell and T-cell
-Autoimmune diseases
Secondary Immunodeficiency
-Results from underlying disorder
-from drugs taken for disorders (transplant rejection drugs, chemotherapeutic agents, prednisone)
-Infection is the greatest concern
-most common
-HIV
Radiation therapy oral cancer
- mucositis
-red and ulcerated
-painful
-difficulty eating - difficulty swallowing
- loss of taste
-xerostomia
-radiation caries
-osteoradionecrosis
-should have a complete oral exam before starting treatment
Chemotherapy oral cancer
-mucositis
-oral ulcerations
-decrease in bone marrow cells
-leads to opportunistic infections “candida”
-bleeding problems
Effects of therapy for oral cancer
- tooth and gingival discoloration (tetracycline, minocycline)
-gingival enlargement medications ( Phenytoin(Dilantin), Nifedipine (procardia), Cyclosporine (transplant drug)
HIV and AIDS
Sexual contact/ blood
-HIV CD4 T-helper cell; depleted as progressees; decreases ad condition worsens
- immune system continues to depress AIDS eventually develop
