Exam 1 Ch. 14 Oral And GI Flashcards
What is the general name for an apthous ulcer
Canker sore
If a patient has a painful ulceration in their mouth characterized by a white exudate and red rim what do they have
An aphthous ulcer
How much of the population is affected by an apthous ulcer
40%
Who is most likely to get an aphthous ulcer
Females less than 20 years old (reproductive age) and those with celiac disease/IBD
What is also known as the extreme version of an apthous ulcer
Behcet disease
What are 3 things that increase the likelihood of an aphthous ulcer
- trauma/foods
- nsaids/corticosteriods
- vitamin B12
What is HSV-1
Oral herpes
Childhood HSV infection are usually symptomatic or asymptomatic?
80% asymptomatic
Most adults have what relationship with HSV
60% are carriers
Where is HSV dormant in adults
Trigeminal ganglion (CN v)
Reactivation of HSV in adults is known as what
Recurrent herpetic stomatitis
Childhood HSV can present itself as symptomatic and known as what?
Acute herpetic gingivostomatitis
Does location indicate type of HSV
No!
What are major symptoms of HSV
Grouped vesicles resulting in itching/burn, with HA, sore throat
Is there a cure for HSV
No, antiviral drugs decrease replication reducing recurrence
If HSV spreads to the CNS what is it known as
Herpesviral encephalitis (life threatening/HSV-1)
What is also known as thrush
Oral candidiasis
What is the occurrence of thrush in new borns
About 40%
What is the characteristic of oral candidiasis
Gray/white pseuodmembranes that can be scraped off
In what ways is oral candidiasis opportunistic
Decreases immune status, broad spectrum antibiotics, diabetes
How do physicians make diagnosis of the oral candidiasis
Leukoplakia, candidemia, oral CA
What are the two types of an oral proliferative lesion
Fibroma and pyogenic granuloma
Where is a fibroma most commonly found
Along the bite line
What is a characteristic of a fibroma
A nodular mass following chronic irritation
What is another name for a pyogenic granuloma
Pregnancy tumor
Why are pregnant women and children likely to get pyogenic granuloma
Hormonal factors, irritation, rapid growth
What are characteristicsof a pyogenic granuloma
Hemangioma on gingiva, red/purple
What is the treatment of a pyogenic granuloma
Remove irritant or excision
What is the difference between thrush and leukoplakia
Thrush can be scraped off, leukoplakia cannot
What are characteristics of leukoplakia
Raised white patch that can’t be scraped off due to epithelial hyperplasia/keratosis
Who is most likely to get leukoplakia
Males (2x) age 40-70 years
What are the risks of leukoplakia
Inflammation, tobacco, alcohol, candidiasis
How is leukoplakia diagnosed
Rule out cancer through biopsy, 25% are precancerous
If a leukoplakia is precancerous what kind is it
Squamos cell carcinoma
What is erythoroplakia
Red oral lesion with irregular borders
Who is most likely to get an erythroplakia
Males age 40-70
What increases risk of erythroplakia
Tobacco use, >50% transition into cancer
What type of cancer is about 2x more common among males
Oral cancer
What mutations are common in oral cancer
TP53 mutations from sites of dysplasia
Are multiple primary tumors common in squamos cell carcinomas
Yes
What is the prognosis of those with squamos cell carcinoma
Poor <50% long term survival, early detection best, pain/dysfunction = advanced stages
What are the risks of squamos cell carcinoma
Alcohol, tobacco, >30 years old, HPV-16
What are characteristics of oral squamos cell carcinomas
Raised firm lesion of white or red with irregular borders
What are the 2 most common places of oral squamos cell carcinoma
Ventral (inferior) tongue and floor of the mouth
Where is oral squamo cell carcinoma most likely to invade or metastasize
Cervical nodes
HPV associated oral squamos cell carcinoma is most likely located where
Base of tongue and tonsillar crypts
Where are primary salivary gland pathologies found
Rare but MC in parotid glands
What is indicated by dry mouth due to decreased saliva production
Xerostomia
What is an autoimmune attack on salivary AND lacrimal glands
Sjogren syndrome
What happens to the tongue from xerostomia
It can fissure and ulcerate creating risk for cadidiasis
What is sialadenitis
Inflammation and enlargement of salivary glands
What are two causes of sialadenitis
Viral and bacterial
Viral sialadenitis is mc caused from what
Mumps virus infection
What can viral sialadenitis create in adults
Pancreatitis and orchitis
What causes bacterial sialadenitis
MC staph. Aureus infection with dehydration being a risk
What is it called when saliva collects within tissue creating an inflamed cyst
Mucocele follows ductal obstruction
What is the liklihood of cancers ratio to salivary gland size
Smaller salivary glands tumors are less common but are greater cancer risk and vice versa for larger glands
Who is mostly impacted by salivary gland neoplasms
MC females 60-80 years old
What is the mc impacted gland from salviary gland neoplasms
Parotid
What is a pleomorphic adenoma
Mc a benign tummor that is painless and encapsulated
What is an invasive, affixed form of a parotid gland neoplasms that is aggressive
Carcinoma ex pleomorphic adenoma
What is Zenker’s diverticulum
Lower esophageal outpouching
What causes Zenker’s diverticulum and what does it affect
From increased pressure in the pharynx creating uncoordinated swallowing and cricopharyngeus muscle spasm
Why is halitosis associated with zenker’s diverticulum
A bolus accumulates within the lower esophageal outpouching
How is zenker’s diverticulum diagnosed
Through barium swallowing and video fluoroscopy
Which esophageal lesion is associated with atresia, tracheal fistula, stenosis that produces regurgitation
Mechanical esophageal lesion
Which esophagial lesion is produced from achalasia resulting in aperistalsis
Functional esophageal lesions
What happens in ectopia esophageal lesion
Mostly asymptomatic that is an ectopic gastric mucosa (inlet patch ) located in the upper 1/3
What does esophageal varices of esophageal lesions follow
Follows portal HTN
What is achalasia
Failure to relax due to functional esophageal obstruction
What are the 3 causes of achalasia
Incomplete LES relaxation, increased LES tone, esophageal aperistalsis
How is achalasia treated
Dialation or injection of botulinium toxin
Dilated esophagus from achalasia produces what
Dysphagia, regurgitation, “heart burn” producing weight loss sometimes
How is achalasia diagnosed
Barium swallowing producing “bird beak sign”
What is the most common type of achalasia
Primary that is due to loss of inhibitory innervation to LES (idiopathic)
What causes secondary achalasia
Co-morbidity impairing LES funx
What are common co-morbidities causing secondary achalasia
Chagas disease, diabetes, polio, inflammation near Auerbach’s plexus
What causes esophageal varices
Portal venous congestion producing portal HTN
What are 2 causes of portal venous congestion in esophageal varices
Blood in esophageal venous plexus making it dilated/tortuous, or cirrhosis from alcohol/flatworm
When are esophageal varices at risk for severe hemorrhage
When its asymptomatic
How does advanced cirrhosis affect the CNS
Liver failure produces toxins into CNS producing hepatic encephalopathy
What are 2 main symptoms of esophagitis
Odynophagia and dysphagia
What is GERD
Gastroesophageal reflux disease = idiopathic LES dysfunction
What is the most common cause of esophagitis
GERD
What is the MC GI complaint
GERD
What are some symptoms of GERD
Dysphagia, heartburn, “sour brash”
What are major risks of esophagitis
Obesity and increased gastric volume
What are some treatments/managements of GERD
Sleep at angle, weight loss, PPI, not laying down within 2 hours of eating, no carbonated drinks
What causes chemical esophagitis
Acute, pill induced, chemo, irradiation
Who is most likely impacted by infectious esophagitis
Debilitated and immunosupressed
When is infectious esophagitis most likely to hhappen
After an ulcer from microbes (fungal/viral)
What cases esophageal lacerations
Trauma from coughing or vomiting
What type of tear is most likely a part of esophageal laceration
Mallory weiss tear
Where is a longitudinal tear located at in a mallory weiss tear
Gastroesophageal jxn
Mallory weiss tear is associated with how many upper GI bleeds
50%
What is a hiatal hernia
Stomach protrudes to thorax widening esophageal hiatus
What are the characteristics of axial hiatal hernia
“Sliding” it is the MC and it is bell shaped
What are the characteristics of non axial hiatal hernia
“Rolling” and part of the stomach protrudes causing stragulation and obstruction
Who is mostly affected by hiatal hernia
70% are greater than 70 years old
What hiatal hernia is symptomatic
Non axial which mimics GERD causing possible perforation/hemorrhage
What is Barret esophagus
Metaplastic columnar epithelium replaces the stratified squamos epithelium after stomach acid damage
Where does barret esophagus take place
The distal esophagus
Who is most at risk for barrett esophagus
Caucasian males that are obese and 40-60 years old
What symptom of barret esophagus prompts an evaluation
GERD
What are some complications from barrett esophagus
Esophageal adenocarcinoma, ulcerations, strictures
How do you diagnose barrett esophagus
Esophagoscopy and biopsy under regular surveillance
How do you treat barrett esophagus
Stop irritants or meds (PPI’s, surgery)
What are the 3 types of esophageal tumors
Leiomyoma, adenocarcinoma, squamos cell carcinoma
Which esophageal tumor is MC in the US and which is MC worldwide
Adenocarcinoma = MC in US and squamos cell carcinoma = MC worldwide
What are the risks for an adenocarcinoma esophageal tumor
Similar to GERD
What is an adenocarcinoma esophageal tumor caused by
Esophageal metaplasia/dysplasia
Which esophageal tumor makes up 90% of all esophageal CA
Squamos cell carcinoma
What are indicators of an advanced adenocarcinoma
Obstruction = dysphagia/odynophagia
What are some symptoms of an advanced adenocarcinoma
Vomit, cachexia, fatigue
Which esophageal tumor has early lymphatic invasion and what is the prognosis
Adenocarcinoma, poor <25% at 5 years
How do you diagnose an adenocarcinoma
Esophagoscopy, endoscopy = if abnormal image shown then biopsy taken
What are 3 characteristics of a diffuse infiltration of an esophageal adenocarcinoma
Flat/raised, exophytic, ulceration
Who is most at risk for a squamos cell carcinoma esophageal tumor
African american males older than 45 years with alcoholism, HPV, or taking nitrosamines
Where is squamos cell carcinoma going to be impacting most, geographically
Rural
Why do those with squamos cell carcinoma (esophageal) have a poor prognosis <10% at 5 years
Due to lymphatic mets
What does a cardio-pulmonary invasion with an esophageal squamos cell carcinoma cause
Possible fistula
What can also result from a squamos cell carcinoma (esophageal)
Strictures, hemorrhage
Mucosal ulcerations can produce hemorrhages producing what
Hematemesis and melena
What is the cause of the most common infection of the stomach
Helicobacter pylori
What is an inflammation of gastric mucosa
Gastritis
What are the 2 forms of the gastric inflammatory diseases
Acute and chronic gastritis
Are neutrophils associated with acute or chronic gastritis
Acute gastritis
What can cause the acute erosive hemorrhagic gastritis
Hemorrhage that is from possible erosion/ulceration
Acute gastritis is dose dependent with what
Nsaids
What meds are associated with acute gastritis
PPI’s, H2 receptor antagonists = decrease gastric acidity
Hematemsis with acute gastritis is associated with who
Alcoholics
Acute peptic ulcerations can cause what type of hemorrhage
Hematemesis
What are 3 causes of acute peptic ulceration
- Severe physiological stress
- High dose of NSAIDS
- Intracranial disease(vagal nerve)
What is rare with chronic gastritis
Hematemesis
What are the multifactorial causes of chronic gastritis
- helibacter pylori
- increased age
- other stressors
What can follow chronic gastritis
- peptic ulcer disease
- gastric adenocarcinoma
What are the risks of chronic gastritis
Poor childhood sanitation/hygeine
Dysplasia/metaplasia from chronic gastritis produces what
Carcinogenic = gastric adenocarcinoma, MALT lymphoma
Who is most commonly affected by autoimmune gastritis
Elderly about 60 years old
What antibodies are released from autoimmune gastritis
Parietal cells and I.F.
Why does autoimmune gastritis complicate erythropoiesis
Pernicious anemia
What are two identifiers of peptic ulcer disease
Pin point pain (granulation tissue), and hemorrhage
Where doe peptic ulcer disease affect
Proximal duodenum(4x) and gastric antrum
Who is more at risk from peptic ulcer disease
Males
What factors contribute to peptic ulcer disease
Increase acidity (ulcerogenic), nsaids (decrease gastric protection), h. Pylori
Why can peptic ulcer disease be a medical emergency
Possible perforation/hemorrhage
What is a major symptom of peptic ulcer disease
Epigastric pain 1-3 hours postprandial
Which type of peptic ulcer disease is releived postprandial and which type worsens postprandial
Duodenal = releif, gastric= worse
What are 3 types of gastric polyps and which is MC
Inflammatory and hyperplastic polyps (MC), fundic gland polyp, gastric adenomas
Who is most commonly afffected by a gastric adenoma
Males age 50-60
What is associated with 90% of all stomach cancers
Gastric adenocarcinomas
Who mostly gets gastric adenocarcinomas
Males age 55
Males from which country are more likley to get gastric adenocarcinomas
Japan
What is pyloric stenosis
Hypertrophy/narrowing of pyloric sphincter
What is a characteristic of pyloric stenosis in newborns
Non bile stained projectile vomiting
Who is most likely to get pyloric stenosis
White males, turner syndrome
What treatment is associated with pyloric stenosis
Pyloromyotomy
Intestinal obstructions are most commonly found where
In SI
What is an abdominal wall defect allowing the intestine to protrude =inflammation
Hernia
What is an intestinal obstruction with adherent segments
Adhesions producing inflammation = fibrosis
What is a proximal segment telescoping into a distal segment
Intussusception
What is a twisting loop of bowel
Volvulus, possible infarction
What is a congenital outpouching of the SI
Meckel diverticulum
What is a lack of neurologic ganglia in the rectum
Hirschsprung disease
What causes hirschsprung disease
Defective neural crest cell migration
Who is impacted more by hirschsprung disease
Females
What arteries are impacted by ishemic bowel disease
Superior mesenteric, inferior mesenteric, celiac
Ischemia in ischemic bowel disease causes what
Hypotension/occlusion, mucosal infarction
What are 3 types of ischemic bowel disease
Thrombosis, arterial embolism, non occlusive ischemia
What are characteristics of chronic ischemic bowel disease
Episodic bloody diarrhea mimicking IBD
What are characteristics of actue ischemic bowel disease
Abdominal pain, frank blood in stool, risk for septic shock = 50% mortality rate
What is angiodysplasi
Vascular lesion
Where are angiodysplasias commonly found
MC in cecum, or ascending colon
What are angiodysplasias hypothesized to develop following what
Mechanical stress (constipation)
What are the two types of hemorrhoids
Internal = above anorectal line, external = below anorectal line
When hemorrhoids irritates surrounding tissues what happens
Perianal itching, frank blood in stool
What are the top 3 malabsorption diseases in the US
Celiac, crohn, pancreatic insufficiency
What is excessive fat in feces called
Steatorrhea
What is bloody diarrhea
Dysentery
What is celiac disease
Immune mediated reaction to gliadin
What produces villous atrophy and what disease is it associated with
B and t cells damaged within celiac disease
Where does celiac disease impact
Duodenum and jejunum
What is dermatitis herpetiformis
Celiac disease manifesting on the skin
What disease is associated with cycles of mucosal injury, malnutrition, inflammm.
Environmental enteropathy
Autoimmune environmental enteropathy involves what
Villus flattenin
When is lactos intolerance acquired
In young adulthood MC
What is an indication of traveler’s disease
> 3 unformed or loose stools within 24 hours
What is the mc bacterial enteric pathogen in the US
Campylobacter jejuni
Campylobacter jejuni may initiate what
Reactive arthritis
How long does acute self limited colitis last
<1 month
What is pseudomembranous colitis
Antibiotics disrupts flora (antibiotic associated colitis)
What causes pseudomembranous colitis
Clostridium difficile overgrows = enterotoxins= inflammation/cell death
Who is most susceptible to pseudomembranous colitis
Old age, hospitilization, decreased immunity
What are psuedomembranes
Cellular debris and leukocytes
What is viral gastroenteritis
Infection that leads to superficial injury to the stomach/SI
1/2 of all gastroenteritis is associated with what
Viral gastroenteritis
What causes viral gastrroenteritis in children
Rotavirus
What causes viral gastroenteritis in adults
Norovirus
How does one get viral gastroenteritis
Direct viral contact via contaminated food/H2O
What is treatment for viral gastroenteritis
Self limiting, fluid replacement
What type of parasitic disease affect greater than 1/2 the world
Ascaris lumbricoides
What is a flagellated protozoa that resists cold and chlorine
Giardia lamblia
What is giardia lamblias affect on the body
Its non-invasive and alters the SI enzymes
What is another name for giardiasis
Beaver fever
What is giardiasis
Malabsorption = diarrhea, anorexia, cramps
What is sigmoid diverticulitis
Acquired diverticulum usually within the sigmoid colon
What increases risk of sigmoid diverticulitis
Age and refined foods, decreased fiber = increase strain/pressure
What is another possible cause of sigmoid diverticulitis
Possible infection = perforation = hemorrhage
Who is most susceptible to sigmoid diverticulitis
50% of people > 60
What is the sensation of inadequate BM and what is it usually associated with
Tenesmus with sigmoid diverticulitis
What are main treatments for sigmoid diverticulitis
Increased fiber = decresed exaggerated peristalsis= reduce intraluminal pressure
When does irritable bowel syndrome usually occur
Mc females 20-40 years old, psychological stress
What is inflammatory bowel disease
Abnormal GI immune response = chronic/relapsing
What are the 2 types of inflammatory bowel disease
Crohn disease and ulcerative colitis
Where does crohns disease affect
Entire GI, MC in ileum
Where does ulcerative colitis usually affect
Rectum/distal colon within the mucosa/submucosa
What is the body’s reaction during inflammatory bowel disease
Microbiota, epithelial dysfunction, aberrant immune response
What happens in crohns disease
Regional inflammation/fissures/ creeping fat
What type of mediated reaction is with crohns disease
T cell mediated
What does crohns disease open up the GI up to
Risk for adenocarcinoma
What is ulcerative colitis
Superficial inflammation = mucosal ulcerations
Where does ulcerative colitis start
Always begins in rectum to proximally
Who is most likley to get ulcerative colitis
20-25 years old
What is inhibitory to ulcerative colitis
Smoking
What is ulcerative colitis associated with
Toxic megacolon = polyarthritis, AS, eye irritation
What do relapsing episodes of ulcerative colitis look like
Stool is grossly bloody/mucoid
What can ulcerative colitis lead to
Adenocarcinoma
What is an autosomal dominant cancer syndrome
Familial adenomatous polyposis
What does familial adenomatous polyposis affect
APC gene on chromosome 5
How many people develop cancer from familial adenomatous polyposis
100% mc before age 30
What is common in the stool. Of those with familial adenomatous polyposis
Occult blood with possible anemia
How is familial adenomatous polyposis diagnosed
> 100 adenomas
What is lynch syndrome
Hereditary cancer syndrome
How does one get lynch syndrome
Inherited mutations alter DNA mismatch repair
What is the most common type of tumor of the colon
Adenocarcinomas next is carcinoid tumors
What is the mc malignancy of the GI tract
Colorectal adenocarcinoma
Who is mc affected with colorectal adenocarcinoma
Ages 50-70 males in developed nations with highly processed diets
What dietary risks are associated with colorectal adenocarcinomas
Low fiber=low stool bulk, low antioxidants, high fat/carbs,
Where is colorectal adenocarcinoma mc mets to
Liver
What are the two types of small intestine tumors
1/2=adenocarcinomas, 1/2=carcinoids
Where are most of the tumors of the SI
Duodenum
What is the mc cause of acute abdomen
Acute appendicitis
How does early compare to late acute appendicitis
Early=periumbilical/epigastric discomfort
Late=RLQ tender/deep constant pain progress to sharp
Who is mc affected by acute appendicitis
Male adolescents
What is a common cause of acute appendicitis
Obstruction = ischemia = inflammation
If acute appendicitis results in a rupture what happens
High morbidity/mortality or sepsis
What is the mc tumor of the appendix
Carcinoid possible site for mucocele
