GIT - oral cavity

Question 1

diseases of oral cavity (3)

Answer 1

• inflammations - HSV, HFMD, candida
• oral ulcers
• neoplasms: leukoplakia, squamous cell neoplasm

Question 2

causes of mouth ulcers

- list 3

Answer 2

• trauma
• recurrent aphthous ulcers
• infection: HSV, candidiasis, HFMD
• blood disorders
• GIT disorders
• mucocutaneous
• cytotoxic chemotherapy
• neoplasms

Question 3

aphthous ulcers

• what is it
• age group it affects

Answer 3

superficial ulceration of oral mucosa
recurrent
most common <20yrs
resolves by itself

Question 4

leukoplakia (neoplasm)

- what is it (colour)

Answer 4

white patch/plaque - thickened keratotic hyperplastic mucosa
- cannot be scrapped off
5-25% precancerous

Question 5

erythroplakia (neoplasm)
colour
complication

Answer 5

red area in the mouth

high risk of malignant transformation

Question 6

differential diagnosis of white plaque like leokoplakia

Answer 6

• candidiasis

- lichen planus: chronic inflammation - sores can be white/red, burning pain

Question 7

tumours of oral cavity (oropharynx) (5 cell types affected)

Answer 7

• squamous epithelium
• glandular epithelium
• soft tissue
• melanogenic system (melanocytes)
• unclassified

Question 8

neoplasm arising from squamous epithelium

Answer 8

squamous cell papilloma
HPV neg SCC
HPV pos SCC

Question 9

squamous epithelium papilloma

• cause
• gross and microscopic appearance

Answer 9

most common benign epithelial neoplasm
may have HPV
- exophytic, warty, cauliflower looking lesions
- micro: papillary projections of fibrovascular core on ss epithelium

Question 10

HPV neg SCC
affects what age range
which part does it affect
association
complications

Answer 10

males (50-70)
most common on the lips - gum - tongue
associated w/ leukoplakia w/ dysplasia
well-differentiated and keratinising  
local infiltration/ metastasis to neck lymph nodes

Question 11

HPV pos SCC
affects who more
risk factor
prognosis?

Answer 11

better prognosis that HPV neg SCC
risk factor: oral sexual contact
young Caucasians w/ high socioeconomic status

Question 12

salivary gland diseases

Answer 12

• inflammation - mumps, s.aureus, s.viridans, SJS (autoimmune)
• sialolithiasis (salivary gland stones)
• neoplasms

Question 13

salivary gland neoplasms

• examples of benign and malignant
• which gland is most commonly affected

Answer 13

parotid gland most commonly affected > submandibular

most neoplasms in salivary gland are benign

• pleomorphic adenoma (most common)**
• warthin tumour

malignant tumours:

• mucoepidermoid carcinoma
• adenocarcinoma

smaller tumours are likely to be more malignant

Question 14

pleomorphic adenoma

• most likely to affect what area
• characteristics
• removal
• malignancy
• 2 components

Answer 14

benign
most common in parotid
painless, slow-growing 
prone to recurrence - no true capsule, need to remove entire tumour 
but unlikely to turn malignant 

• epithelial component
• myoepithelial: cartiligenous - micro: produce lobules of cartilage

Question 15

Warthin tumor

• who it affects
• where it affects
• macroscopic and microscopic tumours

Answer 15

benign
super common in SG: 2nd
happens in parotid gland
males (50-70yrs)

macro: oval, round encapsulated mass
micro: double-layer of epithelial cells, dense lymphoid stoma w/ germinal centres

Question 16

esophagus diseases (5)

Answer 16

• congenital: atresia (the esophagus got blocked midway), tracheo-esophageal fistula
• motor dysfunction: achalasia (lower esophagus cannot open during swallowing), hiatus hernia
• esophageal varices
• esophagitis
• neoplasm

Question 17

esophageal varices cause

Answer 17

portal HTN (high BP in portal vein) -> buildup of blood near esophagus -> cause the vessels to dilate

Question 18

hiatus hernia
cause
+ complications (4)

Answer 18

reflux esophagitis (heartburn)
caused by weakness in the diaphragm -> herniation through when stomach pushes upwards

effects:

• peptic ulceration
• dysphagia (cannot swallow), caused by sclerosis and stricture of the esophagus
• columnar metaplasia = Barrett esophagus - cause of gastric reflux -> damage the epithelium, esophagus undergoes change in epithelium (stratified squamous -> simple columnar)
• dysplasia: adenocarcinoma

Question 19

esophagitis causes (4)

Answer 19

• reflux: GERD** (gastroesophageal reflux disease) & barrett esophagus
• infection: HSV, CMV, candida, bacteria, parasites
  travelled downwards from oral infection
• drugs/toxins
• cytotoxic chemotherapy/ radiation

Question 20

GERD (gastroesophageal reflux disease)

• what increases risk of getting GERD
• clinical presentation
• characteristics: macro + micro (4)

Answer 20

most common cause of esophagitis
caused by: lower esophageal sphincter unable to close completely -> allows gastric acid to go up the esophagus -> epithelial wall secrete inflammatory cells

• age, BMI, tobacco increases risk
• more prevalent in the west

clinical presentation: heartburn, acid regurg, sore throat, cough

characteristics:
- erosions, strictures
- micro: basal zone hyperplasia, 
inflammatory cells (lymphocytes, eosinophils), 
elongated lamina propia papillae,
polymorphs

Question 21

barrett esophagus

• characteristics
• effects
• diagnosis

Answer 21

squamous -> columnar epithelium
w/ red mucosa
causes ulceration/ bleeding/ stricture/ dysplasia
may form adenocarcinoma

diagnosis: columnar epithelium above GE junction
intestinal metaplasia - goblet cells in esophagus

Question 22

neoplasms in esophagus (3)

Answer 22

• SCC
• adenocarcinoma
• leiomyoma

Question 23

SCC in esophagus

• age group it affects
• risk factors

Answer 23

affects older male group

increased risk w/ alcohol, tobacco, nitrites, nitrosamines, poverty, achalasia

Question 24

SCC in esophagus

• invasive?
• which part does it affect

Answer 24

invasive

more common affecting middle 1/3 of esophagus - mediastinal group