Mouth, Salivary, Esophagus Flashcards
What causes parotid gland swelling?
The classic cause is mumps. The best treatment for mumps and the complication of infertility is prevention through immunization. Parotid gland swelling may also be due to a neoplasm, of which pleomorphic adenoma is the most common type; Sjögren syndrome; sialolithiasis (a stone in the parotid duct); sarcoidosis; or bulimia. Alcoholism can cause parotid gland hypertrophy as well. Remember too that the parotid gland contains lymph nodes within its parenchyma (unique in this regard), which can become enlarged in a number of conditions, as with lymph nodes elsewhere.
Define stomatitis. What does it suggest?
Stomatitis is an inflammation of the mucous membranes of the mouth. The classic finding is fissuring of the corners of the mouth (angular stomatitis). Watch for deficiencies of B-complex vitamins (riboflavin, niacin, pyridoxine) or vitamin C.
What factors increase the risk of oral cancers? Describe the typical appearance.
Smoking or chewing tobacco and alcohol consumption are the main risk factors for oral cancer; their effects are synergistic. Also look for poor oral hygiene. Lesions often begin as leukoplakia (white patch) or malakoplakia (red patch). Oral hairy leukoplakia can resemble leukoplakia somewhat but is an unrelated condition affecting HIV-positive patients and is associated with the Epstein-Barr virus. The clinical setting should help you distinguish the two.
What are the common causes of a neck mass in children?
In children, watch for thyroglossal duct cysts, which have a midline location and elevate with tongue protrusion; branchial cleft cysts, which are lateral in location and often become infected; cystic hygroma, a benign tumor also known as lymphangioma that is associated with Turner syndrome and treated with surgical resection; and cervical lymphadenitis. Cervical lymphadenitis is usually due to streptococcal pharyngitis, Epstein-Barr virus (common in the second and third decades), cat-scratch disease, or mycobacterial infection (scrofula). In terms of malignancy in children, cervical lymphadenopathy may be present in cases of leukemia or lymphoma. In adults, suspect malignancy, either lymphadenopathy from a primary tumor (lymphoma) or a metastatic neoplasm (usually squamous cell carcinoma). The mass may also represent the tumor itself (especially with thyroid cancer).
In adults, What are the common causes of a neck mass?
In adults, suspect malignancy, either lymphadenopathy from a primary tumor (lymphoma) or a metastatic neoplasm (usually squamous cell carcinoma). The mass may also represent the tumor itself (especially with thyroid cancer).
How are bleeding esophageal varices treated?
First, think of the ABCs (airway, breathing, and circulation). Stabilize the patient with intravenous fluids and blood if needed. If indicated, correct any clotting factor deficiencies with fresh frozen plasma, fresh blood, and vitamin K. Give octreotide to cause splanchnic vasoconstriction and decrease bleeding. Give prophylactic antibiotics (oral norfloxacin, IV ciprofloxacin, or IV ceftriaxone) before endoscopy. Endoscopy of the upper gastrointestinal (GI) tract is performed to determine the cause of the upper GI tract bleed (there are many possibilities in an alcoholic). Once varices are identified on endoscopy, sclerotherapy of the veins is attempted with cauterization, banding, or vasopressin administration.
Describe the workup for an unknown cancer in the neck.
The workup includes random biopsy of the nasopharynx, palatine tonsils, and base of the tongue, as well as laryngoscopy, bronchoscopy, and esophagoscopy (with biopsies of any suspicious lesions). This approach is known as triple endoscopy with triple biopsy.
