Nick Newman Flashcards
What is the free radical theory of ageing
Free radicals interact with cellular proteins and change there structure leading to loss of function or cell death, free radical damage accumulated throughout life and contributes to ageing through errors in protein synthesis and mitochondrial ageing
How does cellular senescence contribute to ageing and what is hayflicks limit
How does telomere shortening contribute to ageing
How do genetic factors contribute to ageing
Cellular senescence- stable cell arrest in which cells become resistant to growth promoting stimuli in response to DNA damage
Hayflicks limit= normal human cells can only divide 40-60 times before programmed cell death or apoptosis
Telomeres shorten every time a cell divides causing cell to gradually loose function and mitotic ability
Some disorders cause or delay ageing such as progeria
What is xerostomia
Who does it most commonly affect
Symptoms and clinical features (6)
Xerostomia unstimulated saliva flow rate (vs normal)
Xerostomia stimulated saliva flow rate (vs normal)
Xerostomia is dry mouth with saliva that is sparse, springy or frothy, commonly affecting the elderly due to disease and medication
Difficulty eating or speaking, unpleasant taste, caries (root caries), candidosis, loss of denture retention, low saliva flow rate
Unstimulated: below 0.1ml/min (normal 0.3-0.5)
Stimulated: below 0.5ml/min (normal 1-3)
What is ptyalism
Condition causing over production of saliva, it is not usually an issue as excess saliva swallowed
What are salivary calculi Who / where does it usually affect Cause Symptoms (2) Treatment (small vs large)
Formation of mineralised stone in salivary gland or duct
Affects adults, males more often, 80% SM gland
Caused by calcium and magnesium phosphates depositing around nidus and forming mineralised mass
-Mealtime syndrome
-persistant obstruction leads to infection, fibrosis and swelling of gland
Small stones- may be manipulated out of duct
Large stones- lithotripsy or surgical removal under LA
What is a mucocele
Types (mucous extravasion, mucous retention cyst, ranula)
Treatment
Cavity filled with mucous
Mucous extravasion: most common mucocele, trauma causes collection of superficial saliva, found in minor salivary glands of lower lip of children and young adults
Mucous retention cyst: less common mucocele, salivary ducts dilate following obstruction forming epithelial lined mucocele, major or minor glands
Ranula: uncommon mucocele arising on FOM from SL gland
Treatment- untreated mucoceles rupture, if not can be excised with underlying gland
What is sjogrens syndrome
Who does it usually affect
Cause
Symptoms (3)
An autoimmune connective tissue disorder affecting exocrine glands particularly salivary and lacrimal glands
Usually affects middle age women- F:M - 9:1, rheumatoid arthritis patients, lupus erythermatosus patients
Unknown cause but genetic predisposition- causes lymphocytes to infiltrate glands and cluster around ducts and gradually replace acinar cells
Dry mouth/eyes, xerostomia, predisposition to infection
What are the types of sjogrens syndrome (primary, secondary)
Clinical features and radiography (4)
Treatment
Primary- causes dry mouth and eyes not associated with any connective tissue disease
Secondary- dry mouth and eyes associated with rh arthritis or other CT disease
.Oral mucosa- dry, red, shiny, parchment like
.Tongue- red, cobblestone, atrophy of papilla
.Candida common
.Radiographic snowstorm appearance
Reassurance, water sips, saliva substitute, OHI, diet advice, fluoride
What is suppurative sialadenitis
Who / where does it usually affect
Bacteria (3)
Treatment
Inflammation of salivary gland due to infection with suppuration causing pain and swelling
Debilitated patients with xerostomia or sjogrens - usually parotid
Staph aureus, streptococci, oral anaerobes
Antibiotics
What is mumps
Cause
Symptoms (5)
Infection usually seen in children causing painful swelling in parotid gland
Rubulavirus (paramyxovirus)
Headache, malaise, fever, swelling of parotid, stensons duct red and enlarged
How does radiotherapy damage the salivary glands (2)
Radiation damages stem cells in ductal system of glands
Radiation causes damage to blood vessels supplying glands leading to fibrosis
What are the benign salivary gland tumours (2)
What are the malignant salivary gland tumours (4)
What are the tumour like conditions of salivary glands (2)
Pleomorphic adenoma
Warthins tumour
Mucoepidermoid carcinoma (G3)
Polymorphous adenocarcinoma
Adenoid cystic carcinoma
Acinic cell carcinoma
Sialosis
Acute necrotising sialometaplasia
What is pleomorphic adenoma
Who does it usually affect
Histology (4)
Clinical features (3)
Treatment
Benign salivary tumour characterised by broad range of tissue types including epithelial and CT, most common salivary tumour
Middle age, more often females
- disorganised arrangement of tissues
- capsule that is rarely complete
- ducts
- sheets and strands of epithelial cells
Accounts for 75% parotid tumours, slow growing rubbery firm non painful swelling, overlying skin mobile
Treatment- wide excision
What is warthins tumour
Who and where does it usually affect
Second most common salivary tumour, it is a benign cystic tumour containing epithelial and lymphoid tissue
40+ years, smokers, usually parotid
What is mucoepidermoid carcinoma G3
Histology (2)
Clinical features (3)
Treatment
Most common malignant salivary tumour, a tumour containing mucin filled cysts
Contains numerous cysts lined by epithelium
Variable numbers of mucus secreting goblet cells
- half arise in parotid
- slow growing tumour that infiltrates into surrounding tissues
- differential diagnosis mucocele
Treatment - wide excision
