Non-neoplastic Salivary Gland Pathology

Question 1

4 causes of non-neoplastic salivary pathology

Answer 1

• Trauma
• Blockae
• Infection
• Autoimmune

Question 2

Tx for mumps

Answer 2

Palliative - analgesic, soft diet and fluids

Resolves in 2 weeks

Vaccinate!

Question 3

What usually causes acute sialadenitis

Answer 3

Most result from ductal obstruction/decreased salivary flow, allowing retrograde spread of bacteria

Question 4

Chronic systemic autoimmune disorder that principally involves the exocrine glands

Answer 4

Sjogrens syndrome

Question 5

What is secondary Sjogrens (Sicca syndrome)

Answer 5

Sjogresn plus another associated autoimmune disease

Question 6

What two molecules have been found to be associated with Sjogrens which indicates autoimmune

Answer 6

RF, ANA

Question 7

What two autoimmune diseases are closely associated with Sjogresn

Answer 7

RA

SLE

Question 8

List 7 symptoms of Sjogrens Syndrome

Answer 8

• Reduced saliva
• Mouth soreness
• Difficulty chewing/swallowing
• Abnormal taste
• Difficulty in speech
• Difficulty in controlling dentures
• Caries

Question 9

How is Sjogrens syndrome diagnosed

Answer 9

Labial gland biopsy

Question 10

Management of Sjogrens Syndrome

Answer 10

• Exclude candida
• Encourage OH
• Fluoride
• Mouthwash
• Salivary stimulants and replacements

Question 12

Composition of saliva:

Answer 12

• Electrolytes (Calcium, sodium, potassium, fluoride)
• Ig
• Small organic molecules (urea, amino acids, glucose)

Question 13

What is the pH of the saliva

Answer 13

6-7

Question 14

Functions of saliva:

Answer 14

• Protection
• Buffering
• Antimicrobial
• Digestion
• Taste

Question 15

Daily saliva flow rate-

Answer 15

500-600ml/day

Question 16

If you ordered a blood test for CRP levels, what conditions would you be looking to exclude

Answer 16

Sjogrens

Sarcoidosis

Question 17

If you ordered a blood test for sACE levels, what condition would you be looking to exclude

Answer 17

Sarcoidosis

Question 18

Is you ordered a blood test to check for serum calcium and phosphate levels, what would you be looking to exclude?

Answer 18

Hyperparathyroidism (can cause dry mouth)

Question 19

Systemic conditions which can cause dry mouth:

Answer 19

• Sjogrens Syndrome
• Sarcoidosis
• Diabetes
• Hyperparathyroidism

Question 20

Example of salivary gland developmental disorder

Answer 20

Hypoplasia

Question 21

Example of tumour like lesion of the salivary gland:

Answer 21

Sialadenosis

Question 22

What is this?

Answer 22

Adenomatoid hyperplasia

Rare. Usually males. Usually major glands, usually 6th decade of life.

Question 23

Systemic condition known to cause Sialolithiasis

Answer 23

Gout

Question 24

MAnagement of sialolithiasis

Answer 24

• Surgical
• Shock wave
• Milk out
• Endoscopy
• Guided basket retrieval

Question 25

Acute condition usually secondary to localised or systemic cause of reduced salivary flow.

Answer 25

Acute Ascending Sialadenitis

Question 26

Management of Acute Ascending Sialadenitis:

Answer 26

Flucloxacillin or Clindamycin

Question 27

Signs and Symptoms of Acute Ascending Sialadenitits

Answer 27

* Sudden onset * Reduced salivary flow * Gland painful, swollen, tender to touch * Purulent discharge from duct orifice * Erythematous overlying skin * Fever

Question 28

Chronic condition caused by recurrent bacterial infection or non-infectious conditions such as radiotherapy, autoimmune disease or stones. Characterised by low grade tenderness and minor degree swelling.

Answer 28

Chronic Sialadenitis

Question 29

How does Sarcoidosis present in the salivary glands?

Answer 29

Enlargement and Xerostomia.

Question 30

Common symptoms of Sarcoidosis

Answer 30

* Dyspnoea * Dry cough * Chest pain * Fever * Malaise * Fatigue * Weight loss

Question 31

What % of Sarcoidosis have abnormal chest x-ray

Answer 31

90%

Question 32

List causes of Xerostomia

Answer 32

* Drugs * Radiation * Dehydration * Severe DM * Sarcoidosis * Psychogenic * Graft vs Host Disease * Hyperparathyroidism * Amyloidosis * Sjogrens Disease * Cholinergic dysfunction

Question 33

Painless, non-inflammatory, non neoplastic swelling of the salivary glands. Aetiology not well understood but associated with alcohol abuse, cirrhosis, diabetes, anorexia, bulimia and drugs.

Answer 33

Sialosis

Question 34

Clinical features of Xerostomia

Answer 34

* Halitosis * Dental caries * Candidosis * Ascending sialadentitis * Difficulty swallowing dry foods * Poor retention of dentures

Question 35

Diagnosis of Xerostomia

Answer 35

* Basis of history and exam * Blood tests * Salivary flow rate * Biopsy * Sialography

Question 36

Management of dry mouth:

Answer 36

* Fluoride therapies, regular dential check up (preventive) * Mouthwashes, gels * Gums, pilocarpine

Question 37

Overactivity of what cell leads to abnormal apoptosis in Sjogrens

Answer 37

B cells