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Study Notes - Gastroenterology > *Oral conditions (lecture 1) > Flashcards

*Oral conditions (lecture 1) Flashcards

1
Q

Where are the lingual tonsils located?

A

At the postural lateral side of the tongue (key site where oral cancer can present)

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2
Q

What is the torus mandibularis?

A

A bony growth in the mandible along the surface nearest to the tongue

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3
Q

What is anaemia?

A

A decrease in the amount of red blood cells

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4
Q

What is a haematinic?

A

A hematinic is a nutrient required for the formation of blood cells in the process of hematopoiesis. The main hematinics are iron, B12, and folate

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5
Q

How can anaemia/ haematinic deficiencies present in the oral cavity?

A

Angular chelitis

Recurrent oral ulceration

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6
Q

What is angular chelitis?

What causes it?

A

Cracking at the side of the mouth that may extend around the lips (painful and can crack and bleed)
Caused by candida, staph coccus, strep cocci or staple aureus infection (can be a combination of these)
It is therefore an infection however a haematinic deficiency is a predisposing factor

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7
Q

What are the most common type of recurrent mouth ulcers?

A

Aphthous stomatitis (ulceration)

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8
Q

What are the 3 different types of aphthous ulcers?

A

Minor (most common) = small (less than 10mm across), pale yellow with a red swollen area around them, usually come in about groups of 5 and disappear in 7-10 days without leaving a scar
Major = usually 10mm or larger across, get one or 2 at a time, lasts from weeks to months and leaves a scar, can be very painful
Herpetiform = tiny pin-head size ulcers, get multiple at the one time and some may join together, lasts a week to 2 months, usually very painful

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9
Q

When should mouth ulcers be investigated further?

A

When they suddenly start or if they become a lot worse than normal

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10
Q

What are 3 examples of GI diseases that manifest with recurrent oral ulceration?

A

Crohns
UC
Coeliac

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11
Q

Is Crohns or UC granulomatous?

A

Crohns

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12
Q

Symptoms/ signs of oral Crohns disease? (4)

A

Oral ulceration
Lip swelling (usually fluctuates initially, swelling is soft and not painful usually, swelling can lead to cracking)
Gingivitis
Cobble-stoning

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13
Q

Oral manifestation of type II diabetes?

A

Acute pseudomembranous candidiasis - candida yeast infection in the mouth - thrush (yeast feeds on high levels of salvia sugar) - also caused by anything that lowers your immune system

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14
Q

What is an adverse side effect of nicorandil (used to treat angina)?

A

Oral ulceration - patient can be taking the drugs for many years before they develop a problem (patients should stop the drug as soon as they develop ulcers if got them in mouth, likely to have them somewhere else)

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15
Q

What is an adverse side effect of ACEI?

A

Mouth ulcers

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16
Q

What side effect in the mouth do NSAIDs have?

A

Can cause recurrent mouth ulcers

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17
Q

What oral symptom do many drugs have?

A

A dry mouth (mainly anti-muscarinic medications)

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18
Q

What is lichen planus?

A

A non-infectious rash that affects many areas of the body e.g. oral mucosa, skin, scalp, nails, genitals

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19
Q

Is lichen Planus related to cancer?

A

Yes, it is a potentially malignant condition

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20
Q

Where does lichen plans most commonly affect?

A

The tongue and buccal mucosae

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21
Q

Symptoms of oral lichen planus?

A

Sometimes asymptomatic, can cause sensitivity to sour/ spicy food, can cause atrophy of the oral mucosae and blister and white plaques
If erosive lichen planus, it can cause painful ulcers to develop

22
Q

What is a cause of lichen planus?

A

Usually unknown cause but can be due to a type 4 hypersensitivity reaction to the likes of dental filling materials

23
Q

What is another name for mucous membrane pemphigoid?

What is it?

A

Cicatricial pemphigoid
Rare condition that causes blisters and vesicles to form in mucosal membrane (most commonly the eyes and mouth) leading to ulcer formation

24
Q

What is an autoimmune disorder which can cause a severe dry mouth?

A

Sjogren’s syndrome

25
Q

What are the 2 different types of Sjogrens syndrome?

A

primary – when the syndrome develops by itself and not as the result of another condition
secondary – when the syndrome develops in combination with another autoimmune disorder, such as lupus or rheumatoid arthritis

26
Q

What are the symptoms of Sjogren’s syndrome?

A

Dry mouth and/ or eyes

27
Q

What are 3 signs of a dry mouth?

A

Very sticky oral mucosa
Shiny appearance
Increased tooth decay

28
Q

What are the 3 ways in which HIV/ AIDs can manifest in the mouth?

A

Hairy leukoplakia
Kaposi’s sarcoma
Candiditis (usually chronic)

29
Q

What is Kapok’s sarcoma?

A

A type of cancer that forms from the cells lining the blood vessels or lymph vessels (most common develops in a patient with HIV/ AIDs)

30
Q

What is oral leukoplakia?

A

An oral mucosal white patch that will not rub off and is not attribute to any other disease - it is pre-malignant (e.g. not candidiases, oral lichen planus, etc.)

31
Q

What is oral hairy leukoplakia?

A

A shaggy white patch on the side of the tongue seen in HIV patients cased by EBV (not pre-malignant)

32
Q

What are the risk factors for leukoplakia formation?

A

Alcohol
Smoking
(repeated candidiasis is also a cause)

33
Q

What is the annual rate of transformation of leukoplakia into squamous cell carcinoma?

A

1.36%

34
Q

Is leukoplakia painful?

A

not normally

35
Q

What is the most common site for leukoplakia formation?

A

The buccal mucosa (the floor of the mouth is the highest risk site)

36
Q

What feature of leukoplakia should make you more concerned?

A

Speckled to a homologous white patch

37
Q

What are the main risk factors for leukoplakia malignant transformation?

A 
Female gender
long duration
non-homogenous appearance
on the tongue/ floor of mouth
greater than 200mm size
presence of dysplasia
38
Q

Diagnosis of leukoplakia?

A

Careful clinical examination
Exclude other disorders or causes
Refer to dentist and if they are not registered refer to oral medicine or maxofacial surgeons

May me biopsied

39
Q

Management of leukoplakia?

A

If at an increased risk of mouth cancer, it cane removed
If not it is carefully monitored
Appropriate counselling regarding smoking cessation and alcohol moderation is also given

40
Q

What is erythroplakia?

A

a fiery red patch that cannot be characterized either clinically or pathologically as any other definable lesion

41
Q

What is sub-mucous fibrosis?

A

A condition where patients develop fibrous bands in the mouth
Associated with ereca nut

42
Q

What are the most common potentially malignant conditions of the oral cavity?

A 
leukoplakia
Lichen planus
Erythroplakia
Platal lesions in reverse smokers
Chronic candidiasis
Sub-mucous fibrosis
Actinic keratosis
43
Q

What are common benign epithelial tumours of the oral cavity?
What causes these?
Are they are risk of malignant transformation?

A

Squamous cell papillomas
HPV
No

44
Q

What type of cancer are most oral malignancies?

A

Squamous cell carcinoma

45
Q

Where are the high risk sites for oral cancer?

A

Floor of the mouth and ventral and lateral aspects of the tongue

46
Q

How does cancer of the lower lip typically present?

A

Non-healing ulcer or small lump

47
Q

What type of cancer do patients tend to get on their lip?

A

Squamous cell carcinoma

48
Q

What is the most frequent aetiological cause of lip cancer?

A

Sunlight

49
Q

What are known risk factors for intra-oral cancer? (3)

A

Tobacco
Alcohol
Areca nuts

50
Q

Apart from squamous cell carcinoma, what are some of the rarer causes of oral malignancies?

A 
Kaposi's sarcoma
Salivary gland tumours e.g. adenoid cystic carcinoma
Lymphoma
Malignant melanoma
Neoplasms of bones and connective tissue
Metastases
51
Q

Symptoms of oral cancer?

A 
Mainly asymptomatic unless it invades nerves early
Pain
Halitosis
Parasthesia/ anaesthesia
Mobility/ loss of teeth
Trismus (spasm of jaw)
Restricted tongue movement
Weight loss
52
Q

Appearance of an oral cancer?

A 
Non-healing ulcer
White patch
Red patch
Exophytic (growing outwards)
Swelling
Non-healing extraction socket
Mobile teeth

Study Notes - Gastroenterology (42 decks)

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