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GI > Oral Manifestations of systemic disease > Flashcards

Oral Manifestations of systemic disease Flashcards

1
Q

where is oral ulceration found?

A

= discontinuously in the oral mucosa

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2
Q

how can oral oral ulceration present?

A

1) solitary ulcers

2) multiple ulcers

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3
Q

what should you try to exclude in a solitary ulcer?

A

= exclude TRAUMA

- physical or chemical

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4
Q

how long would presence of an ulcer last if malignant?

A

= 3weeks

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5
Q

what type of cancer would should malignancy in solitary ulcers?

A

oral squamous cell carcinoma

  • feels solid & hard
  • crater in middle
  • roles at edges
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6
Q

what is another possible cause of a solitary ulcer?

A

= infection

e. g. TB
- primary or secondary infection of mycobacterium tuberculosis

e.g. syphilis

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7
Q

what physical finding would indicate primary syphilis?

A

crusting lesion on the lips

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8
Q

what finding would you see on secondary syphilis?

A

= snarling tract ulcer

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9
Q

what is the most common cause of multiple ulcers?

A

= recurrent aphthous ulceration

  • patient otherwise well
  • stress related?
  • exclude haematinic deficiency and GI disease
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10
Q

wha are he 3 types of recurrent aphthous ulceration?

A
  • major
  • minor
  • herpetiform
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11
Q

what condition may be associated with multiple ulcers?

A

= bechets

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12
Q

what is bechets?

A

multi system condition
- hereditary systemic vasculitis

(almsot identical to oral ulcers as RAU)

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13
Q

what is one of the most important things to exclude in pains with ulcers and symptoms might they show?

A

= anaemia

Symptoms;

  • mucosal pallor
  • oral ulceration
  • glossitis
  • angular chelitis
  • predisposition to candida
  • disturbed taste
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14
Q

what is glossitis?

A

= red raw tongue

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15
Q

what sort of infection would indicate multiple ulceration?

A

= primary herpetiform gingivo stomatitis

e.g. herpes

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16
Q

what 3 diseases fall under multiple ulcers?

A

1) lichen planus
2) lupus erythmetosus
3) vesiculobullous disease = pemphigus and pemphigoid

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17
Q

wha symptoms would be associated with lichen planus?

A

= auto-immune skin condition

Presentation

  • lace like pattern
  • not painful (asymptomatic)
  • bilateral
  • can affect skin
  • pre malignant or potentially malignant
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18
Q

what is associated with lupus erythematosus?

A

= discoid or systemic

Oral manifestations;

  • ulcers
  • white patches
  • red & white patches
  • similar to lichen planes
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19
Q

describe VB disease - pemphigus vulgarisms?

A
  • oral lesions are 1st manifestations
  • oral lesions precede skin lesions by 1 year or more
    = painful oral ulceration
    = precede by blisters (rupture easily)
    = niksolky sign
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20
Q

describe VBdisease - pemphigoid disease?

A

= bening mucous membrane pemphigoid

  • blisters more likely o be observed
  • painful oral ulceration
  • affects mucous membrane of other organs e.g. eye
21
Q

describe the difference between pemphigoid and pemphigus?

A

Pemphigoid
= sub-epithelial bullae

Pemphigus
= intra-epithelial bullae

22
Q

when can oral manifestations occur as a result of GI consequences?

A

1) underlying malabsorption

2) consequent haematinic deficiency

23
Q

what is Crohn’s disease?

A

= oral manifestations in 0.5%-20% of cases

  • oral lesions may precede abdominal symptoms
  • do not necessarily correlate with intseinanl disease activity
24
Q

what are features of Crohn’s disease?

A
  • cobble stoning of mucosa
  • localised mucogingivitis
  • linear ulceration
  • tissue tags/polyps
  • diffuse swelling (commonly of lips)
  • pyostomatiis vegetates
25
Q

what is ulcerative colitis?

A

= oral ulceration

  • pyostomatiis vegetates
  • angular stomatitis
  • reflects severity of intestinal disease (exacerbation and remission)
26
Q

what classifies white patches?

A

= those that wipe off or not

27
Q

white patches that do and don wipe off?

A 
DO
= usually psuedo-membranous candidieasis/thrush
DONT 
- trauma 
- epithelial dysplasia 
- neoplasia 
- chronic mucocutaneous
- candidiasis
28
Q

what could be the cause of oral pigmentation?

A
  • racial pigmentado
  • melanotic macules
  • malignancy
  • smoking
  • Addison’s disease
    (excess ACTH/MSH released from pituitary in response to reduced cortisol level)
29
Q

what is the term for dry mouth?

A

= xerostomia

Causes

  • radiation therapy
  • drugs
  • sjogren’s (auto-immune condition)
30
Q

wha is sjogrens syndrome?

A

= dry eyes and dry mouth
- commonly affects females more than males (can be primary or secondary - secondary associated with other auto-immune disease)

Oral manifestations;
- large salivary glands 
- as a result of drug mouth; 
= increased caries
= depapillaed tongue
= red, dry, wrinkled mucosa
= increased predisposition o candida
31
Q

what happens in leukaemia?

A 
= gingival enlargement 
= peechiae
= mucosal bleeding 
= ulceration 
= infiltration by malignant cells
= boggy gingiivae 
= presentation due to 
immuno-compromise; 
- candida 
- herpes infection 
- opportunistic infection
32
Q

describe lymphomas presentation in the mouth?

A

= palpable lymph nodes
- extra/intra oral diffuse swellings
= ulceration
= tooth migration/mobility

33
Q

wha are oral manifestations of HIV?

A 
= ulceration 
= Kaposi's sarcoma 
= HPV lesions 
= salivary gland swelling 
= due to immuno-supression 
= increased risk of malignancy
34
Q

LECTURE 2 - ORAL PRE-MALIGNANCY & CANCER

A

LECTURE 2 - ORAL PRE-MALIGNANCY & CANCER

35
Q

what are the characteristics of asympomatic invasive oral cancers?

A

surface texture: granular or smooth

elevation: 1mm max

No ulceration
No bleeding
Not induced

36
Q

what ar the risk factors for oral cancers?

A
  • tabacco
  • alcohol
  • diet & nutrition
  • HPV
  • UVL
  • Candida
  • syphilis/dental facttors
37
Q

what are the important carcinogenic chemicals present in tobacco smoke?

A
  • arsenic
  • cyanide
  • CO
38
Q

what is the recommended unit intake for alcohol a week?

A

14 unis a week for men and women

One uni

  • half pint
  • shot
  • glass of wine
39
Q

what is the recommended daily maximum alcohol unit for men a day?

A

2 unis

+ 2 days free of alcohol a week

40
Q

how many units do men and women need to consume in a day in order for it to count as a binned drink?

A

FEMALES
= 6 unites

MALES
= 8 unites

41
Q

what sort of diet makes you at risk for developing oral cancer?

A

low in VIt A,C and iron

42
Q

what is atrophy of mucosa more susceptible to?

A

local carcinogen

43
Q

what is oral sex associated with?

A

HPV 16 & 17
= oropharyngeal cancer
- viruses may come and now
- increased prevalence of age

44
Q

what are high risk sites for developing oral cancer?

A
  • soft (non-keratinising) site
    e.g. ventral tongue/floor of mouth
    lateral tongue
  • rare sites (UK)
    = dorsal tongue
    = hard palate

note;
- buccal mucosa (asia)

45
Q

what are potentially malignant lesions?

A
  • erythroplakia
  • erythroleukoplasia
  • leukoplakia
  • erosive lichen planus
  • sub mucous fibrosis
  • dyskeratosis congenita
  • sideropenic dysphagia
46
Q

what are the warning signs for oral cancer?

A
  • red/white / red & white lesions
  • ulcers (exclude trauma, drugs, systemic)
  • numb feeling (e.g. lip/face)
  • unexplained plain in mouth or neck
  • change in voice
  • dysphagia
47
Q

what are other orofacial manifestations of cancer?

A
  • drooping eye lid or facial palsy
  • fracture of mandible
  • double vision
  • blocked or bleeding from nose
  • facial swelling
48
Q

what 4 questions should we ask a patient with suspicious lesions present?

A

1) how long has the lesion been present?
2) is it painful? (pain is usually LATE manifestation of oral cancer, but would be expected if benign ulcer)
3) does patients smoke/drink..how much?
4) what colour is the lesion?

GI (43 decks)

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