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BDS5 oral disease > orofacial granulomatosis & crohn's disease, UC > Flashcards

orofacial granulomatosis & crohn's disease, UC Flashcards

1
Q

define orofacial granulomatosis (3)

A
  • non-specific granulomatous inflammation
  • non-caseating granulomas, multinucleate Langhan’s-type giant cells within the oral mucosa
  • often considered a manifestation of Crohn’s, but may develop Crohn’s after OFG
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2
Q

OFG age group

A

adult (20-40yo)

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3
Q

common features of OFG (6)

A
  • lip swelling/cheilitis granulomatosa
  • cobblestoning (esp BM)
  • mucosal tags (esp BM)
  • cherry red gingival erythema and hyperplasia
  • slit-like ulcers in sulci
  • submandibular duct staghorning
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4
Q

management of OFG (6)

A
  • diet restriction - cinnamon, benzoates, avoid preservatives
  • topical calcineurin inhibitor or steroids
  • intralesional triamcinolone at LM/lip boundary
  • immunosuppression (pred, aza, mercaptopurine, methotrexate)
  • immunomodulators (eg anti TNF)
  • surgery - excise fibrous bands, cheiloplasty
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5
Q

what infection may arise from using topical corticosteroids for OFG?

A

pseudomembraneous candidiasis

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6
Q

possible side effect of intralesional triamcinolone at lip/LM boundary

A

hypopigmentation

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7
Q

what conditions are associated with OFG?

A
  • Meischer’s syndrome (cheilitis granulomatosa)
  • Melkersson-Rosenthal syndrome (labial and perioral swelling, LMN CVII paralysis, plicated tongue)
  • foodstuffs type IV hypersensitivity
  • sarcoidosis
  • angioedema
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8
Q

what substances trigger a foodstuffs type IV sensitivity which may appear as OFG? (3)

A
  • cinnamon
  • cinnamaldehyde
  • benzoate
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9
Q

give some of the features of Melkersson-Rosenthal syndrome (3)

A
  • labial and perioral swelling
  • LMN CVII paralysis
  • plicated tongue
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10
Q

describe sarcoidosis

A
  • systemic granulomatous condition (non-caseating)
  • unknown aetiology with genetic predisposition
  • middle-aged females, Afrocaribbean, Scandinavian
  • most have spontaneous resolution but may have relapse/remission
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11
Q

sarcoidosis demographic

A
  • middle-aged females
  • Afrocaribbean and Scandinavian especially
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12
Q

list some of the IO (3) and EO (5) features of sarcoidosis

A

IO:
- loose teeth, bone pain
- swollen glands (parotid esp) +/- xerostomia
- soft tissue swelling, ulcers, gingivitis, pain (OFG-type symptoms)
EO:
- increased serum ACE and CXR hilar adenopathy
- dry cough, dyspnoea, chest pain
- skin bumps/raised broad lesions
- fever, malaise, weight loss, arthralgia
- dry eyes

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13
Q

what autoimmune disease does sarcoidosis mimic?

A

sjogren’s syndrome

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14
Q

describe Crohn’s disease

A
  • inflammatory bowel disease causing chronic inflammation of GI tract
  • young adult females (2nd peak in old age)
  • aetiology largely unknown
  • flares and asymptomatic intervals
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15
Q

GI s/s of Crohn’s disease (7)

A
  • skip lesions and string sign, thickened bowel
  • fissures/rosethorning, deep ulcers, fistulae
  • abdominal pain, diarrhoea, abdominal distention
  • anaemia, weight loss
  • rectal bleeding, perianal sepsis
  • transmural chronic granulomatous inflammation
  • cobblestoning, excess mucus
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16
Q

Crohn’s-specific oral manifestations (6)

A
  • diffuse buccal and labial swelling
  • cobblestoning
  • mucosal tags
  • linear ulcers in sulci
  • gingival swelling
  • staghorning
17
Q

investigations for Crohn’s disease (4)

A
  • bloods
  • CXR (exclude other granulomatous)
  • faecal calprotectin (biomarker)
  • biopsy (granulomatous inflammation)
18
Q

management for crohn’s disease

A
  • as for OFG (diet, topical, immunosuppression/modulation)
  • topical antimicrobials (common Staphy and Candida on outer lips)
  • dapsone, biologics (infliximab, adalimumab)
19
Q

describe ulcerative colitis

A
  • inflammatory bowel disease causing chronic inflammation of superficial lining of colon
  • backwash involvement of ileum
  • middle aged men, esp Jewish, strong FH
  • aetiology largely unknown
  • relapse and remission
20
Q

GI s/s of ulcerative colitis (5)

A
  • painless bloody diarrhoea with mucus and fever
  • colon polyps (can become malignant) and pseudopolyps
  • shallow ulceration, abscesses, purulent exudate
  • loss of goblet cells
  • red, inflamed mucosa, easily bleeds
21
Q

oral manifestations of ulcerative colitis (6)

A
  • pyostomatitis vegetans
  • snail-track ulcers
  • aphthous ulcers, stomatitis
  • halitosis, acidic taste
  • tongue coating
  • gingivitis/periodontitis
22
Q

what is pyostomatitis vegetans

A

small white/yellow pustules on erythematous/oedematous background

23
Q

give some extra-GI manifestations of ulcerative colitis (5)

A
  • skin = erythema nodosum, pyoderma gangrenosum
  • gall stones, sclerosing choleangiitis
  • joint inflammation
  • renal stones, UTIs
  • phlebitis, vasculitis

BDS5 oral disease (26 decks)

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