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Cranio Exam 3 > Sialadenitis > Flashcards

Sialadenitis Flashcards

1
Q

define sialadenitis

A

inflammation of salivary glands

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2
Q

2 types of infectious sialdenitis

A
  • viral (mumps)

- Bacterial – caused by ductal obstruction–> retrograde infection from staph. aureous, strep viridains, hempphylus sp

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3
Q

causes of bacterial sialdenitis

A
  • after recent surgery–> acute parotitis
  • medication-related xerostomia
  • duct blockage by stone, structure, adjacent tumor
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4
Q

non-infectious sialdenitis

A
  • immune-mediated sialadenitis (AKA LESA or Sjögrens)
  • sarcoidosis
  • postirradiation
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5
Q

what causes reduced salivary flow?

A
  • drugs; opiates, antihypertensives, antidepressants, anticholinergics
  • sjogren syndrome
  • dehydration
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6
Q

examples of abnormal gland architecture that cause reduced salivary flow

A
  • sialoiths (stones)
  • strictures
  • sialectasis (abnormal dialation of gland)
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7
Q

infectious parotitis

A

depends on disease entity, but manifests with pain and swelling

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8
Q

signs and symptoms of acute bacterial parotitis

A
  • retrograde infection–> progressive swelling of gland for 1-2 weeks
  • malaise
  • anorexia
  • dehydration
  • fever
  • purulence of stenson’s duct (parotid)
  • pain worsens with eating or drinking
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9
Q

predisposing factors of acute bacterial parotitis

A
  • mouth dryness
  • obstructed duct
  • poor oral hygiene
  • elderly patients
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10
Q

microscopically acute bacterial parotitis looks like

A

sheets of neutrophils

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11
Q

viral parotitis

A

(mumps)

  • highly contagious
  • member of paramyxovirus
  • transmitted thru direct contact droplet spread
  • fever, malaise, headache, myalgia and swelling of parotids
  • people living in close quarters
  • mild illness–> infertility, deafness, pancreatitis, meningitis
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12
Q

diagnosis of viral parotitis

A

clinical ground or labs for mumps specific IgM and IgG or viral culture from parotid swab

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13
Q

HIV parotitis

A

nonpainful bilateral enlargement of parotids is common

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14
Q

treatment of acute parotitis (sialadenitis)

A
  • bacterial–antibiotics; B lactamase inhibitor like Augmentin; plus incision and drainage in some cases
  • viral (mumps)–palliative (non-aspirin antipyretics)
  • avoidance of sour foods and drinks
  • self-limiting course
  • mortality rare except for encephalitis
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15
Q

non-infectious sailadenitis

A

depends on disease entity but generally manifests with pain and swelling as well

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16
Q

signs and symptoms of sialadenitis

A
  • immune-mediated sialadenitis (Sjogren’s)–chronic swelling of parotid with dry mouth and eyes, accompanied with other autoimmune disease
  • sarcoidosis–chronic nontender swelling of parotid and other salivary glands
  • postirradiation–severe dry mouth and mucositis and candidal infection
17
Q

sjogren syndrome

A

autoimmune disease with autoantibodies against salivary ductal cells
(lymphoepithelial sialadenitis)

18
Q

primary sjogren syndrome

A

sicca syndrome

-dry mouth and dry eyes

19
Q

secondary sjogren syndrome

A
  • dry mouth and dry eyes

- any collagen-vascular disease (rheumatoid arthritis or lupus erythematosus most common)

20
Q

diagnosis of sjogren syndrome

A
  1. blood work up – ANA, SS-A & SS-B & rheumatoid factor
  2. sialography (evaluate salivary duct system by contrast medium)
  3. schrimer test (to evaluate tear flow)
  4. salivary biopsy (lymphocytic infiltration of normal salivary gland)
21
Q

sjogren syndrome increases risk for ______

A

non-hodgkin lymphoma

-usually B cell lymphoma

22
Q

lab finding for Sjogren syndrome SS-A

A

80

23
Q

lab finding for sjogren syndrome SS-B

A

70

24
Q

define sialography

A

inject duct with material and take another x ray to see if the saliva washed it all out

25
Q

lab biopsies are ____% positive in labial salivary biopses and ____% positive in parotid biopsies with sjogren syndrome

A

50% and 90%

26
Q

in Sjogren syndrome, the salivary gland is replaced by ____ tissue

A

lymphoid

27
Q

what accumulates in the parotid gland during Sjogren syndrome?

A

epimyoepithelial islands

leftover parotid duct

28
Q

only need _____ periductal lymphocytic infiltration foci to state patient has Sjogren sydrome

A

2

29
Q

management of Sjogren syndrome

A
  • topical oral moisturizers or Sialogauge (Rx stimulant of saliva) (Pilocarpine, Cevimeline)
  • antifungal for candidiasis
  • restorative treatment, full coverage crowns
  • immunosuppressive tx for assoc autoimmune disorders
  • periodic re-evaluation, FNA if needed to confirm or r/o lymphoma
30
Q

sarcoidosis

A

multisystem granulomatous disease

  • no definite ID of infectious agent
  • probs related to an abnormal immune response to bacterial antigenic component
31
Q

pathology of sarcoidosis

A

granulomatous inflammation

-special stains for pathogens are negative

32
Q

granuloma

A

rich in histiocytes and macrophages and giant cells

33
Q

clinical signs and symptoms of sarcoidosis

A
  • african americans, 20-40 yrs, 10X more affected than whites with more predilection to females
  • pulmonary manifestations, including dyspnea and dry cough, chest pain, fever, malaise, fatigue, arthralgia, paratracheal lymphadenopathy
  • skin/oral, heart, CNS, salivary gland involvement
34
Q

uveoparotid fever (heerfordt’s syndrome)

A

uveitis
parotid gland enlargement
facial paralysis
fever

35
Q

diagnosis of sarcoidosis

A
  • pathology–granulomas
  • blood test – elevated angiotensin-converting enzyme (ACE)
  • skin “Kveim test” (intradermal injection with Sarcoidal antigen. In 4-6 weeks elevations/nodules at site of injection
  • labial salivary biopsy “granulomatous sialadenitis”
  • chest films show pulmonary infiltrates, hilar LAD
36
Q

treatment and prognosis of sarcoidosis

A
  • spontaneous remission in 60-80% of patients
  • systemic corticosteroids effective in 20% of cases
  • 10% of cases corticosteroid treatment ineffective but patients live with disease
  • 4-10% of cases patients die from lung, heart, and central nervous system complications

Cranio Exam 3 (9 decks)

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