Sialadenitis

Question 1

define sialadenitis

Answer 1

inflammation of salivary glands

Question 2

2 types of infectious sialdenitis

Answer 2

• viral (mumps)

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

Question 3

causes of bacterial sialdenitis

Answer 3

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

Question 4

non-infectious sialdenitis

Answer 4

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

Question 5

what causes reduced salivary flow?

Answer 5

• drugs; opiates, antihypertensives, antidepressants, anticholinergics
• sjogren syndrome
• dehydration

Question 6

examples of abnormal gland architecture that cause reduced salivary flow

Answer 6

• sialoiths (stones)
• strictures
• sialectasis (abnormal dialation of gland)

Question 7

infectious parotitis

Answer 7

depends on disease entity, but manifests with pain and swelling

Question 8

signs and symptoms of acute bacterial parotitis

Answer 8

• 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

Question 9

predisposing factors of acute bacterial parotitis

Answer 9

• mouth dryness
• obstructed duct
• poor oral hygiene
• elderly patients

Question 10

microscopically acute bacterial parotitis looks like

Answer 10

sheets of neutrophils

Question 11

viral parotitis

Answer 11

(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

Question 12

diagnosis of viral parotitis

Answer 12

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

Question 13

HIV parotitis

Answer 13

nonpainful bilateral enlargement of parotids is common

Question 14

treatment of acute parotitis (sialadenitis)

Answer 14

• 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

Question 15

non-infectious sailadenitis

Answer 15

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

Question 16

signs and symptoms of sialadenitis

Answer 16

• 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

Question 17

sjogren syndrome

Answer 17

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

Question 18

primary sjogren syndrome

Answer 18

sicca syndrome

-dry mouth and dry eyes

Question 19

secondary sjogren syndrome

Answer 19

• dry mouth and dry eyes

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

Question 20

diagnosis of sjogren syndrome

Answer 20

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)

Question 21

sjogren syndrome increases risk for ______

Answer 21

non-hodgkin lymphoma

-usually B cell lymphoma

Question 22

lab finding for Sjogren syndrome SS-A

Answer 22

80

Question 23

lab finding for sjogren syndrome SS-B

Answer 23

70

Question 24

define sialography

Answer 24

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

Question 25

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

Answer 25

50% and 90%

Question 26

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

Answer 26

lymphoid

Question 27

what accumulates in the parotid gland during Sjogren syndrome?

Answer 27

epimyoepithelial islands | leftover parotid duct

Question 28

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

Answer 28

2

Question 29

management of Sjogren syndrome

Answer 29

- 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

Question 30

sarcoidosis

Answer 30

multisystem granulomatous disease - no definite ID of infectious agent - probs related to an abnormal immune response to bacterial antigenic component

Question 31

pathology of sarcoidosis

Answer 31

granulomatous inflammation | -special stains for pathogens are negative

Question 32

granuloma

Answer 32

rich in histiocytes and macrophages and giant cells

Question 33

clinical signs and symptoms of sarcoidosis

Answer 33

- 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

Question 34

uveoparotid fever (heerfordt's syndrome)

Answer 34

uveitis parotid gland enlargement facial paralysis fever

Question 35

diagnosis of sarcoidosis

Answer 35

- 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

Question 36

treatment and prognosis of sarcoidosis

Answer 36

- 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