Sialadenitis Flashcards
define sialadenitis
inflammation of salivary glands
2 types of infectious sialdenitis
- viral (mumps)
- Bacterial – caused by ductal obstruction–> retrograde infection from staph. aureous, strep viridains, hempphylus sp
causes of bacterial sialdenitis
- after recent surgery–> acute parotitis
- medication-related xerostomia
- duct blockage by stone, structure, adjacent tumor
non-infectious sialdenitis
- immune-mediated sialadenitis (AKA LESA or Sjögrens)
- sarcoidosis
- postirradiation
what causes reduced salivary flow?
- drugs; opiates, antihypertensives, antidepressants, anticholinergics
- sjogren syndrome
- dehydration
examples of abnormal gland architecture that cause reduced salivary flow
- sialoiths (stones)
- strictures
- sialectasis (abnormal dialation of gland)
infectious parotitis
depends on disease entity, but manifests with pain and swelling
signs and symptoms of acute bacterial parotitis
- 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
predisposing factors of acute bacterial parotitis
- mouth dryness
- obstructed duct
- poor oral hygiene
- elderly patients
microscopically acute bacterial parotitis looks like
sheets of neutrophils
viral parotitis
(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
diagnosis of viral parotitis
clinical ground or labs for mumps specific IgM and IgG or viral culture from parotid swab
HIV parotitis
nonpainful bilateral enlargement of parotids is common
treatment of acute parotitis (sialadenitis)
- 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
non-infectious sailadenitis
depends on disease entity but generally manifests with pain and swelling as well
signs and symptoms of sialadenitis
- 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
sjogren syndrome
autoimmune disease with autoantibodies against salivary ductal cells
(lymphoepithelial sialadenitis)
primary sjogren syndrome
sicca syndrome
-dry mouth and dry eyes
secondary sjogren syndrome
- dry mouth and dry eyes
- any collagen-vascular disease (rheumatoid arthritis or lupus erythematosus most common)
diagnosis of sjogren syndrome
- blood work up – ANA, SS-A & SS-B & rheumatoid factor
- sialography (evaluate salivary duct system by contrast medium)
- schrimer test (to evaluate tear flow)
- salivary biopsy (lymphocytic infiltration of normal salivary gland)
sjogren syndrome increases risk for ______
non-hodgkin lymphoma
-usually B cell lymphoma
lab finding for Sjogren syndrome SS-A
80
lab finding for sjogren syndrome SS-B
70
define sialography
inject duct with material and take another x ray to see if the saliva washed it all out
lab biopsies are ____% positive in labial salivary biopses and ____% positive in parotid biopsies with sjogren syndrome
50% and 90%
in Sjogren syndrome, the salivary gland is replaced by ____ tissue
lymphoid
what accumulates in the parotid gland during Sjogren syndrome?
epimyoepithelial islands
leftover parotid duct
only need _____ periductal lymphocytic infiltration foci to state patient has Sjogren sydrome
2
management of Sjogren syndrome
- 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
sarcoidosis
multisystem granulomatous disease
- no definite ID of infectious agent
- probs related to an abnormal immune response to bacterial antigenic component
pathology of sarcoidosis
granulomatous inflammation
-special stains for pathogens are negative
granuloma
rich in histiocytes and macrophages and giant cells
clinical signs and symptoms of sarcoidosis
- 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
uveoparotid fever (heerfordt’s syndrome)
uveitis
parotid gland enlargement
facial paralysis
fever
diagnosis of sarcoidosis
- 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
treatment and prognosis of sarcoidosis
- 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
