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Ulceration Flashcards

1
Q

What are the differential diagnoses for oral ulceration?

A 
So (BIGS) Systemic: Blood/Infection/GI/Skin
Many: Malignancy
Laws: Local
And: Apthae
Directives: Drugs
Oh!: Others
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2
Q

What are examples of ‘Other’ causes of ulceration?

A

Necrotising Sialometaplasia
Vasculitides: Wegners and Bechets
Rheumatoid: SLE

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3
Q

What are examples of malignant causes of oral ulceration?

A

SCC

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4
Q

What are examples of Local causes of oral ulceration?

A

Trauma

burns

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5
Q

What are examples of Apthae causes of oral ulceration?

A

RAS

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6
Q

What are examples of Drugs causes of oral ulceration?

A 
Olanzapine
Serataline inhibitors
Nicorandil
carbamezapine
losartan
cytotoxic
cocaine
immunosupressants
phenytoin
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7
Q

What are the causes of blood related ulceration?

A

Anaemia, Leukamia, Neutropaenia, Haematinic deficiency

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8
Q

what are the causes of infection related ulceration?

A

Viral: VZV, Herpesm Coxsackie, Herpangina, EBV
Bacteria: syphylis, TB
fungi: Histoplasmosis

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9
Q

What are the causes of GI related oral ulceration?

A

Coeliac, Crohns, UC

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10
Q

What are the causes of Skin related ulceration?

A

Lichen plaunus and VB diseases

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11
Q

What is the clinical appearance of traumatic ulceration? How does this differ from chmical ulceration?

A

single localized deep ulcer

chemical ulceration is much more diffuse and often has a fibrous slough present

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12
Q

What is the pathogenesis of Bechets disease?

A

HLA B5, HLA BW51, HLA-DR7

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13
Q

Which population is more commonly affected Becets syndrome?

A

Mediterranean, middle east, Japan

3-rd-4th decade, males

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14
Q

What is RAS?

A

A common cause of oral ulceration

Affects 10-20% of the population

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15
Q

What is the aetiology of RAS?

A

AB mediated cytotoxicity reaction

T cells and humoral component

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16
Q

What are the predisposing factors of RAS?

A 
Trauma: may instigate RAS in a predisposed patient 
Stress
Vit B12 def
Systemic disease : Anaemia, Becets 
Smoking cessation
Chemical:SLS
Hormonal 
Food allergies: cinnamon aldehyde and Benzoates
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17
Q

What is the clinical appearance of RAS?

A

Yellow white fibrinopirulent membrane

Erythmatous halo

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18
Q

What are the three types of RAS?

A

Minor
Major
Herpetiform

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19
Q

Which form of RAS is most common?

A

Minor

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20
Q

How do you diagnosis RAS?

A

Clinically
DO NOT biopsy

Bloods taken too
FBC/ferritin/folate/b12/ATTG

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21
Q

How do you manage RAS?

A

Caramellose sodium paste
Clobetesol

Topical steroids:
Betamethasone: betnesol (500mcg 10ml water). Spit and rinse tds
Beclomethasone diproprionate spray: 2 puffs on ulcer tds
Hydrocortisone hemmisuccinate pellets: 2.5mg dissolve next to ulcer up to four time per day

Topical antiseptics: CHX

Systemic: prednisalone, azothiarpine

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22
Q

In which diseases is ATTG positive in?

A

Rheumatoid arthritis
Coeliac
Type 1 diabetes

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23
Q

List all the drug management options for RAS?

A

Caramellose sodium paste
CHX

Lidocaine

Benzydamine mouthwash (diff lam)
Betamethasone tablets
Beclomethasone disproportionate inhaler 50mcg

Hydrocortisone Oralmucosal tablets

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24
Q

What are the signs and symptoms of becets?

A

Eyes: relapsing iridocyclitis, uveitis, retinal vascular changes, optic atrophy
Skin: pathergy, erythema nodosum
Others: neurological diseases and thrombosis of vena cavae

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25
What are the causes of oral mucosal soreness?
``` Dry mouth Epithelial thinning eg candida LP and VB Psychogenic: BMS/OD Deficiency state: B12 def Neuropathies: Diabetes ```
26
What diseases can arise from haematological diseases?
``` RAS Glossitis Oral dysaesthesia Candidiasis Kelly Paterson Syndrome ```
27
What is the difference between RAS and Apthous like?
Apthous like: ``` Doesn't start in childhood No positive FH Doesn't resolve with age Signs and symptoms unusual for RAS Occurs usually with drugs ```
28
What are the different types of anaemia?
Microcytic Normocytic Macrocytic
29
What are the causes of microcytic anaemia?
Anaemia of chronic disorder Thalassemia Fe def anaemia
30
What are the causes of normocytic anaemia?
Anaemia of chronic disorder Acute blood loss Marrow infiltration Hemolysis
31
What are the causes of macrocytic anaemia?
``` Folate and B12 def Hypothyroidism Alcohol excess Liver disease Myelodysplasia ```
32
What are the causes of fe def anaemia?
Microcytic anaemia ``` Caused by: Diet Blood loss Physiological Malabsorption eg coeliac ```
33
How much iron is stored in Hb?
3 grams
34
What are the features if Fe def anaemia?
Glossitis Kolionychia Angular chelitis Pharyngeal webs
35
What are the causes of anaemia of chronic disorder?
Malignancy Uraemia Endocrine diseases Chronic Inflam
36
What is the main problem in Anemia of chronic disorder?
Failure of iron transport from RE cells to rbc GIVR erythropoietin
37
What is thalassaemia?
Inherited problem with Hb synthesis AR | Normal adult is alpha 2 beta 2
38
What is the aetiology behind sickle cell anaemia?
Abnormal beta chain synthesis
39
Which group of people are more commonly affected by thalassemia?
Mediterranean
40
What are the two types of haemolytic anaemia?
Inherited and acquired
41
What happens to the RBC in Haemolytic anaemia?
Increased rate of RBC destruction | Usual survival is 100-120 days
42
What are the inherited haemolytic anaemia diseases?
Sickle cell anaemia | Deficiency in metabolic enzymes eg G6PD
43
What are the main causes of aquired haemolytic anaemia?
Infection | Traumatic hemolysis
44
What types of diseases are associated with marrow infiltration anaemia?
``` Aplastic anaemia associated with infection and drugs leukoerthroblastic anaemia (associated with metastatic cancer) ```
45
Where is B12 stored?
Liver 2-3mg
46
How is B12 absorbed?
combines with intrinsic factor secreted by the gastric parietal cells This then is absorbed in the terminal ileum
47
What are the causes of B12 def?
Diet IF def: pernicious anaemia Malabsorption
48
What are the signs and symptoms of B12 def?
Anaemia Jaundice Glossitis Neurological lesions
49
What tests can be done if suspect B12 def?
Bloods Bone marrow shows megaloblastic chnage Tests for ab against pareital and IF Schilling test
50
What happens to folic acid once absorbed into body?
Converted to H4 folate
51
What are the causes of folic acid def?
Drugs: anticonvulsants OCP, alchoholis Increased use: pregnant, malignancy Loss: dialysis
52
What are the symptoms of folate def?
Glossitis Megaloblastic bone marrow Jaundice
53
What is pathergy and what syndrome is this seen in?
It is when you get severe brusing even from a small bump/graze seen in bechets
54
What is erythema nodusum and what syndrome is it seen in?
inflammation of the fat cells under the skin seen in bechets
55
People with RAS should avoid which food types?
Benzoates
56
What is cyclic neutropenia?
Absolute reduction in circulating neutrophils and in bone marrow too
57
What are the symptoms of cyclic neutropenia?
During episodes of reduced neutrophils : Fever Malaise Cervical lymphadenopathy Infections Oral ulcers mainly on non keratinised surfaces Patients more prone to severe perio
58
What is the cause if necrotising sialometaplasia?
Is it caused by altered blood supply which leads to local ischemia which then causes the salivary glands to infarct
59
What are the signs and symptoms of necrotising sialometaplasia?
Deep non healing ulcer usually on the palate and also associated with anaesthesia to the surrounding area
60
What are the causes of recurrent oral mucosal ulceration?
Recurrent Apthous ulceration Apthous like ulceration Erythema multiforme Recurrent intra oral herpes

Oral Med (31 decks)

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