Ulcers

Question 1

what is an ulcer

Answer 1

breach in the mucosa
localised defect with destruction of epithelium underlying connective tissue

Question 2

give generalised causes of ulcers

Answer 2

trauma
infective
immunological
neoplastic
nutritonal
inflammatory
hypersensitivty
idiopathic

Question 3

how would a traumatic ulcer appear

Answer 3

white keratitis borders
soft

clear causative agent

Question 4

describe recurrent aphthous ulcers

give types of RAS

Answer 4

grey/yellow/white centre with red erythematous halo

minor - <1cm, heal 2-3 wks
major - >1cm, long time heal
herpetiform - small ulcers that may coalesce

Question 5

why might a pt have aphthous ulcers

what tests would you undertake

Answer 5

child/teen associated w growth
GI/GU pathology
malnourishment, anaemia

diagnosis of exclusion
FBC, U+E, coeliac screen, vitb12, folate, ferritin, HIV, crohns

Question 6

how would a neoplastic ulcer present

Answer 6

exophytic [protrude]
rolled borders
raised
hard
non moveable
sensory disturbance

Question 7

how would behcet’s present

Answer 7

ulceration oral + genital
skin lesions
uveitis
ocular lesions
multisystem

indistinguishable from RAS
no single test

Question 8

what is TUGSE

how does it appear

Answer 8

traumatic ulcerative granuloma with stromal eosinophilia

rare, benign, self limiting

white halo, granulating

diagnose w biopsy
topical/intralesional steroid

Question 9

what are some iatrogenic causes of ulcers

Answer 9

chemo/radiotherapy
GVDH
drug-induced = K channel blockers, bisphosphonates, NSAIDs

Question 10

Difference between recurrent oral ulceration and recurrent aphthous stomatitis

Answer 10

RUO is repeated ulceration of different types, due to systemic/infections/trauma, can be triggered by disease like crohns or behcets, vary in presentation, managed by treating underlying cause

RAS is repeated ulcers of unknown aetiology, thought to be immune-mediated, triggered via stress/trauma/genetics/deficiencies, yellow-grey base with erythematous border, minor major or herpetiform, tx with systemic relief

Question 11

Triggers of RAS

Answer 11

idiopathic
trauma, stress, haematinic deficiency, hormonal imbalance

Question 12

what info from history to confirm minor aphthous ulcers

Answer 12

small ulcers
heal within 7-10 days
do they leave behind scars
does it happen on gingivae
any other ulcers elsewehre
every have multiple which join togwether

Question 13

Apart from oral ulceration, other clinical features of Behcet’s

Answer 13

genital ulcers
skin lesions
ocular lesions [uveitis]
vascular involvement [dvt]

Question 14

Name 2 non-steroidal treatment for the ulcers

Answer 14

benzydamine mw/spray
lidocaine
chx