key points OFG Flashcards
definition
oedema in oral and facial STs by blockage of lymphatic drainage due to an immune reaction
- no increase in exudate of fluid from capillaries into tissues - obstruction of lymphatic drainage is the problem. Fluid accumulates
onset and resolve
comes up quickly and settles only v slowly/not at all
often continuous swelling which changes in intensity
- trigger can be intermittent/constant
histology
GCs which block lymphatic drainage
MN
oedema, dilated lymph
angioedema definition
oedema of oral and facial STs due to increase in fluid exudate from capillaries (vascular permeability) but with no lymphatic drainage
comes up quickly and resolves quickly (24-48hrs)
angioedema histology
fluid in CT bundles
other granulomatous diseases producing tissue GCs
sarcoidosis
TB
Crohn’s
clinical appearance
angular cheilitis lip fissuring and crusting erythema of perioral tissues swelling of lips full thickness gingivitis (starts as erythema) - false pockets swelling of IO tissues cobblestoning staghorning - SM duct enlarged mucosal tags ulceration
presentation age
any age - common later childhood and adolescent
Crohn’s screening
parental awareness of importance of altered bowel habit/abdo pain
growth monitoring
faecal calprotectin assay
faecal calprotectin assay
unreliable young kids
>7yrs good marker for inflammatory bowel changes
screening test for endoscopy
good predictor of Crohn’s disease activity
T1 hypersensitivity - angioedema
degranulation of mast cells in response to an allergen
IgE
granules send vasoactive compounds into tissues, act upon local bv’s to increase vascular permeability and fluid exudates
T4 hypersensitivity OFG
T cells activated by an allergen, trigger macrophages to become active
produce activated macrophages which try to phagocytose the allergen
if not possible, macrophages will fuse into MNGCs to try to phagocytose allergen
- difficulty in removing trigger
- induced by IL-4
initial management
consider whether orofacial or part of Crohns
- GI symptoms, faecal calprotectin
- start sequential growth monitoring
take dietary history
- identify ‘overuse’ of dietary allergens
- discuss role of a complete exclusion diet trial
exclusion diet
benzoic acid sorbic acid cinnamon products chocolate E210-219 where not inc in above
for 3m
after exclusion diet
test reintroduction of fav foods
can then choose what foods they will inc etc