key points OFG Flashcards

1
Q

definition

A

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

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2
Q

onset and resolve

A

comes up quickly and settles only v slowly/not at all
often continuous swelling which changes in intensity
- trigger can be intermittent/constant

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3
Q

histology

A

GCs which block lymphatic drainage
MN
oedema, dilated lymph

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4
Q

angioedema definition

A

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)

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5
Q

angioedema histology

A

fluid in CT bundles

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6
Q

other granulomatous diseases producing tissue GCs

A

sarcoidosis
TB
Crohn’s

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7
Q

clinical appearance

A
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
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8
Q

presentation age

A

any age - common later childhood and adolescent

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9
Q

Crohn’s screening

A

parental awareness of importance of altered bowel habit/abdo pain
growth monitoring
faecal calprotectin assay

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10
Q

faecal calprotectin assay

A

unreliable young kids
>7yrs good marker for inflammatory bowel changes
screening test for endoscopy
good predictor of Crohn’s disease activity

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11
Q

T1 hypersensitivity - angioedema

A

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

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12
Q

T4 hypersensitivity OFG

A

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

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13
Q

initial management

A

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

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14
Q

exclusion diet

A
benzoic acid
sorbic acid
cinnamon products
chocolate
E210-219 where not inc in above

for 3m

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15
Q

after exclusion diet

A

test reintroduction of fav foods

can then choose what foods they will inc etc

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16
Q

is skin testing reliable?

A

no

17
Q

what are benzoates found in?

A

tomato and tomato based products

18
Q

medical therapy

A

topical
intralesional steroid injection
systemic tx

19
Q

topical tx

A

miconazole/hydrocortisone to angular cheilitis
tacrolimus ointment 0.03% to lip swelling and facial erythema
- absorbed and carried to local lymphatics where it can help to disperse obstructing GCs

20
Q

intralesional steroid injection

A

triamcinolone injected into area of swelling - often weekly for 3wks
often needs repeating - every 6m

21
Q

systemic tx

A

pulsed azithromycin 3m - 3 days every week
systemic immune modulation
- prednisolone pulse for short term issues
- azathioprine/mycophenolate
biologics have been used w some success