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Flashcards in P11- GI pathology for dentists Deck (69)
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1

Name 2 inflammatory conditions.

-Inflammatory bowel disease
-Coeliac disease

2

Name 2 inflammatory bowel diseases.

-Crohn disease
-Ulcerative colitis

3

What is an inflammatory bowel disease ?

Chronic condition due to inappropriate mucosal immune activity

4

who are inflammatory bowel disease more common in?

-developed nations and males
-higher incidence in Ashkenazi jews
-frequently present in young adulthood

5

Describe the pathogenesis of inflammatory bowel disease.

• Hygiene hypothesis
• Thought due to combination of defects in host response to intestinal microbes, intestinal epithelial function and immune responses

6

Describe the genetic pathogenesis of inflammatory bowel disease.

increased risk with affected family members (Crohn – 50% concordance monozygotic twins and ass with NOD2 gene)

7

Describe the immune response of the inflammatory bowel disease.

association with certain types of T helper cells and interleukin receptors, treated immunosuppression

8

Describe the epithelial defect of inflammatory bowel disease.

barrier dysfunction, abnormal Paneth cell granules

9

Describe the microbes of inflammatory bowel disease.

more limited flora thought to have greater impact

10

what can help the microbes in the inflammatory bowel disease?

antibiotics

11

What impact does smoking have on inflammatory bowel diseases?

Crohn - smoking makes the disease worse
Ulcerative colitis - smoking can help

12

Describe the Crohn vs UC features.

Crohn
• Anywhere in GI tract
• Skip lesions !!!!
• Thick wall
• Strictures
• Deep, knife-like ulcers
• Moderate pseudopolyps
• Transmural inflammation
• Granulomas (35-50%)
• Fistulae/sinuses
• Recurrence after surgery
UC
• Limited to colon and rectum
• Continuous disease !!!!
• Thin wall
• No strictures
• Superficial, broad based ulcers
• Marked pseudopolyps
• Mucosal inflammation
• No granulomas
• No fistulae/sinuses
• No recurrence after surgery

13

What can be seen histologically in Crohn's disease?

-Crypt abcess -neutrophiles leaked out
-Granuloma -aggregate of histiocytes

14

what are the oral manifestations of Crohn's?

– oral lesions may precede in 30%
− oral ulcers and ‘cobblestone mucosa’
similar to elsewhere in GI tract − recurrent aphthous ulcers

15

what are the oral manifestations of UC?

-Recurrent aphthous ulcers
-Pyostomatitis vegatans

16

what is Coeliac disease?

Immune mediated disease due to ingestion gluten containing cereals

17

what is the prevalence of coeliac disease?

1% prevalence in countries of mostly caucasian European descent

18

Who does coeliac disease normally present in?

30-60 years

19

what is coeliac disease in association with?

HLA-DQ8, dermatitis herpetiformis and other auto-immune diseases

20

Describe the pathogenesis of coeliac disease.

-Gliadin (component of gluten) triggers immune system
-activation of intra- epithelial lymphocytes
-Tissue damage

21

What is the histology of coeliac disease?

• Villous atrophy
• Crypt hyperplasia
• Increased intra-epithelial lymphocytes

22

What are the oral manifestations of coeliac disease?

• Enamel defects
• Delayed eruption
• Recurrent aphthous ulcers
• Angular cheilitis
• Atrophic glossitis

23

what 4 types of cancers are in this lecture?

• Oral squamous cell carcinoma
• Oesophageal :
- squamous cell carcinoma
- adenocarcinoma
• Colo-rectal carcinoma
• Anal carcinoma

24

who is oral squamous cell sarcoma (SCC) most common in?

• More common in men
• Increasing incidence with age

25

What is the multifactorial aetiology of oral SCC?

smoking, alcohol, HPV, betel nut, genetics, chronic irrita*on

26

what is the pathogenesis of oral SCC?

successive genetic alterations due to activation/inactivation of oncogenes/ tumour suppression genes

27

what is the morphology of an oral SCC?

Can present as white patch, speckled patch, red patch, verrucous-like or ulceration

28

what is the histology of an oral SCC?

- begins as dysplastic lesion :squamous cells breach basement membrane
- can be poor, moderate or well
differentiated
- must show keratin or prickle cells

29

what are the majority of oesophageal cancers?

Majority are SCC and adenocarcinoma

30

what is the most common type of oesophageal cancer?

SCC commonest worldwide, but adenocarcinoma increasing in western society