Flashcards in P11- GI pathology for dentists Deck (69)
Name 2 inflammatory conditions.
-Inflammatory bowel disease
Name 2 inflammatory bowel diseases.
What is an inflammatory bowel disease ?
Chronic condition due to inappropriate mucosal immune activity
who are inflammatory bowel disease more common in?
-developed nations and males
-higher incidence in Ashkenazi jews
-frequently present in young adulthood
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
Describe the genetic pathogenesis of inflammatory bowel disease.
increased risk with affected family members (Crohn – 50% concordance monozygotic twins and ass with NOD2 gene)
Describe the immune response of the inflammatory bowel disease.
association with certain types of T helper cells and interleukin receptors, treated immunosuppression
Describe the epithelial defect of inflammatory bowel disease.
barrier dysfunction, abnormal Paneth cell granules
Describe the microbes of inflammatory bowel disease.
more limited flora thought to have greater impact
what can help the microbes in the inflammatory bowel disease?
What impact does smoking have on inflammatory bowel diseases?
Crohn - smoking makes the disease worse
Ulcerative colitis - smoking can help
Describe the Crohn vs UC features.
• Anywhere in GI tract
• Skip lesions !!!!
• Thick wall
• Deep, knife-like ulcers
• Moderate pseudopolyps
• Transmural inflammation
• Granulomas (35-50%)
• Recurrence after surgery
• 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
What can be seen histologically in Crohn's disease?
-Crypt abcess -neutrophiles leaked out
-Granuloma -aggregate of histiocytes
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
what are the oral manifestations of UC?
-Recurrent aphthous ulcers
what is Coeliac disease?
Immune mediated disease due to ingestion gluten containing cereals
what is the prevalence of coeliac disease?
1% prevalence in countries of mostly caucasian European descent
Who does coeliac disease normally present in?
what is coeliac disease in association with?
HLA-DQ8, dermatitis herpetiformis and other auto-immune diseases
Describe the pathogenesis of coeliac disease.
-Gliadin (component of gluten) triggers immune system
-activation of intra- epithelial lymphocytes
What is the histology of coeliac disease?
• Villous atrophy
• Crypt hyperplasia
• Increased intra-epithelial lymphocytes
What are the oral manifestations of coeliac disease?
• Enamel defects
• Delayed eruption
• Recurrent aphthous ulcers
• Angular cheilitis
• Atrophic glossitis
what 4 types of cancers are in this lecture?
• Oral squamous cell carcinoma
• Oesophageal :
- squamous cell carcinoma
• Colo-rectal carcinoma
• Anal carcinoma
who is oral squamous cell sarcoma (SCC) most common in?
• More common in men
• Increasing incidence with age
What is the multifactorial aetiology of oral SCC?
smoking, alcohol, HPV, betel nut, genetics, chronic irrita*on
what is the pathogenesis of oral SCC?
successive genetic alterations due to activation/inactivation of oncogenes/ tumour suppression genes
what is the morphology of an oral SCC?
Can present as white patch, speckled patch, red patch, verrucous-like or ulceration
what is the histology of an oral SCC?
- begins as dysplastic lesion :squamous cells breach basement membrane
- can be poor, moderate or well
- must show keratin or prickle cells
what are the majority of oesophageal cancers?
Majority are SCC and adenocarcinoma