Week 3 - A - Oral disease - Ulcers (Apthous, Lichen, Lupus, Bullous), Angular stomatitis, Leuko/erythroplakia, Candidasis, Cancer Flashcards Preview

Year 1(B3) - Gastrointestinal > Week 3 - A - Oral disease - Ulcers (Apthous, Lichen, Lupus, Bullous), Angular stomatitis, Leuko/erythroplakia, Candidasis, Cancer > Flashcards

Flashcards in Week 3 - A - Oral disease - Ulcers (Apthous, Lichen, Lupus, Bullous), Angular stomatitis, Leuko/erythroplakia, Candidasis, Cancer Deck (33)
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1
Q

Multiple local and systemic disorders can give rise to oral ulceration They can present as solitary or multiple ulcers What are different causes of solitary ulcers in the mouth?

A

Trauma - physical or chemical Malignancy - eg oral squamous cell carcinoma Infective

2
Q

What is stomatitis?

A

Stomatitis is inflammation of the mouth and lips. It refers to any inflammatory process affecting the mucous membranes of the mouth and lips, with or without oral ulceration

3
Q

Multiple ulcers also have different causes Aphthous stomatitis is one of the most common diseases of the oral mucosa, and is thought to affect about 20% of the general population to some degree. What is apthous stomatitis also known as? How does it present?

A

Apthous stomatitis aka recurrent apthous ulcers aka canker sores They present as recurrent ulces that are shallow and painful on the tongue or oral mucosa that heal without scarring

4
Q

Although recurrent apthous ulcers are thought to affect roughly 20% of the general population, what diseases can cause them - usually causes severe apthous ulcers?

A

Apthous ulcers are sometimes associated with other conditions Crohn’s disease and coeliac disease Rarely - Haematinic deficiencies (nutrients required for haematopoeisis) - vitamin B12, folic acid, iron

5
Q

In treating recurrent apthous ulcer, what should you try to avoid? How is it usually treated?

A

Try to avoid oral trauma such as hard foods or hard toothbrushes and acidic foods/drinks More severe cases may require steroids eg oral prednisolone

6
Q

What is an important infective cause of multiple ulcers not to miss? mainly seen in children What is it caused by?

A

Gingivostomatitis is a combination of gingivitis and stomatitis, or an inflammation of the oral mucosa and gingiva Primary herperitform gingivo-stomatitis is caused by herpes simplex virus 1 (can be HSV2)

7
Q

What is used to treat primary herpetic gingivostomatitis?

A

The aim of treatment is mostly supportive such as pain control, duration of symptoms, viral shedding and in some cases, preventing outbreak. Aciclovir is often prescribed (usually reserved for severe cases of HSV1 or shingles)

8
Q

Different mucocutaneous disorders are also linked to the formation of multiple ulcers * Lichen planus * Lupus erythematous * Bullous disorders What causes lichen planus? How does it appear on the skin?

A

Lichen planus is caused by T cell mediated inflammation targeting an unknown protein in the skin and mucosal keratinocytes Appears as a pruritic, planar, poly-angular, purple papular rash Typically affects volar aspects of wrists , forarms, shins and ankles

9
Q

How does mucosal lichen planus appear?

A

Usually appears as asymptomatic bilateral white-reticular patches - often adjacent to reddish ulcerated lesions Whitish reticular networks are known as Wickham’s striae - due to thickening of the granular layer (hypergranulosis)

10
Q

What is the treatment of lichen planus?

A

Potent/very potent topical steroids Betnovate - bethametasone valerate or Dermovate - clobetasol proprionate If extensive, can give systemic oral steroids eg prednisolone

11
Q

Both systemic lupus erythematous and discoid lupus can cause cutaneous and oral lesions What is discoid lupus erythematous confined to?

A

Discoid LE is the most common form of chronic cutaneous Discoid LE is confined to the skin above the neck in most patients but can spread below the neck to affect upper back, V of neck, forearms and backs of hands.

12
Q

How do lesions in patients with discoid lupus present? - both oral and cutaneous lesion

A

Typically presents with * Scarring alopecia * Photosensitivity causing red, scaly rash on sun-exposed sites * Butterfly rash across cheeks and noes * Ulceration and or red/white patches in mouth Slow healing leads to post inflammatory pigmentation

13
Q

What is the treatment for discoid lupus?

A

Typically sun avoidance and sunscreen are very important Potent/very potent topical steroids If this does not help, often hydroxychloroquine is tried

14
Q

Which bullous disorder commonly affects the mucosa?

A

Painful mucosal lesions affecting the oral mucosa are often the first sign seen in pemphigus vulgaris (also affects other mucoal areas eg eyes and genitals) Mucosal lesions are rarer in bullous pemphigoid

15
Q

How do the lesions in pemphigus vulgaris present?

A

Painful extensive oral ulceration Begins as blisters that rupture easily Nikolsky sign positive

16
Q

What is angular stomatitis? What is it also known as?

A

Angular stomatitis (cheilitis or cheilosis) is inflammation and fissuring of the corners of the mouth often bilaterally

17
Q

What are different causes of angular stomatitis?

A

Different causes include * ill fitting dentures, * candidiasis Associated with angular stomatitis and glossitis * Iron deficiency * B12 deficiency * B2 deficiency (riboflavin)

18
Q

White patches in the mouth can be divided into those that wipe off and those that do not wipe off Which is pseudomembranous candidiasis? (Thrush) - what is formed here and where in the mouth? Which is leukoplakia?

A

Pseudomembranous candidiasis forms soft white patches on the mucosa which can be wiped off, leaving a red, raw or bleeding and painful surface - buccal mucosa, palate and tongue are common locations Leukoplakia forms an oral mucosal white patch that cannot be wiped off

19
Q

What are different risk factors for oral candidiasis?

A

Risk factors - * extremes of age, * diabetes mellitus, * antibitoics, * immunocompromised, * immunosupression - corticosteroids (incl inhalers), malignancy, HIV

20
Q

What is the treatment of oral thrush? What should be given if the patient is taking warfarin?

A

Miconazole or fluconazole gel are usually indicated for oropharyngeal thrush If contraindicated eg patient is taking warfarin (azoles enhance the anticoagulant effect of warfarin) * Then give nystatin suspension

21
Q

What is leukoplakia? Where in the mouth is affected? Why is it a lesion of worry?

A

Leukoplakia is a white patch in the mouth that cannot be rubbed away and is usually painless Leukoplakia most often appears on the tongue but can appear on the cheeks It is a lesion of worry as it is often a pre-malignant lesion to squamous cell carcinoma and therefore needs treatment

22
Q

What is the most common risk factors for leukoplakia? How is the condition treated?

A

Leukoplaia risk factors * Biggest one is smoking * Excessive alcohol intake is also a risk factor Most patches do not require treatment but it is important that you stop smoking / drinking * Usually a biopsy is taken, which may indicate the need for surgery

23
Q

What is erythroplakia? What is it highly suggestive of?

A

Erythroplakia (red plaque) represents vascularised leukoplakia and is highly suggestive of squamous cell dysplasia Biopsy warranted

24
Q

What is the form of leukoplakia seen in HIV patients that is caused by epsteinn barr virus? Is this pre-malignant?

A

The form of leukoplakia seen in HIV patients is oral hairy leukoplakia - shaggy white patch is seen on the side of the tongue It is not pre-malignant or malignant

25
Q

What is dry mouth known as? What is thought to be the main causes?

A

Xerostomia Dehydration Drugs After radiotherapy Sjorgen’s syndrome - dry eyes, dry mouth , parotid swelling

26
Q

Oral cancers are often preventable if people know and avoid the risk factors What are some risk factors for oral cancers?

A

SMOKING ALCOHOL HPV - 16 and 18 - strongly implicated in those who do not drink or smoke and are young Candida Chewing tobacco Diet and nutrition - low in Vit A, C and iron also increase risk

27
Q

What do smoking and alcohol both increase that is a major carcinogen?

A

Smoking (tobacco) and alcohol can both cause an increase in acetaldehyde - this is a major carcinogen

28
Q

What are the high risk sites of the mouth for oral cancer?

A

Soft non-keratinizing sites * The vental tongue/floor of mouth * Lateral tongue * Soft palate * Tonsillar pillars Rarer sites include - keratinised sites Dorsal tongue and hard palate

29
Q

What are the warning signs for oral cancer?

A

* Lump in the lip or oral cavity * Oral cavity red or red and white patch consistent with erythroplakia or erythroleukoplakia * Persistent neck lump * Ulceration in the oral cavity (unexplained and lasting for more than 3 weeks) Abnormal bleeding may occur also urgent referral for these within 2 weeks are generally recommended

30
Q

What are the key relevant questions to ask a patient when considering oral cancer?

A

* How long has the lesion been present? * Is the lesion painful? - pain is uusally a late manifestation - but would be expected of a benign ulcer * Does the patient smoke or drink and how much? * What colour is the lesion?

31
Q

What type of cancers are the majority of oral cancers?

A

90% of oral cancers are squamous cell carcinomas Other types such as adenocarcinomas (usually fro salivary glands), melanomas, sarcomas may occur

32
Q

How is an oral cancer diagnosed?

A

Biopsy of the lesion is usually the first step in diagnosis If the biopsy confirms that you have mouth cancer, you’ll need further tests to check what stage it’s reached before any treatment is planned - * Fine needle aspiration of neck lymph nodes * Often Ct / PET scan head and neck

33
Q

What are the main treatment options for oral cancer?

A

If found early, surgery +/- adjuvant radiotherapy can be given If found late, chemoradiotherapy is often advised

Decks in Year 1(B3) - Gastrointestinal Class (41):