Oral Inflammatory Lesions Quiz
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Questions and Answers

What is the primary cause of Aphthous Ulcers?

  • Unknown (correct)
  • Weakened immune system
  • Bacterial infection
  • Viral infection

    • What is the most common fungal infection of the oral cavity?

  • Oral Candidiasis (correct)
  • Oral Thrush
  • Oral Leukoplakia
  • Oral Mucositis

    • What is the common location of Atresia, fistulas, and duplications?

  • Stomach
  • Upper esophagus
  • Lower esophagus
  • At or near the tracheal bifurcation (correct)

    • What is the triad of characteristics of Achalasia?

    <p>Incomplete LES relaxation, increased LES tone, and esophageal aperistalsis</p> Signup and view all the answers

    What is the cause of Secondary Achalasia?

    <p>Both A and B</p> Signup and view all the answers

    What is the common result of Atresia, fistulas, and duplications?

    <p>Aspiration, suffocation, pneumonia, fluid and electrolyte imbalances</p> Signup and view all the answers

    What is the common type of esophagitis?

    <p>Chemical Esophagitis</p> Signup and view all the answers

    What is the common source of chemical irritants in Chemical Esophagitis?

    <p>Alcohol, corrosive acids or alkalis, excessively hot fluids, and heavy smoking</p> Signup and view all the answers

    What is the duration for which Aphthous Ulcers usually resolve spontaneously?

    <p>7 to 10 days</p> Signup and view all the answers

    In immunosuppressed individuals, which of the following is the most common cause of infectious esophagitis?

    <p>Candida</p> Signup and view all the answers

    What is the most frequent cause of esophagitis?

    <p>Reflux of gastric contents into the lower esophagus</p> Signup and view all the answers

    What is the clinical feature of reflux esophagitis?

    <p>Heartburn, dysphagia, and regurgitation of sour-tasting gastric contents</p> Signup and view all the answers

    What is the complication of chronic GERD?

    <p>Barrett esophagus</p> Signup and view all the answers

    What is the risk factor for esophageal adenocarcinoma?

    <p>Barrett esophagus</p> Signup and view all the answers

    What is the age range for the occurrence of squamous cell carcinoma?

    <p>45 years and above</p> Signup and view all the answers

    What is the male to female ratio for squamous cell carcinoma?

    <p>4:1</p> Signup and view all the answers

    What is the clinical feature of squamous cell carcinoma?

    <p>Dysphagia, odynophagia, and obstruction</p> Signup and view all the answers

    What is the male to female ratio for adenocarcinoma?

    <p>7:1</p> Signup and view all the answers

    What is the primary cause of Curling ulcers?

    <p>Severe burns or trauma</p> Signup and view all the answers

    What is a common symptom of chronic gastritis?

    <p>Nausea and upper abdominal discomfort</p> Signup and view all the answers

    What is a complication of chronic antral H.pylori gastritis?

    <p>All of the above</p> Signup and view all the answers

    What is the most common cause of chronic gastritis?

    <p>Helicobacter pylori</p> Signup and view all the answers

    What is a diagnostic test for Helicobacter pylori infection?

    <p>All of the above</p> Signup and view all the answers

    What is a risk factor for Helicobacter pylori infection?

    <p>Poverty</p> Signup and view all the answers

    What is a consequence of chronic antral H.pylori gastritis?

    <p>Increased acid secretion</p> Signup and view all the answers

    What is the pH of the gastric lumen?

    <p>pH 1</p> Signup and view all the answers

    What is a type of gastritis associated with intracranial disease?

    <p>Cushing ulcers</p> Signup and view all the answers

    What type of cells are found in the antral glands that release gastrin to stimulate luminal acid secretion?

    <p>G cells</p> Signup and view all the answers

    Which of the following is a mechanism that protects the gastric mucosa?

    <p>The mucus layer protects the epithelium</p> Signup and view all the answers

    What is a common association of Peptic Ulcer Disease?

    <p>H. pylori infection or NSAID</p> Signup and view all the answers

    What is the name of the ulcers that occur in the stomach, duodenum or esophagus of those with intracranial disease?

    <p>Cushing ulcers</p> Signup and view all the answers

    What is the primary function of chief cells in the gastric glands?

    <p>To produce and secrete digestive enzymes such as pepsin</p> Signup and view all the answers

    What is the primary cause of stress-related gastric injury?

    <p>Severe physiologic stress</p> Signup and view all the answers

    What is the location of Curling ulcers?

    <p>Proximal duodenum</p> Signup and view all the answers

    What is the effect of prostaglandins on the gastric mucosa?

    <p>Enhanced bicarbonate secretion and increased vascular perfusion</p> Signup and view all the answers

    What is the time frame in which stress-related gastric injury typically appears?

    <p>Within 3 days of disease</p> Signup and view all the answers

    What is the primary location of peptic ulcers in the stomach?

    <p>Interface of the body and antrum</p> Signup and view all the answers

    What is the effect of H.pylori infection on acid secretion?

    <p>It increases acid secretion by 2-6 times</p> Signup and view all the answers

    What is the common cause of perforation in peptic ulcers?

    <p>Erosion of the ulcer into the peritoneal cavity</p> Signup and view all the answers

    What is the effect of cigarette smoking on peptic ulcers?

    <p>It impairs mucosal blood flow and healing</p> Signup and view all the answers

    What is the common location of duodenal ulcers?

    <p>Proximal duodenum</p> Signup and view all the answers

    What is the effect of hypergastrinaemia on peptic ulcers?

    <p>It increases gastric acid production</p> Signup and view all the answers

    What is the common symptom of peptic ulcers?

    <p>Epigastric burning or aching pain that occurs 1-3 hours after meals</p> Signup and view all the answers

    What is the complication of peptic ulcers that can cause iron deficiency anemia?

    <p>Hemorrhage</p> Signup and view all the answers

    What is the effect of psychological stress on peptic ulcers?

    <p>It increases gastric acid production</p> Signup and view all the answers

    Study Notes

    Oral Inflammatory Lesions

    • Aphthous Ulcers (Canker Sores)
      • Common superficial mucosal ulcerations
      • More frequent in the first 2 decades of life
      • Extremely painful and often recur
      • Cause is unknown
      • Ulcers can be solitary or multiple
      • Most cases resolve spontaneously in 7 to 10 days, but can recur

    Oral Candidiasis (Thrush)

    • Most common fungal infection of the oral cavity
    • Candida albicans is a normal component of the oral flora
    • Predisposing factors:
      • Immunosuppression
      • Specific strain of C. albicans
      • Composition of the oral microbial flora (microbiota)

    Esophagus

    Obstructive and Vascular Diseases

    • Mechanical Obstruction
      • Atresia, fistulas, and duplications
      • Discovered shortly after birth due to regurgitation during feeding
      • Most commonly at or near the tracheal bifurcation
      • Associated with a fistula connecting the upper or lower esophagus to a bronchus or trachea
      • Complications: aspiration, suffocation, pneumonia, fluid and electrolyte imbalances
    • Functional Obstruction
      • Achalasia
        • Characterized by the triad of:
          1. Incomplete LES relaxation
          2. Increased LES tone
          3. Esophageal aperistalsis
        • Primary Achalasia: caused by failure of distal esophageal inhibitory neurons & degenerative changes in neural innervation (idiopathic)
        • Secondary Achalasia: caused by Chagas disease (destruction of the myenteric plexus, failure of LES relaxation, and esophageal dilation), diabetic autonomic neuropathy, etc.

    Esophagitis

    • Chemical Esophagitis
      • Caused by chemical irritants:
        1. Alcohol
        2. Corrosive acids or alkalis
        3. Excessively hot fluids
        4. Heavy smoking
        5. Iatrogenic (cytotoxic chemotherapy, radiation therapy, graft-versus-host disease)
    • Infectious Esophagitis
      • Most frequent in immunosuppressed
      • Caused by:
        1. Herpes simplex viruses (punched-out ulcers)
        2. Cytomegalovirus (CMV), shallower ulcerations
        3. Candida, adherent, gray-white pseudomembranes
        4. Mucormycosis, aspergillosis
    • Reflux Esophagitis
      • Reflux of gastric contents into the lower esophagus is the most frequent cause of esophagitis
      • Clinical condition: Gastroesophageal Reflux Disease (GERD)
      • Causes:
        1. Conditions that decrease LES tone or increase abdominal pressure
        2. Alcohol and tobacco use
        3. Obesity
        4. Pregnancy
        5. Hiatal hernia
      • Clinical Features:
        • Most common in adults, most common in those over 40 years of age
        • Heartburn, dysphagia, regurgitation of sour-tasting gastric contents

    Barrett Esophagus

    • Complication of chronic GERD
    • Characterized by intestinal metaplasia within the esophageal squamous mucosa
    • 10% of persons with symptomatic GERD
    • Typically present between 40 and 60 years of age
    • Confers an increased risk of esophageal adenocarcinoma
    • Majority of esophageal adenocarcinomas are associated with Barrett esophagus
    • Clinical Features:
      • Usually prompted by GERD symptoms and requires endoscopy and biopsy

    Esophageal Tumors

    • Squamous Cell Carcinoma
      • Most common esophageal tumors
      • Occurs > 45 years of age
      • Males: females ratio = 4:1
      • Half occur in the middle third
    • Risk factors:
      • Tobacco and alcohol use
      • Poverty
      • Caustic esophageal injury
      • Achalasia
      • Plummer-Vinson syndrome
      • Frequent consumption of very hot beverages
    • Clinical Features:
      • Dysphagia, odynophagia, and obstruction
      • Extreme weight loss
      • Hemorrhage
      • Aspiration of food through a tracheoesophageal fistula
    • Adenocarcinoma
      • Men: women ratio = 7:1
    • Risk factors:
      • Barrett esophagus and long-standing GERD
      • Tobacco use
      • Obesity
      • Previous radiation therapy
      • Diet low in fruits and vegetables
    • Clinical Features:
      • Pain or difficulty in swallowing
      • Progressive weight loss
      • Chest pain or vomiting

    Stomach

    • Divided into four major anatomic regions: cardia, fundus, body, and antrum
    • Cardia lined mainly by mucin-secreting foveolar cells
    • Antral glands similar, but also contain endocrine cells, such as G cells, that release gastrin to stimulate luminal acid secretion
    • Gastric lumen strongly acidic (pH: one)
    • Mechanisms that protect the gastric mucosa:
      • Mucus layer protects the epithelium
      • Mucosa has a neutral pH due to bicarbonate ion secretion
      • Rich vascular supply to the gastric mucosa delivers oxygen, bicarbonate, and nutrients while washing away acid
      • Protective effects of prostaglandins, which include enhanced bicarbonate secretion and increased vascular perfusion
    • Stress-related gastric injury occurs in patients with severe trauma, extensive burns, intracranial disease, major surgery, serious medical disease, and other forms of severe physiologic stress
    • Ulcers appear in the first 3 days of disease
    • Ulcers are given specific names based on location and clinical associations:
      • Stress ulcers affecting critically ill patients with shock, sepsis, or severe trauma
      • Curling ulcers occur in the proximal duodenum and are associated with severe burns or trauma
      • Cushing ulcers arise in the stomach, duodenum, or esophagus of those with intracranial disease and have a high incidence of perforation

    Acute Peptic Ulceration

    • Causes:
      • NSAIDs
      • Stress ulcers (critically ill patients with shock, sepsis, or severe trauma)
      • Curling ulcers (occurring in the proximal duodenum and associated with severe burns or trauma)
      • Cushing ulcers (intracranial disease, have a high incidence of perforation)
    • Clinical Features:
      • Nausea, vomiting, and coffee-ground hematemesis
      • Perforation

    Chronic Gastritis

    • Symptoms are less severe but more persistent than those of acute gastritis
    • Nausea and upper abdominal discomfort may occur, but hematemesis is uncommon
    • Causes:
      • Helicobacter pylori
      • Autoimmune gastritis (atrophic gastritis), 10% of cases of chronic gastritis
      • Radiation injury and chronic bile reflux

    Helicobacter pylori Gastritis

    • Present in 90% of chronic gastritis affecting the antrum
    • Increased acid secretion that occurs in H. pylori gastritis may result in peptic ulcer disease of the stomach or duodenum
    • H. pylori infection causes antral gastritis with high acid production, despite hypogastrinemia
    • Chronic antral H. pylori gastritis may progress to pangastritis, resulting in multifocal atrophic gastritis, reduced acid secretion, intestinal metaplasia, and increased risk of gastric adenocarcinoma
    • H. pylori infection is associated with poverty, household crowding, limited education, residence in areas with poor sanitation
    • Diagnosis:
      • Serologic test for anti–H. pylori antibodies
      • Fecal bacterial detection
      • Urea breath test
      • Gastric biopsy (analyzed by rapid urease test, bacterial culture, or PCR)

    Complication of Chronic Gastritis

    • Peptic Ulcer Disease (PUD)
      • Most often associated with H. pylori infection or NSAID
      • PUD may occur in any portion of the gastrointestinal tract exposed to acidic gastric juices
      • Most common in the gastric antrum and first portion of the duodenum

    Peptic Ulcer Disease (PUD)

    • Epidemiology:
      • PUD is common and is a frequent cause of physician visits worldwide
    • Gastric hyperacidity is fundamental for PUD
    • H. pylori infection
    • Hypergastrinaemia (Zollinger-Ellison syndrome: PUD in the stomach, duodenum, and even jejunum, caused by tumor
    • Cofactors in peptic ulcer:
      • Cigarette smoking (impairs mucosal blood flow and healing)
      • High-dose corticosteroids (suppress prostaglandin synthesis and impair healing)
      • Alcoholic cirrhosis
      • Chronic obstructive pulmonary disease
      • Chronic renal failure
      • Hyperparathyroid

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    Description

    This quiz covers types of oral inflammatory lesions, including aphthous ulcers and oral candidiasis, their causes, symptoms, and treatments.

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