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what is an aphtous ulcer?
what percentage of the population have aphthous ulcers?
how do you treat mouth aphthous ulcers?
- LA mouth wash
- topical 0.1% triamcinolone steroids
- topical choline salicylate
mortality from oral ca?
why is oral ca more common in asia?
they chew betel nuts
risk factors for oral ca?
- poor diet
- betel nuts
clinical picture of oral ca?
- solitary red patch
- fixed lump
- lip numbness
what is trismus?
difficulty opening mouth
what does PDT, used for treating oral ca, stand for?
what is vincent's angina?
invasion of the mucous membrane by BORRELIA VINCENTI a commensual
esp if the host is immunocompromised
what are the symptoms of vincent's angina?
- painful, deep ulcers in gums
treatment of vincent's angina?
- H2O2 mouthwash
- broad spectrum abx
what is candidiasis caused by?
- CANDIDA ALBICANS
- commensal yeast
management for candidiasis?
- amphotericin suspension
- lozenges for oral thrush
what is parotitis?
- painful parotid swelling
- could cause and abscess
name a viral and bacterial cause of parotitis?
where in the GI tract can you get ulcers?
what is steven-johnson's syndrome?
- when the epidermis separates from the dermis
- due to hypersensitivity
name two systemic non-GI diseases that can cause ulcers?
name two types of malignancies that can cause oral ulcers?
- kaposi's sarcoma
name some systemic diseases that can cause parotid gland swelling?
what percentage of the population have GORD?
symptoms of GORD?
- worse when lying/bending/night
- 'acid laryngitis'
- weight loss
GORD could mimic what conditions? (2)
- asthma (chronic cough)
risk factors for GORD?
- NOT ALCOHOL
non medical management for GORD?
- weight loiss
- stop smoking
- sleep sitting up
medication for GORD?
- histamine receptor antagonists
tests you would do for someone who presents with GORD?
- and measure pH at gastro-oesophageal junction
- diagnostic is if it's <4
complications of GORD?
- barrett's oesophagus
- anaemia from chronic blood loss
- benign oesophageal stricture
- gastric volvulus
- hiatus hernia
what is barrett's oesophagus?
- metaplasia of the oesophus from squamous to collumnar
- could lead to dysplagia and ca
foods that are risk factors for GORD?
name an infection that can causes oesophagitis?
what is eosinophilic oesophagitis?
- associated with atopic features and presents with dysphagia
- kids: treat with elimination diet
- adults: give PPIs, montelukast, topical steroids
through which muscle does the pharynx herniate in a pharyngeal pouch?
symptoms of a pharyngeal pouch?
what is the pain like in a pharyngeal pouch?
- like CP
- NOT like heartburn
tests for a pharyngeal pouch?
- barium swallow
- endoscopy if you're suspection a perf
treatment of a pharyngeal pouch?
what is achalasia of the oesophagus?
- hypertrophy of the lower oesophageal sphincter so it can't relax
- -> progressive dilatation of the oesophagus
two queried causes of achalasia of the oesophagus?
- lack of NO release from inhibitory neurones to sphincter
- dodgey dorsal vagal nuclei in brainstem
- Chagas disease
what causes Chagas disease?
why do you always endoscopy someone who you suspect has achalasia of the oesophagus?
ca of the cardia presents the same way
what does manometry show in achalasia of the oesophagus?
- increased pressure at the sphincter
- decreased contractility of the dilated oesophagus
complications of a pharyngeal pouch?
pulmonary aspiration esp at night
describe the dysphagia of oesophageal achalsia?
- solids get stuck
- liquids are better
- standing and moving during eating helps
complications of achalasia of the oesophagus?
- pulmonary aspiration esp at night
- oeso squamous cell ca
what is the endoscopic treatment of oesophageal achalasia?
- forceful pneumatic dilatation of sphincter
- or inject botox into sphincter
what is the surgical management of oesophageal achalasia?
- Heller's op: myotomy
- with partial fundoplication to stop risk of post-op reflux
what is nutcracker oesophagus?
- extremely forceful oesophageal peristalsis
- angina-like pain and dysphagia
- give nifedipine or nitrates