Escolar Documentos
Profissional Documentos
Cultura Documentos
Herpes Virus - Herpetic Stomatitis, Cold Sore, Fever Blisters. HSV 1; HSV 2 (STD)
-Small vesicles containing clear fluid
-Dormant in Ganglia; reactivated by Stress, fever, trauma, sun, infection
Lips and nose
-Immunocompromised more virulent. Gingivostomatitis. Conjunctiva. Esophagus
-Presentation: Vesicles-bullae. Rupture produces painful ulcers
- Epidemiology - HSV-1 asymptomatic primary infection in children age 2-4 yrs, 10-20% of infections cause acute herpetic
gingivostomatitis
- HSV-2 w/sexual maturity, 2-4 outbreaks in first year
-Causes: HSV-1 & HSV-2, re-activation of virus results from stress and immunosuppression
-Duration: 3-4 weeks, infection for lifetime
-Rx: Topicals for pain & antivirals
Candidiasis - Thrush, Monoliasis due to Candida albicans
- Pseudomembranous, white, curd-like, circumscribed
- Diabetes, Antibiotics, Glucocorticoids, Anemia, Cancer, HIV
Coxsackie (hand-foot-mouth) Painful small vesicles on the hands, feet, and diaper area
- Small ulcers in the throat, tongue, soft palate
-Epidemiology - <10 years of age. Summer & Fall
-Causes Coxsackievirus or Enterovirus
-Duration Recovery in 5-7 days
-RX: Palliative (Tylenol & NSAIDS). No aspirin in kids can be used in adults
Oral Cancer
-Majority are squamous cell carcinoma
-Usually seen after age 40
-Lesions may cause localized pain or difficulty chewing, but most are asymptomatic
-If detected early, 90% survival rate
-Otherwise, only 20% - 40%
Salivary Glands
Sialadenitis - Inflammation of salivary glands due to Trauma, Infection (Mumps), Autoimmune
- Due to rupture of salivary duct with leakage into surrounding tissue and Blockage of duct
- Chronic: decreased production of saliva or autoimmune due to sjorgren syndrome
Lichen Planus
-Presentation: - dry and undulating, "lichen-like" appearance of affected skin
- Affects the mucous membranes (tongue and insides of cheek)
- Papules that form plaques
- Oral lesions can appear prior to the skin eruptions
- Can be tender or painful
- White, lace-Iike pattern is Wickham's striae
-Epidemiology: benign chronic disease, self limiting, 30-60 yrs, F>M, uncommon in children
-Causes: Unknown. Allergic or immune reaction, Hepatitis C, liver disease, pharmaceuticals
-Duration: self-limiting w/resolution at 1-2 yrs
-Rx: palliative (antihistamine, topical anesthetics, steroids, immunosuppressants)
Pemphigoid
-Presentation - Bullae on mucous membranes, including the oral cavity.
- Itching & pain
- gingiva is desquamative
- Deposition of IgG and complement in the basement membrane
-Epidemiology: most frequent blistering disease of the skin (7-10/million/yr), elderly,
F>M
-Causes: autoimmune, antibodies to BPAG2 (collagen type 18) cause blistering, medications (penicillin, etanercept (Enbrel),
sulfasalazine (Azulfidine) and furosemide (Lasix).
-Duration: months-years, relapsing-remitting
-Rx: biopsy and steroids, immunosuppressants
Bacterial
Acute necrotizing ulcerative gingivitis/periodontitis
-Presentation: Inflammation & infection of ligaments & bone that support the teeth
-Epidemiology: - very common, 3050% of US population
- 10% have severe forms
- increased w/smoking, stress, poor oral hygiene, HIV, leukemia, Crohns,
diabetes, Down syndrome
-Causes: spirochetes, bacteroides, unknown
-Rx: good oral hygeine, antibiotics, smoking cessation, stress reduction, life style changes
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Describe the types of Protein-Energy Malnutrition and their significant features and explain
the mechanisms of the adverse effects of each
Protein-Energy Malnutrition (PEM)
-Common in low income countries. Up to 25% of children
-Developed countries. Elderly & debilitated patients
-Malnutrition:
-BMI <16 kg/m2
-(Normal BMI 18.5-25 kg/m2)
-Body weight <80% normal
-2 Protein Compartments which are Regulated differently
Primary: Marasmus, Kawashiorkor
Secondary: Cachexia
Marasmus
-Weight <60% of normal
-Catabolism/depletion: somatic protein & subcutaneous fat
-Normal serum albumin
- Low leptin HPA release of cortisol lipolysis
- Emaciated extremities
- Head appears too large for body
- Anemia and vitamin Deficiencies
Kwashiorkor
-Protein deprivation > calorie reduction
-Weaned too early, chronic diarrhea, nephrotic syndrome, extensive burns
-Loss of visceral protein, spared subcutaneous fat & muscle
-Hypoalbuminemia edema
-Weight loss masked by fluid retention
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Explain the functions of Vitamin A, D and C and the clinical effects of the deficiency and
toxicity of each
FUNCTIONS OF VITAMIN A:
1. RETINA: retinal+opsin = rhodopsin
-Rhodopsin + light = neuronal activity = VISION
2. CELL GROWTH & DIFFERENTIATION: retinoids + retinoic acid receptors
-(RAR, RXR) = growth/ differentiation of mucus secreting epithelium
3. METABOLIC EFFECTS: fatty acid oxidation in fat tissue and muscle, adipogenesis, lipoprotein metabolism, obesity
4. IMMUNE SYSTEM: stimulate immune response in intestines, antioxidant
CLINICAL USE OF VITAMIN A:
1. Treat skin disorders (acne/psoriasis) BEWARE TERATOGEN!
2. Acute Promyelocytic Leukemia
- Truncated RAR gene blocks myeloid cell differentiation
- Retinoic acid treatment overcomes the block causing leukemia cells to differentiate into neutrophils
VITAMIN A DEFICIENCY:
CAUSES:
1.Undernutrition
2.Malabsorption of fats:
-Infection in children,
-Absorption poor in infants
-Celiac disease, Crohns disease, colitis
-Bariatric surgery
-Elderly persons w/continuous use of mineral oil (laxative)
SYMPTOMS:
1. RETINA: impaired vision, night blindness especially
2. DIFFERENTIATION OF EPITHELIUM: epithelial metaplasia & keratinization
-EYES
1. Xerophthalmia: Dry eye - keratinization of lacrimal & mucus secreting epithelium
2. Bitot spots: Keratin debris in eye
3. Keratomalacia: erosin of corneal surface
-UPPER RESPIRATORY
1. Squamous metaplasia: predisposes to pulmonary infections, predisposes to renal and urinary stones
3. IMMUNE DEFICIENCY
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Measured by BMI
-Weight in kg / (height in meters)2
- Normal: 18-25 kg/m2
- Overweight: 25-30 kg/m2
-Obese: over 30 kg/m2
-Skinfold measurements
-Circumferences (i.e. waist to hip ratio)
-Not only total body weight, but also Distribution
-Visceral Obesity
-Fat accumulation in trunk and abdomen
-Higher risk for disease