Note: This material is copyrighted. All ights reserved. (Edward F. Goljan, M.D.) PART IL NOTES SUBJECT PAGES Gastrointestinal 1-16 Hepatobiliary/pancreas 17-33 Renal/lower urinary 34-61 STD/gynecology 62-80 Endocrine 81-105 Musculoskeletal 106-122 Skin 123-135 CNS/special senses 136-154: j Note: This material is copyris iohted. All rights reserved. (Edward F. Goljan, M.D) GASTROINTESTINAL PATHOLOGY ORAL CAVITY AND SALIVARY GLANDS @ Common infections in the oral cavity Disease Clinical Comments Organism Coxsackievirus Herpangina| Hand-foot-mouth disease Children between 3-10 yr. Fever, pharyngitis, cervical lymphadenopathy. Multiple vesicles and/or ulcers surrounded by erythema located on soft palate and pharyngeal tissue. Young children. Fever and vesicles located in mouth and distal extremities. Herpes simplex typel Gingivostomatitis Children <5 years old, Primary disease produces systemic signs of fever and cervical adenopathy. Painful vesicles usually develop on the lips, gingiva, oropharyngeal mucosa. Remains dormant in cranial sensory ganglia, Recurrent herpes simplex (herpes labialis) is nonsystemic and involves the vermilion border of lips. Reactivated by stress, sunlight, menses. "| Epstein-Barr virus (EBV) Pharyngitis Hairy leukoplakia Infectious mononucleosis is commonly associated with an exudative pharyngitis/tonsillitis and painful cervical adenopathy. Palatal petechia are present. Bilateral white, hairy excrescences on lateral border of tongue, Pre-AIDS defining lesion. Not a precursor to cancer. Rx: acyclovir —_— Streptococcus pyogenes Pharyngitis Aonsillitis 20-35% of cases of exudative pharyngitis/tonsillitis. Majority (-0%) viral induced (adenovirus, EBV, coxsackievirus). Lab Dx: direct antigen detection or culture (gold standard), Rx: penicillin G. Clo Rose vex Candida albicans Oral candidiasis Thrush (pseudomembranous candidiasis) may occur in neonates (while passimg—througt the birth canal) or immunocompromised patients (common in AIDS). Pseudoifiembrane covers the oral mucosa. When wiped off, it leaves a bleeding mucosal surface. Gram stain reveals budding yeasts and pscudohypha. Pre-AZDS defining lesion. ‘Actinomyces Israeli “Anaerobs. Gram + {filamentous bacteria. Draining sinuses inthe jaw, chest cavity, apd abdomen. | aK ESN Sulfur granules contain bacteria, (eellow & Leukoplakic lesions in mouth or genital area: Bx to R/O squamous dysplasia/cancer @ — Smokeless tobacco: verrucoid squamous cancer Si placed @ Squamous cancer in mouth: 1. causes~ A. smoking MCC B. alcohol CC. smoking/aleohol are synergistic 2 sites— ‘A. _ lateral border of tongue MC site B lower lip: note- upper lip is a basal cell carcinoma La qeanors el cesenene 1 geeees in the mouth in the area where the tobacco isNote: This material is copyrighted. All rights reserved. (Edward F. Goljan, M.D.) C. under tongue © — Oral pigmentation: 1. Peutz-Jeghers sonarome 2. Addison's disease => \ Bose. 3. Pb poisoning in adult “=== @ Gum hyperplasia: 1. phenytoin 2. pregnancy 3. scurvy 4, acute monocytic leukemia & Deviation of uvula to the opposite side in a patient with exudative tonsillitis: peritonsilar abscess Salivary glands: 1. mumps MC infection 2. mixed tumor MC neoplasm— parotid MC location 3. mucoepidermoid carcinoma is the MC malignant salivary gland tumor 4. — minor salivary gland tumors are more likely to be malignant than major salivary gland tumors ESOPHAGUS i & Dysphagia for solids not liquids: sign of mechanical obstruction ° 1 strictures, ~~ 2. Plummer-Vinson esophageal web associated with iron deficiency 3. esophagealcancer ~~ —— — 4, Barrett's esophagus with ulceration and stricture " coe © Dysphagia for solids and liquids: . enedom, 1. peristalsis problem 2. causes— V7 eds emeotly muscle, A. achalasia rect B. progressive systemic sclerosis/CREST syndrome C. polymyositis: upper esophagus in striated muscle D. myasthenia gravis: upper esophagus in striated muscle © — Odynophagia 1. painful swallowing 2. MCCis esophagitis cendioa © TE fistula: 1. proximal esophagus ends blindly and distal esophagus arises from the trachea (air in the stomach) ->7 2. polyhydramnios in mother @ Patient with dysphagia and a fetid 0 1. Zenker’s diverticulum —> © 2. MC diverticulum in the esophagus 3. pulsion diverticulum through an area of weakness in cricopharyngeus muscle 4. collects food (bad breath)/inflamed & Motor disorders of esophagu: 1. achalasia is MC motor disorder of esophagus— ‘A. failure of relaxation of LES sphincter due to absent myenteric ganglion cells: ganglion cells normally contain vasointestinal peptide, which relaxes the LES aperistalsis sud dilatation of proximal esophagus see ace 5 Wee \ Mw OHNO muller g