werner@aecom.UUCP (Craig Werner) (03/06/86)
<<<>>> > A young woman brings her 8-year old son to the Pediatric clinic you > are rotating through. Half hysterical, she explains that he has refused > to eat for two days. You examine the child. He is not febrile or weak. > In fact, he is quite healthy looking, as well as restless and uncooperative. > After some effort, you convince him to open his mouth for examination, which > reveals a hard-palate (first half of the roof of the mouth) which is > inflamed, ulcerated, and in a layman's term, thoroughly disgusting. > > 1. What is the best course of action? > 2. What treatment would be recommended? > 3. What is a possible (general or specific) cause? > [ark@alice suggested the child lay off the "Fizzies", a candy of some sort. It's close but not quite.] Let me answer this case methodically. The actual diagnosis is at the end. 1. Best course of action. Do nothing for a week. Most pathology in the mouth is due to trauma, and most mouth trauma will heal in a week. So wait a week - if it was just trauma, it will go away. If it wasn't, a week's wait will not alter the course much. Remember this is a condition of 2 days duration (actually yesterday and today = 2, which is really 1), and the child is otherwise healthy. 2. "The practice of medicine is to do as much nothing as possible" said Samuel Shem, as I have described above. However, an Anxiolytic such as Valium could be prescribed -- NOT for the kid, he's doing fine -- for the MOTHER :-)! 3. This type of lesion - an ulcerated hard palate, the whole thing, has a name, which as you'll see is descriptive of the cause. It's called a "Pizza Sign," and it's usual cause is eating that first slice of pizza when it's still too hot (Stouffer's French Bread Pizza always does this to me). Just to go over some general topics. "Fizzies" or hot liquid would probably burn the tongue and soft palate further back in the mouth. The hard palate is what is hit during the act of biting something. Any lesion in the mouth that doesn't heal within a week or two is to be considered suspicious, especially in a smoker, drinker, or chawer. Any suspicious lesion in the midline, above or below the tongue, will probably turn out to be benign or developmental. Anything off the midline should get thee to a ENT will all deliberate speed. Most oral cancers, I should add, are not picked up by doctors. They are picked up by dentists. In this case, it is probably a case of doctors being farsighted - they try so hard to look back at the throat, they miss the mouth. Some huge oral cancers, though, have been completely ignored or denied by patients, and by huge I mean inches and pounds. An alternate explanation is that nowadays, people go for regular dental checkups but not regular physicals, but that's another topic. [I open the floor to discussion.] [To dr@ski, in case the mail fails, don't worry about it. Your postings were excellent.] -- Craig Werner !philabs!aecom!werner "... you can do anything you want, but not everything you want."
morris@Shasta.ARPA (Kathy Morris) (03/09/86)
In article <2302@aecom.UUCP> werner@aecom.UUCP (Craig Werner) writes: ><<<>>> >> A young woman brings her 8-year old son to the Pediatric clinic you >> are rotating through. Half hysterical, she explains that he has refused >> to eat for two days. > However, an Anxiolytic such as Valium >could be prescribed -- NOT for the kid, he's doing fine -- for the MOTHER :-)! Of course, the mother won't be happy without a prescription for *something*. Surely it would be more useful to *explain* what you think the problem is? I thought that was the difference between treating people and treating animals -- people deserve (and should get!) explanations. Perhaps you missed your true calling in life :-) Kathy Morris (morris@diablo.stanford.edu, ...!Glacier!diablo!morris)