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dental management > 5. gastrointestinal and hepatic ds. > Flashcards

5. gastrointestinal and hepatic ds. Flashcards

1
Q

what is the livers dual blood supply

A

20% hepatic artery - oxygented blood
80% portal vein - nutrients

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2
Q

function of hepatocytes

A
  • synthesize proteins
  • synthesize bilirubin
  • produces bile and cholesterol
  • regulate nutrients
  • prepares drugs for excretion
  • responsible for drug conjugation and metabolism
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3
Q

what is phase I and phase II

A

phase I - cytochrome p450; can produce toxic metabolites

phase II - conjugation (glucuronidation, sulfation, inactivation by glutathione, etc)

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4
Q

signs of liver ds

A

jaundice
ascites
edema
gi bleed
dark urine
light stool
mental confusion

xanthelasma

spider angiomas

palmar erythema

asterixis

hyperpigmentation

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5
Q

symptoms of liver ds

A

appetite loss

bloating

nausea

RUQ pain

fatigue

mental confusion

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6
Q

what is this

A

xanthelasma

signs of liver ds. due to cholesterold deposits in the dermis

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7
Q

what is this

A

spider angioma

sign of liver ds but not specific for liver ds

due to loss of clotting factors

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8
Q

what is asterixis

A

aka a flapping tremor

classic sign of hepatic encephalopathy (HE)

jerky movements when hands are extended at wrists

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9
Q

HE

A

hepatic encephalopathy

  • syndrome of altered neurologic function relayed to dysregulation of metabolism seen exclusively in pts with severe liver ds.

chronic for pts with cirrhosis

rarely fatal but big cause of hospitalizations of pts with cirrhosis

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10
Q

blood tests for liver ds

A

most common CBC and CMP

complete blood count (CBC) and comprehensive metabolic panel (CMP)

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11
Q

CBC evaluates what

A

RBC, WBC and platelets (PLTs)

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12
Q

CMP evaluates what

A

chemical lscreen or SMAC 14 (sequential multiple analysis - computer)

consist of 14 blood tests that serves as a broad screening tool.

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13
Q

liver function tess

A
  • bilirubin
  • ALP = alkaline phosphatase
  • Transaminases
    • AST or SGOT asparate amino transferase
    • ALT or SGPT alanin amino transferase
    • GGT gama-glutamyl transferase
  • Albumin
  • Globulin

need to knw the abbreviations

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14
Q

increase bilirubin

A

increased severity of liver injury

increased unconjugated serum (indirect) is NOT indicative of liver ds

increased conjugated (direct) IS indicative of liver ds

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15
Q

if alkaline phosphatase is high

A

may indicate a cholestatic ds

not specific for liver ds though

altered in myriad of ds especially bone neoplasms (normal and neoplastic bone)

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16
Q

ast high

A

aspartate aminotransferase SGOT

realted to glutamin oxalate metabolic pathways

indicates damage to the hepatocytes from hepatocellular ds

17
Q

alt high

A

alanine aminotransferase SGPT

part of pyruvate pathway in cell metabolism

indicates damage to the hepatocytes from hepatocellular ds

18
Q

ggt high

A

need for prot synth

used to detect alchol induced liver cell injury

indicates damage to the hepatocytes from hepatocellular ds

19
Q

ast:alt ratio

A

aspartate aminotransferase: alanine aminotransferase

ratio is more informative

lower the ratio, the most specific indicator of hepatic ds

20
Q

if albumin is low

A

hypoalbuminemia

not specific to liver ds

but indicative of chronic liver ds

21
Q

hepatitis b

A
  • enveloped DNA virus while all the others are RNA viruses
  • serum hepatitis, blood borne.
  • chronicity 90% in infants, 25-50% in children and less than 5% in adults.
22
Q

hepatitis C

A
  • RNA virus. No vaccine.
  • higher risk for baby boomers
  • theres a high risk for becoming chronic 75 to 85%
23
Q

mavyret

epclusa

harvoni

are used for what

A

mavyret (glecaprevir/pibrentasvir)

epclusa (sofosbuvir/velpatasvir)

harvoni (ledipasvir/sofosbuvir)

for hep C protease inhibitor therapy

24
Q

hepatitis D

A
  • coinfectin with HBV
  • more severe than HBV alone
  • higher risk of fulminant hepatitis with massive hepatocellular destruction
25
Q

hepatitis A and E

A

infectious, fecal-oral

v contagious and transmissible AIR BORNE not bood like the others

vaccinations

26
Q

viral hepatitis dental considerations

A
  • pt with active hep acute or chronic
    • defer all elective dental tc
      • if emergenct, consider referral, consult physician, isolation may be necessary
27
Q

viral hepatitis oral manifestations

A

bleeding

mucosal jaundice

glossitis

angular cheilosis

extrahepatic immunologic disorders with chronic HCV with oral lichen planus and sjogren like syndrome

28
Q

alcoholic liver ds dental considerations

A
  • pts with suspected, active, untx alcoholic liver are not candidates for routine, elective dental tx
  • oral neglect is common, should pts should demondstate ability to care for their dentition before any signifcant tx is provided
29
Q

AST: ALT ratio for alcholic liver ds

A

greater than 2

different than the generic rule that low ratio means liver ds.

ggt is also elevated.

30
Q

alcoholic liver ds oral manifestations

A
  • neglect
  • bleeding
  • ecchymoses
  • petechiae
  • glossitis
  • angular cheilosis
  • alcohol odor
  • partoid enlargment
  • xerostomia
  • pt with jaudiced mucosal tissue and breath that is sweet and musty are associated with liver failure
    • alcohol abuse is a strong risk factor for oral squamous cell carcinoma.
31
Q

peri/intra oral dental tx considertions in liver ds

A
  • perform extractions as atraumatically as possible
  • if doin SRP, do one tooth at a time not a whole quadrant
  • have local hemostatic agents available
    • place sutues in all extraction sites
32
Q

post dental tx considerations in liver ds

A
  • have pt sit for 20 mins to make sure local hemostatis is adequate before sending them home
  • do not rx NSAIDs for pain management
  • Can give acetamniphen up to 2g daily
  • supply pt with gauze
    *
33
Q

is antibiotic prophylaxis needed for pts with liver ds

A
  • NOT needed prior if no oral infection is present
  • pt with SEVER LIVER DS may need ab prophylaxis for invasive/surgical procuedures. Weigh out risk and benefits.
34
Q

LA to avoid for liver ds pts bc metabolized by the liver

A
  • lidocaine
  • mepivacaine
  • prilocaine
  • bupivacaine
    *
35
Q

analgesics to avoid for liver ds pts bc metabolized by the liver

A

aspirin (anticoagulant in nature and pt already has bleeding probs, need to coagulate)

acetaminophen (tylenol, datril) - can be used but limited. max daily dose 3-4 g.

codeine

meperidiene

ibuprofen (motrin)

hydrocodone, oxycodone

36
Q

sedatives to avoid for liver ds pts bc metabolized by the liver

A

diazepam

barbiturates

37
Q

antibiotics to avoid for liver ds pts bc metabolized by the liver

A

ampicillin

tetracycline

metronidazole

vancomycin

38
Q
A
39
Q

if need a sedative for a liver ds pt what would you use

A

lorazepam - bc its half life is so short that it would not last a long time in the system

dental management (8 decks)

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