7- Gastrointestinal diseases

Question 1

What are peptic ulcer diseases?

Answer 1

they are diseases that compromise the mucosa of the gastrointestinal tract: commonly found in the stomach & duodenum

Question 2

What are factors that would increase the likelihood of development of peptic ulcer diseases?

Answer 2

1.) Genetics
2.) Smoking
3.) Alcohol use
4.) Prolonged NSAID use

Question 3

What are the pathophysiologies of peptic ulcers?

Answer 3

1.) Decrease mucosal defense
2.) increased hostile factors
3.) A presence of helicobacter pylori (around 60-90%)

Question 4

What does helicobacrer pylori do in peptic ulcers?

Answer 4

1.) It adheres to the surface of the GI tract
2.) Causes the formation of ammonia

Question 5

What does a decrease of mucosal defense result in peptic ulcers?

Answer 5

1.) Reduced prostaglandin syntehsis
2.) Decreased mucous production
3.) Reduced bicarbonate secretion

Question 6

What does an increase in hostile factors result in peptic ulcers?

Answer 6

1.) Increased acid production
2.) Increased gastrin and pepsin production

Question 7

What are the symptoms of peptic ulcer disease?

Answer 7

1.) Epigastric pain
2.) Feeling of fullness
3.) Nausea
4.) Black, tarry stool if there is GI bleeding

Question 8

What kind of epigastric pain can exacerbate in duodenal ulcers?

Answer 8

When the stomach is empty

Question 9

What kind of epigastric pain can exacerbate in gastric ulcers?

Answer 9

When you are eating

Question 10

What are the medical managements used for peptic ulcer diseases?

Answer 10

1.) Anti-secretory medications:

• histamine receptor antagonists
• Proton pump inhibitors
• Prostaglandins

2.) Antibiotics

3.) Reduction/cessation of: smoking, alcohol use, NSAID use, stress

Question 11

What are the dental management used for peptic ulcer diseases?

Answer 11

1.) H. pylori can be found in dental plaque

2.) Used to treat ulcers can disrupt the oral flora

3.) If there is stenosis, can result in the regurgitation of acid into the oral cavity:
- enamel erosion & soft tissue damage.

Question 12

What are the treatment planning considerations for peptic ulcer diseases?

Answer 12

1.) Stress management
2.) Pain management: Recommend acetaminophen over NSAIDs
3.) Chair position: Certain positions can exacerbate pain

Question 13

What is an inflammatory bowel disease?

Answer 13

It includes ulcerative colitis + Crohn’s disease which is more common US and Europe.

*They are the unknown cause is genetic predisposition triggered by environmental factors.

Question 14

What are the pathophysiologies of IBD?

Answer 14

1.) Impaired intestinal barrier: bacterial penetration
2.) Characterized by ulcers: uniform in ulcerative colitis + crohn’s has skip lesions
3.) Cyclical diseases: repeated inflammation and healing can result in intestines adhering to the abdominal wall

Question 15

What are the symptoms of IBD?

Answer 15

1.) Abdominal cramps

2.) Diarrhea

3.) Rectal bleeding or bloody diarrhea (ulcerative colitis)

4.) Malabsorption:
- Nutrition
- Dehydration
- Weight loss

Question 16

What are the medical managements of IBD?

Answer 16

1.) Palliative treatment: meds only used to managed.
2.) Anti-diarrheals
3.) Anti-inflammatories: corticosteroids
4.) Immunosuppressants
5.) Surgical resection of diseased areas

Question 17

What are the dental symptoms seen in IBD?

Answer 17

1.) Triggering of conditions due to antibiotics
2.) Immunosuppressants making the patient more vulnerable to infections & slower healing
3.) Aphthous-like ulcers

Question 18

What are treatment planning considerations?

Answer 18

1.) Only urgent care is recommended during flares
2.) Avoid NSAIDs: use acetaminophen or opioids as alternatives.
3.) Monitor for side effects of prolonged medication use

Question 19

What is hepatitis?

Answer 19

it is an inflammation of the liver.

Question 20

What are infectious examples of hepatitis?

Answer 20

1.) Tuberculosis
2.) Syphilis
3.) Viral:
- Heptatitis viruses
- Epstein-Barr virus

Question 21

What are the non-infectious examples of hepatitis?

Answer 21

1.) Hepatotoxic drugs
2.) Alcohol

Question 22

What are the pathophysiologies of hepatitis A virus?

Answer 22

1.) It’s acute: so not persistent and quite mild but can spread quite easily
2.) Fecal oral transmission
3.) Viral loads peak 2 weeks after infection
4.) Life-long immunity after infection
5.) Complications are rare

Question 23

What are the pathophysiologies of the hepatitis B virus?

Answer 23

1.) Can be acute or chronic
2.) It is spread through bodily fluids: typically transmitted

Question 24

What are the pathophysiologies of hepatitis C virus?

Answer 24

1.) Acute or chronic
2.) Transmitted through parenteral route (and more rarely through sex)

Question 25

What are the pathophysiologies of hepatitis D virus?

Answer 25

1.) Will replicate if you have been already infected with HBV
2.) rapid progression to liver failure and cirrhosis
3.) Fatality rate with a combination of HBV will be at its highest sitting at 20%.

Question 26

What is a coinfection?

Answer 26

When both HDV and HBV infect the individual at the same time.

Question 27

What is a superinfection?

Answer 27

When there is more consequences than co-infection in which can infect someone who is already a carrier of hepatitis B

*More likely to develop a chronic type of co-infection and more likely to develop something called fulminant hepatitis (massive dying hepatitis)

Question 28

What is the pathophysiology of Hepatitis E?

Answer 28

1.) It is spread through the fecal route
2.) It is less contagious than Hep A, but can manifest as a both acute or chronic types of hepatitis

Question 29

What are the symptoms of viral hepatitis?

Answer 29

1.) Non-specific:
- fever
- fatigue
- lack of appetite
- joint pain

2.) Jaundice
3.) Dark urine

Question 30

What are the complications of viral hepatitis?

Answer 30

1.) Fulminant hepatitis:
- massive necrosis of hepatocytes. The mortality rate of about 80%

2.) Cirrhosis:
- Replacement of hepatocytes with fibrotic tissue after damage.
- most common in all types

Question 31

For what variant of hepatitis infections are there vaccines for?

Answer 31

1.) Hep A Virus
2.) Hep B Virus (HDV)

Question 32

True or False, there is a vaccine for Hep C virus?

Answer 32

False, there is no vaccine for Hep C virus.

Question 33

What is the acute medical management of hepatitis?

Answer 33

1.) primarily supportive:
- IV fluids, anti emetics, symptomatic treatment.

Question 34

What is the chronic medical management of hepatitis?

Answer 34

1.) Supportive care:
- Antiviral medications against HBC, HCV

Question 35

What are the dental managements of viral hepatitis?

Answer 35

1.) Immunization of HBV for healthcare providers
2.) Urgent care for those with active hepatitis
3.) Caution with drugs metabolizing in the liver in severe diseases.
4.) Avoid corticosteroids: may enhance viral replication
5.) Excessive bleeding may occur in end-stage liver disease

Question 36

What are some treatment plan considerations for hepatitis infections?

Answer 36

1.) No special tx for anyone recovering from hepatitis
2.) Bleeding be in issue for those with significant liver damage
3.) Special care to look for oral manifestations:
- lichen planus
- Sjogren-like xerostomia
- Squamous cell carcinoma

Question 37

What is alcohol liver disease?

Answer 37

Damage to the liver due to chronic excessive alcohol intake.

Question 38

What are the 3 stages of liver damage?

Answer 38

1.) Fatty liver/steatosis
2.) Alcoholic hepatitis
3.) Fibrosis/cirrhosis

Question 39

What does the fatty liver/steatosis stage of liver damage encompass?

Answer 39

• Fatty infiltrates into hepatocytes (fat moving into the hepatocyte)
• Reversible

Question 40

What does the alcoholic hepatitis stage of liver damage encompass ?

Answer 40

• Diffuse inflammation in the liver
• Reversible but can be fatal if widespread

Question 41

What does fibrosis/cirrhosis stage of liver damage encompass?

Answer 41

• Fibrosis and abnormal liver structure
• Irreversible

Question 42

What does a chronic ethanol intake cause?

Answer 42

Results in acetalhydrate, which is a hepatotoxic which can cause damage to the lipids & cause oxidative stress.

Question 43

What can acetylhydrate produce?

Answer 43

NADH & Lipid peroxidation

Question 44

What can NADH production from acetyl hydrate cause?

Answer 44

1.) Can cause an increase in lipogenesis & decrease in FA oxidation for fatty liver.

2.) oxidative stress for hepatocyte injury

Question 45

What can lipid peroxidation cause?

Answer 45

1.) Hepatocyte injury

Question 46

What are the symptoms of alcoholic liver disease?

Answer 46

• Abdominal swelling
• dry mouth
• bleeding from enlarged esophageal veins
• yellowing of the skin
• red, spider-like veins
• redness on feet
• memory problems
• numbness in extremities
• fainting

Question 47

How is alcoholic liver disease managed?

Answer 47

1.) Abstaining from alcohol
2.) Management of withdrawal symptoms
3.) Corticosteroids
4.) Nutrition support:
- calories
- iron
- folate

Question 48

Why are untreated alcoholic liver disease patients not candidates for elective dental care?

Answer 48

1.) Bleeding tendencies

2.) Metabolism of drugs: -tolerance to local anesthesia

3.) Spread of infections: - Healing may be impaired
- Reduced ability to clear transient bacteremias

4.) Results of Glossitis due to nutritional deficiencies

5.) Halitosis: liver failure is associated with a sweet. musty odor

6.) EOE/IOE: hypertrophied salivary glands, angular cheilitis, jaundiced gingiva, increased risk of oral squamous cell carcinomas

Question 49

What are treatment plan modifications made for patients with alcoholic liver disease?