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REVISION BDS > Diseases > Flashcards

Diseases Flashcards

1
Q

type 1 diabetes

A

insulin deficient

autoimmune B cell destruction

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2
Q

type 2 diabetes

A

insulin resistant

metabolic disorder

generally old, fat, no exercise, genetically predisposed

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3
Q

signs/symptoms of diabetes

A

ketoacidosis (rare in type 2)

hyperglycaemia

polydipsia (thrist)

polyurea (urine)

ketoacidosis (glucose cannot be used for energy, so fat used)

swearing

palpitations

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4
Q

complications of diabetes

A

large vessel

  • stroke risk
  • MI risk
  • claudicatin/foot amputation

small vessel

  • poor wound healing
  • renal disease
  • maculopathy
  • neuropathy - weak/muscle wasting
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5
Q

test for diabetes

A

RPG - random plasma gluocse (>11.1mMol/L=Diabetes)

HbA1C

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6
Q

type 1 diabetes tx

A

basal-bolus insulin injection

split mixed insulin injection

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7
Q

type 2 diabetes tx

A

less 10%% fat intake in diet

  • count carbohydrates
  • gastric bypass
  • diet pills - sibutramine
  • oral hypoglycaemic agent

sulphonylureas-gliclaszide

  • increase insulin secretion and sensitvity
  • hypoglucaemia

biguanides metformin

  • increase insuline sensitvity
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8
Q

dental impact of diabetes

A

gingivitis/periodontitis

poor wound healing

oral candidiasis

xerostomia -> inc incidence of caries

give prophylatic antibiotics for invasive treatment

LA given should not interfere with eating as may become hypo

  • tx in morning after breakfast and hypoglycaemic agents
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9
Q

hyperthyroidism

causes

A
  • Graves disease (70-80%) autoimmune - stimulates TSH
    • sign - opthalmopathy
  • toxic multi-noduluar goitre
  • pituitary adenoma (rare)
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10
Q

signs/symptoms of hyperthryoidism

A

increased metabolism

diarrhoea

palpitations. tachycardia. atrial fibrilation

hypertension, heart failure

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11
Q

test for hyperthyroidism

A

blood test for TSH

  • low T3 and T4
  • high, if adenoma
  • high TSH and T3 adn T4

FNB - fine needle biopsy

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12
Q

tx for hyperthyroidism

A

raidiopaque iodine

partial thyroidectomy

give carbimazole and T4 replacement (prolonged tx =hyperthyroidism)

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13
Q

dental relevance of hyperthryoidism

A

inc pain and anxiety

goitre if detected by dentists

accelerate periodontal disease

premature toth eruption thryotoxic crisis can be preciptitated by stress, surgical procedures and infections - medical emergency, mortality of 10%

pt with hyperthyroidism may be sensitive to adrenaline (LA)

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14
Q

hypothryoidism

causes

A

Hashimoto’s thyroiditis - autoimmune

too much iodine

thyroidectomy

thryoid atrophy

drug induced - carbimazole

hypothalamic/pituitary disease - rare

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15
Q

signs/symptoms of hypothyroidism

A

hair loss

slow mental state

heat intolerant

dry skin

weight gain

brachycardia

goitre

angine

delayed reflexes

constipation

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16
Q

tests for hypothyroidism

A

blood test for TSH

  • high T3 and T4
  • rare - low TSH and T3 and T4

FNB - fine needle biopsy

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17
Q

tx for hypothyroidism

A

with t4 replacements

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18
Q

dental relevance of hypothyriodism

A

low pain threshold

delayed tooth eruption

enlarge tongue

bad wound healing

myxodema - if give sedation can cause coma

sensitive to opioids and bezodiazepine

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19
Q

causes of hyperadrenalism

A

adrenal tumour

pituitary adenoma

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20
Q

Conn’s syndrome

A

increased aldosterone

increased Na/H2O reabsorption

resulting in poor BP control, risk of stroke, MI and renal failure

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21
Q

treatmeant for Conn’s syndrome hyperadrenaalism

A

ACE inhibitors - enalapril, ramapril

angiotensin 2 blocker

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22
Q

Cushing’s syndrome

A

increased ACTH - increased cortisol

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23
Q

signs/symptoms of Cushing’s syndrome

A

balding

moon face

buffalo hump

acne

weight gain

thin skin

hypertension

diabetes

osteoporosis

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24
Q

test for Cushing’s syndrome

A

increased cortisol in urin

CRH test - give CRH and produce high levels of ACTH

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25
Q

treatment for Cushing’s syndrome

A

reduce therapeautic steroid use

remove tumour

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26
Q

Addison’s disease

A

destruction of adrenal tissue due to autoimmune disease - not producing enough steroid hormones, inc cortisol

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27
Q

signs/symptoms of Addison’s disease

A

hypotension

vomitting

dehydration

weight loss

buccal pigmentation - melanin

postural hypotension (low BP)

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28
Q

addison’s disease is

A

hypoadrenalism

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29
Q

test for Addison’s disease

A

give ACTH, no plasma cortisol level rise

check plasma level for cortisol

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30
Q

tx for addison’s disease

A

therapeutic corticosteroids

  • hydrocortisone - hypertension
  • prednisolone - atheroscelrosis
  • bethamethasone - inc infection risk
  • fludrocortisone - peptic ulceration and inc cancer risk, osteoporosis
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31
Q

dental relavance of Addison’s disease/hypoadrenalism

A

steroid prophylaxis if: surgery, infection or physiological stress

NOT routine tx, PMH steroid use

antibiotics as prone to infection

buccal pigmentation commmon

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32
Q

asthma

A

reversible airflow obstruction

hypersensitivity reaction

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33
Q

normal resp rate

A

12-15 breaths/min

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34
Q

signs/symptoms of asthma

A

inflammation in airways

excess mucous

smooth muscle constriction

cough

stridor

wheeze

dyspnoea

pain

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35
Q

test for asthma

A

FEV1 - forced expiratory volume

chest x-ray

FEV1/FVC

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36
Q

tx asthma

A

beta2 agonists

  • salbutamol
  • short acting bronchodilator - tx initial IgE hypersensitivity response

short acting B2 agonist and anti-inflammatory, corticosteroids

  • beclomethasone
  • budesmide
  • fluctisone
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37
Q

dental relevance of asthma

A

NSAIDs can worsen asthma attack

inhaled steroids - change in oral mucosa

inhaler before tx, spacer to prevent deposisiton

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38
Q

COPD

A

chronic obstructive pulmonary disease

chronic bronchitis and emphysema

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39
Q

emphysema

A

destruction of alveoli, others dialte to fill space

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40
Q

causes of COPD

A

smoking

tumours - asbestos

fibrosis - coal, berylium

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41
Q

signs/symptoms of COPD

A

chronic cough

shortness of breath

sputum produced

expiratory wheeze

poor ventilation

narrow airways

restrictive lung defects - reduced FVC, lung volume, oxygenation, inc work of breathing

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42
Q

complications of COPD

A

pnumothorax

right heart failure

expiratory failure

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43
Q

tests for COPD

A

FEV1 - forced expiratory volume

chest x-ray

FEV1/FVC

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44
Q

tx for COPD

A

stop smoking

long acting bronchidilator - salmeterol + fluctisone

oral steroids

O2 support

antibiotics for infections

physiotherapy

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45
Q

dental relevance for COPD

A

keep session short

care with rubber dam

candida infection for oral steroids

no sedation

inhaler before treatment

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46
Q

cystic fibrosis

A

autosomal recessive disorder, affecting the gene coding for the CFTR protein on chromosome 7

defect Cl- channels, excess thick mucous in lungs and pancreas

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47
Q

signs/symptoms of Cystic fibrosis

A

cough

diarrhoea

poor weight gain

osteoporosis

chest infections - pseudomnas and staph cocci

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48
Q

complications of cystic fibrosis

A

malabsorption

pneumonia

lung damage - pulmonary failure

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49
Q

test for cystic fibrosis

A

heel prick

  • Guthrie test in children
  • test for hypothyroidism and sickle cell anaemia

sweat test

  • increased NaCl in sufferers of CF
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50
Q

tx for cystic fibrosis

A
  • physiotherapy - mucous removed from lungs
  • exercise - increased pulmonary strength and defends against osteoporosis
  • heart and lung transplant - new lungs no Cl- channel defect
  • medication
    • b2 agonists
    • antibiotics - decreased chest infections
    • steroids to reduce inflammation
    • DNAse to breakdown mucous
    • pancreatic enzyme replacment
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51
Q

dental impact of CF

A

increased caries

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52
Q

hypertension defined as

A

140/90

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53
Q

causes of hypertension

A

usually secondary

Risk factors

  • age
  • race
  • obesity
  • alcohol
  • FH
  • pregnancy
  • stress

Diseases

  • Cushing’s syndrome
  • hyperthyroidism
  • atherosclerosis
  • renal artery stenosis
  • phenochromcytoma

Drugs

  • corticosteroids
  • sympatomemetics
  • NSAIDs
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54
Q

signs/symtoms of Hypertension

A

TIAs (transient ischamic attacks)

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55
Q

complications of hypertension

A

atherosclerosis

MI

stroke

claudication

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56
Q

tests for hypertension

A

urine analysis

ECG

renal ultrasound

renal angiography

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57
Q

tx for hypertension

A

treat underlying cause

lifestyle changes

review cardiac symptoms drugs

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58
Q

dental relevance of hypertension

A

best treated under LA

care with adrenaline

inc post-op bleedng

no tx if 160/110

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59
Q

heart failure is

A

output of heart is unable to meeting demands of the tissues

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60
Q

causes of heart failure

A

low output

  • MI
  • valve disease
  • arrhythmias
  • atrial fibrilation

high output

  • anaemia
  • hyperthyroidism - thyrotoxicosis
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61
Q

symptoms of heart failure

A

left heart failure

  • dyspnoea
  • hypotenion
  • arrhythmias
  • atrial fibrilation

right heart failure

  • venous pressure elevated
  • oedema in ankles
  • enlarged liver/poor GI
  • fatigure weakness
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62
Q

test for heart failure

A

chest x ray - caridiac enlargement/pneumonia oedma

ECG

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63
Q

tx heart failure

A
  • exercise
  • Low salt diet
  • Diuretics, ACE inhibitors, incotrope – Digoxin (decrease force of contraction)
    • Reacts with verapamil and Las
  • Surgery
  • Oxygen – low O2
  • Morphine for pain
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64
Q

dental relevance of heart failure

A
  • Orthopnoea
  • Digoxin reacts with adrenaline and LA
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65
Q

ischaemia

A

narrowing of blood vessels leading to imbalance of blood supply from the heart and demand from the tissues

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66
Q

causes of ischaemia

A

coronary atheroma

  • plaque with platelet aggregates, smooth muscle fibrosis

risk factors

  • age
  • male
  • family history
  • smoking
  • hypertension
  • obesity
  • alcohol
  • oral contraceptive
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67
Q

signs/symptoms of ischaemia

A

angina pectoris

  • classic - worse with exercise, subsides with rest
  • unstable - rapid deterioration

peripheral vascular disease

breathlessness

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68
Q

test for ischaamia

A

ECG - at rest and at exercise

angiography

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69
Q

treatment for ischaemia

A

diet and smoking advice

reduce afterload

reduce preload - nitrates

bypass blockage (CABG)

aspirin - anti-platelet, decreased MI risk

diuretics

ACE inhibitors

Ca2+channel blockers

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70
Q

infarction

A

blood vessel occlusion

no o2 delivery - necrosis of tissue

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71
Q

causes of infarction

A

progression of ischaemia - atheroma (ulcerative plaque with platelet aggregates)

thrombosis on surface, platelets detaches and blocks vessels

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72
Q

signs/symptoms of infarction

A

complications

  • MI - coronary artery atheroma - death, arrythmias, heart failure, embolism
  • Stroke - carotid artery, loss of function of areas in brain - necrosis
  • TIAs
  • claudication - femoral or popliteal
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73
Q

Test for infarction

A

ECG

  • T wave inversion = MI
  • Q wave can indicate previous MI
  • Cardiac enzymes – creatine kinase, troponin
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74
Q

tx for infarction

A

open blood flow to ischaemic tissue - angioplasty

bypass blockage

amputation

thrombolysis of atheroma

give aspirin straight away

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75
Q

endocarditis

A

inflammation of the hear endocardium, vegetation on the valves due to microbial infection

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76
Q

causes of endocarditis

A
  • Previous endocarditis
    • Rheumatic fever
  • Heart valve replacement
  • Scaling
  • Tooth brushing
    • Strept. Veridans – oral commensual
  • Extraction
    • Staph aureus
  • Endodontics
    • Streptococci
  • Implants
    • Enterococci
  • Incision of abscesses
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77
Q

signs/symptoms of endocarditis

A

heart murmur

rashes

flu

weight loss

splenomegaly

78
Q

test for endocarditis

A

endocardiogram - vegetation on heart valves

blood cultures

79
Q

tx for endocarditis

A

4 weeks of bactercidal antibiotics - valmycin

o2 support

80
Q

dental relevance of endocarditis

A

check risk category according to SDCEP guidance

81
Q

congenital heart defects

A

stuctural/functional defects of the heart present at birth

can manifest at any time

82
Q

types of congenital heart defects

A
  • Atrial septal defects
  • Ventricular septal defects
    • Mixing O2 and non-O2 blood
  • Patent ductus arteriosus
    • Irregular transmission from aorta and pulmonary artery
  • Co-arctation of aorta
    • Narrowing of aorta where ductus arteriosus connected
    • Ischaemia to lower limbs
    • Left ventricular hypertrophy
83
Q

signs/symptoms of congenital heart defects

A

poorly oxygenated blood

heart murmur/failure

chest infections

84
Q

test for congenital heart defects

A

chest x-ray

angiography

ECG

MRI

85
Q

treatment of congenital heart defects

A

surgical correction

86
Q

valve disease causes

A

Can occur in aortic, pulmonary, mitral and tricuspid

Causes

  • Congenital
  • MI
  • Rheumatic fever
  • Dilation of aortic roots (aortic anneuyrism)

same signs/symptoms as heart failure

87
Q

test for valve diseases

A

chest x ray

angiography

ECG

MRI

doppler ultrasound

88
Q

tx for valve disease

A

valve replacement (prosthesis)

Antibiotics and anticoagulants needed

89
Q

anaemia

A

reduction in the o2 carrying capacity, defined by low Hb

90
Q

normal male Hb

A

13.5g/100ml

91
Q

normal female Hb

A

11.5g/100ml

92
Q

thalassemia can cause

A

cirrhosis

gallstones

skeletal hyperplasia

treat with blood transfusion - DO NOT overload with Fe (heart failure)

93
Q

causes of anaemia

A

Decreased production

  • Marrow failure – overall decrease in RBC
  • Renal failure - EPO
  • Deficiency in Fe, folic acid, vitamin B12
  • Abnormal globin chains – thalassemia
  • Chronic inflammatory disease

Increased losses

  • Excessive bleeding
  • Menstruation

Increased demand

  • Pregnancy
  • Cancer
  • Hypothyroidism – bradycardia
94
Q

signs/symptoms of anaemia

A

fatigue

weak

dizzy

palpitations

tachycardia

brittle nails

95
Q

tests for anaemia

A
  • Endoscopy – chrons
    • MCV = HCT/RCC measure micro/normo/macro cytic
  • FBC
    • HCT = RCC/FBC x 100%.45% men, 40% women
  • Renal function
  • Bone marrow
  • Haemintinc test
96
Q

tx for anaemia

A
  • Fe replacement
  • Folic acid replacement
  • Vit B12 replacement
  • Blood transfusion
  • EPO
97
Q

dental relevance of anaemia

A
  • Pale mucosa
  • Angular cheilitis
  • Smooth tongue (Fe deficient)
  • Beefy tongue (vit B12 deficient)
  • Oral ulcerations
  • Poor wound healing
98
Q

thrombophilia

A

increased risk of bleeding

99
Q

thrombocytopenia

A

decreased number of platelets

100
Q

causes of thromobophilia or thrombocytopenia

A

idiopahtic

alcohol

drugs - penicillin, heparin

101
Q

thrombocythemia

A

increased numbers of platelets

102
Q

causes of thrombocythemia

A

inherited

  • protein C syndrome
  • protein 5 syndrome
  • antithrombin 3 deficient
  • factor V leiden
  • thrombocythaema

acquired

  • anti-phospholipid - lupus
  • surgery
  • pregnancy
  • trauma
  • oral contraceptives
103
Q

signs/symptoms of thrombocythemia

A

shortness of breath - protein C/s when start on warfarin, risk of skin necrosis

palpitations

chest pain

DVT

inc risk of MI

inc risk of stroke

104
Q

test for thrombocythemia

A

INR - ratio of prothrombin time: prothrombin time (norm)

105
Q

treatment for thrombocythemia

A

oral anticoagulants

  • warfarin
  • dabigatran
  • rivaroxaban

heparins

antiplatelets

  • aspirin
  • clopidogrel
  • dipyridamole
106
Q

dental relevances of thrombocythemia

A

inc risk of haemorrhage

when restrat warfarin - hypercoagulation rebound state

if on warfarin - appointment within 24hrs of INR, do in the morning, avoid block injections. DO NOT TREAT IF INR >4

107
Q

haemophilia

A

inherited bleeding disorder

  • Factor VII
  • Factor IX
  • factor XI
  • Von Willebrand’s
108
Q

haemophilia A

A

factor VII deficiency

sex linked recessive, female carriers, male sufferers

tx: desmopressin, controls transport of factor VII

109
Q

haemophilia B

A

factor IX deficiency

tx: give factor IX, pt can develop antibodies to factors, if low level inhibition inc conc

110
Q

Von Willibrand’s

A

decrease in VWb factor

VWBf is precursor to factor VIII

decreased platelet adhesion

Type 1 mild dominant

Type 2 mild dominant

Type 3 severe recessive - Treat in Hospital

Treatment of VWBf

  • DDAVP – desmopressin, mild cases treat with Tranexamic acid
111
Q

dental relevances of bleeding disorders

A

gingival bleeding

prolonged bleeding following XLA

112
Q

leukaemia

A

tumours of haemopoietic precursor cells in bone marrow

translocation mutations - switch off tumour precursor, switch on oncogenes

113
Q

process of leukeamia

A

clonal proliferation of cells

replacement of marrow

marginalisation of noraml marrow

marrow failure

organ infiltration

114
Q

types of leukaemia and who they commnly affect

A

Acute lymphoblastic leukaemia

  • Kids

Chronic lymphoblastic leukaemia

  • B cells

Acute myeloid leukaemia

  • Adults

Chronic Myeloid leukaemia

  • Neutrophils
115
Q

signs/ symptoms of leukaemia

A

anaemia

neutropenia

  • inc infection
  • perianal thrush
  • tonsilitus/pharygitis
  • pneumonia/bronchitis

thrombocyopenia

  • bruise easily
  • decreased clotting
  • inc gingival bleeding

lymphadenopathy

splenomegaly

hepatomegaly

bone pain in children

116
Q

treatment for leukaemia

A

chemotherapy

radiotherapy

haemopoietic stem cell transplant

monoclonal antibodies

117
Q

dental relevance of leukaemia

A

ginigval bleeding

oral ulceration

  • necrotic ulcerative periodontitis
  • mucosititis

gingival enlargment

candidosis

ROU - herpes

Lytic bone lesions

118
Q

lymphoma is

A

clonal proliferation of cells in the lymph system

119
Q

stages of lymphoma

A
  1. 1 site
  2. 2 sites
  3. above and below diaphragm
  4. non-lymph tissues
120
Q

Hodgkins Lymphoma

A

cancer of lymph system

121
Q

signs/symptoms of hodgkin’s lymphoma

A

lymphadenopathy

fever

night sweats

infection

weight loss

122
Q

non-hodgkins lymphoma

A

affects non nodular lymph tissue

Causes

  • H pylori
  • EBV
  • Immunosuppression – autoimmune
  • Arthritis
  • Transplant

Signs/Symptoms

  • Lymphadenopathy
  • Waldeyer’s ring
123
Q

test for lymphoma

A

blood tests

124
Q

treatment of lymphoma

A
  • Hodgkins
    • Stage 1 and 2 – 90% survival
    • Stage 3 and 4 – 60%
  • Non- hodgkins
    • Aggressive
    • Difficult to treat
125
Q

dental relevance of lymphoma

A

lymphadenopathy

anaemia - bleeding

126
Q

multiple myeloma is

dental relevance

A

Malignant proliferation of plasma cells

  • Paraprotein in blood

Lytic jaw bone lesions

127
Q

impact of loss of kidney function

A
  • Loss of excretory function
  • Loss of acid/base balance
  • Loss of H2O and electrolyte failure
  • Endocrine function
    • EPO - anaemia possible complication
    • Ca2+ metabolism, decreased vit D
    • Renin production decreased – hypertension
128
Q

acute renal failure

A

rapid loss of renal function hours/days

pt anuric with H2O retention

129
Q

causes of acute renal failure

A

pre-renal

  • all pre-renal causes = acute
  • decreased blood flow to kidneys
  • hypovolaemia
  • hypotension
  • heart failure
  • renal atery stenosis

renal

  • glomerulonephritis
  • acute tubular necrosis
  • drug damage - NSAIDs
  • rhabdomyolysis
  • lupus (SLE)

post-renal

  • kidney stones
  • enlarged prostate
  • bladder tumour
130
Q

sigsn/symptoms of acute kidney failure

A

fatigue

loss of appetite

headache

nausea

peripheral oedema

pulmonary oedema - treat with diuretics

metabolic acidosis - treat with NaHCO3

hyperkalaemia - treat with antiperkalemics

131
Q

tx of acute kidney failure

A

dialysis/nutrition support

acute is reversible

132
Q

chronic renal failure

A

gradual loss of renal function

over years

associated with ESRD

133
Q

causes of chronic renal failure

A
  • diabetes (40%), secondary cause
  • hypertension (25%), secondary cause
  • glomerulophritis (12%), primary cause
134
Q

signs/symptoms of chronic renal failure

A

anaemai

hypertension

oedema

nuropathy

hypocalcaemia

hypertension

encephalopathy

Fe deficieny anaemia - decreased EPO

pulmonary oedema

hyperkalemia

135
Q

test for chronic renal failure

A

serum creatinine >0.6-1.2mg/Dl

GFR < 60ml/min/1.73

136
Q

tx of chronic renal failure

A

haemodialysis outside the body

  • blood pumped from atrio-venous fistula to dialyser then back to AV fistula
  • heparin given for anticoagulation

peritoneal dialysis

  • inside the body
  • fluid pumped into peritoneal space, waste products discarded

endocrine replacement

  • EPO injections
  • renin replacement
  • vit D for Ca2+

renal transplant

  • rejection risk
  • immunosuppression - inc infection
  • cardiac mortality
137
Q

dental relevance of renal failure

A
  • Treat after haemodialysis
  • Increased cardiac risk
  • Drug complications
    • Prednisolone
    • Cylosporin
    • Azthropine
  • Ulceration
  • Candidiasis
  • Parotiditis
  • Stomatitis
  • Lytic jaw bone lesions
  • Uraemic stomatitis
  • Slow tooth eruption
  • Xerostomia
138
Q

recurrent oral ulcerations ROU

A

minor aphthae - most common

major aphthae - any mucosa affected

herpetiform aphthae - herpes like small sores

139
Q

oral foacial granulomatosis

A

swelling of lips and cobblestoning of buccal mucosa

140
Q

causes of GORD

A

hiatus hernia - defect of lower oesophageal sphincted, sphincter is found in the thorax

impaired clearing into stomach

impaired gastric emptying

141
Q

signs/symptoms of GORD

A

epigastric burning

dysphagia

GI bleeding

pain

142
Q

complications of GORD

A

ulceration

inflammation

metaplasia - Barrett’s Oesphagus

  • strat. Squamous to simple columnar epithelium, can become cancerous – adenocarcinoma
143
Q

tx for GORD

A

stop smoking

weight loss

avoid triggers e.g. coffee

antacids (rennies)

H2 receptor anatgonists - ranitidine

protien pump inhibitors - omeprazole, lansoprazole, pantoprazole

144
Q

peptic ulcer disease

A

present in oesphagus, duodenum, stomach

over production of acid

145
Q

causes of peptic ulcer disease

A

excessive acids

reduced protective barrier - caused by H Pylori

NSAIDS and corticosteroids

146
Q

signs/symptoms of peptic ulcer disease

A

gastro-oesphageal burning

pain - relieved by eating

vomiting blood

147
Q

complications of peptic ulcer disease

A

acid can burn through peritoneum/arteries

lymphoma of stomach if left untreated

148
Q

tests for PUD

A

endoscopy

history

barium swallow

149
Q

tx for PUD

A

triple therapy

  • Antibiotics
    • Amoxycillin
    • Metronidazole
  • Protein pump inhobitors
    • Omeprazole

Vagotomy – sever vagus nerve – reduced ACh which reduces acid secretion, but also reduces motility

Gastrectomy

150
Q

dental relevance of PUD

A

avoid NSAID prescription

151
Q

Crohn’s disease

A

Granulomatous disease affects any part of the GI tract from mouth to anus

  • Discontinuous
  • Non-vascular oedematous cobblestoning
  • Transmural
  • Serosa

Unknown cause

  • Risk factors
    • Smoking
    • Psychological
    • Genetic
152
Q

signs/symptoms of Crohn’s

A
  • Abdominal pain and diarrhoea
  • Orofacial granulomatosis
  • Mucosal cobblestoning
  • Thickened gastro-intestinal wall
  • Abcesses
  • Malabsorption
  • Food intolerance
  • Persistent viral infection – immunocompromised
153
Q

tests for Crohn’s

A
  • Blood test
  • Faecal testing
  • colonoscopy
  • endoscopy
  • barium studies
154
Q

treatment for Crohn’s

A
  • corticosteroids - anti-inflammatory
    • prednisolone
  • ASA – anti-inflammatory
    • Mesalazine
  • Immunosuppressants
    • Azathioprine, methotrexate
  • Palliative
    • Colectomy
155
Q

dental relevance of Crohn’s

A

Orofacial granulomatosis

  • Granuloma – block lymphatics, immunocompromised à viral infection
  • Lip swelling
  • Cobblestoning of buccal mucosa
  • Angular chelitis
  • Gingivitis
  • Ulceration
  • Food intolerance
156
Q

ulcerative colitis

A

chronic inflammation

colon and terminal ileum

  • vascular
  • ulcers
  • mucosal - mucosal abscesses

Unknown cause

  • Risk factors
    • Smoking g
    • Psychological
    • Genetic
157
Q

signs and symptoms of ulcerative colitis

A

bloody diarrhoea

mucosal abscesses

destruction of goblet cells

abdominal pain

158
Q

complication of UC

A

can develop into carcinoma

159
Q

tests for UC

A
  • Blood test
  • Colonoscopy
  • Endoscopy
  • Barium studies
  • Faecal testing
160
Q

tx for UC

A
  • Colonectomy CURES UC
  • Acute – treat with predisnolone
  • Long term – treat with non-steroidal immunosuppressant
161
Q

dental relevance of UC

A

ulceration

immunocompromised - viral infection

162
Q

coeliac disease

A

intolerance to alpha-glaiden component of gluten

Signs/symptoms

  • Weight loss
  • Fatigue
  • Abdominal pain
  • Diarrhoea

NEED LIFELONG GLUTEN FREE DIET

163
Q

complications and tests for coeliac disease

A

Complications

  • T lymphocytes
    • Release cytokines
    • Villous atrophy jejunum
    • Malabsorption of Fe, Vit B12, folic acid, fat
  • Anaemia
  • Failure to thrive in children
  • Increased risk of lymphoma

Test

  • Endoscopy
  • Jejunal biopsy
  • Faecal fat
  • Antibodies
    • Presence of anti-glaiden
164
Q

dental relevance of coeliac disease

A

oral ulceration

aphthae

glossitis

dysphagia

linked with dermatitis herpetiformis - IgA deposited in skin

165
Q

bowel carcinoma

risk factors

A
  • Polyposis in small intestine, small risk
  • Polyposis in large intestine, increased risk

Risk Factors

  • Crohn’s
  • Ulcerative colitis
  • Family history
  • Polyps
  • Smoking
  • Diet/ exercise
  • Drinking
166
Q

signs/symptoms of bowel carcinoma

A

weight loss

abdominal pain

blood in poo

167
Q

complications and tests for bowel carcinoma

tx needed

A

Complications

  • Metastasis – liver, lung and bone
  • Anaemia

Test

  • Colonoscopy
  • Biopsy
  • FOB test
  • CT – check metastasis
  • Duke’s classification

Treatment

  • Surgery
  • Chemotherapy
  • Radiotherapy
168
Q

dental relevance of bowel carcinoma

A

oral presentation of anaemia

169
Q

jaundice

A

accumulation of bile in the skin

yellow pigmentation and itch

macrophages in spleen and bone produced

170
Q

pre-hepatic jaundice

A

Increased haem load

  • Abnormal RBC
    • Haemolytic anaemia
    • Autoimmune disease
  • Gilbert’s disease
    • Decreased uptake of billrubin

Treatments

  • Treat anaemia and autoimmune disease
171
Q

hepatic jaundice

A

Cannot conjugate bilirubin in cell

  • Hepatitis (for both)

Cannot secrete bilirubin from cell

  • Cirrhosis (for both)

Signs/Symptoms

  • Unconjugated bilirubin therefore normal stool
172
Q

post-hepatic jaundice

A

Obstruction

  • Intrahepatic (biliary sclerosis)
  • Extra-hepatic (gallstones)
    • Inflammation of gallbladder – Cholecystitis
    • Gallstones causes pain in shoulder and abdominal pain bought on by fatty diet
  • Pancreatic carcinoma

Signs/Symptoms

  • Conjugated bilirubin therefore pale urine and dark stool

Treatments

  • Remove obstruction – stent, ERCP
  • Remove gallbladder
  • Reduce fat diet
  • Cholestryramine - sequesters bile acid therefore no reabsorption into GIT
173
Q

tests for jaundice

A

ultrasound

x-ray - radiopaque gallstones

ERCP

174
Q

causes of liver failure

A

alcohol

drug induced (paracetamol)

hepatitis

cancer

cystic fibrosis - bile ducts blocked by mucous

175
Q

cirrhosis

signs/symptoms

A

jaundice

osphageal varices

oedema (ascites) in the abdomen

encephalopahty - accumulation of toxins in BS, confusion in brain

spider naevi

palmer erythema

176
Q

cirrhosis

complications

A

dec platelets - throbocytopenia

dec clotting factors

dec albumin - slow drug transport

dec metabolism of drugs

177
Q

tests for liver failure

A

INR

hepatic cell enzymes - ALT and GGT

178
Q

tx for liver failure

A

treat underlying cause of cirrhosis - e.g. stop drinking

transplant

179
Q

dental relevance of cirrhosis

A
  • Drug metabolism affected
  • Avoid NSAIDs
  • Avoid anti-fungals (fluconazole)
  • avoid intravenous sedation
  • If reduced platelets
    • Treat within 24hrs INR
    • Test in morning
    • Limit to 3 extractions
180
Q

transmission of HIV

A

blood

saliva

semen

breast milk

vaginal secretion

181
Q

progression of HIV

A

acute primary infection

latent period

symptomatic stage

182
Q

signs/symptoms of HIV

A

fever

weight loss

swollen lymph

183
Q

complications fo HIV

A

AIDS - CD4+ <200ul of blood

1 of 25 conditions indicative of severe immunosuppression

184
Q

test for HIV

A

blood test for CD4+ AIDS r pressure of antiretrovirals

185
Q

tx of HIV

A

treat infections (fluconazole antifungal)

anti-retrovirals - AZT and HAART

protease inhibitors

186
Q

dental relevance of HIV

A
  • Candidosis
  • Karposi’s sarcoma – blood vessels lesions present on the skin
  • Hairy leukoplakia
  • Periodontal disease
  • Children – enlarged parotid gland
187
Q

Hep A

A

Spherical single stranded RNA

Transmission:

  • faecal, oral or H2O borne

test

  • antigen present in faeces

treat

  • vaccine 1: single dose, booster within 6 months. Gives 10 years protection
  • vaccine 2: human normal immunoglobulin. Gives 4 months protection
188
Q

hep B

A

HBeAg has a 1/3 of chance infection from sharps injury

Double stranded DNA

8 subtypes

Transmission

  • IV drug users
  • Sexual
  • Infants borne infected – high risk HIV as immunocompromised
  • Organ transplant

complications

  • cirrhosis
  • liver cancer

Treatment

  • Within 48 hours of injury – human immunoglobulin from pooled plasma
  • Vaccine: 3 stages – initial, 1 month post and then 6 months post
189
Q

hep C

A

Enveloped RNA

Transmission

  • IV drug users
  • Sexual
  • Infants borne infected – high risk HIV as immunocompromised
  • Organ transplant

Complications

  • Hepatocellular carcinoma – treat with interferon-alpha and ribavirin
  • Jaundice
  • Cirrhosis
190
Q

hep D

A
  • Small RNA virus
  • Transmission
    • Faecal contaminated H2O and food
    • Blood borne
    • Cannot cause harm on own, need co-infection such as Hep B
191
Q

Hep E

A
  • Single stranded RNA
  • Spore forming
  • Transmission
    • H2O

REVISION BDS (43 decks)

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