diseases Flashcards
diabetes type 1
insulin deficient
autoimmune
B cell destruction
type 2 diabetes
insulin resistant
metabolic disorder
(old, fat, no exercise, genetically predisposed)
signs/symptoms of diabetes
- Ketoacidosis (rare in type 2)
- Hyperglycaemia
- Polydipsia (excessive thirst)
- Polyurea (need to urinate more frequently)
- Ketoacidosis (glucose cannot be used for energy, so fat used)
- Sweating
- Palpitations
large vessel complications of diabetes
stroke risk
MI risk
claudication/foot amputation
small vessel diabetes complications
poor wound healing
renal disease
maculopathy
neuropathy - weak/muscle wasting
test for diabetes
RPG - random plasma glucose
RPG for diabetes
>11.1mMol/l
tx type 1
basal bolus insulin injections
split mixed insulin injection
type 2 tx
less 10% fat intake in diet
- count carbohydrates
- gastric bypass
- diet pills - sibutramine
- oral hypoglycaemic agen
sulphonylureas- gliclazide
- inc insulin sectretion and sensitivity
- hypoglycaemia
biguanides metformin
- inc insulin sensitivity
dental relevance of diabetes
- Gingivitis/ periodontitis
- Poor wound healing
- Oral candidiasis
- Xerostomia -> increased incidence of caries
- Give prophylactic antibiotics for invasive treatment
- LA given should not interfere with eating as may become hypoglycaemic
- Treat in morning after breakfast and hypoglycaemic agents
causes of hyperthyroidism
graves disease (70-80%) autoimmune - stimulates TSH (sign othalomopathy)
toxic muti-nodular goitre
pituitary adenoma (rare)
signs/symptoms of hyperthyroidism
- increased metabolism
- diarrhoea
- palpitations, tachycardia, atrial fibrilation
- hypertension, heart failure
test for hyperthyroidism
blood test for TSH
- low, T3 and T4
- high, if adenoma
- high TSH and T3 and T4
fine needle biopsy (FNB)
tx of hyperthyroidism
radiopaque iodine
partial thyroidectomy
give carbimazole and T4 replacement (prolonged tx = hyperthyroidism)
dental relevance of hyperthyroidism
- Increased pain and anxiety
- Goitre if detected by dentists
- Accelerate periodontal disease
- Premature tooth eruption
- Thyrotoxic crisis can be precipitated by stress, surgical procedures and infections
- This is medical emergency and carries mortality of 10%
- Patients with hyperthyroidism may be sensitive to adrenaline (LA)
causes of hypothyroidism
hashimoto’s thyroiditis - autoimmune
too much iodine
thyroidectomy
thyroid atrophy
drug induced - carbimazole
hypothalamic/pitutary disease - rare
signs/symptoms of hypothyroidism
hair loss
slow mental state
heat intolerant
dry skin
weight gain
brachycardia
goitre
angine
delayed reflexes
constipation
tests for hypothyroidism
blood tests
- high T3 and low T4
- rare - low TSH and T3 and T4
fine needle biopsy
tx hypothyroidism
with T4 replacement
dental relevance of hypothyroidism
- Low pain threshold
- Delayed tooth eruption
- Enlarge tongue
- Bad wound healing
- Myxoedema – if give sedation can cause Coma
- Sensitive to opioids and benzodiazepine
