Diseases of Human Systems Flashcards
What is the difference between primary endocrine disease and secondary endocrine disease?
PRIMARY = gland failure
SECONDARY = control failure
Where is the pituitary gland located?
At base of brain & sits in the sella tursica
What can occur if there is abnormal growth of the pituitary gland?
Presses on the optic chiasm & affects vision
What hormones are released from the anterior pituitary gland?
- thyroid stimulating hormone
- growth hormone
- adrenocorticotrophic hormone
- follicle stimulating hormone
What hormones are released from the posterior pituitary gland?
- anti-diuretic hormone (ADH)
- oxytocin
What is the difference between a function pituitary adenoma vs a non functional pituitary adenoma?
Functional - produces an active hormone eg GH causes acromegaly
Non-Functional - space occupying does not secrete hormone, causes visual field defects
How is growth hormone released into the body?
- Hypothalamus secretes GHRH (growth hormone releasing hormone)
- Anterior pituitary stimulated & releases growth hormone
What is the result of excess growth hormone production?
In children - gigantism
In adults - acromegaly
What might spacing of teeth & spontaneous changes in occlusion be a sign of?
Acromegaly
What are the general presenting features of acromegaly?
- enlarged supraorbital ridges
- broad nose
- thickened lips
- enlarged hands
- large mandible (class III)
- spacing of teeth
- large tongue
- T2 diabetes
Give some intraoral features of Acromegaly:
- enlarged tongue
- interdental spacing
- ‘shrunk’ dentures
- reverse overbite
Give a type of hyperthyroidism:
Graves disease
- auto antibodies stimulating the TSH receptor, release of more hormone
What are some signs of hyperthyroidism?
- warm moist skin
- tachycardia & atrial fibrillation
- high BP
- tremor
- proptosis of eyes
What are some symptoms of hyperthyroidism?
- hot & excess sweating
- weight loss
- diarrhoea
- palpitations
- irritable
- manic
What autoimmune disease may this person be suffering from?
Graves disease (hyperthyroidism)
What is a cause of Hypothyroidism?
Hashimoto’s autoimmune disease
What are some primary forms of Hypothyroidism?
- Hashimotos
- idiopathic atrophy
- thyroidectomy surgery
- iodine deficiency
What are some signs of Hypothyroidism?
- dry coarse skin
- bradycardia
- confusion
- goitre (hashimotos can cause inflammation of thyroid gland)
- delayed reflexes
What are some symptoms of Hypothyroidism?
- tiredness
- cold intolerance
- weight gain
- constipation
- goitre
- puffed face & extremities
- angina
What investigations may be used to look into a pt with suspected thyroid disease?
Blood
- TSH
- T3 & T4
Imaging
- ultrasound scan
- radioisotope scans
Tissue
- biopsy
How is hyperthyroidism treated?
- Carbimazole
- Beta blockers to reduce anxiety, tremors & palpitations
- Radioiodine
- Partial thyroidectomy
How is Hypothyroidism treated?
- Give T4 tablets (thyroxine)
What is T1 diabetes mellitus?
INSULIN DEFICIENCY
- autoimmune destruction of pancreatic B cells
What very dangerous side effect can occur in young people suffering from T1 diabetes?
Ketoacidosis
- body cells cannot access glucose for metabolism so they start to metabolise fat & this results in ketones production (which is acidic!!)
What are some symptoms of T1 diabetes?
- polyuria
- polydipsia (extreme thirst)
- tiredness
What is T2 diabetes?
Defect in insulin synthesis, secretion & action
- inadequate B cell response to hyperglycaemia
-
What medications can induce diabetes?
- corticosteroids
- immune suppressants (clyclosporin)
- cancer medication (imatinib, nilotinib)
What are the risk factors for development of gestational diabetes?
- overweight
- family history of diabetes
- previous gestational diabetes
What are some complications associated with diabetes?
- CV risk due to atheroma = angina & MI
- poor wound healing
- renal disease
- eye disease
- neuropathy
How does Diabetes affect dentistry?
- infection risk
- poor wound healing risk
- periodontal disease risk
What does “anemia” mean?
low haemoglobin levels
What does “leukopenia” mean?
low white cell count
What does “thrombocytopenia” mean?
low platelet count
What does “pancytopenia” mean?
reduction in ALL cells
What are some potential reasons for a pt to have low iron levels?
- low intake of meat, green leafy veg
- achlorhydria (lack of stomach acid so non-haem iron not converted)
- coeliac disease causes reduction in absorption
- GI tract bleeding (crohns, UC, gastric ulcer etc)
What are haematinics?
Things used to make RBCs
- vitamin B12
- iron
- folic acid
Explain how vitamin B12 is absorbed:
- gastric parietal cells release intrinsic factor
- intrinsic factor binds to Vit B12
- this is then absorbed in the Ileum
Why might a pt be deficient in vitamin B12?
- lack of intake (vegans)
- lack of intrinsic factor (eg Pernicious Anaemia or gastric disease)
- disease of terminal ileum (eg Crohns)
What can a folic acid deficiency in foetas cause?
Spina bifida
What types of anaemia are as a result of abnormal globin chains?
- thalassaemia
- sickle cell
What is Thalassaemia?
Anemia condition in which:
- normal haem production
- genetic mutation of globin chains
What clinical effects can arise as a result of thalassaemia?
- chronic anaemia
- marrow hyperplasia
- splenomegaly
- cirrhosis
- gallstones
How is thalassaemia managed?
- blood transfusions
- prevent iron overload
How do RBCs in sickle cell anaemia differ from normal RBCs?
Curled up edges
- no longer able to squeeze through capillaries
What are the clinical signs of anaemia?
- pale
- tachycardia
- pale mucosa
- smooth tongue
- beefy tongue in vitamin B12 deficiency
You suspect that your patient may be suffering from anaemia, what should you do?
Refer them for
- FBC
- renal function tests
- faecal occult blood test if suspected GI bleeding
How does anaemia affect dentistry?
- lower O2 capacity for GA
- mucosal atrophy
- candidiasis
- recurrent oral ulceration
- sensory changes
What is lymphoma?
clonal proliferation of lymphocytes arising in a lymph node or associated tissue (solid mass but some cells in blood)
What are some warning symptoms of potential lymphoma?
- fever
- swelling of face & neck
- lump in neck, armpit or groin
- excessive sweating at night
- unexpected weight loss
- loss of apetite
- breathlessness
- weak feeling
How does chemotherapy work?
Targets cells with a high turnover rate
**HENCE WHY THE ORAL MUCOSA IS SO OFTEN AFFECTED
Give examples of macrocytic anaemias:
Iron/folate/vit b12 deficiency
What is an inherited bleeding disorder?
Acquired defect that affects the coagulation of the blood by either affecting:
- coagulation factors/control proteins
- platelets
- both
Give examples of disorders that reduce coagulation factors:
- Haemophilia A (factor VIII)
- Haemophilia B (factor IX)
- von Willebrand’s disease (factor VIII & reduced platelet aggregation)
What is the normal amount of factor production (of coagulation products)
1iu (international unit)
How is mild/carrier haemophilia A managed?
- DDAVP = desmopressin which releases factor VIII that has been bound to endothelial cells
- Tranexamic acid = inhibitor of fibrinolysis
How is moderate & severe haemophilia A managed?
recombinant factor VIII medication
What is the incidence of Haemophilia A in the UK?
1:10,000
What is the incidence of Haemophilia B in the UK?
1:50,000
A pt has severe haemophilia A, where will their dental treatment be carried out?
Dental treatment unit attached to the haemophilia centre for monitoring
What local anaesthetic techniques can be dangerous for pts with haemophilia?
- IDB
- lingual infiltration
A pt with severe haemophilia has just had a dental extraction, what is their post-op regime?
Pts observed overnight at the haemophilia centre
A pt with mild haemophilia has just had a dental extraction, what is their post-op regime?
Pt observed for 2-3 hours following surgery
What can cause thrombocytopenia?
- idiopathic
- drug related = penicillin based drugs or heparin
- alcohol
- leukaemia
What platelet count is considered “safe” and means dental treatment can be carried out in a primary care setting?
100x10^9/L
(50 x 10^9 in a hospital setting)
What is an example of a coumarin anticoagulant drug?
Warfarin
What is an example of a direct thrombin inhibitor drug?
Dabigatran
What are examples of factor Xa inhibitor drugs?
- apixaban
- rivaroxaban
- edoxaban
How does warfarin work as an anticoagulant?
Inhibits production of vitamin K dependent clotting factors (2, 7, 9 ,10)
- slow onset over three days
How is warfarin response measured?
INR (ratio of pro-thrombin to thrombin)
- normal between 2-3
- <4 for dental treatment
What drugs can interact with warfarin?
- metronidazole
- NSAIDs
- carbamazepine
- aspirin
- fluconazole
What is type 1 respiratory failure?
Gas exchange failure eg
- emphysema
- thickening of alveolar wall
How do wheeze & stridor differ?
Wheeze - expiratory noise
Stridor - inspiratory noise
What drug types can improve airway patency?
- bronchodilators = B2 agonist & anticholinergics
- anti-inflammatory = corticosteroids
What drugs can impair ventilation?
Beta blockers = make airway narrower by increasing effect of smooth muscle contraction
Benzodiazepines
Opioids
What type of drug is salbutamol?
Short acting beta2 agonist
How do anticholinergic drugs work?
Inhibit muscarinic nerve transmission in autonomic nerves
- relaxation of smooth muscle
What occurs in asthma pts?
Airway narrowing due to:
- bronchial smooth muscle constriction
- bronchial mucosal oedema
- excessive mucous secretion into the airway lumen
What are the symptoms of asthma?
- cough
- wheeze
- shortness of breath in acute attack
- worse overnight & early morning
- difficulty breathing OUT
What core asthma drugs are used to treat the condition?
- short acting beta-adrenergic agonists
- inhaled corticosteroids (low dose initially but can move to high dose if need be)
- Regular long acting beta adrenergic agonist
- Adjuvant therapy = prednisolone etc.
When should asthma pts begin using low dose inhaled corticosteroids everyday?
If using short acting b2 agonist >3 times a week
What is COPD?
Condition with mixed airway obstruction & destructive lung disease
- asthma component
- empysema component
What is emphysema?
Destruction of alveoli
What is the biggest preventable risk factor associated with COPD?
Smoking !
What are the symptoms of COPD?
- chronic cough
- production of mucous
- fatigue
- shortness of breath
- dyspnea
- chest discomfort
What do inhaled steroids put pts at risk of?
Candida risk
- can be lowered by rinsing mouth after use & using spacer devices
Mutation to what gene causes cystic fibrosis?
CFTR gene found on chromosome 7
What is cystic fibrosis?
Inherited genetic disease in which:
- excess sticky mucous production
- from all body systems
What are the main symptoms seen in children with cystic fibrosis?
- troublesome cough
- repeated chest infections
- prolonged diarrhoea
- poor weight gain
What can be some consequences of cystic fibrosis?
- liver dysfunction
- prone to osteoporosis
- diabetes symptoms (due to prolonged pancreas disease)
- reduced fertility
What treatment is available for cystic fibrosis patients OTHER than medication?
- physiotherapy
- exercise
- transplantation
What medications can be used to treat pts with cystic fibrosis?
- bronchodilators
- antibiotics to treat chest infections
- steroids to reduce inflammation
- pancreatic enzyme replacement
- CFTR modulators
- stem cell treatment
Give some different causes of lung cancer:
- smoking
- asbestos
- second hand smoke
- radiotherapy
What are some signs and symptoms of lung tumours?
- persistent cough
- blood stained sputum
- pneumonia
- dysphagia
- persistent hoarseness
What is sleep apnoea?
Airway obstruction whilst asleep that prevents pt breathing normally
- 10secs or more duration
What can occur as a result of sleep apnoea?
- drowsiness during the day
- increased MI risk
What can be used to treat obstructive sleep apnoea?
- mandibular advancement appliance
- CPAP (continuous positive airway pressure)
Give examples of some GI diseases than can cause malabsorption:
- pernicious anaemia
- coeliac disease
- crohn’s disease
What are antacids?
Medications taken to help with excess gastric acid formation
- alkalis that for a salt with gastric acid & neutralise its effects
What drug groups can reduce acid secretion in the stomach?
- H2 receptor blockers
- proton pump inhibitors
What type of drug is omeprazole?
Proton pump inhibitor
What may be some causes of dysphagia?
- external compression from tumour
- fibrosis of muscles due to GORD or scleroderma
- neuromuscular dysfunction (eg parkinsons)
What are the 3 main causes of GORD?
- defective lower oesophageal sphincter
- impaired lower clearing
- impaired gastric emptying
What are some signs & symptoms of GORD?
- epigastric burning
- dysphagia
- GI bleeding
- severe pain due to oesophageal spasm
How can GORD be managed?
- stop smoking
- lose weight
- antacids (eg gaviscon)
- PPIs & H2 blockers
Infection with what organism can cause peptic ulcer disease?
Helicobacter pylori
- causes loss of protective mucous barrier within stomach
What are some complications associated with peptic ulcer disease?
- perforation of stomach
- haemorrhage
- malignancy
- anaemia
What are the effects of liver failure?
- prolonged bleeding (raised INR)
- ascites (fluid retention)
- portal hypertension
- encephalopathy
- jaundice
What are some effects of hepatic disease on dentistry?
- bleeding tendency (due to reduced clotting factor synthesis)
- prolonged effect of sedatives
- avoid antifungals
- drug dosages may need reduced
- may need to avoid NSAIDs due to bleeding risk
Give examples of reversible risk factors for cardiovascular disease:
- smoking
- obesity
- diet
- exercise
- hypertension
- T2 diabetes
How can the dental team aid with cardiac disease prevention?
- deliver general health educational messages
- smoking cessation advice
What drugs are used to prevent CV disease?
- statins
- diuretics
- calcium channel blockers
- ACE inhibitors
- beta adrenergic blockers
What drugs may you prescribe that interact with statins?
Fluconazole (statin should be omitted during antifungal therapy)
What CV drugs make heart failure worse?
Beta blockers
What may patients taking beta-blockers experience getting out of dental chair?
postural hypotension
What is the effect of diuretics?
Increase salt & water LOSS
- reduce plasma volume
- reduce cardiac workload
How do ACE inhibitors work?
- inhibit conversion of angiotensin I to angiotensin II (vasoconstrictor)
- prevents aldosterone dependent reabsorption of salt & water
How do nitrates work (CV medication)?
- dilate veins which reduces preload to heart
- dilate resistance arteries
What emergency treatment is used for angina?
GTN spray to reduce preload to heart
- sometime aspirin can be chewed if unsure if MI or angina
What are some risk factors associated with hypertension?
- increasing age
- obesity
- alcohol
- smoking
- stress
- drugs (corticosteroids, oral contraceptives etc)
- pregnancy
- family history
What is infective endocarditis?
Infection/microbial colonisation of thrombi of the endocardium (usually on the valves)
What dental procedures are a risk for development of IE?
Procedures involving manipulation of the dento-gingival junction and causing a bacteraemia
- XLAs
- perio treatment
- gingival surgery
- implants
Who makes the decision on wether or not to give antibiotic prophylaxis before dental treatment?
Made my patient and their physician (eg GP)
