Human Health and Disease Flashcards
How many valves in the heart?
4
What are the four valves in the heart?
Tricuspid, Mitral, Pulmonary, Aortic
Which valves are open during systole (contraction)?
Pulmonary and Aortic
Which valves are open during asystole (relaxation)?
tricuspid and mitral
What does non-return valve mean?
no back-flow of blood once the valve is shut
Are cardiac valves non-return?
yes
What are the two main types of valvular heart disease?
valvular stenosis and valvular incompetence
What is valvular stenosis?
narrowing of the valve orifice that limits the quantity of blood passing through the valve
What is valvular incompetence?
failure of the non-return function of valves leading to valvular regurgitation
What valves are affected in left heart valvular disease?
Mitral and aortic
Which or mitral and aortic valvular disease is more common?
mitral
What can cause mitral stenosis?
age related calcification of the valve or rheumatic heart disease
What can cause mitral regurgitation?
age related degeneration, rheumatic heart disease, mitral valve prolapse, rupture of papillary muscle due to IHD
Which valves are affected in right hear valvular disease?
tricuspid and pulmonary
What is the dental relevance of valvular disease?
increased bleeding risk, increased infective endocarditis risk, reduction in cardiac output, heart failure
What are some dentally relevant side effects of the drugs used to treat valvular disease?
increased bleeding risk due to anticoagulants, gingival hyperplasia due to calcium channel blockers, ulceration by ACE inhibitors, dry mouth by polypharmacy
Are damaged valves more or less likely to become infected?
more likely
What can turbulent blood flow (often caused by poorly functioning valves) predispose an individual to?
infective endocarditis
What is infective endocarditis?
an acute or chronic disease resulting from an infection of a focal area of the endocardium, usually involving a heart valve.
What is acute infective endocarditits?
a destructive infection of a previously normal heart valve with a highly virulent organism
What is chronic infective endocarditis?
a slow often symptomless infection of a previously abnormal valve with organisms of low virulence
Where do the organisms that can cause infective endocarditis come from?
Oropharynx, respiratory tract, skin, gastrointestinal and urinary tract
Is left or right heart infective endocarditis more common?
left (95% of cases are left sided)
What are the lesions that appear due to infective endocarditis?
called vegetations, they are grape-like masses composed of bacteria and blood clot components
What are the steps involved in formation of infective endocarditis vegetations?
endocardial injury followed by adherence of platelets and fibrin, this mass becomes infected by microorganisms in the blood
What are some specific symptoms from infective endocarditis?
Splinter Haemorrhages, Roth Spots, Janeway Lesions
What are splinter haemorrhages?
tiny blood clots that run vertically in fingernails
What are janeway lesions?
non-painful red lesions on the palms and soles due to de-positioned immune complexes
What are roth spots?
areas of retinal haemorrhage due to a breakdown of vessels
Which dental procedure gives the highest risk of bacteraemia?
dental extraction and periodontal surgery
What are the five major types of arthritis?
osteoarthritis, rheymatoid arthritis, ankylosing spondylitits, gout, septic arthritis
What is osteoarthritis?
arthritis caused by cartilage death
What is rheumatoid arthritis?
arthritis caused by synovial inflammation and overgrowth
What is ankylosing spondylitis?
arthritis caused by inflammation and new bone formation at the entheses
What is gout?
arthritis caused by crystals in the synovial fluid
What is septic arthritis?
arthritis caused by an infection within the joint
What is the point in a synovial joint where tendons/ligaments/joint capsules inset into the bone called?
entheses
Where is synovial fluid produced?
the synovium
Why is it important that the synovium passes nutrients to the cartilage?
the cartilage itself has no blood vessels or nerve cells
What happens to the cartilage in osteoarthritis?
it dies in patches
What happens to the bones in osteoarthritis?
they sit closer and eventually rub together leading for formation of sclerotic bone
What happens to the joint capsule in osteoarthrits?
it gets stretched, thicker and more fibrotic
What are seronegative spondyloarthropathies?
a group of joint disorders negative for rheumatoid factors
What are the four types of seronegative spondyloarthropathies?
ankylosing spondylitis, reactive spondylitis, psoriatic arthritis, enteropathic arthritis
What is ankylosing spondylitis?
inflammation and new bone formation at the entheses which eventually forms bone bridges between the vertebrae causing ridigity in the joints
What is the characteristic posture of a person with ankylosing spondylitis?
question mark posture
Does ankylosing spondylisits always occur at joints?
no, it can occur at any entheses
What happens in gout?
if urate levels get too high, they can deposit as crystals in the synovial fluid causing an intense inflammatory response
Which conditions predispose an individual to gout?
renal and cardiac
What are gouty tophi?
swellings under the skin with a yellowish discolouration which can show calcification on a radiograph
Drinking which type of alcohol in particular in excess can predispose an individual to gout?
beer
Is septic arthritis more common in undamaged joints or in joints previously damaged by arthritis?
joints previously damaged by arthritis
What becomes inflamed in rheumatoid arthritis?
the synovium
How do the bones get damaged in rheumatoid arthritis?
the synovium cells become overgrown and invasive which eats into the bones additionally, the persistent inflammation can cause generalised cartilage loss
What is swan-necking in relation to rheumatoid arthritis?
the joint at the base of the finger flexes, the middle joint extends and the distal joint flexes
What is boutonniere in relation to rheumatoid arthritis?
the middle joint become stuck in a flexed position and the outermost joint hyperextends
What is sjogren’s syndrome?
an autoimmune disorder characterised by progressive inflammation and destruction of epithelial exocrine glands
What are some predominant symptoms relating to sjogren’s?
dry eyes, dry mouth, dry skin, joint pains, fatigue, respiratory problems, raynaud’s, parotid swelling
What are common oral health problems related to sjogren’s?
oral ulceration, dryness, dental caries
What drug type can be used to treat most types of arthritis?
non-steroidal anti-inflammatory drugs
Give two examples of NSAIDs
ibuprofen and naproxen
What are some side effects of NSAIDs?
gastric or duodenal ulceration, increased risk of heart attack or stroke, kidney problems
Which type of arthritis should you not give NSAIDs to?
osteoarthritis
Which is the first treatment for inflammatory arthritis?
corticosteroids
What are the potential treatment options for inflammatory arthritis?
disease modifying agents, biological agents, bisphosphonates
Why would you start with corticosteroids and another treatment for inflammatory arthritis?
the steroids act as a bridge, to reduce symptoms while the main medication begins to work
Give three examples of disease modifying agents
methotrexate, sulphasalazine, leflunomide
What are some side effects of methotrexate?
hepatoxicity, pulmonary toxicity, stomatitis
What are some side effects of sulphasalazine?
skin reactions or diarrhoea
What are some side effects of leflunomide?
hypertension
What is an example of a biological agent used to treat inflammatory arthritis?
anti-TNF
What are some side effects of anti-TNF?
the patient will be immunosuppressed and predisposed to infection
What are some side effects of bisphosphonates?
patients can be predisposed to osteonecrosis of the jaw
What is the medication used for acute attacks of gout?
colchicine
What is the medication used to prevent gout recurrence?
allopurinol
