Kidney/Gastro Flashcards
Chronic kid disease
prog loss of renal function persisting for more than 3 months
Chronic kidney disease cause
diabetes, htn, Chronic glomerulonephritis Polycystic kidney disease
Chronic kid disease Pathophysiology
Progressive destruction/deterioration of nephrons Hypertrophy of remaining nephrons to compensate Homeostasis preserved until >50% nephron destruction
Best measure of overall kidney function
GFR
in early kidney disease, patients are
asymptomatic - 50% nephron destruction before symptoms
Chronic kid disease progression
nitrogenous waste builds up in the blood, leading to symptoms.
Kidneys perform fewer excretory, endocrine, metabolic functions. This is where patients get their symptoms.
Chronic kid disease conservative care
decrease nitrogenous waste intake (diet), manage HTN, manage fluids, electrolytes, Na, K.
Stage 1 and Stage 2 has more
conservative care
—— and —— are two major contributing factors
HTN, Diabetes
Stage 3 treatment
More aggressive conservative care.
Dialysis for
some stage 4 (depends on how pt is doing, risk factors), all for stage 5.
Hemodialysis done every
2-3 days for 3-4 hours per session. In between sessions, life is pretty normal. Day after is the best day for dental tx.
—– injected during dialysis process
heparin.
20% of US patients on
peritoneal dialysis
—— surgically created in forearm for hemodialysis
AV fistula. DO NOT EVER USE IT.
Avoid/adjust dosage of nephrotoxic drugs and those excreted by the kidneys if GFR < —-
60
No BP cuff on arm with
AV shunt.
If AV shunt infected, it will likely be a
staph infection
Peptic ulcer disease is
chronic.
Most peptic ulcers tend to be in the
duodenum.
Most common cause of peptic ulcer disease
Heliobactor pylori
Heliobactor pylori hang out
where the gastric epithelium meets the overlying mucous.
H pylori produces a —– that hyrdrolyzes urea to ammonia and CO2
urease
H pylori - host inflammatory response to —- causes damage
ammonia
NSAIDs
Topical irritant, decrease ——– production, inhibit —– secretion, decrease mucosal ——–
prostaglandin
mucous
blood flow
• 2nd most common cause of peptic ulcer disease
NSAIDS
NSAID ulcers more often in
stomach
If older than 60, long term (more than 1 month) NSAIDs, simultaneous use of alcohol, steroids, aspirin
patient is at increased risk to develop peptic ulcer disease.
Peritoneal perf
worst case scenario - now gastrointestinal bacteria in sterile peritoneum. Life threatening.
Healed ulcers can
fibrose.
Pyloric stenosis
delayed gastric emptying - due to fibrosis potentially.
Peptic ulcer disease symptoms
Empty stomach or 90min-3h after eating
Worsening ulcer can lead to
angina symptoms
Peptic ulcer patients are treated by
attacking acid.
If infected with H pylori
use antibiotics with proton pump inhibitor
For peptic ulcer dental patients, avoid
NSAIDs, aspirin
For patients with peptic ulcer disease and pain, you can prescribe
Prescribe: acetaminophen, acetaminophen combinations
Ulcerative colitis
Mucosa
Large intestine and rectum
Crohn’s disease
Full-thickness bowel wall
Can involved any portion of alimentary canal
UC crohns, causes
idiopathic, immune disfunction in genetically susceptible people.
UC characterized by
remissions and exacerbations.
UC predisopses to
colon carcinoma. - 10x more likely.
—-% of UC patients relapse in a year
50
In crohns disease —– of small bowell occurs
thickening and stenosis
Resections can be done.
Crohns - —– year delay in diagnosis
3 - due to difficulty and variability in presentation
1st line for UC/crohns
antidiarrheal, antiinflammatory (antiinflamatory specific for GI).
2nd line for UC/crohns
immunosuppressive agents and antibiotics
Corticosteroids to induce
remission in moderately- severely ill patients
UC crohns, Avoid —- drugs
——
anti-inflammatory, Ibuprofen
Caution with antibiotics (Clindamycin)-monitor for signs/ symptoms of ———
pseudomembranous colitis
Sulfasalazine (an anti-inflammatory for IBD) can cause ————
leukopenia & thrombocytopenia
If patient is given broad spectrum antibiotic, normal gut bacteria is wiped out, making it predisposed to
Pseudomembranous colitis. (C. difficile)
-amox, clindamycin
P. colitis - Timing: within —– of antibiotic administration
4-10d
PCP—Treat C. difficile infection
Oral metronidazole
Vancomycin
For P. colitis - ——- dental care until ——-
Delay elective
free of disease symptoms
C. dificile not likely after
single dose of antibiotic following IE prophylaxis.