Kidney/Gastro

Question 1

Chronic kid disease

Answer 1

prog loss of renal function persisting for more than 3 months

Question 2

Chronic kidney disease cause

Answer 2

diabetes, htn, Chronic glomerulonephritis Polycystic kidney disease

Question 3

Chronic kid disease Pathophysiology

Answer 3

Progressive destruction/deterioration of nephrons Hypertrophy of remaining nephrons to compensate Homeostasis preserved until >50% nephron destruction

Question 4

Best measure of overall kidney function

Answer 4

GFR

Question 5

in early kidney disease, patients are

Answer 5

asymptomatic - 50% nephron destruction before symptoms

Question 6

Chronic kid disease progression

Answer 6

nitrogenous waste builds up in the blood, leading to symptoms.

Kidneys perform fewer excretory, endocrine, metabolic functions. This is where patients get their symptoms.

Question 7

Chronic kid disease conservative care

Answer 7

decrease nitrogenous waste intake (diet), manage HTN, manage fluids, electrolytes, Na, K.

Question 8

Stage 1 and Stage 2 has more

Answer 8

conservative care

Question 9

—— and —— are two major contributing factors

Answer 9

HTN, Diabetes

Question 10

Stage 3 treatment

Answer 10

More aggressive conservative care.

Question 11

Dialysis for

Answer 11

some stage 4 (depends on how pt is doing, risk factors), all for stage 5.

Question 12

Hemodialysis done every

Answer 12

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.

Question 13

—– injected during dialysis process

Answer 13

heparin.

Question 14

20% of US patients on

Answer 14

peritoneal dialysis

Question 15

—— surgically created in forearm for hemodialysis

Answer 15

AV fistula. DO NOT EVER USE IT.

Question 16

Avoid/adjust dosage of nephrotoxic drugs and those excreted by the kidneys if GFR < —-

Answer 16

60

Question 17

No BP cuff on arm with

Answer 17

AV shunt.

Question 18

If AV shunt infected, it will likely be a

Answer 18

staph infection

Question 19

Peptic ulcer disease is

Answer 19

chronic.

Question 20

Most peptic ulcers tend to be in the

Answer 20

duodenum.

Question 21

Most common cause of peptic ulcer disease

Answer 21

Heliobactor pylori

Question 22

Heliobactor pylori hang out

Answer 22

where the gastric epithelium meets the overlying mucous.

Question 23

H pylori produces a —– that hyrdrolyzes urea to ammonia and CO2

Answer 23

urease

Question 24

H pylori - host inflammatory response to —- causes damage

Answer 24

ammonia

Question 25

NSAIDs

Topical irritant, decrease ——– production, inhibit —– secretion, decrease mucosal ——–

Answer 25

prostaglandin

mucous

blood flow

Question 26

• 2nd most common cause of peptic ulcer disease

Answer 26

NSAIDS

Question 27

NSAID ulcers more often in

Answer 27

stomach

Question 28

If older than 60, long term (more than 1 month) NSAIDs, simultaneous use of alcohol, steroids, aspirin

Answer 28

patient is at increased risk to develop peptic ulcer disease.

Question 29

Peritoneal perf

Answer 29

worst case scenario - now gastrointestinal bacteria in sterile peritoneum. Life threatening.

Question 30

Healed ulcers can

Answer 30

fibrose.

Question 31

Pyloric stenosis

Answer 31

delayed gastric emptying - due to fibrosis potentially.

Question 32

Peptic ulcer disease symptoms

Answer 32

Empty stomach or 90min-3h after eating

Question 33

Worsening ulcer can lead to

Answer 33

angina symptoms

Question 34

Peptic ulcer patients are treated by

Answer 34

attacking acid.

Question 35

If infected with H pylori

Answer 35

use antibiotics with proton pump inhibitor

Question 36

For peptic ulcer dental patients, avoid

Answer 36

NSAIDs, aspirin

Question 37

For patients with peptic ulcer disease and pain, you can prescribe

Answer 37

Prescribe: acetaminophen, acetaminophen combinations

Question 38

Ulcerative colitis

Answer 38

Mucosa

Large intestine and rectum

Question 39

Crohn’s disease

Answer 39

Full-thickness bowel wall

Can involved any portion of alimentary canal

Question 40

UC crohns, causes

Answer 40

idiopathic, immune disfunction in genetically susceptible people.

Question 41

UC characterized by

Answer 41

remissions and exacerbations.

Question 42

UC predisopses to

Answer 42

colon carcinoma. - 10x more likely.

Question 43

—-% of UC patients relapse in a year

Answer 43

50

Question 44

In crohns disease —– of small bowell occurs

Answer 44

thickening and stenosis

Resections can be done.

Question 45

Crohns - —– year delay in diagnosis

Answer 45

3 - due to difficulty and variability in presentation

Question 46

1st line for UC/crohns

Answer 46

antidiarrheal, antiinflammatory (antiinflamatory specific for GI).

Question 47

2nd line for UC/crohns

Answer 47

immunosuppressive agents and antibiotics

Question 48

Corticosteroids to induce

Answer 48

remission in moderately- severely ill patients

Question 49

UC crohns, Avoid —- drugs

——

Answer 49

anti-inflammatory, Ibuprofen

Question 50

Caution with antibiotics (Clindamycin)-monitor for signs/ symptoms of ———

Answer 50

pseudomembranous colitis

Question 51

Sulfasalazine (an anti-inflammatory for IBD) can cause ————

Answer 51

leukopenia & thrombocytopenia

Question 52

If patient is given broad spectrum antibiotic, normal gut bacteria is wiped out, making it predisposed to

Answer 52

Pseudomembranous colitis. (C. difficile)

-amox, clindamycin

Question 53

P. colitis - Timing: within —– of antibiotic administration

Answer 53

4-10d

Question 54

PCP—Treat C. difficile infection

Answer 54

Oral metronidazole

Vancomycin

Question 55

For P. colitis - ——- dental care until ——-

Answer 55

Delay elective

free of disease symptoms

Question 56

C. dificile not likely after

Answer 56

single dose of antibiotic following IE prophylaxis.