Liver and GI (DeLuke) Flashcards
What Hepatitis is transmitted by the oral-fecal route?
Hepatitis A
What was the first Hepatitis discovered?
Hepatitis A
Which is associated with unsafe drinking water in deveoping countries?
Hepatitis E
Which Hepatitis is significant to dentists? Why?
B. It is transmitted by blood or saliva exposure.
Which Hepatitis has a vaccine?
Hepatitis B
Which Hepatitis coexists with B?
Hepatitis D
What is the most effective treatment for patients with a chronic viral hepatitis?
Interferon B
Which recently identified Hepatitis is similar to C?
Hepatitis G
What are the three main entities of alcoholic liver diseases?
- Fatt infiltrate (reversible)
- Alcoholic Hepatitis (reversible)
- Cirrhosis (irreversible)
Which Hepatitis has a vaccine?
Hepatitis B
Which Hepatitis viruses coexist?
Hepatitis B and D
The dentist should be concerned with what in a patient with hepatitis on interferon Alpha therapy?
Platelet count
What is an alcoholic liver disease that is reversible and seen in early chronic alcoholics (hepatocytes show increased fatty acid uptake, decreased fatty acid oxidation and lipoprotein secretion)?
Fatty infiltration
What is an alcoholic liver disease that is reversible and is characterized by inflammatory cells invading and killing hepatocytes?
Alcoholic hepatitis
What is an alcoholic liver disease that is irreversible and seen in long-term chronic alcoholics?
Cirrhosis
Alcoholic hepatitis has what interaction between the hepatocytes and ethanol and is it reversible?
Ethanol causes surface cell changes on hepatocytes making them appear as antigens and setting up an inflammatory immune response
In cirrhosis, liver cells are replaced by what?
Fibrous tissue
What causes splenomegaly in cirrhosis?
Hepatic flow slow, blood backs up in in the spleen, causing splenomegaly and increased platelet destruction
The symptoms of cirrhosis causing kidney abnormalities that lead to ascites and peripheral edema are due to what?
Portal hypertension
Jaundice in a patient with cirrhosis results from what?
Decreased processing of bilirubin in damaged or destroyed hepatocytes
Jaundice is first seen where?
Floor of the mouth
When considering liver disease, consider what 4 functions of the liver?
- Coagulation
- Metabolism
- Bile regulation
- Protein synthesis
What is jaundice of the eye?
Scleral icthyus
What may cause enlarged parotids?
Bulimia, malnutrition, alcohol abuse
What are some oral manifestations of bulimia?
- Enlarged parotid glands
- Erosion of the palatal surfaces of maxillary teeth (especially anterior teeth)
- Esophagitis (not necessarily benign)
- (This is systemic) electrolyte imbalance
If a patient has an enlarged liver due to cirrhosis, what pain will they present with?
Upper right quadrant
What is the cause of alcoholic encephalopathy?
Patient cannot break down ammonia in the body
An alcoholic may show what enlarged glands?
Enlarged parotid glands
What is the cause of thrombocytopenia in a Cirrhosis patient?
Enlarged spleen eats up more platelets because of a backup
What antibiotic should be prescribed to a patient with cirrhosis or impaired hepatic function?
Clindamycin
What pain medication should be lowered or not used in an advanced liver disease case?
Acetaminophen and opioids
All coagulation factors except which 2 are produced by liver parenchymal cells?
- Factor 8
2. VWF
What lab value is elevated in patients with liver disorders?
PT
Alcohol causes what type of platelet defect?
Impaired aggregation because diminished thromboxane A2
Does the dentist need a liver function test or a CBC (platelet count, PTT, PT, BT) for a liver patient?
CBC. We’re concerned with bleeding.
A bulimic patient will show what during periods of starvation?
Parotid gland enlargement
Electrolyte imbalance caused by frequent vomiting leads to loss of Cl and H causing an alkylosis, for which the body compensates by excreting K to absorb H, causing what?
Hypokalemic hypochloremic metabolic alkalosis
What results when a portion of the stomach protrudes into the chest cavity through a weakened portion of the diaphragm giving GERD symptoms?
Hiatal hernia
Pain with a hiatal hernia is relative to what?
The patient’s position
What is a sharply defined break in the GI mucosa greater than 3mm that results from chronic acid-pepsin secretion and the disruptive effects of H. pylori?
Peptic Ulcer Disease (PUD)
What are 4 things than can actively promote peptic ulcers?
- Gastrin
- Histamine
- Pepsin
- Increased vagal activity
What is a differentiating symptom between a gastric ulcer and a duodenal ulcer?
Gastric ulcer will have pain with food ingestion
Duodenal ulcer will have relief with food ingestion
What are 3 mechanisms by which H.pylori causes mucosal damage leading to peptic ulcer disease?
- Negative feedback for gastrin is halted causing increased acid release
- Local inflammatory response to the bacteria in the stomach
- Bacteria produce cytotoxins
What is a side effect of anticholinergics given for the treatment of peptic ulcer disease?
Xerostomia
What oral fungal infection is common for peptic ulcer disease?
Candida
What side effect of peptic ulcer disease can manifest as gingival bleeding?
Thrombocytopenia
What should a peptic ulcer patient be prescribed for pain management?
Acetaminophen (not NSAIDS or ASA)
What is a differential between Crohn’s disease and Ulcerative colitis?
Crohn’s will have colon ulcers and oral manifestations . Ulcerative colitis confined to colon.
What therapy might a patient with Ulcerative colitis or Crohn’s disease be on?
Long term steroids
What will be the appearance of Crohn’s disease oral manifestations?
Wwill be like aphthous ulcer or diffuse granulomatous swellings
Which disease is transmural (going through all layers) primarily involving ileum and right colon: Crohn’s or Ulcerative colitis?
Crohn’s disease
Which disease manifests in mucosal ulcerations of lower colon and rectum: Crohn’s or Ulcerative colitis?
Ulcerative colitis
What is the age range for Crohn’s?
20-30, 40-50
Which disease has an unknown genetic etiology: Crohn’s or Ulcerative colitis?
Crohn’s
Which disease has perianal involvement and fistulas commonly: Crohn’s or ulcerative colitis?
Crohn’s
Which disease has rectal involvement in 100% of the cases: Crohn’s or Ulcerative colitis?
Ulcerative colitis
What is caused by broad spectrum antibiotics (Clindamycin, ampicillin, amoxicillin, cephalosporin) eliminating normal flora of gut and allowing C.difficle to bloom and produce enterotoxin?
Pseudomembranous colitis in distal colon
Should an anti-diarrheal be given to a patient experiencing pseudomembranous colitis?
No. The diarrhea is getting the toxin out
What is the timeline for pseudomembranous colitis to appear with antibiotic administration?
Usually w/in 4-10 days. May develop 1-8 weeks after antibiotic administration
