Midterm #3 Flashcards
Docusate
Laxative used for constipation.
- Water retention in stools, softens stools
- OTC (e.g., Dulcelax)
What are the characteristics of Hepatitis D?
Source: blood body fluids
Route of Transmission: Percutaneous, permucosal
Chronic Infection: Yes
Prevention: pre/post exposure immunization, blood screening, risk behavior modification
What are the characteristics of hepatocellular carcinoma?
Hepatocellular carcinoma
- Most deadly cancer
- It has been increasing due to increases in the incidence of Hep B and C
Which nutrients are absorbed in the stomach?
Water, alcohol
Mesalamine
Used for Crohn’s disease. Is an anti-inflammatory. Corticosteroids-act systemically and Metronidazole has an antibiotic mechanism and they can also be used for Crohn’s. b. Ulcerative colitis • Similar to Crohn’s disease but limited to colon and more generalized (no strictures) • Medications are similar to Crohn’s disease
What are the causes and symptoms of peptic ulcer disease?
- Includes gastric and duodenal ulcers
a. Causes: (1) Inflammation of epithelium (2) Errosion (3) Infection by H. pylori (70-80% incidence)
b. Symptoms: • Epigastric burning, alleviated by eating or antacids • Pain worse on empty stomach and at nigh • Pain often mistaken for a heart attack and vice versa - One treatment includes suppressing acidity to heal sores (but not cure) • Antacids, PPIs, H2 blockers
What is cholecystitis?
Cholecystitis (bile is common mechanism for excretion of toxins and drugs)
- Acute often caused by gallstones and obstruction. Can become chronic
- Cholestasis causes jaundice
What are the characteristics of Hepatitis A?
Source: Feces
Route of Transmission: Fecal/oral
Chronic Infection: No
Prevention: pre/post exposure, immunization
What are the metabolic diseases of the liver often associated with?
Metabolic disease:
- Often associated with iron overloads
- Wilson’s disease: copper metabolic defect goes to hepatitis then cirrhosis
Which nutrients are absorbed in the colon?
Water, electrolytes
What are the characteristics of Hepatitis C?
Source: blood body fluids
Route of Transmission: Percutaneous, permucosal
Chronic Infection: Yes
Prevention: blood screening, risk behavior modification 6. Hep C virus found in >170 million carriers worldwide • Acute phase usually asymptomatic and not diagnosed • Chronic phase, Ab present at 5-20 weeks • 60% related to parenteral exposure • Caused by RNA virus • Can lead to hepatocarcinoma • No vaccines
What are the characteristics of GERD?
Gastroesophageal reflux disease (GERD) is chronic; ‘acid reflux” is acute (isolated incidents)
- Episodes referred to as heartburn and occurs daily in 7% of population
- Aggravating factors: empty stomach, inclined, increased age, obesity, fatty foods, caffeine/alcohol/smoking, large meals, some drugs
- Relief: small meals, reduced fat, reduced weight, elevate head of bed, avoid aspirin/NSAIDs
- Dental tips: • Protect teeth from erosion by gastric acids (i.e., mouth guard, neutralize acid with basic solution, don’t brush teeth after gastric juices are in mout-i.e., acidic
What are the characteristics of autoimmune hepatitis?
Autoimmune hepatitis unusual- found in obese females predominantly
- Rapid response to steroids
- 80% have extensive fibrosis
How can you manage an HBV exposure in a dental office?
- Accidental exposure:
- Carefully wash wound-don’t rub (embeds viruses)
- Use antiviral disinfectant (e.g., iodine or chlorine formulations)
- Initiate HBV vaccine series
- Don’t be judgmental
What are the symptoms of irritable bowel syndrome?
- No structural defect –not sure of the exact cause
- Typically episodic pain and bloating
- Could be 5HT-dependent neuromuscular disorder
- 20% of population have suffered (most common GI disorder)
- Most common in young adults and ~50 Years old—possible association with stress and poor diet
Which hepatitis virus is the most significant dental occupation hazard?
a. HBV infection most significant occupational dental hazard (vectors: blood, saliva, nasopharyngeal secretions)
b. In mouth, highest concentration is gingival sulcus
c. Manifestations (infections and bleeding based): • Lichen planus • Periodontal disease • Candidiasis • Increased oral bleeding • Increased incidence of type II diabetes • Sjogrens syndrome
What is Burkitt’s Lymphoma?
Burkitt’s Lymphoma- a type of non-Hodgkin’s lymphoma linked to Epstein-Barr infection and can affect maxilla and mandible; very aggressive from B lymphocytes. Prognosis can be poor.
Loperamine
Treats diarrhea. Imodium; mild opioid agonist: if severe, can use strong opioid agonists
Cimetidine
Used for GERD. H2 receptor blockers-not effective at the H1 receptors (i.e., not good antihistamines)-reduce gastric secretions by blocking H2 receptors in gut.
• Side effects: headaches, diarrhea, drowsiness.
What are the main five liver diseases?
Liver diseases-summary-these diseases can go on to cirrhosis 1. Fatty liver • Caused by ETHOH, obesity and diabetes Mel.
- Hepatitis • Caused by virus, drug or autoimmune
- Biliary disease
- Metabolic disease
- Vascular
In what percent of the population is inflammatory bowel disease found in?
Less than 1%
What are some other details about the liver?
- Fatty (fat globules in hepatocytes) liver-steatosis • Worst destruction is fibrosis. It leads to collagen scar and permanent injury. End stage is cirrhosis • Causes—alcohol, obesity and diabetes (known as the metabolic syndrome)
- If hepatocytes die in large sheets, the areas fill up with blood. Blood can build up due to heart failure and cause backflow around the central vein
- If cannuliculi in liver fill with bile due to cholestasis, the person becomes jaundiced (often caused by drugs)
- Acute more lobular, chronic is more portal with fibrosis and collagen bridges
- Hepatitis is inflammation of liver. If caused by viruses can be contagious and dentists must be very careful with these patients • Can also be caused by toxins and drugs • Acute can often resolve itself. Chronic less likely to recover (fibrosis often a part of this) • Acute caused by Hepatitis A and E viruses (1-3 months) • Hep B and C viruses start with acute hepatitis and progress to chronic with fibrosis progressing to cirrhosis and hepatocellular carcinoma: tend to be the more severe
Omeprazole
Used for GERD. Proton pump inhibitors (PPIs) –available OTC and by Rx
- Mechanism: disrupts hydrogen exchange for K in parietal cells, which blocks production and release of HCl into gut.
- Side effects: diarrhea, interferes with digestion, increases food allerges, oral sores/ulcers
- Often combined with H2 blockers - Can also add sodium bicarbonate for fast release.
Linaclotide
Used for irritable bowel syndrome.
b. Treatment:
(1) Typically symptomatic (i.e., deal with diarrhea or constipation with diet and anti-stress changes)
(2) Drugs: only linaclotide (Linzess) is FDA-approved for IBS with constipation • It is a guanylate cyclase-C agonist-it increases bowel movement, fluid secretion and reduces pain
• Side effects: diarrhea, gas
What are the symptoms of Crohn’s Disease?
Crohn’s is an IBS.
(1) Crohn’s disease
(a) Symptoms: • Chronic diarrheal problems • Can affect entire GI, but more intense in ileum and colon and intermittent areas with strictures between -ulcerations -swelling and scarring • Hypogastric pain • Perianal fissures/fistules • Higher incidence of arthritis • Fatty liver • Possible genetic link • Perhaps abnormal inflammatory response to normal flora • Has remission • Increase incidence of colon cancer
Fatty liver disease is an inflammatory disease. True or False?
False. It is not.
• Caused by ETOH, obesity, diabetes mellitus etc.
What are the characteristics of the liver?
- Liver made up of hepatocytes, duct cells and blood vessels
- Organization: Portal tracts contain the triad (portal triad) of (i) bile ducts, (ii) portal veins (bring blood from gut with nutrients and recently consumed drugs), and (iii) hepatic artery from the heart. Blood goes to the sinusoids and enriches hepatocytes, then goes to central vein and drains back to the heart to be recycled. Blood from different sources mix in the sinusoids drains into the “central veins” and exits to the hepatic vein that goes to the heart
- Hepatocytes do all of the metabolic work of the liver and absorb nutrients and drugs.
- Most hepatotoxic events occur around the ‘central vein’ • Drugs are the #1 cause of liver toxicity!
- Biopsy of liver can be potentially dangerous due to major hemorrhaging
Antacids
Used for GERD. Antacids-neutralize gastric HCl
• Types: magnesium salts (can cause diarrhea); bicarbonate (causes gas); calcium carbonate (chalky and constipation); aluminum salts (not very effective)
Which nutrients are absorbed in the ileum?
Bile salts, B12, Cl
Esomeprazole
Used for GERD. Proton pump inhibitors (PPIs) –available OTC and by Rx
- Mechanism: disrupts hydrogen exchange for K in parietal cells, which blocks production and release of HCl into gut.
- Side effects: diarrhea, interferes with digestion, increases food allerges, oral sores/ulcers
- Often combined with H2 blockers
Lansoprazole
Used for GERD. Proton pump inhibitors (PPIs) –available OTC and by Rx
- Mechanism: disrupts hydrogen exchange for K in parietal cells, which blocks production and release of HCl into gut.
- Side effects: diarrhea, interferes with digestion, increases food allerges, oral sores/ulcers
- Often combined with H2 blockers
How is evaluation of hepatitis severity usually performed?
Evaluation of hepatitis severity:
- Grade= degree of inflammation
- Stage= degree of fibrosis-this is the most important for prognosis-extreme if it progresses to cirrhosis that includes collagen surrounding hepatic nodules (hepatocytes)
What does acute leukemia primarily affect?
Acute leukemia principally affects bone marrow
Famotidine
Used for GERD. H2 receptor blockers-not effective at the H1 receptors (i.e., not good antihistamines)-reduce gastric secretions by blocking H2 receptors in gut.
• Side effects: headaches, diarrhea, drowsiness.
Ranitidine
Used for GERD. H2 receptor blockers-not effective at the H1 receptors (i.e., not good antihistamines)-reduce gastric secretions by blocking H2 receptors in gut.
• Side effects: headaches, diarrhea, drowsiness.
What are the characteristics of Hepatitis E?
Source: feces
Route of Transmission: fecal/oral
Chronic Infection: oral
Prevention: ensure safe drinking water
Bismuth subsalicylate
Treats diarrhea. Is Pepto-Bismol.
Anti-cholinergics such as atropine can also be used to treat diarrhea.
Which nutrients are absorbed in the duodenum?
Fe, Ca, Mg, Na, Fats, water, proteins, vitamins,
Milk of Magnesia
Used to treat peptic ulcer disease.
Cure if H pylori-related –H pyloria is contagious especially within family members
- Prevpac; combination of lansoprazole (a PPI) and the antibiotics amoxicillin and clarithromycin
- Milk of Magnesia (magnesium based) may also help kill bacteria
What are the characteristics of Hepatitis B?
Source: blood body fluids
Route of Transmission: Percutaneous, permucosal
Chronic Infection: Yes
Prevention: pre/post exposure, immunization
- Heb B virus, 2 billion chronically exposed in world, 350 infected. 15-25% of infected will go into chronic phase and most will die from complications. Can lead to cancer of liver (hepatocarcinoma) -important to get vaccinated.
- • Caused by DNA virus
- • Cirrhosis (chronic phase)= portal hypertension; causes ascites 85% of time in chronic phase with cirrhosis
Which nutrients are absorbed in the jejunum?
carbohydrates, proteins
Prevpac
Used to treat peptic ulcer disease.
Cure if H pylori-related –H pyloria is contagious especially within family members
• Prevpac; combination of lansoprazole (a PPI) and the antibiotics amoxicillin and clarithromycin
Bisacodyl
Laxative used for constipation.
- Stimulant of smooth muscles
- Fast acting
- OTC
- Suppository/oral
- Cramps
