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3rd Year BDS > More Human Diseases > Flashcards

More Human Diseases Flashcards

1
Q

Name 6 pathophysiologies for upper GI disease?

A 
Peptic
Malignancy
Autoimmunity
Funcional
Infective
Genetic
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2
Q

What is the definition of helicobacter pylori and how is it transmitted?

A

Flagellate bacteria from spirochete

Transmitted human to human

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3
Q

How is helicobacter pylori adapted to survive in the stomach?

A

Adapted to stomach

Converts urea to ammonia to neutralise periplasm

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4
Q

What disease does helicobacter pylori cause?

A 
Chronic gastritis
Atrophic gastritis (impaired acid prod)
Antral gastritis (increased acid production)
Pan gastritis (increased prolif of gastric cells)
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5
Q

Which precancerous conditions can helicobacter pylori cause?

A

Gastric carcinoma

MALToma

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6
Q

How to diagnose for helicobacter pylori infection?

A

Serum
Faecal antigen
Urease breath test
CLO test

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7
Q

What is the definition of gastro-oesophageal reflux disease?

A

Reflux acid content into the oesophagus

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8
Q

What are the symptoms for Gastro-oesophageal reflux disease?

A

Chronic cough

Hoarse voice

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9
Q

What are the predisposing factors for Gastro-oesophageal reflux disease?

A 
Lifestyle 
Obesity
Increased Intra-abdominal pressure
Smoking
Alcohol
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10
Q

What causes GORD?

A

Lower oesophageal sphincter relaxation

increased or higher frequency

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11
Q

What treatment can be prescribed for GORD?

A

Proton pump inhibitor
Change lying position
Diet

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12
Q

Name the 4 grades for oesophagitis?

A

A
B
C
D

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13
Q

What is the definition of metaplasia?

A

Where one organ’s lining mutates and becomes the lining of a different organ

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14
Q

What is the definition of Barrett’s oesophagus?

A

Metaplasia of the oesophagus from acid exposure

Can be precancerous

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15
Q

What is the aetiology for peptic disease for upper GI disease?

A

Helicobacter pylori
NSAIDs
Zollinger-Ellison disease

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16
Q

Name the 2 types of oesophageal cancer?

A

Squamous cell carcinoma

Adenocarcinoma

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17
Q

Prognosis of squamous cell carcinoma?

A

1 yr 36%

5 yrs 12%

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18
Q

Prognosis of adenocarcinoma?

A

5 yrs:

  • localised 45%
  • nodes 24%
  • meta 4%
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19
Q

What are the risk factors squamous cell carcinoma?

A

Smoking

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20
Q

How to diagnose and stage oesophageal squamous cell carcinoma?

A 
Endoscopy
Biopsy
CT
Ultrasound
PET
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21
Q

What is the treatment for oesophageal squamous cell carcinoma?

A

Radiotherapy

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22
Q

What are the risk factors adenocarcinoma?

A

Smoking
Alcohol
HP

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23
Q

What are the signs and symptoms for adenocarcinoma?

A

Dysphagia

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24
Q

How to diagnose and stage oesophageal adenocarcinoma?

A 
Endoscopy
Biopsy
CT
Ultrasound
PET
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25
How to treat oesophageal adenocarcinoma?
Radiotherapy Oesophagectomy Chemotherapy
26
What are the risk factors for gastric adenocarcinoma?
HP Smoking Obesity
27
How do patient present when they have a gastric adenocarcinoma?
Late stage: - significant invasion of wall - metastasis to nodes Little symptoms till disease advanced
28
What is a diagnostic aid for a patient with gastric adenocarcinoma
Iron-deficiency anaemia
29
How to diagnose and stage gastric adenocarcinoma?
``` Endoscopy Biopsy CT Ultrasound PET ```
30
What is the prognosis of gastric adenocarcinoma?
Less than 20% after 2 years
31
What is the definition of a MALToma?
HP related | Indolent marginal zone b cell lymphoma of the mucosa-associated lymphoid tissue or aggressive large b-cell lymphoma
32
What is the treatment for MALToma?
Resolution of HP infection for MALToma DLBCL more problematic Radiotherapy Surgery (bypass)
33
What is the prognosis for MALToma?
90% survival at 5 years
34
What is the definition of a neuroendocrine tumour and treatment?
Enterochromaffin-like cells of the gastric mucosa Incidental finding Treatment: - treat symptoms
35
What is the definition of a GIST and treatment?
``` Gastrointestinal stromal tumour: - SM cells - cajal cells tumour - low malignancy rate Treatment: - surgery ```
36
What is the definition of Crohn's disease?
Full GI tract Genetic Environment related to vit D
37
What are the symptoms for Crohn's disease?
Mouth ulcers Abdominal pain Diarrhoea Obstruction
38
What are the treatments for prognosis? *****
Surgery Medical management Immunosuppression
39
What is the definition of coeliac disease?
Allergy to gluten Malabsorption of nutrients Abs made against gluten Inflammation of SI
40
What are the symptoms for coeliac disease?
Dyspepsia Diarrhoea Abdominal bloating Weight loss
41
What is the treatment for Coeliac disease?
Diet modification
42
What are the complications for coeliac disease?
Refractory | Lymphoma
43
What is the treatment for oesophageal dysmotility?
Botox injection Rat tail oesophagus Surgery
44
Name 2 types of infection the upper GI tract can get?
Candida | Tropical sprue
45
What are the risk factors for candida infection?
Immunocompromised | Steroid inhalers
46
What is the treatment for candida?
Fluconazole
47
What are the signs and symptoms for candida?
Dysphagia | Odynophagia
48
What causes tropical sprue?
Bacteria Parasites Viruses
49
How does tropical sprue cause har,?
Flattens villi causing malabsorption
50
What are the symptoms for tropical sprue?
Nutrient deficiency Diarrhoea Fatigue
51
What is a form of tropical sprue?
Giardiasis
52
What is the definition of small bowel bacterial overgrowth?
Bacterial overgrowth in the small bowel?
53
What are the predisposing factors for small bowel bacterial overgrowth?
Absence of ileocecal valve Bypass surgery Diabetes Developmental
54
What is the treatment for small bowel bacterial overgrowth?
Antibiotics
55
What are the symptoms for small bowel bacterial overgrowth?
Malabsorption
56
Name 5 other things that can cause harm to the oesophagus?
``` Caustic injury Foreign body Food bolus Strictures EoE ```
57
Name 8 rare oesophageal disorders?
``` Vasculitis Behcet (ulcer) Churg-strauss (ulcer) Dermatomyositis (ulcer) CT disease Scleroderma (dysmobility) Mix CT disease (dysmobility) Crest syndrome (dysmobility) ```
58
NAme 4 rare gastric diseases?
Genetic: - menetrier disease (overgrowth of mucous cells) - HHT - FAP - Peutz-Jegher
59
What are the oral manifestations for Crohn's?
Oral mucosal ulceration Mucogingivitis Cobblestoning
60
What are the oral manifestations for Coeliac disease?
Enamel hypoplasia Delayed tooth eruption Glossitis IDA
61
What are the oral manifestations Pernicious anaemia?
Atrophic glossitis
62
What are the oral manifestations Peutz Jegher syndrome?
Melanotic macules
63
What are the oral manifestations Plummer vision?
Stomatitis
64
What are the oral manifestations HP and PUD?
Dental erosion Bad taste in mouth Halitosis Mucositis
65
What are the oral manifestations Gardner's syndrome?
Osteomas | Supernumerary teeth
66
What are the functions of the liver?
Synthesis Excretory Metabolic Storage
67
Name 2 types of liver disease?
Acute | Chronic (inflammation, fibrosis and cirrhosis)
68
Name 5 features of liver disease?
``` None Jaundice Synthetic dysfunction Metabolic dysfunction Features of portal hypertension ```
69
Name 2 types of jaundice for the liver?
Hepatic | Cholestatic
70
Name 2 types of synthetic dysfunction for the liver?
Oedema | Coagulopathy
71
Name 2 types of metabolic dysfunction for the liver?
Hypoglycaemia | Encephalopathy
72
Name 2 features of portal hypertension for the liver?
GI bleeding Ascites Hernia
73
What are the risk factors for liver disease?
``` Alcohol* Blood-borne viruses Obesity Diabetes Hyperlipidemia Autommunity Medication Family history UC Chronic biliary tract disease/hepatobiliary surgery ```
74
What is the mechanism for alcoholic liver disease?
``` Liver excretes the alcohol Alcohol causes fat accumulation in liver Alcohol is a toxin to the liver Steatosis Continued for a while causes fibrosis and cirrhosis ```
75
What is the treatment for alcoholic liver disease?
Stop drinking | Possible liver transplant
76
What is the definition of hepatitis A?
``` Acute RNA Oro-faecal transmission Long life disease Vaccination and avoid contaminated food and water ```
77
What is the definition of hepatitis B?
DNA Vertical/parenteral/sexual transmission Chronic Co-infection with hepatitis D
78
What is the definition of hepatitis C and its treatment?
``` ssRNA Parenteral Vertical Sexual Combination therapy ```
79
What is the definition of hepatitis E?
Via contaminated food and water Hepatic failure in pregnancy No chronic No treatment
80
What is the definition of non-alcoholic fatty liver disease?
Fatty liver Leads to steatohepatitis Further to fibrosis and cirrhosis
81
What are the risk factors for non-alcoholic fatty liver disease?
``` Obesity Diabetes Hyperlipidemia Malnutrition TPN Alcohol/Drugs Genetical ```
82
How to diagnose for non-alcoholic liver disease and treatment?
Blood testing | No specific treatment
83
What is the definition of autoimmune liver diseases?
Inflammatory | Autoantibodies against nuclear and cytosolic microsomal
84
Name 3 types of autoimmune liver disease?
AIH PBC PSC
85
How to diagnose autoimmune liver disease?
Abs test | Histology
86
What is the definition of drug and toxin-related liver disease?
Zonal necrosis leads to hepatitis leads to cholestasis leads to steatosis leads to fibrosis leads to cirrhosis
87
Name 4 heritable liver diseases?
Hereditary haemochromatosis (Fe overload) Wilson's disease (Cu overlaod) Alpha-1 antitrypsin deficiency Gilbert's disease (more unconjugated bilirubin)
88
Name the most common liver cancer?
Hepatocellular carcinoma: - cirrhosis, hep B and C - scans and detect alpha-fetoprotein
89
Name 4 rare causes of liver disease?
Cryptogenic Infections (bac or parasite) Vascular insults Systemic diseases
90
Name 3 biliary diseases?
Gallstones Autoimmune disease Cancer:
91
How to monitor liver function test?
``` Bilirubin Albumin Enzymes Clotting profile FBV ```
92
What are 2 types of autoimmune disease of the biliary tract?
- primary biliary cirrhosis | - primary sclerosing cholangitis
93
What are the 2 types of cancer of the biliary tract?
Cholangiocarcinoma | Cancer of the gallbladder
94
Name the 2 most common child cancers?
Leukaemia (80 % ALL) | Lymphoma
95
Name the 5 most common adult cancers?
``` Breast Prostate Lung Colorectal Bladder ```
96
Name the 4 risk factors for breast cancer?
Reproductive history Hormone therapy Breast density BRAC1/2
97
Name the 6 types of breast cancer?
``` Ductal carcinoma in situ Lobular carcinoma in situ Invasive ductal breast cancer Invasive lobular breast cancer Inflammatory breast cancer Paget disease ```
98
Name the 3 types of treatment for breast cancer?
Surgery Radio Chemo Combo of all
99
Name the 4 types of leukemia?
Acute myeloid Acute lymphoblastic Chronic myeloid Chronic lymphocytic
100
What is the definition of a leukaemia?
The malignant cell is a bone marrow derived haemopoietic stem cell which grows uncontrollably and invades and takes over the bone marrow. Invade blood cells and enlarge all organs
101
Name the 3 environmental associations for leukemias?
Benzene Chlorambucil Radiation treatment
102
Name the 3 clear genetic events that link to leukaemia progression?
Down's syndrome patients CML and ALL: - philadelphia chromosome - long arm of Ch22 translocated to long arm of chromosome 9 - forms bcr-abl AML: - associated with t15:17 preventing the natural maturation of the myeloid cell line
103
What is the definition of acute leukaemia?
Acute leukaemia is when the bone marrow is overrun with immature myeloid and lymphoid precursors are unable to mature further.
104
What are the signs for acute leukaemia?
Anemia Bleeding Infection Organ enlargement
105
What are the treatment options for acute leukaemias?
Correction of RBC and platelet problem Treat infection Keep hydrated Guard against acute tumour lysis syndrome
106
What is the specific treatment for AML?
Cytosine arabinoside | Daunorubicin
107
What is the specific treatment for ALL?
Vincristine Prednisone Daunorubicin If involves brain needs methotrexate or radiation therapy
108
What are the signs and symptoms for CML?
``` Weight loss Sweating Anaemia Bleeding Infections Enlarged spleen. ```
109
What is the treatment for CML?
Alpha interferon | Hydroxyurea
110
What can CML progress to?
Acute leukemia (blast transformation) can cause rapid death
111
What is the definition of chronic lymphocytic leukaemia?
Incurable malignant proliferation of predominantly mature B cells
112
What ae the signs and symptoms for CLL?
Anaemia Bleeding Infection Enlarged lymph nodes and spleen
113
How can a blood test confirm a diagnosis of CLL?
Increase in WBC and predominantly lymphocytes, anaemia and thrombocytopenia on blood testing Lymphocytes on blood film (smear cells as they rupture) Bone marrow biopsy
114
What is the treatment for CLL?
Oral chlorambucil | +/- prednisolone
115
Name the 9 most common side effects of chemotherapy?
Anaemia (reduced bone marrow) Thrombocytosis (thrombocytopenia) Mandibular tori Mucositis (and ulceration) Dysphagia Hair loss (hair follicle turnover - reversible) Sterility (affects high turnover sperm cell. Pre-treatment samples can be saved) Cataracts Vomiting (there is a direct stimulation of the vomiting centre in brain stem)
116
Name the 2 types of lymphoma?
Hodgkin's | Non-Hodgkin's
117
What are the signs and symptoms for Hodgkin's lymphoma?
``` Sweating (especially at night) Fever Weight loss Pruritus Fatigue Anorexia Pain in the lymph nodes on drinking alcohol ```
118
How is Hodgkin's lymphoma diagnosed and staged?
Lymph node biopsy Chest x-ray CT BM scan
119
What is the definition of Non-Hodgkin's lymphoma?
highly heterogenous disease of malignant lymphatic cells which can infiltrate a variety of structures.
120
What are the 2 types of Non-Hodgkin's lymphoma?
High grade | Low grade
121
What is the treatment regime for High grade NHL?
CHOP: - cyclophosphamide - hydroxyaunrubicin - oncovin - prednisolone.
122
What does CHOP stand for?
- cyclophosphamide - hydroxyaunrubicin - oncovin - prednisolone.
123
What is the treatment for low grade NHL?
Not curable and rumbles on for years with symptomatic treatment with chlorambucil or radiotherapy for masses as they arise.
124
What are the signs and symptoms for NHL?
Bruising | Anaemia and Infections
125
What tests ca be conducted to confirm a diagnosis of NHL?
Reduced RBC and platelet numbers, with raised white cell count on blood tests Abnormal liver function tests if liver involved A chest x-ray and CT scan will show masses which will require a biopsy to provide sub-type diagnosis. Bone marrow aspirate is needed to determine spread
126
What are the risk factors for lung cancer?
``` Smoking Urban living Asbestos exposure Coal burning Passive smoking Arsenic Fe oxide ```
127
What are the clinical features of lung cancer?
``` Cough Haemoptysis Chest pain Bone spread leading to fractures Metastases to bone and the brain Finger clubbing Weight loss Lymphadenopathy ```
128
What is the definition of Pancoast's tumour in relation to lung cancer?
Invasion of the brachial plexus causing pain (Pancoast’s tumour)
129
What is the definition of Horner's syndrome in relation to lung cancer?
Invasion of the sympathetic ganglions (Horner’s syndrome); involves recurrent laryngeal nerves leading to hoarseness and invasion of the oesophagus, heart and veins
130
What investigations can be conducted to diagnose lung cancer?
Chest x-ray for masses Sputum cytology for malignant cells Bronchoscopy for biopsy CT scan for peripheral lesions.
131
What investigation to use to stage a lung cancer tumour?
MRI
132
Name the 2 types of lung cancers?
Non-small cell | Small cell
133
Name 4 types of non-small cell lung cancers?
Squamous cell carcinoma Large cell Adenocarcinoma ALveolar
134
Name a type of small cell lung cancer?
Endocrine cell
135
How can skin change with lung cancer?
Pigmented skin in axillae (acanthosis nigricans) | Herpes zoster Dermatomyositis
136
What are the treatment options for lung cancer?
``` Surgery Radiotherapy Chemo for small cell cases Haemodialysis Haemofiltration Peritoneal dialysis ```
137
What are the risk factors for colorectal cancer?
High meat/low fibre diet Family history Hereditary non-polyposis carcinoma Familial adenomatous polyposis
138
What genetic mutations contribute to colorectal cancer?
K-ras | c-myc
139
Dukes stage A?
Bowel only
140
Dukes stage B?
Through bowel wall
141
Dukes stage C?
Spread to regional lymph nodes
142
Dukes stage D?
Distant metastases
143
What are the signs and symptoms for lower colorectal cancer
descending colon with bleeding, narrowing and obstruction, leading to alternating diarrhoea and constipation, which may be accompanied by bleeding per rectum
144
What are the signs and symptoms for upper colorectal cancer
mass on examination or blood loss related anaemia | Liver involvement will present with jaundice
145
What investaigantions can be done to aid diagnosis?
Barium enema Endoscopy USS of Liver Bloods
146
What is the treatment for colorectal cancer?
Surgery Chemotherapy for B/C (5-Fluorouracil and levamisole) Radio
147
How to diagnose prostate cancer?
Palpation of hard prostate Elevated PSA Biopsy Transrectal USS
148
What are the signs and symptoms for prostate cancer?
Presence of prostatic specific antigen | Obstructive urinary flow
149
What is the treatment for prostate cancer?
Surgery Radiotherapy Metastasis: - androgen ablation therapy
150
Name the 4 risk factors for bladder cancer?
Smoking Benzidine Cyclophosphamide Chronic infection like schistosomiasis
151
What are the signs and symptoms of bladder cancer?
Haematuria | Painless
152
What investigations aid diagnosis of bladder cancer?
Cytological exam of urine Urography Cystoscopy
153
What is the treatment for bladder cancer?
Surgery Radio Chemo
154
What is an oral side effect for radiotherapy?
Osteoradionecrosis
155
What is an oral side effect for chemotherapy?
Candidiasis
156
What is the 5 Yr survival rate for NSCLC?
25%
157
Name the 4 stages of Hodgkin's disease?
I II III IV
158
Describe stage I of Hodgkin's Lymphoma?
Single site with radio
159
Describe stage I of Hodgkin's Lymphoma?
2 or more sites on same side of diaphragm Radio +/- chemo if symptomatic
160
Describe stage III of Hodgkin's Lymphoma?
SItes on both sides of diaphragm | Chemo
161
Describe stage IV of Hodgkin's Lymphoma?
Widespread involvement of non-lymphatic tissue | Chemo
162
What is SI 5 Yr survival rate for Hodgkin's lymphoma?
90%
163
What is the 5 yr survival for colorectal cancer?
45% | Dukes A 95%
164
What is the 5 yr survival for prostate cancer after surgery?
80-90%
165
Which gender is more at risk of haem cancers?
Men
166
What % of all cancers are haem cancers?
10%
167
What is the most common child cancer?
Leukemia
168
What % of all cancers does leukemia comprise of for childhood cancer?
30%
169
Explain the normal hematopoiesis process for the common myeloid progenitor cell?
Differentiate to erythromegakaryotic progenitor cells formins erythrocytes and platelets Common myeloid progenitor cells differentiation to monocytes that become macrophages Myeloid progenitor cells can also differentiate into neutro, eosino and basophils
170
What cells does acute lymphocytic leukemia affect?
Lymphoid progenitor
171
What cells do Acute myeloid leukaemia affect?
Myeloid progenitor
172
What cells fo chronic lymphoid leukemia?
B cells/T cells
173
What cells do multiple myeloma?
Plasma cells
174
What cells do myeloproliferative disorders affect?
``` Neutro Eosino Baso Mono Platelets Red cells ```
175
Name 2 types of acute leukemias?
Acute lymphoblastic leukemia | Acute myeloid leukemia
176
Name 2 types of chronic leukaemias?
Chronic myeloid leukaemia | Chronic lymphocytic leukaemia
177
Name 2 types of malignant lymphomas?
NHL | HL
178
Name 3 other categories of haem cancers?
Multiple myeloma Myelodysplastic syndrome Chronic myeloproliferative disease
179
When does NHL peak epidemiologically?
18-35 | 75+
180
Describe the difference between acute and chronic leukemias?
``` Acute: - leukaemic cells do not differentiate - BM failure - rapidly fatal if untreated - curable Chronic: - leukaemic cells can differentiate - prolif without BM failure - survival for a few years - No cure with BM transplant ```
181
What diseases has been related for NHL?
Glandular fever | Also has peak at 18-35
182
Describe the difference between leukaemia vs lymphoma?
``` Leukemia - BM: - stem cell - lymphoid progenitor - b progenitor - pre B - immature B Lymphoma - lymphoid tissue: - Germinal centre B cell - Plasma cell - mature naive b cell - memory b cell ```
183
What are the clinical features for acute leukaemia?
BM failure: - anaemia - thrombocytopenic bleeding - infection because of neutropenia
184
What are the key properties for multipotential hematopoietic stem cells?
Self-renewing population | Multi-potent
185
Name 4 myeloid malignancies?
Red Plat Gran Mono
186
Name 2 Lymphoid malignancies?
B and T
187
What are the systemic symptoms for a patient with lymphoma?
``` Fever Drenching sweat Weight loss Pruritus Fatigue ```
188
What are the nodal diseases found with lymphoma presentation?
Lymphadenopathy: - >90% HL with nodal disease - 60% NHL present with nodal disease
189
What was the most common localisation of cancer for head and neck lymphomas?
Waldeyer's ring 149 hits | Parotid and salivary glands 41
190
What are the different presenastions of lymphadenopathy?
Localised and painful Localised and painless Generalised and painful Generalised and painless
191
Give 1 example of a disease present for localised and painful type of lymphadenopathy?
Bacterial infection in draining site
192
Name 5 diseases present for localised and painless type of lymphadenopathy?
``` Rae infections Catch scratch fever TB Metastatic carcinoma from draining site (hard) Lymphoma (rubbery) ```
193
Name 5 disease for generalised and painful type of lymphadenopathy?
``` Viral infections EBV CMV Hepatitis HIV ```
194
Why is ALL/Lymphoblastic lymphoma related?
Same disease | Different area
195
Why is CLL/SCLL related?
Same disease with different presentation
196
Why is Burkitt's lymphoma/leukaemia related?
Same disease with different presentations
197
Why is HL/DLBLFL related?
Same disease with different presentations
198
Name 5 diseases for generalised and painless type of lymphadenopathy?
``` Lymphoma Leukaemia CT diseases Sarcoidosis Drugs ```
199
Name the 7 clinical features for multiple myeloma?
``` Bone pain and lytic lesions Anaemia Recurrent infections Renal failure Amyloidosis Bleeding tendency Hyperviscosity syndrome ```
200
Name 5 risk factors for oestonecrosis of the jaw?
``` Dental disease or surgery oral trauma Periodontitis Chemotherapy or steroids Nitrogen-containing bisphosphonates ```
201
Describe the structure of the lymph node?
Cortex Paracortex Medulla Germinal centre Mantle zone Marginal zone Forms the B cell follicle
202
Where does osteonecrosis of the jaw normally affect?
Mandible 2/3 cases
203
Explain the B cell maturation pathway?
``` Progenitor cell Pre B cell Immature B cell Naive B cell Enter GC Interacts with antigen Somatic hypermutation Forms centrocyte Differentiates to Memory B cell or plasma cell ```
204
What is the definition of lymphadenopathy?
Swollen lymph nodes
205
What are the extranodal diseases presentation for lymphoma?
40% of NHL present with extranodal component
206
How much fluid does a kidney process?
180L
207
Name the 6 functions of the kidney?
``` Maintain homeostasis Regulate body water Eliminate waste products of metabolism Regulate blood pressure Ca and bone meta Erythropoiesis ```
208
Name the 6 ways to assess kidney function?
``` Serum urea Serum creatinine Endogenous creatinine clearance GFR Isotope GFR (GS) - 55 chromium EDTA Derived formulae for GFR ```
209
What is the average GFR?
120mL/min
210
When can the kidneys be considered compromised when judging GFR?
Less than 60mL/min
211
What is creatinine and its levels in M/F?
``` Breakdown of creatine in muscles Mr 113 Can give info on renal function 60-90 F 70-116 M ```
212
What are the 2 formulas to estimate GFR?
MDRD | Cockroft-Gault
213
How does estimated GFR equation change for an African patient?
Usually have higher muscle mass compared to other ethnicity (less fat) Raised to 1.210
214
How to measure the degree of renal insufficiency?
``` eGFR = % kidney function Only an estimate Wide CI Usually underestimates Remember ethnicity ```
215
What is a healthy GFR value?
>60 mL/min
216
What is the creatinine difference between blood and urine?
Higher in urine, as it is being excreted | Excretion test may give false results
217
Stage 1 kidney disfunction GFR?
Kidney damage | >90 GFR
218
Stage 2 kidney disfunction?
Mild | 60-89 GFR
219
Stage 3 kidney dysfunction GFR?
Moderate | 30-59 GFR
220
Stage 4 kidney disfunction?
Severe | 15-29 GFR
221
Stage 5 kidney disfunction GFR?
Kidney failure | <15 or RRT GFR
222
What are the levels of kidney disease and their prevalence per 10,000 patients?
``` At risk 460 Initiation 380 Progression 60 End stage 6 per 10,000 at GP practice ```
223
What are the clinical problems of CKD?
Underecognition at earlier stages of kidney dysfunction | Growth of 6-8% per annum of dialysis patients
224
Name the 7 causes of kidney disease?
``` Diabetes TI/II High BP Glomerular disease Congenital disease Inherited diseases (polycystic) Obstruction to flow of urine Unknown ```
225
What is the size of a kidney?
11cm
226
What type of genetic is polycystic kidney disease?
Autosomal dominant disease
227
What to implement to delay progression and reduce CVS risk for CKD?
ACEI BP control Glucose control SMoking cessation
228
What to implement to prevent uraemic complications for CKD?
Malnutrition Anaemia CaPO4 PTH Acidosis
229
What are the comorbidities of CKD?
Cardiac diseases Vascular diseases Drug inters Neuropathy/Retinopathy
230
How to prepare for RRT?
Education Informed choice Timely access placement/transplant listing Timely initiation of RRT
231
What are the contraindications for dialysis?
Blindness IHD Dementia Non-english speaker
232
What ae the causes of hypertension in chronic renal failure?
Volume/total body Na excess Stimulation of renin-angiotensin system Augmented sympathetic tone
233
What is the rationale for ACE/All inhibition in chronic renal failure?
Reduction of proteinuria and BP Reduced hyperfiltration and reduced loss of albumin and proteins Less renal cell growth and fibrosis
234
What drug is best for TI diabetes for HBP?
ACE-I
235
What drug is best for TII diabetes for HBP?
ARBs
236
What are the results of taking ACE/ARBs?
Prevent progression of neuropathy and promote regression to normoalbuminuria
237
What type of care does a SI/II CKD patient need?
Assessment and shared care
238
What type of care does a SIII CKD patient need?
Renal clinic and shared care
239
What type of care does a SIV/V CKD patient need?
Pre-dialysis | Low clearance clinic
240
What is the GS treatment for HT in CKD?
Converting enzyme inhibitor or AllA
241
Which stages of CKD is HT usually present?
SII/III/IV | Common
242
Which stages of CKD does anaemia usually present?
SII - rare SIII - uncommon SIV - common
243
Which stages of CKD does divalent ion metabolism usually present?
SII - rare SIII - rare SIV - uncommon
244
Name the 5 causes of anaemia of renal disease?
``` Iron deficiency Blood loss Haemolysis Inhibitor of erythropoiesis Relative erythropoietin deficiency ```
245
What are the disordered haemostasis diseases present with renal disease and how to treat it?
``` Uraemic platelet dysfunction - increased bleeding time Desmopressin: - releases vWF multimers from endothelium - promote platelet aggregation ```
246
Name 4 examples of renal bone disease?
Hyperparathyroidism Osteoporosis Osteomalacia Adynamic bone disease
247
Why does renal bone disease occur in renal disease?
Reduced GFR leads to hyperphosphatemia Loss of renal tissues leads to lack of active Vit D Indirect reduction in Ca absorption
248
What are the signs that renal bone disease is present in renal disease?
Low Ca Raised PO4 Secondary hyperparathyroidism (elevated PTH) Can progress to teritary
249
How to manage renal bone disease?
``` Control PO4: - diet - PO4 binders (Ca acetate) Normalise Ca and PTH: - active Vit D (calcitriol) Parathyroidectomy ```
250
Name the 4 types of ahemodialysis access?
Arteriovenous fistula AV prosthetic graft Tunnelled venous catheter Temporary venous catheter
251
What are the fluid and dietary restrictions for dialysis?
``` Fluid: - dictated by residual urine output - interdialytic weight gain Dietary: - K - Na - PO4 ```
252
Explain the process of peritoenal dialysis?
A balanced dialysis solution is instilled into the peritoneal cavity via a tunnelled, cuffed catheter, using the peritoneal mesothelium as a dialysis membrane After a dwell time the fluid is drained out and fresh dialysate is instilled
253
What are the modalities of peritoneal dialysis?
Continuous ambulatory peritoneal dialysis Automated peritoneal dialysis Hybrid
254
What is contained in a dialysis fluid?
Balanced concentration of electrolytes Glucose is a osmotic agent for ultrafiltration of fluid Peritoneal transport can be high or low transporter Dwell times can be adjusted according to transport characteristics
255
What are the complications for peritoneal dialysis?
``` Gram +ve: - skin contaminant Gram -ve: - bowel origin Mixed: - suspected complicated peritonitis (perforation) Exit site infection Ultrafiltration failure Encapsulating peritoneal sclerosis ```
256
Name the 4 oral complications of end stage renal disease?
Parotitis Stomatitis Uraemic factor Oesophagitis
257
Explain the process of renal transplantation?
Placed into the iliac fossa and anastomosed to the iliac vessels Native kidney stays
258
When would the native kidney be removed?
Size (polycystic) | Infection (pyelonephritis)
259
Name the 4 complication for renal transplantation?
Rejection Infection CV Malignancy
260
Name the CV complication after renal transplantation?
``` Underlying renal disease CRF HT Hyperlipidaemia PT diabetes ```
261
Name 5 types of immunosuppressants in renal transplantation?
``` Non specific T cell mTOR inhib Anti-IL2 receptor abs T cell abs ```
262
Name 2 example of non-specific immunosuppression for renal transplant?
Prednisone | Azathioprine
263
Name 3 example of T cell activation immunosuppression for renal transplant?
Cyclosporine Tacrolimus MMF
264
Name 1 examples of mTOR inhibitor immunosuppression for renal transplant?
Rapamycin
265
Name 2 T cell abs immunosuppression for renal transplant?
AKG | OKT3
266
WHat are the risk factors for CKD?
``` Genetics HT RAS Lipids Smoking Diet Exercise ```
267
Name 4 examples of conventional infection after renal transplantation?
HepB UTI (bacteremia) Pneumonia HSV
268
Name 6 examples of unconventional infection after renal transplantation?
``` TB CMV EBV Aspergillus HepA Cryptococcus ```
269
What are the oral complications following renal transplantation?
``` Gingival hyperplasia Aphthous ulceration Herpes simplex virus (cold sore) Leukoplakia (can become squamous carcinoma) Candidiasis (co with HSV) Kaposi's sarcoma ```
270
What drugs can cause gingival hyperplasia?
``` Cyclosporine Phenytoin Nifedipine Diltiazem (Ca antag) ```
271
What is post transplant lymphoproliferative disease?
1-2% of all transplantees Incidence rising After primary or reactivation of EBV infection
272
What type of cancers can occur after renal transplantation and their RR
``` Relative risk 2 - colon, lung and breast 3 - testes and bladder 5 - melanoma, leukaemia and cervical 15 - renal 20 - non-melanoma skin, Kaposi, carcom, NHL and PTLD ```
273
Where is the liver positioned?
RUQ
274
How many lobes does the liver have?
2
275
What is the blood flow rate to the Liver?
5L per min
276
What type of blood does the portal vein carry?
Nutrient rich blood from GI | 50% O2 and 75% BF
277
What are kupffer cells?
Special white blood cells (macrophages) which help regulate molecules entering the sinusoids. The phagocytose molecules
278
What is the function of stellate cells?
Around sinusoid and help with structural integrity
279
Which zone of the liver acinus has more O2?
Zone 1 most | Zone 3 least
280
What are the metabolic functions the liver?
``` Biotransformation of: - drugs - toxins - hormones Nilfe formation and excretion haem meta Intermediate meta of: - glycogen and lactate - plasma port - clot factor - ammonia removal Lipids ```
281
What would happen if a patient had no bile?
Weight loss | Vitamin deficiency
282
Explain the basic process of RBC destruction?
``` In spleen: - converted to haem and globin Globin recycled Haem oxidised forming iron and biliverdin Biliverdin converted to bilirubin ```
283
What happens to bilirubin?
Travels to liver via albumin Undergoes phase 2 reaction to become unconjugated Helps form bile acid
284
What is the most common cause of unconjugated hyperbilirubinemia?
Haemolysis | Increased RBC breakdown
285
What causes conjugated hyperbilirubinemia?
Obstructive jaundice: - no bile release, not enter bowel - due to gallstones
286
What causes non-obstructive or hepatocellular jaundice?
Dysfunction or death of hepatocytes, resulting in release into circulation
287
What is a key plasma protein the liver produces?
Albumin
288
Which vitamin is essential cofactor for II VII IX and X
D
289
How can liver disease impact clotting?
Vit D absorption | Clotting factor synthesis
290
Name the 6 common causes of Liver diesease?
``` Alcohol Non-alcoholic steatohepatitis Viral Drugs Autoimmunity/genetic Cancer ```
291
Name 6 symptoms of liver disease?
``` Fatigue Nausea Weight loss Drowsiness Jaundice Abnormal bleeding ```
292
Name 6 signs for liver disease?
``` Jaundiced sclera General jaundice Ascites Hepatomegaly Splenomegaly Bruising ```
293
Name the 4 dental considerations for a patient with liver disease?
Oral and gingival hygiene Bleeding tendency Altered drug metabolism (local anaesthetic, sedation) Risk of viral hepatitis for the dental practitioner
294
Name 6 oral signs for liver disease?
``` Angular cheilitis Haematomas, petechiae Gingival bleeding Xerostomia, sialadenitis Lichen planus – associated with HCV Glossitis – associated with alcoholism and nutritional deficiencies ```
295
What is necessary to check before any dental procedure of a patient with liver disease?
Check that the patient’s clotting and platelet count is normal. Where any derangement is seen, seek medical advice prior to proceeding. During the dental procedure, minimise mucosal trauma and keep any procedure to the minimum required. No NSAIDs If difficult send to hospital setting
296
Should sedation be avoided for liver disease patient?
``` Yes Altered excretion function Ammonia excretion Overdosing Hospital for GA ```
297
Name the 6 the signs for LA toxicity?
``` Peri-oral tingling Drowsiness, confusion Unconsciousness Seizures Arrhythmias Cardiac arrests ```
298
How can liver disease impact LA?
Reduced amount for LA toxicity
299
Name the 5 drugs contraindicated for liver disease patients?
``` Benzodiazepines Aspirin Antifungals e.g. miconazole Antibiotics e.g. erythromycin, metronidazole, tetracycline Strong opiates e.g. morphine ```
300
Name the 4 drugs to be wary about prescribing for a liver disease patient?
Amide local anaesthetics NSAIDs Paracetamol Mild opiates e.g. codeine
301
What is considered to be the foregut?
Mouth-mid duodenum
302
What is considered to be the midgut?
mid-duodenum to mid-transverse colon
303
What is considered to be the hindgut?
Mid-transverse colon to anus
304
What are the symptoms for gastroesophageal reflux disease?
``` Heartburn Regurgitation Dysphagia Chest pain Hypersalivation Globus sensation Odynophagia ```
305
What treatment can be used for GI disease?
Lifestyle changes Proton pump inhibitors H.pylori testing (CLO test) Anti-reflux surgery
306
What drugs are avoided for GI disease patients?
Ca ch blockers NSAIDs Anticholinergics
307
What alarming symptoms of GI disease should suggest a urgent referral?
``` Dysphagia Persistent vom Unintentional weight loss Gi bleeding Abdominal swelling ```
308
Dental implications of GI disease?
Tooth erosion Halitosis Mucosal erythema Burning mucosal sensation
309
What drug should be avoided for GI disease patients?
Aspirin
310
What preventative action can be taken for patients with GI disease?
Dietary advice Treatment of reflux with PPI ENhancing tooth surface integrity Place adhesive physical barrier on susceptible tooth surfaces
311
Name the 5 general symptoms of Liver disease?
``` Jaundice Fever Loss of body hair Coagulopathy Bruising ```
312
Name 11 causes of jaundice?
``` Viral Bacterial Hepatoma Metastatic disease Drugs Alcohol Wilson's disease Ischaemia Obstruction Sepsis Autoimmune Congestive ```
313
Symptoms for pre-hepatic jaundice?
Haemolytic anaemia or excessive prod of blood cells
314
Name 3 causes for hepatic jaundice?
Poisons Infections Tumours
315
WHat is the definition of post-hepatic jaundice?
Obstruction to the drainage of bile from liver
316
Name 7 antibiotics contraindicated for liver disease patients?
Erythromycin estolate - causes cholestasis Tetracycline - dose related hepatotoxicity Chloramphenicol - markedly increased half life Antituberculous therapy in combinations, pyrazinamide Griseofulvin - contraindicated Nalidixic acid Nitrofurantoin prolonged use
317
What should a dentist do in situations a patient becomes acutely unwell?
Ensure adequate airway Breathing: central cyanosis or fetor Circulation: tachy, pale or suggestion of other complications
318
Name 4 causes of IBD?
Ischemia Infection Degenerative Inflammatory
319
What are the signs and symptoms of Crohn's?
Lesions may be found anywhere between the mouth and the anus Thickened bowel wall with cobblestone appearance Deep ulcers that cross the muscularis mucosae Granulomas are common
320
What are the signs and symptoms of UC?
Disease is confined to the colon Thin bowel wall Disease is continuous Ulcers do not cross the muscularis mucosae Granulomas are uncommon and associated with crypts
321
Name 7 oral manifestations for patient with IBD?
Periodontitis Aphthous lesions/stomatitis (typically labial/buccal mucosa) Pyoderma (pyostomatitis) vegetans Nodular granulomatous submucosal lesions Cobblestone mucosal swelling Oral tags Swollen lips (orofacial granulomatosis)
322
Name 5 types of immunomodulators for treatment of IBD?
``` Thiopurines, for example, azathioprine Methotrexate Calcineurin inhibitors, for example, cyclosporin A, tacrolimus Corticosteroids Anti-TNFa, for example, infliximab ```
323
What oral symptoms do iron deficiency anaemia patient show?
Angular cheilitis and aphthous ulcers | But this anaemia may be of greater concern such as bowel cancer
324
Name 2 enzymes present in the mouth?
Salivary amylase | Lingual lipase
325
What does the terminal ileum absorb?
B12 | Bile acid
326
How does the SI have a large SA?
Folds of the bowel surface covered by villi and microvilli
327
Function of cheif cells?
Secretes pepsinogen and converted to pepsin
328
Function of parietal cell?
Secrete HCl and intrinsic factor (bind B12)
329
What is the function of the colon?
Water reabsorption | 200g into the stool
330
What are the macroscopic pathology of Crohn's disease?
Deep ulcers and fissures in the mucosa Strictures Fistulae, for example between bowel and bladder/vagina (in women) Areas of affected mucosa that are not continuous, called ‘skip lesions’
331
What are the symptoms of Crohn's disease?
Abdominal pain Weight loss Diaarhoea
332
What are the oral manifestations for Crohn's disease?
Diffuse facial and lip swelling Cobblestoning of the mucosa Ulceration Mucosal tags
333
What tests can be done to investigate Crohn's disease?
Blood test Barium enema GI endoscopy
334
What drug treatment can be undertaken for a Crohn's patient?
Oral steroids Anti-inflammatory Immunosuppressive drugs High fibre low fat diet
335
What surgical treatment can be undertaken for a Crohn's patient?
Complications such as strictures and fistulas intervention
336
What are the macroscopic pathology of ulcerative colitis?
Affects only the colon Starts in the rectum and then extends backwards (proximally) by varying amounts Continuously involves bowel (NO skip lesions, unlike Crohn’s) Produces ulcers and pseudo-polyps
337
What are the extraintestinal features for UC and Crohn's?
``` Anaemia (due to blood loss) Arthritis Clubbing Skin conditions Uveitis ```
338
What are the oral manifestations for UC?
Aphthous ulcers | Angular cheilitis
339
What tests can be done to investigate ulcerative colitis?
Blood test Stool culture Barium enema GI endoscopy
340
What drug treatment can be undertaken for a ulcerative colitis?
Oral steroids Anti-inflammatory Immunosuppressive drugs High fibre low fat diet
341
What surgical treatment can be undertaken for a Crohn's patient?
Colectomy | Stoma
342
What are the symptoms of Coeliac disease?
``` Feeling generally tired and weak Weight loss Diarrhoea +/- steatorrhoea Abdominal distension and pain Anaemia ```
343
What tests can be done to investigate coeliac disease?
Blood test | GI endoscopy
344
What are the oral presentations for Coeliac disease?
``` Features of anaemia Oral ulceration Glossitis Angular cheilitis Enamel defects ```
345
What is the definition of TI diabetes?
Autoimmune destruction of Beta cells leads to reduced insulin production
346
What is the definition of TII diabetes?
Body becomes increasingly resistant to effects of insulin | Pancreas works harder to control plasma glucose levels
347
Name 8 diseases that cause 2nd diabetes?
``` Chronic pancreatitis Haemochromatosis Cystic fibrosis Acromegaly Cushing's Glucagonoma Pheochromocytoma Steroids ```
348
What is the definition monogenic diabetes?
Maturity onset diabetes of the young Not TI or TII Autosomal dominant Glucokinase, HNF1A and NHF4A
349
What is the treatment for monogenic diabetes?
HNF1A and HNF4A responds to sulfonylurea | Glucokinase no treatment
350
Describe the signs and symptoms of undiagnosed diabetes?
``` Thirst Polyuria Polydypsia Weight change Lethargy SKin changes Blurred vision Recurrent candida infections ```
351
What is the normal value for fasting plasma glucose?
<6.0
352
What is the diabetic valve for fasting plasma glucose?
>7.0
353
What is the intermediate valve for fasting plasma glucose?
6.1-6.9
354
What is the normal value of 2hr OGTT?
<7.7
355
What is the intermediate value of 2hr OGTT?
7.8-11.0
356
What is the diabetes value of 2hr OGTT?
>11.1
357
What are the requirements for a clinical diabetes diagnosis?
1 typical symptom + 1 diagnostic blood test | 2 diagnostic blood test
358
When should HbA1c should be used?
True fasting blood sampling is not possible OR | following identification of impaired fasting plasma glucose
359
Explain how the HbA1c test works?
Glucose binds irreversibly to haem in RBCs forming Hb1Ac Higher glucose, Higher Hb1Ac Can reflect the blood glucose over 2-3 months
360
Name low, medium and high levels of the Hb1Ac test?
Low: 48 Medium: 64 High: 97 Lowering your Hb1Ac by 10 mmol/mol reduces your risk of complications by 20%
361
Name the 3 macrovascular complications for diabetes?
Coronary artery disease Cerebrovascular disease Peripheral vascular disease
362
Name the 4 microvascular complications for diabetes?
Peripheral neuropathy Retinopathy Nephropathy Autonomic neutropathy
363
How do diabetics monitor their blood glucose?
Capillary blood glucose Prick fingers Devices available
364
What should the blood glucose targets be over the day?
Before breakfast: 5-6 mmol/L Before meals: 4-7 mmol/L 2 hrs after meal: 5-9 mmol/L Bedtime: 6-8 mmol/L
365
How can ketone monitoring be useful for diabetics?
Presence of ketones indicates lack of insulin Urine or blood test Levels change much faster
366
What are the normal, rapid action and immediate action for ketone monitoring?
Normal: <0.6 Rapid: 0.6-1.5 Immediate: >1.5
367
What is the definition of Flash CGM?
Freestyle libre sensor contains a small filament underneath the disk that is inserted into the back of the arm Filament measures the glucose level of the interstitial tissue under your skin Sensor lasts up to 14 days and needs to be scanned at least every 8 hours - continuous glucose info Water resistant up to 1m for 30 mins Measures interstitial rather than blood glucose
368
Name the 4 categories for treatment of TII diabetes?
Diet Exercise Drugs Insulin
369
Name the oral manifestations for diabetes?
Xerostomia; burning sensation in the mouth Impaired/delayed wound healing; increased incidence and severity of infections; Secondary infection with candidiasis; Parotid salivary gland enlargement; Gingivitis; and/or periodontitis.
370
Name 7 drug treatment options for diabetes?
``` Metformin Sulfonylureas Pioglitazone DPP-4 inhibitors SGLT-2 inhibitors GLP-1 Insulin ```
371
How successful is counterweight plus to aid TII diabetes?
Counterweight Plus: 53/149 achieved remission Control diet: 5/149 achieved remission Remission defined as Hb1Ac <48 mmol/mol
372
How can exercise impact TII diabetes?
Compared to a very low control | Exercise can help
373
Why should we treat diabetes?
Reduce hyperglycaemia and CVD
374
Describe 2 types of regimes for insulin taking?
Basal, basal bolus or basal plus | Twice daily mixed
375
Name the 4 requirements for an insulin pump therapy?
TI diabetes Testing at least 4 times a day Educated on carb counting significant hypos or poor control despite optimal basal bolus therapy
376
Explain how the closed loop device works?
``` Artificial pancreas Low user input Accurate and reliable glucose monitoring Algorithms incorp glucose data to adjust dose Internal or external ```
377
Name 2 types of hypoglycaemia?
Mild | Severe
378
Name 2 causes of hypoglycaemia?
``` Insulin therapy Sulfonylurea therapy (glipizide and gliclazide) ```
379
What is the frequency of hypos for a T1 diabetes patient?
2 mild hypos per week | 1 severe hypo per year
380
Name the 11 clinical features of a hypoglycaemic attack?
``` Confusion Drowsiness Odd behaviour Speech difficulty Incoordination Malaise Headache Palpitations Hunger Trembling Sweating ```
381
Explain glucose metabolism?
Oral intake Gluconeogenesis + glycogen breakdown Glucose use in brain, muscle and adipose tissue
382
Name the 6 adverse effects of hypoglycaemia?
``` Coma Seizure Hemiplegia Fracture Arrhythmia Myocardial ischaemia ```
383
Describe S1 of immediate management of conscious patient?
Give 15-20g quick acting carbs patient choice: e. g. - 150-200 mL of pure fruit juice - 5-7 Dextrosol tablets or 4-5 glucotabs - 3-4 heaped teaspoons of sugar dissolved in water
384
Describe S2 of immediate management of conscious patient?
Repeat capillary blood glucose measurement 10-15 minutes later. If less than 4.0 mmol/L repeat step 1 up to 3 times
385
Describe S3 of immediate management of conscious patient?
Blood glucose remains less than 4.0 mmol/L after 45 mins contact doctor Consider 1mg of glucagon IM or IV 10% glucose infusion at 100ml/hr
386
Describe S4 of immediate management of conscious patient?
Once blood glucose above 4.0mmol/L and recovered, then give long acting carb e.g. - 2 biscuits - sliced bread
387
Describe S1 of immediate management of conscious patient whom is confused and disorientated?
Uncoop but able to swallow: - 1.5-2 tubes glucogel/dextrogel - glucagon 1mg IM Glucagon may not be effective for sulfonylurea or malnourished
388
Describe S1 of immediate management of unconscious patient?
Check ABC Give IV glucose over 15 mins as 75ml 20% or 150ml 10% Or 1mg glucagon IM Recheck after 10 mins to see above 4 mmol/L
389
What are the sick day rules for TI diabetes?
Body stressed = blood glucose higher Don't stop insulin Drink plenty Check levels of glucose and ketones
390
What are the consequences of missing insulin?
``` Increased resp rate Ketones on breath Abdominal pain Nausea Vomiting ```
391
What are the sick day rules for TII diabetes?
``` Rest FLuids Treat associated symptoms Antibiotics indicated Check levels more reg Adjust meds: - stop metformin if risk of dehydration - stop SGLT-2 inhibitor if very unwell ```
392
What is the definition of diabetic ketoacidosis?
Characterised by hyperglycaemia, acidosis and ketonaemia BG >11 Ketones > 3 pH < 7.3 (HCO3 <15)
393
If DKA is detected, what should you do?
1L IV NaCl 0.9% over 1 hr within 30 mins | Sol IV insulin of 6 units/hr within 30 mins
394
How to detect DKA clinically?
``` H+ > 45 HCO3 <18 pH <7.3 Check U and Es Lab blood glucose Check urine and blood ketones ```
395
What pH, HCO3 and H+ is severe DKA?
pH <7.1 HCO3 < 5mmol/L H+ > 80mEq/L
396
Name the 10 endocrine organs?
``` Testes Ovaries Pancreas Adrenal gland Thymus Parathyroid Thyroid Pituitary Hypothalamus Pineal gland ```
397
WHat hormones are required for repro?
LH and FSH
398
What hormones are required for metabolish?
TSH
399
What hormone is required for lactation?
Prolactin
400
What hormone is required for growth
GH
401
What hormones is required for stress?
ACTH
402
WHat hormones is required for water balance?
ADH
403
What hormones is required for parturition?
Oxytocin
404
What are some endocrine conditions?
``` Hypothyroidism Amyloidosis Lymphoma Syphilis Secondary macroglossia from benign or malignant space occupying lesions ```
405
Name 6 endocrinopathies?
``` Adrenal insufficiency Cushing's Hypothyroidism Thyrotoxicosis Goitre Acromegaly ```
406
What does the glomerulosa produce in the adrenal gland?
Mineralocorticoids
407
What does the fasciculata produce in the adrenal gland?
Glucocorticoids
408
What does the reticularis produce in the adrenal gland?
Androgens
409
What do the adrenal glands produce?
Adrenaline | Noradrenaline
410
Name the 2 types of adrenal insufficiency?
Primary - High ACTH | Secondary - Low ACTH
411
What is the definition of primary adrenal insufficiency?
Autoimmune (tuberculous adrenalitis) | ACTH not able to interact with Adrenal gland
412
What is the definition of secondary adrenal insufficiency?
Tumour in the hypothalamic-pituitary region | No form of ACTH
413
What is the definition of tertiary adrenal insufficiency?
WIthdrawal of exogenous glucocorticoid admin
414
Name the 4 discriminatory diagnostic features for adrenal insufficiency?
Skin hyperpigmentation Alabaster-coloured pale skin Low BP Postural hypotension
415
Name a test for adrenal insufficiency?
Short synacthen test
416
Explain how the short synacthen test works?
``` Assess renal reserve Any time of day without fasting Inj synthetic ACTH Take baseline cortisol before and one 30 mins later Only for adrenal gland ```
417
For a dental patient with adrenal insufficiency what must they take addition to their current medication before a dental extraction?
20mg (double/triple of normal dose) hydrocortisone or double usual dose of prednisolone before procedure Resume normal dose after
418
Name the 4 clinical features that best discriminate Cushing's syndrome?
Easy bruising Facial plethora Proximal myopathy or proximal muscle weakness Striae - especially if reddish purple and >1cm wide Moon faced
419
What is the definition of Cushing's syndrome?
ACTH dependent - Cushing's or Ectopic ACTH secrete ACTH independent - Adrenal adenoma/carcinoma Exogenous steroids
420
What investigation can aid in the diagnosis for Cushing's?
Demonstrate excess cortisol: - 24 hr urinary free cortisol - overnight dexamethasone suppression test
421
Name 4 conditions associated with hypercortisolism without cushing's syndrome?
Preg Depression/other psy conditions Alcohol dependence Morbid obesity
422
What is the definition of hypothyriodism?
Negative feedback loop | Low thyroid hormone Low T4/3 but high TSH
423
Name the 2 types of thyroid hormone?
T4 - thyroxine T3 - triiodothyronine Deiodinase enzymes convert T4 to T3
424
What is the normal range for TSH?
0.35-0.45
425
What is the normal range for free t3?
3-7
426
What is the normal range for free t4?
10-25
427
What is the definition of thyrotoxicosis?
High T4/T3 and low TSH
428
What is the treatment for hypothyroidism?
Levothyroxine
429
How to test for hypothyroidism?
TFT testing interval | GAFUR
430
WHat are the main causes for hypothyrodism?
Atrophic autoimmune thyroiditis Hashimoto's thyroiditis Post-treat thyrotoxicosis
431
Name 4 diseases that have thyrotoxicosis common as a symptom?
Graves Toxic multinodular goitre Autonomously functioning adenoma Thyroiditis
432
What are the discriminatory signs for thyrotoxicosis?
Goitre Tremor Ocular signs
433
What investigations help for thyrotoxicosis diagnosis?
TSH, T4 and T3 | TPO and TRABs
434
What treatment options are there for thyrotoxicosis?
``` Carbimazole: - once daily - gives rash Propylthiouracil: - 2 daily - rash Beta blocker Low dose radioiodine: - can cause hypothyroidism Thyroid surgery: - recurrent laryngeal nerve - Ca issue ```
435
What are the 3 differential diagnoses for thyroid nodules?
Multinodular goitre with a dominant nodule Thyroid cyst Thyroid cancer
436
What is the aetiology for goitre?
``` Autoimmune thyroid disease Sporadic Endemic Preg Drug induced Thyroiditis ```
437
What can a ultrasound signify for thyroid lumps?
3cm mass in R lobe of thyroid suggestive but not diagnostic of follicular thyroid cancer R diagnostic hemithyroidectomy
438
What is the definition of acromegaly?
An increased secretion of growth hormone causing changes in appearance
439
What could acromegaly be caused by?
Growth hormone secreting tumour
440
Name 9 complications associated with acromegaly?
``` Visual field defect Headaches Diabetes Decreased libido Sleep apnoea Hypertension Cardiomyopathy Arthritis Carpal tunnel ```
441
Give 5 tests that can aid acromegaly diagnosis?
Blood test: - IGF1 - Glucose - Thyroid hormone - Oestrogen - FSH
442
Explain how the oral glucose tolerance test is carried out?
Baseline blood sample Measured dose of glucose Blood drawn at intervals Determine how quickly blood can be cleared For acromegaly, check growth hormone levels Can do MRI after
443
What are the treatment options for acromegaly?
Removal of tumour Sandostatin analogue if surgery fails GH inhibition (Pegvisomant) Dopamine can suppress GH secretion

3rd Year BDS (21 decks)

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