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BDS4 EXAM PREP > Diseases > Flashcards

Diseases Flashcards

(191 cards)

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1
Q

type 1 diabetes

A

insulin deficient

autoimmune B cell destruction

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2
Q

type 2 diabetes

A

insulin resistant

metabolic disorder

generally old, fat, no exercise, genetically predisposed

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3
Q

signs/symptoms of diabetes

A

ketoacidosis (rare in type 2)

hyperglycaemia

polydipsia (thrist)

polyurea (urine)

ketoacidosis (glucose cannot be used for energy, so fat used)

swearing

palpitations

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4
Q

complications of diabetes

A

large vessel

  • stroke risk
  • MI risk
  • claudicatin/foot amputation

small vessel

  • poor wound healing
  • renal disease
  • maculopathy
  • neuropathy - weak/muscle wasting
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5
Q

test for diabetes

A

RPG - random plasma gluocse (>11.1mMol/L=Diabetes)

HbA1C

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6
Q

type 1 diabetes tx

A

basal-bolus insulin injection

split mixed insulin injection

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7
Q

type 2 diabetes tx

A

less 10%% fat intake in diet

  • count carbohydrates
  • gastric bypass
  • diet pills - sibutramine
  • oral hypoglycaemic agent

sulphonylureas-gliclaszide

  • increase insulin secretion and sensitvity
  • hypoglucaemia

biguanides metformin

  • increase insuline sensitvity
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8
Q

dental impact of diabetes

A

gingivitis/periodontitis

poor wound healing

oral candidiasis

xerostomia -> inc incidence of caries

give prophylatic antibiotics for invasive treatment

LA given should not interfere with eating as may become hypo

  • tx in morning after breakfast and hypoglycaemic agents
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9
Q

hyperthyroidism

causes

A
  • Graves disease (70-80%) autoimmune - stimulates TSH
    • sign - opthalmopathy
  • toxic multi-noduluar goitre
  • pituitary adenoma (rare)
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10
Q

signs/symptoms of hyperthryoidism

A

increased metabolism

diarrhoea

palpitations. tachycardia. atrial fibrilation

hypertension, heart failure

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11
Q

test for hyperthyroidism

A

blood test for TSH

  • low T3 and T4
  • high, if adenoma
  • high TSH and T3 adn T4

FNB - fine needle biopsy

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12
Q

tx for hyperthyroidism

A

raidiopaque iodine

partial thyroidectomy

give carbimazole and T4 replacement (prolonged tx =hyperthyroidism)

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13
Q

dental relevance of hyperthryoidism

A

inc pain and anxiety

goitre if detected by dentists

accelerate periodontal disease

premature toth eruption thryotoxic crisis can be preciptitated by stress, surgical procedures and infections - medical emergency, mortality of 10%

pt with hyperthyroidism may be sensitive to adrenaline (LA)

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14
Q

hypothryoidism

causes

A

Hashimoto’s thyroiditis - autoimmune

too much iodine

thyroidectomy

thryoid atrophy

drug induced - carbimazole

hypothalamic/pituitary disease - rare

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15
Q

signs/symptoms of hypothyroidism

A

hair loss

slow mental state

heat intolerant

dry skin

weight gain

brachycardia

goitre

angine

delayed reflexes

constipation

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16
Q

tests for hypothyroidism

A

blood test for TSH

  • high T3 and T4
  • rare - low TSH and T3 and T4

FNB - fine needle biopsy

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17
Q

tx for hypothyroidism

A

with t4 replacements

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18
Q

dental relevance of hypothyriodism

A

low pain threshold

delayed tooth eruption

enlarge tongue

bad wound healing

myxodema - if give sedation can cause coma

sensitive to opioids and bezodiazepine

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19
Q

causes of hyperadrenalism

A

adrenal tumour

pituitary adenoma

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20
Q

Conn’s syndrome

A

increased aldosterone

increased Na/H2O reabsorption

resulting in poor BP control, risk of stroke, MI and renal failure

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21
Q

treatmeant for Conn’s syndrome hyperadrenaalism

A

ACE inhibitors - enalapril, ramapril

angiotensin 2 blocker

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22
Q

Cushing’s syndrome

A

increased ACTH - increased cortisol

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23
Q

signs/symptoms of Cushing’s syndrome

A

balding

moon face

buffalo hump

acne

weight gain

thin skin

hypertension

diabetes

osteoporosis

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24
Q

test for Cushing’s syndrome

A

increased cortisol in urin

CRH test - give CRH and produce high levels of ACTH

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25
treatment for Cushing's syndrome
reduce therapeautic steroid use remove tumour
26
Addison's disease
destruction of adrenal tissue due to autoimmune disease - not producing enough steroid hormones, inc cortisol
27
signs/symptoms of Addison's disease
hypotension vomitting dehydration weight loss buccal pigmentation - melanin postural hypotension (low BP)
28
addison's disease is
hypoadrenalism
29
test for Addison's disease
give ACTH, no plasma cortisol level rise check plasma level for cortisol
30
tx for addison's disease
therapeutic corticosteroids * hydrocortisone - hypertension * prednisolone - atheroscelrosis * bethamethasone - inc infection risk * fludrocortisone - peptic ulceration and inc cancer risk, osteoporosis
31
dental relavance of Addison's disease/hypoadrenalism
steroid prophylaxis if: surgery, infection or physiological stress NOT routine tx, PMH steroid use antibiotics as prone to infection buccal pigmentation commmon
32
asthma
reversible airflow obstruction hypersensitivity reaction
33
normal resp rate
12-15 breaths/min
34
signs/symptoms of asthma
inflammation in airways excess mucous smooth muscle constriction cough stridor wheeze dyspnoea pain
35
test for asthma
FEV1 - forced expiratory volume chest x-ray FEV1/FVC
36
tx asthma
beta2 agonists * salbutamol * short acting bronchodilator - tx initial IgE hypersensitivity response short acting B2 agonist and anti-inflammatory, corticosteroids * beclomethasone * budesmide * fluctisone
37
dental relevance of asthma
NSAIDs can worsen asthma attack inhaled steroids - change in oral mucosa inhaler before tx, spacer to prevent deposisiton
38
COPD
chronic obstructive pulmonary disease chronic bronchitis and emphysema
39
emphysema
destruction of alveoli, others dialte to fill space
40
causes of COPD
smoking tumours - asbestos fibrosis - coal, berylium
41
signs/symptoms of COPD
chronic cough shortness of breath sputum produced expiratory wheeze poor ventilation narrow airways restrictive lung defects - reduced FVC, lung volume, oxygenation, inc work of breathing
42
complications of COPD
pnumothorax right heart failure expiratory failure
43
tests for COPD
FEV1 - forced expiratory volume chest x-ray FEV1/FVC
44
tx for COPD
stop smoking long acting bronchidilator - salmeterol + fluctisone oral steroids O2 support antibiotics for infections physiotherapy
45
dental relevance for COPD
keep session short care with rubber dam candida infection for oral steroids no sedation inhaler before treatment
46
cystic fibrosis
autosomal recessive disorder, affecting the gene coding for the CFTR protein on chromosome 7 defect Cl- channels, excess thick mucous in lungs and pancreas
47
signs/symptoms of Cystic fibrosis
cough diarrhoea poor weight gain osteoporosis chest infections - pseudomnas and staph cocci
48
complications of cystic fibrosis
malabsorption pneumonia lung damage - pulmonary failure
49
test for cystic fibrosis
heel prick * Guthrie test in children * test for hypothyroidism and sickle cell anaemia sweat test * increased NaCl in sufferers of CF
50
tx for cystic fibrosis
* physiotherapy - mucous removed from lungs * exercise - increased pulmonary strength and defends against osteoporosis * heart and lung transplant - new lungs no Cl- channel defect * medication * b2 agonists * antibiotics - decreased chest infections * steroids to reduce inflammation * DNAse to breakdown mucous * pancreatic enzyme replacment
51
dental impact of CF
increased caries
52
hypertension defined as
140/90
53
causes of hypertension
usually secondary Risk factors * age * race * obesity * alcohol * FH * pregnancy * stress Diseases * Cushing's syndrome * hyperthyroidism * atherosclerosis * renal artery stenosis * phenochromcytoma Drugs * corticosteroids * sympatomemetics * NSAIDs
54
signs/symtoms of Hypertension
TIAs (transient ischamic attacks)
55
complications of hypertension
atherosclerosis MI stroke claudication
56
tests for hypertension
urine analysis ECG renal ultrasound renal angiography
57
tx for hypertension
treat underlying cause lifestyle changes review cardiac symptoms drugs
58
dental relevance of hypertension
best treated under LA care with adrenaline inc post-op bleedng no tx if 160/110
59
heart failure is
output of heart is unable to meeting demands of the tissues
60
causes of heart failure
low output * MI * valve disease * arrhythmias * atrial fibrilation high output * anaemia * hyperthyroidism - thyrotoxicosis
61
symptoms of heart failure
left heart failure * dyspnoea * hypotenion * arrhythmias * atrial fibrilation right heart failure * venous pressure elevated * oedema in ankles * enlarged liver/poor GI * fatigure weakness
62
test for heart failure
chest x ray - caridiac enlargement/pneumonia oedma ECG
63
tx heart failure
* exercise * Low salt diet * Diuretics, ACE inhibitors, incotrope – Digoxin (decrease force of contraction) * Reacts with verapamil and Las * Surgery * Oxygen – low O2 * Morphine for pain
64
dental relevance of heart failure
* Orthopnoea * Digoxin reacts with adrenaline and LA
65
ischaemia
narrowing of blood vessels leading to imbalance of blood supply from the heart and demand from the tissues
66
causes of ischaemia
coronary atheroma * plaque with platelet aggregates, smooth muscle fibrosis risk factors * age * male * family history * smoking * hypertension * obesity * alcohol * oral contraceptive
67
signs/symptoms of ischaemia
angina pectoris * classic - worse with exercise, subsides with rest * unstable - rapid deterioration peripheral vascular disease breathlessness
68
test for ischaamia
ECG - at rest and at exercise angiography
69
treatment for ischaemia
diet and smoking advice reduce afterload reduce preload - nitrates bypass blockage (CABG) aspirin - anti-platelet, decreased MI risk diuretics ACE inhibitors Ca2+channel blockers
70
infarction
blood vessel occlusion no o2 delivery - necrosis of tissue
71
causes of infarction
progression of ischaemia - atheroma (ulcerative plaque with platelet aggregates) thrombosis on surface, platelets detaches and blocks vessels
72
signs/symptoms of infarction
complications * MI - coronary artery atheroma - death, arrythmias, heart failure, embolism * Stroke - carotid artery, loss of function of areas in brain - necrosis * TIAs * claudication - femoral or popliteal
73
Test for infarction
ECG * T wave inversion = MI * Q wave can indicate previous MI * Cardiac enzymes – creatine kinase, troponin
74
tx for infarction
open blood flow to ischaemic tissue - angioplasty bypass blockage amputation thrombolysis of atheroma give aspirin straight away
75
endocarditis
inflammation of the hear endocardium, vegetation on the valves due to microbial infection
76
causes of endocarditis
* Previous endocarditis * Rheumatic fever * Heart valve replacement * Scaling * Tooth brushing * Strept. Veridans – oral commensual * Extraction * Staph aureus * Endodontics * Streptococci * Implants * Enterococci * Incision of abscesses
77
signs/symptoms of endocarditis
heart murmur rashes flu weight loss splenomegaly
78
test for endocarditis
endocardiogram - vegetation on heart valves blood cultures
79
tx for endocarditis
4 weeks of bactercidal antibiotics - valmycin o2 support
80
dental relevance of endocarditis
check risk category according to SDCEP guidance
81
congenital heart defects
stuctural/functional defects of the heart present at birth can manifest at any time
82
types of congenital heart defects
* Atrial septal defects * Ventricular septal defects * Mixing O2 and non-O2 blood * Patent ductus arteriosus * Irregular transmission from aorta and pulmonary artery * Co-arctation of aorta * Narrowing of aorta where ductus arteriosus connected * Ischaemia to lower limbs * Left ventricular hypertrophy
83
signs/symptoms of congenital heart defects
poorly oxygenated blood heart murmur/failure chest infections
84
test for congenital heart defects
chest x-ray angiography ECG MRI
85
treatment of congenital heart defects
surgical correction
86
valve disease causes
Can occur in aortic, pulmonary, mitral and tricuspid Causes * Congenital * MI * Rheumatic fever * Dilation of aortic roots (aortic anneuyrism) same signs/symptoms as heart failure
87
test for valve diseases
chest x ray angiography ECG MRI doppler ultrasound
88
tx for valve disease
valve replacement (prosthesis) Antibiotics and anticoagulants needed
89
anaemia
reduction in the o2 carrying capacity, defined by low Hb
90
normal male Hb
13.5g/100ml
91
normal female Hb
11.5g/100ml
92
thalassemia can cause
cirrhosis gallstones skeletal hyperplasia treat with blood transfusion - DO NOT overload with Fe (heart failure)
93
causes of anaemia
Decreased production * Marrow failure – overall decrease in RBC * Renal failure - EPO * Deficiency in Fe, folic acid, vitamin B12 * Abnormal globin chains – thalassemia * Chronic inflammatory disease Increased losses * Excessive bleeding * Menstruation Increased demand * Pregnancy * Cancer * Hypothyroidism – bradycardia
94
signs/symptoms of anaemia
fatigue weak dizzy palpitations tachycardia brittle nails
95
tests for anaemia
* Endoscopy – chrons * MCV = HCT/RCC measure micro/normo/macro cytic * FBC * HCT = RCC/FBC x 100%.45% men, 40% women * Renal function * Bone marrow * Haemintinc test
96
tx for anaemia
* Fe replacement * Folic acid replacement * Vit B12 replacement * Blood transfusion * EPO
97
dental relevance of anaemia
* Pale mucosa * Angular cheilitis * Smooth tongue (Fe deficient) * Beefy tongue (vit B12 deficient) * Oral ulcerations * Poor wound healing
98
thrombophilia
increased risk of bleeding
99
thrombocytopenia
decreased number of platelets
100
causes of thromobophilia or thrombocytopenia
idiopahtic alcohol drugs - penicillin, heparin
101
thrombocythemia
increased numbers of platelets
102
causes of thrombocythemia
inherited * protein C syndrome * protein 5 syndrome * antithrombin 3 deficient * factor V leiden * thrombocythaema acquired * anti-phospholipid - lupus * surgery * pregnancy * trauma * oral contraceptives
103
signs/symptoms of thrombocythemia
shortness of breath - protein C/s when start on warfarin, risk of skin necrosis palpitations chest pain DVT inc risk of MI inc risk of stroke
104
test for thrombocythemia
INR - ratio of prothrombin time: prothrombin time (norm)
105
treatment for thrombocythemia
oral anticoagulants * warfarin * dabigatran * rivaroxaban heparins antiplatelets * aspirin * clopidogrel * dipyridamole
106
dental relevances of thrombocythemia
inc risk of haemorrhage when restrat warfarin - hypercoagulation rebound state if on warfarin - appointment within 24hrs of INR, do in the morning, avoid block injections. DO NOT TREAT IF INR \>4
107
haemophilia
inherited bleeding disorder * Factor VII * Factor IX * factor XI * Von Willebrand’s
108
haemophilia A
factor VII deficiency sex linked recessive, female carriers, male sufferers tx: desmopressin, controls transport of factor VII
109
haemophilia B
factor IX deficiency tx: give factor IX, pt can develop antibodies to factors, if low level inhibition inc conc
110
Von Willibrand's
decrease in VWb factor VWBf is precursor to factor VIII decreased platelet adhesion Type 1 mild dominant Type 2 mild dominant Type 3 severe recessive - Treat in Hospital Treatment of VWBf * DDAVP – desmopressin, mild cases treat with Tranexamic acid
111
dental relevances of bleeding disorders
gingival bleeding prolonged bleeding following XLA
112
leukaemia
tumours of haemopoietic precursor cells in bone marrow translocation mutations - switch off tumour precursor, switch on oncogenes
113
process of leukeamia
clonal proliferation of cells replacement of marrow marginalisation of noraml marrow marrow failure organ infiltration
114
types of leukaemia and who they commnly affect
Acute lymphoblastic leukaemia * Kids Chronic lymphoblastic leukaemia * B cells Acute myeloid leukaemia * Adults Chronic Myeloid leukaemia * Neutrophils
115
signs/ symptoms of leukaemia
anaemia neutropenia * inc infection * perianal thrush * tonsilitus/pharygitis * pneumonia/bronchitis thrombocyopenia * bruise easily * decreased clotting * inc gingival bleeding lymphadenopathy splenomegaly hepatomegaly bone pain in children
116
treatment for leukaemia
chemotherapy radiotherapy haemopoietic stem cell transplant monoclonal antibodies
117
dental relevance of leukaemia
ginigval bleeding oral ulceration * necrotic ulcerative periodontitis * mucosititis gingival enlargment candidosis ROU - herpes Lytic bone lesions
118
lymphoma is
clonal proliferation of cells in the lymph system
119
stages of lymphoma
1. 1 site 2. 2 sites 3. above and below diaphragm 4. non-lymph tissues
120
Hodgkins Lymphoma
cancer of lymph system
121
signs/symptoms of hodgkin's lymphoma
lymphadenopathy fever night sweats infection weight loss
122
non-hodgkins lymphoma
affects non nodular lymph tissue Causes * H pylori * EBV * Immunosuppression – autoimmune * Arthritis * Transplant Signs/Symptoms * Lymphadenopathy * Waldeyer’s ring
123
test for lymphoma
blood tests
124
treatment of lymphoma
* Hodgkins * Stage 1 and 2 – 90% survival * Stage 3 and 4 – 60% * Non- hodgkins * Aggressive * Difficult to treat
125
dental relevance of lymphoma
lymphadenopathy anaemia - bleeding
126
multiple myeloma is dental relevance
Malignant proliferation of plasma cells * Paraprotein in blood Lytic jaw bone lesions
127
impact of loss of kidney function
* Loss of excretory function * Loss of acid/base balance * Loss of H2O and electrolyte failure * Endocrine function * EPO - anaemia possible complication * Ca2+ metabolism, decreased vit D * Renin production decreased – hypertension
128
acute renal failure
rapid loss of renal function hours/days pt anuric with H2O retention
129
causes of acute renal failure
pre-renal * all pre-renal causes = acute * decreased blood flow to kidneys * hypovolaemia * hypotension * heart failure * renal atery stenosis renal * glomerulonephritis * acute tubular necrosis * drug damage - NSAIDs * rhabdomyolysis * lupus (SLE) post-renal * kidney stones * enlarged prostate * bladder tumour
130
sigsn/symptoms of acute kidney failure
fatigue loss of appetite headache nausea peripheral oedema pulmonary oedema - treat with diuretics metabolic acidosis - treat with NaHCO3 hyperkalaemia - treat with antiperkalemics
131
tx of acute kidney failure
dialysis/nutrition support acute is reversible
132
chronic renal failure
gradual loss of renal function over years associated with ESRD
133
causes of chronic renal failure
* diabetes (40%), secondary cause * hypertension (25%), secondary cause * glomerulophritis (12%), primary cause
134
signs/symptoms of chronic renal failure
anaemai hypertension oedema nuropathy hypocalcaemia hypertension encephalopathy Fe deficieny anaemia - decreased EPO pulmonary oedema hyperkalemia
135
test for chronic renal failure
serum creatinine \>0.6-1.2mg/Dl GFR \< 60ml/min/1.73
136
tx of chronic renal failure
haemodialysis outside the body * blood pumped from atrio-venous fistula to dialyser then back to AV fistula * heparin given for anticoagulation peritoneal dialysis * inside the body * fluid pumped into peritoneal space, waste products discarded endocrine replacement * EPO injections * renin replacement * vit D for Ca2+ renal transplant * rejection risk * immunosuppression - inc infection * cardiac mortality
137
dental relevance of renal failure
* Treat after haemodialysis * Increased cardiac risk * Drug complications * Prednisolone * Cylosporin * Azthropine * Ulceration * Candidiasis * Parotiditis * Stomatitis * Lytic jaw bone lesions * Uraemic stomatitis * Slow tooth eruption * Xerostomia
138
recurrent oral ulcerations ROU
minor aphthae - most common major aphthae - any mucosa affected herpetiform aphthae - herpes like small sores
139
oral foacial granulomatosis
swelling of lips and cobblestoning of buccal mucosa
140
causes of GORD
hiatus hernia - defect of lower oesophageal sphincted, sphincter is found in the thorax impaired clearing into stomach impaired gastric emptying
141
signs/symptoms of GORD
epigastric burning dysphagia GI bleeding pain
142
complications of GORD
ulceration inflammation metaplasia - Barrett's Oesphagus * strat. Squamous to simple columnar epithelium, can become cancerous – adenocarcinoma
143
tx for GORD
stop smoking weight loss avoid triggers e.g. coffee antacids (rennies) H2 receptor anatgonists - ranitidine protien pump inhibitors - omeprazole, lansoprazole, pantoprazole
144
peptic ulcer disease
present in oesphagus, duodenum, stomach over production of acid
145
causes of peptic ulcer disease
excessive acids reduced protective barrier - caused by H Pylori NSAIDS and corticosteroids
146
signs/symptoms of peptic ulcer disease
gastro-oesphageal burning pain - relieved by eating vomiting blood
147
complications of peptic ulcer disease
acid can burn through peritoneum/arteries lymphoma of stomach if left untreated
148
tests for PUD
endoscopy history barium swallow
149
tx for PUD
triple therapy * Antibiotics * Amoxycillin * Metronidazole * Protein pump inhobitors * Omeprazole Vagotomy – sever vagus nerve – reduced ACh which reduces acid secretion, but also reduces motility Gastrectomy
150
dental relevance of PUD
avoid NSAID prescription
151
Crohn's disease
Granulomatous disease affects any part of the GI tract from mouth to anus * Discontinuous * Non-vascular oedematous cobblestoning * Transmural * Serosa Unknown cause * Risk factors * Smoking * Psychological * Genetic
152
signs/symptoms of Crohn's
* Abdominal pain and diarrhoea * Orofacial granulomatosis * Mucosal cobblestoning * Thickened gastro-intestinal wall * Abcesses * Malabsorption * Food intolerance * Persistent viral infection – immunocompromised
153
tests for Crohn's
* Blood test * Faecal testing * colonoscopy * endoscopy * barium studies
154
treatment for Crohn's
* corticosteroids - anti-inflammatory * prednisolone * ASA – anti-inflammatory * Mesalazine * Immunosuppressants * Azathioprine, methotrexate * Palliative * Colectomy
155
dental relevance of Crohn's
Orofacial granulomatosis * Granuloma – block lymphatics, immunocompromised à viral infection * Lip swelling * Cobblestoning of buccal mucosa * Angular chelitis * Gingivitis * Ulceration * Food intolerance
156
ulcerative colitis
chronic inflammation colon and terminal ileum * vascular * ulcers * mucosal - mucosal abscesses Unknown cause * Risk factors * Smoking g * Psychological * Genetic
157
signs and symptoms of ulcerative colitis
bloody diarrhoea mucosal abscesses destruction of goblet cells abdominal pain
158
complication of UC
can develop into carcinoma
159
tests for UC
* Blood test * Colonoscopy * Endoscopy * Barium studies * Faecal testing
160
tx for UC
* Colonectomy CURES UC * Acute – treat with predisnolone * Long term – treat with non-steroidal immunosuppressant
161
dental relevance of UC
ulceration immunocompromised - viral infection
162
coeliac disease
intolerance to alpha-glaiden component of gluten Signs/symptoms * Weight loss * Fatigue * Abdominal pain * Diarrhoea NEED LIFELONG GLUTEN FREE DIET
163
complications and tests for coeliac disease
Complications * T lymphocytes * Release cytokines * Villous atrophy jejunum * Malabsorption of Fe, Vit B12, folic acid, fat * Anaemia * Failure to thrive in children * Increased risk of lymphoma Test * Endoscopy * Jejunal biopsy * Faecal fat * Antibodies * Presence of anti-glaiden
164
dental relevance of coeliac disease
oral ulceration aphthae glossitis dysphagia linked with dermatitis herpetiformis - IgA deposited in skin
165
bowel carcinoma risk factors
* Polyposis in small intestine, small risk * Polyposis in large intestine, increased risk Risk Factors * Crohn’s * Ulcerative colitis * Family history * Polyps * Smoking * Diet/ exercise * Drinking
166
signs/symptoms of bowel carcinoma
weight loss abdominal pain blood in poo
167
complications and tests for bowel carcinoma tx needed
Complications * Metastasis – liver, lung and bone * Anaemia Test * Colonoscopy * Biopsy * FOB test * CT – check metastasis * Duke’s classification Treatment * Surgery * Chemotherapy * Radiotherapy
168
dental relevance of bowel carcinoma
oral presentation of anaemia
169
jaundice
accumulation of bile in the skin yellow pigmentation and itch macrophages in spleen and bone produced
170
pre-hepatic jaundice
Increased haem load * Abnormal RBC * Haemolytic anaemia * Autoimmune disease * Gilbert’s disease * Decreased uptake of billrubin Treatments * Treat anaemia and autoimmune disease
171
hepatic jaundice
Cannot conjugate bilirubin in cell * Hepatitis (for both) Cannot secrete bilirubin from cell * Cirrhosis (for both) Signs/Symptoms * Unconjugated bilirubin therefore normal stool
172
post-hepatic jaundice
Obstruction * Intrahepatic (biliary sclerosis) * Extra-hepatic (gallstones) * Inflammation of gallbladder – Cholecystitis * Gallstones causes pain in shoulder and abdominal pain bought on by fatty diet * Pancreatic carcinoma Signs/Symptoms * Conjugated bilirubin therefore pale urine and dark stool Treatments * Remove obstruction – stent, ERCP * Remove gallbladder * Reduce fat diet * Cholestryramine - sequesters bile acid therefore no reabsorption into GIT
173
tests for jaundice
ultrasound x-ray - radiopaque gallstones ERCP
174
causes of liver failure
alcohol drug induced (paracetamol) hepatitis cancer cystic fibrosis - bile ducts blocked by mucous
175
cirrhosis signs/symptoms
jaundice osphageal varices oedema (ascites) in the abdomen encephalopahty - accumulation of toxins in BS, confusion in brain spider naevi palmer erythema
176
cirrhosis complications
dec platelets - throbocytopenia dec clotting factors dec albumin - slow drug transport dec metabolism of drugs
177
tests for liver failure
INR hepatic cell enzymes - ALT and GGT
178
tx for liver failure
treat underlying cause of cirrhosis - e.g. stop drinking transplant
179
dental relevance of cirrhosis
* Drug metabolism affected * Avoid NSAIDs * Avoid anti-fungals (fluconazole) * avoid intravenous sedation * If reduced platelets * Treat within 24hrs INR * Test in morning * Limit to 3 extractions
180
transmission of HIV
blood saliva semen breast milk vaginal secretion
181
progression of HIV
acute primary infection latent period symptomatic stage
182
signs/symptoms of HIV
fever weight loss swollen lymph
183
complications fo HIV
AIDS - CD4+ \<200ul of blood 1 of 25 conditions indicative of severe immunosuppression
184
test for HIV
blood test for CD4+ AIDS r pressure of antiretrovirals
185
tx of HIV
treat infections (fluconazole antifungal) anti-retrovirals - AZT and HAART protease inhibitors
186
dental relevance of HIV
* Candidosis * Karposi’s sarcoma – blood vessels lesions present on the skin * Hairy leukoplakia * Periodontal disease * Children – enlarged parotid gland
187
Hep A
Spherical single stranded RNA Transmission: * faecal, oral or H2O borne test * antigen present in faeces treat * vaccine 1: single dose, booster within 6 months. Gives 10 years protection * vaccine 2: human normal immunoglobulin. Gives 4 months protection
188
hep B
HBeAg has a 1/3 of chance infection from sharps injury Double stranded DNA 8 subtypes Transmission * IV drug users * Sexual * Infants borne infected – high risk HIV as immunocompromised * Organ transplant complications * cirrhosis * liver cancer Treatment * Within 48 hours of injury – human immunoglobulin from pooled plasma * Vaccine: 3 stages – initial, 1 month post and then 6 months post
189
hep C
Enveloped RNA Transmission * IV drug users * Sexual * Infants borne infected – high risk HIV as immunocompromised * Organ transplant Complications * Hepatocellular carcinoma – treat with interferon-alpha and ribavirin * Jaundice * Cirrhosis
190
hep D
* Small RNA virus * Transmission * Faecal contaminated H2O and food * Blood borne * Cannot cause harm on own, need co-infection such as Hep B
191
Hep E
* Single stranded RNA * Spore forming * Transmission * H2O

BDS4 EXAM PREP (25 decks)

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