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LIVER

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kukuhkjhh's version from 2017-04-30 20:14

Section 1

Question Answer
What are some of the many jobs of the liver (9) ? 1. Carb metabolism 2. Protein metabolism 3. lipid metabolism 4. Coagulation factor production 5. thrombopoietin 6. Breaks down/modifies toxic substances 7. stores glycogen, VIT A, VIT D, VIT b12 , VIT K, iron and copper 8. Produces albumin 9. synthesizes angiotensinogen
The liver is responsible for carb metabolism , what 3 jobs specifically does it perform ?1. gluconeogensis 2. glycogenolysis 3. glycogenesis
What are the 2 jobs of lipid metabolism ?1. cholesterol synthesis 2. lipogenesis
What coagulation factors does the liver produce ?1, 2, 5, 7, 9 , 10 , 11 and protein C and S and anti-thrombin
What does thobopoietin do?regulates the production of platelets
What does cirrhosis lead to?fibrosis, jaundice, ascites, portal HTN, liver dysfunction
What is hepatitis ?inflammation of the liver, due to infection (usually viral)
What are some other causes of hepatitis besides viral ?ACTAMINOPHEN , Alcohol, hereditary , billiary obstruction
What are the 2 major viral forms of hepatitis we see in the dental seating B and C related to dental
What type of virus is hepatitis ?All except HBV are RNA viruses, HBV is a DNA virus
How do you contract HAV and HEV ?spread fecal-oral route
, associated with poor sanitary conditions// HIGHLY contagious
What hepatitis's are serum hepatitis ?HBV, HCV and HDV
How do you contact serum hepatitis ?Parenteral routes, and less commonly by intimate or sexual exposure
Which hepatitis could cause hepatocellular carcinoma ?HBV abd HCV
What is alcoholic liver disease manifest from ?EtOH is hepatic and its metabolite, aetyladehyde is fibrinogenic
Is alcoholic hepatitis reversible ?considered reversible but can be fatal
What are sign of liver disease jaundice, tender or swollen or shrunken liver, ascites, hepatic encephalopathy , spider angiomas, palmar erythema, bilirubinemia, increased enzyme levels and prolonged prothrombin time
What are the 4 risks of treating a patient with HEPATIC DISEASE ?1. Risk of BLEEDING (increased risk as liver function decreases) 2. Risk of DRUG ACTIONS/INTERACTIONS ( minimize use of drugs metabolized by the liver/ unpredictable drug metabolism) 3. Risk of INFECTION (risk of transmission/ immunomodulators) 4. Risk of ABILITY TO WITHSTAND CARE (good)
What are the concerns in treating a patient with alcoholic liver disease? INCREASED BLEEDING
What lab tests would you order for a patient with alcoholic liver disease ?INR
What oral sedative would you give to a patient with alcoholic liver disease ?VALIUM -but think of the interactions
How does acute alcohol intake affect the dental procedure ?results in high blood levels of concomitantly administered drugs
What does chronic EtOH cause ?increases drug metabolism
What lab measure should you use as a guide of liver's synthetic ability ?Serum albumin
When do you schedule patients with alcoholic liver disease ?morning appointments
What should you always do during dental TX with hectic disease patients ?always use local hemostatic agents during surgical procedures or when bleeding is anticipated
What should be done AFTER dental treatment for patients with hepatic disease ? 1. LIMIT USE OF ASA and NSAIDS 2. COX 2 inhibitors and narcotics for analgesia 3. Avoid more than 4gm of acetaminophen a day
What should you prescribe for analgesia for hepatic disease patients ?Cox 2 inhibitors
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Section 2

Question Answer
Crohn's and ulcerative colitis can be associated with what in the oral cavity Crohn’s and ulcerative colitis can be associated with oral lesions that resemble aphthous
What types of oral lesions do you see in chron's disease patients ?nodular area which has ulceration / some are very similar to aphthous stomatitis
What is ulcerative colitis ?irritable bowel symptoms(e.g. watery diarrhea with periodic constipation and cramping) 

Where do most lesions involved with ulcerative colitis form ?most lesions form in descending colon
What are the oral complications of GI disease?RAS-like lesions in 20% of UC patients / Association with pyostomatitis vegans / Atypical linear oral ulcerations with hyper plastic margins or papulondular "cobblestone" proliferations unique to Crohn's
What is pyostomatitis vegans ?rare, chronic, non-neoplastic disorder of unknown etiology
Who is p. vegans seen in typically ?men are affected with PV twice as often as women, peak age range is 3rd-6th decade
What is PV characterized by ?characterized by miliary pustules, erosions and a vegetating dermatosis of the skin and mucous membranes
What is the PRIMARY objective in the treatment of PV ?must be identifying and/or controlling the associated bowel disease
How are oral lesions associated with PV affectively treated treated effectively with topical corticosteroids
What is lichen planus ? common dermatologic disease of skin and mucous membranes
Who is lichen planus often seen in ?middle aged women
What are the various forms of lichen planus ?1. RETICULAR - asymptomatic, Wichham's striae 2. PLAQUE LIKE- asymptomatic 3. BULLOUS/EROSIVE - symptomatic
What ist he etiology of lichen planus ?IMMUNE MEDIATED T-cell mediated degeneration of the basal cell layer of epithelium
What is lichen planus associated wit ?associated with stress, drug hypersensitivity (licenoid drug reaction) or INFECTION (HCV)
What drugs can cause lichen planus1. NSAIDS 2. Allopurionl 3. Sulfonamides 4. tetracyclines 5. ACE inhibitors 6. HCTZ 7. lorazepam 8. sulfonylureas
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