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
