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Gastrointestinal System

Gastrointestinal System. Gastrointestinal Disease. Intestinal Malabsorption. Inflammatory Bowel Disease. Ulcerative Colitis Regional Enteritis (Crohn’s Disease). Hepatobiliary Disease. Liver Functions. Synthesis Billirubin Protein Globulins Albumin Prothrombin Clotting Factors.

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Gastrointestinal System

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  1. Gastrointestinal System

  2. Gastrointestinal Disease

  3. Intestinal Malabsorption

  4. Inflammatory Bowel Disease • Ulcerative Colitis • Regional Enteritis (Crohn’s Disease)

  5. Hepatobiliary Disease

  6. Liver Functions • Synthesis • Billirubin • Protein • Globulins • Albumin • Prothrombin • Clotting Factors

  7. Liver Functions • Metabolism • Proteins • Carbohydrates • Lipids • Biochemical Functions • Coagulation • Drug Metabolism

  8. Liver Disease Bleeding Disorders Digestive Problems Infections Metabolic Disorders Altered Drug Metabolism

  9. Hepatitis Liver Disease Jaundice Hospitalization Transfusion Alcohol MEDICAL HISTORY

  10. Hepatic Disease • Viral Hepatitis • Cirrhosis

  11. Liver Disease(Etiologic Factors) • Toxins (alcohol, drugs) • Infectious (viruses, bacteria, parasite) • Bile Excretion Disturbance • Tumors (Primary, Metastatic)

  12. Cirrhosis(liver fibrosis) • Laennec’s (Alcoholic) • Biliary • Post-Necrotic

  13. HEPATOTOXINS

  14. Hepatotoxins • Chloroform • Carbon Tetrachloride • Phosphorous • Mushrooms • Drugs

  15. Alcoholism

  16. Findings • Jaundice • Facial Erythema • Spider Telangiectasia • Parotid Enlargement

  17. ICTERUS (Jaundice) Hyperbilirubinemia >2.5 mgm/100 ml Normal < 1 mgm/100 ml

  18. Alcoholism(Oral Complications) • Poor oral hygiene • Periodontal disease • Xerostomia • Caries • Altered drug metabolism • Hemorrhage

  19. Alcoholic Liver Disease(Lannec’s Cirrhosis) • Bleeding Tendencies • Drug Metabolism

  20. Laboratory Tests(Liver Function) • AST – (SGPT) • ALT – (SGOT) • Billirubin – (CB, UCB) • LDH • ALK PHOS

  21. Acquired Hypoprothrombinemias

  22. Vitamin K(Fat Soluble)&Intestinal FloraLiverProthrombin

  23. Dental Management of the Liver Failure Patient

  24. Dental Management of Patient with Alcoholic Liver Disease • Detection by a. History b. Clinical examination c. Repeated odor on breath d. Information from family members or friends • Referral or consultation with a physician to a. Verify history b. Check current status c. Check medications d. Check laboratory viruses e. Obtain suggestions for management

  25. Dental Management of Patient with Alcoholic Liver Disease (cont.) • Laboratory screening (if otherwise not available from physician) a. CBC with differential b. AST, ALT c. Bleeding time d. Thrombin time 4. Minimize drugs metabolized by liver

  26. Dental Management of Patient with Alcoholic Liver Disease (cont.) • If screening tests abnormal, for surgical procedure consider using a. Antifibrinolytic agents b. Fresh frozen plasma c. Vitamin K d. Platelets

  27. Common Dental Drugs Metabolized Primarily by the Liver • Local Anesthetics Lidocaine (Xylocaine) Mepivacaine (Carbocaine) • Analgesics Acetaminophen (Tylenox, Datril) Acelysalicylic acid (aspirin) Codeine Meperidine (Demerol)

  28. Common Dental Drugs Metabolized Primarily by Liver (cont.) • Sedatives • Diazapam (Valium) • Barbiturates • Chlordiazepoxide • Antibiotics • Ampicillin • Tetracycline

  29. Hepatitis (Inflammation of the liver)

  30. Primary Viral Drug Infected Toxic Secondary Mono Syphilis (2 °) TB Hepatitis(Inflammation of the Liver)

  31. VIRAL HEPATITIS

  32. Viral Hepatitis A – HAV B – HBV C – Non-A, Non-B (Transfusion Related) D – HDV (Delta) E – Non-A, Non-B (Enteric Related)

  33. Symptoms of Acute Hepatitis • Prejaundiced phase • Loss of appetite, nausea, vomiting, headache, fever, muscle soreness • Jaundiced phase • Yellow eyes, white or grey stools, brownish urine

  34. Clinical Stages - Hepatitis • Incubation • Prodromal • Ictal

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