3. Gastrointestinal System

6. Gastrointestinal Disease

11. Intestinal Malabsorption

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

13. Hepatobiliary Disease

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

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

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

20. Hepatitis Liver Disease Jaundice Hospitalization Transfusion Alcohol MEDICAL HISTORY

21. Hepatic Disease • Viral Hepatitis • Cirrhosis

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

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

24. HEPATOTOXINS

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

27. Alcoholism

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

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

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

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

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

36. Acquired Hypoprothrombinemias

37. Vitamin K(Fat Soluble)&Intestinal FloraLiverProthrombin

38. Dental Management of the Liver Failure Patient

39. 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

40. 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

41. 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

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

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

44. Hepatitis (Inflammation of the liver)

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

47. VIRAL HEPATITIS

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

49. 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

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