Physical Assessment 3
PUD is inflammation (with/without/both) ulceration of (upper/lower) GI mucosa caused by gastric contents
- both - upper (stomach and duodenum)
which conditions are associated with metabolic syndrome (hint: theres 2)
- ischemic heart disease - congestive heart failure
what are the main GI disease signs
1. abdominal tenderness 2. hematemesis 3. jaundice 4. weight loss 5. abnormal stool 6. organomegaly/ascites 7. elevated liver abnormalities, low A/G ratio
what are the 5 main GI disease symptoms
1. nausea 2. gastric reflux 3. abdominal cramps/pain 4. diarrhea 5. bleeding tendency or anemia
plasma glucose is considered elevated at what value
100 mg/dl
what percent of ulcers are due to NSAIDs
15-20%
elevated triglycerides are considered to be greater than or equal to what value?
150mg/dl **patient may also be on meds for lipids
what are the most common causes of death for type 1 and type 2
1: renal failure 2: MI
what percent of the US population has diabetes
9.4%
elevated blood pressure falls in which range?
>130/85
hyperglycemia can lead to
atherosclerotic plaques
what are the major hepatitis lab findings
bilirubin, *alanine aminotransferase* (ALT), aspartate aminotransferase (AST)
what are the main features of malabsorption disease and what are they caused by
debilitation, anemia, vitamin deficiency caused by villi destruction
why would blood tests indicate anemia in a patient with malabsorption/intestinal disease
due to iron, B12, and folate deficiencies
you are 25X more likely to acquire ________ with DM than a healthy individual
end stage renal disease
diabetes mellitus can be categorized as what type of disease
endocrine
features of PUD include:
epigastric pain: received by bland food chronic gastritis: caused by irritants like NSAIDs GERD: assoc with acid taste from reflux
what are the levels of control for HbA1c
excellent < 6.5 marginal 6.5 - 8.5 poor > 8.5
what are the signs of hyperglycemic shock you should look for
fatigue, lassitude dry skin gradual progression
arrange the following into focal and diffuse categories: - polyps - hemorrhoids - ulcerative colitis - diverticulitis - Crohn's disease
focal: polyps, hemorrhoids, and diverticulitis diffuse: ulcerative colitis and Crohns (IBD)
what are the five signs of metabolic syndrome and how many does a patient need to have to be considered to have metabolic syndrome?
need 3/5: 1. abdominal obesity 2. elevated fasting triglycerides 3. hypertension 4. elevated fasting glucose 5. low HDL levels
what are the signs of hypoglycemic shock you should look for
nervousness, unconsciousness, then convulsions moist skin rapid progression
what are fosamax, actonel, and Boniva?
nitrogen-containing drugs assoc with ulcers
what oral effects can DM have
poor wound healing increase incidence and severity of caries, gingivitis and PD
why is hepatitis significant to dentistry
possibility of infectivity medication metabolism changes decreased protein production (coagulation) liver failure
what might you notice about the complexion of a person with alcoholic cirrhosis
red complexion and spider angiomas
what can result from DM1 and small vessel sclerosis
retinopathy, nephropathy, neuropathy, gangrene
in alcoholic cirrhosis, hepatic parenchyma is replaced with _______ due to
scar tissue due to chronic hepatic necrosis
which category of disease do hepatitis and hepatic cirrhosis fall into
GI diseases
which bacteria is present in 80% of peptic ulcers
H pylori
is hyperglycemic or hypoglycemic shock more severe? which is more likely to occur?
Hypoglycemic shock for both
what can result from chronic PUD
anemia, decreased platelets and coagulation factors - perforated ulcers can be life threatening
endocrine diseases main signs are
abnormal weight/proportions goiter skin discoloration acetone breath BP abnormality blood/urine glucose abnormality
severity of DM complications is related to ________
glycemic control
healthy vs well controlled diabetes HbA1c normal values should be less than:
healthy: 6% controlled diabetes: 7%
what are the main symptoms of endocrine diseases
heat/cold intolerance weight changes nervousness personality changes altered urinary frequency
what disease is characterized by icterus, elevated liver enzymes, abnormal A/G ratio, fever and liver enlargement
hepatitis
yellow palate is characteristic of which disease
hepatitis
what value indicates hyperglycemic shock? what about hypo?
hyper: >400mg/dl hypo: <40mg/dl
if DM is not well controlled, what happens:
hyperglycemia/ketoacidosis hypoglycemia small vessel sclerosis delayed wound healing opportunistic infections/ rapid progression of other infections
what is the poly triad
in type 1 DM: - polyuria, polydipsia, polyphagia
what causes inflammatory bowel disease
inability of body to down regulate immune system to control GI inflammation
pain meds _______ (increase/decrease) symptoms of PUD
increase
how can DM 2 be managed
initial: diet and oral meds later: insulin
endocrine diseases have a ________ onset
insidious
how is control defined for DM
maintaining blood glucose within physiologic range (HbA1c)
celiac and pancreatic disease are both types of _________
malabsorption conditions
what is considered low HDL in men and women?
men: <40mg/dl women: <50mg/dl
diabetes mellitus is considered what type of syndrome?
metabolic syndrome
which type of diabetes in insulin-dependent
type 1