Važni parametri pri dentalnim zahvatima u bolesnika s cirozom jetre - prikaz slučaja

master's thesis

• Title (english): Important parameters in dental procedures in patients with liver cirrhosis - a case report
• Author: Diana Strmečki
• Mentor: Marko Nikolić (mentor)
• Committee member: Marko Nikolić (predsjednik povjerenstva)
• Committee member: Petar Gaćina (član povjerenstva)
• Committee member: Domagoj Vražić (član povjerenstva)
• Granter: University of Zagreb; School of Dental Medicine; (Chair of Internal Medicine); Zagreb
• Defense date and country: 2022-09-28, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Ciroza jetre patološki je proces u jetrenomu parenhimu koji nastaje zbog nekroze hepatocita, a karakterizira je stvaranje nefunkcionalnog fibroznog tkiva oko nekrotičnih hepatocita i njihova zamjena regenerativnim čvorićima. Uzroci nastanka ciroze jetre su brojni, no bez obzira na njihovu etiologiju, s vremenom dolazi do sličnih oštećenja jetrenog tkiva, tako da i klinička manifestacija terminalnog stadija kroničnih bolesti jetre kod većine bolesnika ima slične simptome. U početnim stadijima bolesti organizacijska struktura jetre još nije u potpunosti narušena pa kliničkih simptoma koji bi upućivali na patološke promjene gotovo da i nema ili su oni blagi i nespecifični. Takvo stanje naziva se kompenziranom fazom bolesti jer su sve funkcije jetre barem djelomično očuvane. Tek se u fazi dekompenzacije počinju se javljati teži klinički simptomi koji su često manifestacija brojnih sistemskih poremećaja nastalih kao komplikacije same kronične bolesti jetre. Uz dramatičnu kliničku sliku, tada su očite i promjene u laboratorijskim parametrima bolesnika koje često ukazuju na pancitopeniju, produljeno vrijeme zgrušavanja krvi, povišene vrijednosti bilirubina i jetrenih enzima u serumu bolesnika, a biopsijom jetre postavlja se konačna dijagnoza ciroze. Stomatološko zbrinjavanje pacijenta u terminalnim stadijima bolesti zahtijeva velik oprez te je za zaustavljanje često opsežnih krvarenja potrebno provođenje dodatnih mjera za postizanje lokalne hemostaze. Važna je i briga o zaštiti imunosuprimiranih pacijenata od komplikacija primarne bolesti uzrokovanih jatrogenim bakterijskim infekcijama, ali i zaštita cijelog medicinskog tima od potencijalnih virusnih zaraza (hepatitis B ili C).

Abstract (english)

Liver cirrhosis is a pathological process in the liver parenchyma that occurs due to the necrosis of hepatocytes. It is characterized by the formation of non-functional fibrous tissue around necrotic hepatocytes and their replacement by regenerative nodules. There are numerous causes of liver cirrhosis, but regardless of their etiology, over time, similar damage to the liver tissue occurs, so the clinical manifestation of the terminal stage of chronic liver diseases has similar symptoms in most patients. In the initial stages of the disease, the organizational structure of the liver is not yet
completely damaged, so clinical symptoms that would point to pathological changes are almost non-existent or mild and non-specific. Such a state is called the compensated stage of the disease since all liver functions are at least partially preserved. It is only in the decompensation phase that severe clinical symptoms begin to appear, which are often a manifestation of numerous systemic disorders arising as complications of the chronic liver disease itself. In addition to the dramatic clinical picture, changes in the patient's laboratory parameters are also evident, which often indicate pancytopenia, prolonged blood clotting time, as well as elevated levels of bilirubin and liver enzymes in the patient's serum, while liver biopsy makes the final diagnosis of cirrhosis. Dental treatment of a patient in the terminal stages of the disease requires great caution, and in order to stop the frequently extensive bleeding, it is necessary to carry out additional measures to
achieve local hemostasis. It is also important to protect immunosuppressed patients from complications of the primary disease caused by iatrogenic bacterial infections, but also to protect the entire medical team from potential viral infections (hepatitis B or C).

• Keywords: ciroza jetre; hemostaza
• Keywords (english): Liver Cirrhosis; Hemostasis
• Language: croatian
• URN:NBN: urn:nbn:hr:127:492985
• Study programme: Title: dental medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica dentalne medicine (doktor/doktorica dentalne medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-10-11 10:48:26