3. Liver Disease

Question 1

Liver function

Answer 1

1. Stores vitamins, minerals, glycogen
2. Hormone production (IGF-1, thrombopoietin, angiotensinogen
3. Breakdown of chemicals in blood (liver can detoxify or toxify, e.g. acetaminophen)
4. Produces bile
5. Kupffer cells and pit cells immune response (kill RBC and tumor cells)

Question 2

Causes of chronic liver disease

Answer 2

1. Hep C/B
2. Alcohol abuse
3. Obesity
4. Medications
5. Wilson’s disease
6. Hemachromatosis
7. Autoimmune inflammation

Question 3

Hep A s/sx

Answer 3

1. Nausea and vomiting
2. Low grade fever
3. Fatigue
4. Loss of appetite
5. Itching
6. Dark urine
7. Pale or clay-colored stools
8. Jaundiced appearance

Question 4

Hep C liver function tests show 2-3x elevation for which enzymes?
- What other test can detect presence of viremia?

Answer 4

ALT, AST, GGTP

HCV RNA test within 1-2 weeks following exposure

Question 5

Dental management concerns?

Answer 5

Potential for abnormal bleeding

• Decreased synthesis of clotting factors
• Decreased platelets

Question 6

Dental management before surgery

- Check what lab values?

Answer 6

1. INR (normal 0.8-1.2)
2. Clotting time
3. Platelet count

Question 7

Drug management for hepatitis

• What four drugs should be avoided and why (two and two)?
• How much anesthetic is considered safe?

Answer 7

1. Drugs metabolized by liver should be avoided or dosage decreased (opioids, acetaminophen)
   - Drugs that affect bleeding (ASA, NSAIDs)
2. Three cartridges

Question 8

What is the earliest indicator of acute Hepatitis B?

Answer 8

HBsAg (surface antigen) - 1 to 2 weeks before onset

Question 9

What lab value indicates whether a patient is immune due to natural infection or immune due to hep B vaccination?

Answer 9

The presence of anti-HBcore.

anti-HBsurface is present in both natural and used in vaccination