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xD3 Med Mgmt Ex1 > ARTICLE: Liver and GI > Flashcards

ARTICLE: Liver and GI Flashcards

1
Q

What are some non-infectious causes of hepatitis?

A
  1. Alcohol
  2. Prescription medications
  3. Drug abuse
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2
Q

What are some infectious causes of hepatitis?

A
  1. Viruses

2. Bacteria

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3
Q

What are some examples of primary hepatitis?

A
  1. Viral-induced

2. Drug-induced

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4
Q

Secondary hepatitis may occur as sequela of what other diseases?

A
  1. Mononucleosis
  2. Syphilis
  3. Tuberculosis
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5
Q

What are primary routes of transmission of HAV?

A
  1. Contact with infected person
  2. Traveling to an endemic region
  3. Ingestion of contaminated food or water
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6
Q

How is an HAV infection diagnosed?

A
  1. Serologic tests for IgM and anti-HAV and IgG anti-HAV

2. Symptoms (fever, fatigue, abdominal discomfort, diarrhea, nausea, and/or jaundice)

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7
Q

How is HAV infection prevented?

A

HAV immune globulin administered either before the exposure or within two weeks following the exposure.

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8
Q

Who is considered at a high risk of HAV infection (and therefore should be vaccinated)?

A
  1. People traveling internationally
  2. Drug users
  3. People with chronic liver disease
  4. Those with occupational risks (althouhg the risk of nosocomial transmission is low for health-care workers)
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9
Q

What are common modes of transmission for HBV?

A
  1. Sexual contact
  2. Blood and blood product transfusions
  3. Perinatally (especially in Asia)
  4. Saliva
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10
Q

Why are healthcare workers (especially those in dentistry) at a 3-5 times increased risk of contracted HBV?

A

Because HBV is transmitted in saliva

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11
Q

How is an HBV infection diagnosed?

A
  1. HBV DNA levels
  2. HBsAg
  3. e antigen / antibody levels
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12
Q

What are the symptoms of an HBV infection?

A

Similar to HAV (fever, fatigue, abdominal discomfort, diarrhea, nausea, and/or jaundice)

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13
Q

A younger person infected with HBV is at a higher risk for what two things?

A
  1. Chronic HBV

2. Hepatocellular carcinoma

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14
Q

What percentage of patients infected with HBV experience a full recovery?

A

90%

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15
Q

What percentage of HBV-infected patients develop chronic complications (such as cirrhosis and hepatocellular carcinoma?

A

5-10%

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16
Q

How many HBV vaccines are there?

A

Two (Engerix-B and Recombivax) both of which use recombinant DNA technology

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17
Q

How is the HBV vaccine administered?

A

In three doses over a six-month period

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18
Q

What should be done for a nonimmunized person with a documented exposure to HBV?

A

Administration of hepatitis B immune globulin, which may offer postexposure protection

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19
Q

Who is at increased risk of contracting HCV?

A
  1. Hemophiliacs
  2. Dialysis patients
  3. Intravenous drug users
    * Note: all of the above have been reduced thanks to blood and blood product screening
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20
Q

What are methods of HCV transmission?

A
  1. Blood
  2. Sexual
  3. Perinatal
  4. Idiopathic
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21
Q

What is the primary method of HCV transmission?

A

Blood

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22
Q

Can HCV be transmitted in saliva?

A

Yes

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23
Q

What is the main diagnostic test for an HCV infection?

A

ELISA (which does not distinguish between exposure and infection)
RT-PCR (which DOES distinguish between exposure and infection)

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24
Q

What percentage of people infected with HCV will develop chronic hepatitis?

A

85%

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25
Q

Chronic HCV infection is the major cause of what two things?

A
  1. Cirrhosis

2. Hepatocellular carcinoma

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26
Q

What are the symptoms of an acute HCV infection?

A

Mild flu-like symptoms

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27
Q

What are symptoms of chronic HCV infection?

A
  1. Fatigue
  2. Nausea
    3 .Abdominal pain
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28
Q

How long may an HCV infection be asymptomatic?

A

May be asymptomatic for several years

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29
Q

What factors may impact whether an HCV infection progresses quickly to cirrhosis or hepatocellular carcinoma?

A
  1. Age (more over 40)
  2. Gender (M more than F)
  3. Chronic alcohol abuse
  4. Quantity of virus at exposure
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30
Q

What is the current management for a patient with HCV?

A

Combination therapy with interferon and ribaviin.

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31
Q

What are some common side effects to HCV combination therapy?

A
  1. Nausea
  2. Fatigue
  3. Malaise
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32
Q

Which HCV treatment drug is associated with teratogenic effects?

A

Ribavirin

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33
Q

HCV patient who do not respond to interferon therapy should receive what?

A

High dose therapy

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34
Q

What is considered for chronic HCV patients with end-stage liver disease?

A

Liver transplant

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35
Q

How may future forms of treatment for HCV differ from current forms of treatment?

A

Future therapies may target the virus rather than current nonspecific forms of antiviral therapy

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36
Q

Future HCV treatments may focus on what targets within the virus?

A
  1. Helicase
  2. Polymerase
  3. Viral proteases
  4. 5’ and 3’ DCV RNA strands
  5. Anti-sense RNA
  6. Ribozymes
  7. RNA decoys
  8. DNA oligonucleotides
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37
Q

Which hepatitis virus is a defective RNA virus that uses the HBV surface antigen as a viral envelope?

A

HDV

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38
Q

Which Hepatitis virus may appear as a coinfection or superinfection with HBV which may progress to a fulminant infection?

A

HDV

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39
Q

How is HDV transmitted?

A
  1. Infected blood products and blood

2. Sexual activity

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40
Q

Who are the primary groups to have HDV?

A
  1. Inttravenous drug users

2. Hemophiliacs

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41
Q

What is used to test for HDV?

A

Serologic testing for both HDV and anti-HDV

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42
Q

How is HDV infection prevented?

A

Effective prevention of HBV will help prevent HDV infection

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43
Q

Has the screening of blood for HBV affected the epidemiology for HDV?

A

Yes

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44
Q

What is the treatment for an HDV infection?

A

There is currently no treatment for an HDV infection

45
Q

What hepatitis virus is highly unstable due tot he lack of a lipid membrane?

A

HEV

46
Q

How is HEV transmitted?

A

Similar to HAV (fecal-oral route)

47
Q

What is the MOST common what HEV is transmitted?

A

Contaminated drinking water (occurs mostly in placed with inadequate sanitary precautions.

48
Q

What are symptoms of an HEV infection?

A
  1. Malaise
  2. Nausea
  3. Abdominal pain
  4. Fever
49
Q

Can HEV progress to fulminant hepatitis and chronic disease?

A

Yes

50
Q

What is a risk for pregnant women with HEV?

A

Fulminant hepatitis

51
Q

What is the treatment for HEV?

A

Only palliative treatment is available

52
Q

Is there an HEV vaccine available?

A

No

53
Q

Which hepatitis virus is caused by two isolated viruses that appear to be almost identical?

A

HGV

54
Q

How is HGV transmitted?

A
  1. Blood and blood products
  2. Sexual activity
  3. Perinatal contact
55
Q

Due to similar transmission routes, with what hepatitis virus may HGV be found in association?

A

HCV

56
Q

Who is at an increased risk for HGV?

A
  1. Transfusion recipients
  2. IV drug users
  3. Dialysis patients
  4. Health care workers with exposure to blood and chronic HCV patients
57
Q

How is HGV diagnosed?

A

Detection of HGV RNA in serum one to four weeks after infection.

58
Q

What indicates past infection of HGV?

A

Anti-HGV

59
Q

Is the remission rate for HGV high or low?

A

Low

60
Q

Does HGV cause significant liver damage?

A

No, even with persistent viremia

61
Q

What is a chronic inflammatory disease of the liver?

A

Autoimmune hepatitis

62
Q

What is the etiology of autoimmune hepatitis?

A

Environmental or viral factors may cause alterations in cellular markers on hepatocytes, leading to an autoimmune response in genetically susceptible individuals.

63
Q

What is the main finding in autoimmune hepatitis?

A

IgG hypergammaglobulinemia due to chronic infections or an alteration in the immune response

64
Q

Can autoimmune hepatitis lead to liver cirrhosis?

A

Yes

65
Q

What is the treatment protocol for autoimmune hepatitis?

A

Steroid therapy, and if that if ineffective, also add azathioprine or its metabolite, 6-mercaptopurine

66
Q

What is a sudden, severe liver dysfunction which may lead to hepatocellular necrosis as well as hepatic encephalopathy?

A

Fulminant hepatitis

67
Q

What are signs of fulminant hepatitis?

A
  1. Jaundice
  2. Hepatomegaly
  3. Right upper quadrant tenderness during inflammatory stage
68
Q

What will be elevated as fulminant hepatitis progresses to liver failure?

A
  1. Liver enzyme levels
  2. Bilirubin levels
  3. PT
  4. PTT
69
Q

What wil be decreased as fulminant hepatitis progresses to liver failure?

A
  1. Hemoglobin

2. Hematocrit

70
Q

What are essential factors for appropriate dental management of patients with liver disease?

A
  1. Comprehensive and current medical and dental histories
  2. Consultation with and/or referral to treating physician(s) prior to dental treatment
  3. Appropriate laboratory investigations
  4. Judicious use or avoidance of prophylactic and therapeutic dental medications that are metabolized in the liver and/or impair hemostasis
  5. Minimalization of soft tissue trauma during dental procedures
  6. Consideration of hospital setting for advanced surgical procedures or severely coagulopathic patients
71
Q

What are “appropriate laboratory investigations” for a patient with liver disease?

A
  1. CBC
  2. PT
  3. PTT
  4. INR
  5. Bleeding time
  6. Liver function test
72
Q

Which medications metabolized in the liver should be used with caution in a patient with liver disease?

A
  1. Methlydopa
  2. Isoniazid
  3. Nitrofuratoin
  4. Acetaminophen
  5. NSAIDS
  6. Penytoin
  7. Phenobarbital
  8. Valproic acid
  9. Sulfonamides
73
Q

What sedatives can impair detoxification in liver disease and should be used cautiously?

A
  1. Diazepam

2. Barbiturates

74
Q

What general anesthetic can impair detoxification in liver disease and should be used cautiously?

A

Halothane

75
Q

What type of local anesthetics are primarily metabolized in the liver and may reach toxic levels with lower doses?

A

Amides

76
Q

What two local anesthetics have metabolism in places other than the liver and where are they metabolized?

A
  1. Articaine (plasma)

2. Prilocaine (lungs)

77
Q

Why should NSAIDS be avoided in a patient with liver disease?

A

An increased risk of GI bleeding and interference with fluid balance

78
Q

What should be considered to prevent gastritis and GI bleeding associated with hepatic dysfunction?

A
  1. Antacid

2. HIstamine receptor antagonist

79
Q

What is a disease in which there is a defect in iron metabolism resulting in malabsorption and iron deposits in the liver, pancreas, heart, kidneys and other organs?

A

Hemochromatosis

80
Q

Iron accumulation in hemochromatosis may lead to what?

A
  1. Diabetes mellitus
  2. Cariomyopathy
  3. Cirrhosis
81
Q

What is the source of the defect in 80% of hemochromatosis patients?

A

Mutations in the HFE gene?

82
Q

A patient who presents with hepatomegaly and hyperpigmentation in the face, neck, forearms and legs may have what condition?

A

Hemochromatosis

83
Q

Which gender is affected by hemochromatosis at a later age?

A

Females

84
Q

What environmental factors affect hemochromatosis?

A
  1. Iron intake
  2. Blood donation
  3. Physiologic blood loss
85
Q

An association has been identified between hemochromatosis and what pathology?

A

Hepatocellular carcinoma

86
Q

What should be prescribed to patients diagnosed with hemochromatosis?

A
  1. Iron depletion therapy

2. Monitoring

87
Q

What should patients with hemochromatosis avoid?

A
  1. Iron supplements

2. Alcohol (if liver abnormalities are present)

88
Q

What is the irreversible end result of fibrous scarring and the normal hepatic architecture being replaced with interconnecting bands of fibrous tissue?

A

Hepatic cirrhosis

89
Q

How is normal function disturbed in hepatic cirrhosis?

A

Inadequate blood flow causing damage to hepatocytes because of fibrous scarring

90
Q

What are the most common etiologic factors resulting in cirrhosis?

A
  1. Hepatitis B
  2. Hepatitis C
  3. Excessive alcohol consumption
91
Q

What are some other causative factors of hepatic cirrhosis?

A
  1. Immune-mediated damage
  2. Genetic
  3. Abnormalities
  4. Nonalcoholic steatohepatitis
92
Q

Liver fibrosis and cirrhosis are diseases marked by an increase in what?

A

Total liver collagen and other matrix proteins that are disruptive to liver architecture and function

93
Q

What are the major complications of cirrhosis?

A
  1. Portal hypertension
  2. Hepatocellular carcinoma
  3. Loss of function
94
Q

In a normal liver, what do stellate cells do?

A

Store retinoids and are present in the spaces of Disse

95
Q

In a liver with cirrhosis what do the stellate cells do?

A

Become myofibroblast-like and express contracile protein.

96
Q

Studies have show what information may be valuable clinically for hepatitis C treatment?

A
  1. Interleukin-10 as a down-regulator of response

2. TNF-alpha as a pro-inflammatory mediator

97
Q

What are treatment options for patients with cirrhosis?

A
  1. Remove the injury-causing stimulus
  2. Antiviral therapy
  3. Liver transplantation
  4. Alternate treatments (e.g. antifibrotic therapy)
98
Q

What is the most common primary cancer of the liver?

A

Hepatocellular carcinoma

99
Q

What is the sixth most common cancer in men (eleventh most common in women) in the United States?

A

Hepatocelllular carcinoma

100
Q

The five year survival rates for hepatocellular carcinoma is around what percentage?

A

2%

101
Q

What are the most common etiologic factors in hepatocellular carcinoma?

A
  1. HBV

2. HCV

102
Q

Is the incidence of hepatocellular carcinoma rising or falling?

A

Rising

103
Q

What is the primary treatment for hepatocellular carcinoma?

A

Surgery if the tumor is respectable

104
Q

Are most hepatocellular carcinomas respectable?

A

No due to the proximity of the lesion to vital structures

105
Q

What is a potential complication of resection of a cirrhotic liver?

A

Poor regeneration, which may lead to liver failure and tumor recurrence

106
Q

What are some oral manifestations of liver dysfunction?

A
  1. Hemorrhagic changes
  2. Petechiae
  3. Hematoma
  4. Jaundiced mucosal tissues
  5. Gingival bleeding
  6. Icteric mucosal changes
107
Q

What two pathologies have been linked to lichen planus in some studies?

A
  1. Sjogren’s syndrome

2. Chronic hepatitis

108
Q

What may be seen in the tongue in a patient with alcoholic hepatitis?

A

Glossitis (especially if combined with nutritional deficiencies.

109
Q

What drugs should be avoided completely in patients with hepatic impairment?

A
  1. Erythromycin
  2. Metronidazole
  3. Tetracycline

xD3 Med Mgmt Ex1 (6 decks)

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