ARTICLE: Liver and GI Flashcards
1
Q
What are some non-infectious causes of hepatitis?
A
- Alcohol
- Prescription medications
- Drug abuse
2
Q
What are some infectious causes of hepatitis?
A
- Viruses
2. Bacteria
3
Q
What are some examples of primary hepatitis?
A
- Viral-induced
2. Drug-induced
4
Q
Secondary hepatitis may occur as sequela of what other diseases?
A
- Mononucleosis
- Syphilis
- Tuberculosis
5
Q
What are primary routes of transmission of HAV?
A
- Contact with infected person
- Traveling to an endemic region
- Ingestion of contaminated food or water
6
Q
How is an HAV infection diagnosed?
A
- Serologic tests for IgM and anti-HAV and IgG anti-HAV
2. Symptoms (fever, fatigue, abdominal discomfort, diarrhea, nausea, and/or jaundice)
7
Q
How is HAV infection prevented?
A
HAV immune globulin administered either before the exposure or within two weeks following the exposure.
8
Q
Who is considered at a high risk of HAV infection (and therefore should be vaccinated)?
A
- People traveling internationally
- Drug users
- People with chronic liver disease
- Those with occupational risks (althouhg the risk of nosocomial transmission is low for health-care workers)
9
Q
What are common modes of transmission for HBV?
A
- Sexual contact
- Blood and blood product transfusions
- Perinatally (especially in Asia)
- Saliva
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
11
Q
How is an HBV infection diagnosed?
A
- HBV DNA levels
- HBsAg
- e antigen / antibody levels
12
Q
What are the symptoms of an HBV infection?
A
Similar to HAV (fever, fatigue, abdominal discomfort, diarrhea, nausea, and/or jaundice)
13
Q
A younger person infected with HBV is at a higher risk for what two things?
A
- Chronic HBV
2. Hepatocellular carcinoma
14
Q
What percentage of patients infected with HBV experience a full recovery?
A
90%
15
Q
What percentage of HBV-infected patients develop chronic complications (such as cirrhosis and hepatocellular carcinoma?
A
5-10%
16
Q
How many HBV vaccines are there?
A
Two (Engerix-B and Recombivax) both of which use recombinant DNA technology
17
Q
How is the HBV vaccine administered?
A
In three doses over a six-month period
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
19
Q
Who is at increased risk of contracting HCV?
A
- Hemophiliacs
- Dialysis patients
- Intravenous drug users
* Note: all of the above have been reduced thanks to blood and blood product screening
20
Q
What are methods of HCV transmission?
A
- Blood
- Sexual
- Perinatal
- Idiopathic
21
Q
What is the primary method of HCV transmission?
A
Blood
22
Q
Can HCV be transmitted in saliva?
A
Yes
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)
24
Q
What percentage of people infected with HCV will develop chronic hepatitis?
A
85%
25
Chronic HCV infection is the major cause of what two things?
1. Cirrhosis
| 2. Hepatocellular carcinoma
26
What are the symptoms of an acute HCV infection?
Mild flu-like symptoms
27
What are symptoms of chronic HCV infection?
1. Fatigue
2. Nausea
3 .Abdominal pain
28
How long may an HCV infection be asymptomatic?
May be asymptomatic for several years
29
What factors may impact whether an HCV infection progresses quickly to cirrhosis or hepatocellular carcinoma?
1. Age (more over 40)
2. Gender (M more than F)
3. Chronic alcohol abuse
4. Quantity of virus at exposure
30
What is the current management for a patient with HCV?
Combination therapy with interferon and ribaviin.
31
What are some common side effects to HCV combination therapy?
1. Nausea
2. Fatigue
3. Malaise
32
Which HCV treatment drug is associated with teratogenic effects?
Ribavirin
33
HCV patient who do not respond to interferon therapy should receive what?
High dose therapy
34
What is considered for chronic HCV patients with end-stage liver disease?
Liver transplant
35
How may future forms of treatment for HCV differ from current forms of treatment?
Future therapies may target the virus rather than current nonspecific forms of antiviral therapy
36
Future HCV treatments may focus on what targets within the virus?
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
37
Which hepatitis virus is a defective RNA virus that uses the HBV surface antigen as a viral envelope?
HDV
38
Which Hepatitis virus may appear as a coinfection or superinfection with HBV which may progress to a fulminant infection?
HDV
39
How is HDV transmitted?
1. Infected blood products and blood
| 2. Sexual activity
40
Who are the primary groups to have HDV?
1. Inttravenous drug users
| 2. Hemophiliacs
41
What is used to test for HDV?
Serologic testing for both HDV and anti-HDV
42
How is HDV infection prevented?
Effective prevention of HBV will help prevent HDV infection
43
Has the screening of blood for HBV affected the epidemiology for HDV?
Yes
44
What is the treatment for an HDV infection?
There is currently no treatment for an HDV infection
45
What hepatitis virus is highly unstable due tot he lack of a lipid membrane?
HEV
46
How is HEV transmitted?
Similar to HAV (fecal-oral route)
47
What is the MOST common what HEV is transmitted?
Contaminated drinking water (occurs mostly in placed with inadequate sanitary precautions.
48
What are symptoms of an HEV infection?
1. Malaise
2. Nausea
3. Abdominal pain
4. Fever
49
Can HEV progress to fulminant hepatitis and chronic disease?
Yes
50
What is a risk for pregnant women with HEV?
Fulminant hepatitis
51
What is the treatment for HEV?
Only palliative treatment is available
52
Is there an HEV vaccine available?
No
53
Which hepatitis virus is caused by two isolated viruses that appear to be almost identical?
HGV
54
How is HGV transmitted?
1. Blood and blood products
2. Sexual activity
3. Perinatal contact
55
Due to similar transmission routes, with what hepatitis virus may HGV be found in association?
HCV
56
Who is at an increased risk for HGV?
1. Transfusion recipients
2. IV drug users
3. Dialysis patients
4. Health care workers with exposure to blood and chronic HCV patients
57
How is HGV diagnosed?
Detection of HGV RNA in serum one to four weeks after infection.
58
What indicates past infection of HGV?
Anti-HGV
59
Is the remission rate for HGV high or low?
Low
60
Does HGV cause significant liver damage?
No, even with persistent viremia
61
What is a chronic inflammatory disease of the liver?
Autoimmune hepatitis
62
What is the etiology of autoimmune hepatitis?
Environmental or viral factors may cause alterations in cellular markers on hepatocytes, leading to an autoimmune response in genetically susceptible individuals.
63
What is the main finding in autoimmune hepatitis?
IgG hypergammaglobulinemia due to chronic infections or an alteration in the immune response
64
Can autoimmune hepatitis lead to liver cirrhosis?
Yes
65
What is the treatment protocol for autoimmune hepatitis?
Steroid therapy, and if that if ineffective, also add azathioprine or its metabolite, 6-mercaptopurine
66
What is a sudden, severe liver dysfunction which may lead to hepatocellular necrosis as well as hepatic encephalopathy?
Fulminant hepatitis
67
What are signs of fulminant hepatitis?
1. Jaundice
2. Hepatomegaly
3. Right upper quadrant tenderness during inflammatory stage
68
What will be elevated as fulminant hepatitis progresses to liver failure?
1. Liver enzyme levels
2. Bilirubin levels
3. PT
4. PTT
69
What wil be decreased as fulminant hepatitis progresses to liver failure?
1. Hemoglobin
| 2. Hematocrit
70
What are essential factors for appropriate dental management of patients with liver disease?
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
What are "appropriate laboratory investigations" for a patient with liver disease?
1. CBC
2. PT
3. PTT
4. INR
5. Bleeding time
6. Liver function test
72
Which medications metabolized in the liver should be used with caution in a patient with liver disease?
1. Methlydopa
2. Isoniazid
3. Nitrofuratoin
4. Acetaminophen
5. NSAIDS
6. Penytoin
7. Phenobarbital
8. Valproic acid
9. Sulfonamides
73
What sedatives can impair detoxification in liver disease and should be used cautiously?
1. Diazepam
| 2. Barbiturates
74
What general anesthetic can impair detoxification in liver disease and should be used cautiously?
Halothane
75
What type of local anesthetics are primarily metabolized in the liver and may reach toxic levels with lower doses?
Amides
76
What two local anesthetics have metabolism in places other than the liver and where are they metabolized?
1. Articaine (plasma)
| 2. Prilocaine (lungs)
77
Why should NSAIDS be avoided in a patient with liver disease?
An increased risk of GI bleeding and interference with fluid balance
78
What should be considered to prevent gastritis and GI bleeding associated with hepatic dysfunction?
1. Antacid
| 2. HIstamine receptor antagonist
79
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?
Hemochromatosis
80
Iron accumulation in hemochromatosis may lead to what?
1. Diabetes mellitus
2. Cariomyopathy
3. Cirrhosis
81
What is the source of the defect in 80% of hemochromatosis patients?
Mutations in the HFE gene?
82
A patient who presents with hepatomegaly and hyperpigmentation in the face, neck, forearms and legs may have what condition?
Hemochromatosis
83
Which gender is affected by hemochromatosis at a later age?
Females
84
What environmental factors affect hemochromatosis?
1. Iron intake
2. Blood donation
3. Physiologic blood loss
85
An association has been identified between hemochromatosis and what pathology?
Hepatocellular carcinoma
86
What should be prescribed to patients diagnosed with hemochromatosis?
1. Iron depletion therapy
| 2. Monitoring
87
What should patients with hemochromatosis avoid?
1. Iron supplements
| 2. Alcohol (if liver abnormalities are present)
88
What is the irreversible end result of fibrous scarring and the normal hepatic architecture being replaced with interconnecting bands of fibrous tissue?
Hepatic cirrhosis
89
How is normal function disturbed in hepatic cirrhosis?
Inadequate blood flow causing damage to hepatocytes because of fibrous scarring
90
What are the most common etiologic factors resulting in cirrhosis?
1. Hepatitis B
2. Hepatitis C
3. Excessive alcohol consumption
91
What are some other causative factors of hepatic cirrhosis?
1. Immune-mediated damage
2. Genetic
3. Abnormalities
4. Nonalcoholic steatohepatitis
92
Liver fibrosis and cirrhosis are diseases marked by an increase in what?
Total liver collagen and other matrix proteins that are disruptive to liver architecture and function
93
What are the major complications of cirrhosis?
1. Portal hypertension
2. Hepatocellular carcinoma
3. Loss of function
94
In a normal liver, what do stellate cells do?
Store retinoids and are present in the spaces of Disse
95
In a liver with cirrhosis what do the stellate cells do?
Become myofibroblast-like and express contracile protein.
96
Studies have show what information may be valuable clinically for hepatitis C treatment?
1. Interleukin-10 as a down-regulator of response
| 2. TNF-alpha as a pro-inflammatory mediator
97
What are treatment options for patients with cirrhosis?
1. Remove the injury-causing stimulus
2. Antiviral therapy
3. Liver transplantation
4. Alternate treatments (e.g. antifibrotic therapy)
98
What is the most common primary cancer of the liver?
Hepatocellular carcinoma
99
What is the sixth most common cancer in men (eleventh most common in women) in the United States?
Hepatocelllular carcinoma
100
The five year survival rates for hepatocellular carcinoma is around what percentage?
2%
101
What are the most common etiologic factors in hepatocellular carcinoma?
1. HBV
| 2. HCV
102
Is the incidence of hepatocellular carcinoma rising or falling?
Rising
103
What is the primary treatment for hepatocellular carcinoma?
Surgery if the tumor is respectable
104
Are most hepatocellular carcinomas respectable?
No due to the proximity of the lesion to vital structures
105
What is a potential complication of resection of a cirrhotic liver?
Poor regeneration, which may lead to liver failure and tumor recurrence
106
What are some oral manifestations of liver dysfunction?
1. Hemorrhagic changes
2. Petechiae
3. Hematoma
4. Jaundiced mucosal tissues
5. Gingival bleeding
6. Icteric mucosal changes
107
What two pathologies have been linked to lichen planus in some studies?
1. Sjogren's syndrome
| 2. Chronic hepatitis
108
What may be seen in the tongue in a patient with alcoholic hepatitis?
Glossitis (especially if combined with nutritional deficiencies.
109
What drugs should be avoided completely in patients with hepatic impairment?
1. Erythromycin
2. Metronidazole
3. Tetracycline
