Dental aspect Hepatitis

Question 1

What pathogens can induce Hepatitis?

Answer 1

Epstein Barr Virus

Hepatitis ABC

Question 2

What relevant drug reactions must we be aware of in regards to in hepatitis

Answer 2

Paracetamol

Question 3

What are the idea and damaging doses of paracetamol?

Answer 3

4g max (8 tabs) in 24 hours
10-15g (20-30 tabs) acute liver damage 
25g (50 tabs) invariably fatal

Question 4

Other than pharmacological and pathogenic, what are other causes of hepatitis?

Answer 4

Autoimmune
Wilson’s disease- Genetic disorder causing accumulation of COPPER (notice brown K-F ring around eye)
Toxins

Question 5

What are the characteristics of acute hepatitis?

Answer 5

Self-limiting inflammation

Similar indications of heptitis

Question 6

What drugs must we be wary of in regards to hepatitis?

Answer 6

Erythromycin- Due to impaired excretion from liver to bile and risk of elevating liver enzymes. THEREFORE HEPATOXIC

Question 7

How can we investigate for hepatitis?

Answer 7

LFTs test (liver enzymes) 
Causation tests i.e. viral serology (pathological), immunoglobulins, auto antibody profile
Liver ultrasonography

Question 8

What are the indications of Chronic Liver Disease?

Answer 8

CIRRHOSIS commonly caused by Hep c or Alcohol
Liver fibrosis
Reduced liver mass
Portal hypertension

Question 9

What can Cirrhosis lead to?

Answer 9

Portal hypertension- this can lead to varicose veins of the lower oesophagus.
These can rupture and bleed

Question 10

What conditions are associated with a reduced Liver mass?

Answer 10

Encephalopathy- inability to metabolise ammonia containing compounds FLAPPING TREMOR
Reduced attention span- Due to ammonia build up on brain
Reverse Sleeping pattern

Question 11

What symptoms and considerations must be made with chronic liver disease?

Answer 11

Loss of lean body mass i.e. shoulders
Accumulation of body water
COAGULOPATHY PROBLEMS *(FACTORS 1, 2, 10 AND 12)

Question 12

What history items can indicate Hepatitis?

Answer 12

Jaundice- impaired function
Alcohol Intake-
Infections
Drug intolerance- Indicates issues in liver enzymes
Bleeding disorders - indicating clotting issues
IVDU
Sexual History- high risk groups such as LGBT and Prostitutes

Question 13

Indication of jaundice?

Answer 13

Yellowness of the Sclera of the eye- PULL DOWN eyelid if you are uncertain

Question 14

Indication of bruising and spider naevi?

Answer 14

Dark spots due to easy internal bleeding

SN- Central red spot with spindle like projections- Will disappear under pressure

Question 15

Indication of ASTERIXIS?

Answer 15

The liver flap

Where hand is extended, the digits of fingers flap

Question 16

Indication of increased Bile salts?

Answer 16

Bile Salts are irritants and excreted through sweat.

Causes patient to SCRATCH.

Question 17

Indication of Sialosis?

Answer 17

Non inflammatory, Non neoplastic enlargements

Question 18

Indication of DUPUYTREN’S CONTRACTURE/

Answer 18

Ring finger flexed due to tightening of the fascia

Question 19

Indication of Palmer Erythema?

Answer 19

Red Palms due to

Question 20

Indications of Gynaecomastia?

Answer 20

Production of mammary tissues in males DUE TO LACK OF METABOLISM FOR OESTROGEN

Question 21

What are the main liver function tests?

Answer 21

ALT
AST
Clotting
Gamma Glutamyl transpeptidase- specific for alcohol induced
Alkaline Phosphatase (FOR LIVER AND BONE ACTIVITY) Non specific

Question 22

What would be the most appropriate course of management be with patients indicated with hepatitis and bleeding?

Answer 22

ACCESS TO FULL BLOOD COUNT AND CLOTTING SCREEN.

This would be a good indication to refer to secondary care