Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Dental Mgmt of Medically Compromised Pts > Hepatic Disease > Flashcards

Hepatic Disease Flashcards

1
Q

• Largest internal organ; located in the R upper quadrant
• Dual blood supply
➢ ~ 20 % Hepatic artery - oxygenated blood
➢ 80% Portal vein –nutrients

A

Liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
  • left and right hepatic ducts forms the _________
  • drains bile from the liver
  • transports waste from the liver and aids in digestion by releasing bile
A

common hepatic duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
  • carries bile from the liver and the gallbladder through the pancreas and into the
    duodenum
  • part of the biliary duct system; formed where the ducts from the liver and gallbladder are
    joined
A

Common bile duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

– drain venous blood from liver to inferior vena cava and on to the right

A

Hepatic Veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

– provides oxygen and nutrition to liver tissues

A

Hepatic Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

– delivers substances absorbed by the gastrointestinal tract (stomach,
intestine, spleen and pancreas) for metabolic conversion and/or removal in the liver

A

Hepatic Portal Vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q 
Functions of \_\_\_\_\_\_\_:
➢ Synthesizes proteins 
- Immunoglobulins
- Albumin
- coagulation factors
- carrier proteins
- growth factors
- hormones
➢ Synthesizes bilirubin 
➢ Produces bile and cholesterol
➢ Regulates nutrients 
- glucose
- glycogen
- lipids
- amino acids 
➢ Prepares drugs for excretion
➢ Responsible for drug conjugation and metabolism 
oPhase I –cytochrome P450; can produce toxic metabolites 
oPhase II –conjugation (glucuronidation, sulfation, inactivation by 
glutathione, etc.)
A

Hepatocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q 
Signs of \_\_\_\_\_;
➢ Jaundice
➢ Ascites (backup of drainage)
➢ Edema 
➢ GI bleed 
➢ Dark urine 
➢ Light stool
➢ Mental confusion
➢ Xanthelasma (Improper storage of cholesterol)
➢ Spider angiomas 
➢ Palmar erythema
➢ Asterixis
➢ Hyperpigmentation
A

Liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q 
Symptoms of \_\_\_\_\_\_\_:
➢ Appetite loss
➢ Bloating 
➢ Nausea
➢ RUQ pain
➢ Fatigue
➢ Mental confusion
A

Liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

___ is a sign of current or past liver disease

- Deposits of cholesterol around the eyes

A

Xanthelasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
  • a.k.a. flapping tremor
  • classic sign in hepatic encephalopathy (HE)
  • jerky movements when hands are extended at wrists.
A

Asterixis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

______ is a syndrome of altered neurologic function related to dysregulation of metabolism seen almost exclusively in pts with severe liver disease

  • can be a chronic problem in pts with cirrhosis, managed medically to varying degrees of success, puntuated with occasional exacerbations
  • these acute exacerbations are rarely fatal
A

Hepatic Encephalopathy (HE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q 
• evaluate the cells that circulate in blood
red blood cells (RBCs)
white blood cells (WBCs)
platelets (PLTs)
• indicator of overall health
• may detect a variety of diseases and conditions
- infection 
- anemia 
- leukemia
- lymphoma
- neutropenia
- etc.
A

Complete blood count (CBC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

• aka chemical screen or,
SMAC 14 (Sequential Multiple Analysis –Computer)
• consists of 14 blood tests which serves as an initial broad medical screening tool
• Includes
- General tests
- Kidney function assessment
- Electrolytes
- Protein tests
- Liver function assessment
• there are also SMAC 8, 12, 16 and 20 variants

A

Comprehensive Metabolic Panel (CMP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the most common Comprehensive Metabolic Panel (CMP) used?

A

SMAC 14

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

___ are the most important liver proteins that are used as carriers of nutrients in blood

A

Albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

oProduct of heme breakdown

oIncreased total bilirubin, increased severity of liver injury

A

➢ Bilirubin (high)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Is unconjugated or conjugated bilirubin harder to detect?

A

Unconjugated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

______ bilirubin
❖Insoluble, bound to albumin, not filtered by kidney
❖Increased SERUM not really indicative of liver disease,
❖indicates hemolysis, ineffective erythropoiesis (thalassemia,
vitamin B deficiency, Gilbert syndrome)

A

Unconjugated (indirect)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

_____ bilirubin
❖Increased SERUM indicative of liver disease
❖Water-soluble, excreted by kidney
❖All URINE bilirubin is conjugated

A

Conjugated bilirubin (direct)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

oaltered in myriad of diseases especially bone neoplasms
onot specific to liver disease,
omay indicate cholestatic disease

A

Alkaline phosphatase (high)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Is the Alkaline phosphatase liver function test a specific indicator of liver function?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

(Transaminases)
–related to glutamic oxalate metabolic pathways
-Produced in kidney and muscles

A
  1. AST - Aspartate Aminotransferase (SGOT)–a.k.a. Serum Glutamic-Oxaloacetic Transaminase-
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

(Transaminases)
–part of pyruvate pathway in cell metabolism
-Produced only in liver

A
  1. ALT - Alanine Aminotransferase (SGPT) –a.k.a. Serum Glutamic-Pyruvic Transaminase-
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

(Transaminases)
needed for protein synthesis
- useful to detect alcohol-induced liver cell injury and chronic alcoholics
- can detect the slightest degree of cholestasis
- sensitive to biliary obstruction, cholangitis, and cholecystitis
- good marker for pancreatic cancer, prostatic carcinoma, and liver cell
-Can show blockage in bile system; alcoholism can affect this too

A
  1. Gama-Glutamyl Transferase (GGT)-
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

AST:ALT ratios more informative

- the _____ the ratio, the more specific an indicator of hepatic disease

A

lower

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

_____ (transaminases) more indicative of cholestatic disease and alcoholic liver disease

A

GGT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

If -___ are high:
oIndicates damage to hepatocytes from hepatocellular disease
oNot individually proportionally reflective of severity of liver damage
oUp to 300 UI/L –> non-specific

A

Transaminases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q 
oSynthesized “exclusively by hepatocytes”
oHalf-life: 18-20 days 
oHypoalbuminemia 
❖More indicative of chronic liver disease
❖Not specific to liver disease 
✓ Malnutrition
✓ Chronic infection 
✓ Gut disease
A

Albumin (low)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

In liver disease, how is prothrombin time effected?

A

Longer bleeding times than normal; larger number

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q 
How are the following function liver tests affected in liver disease? (high or low)
Transaminases
Albumin
Alkaline phosphatase
Bilirubin
A

Transaminases: High
Albumin: Low
Alkaline phosphatase: High
Bilirubin: High

32
Q

_______:
Bilirubin is not being properly metabolized by liver into bile
-bilirubin ends up in the bloodstream causing yellowish skin
-Gray feces

A

Jaundicee

33
Q

All viral hepatitis are ____ virus, except for ______

A

RNA: Hep B (HBV)

34
Q

________ –> host immune response to viral antigens rather
than direct cytopathic effect from virus
o Cytotoxic T-cells
o Proinflammatory cytokines
o Natural killer cell response
o Antibody-dependent cellular cytotoxicity

A

Hepatocellular damage

35
Q
  • Serum hepatitis, blood-borne

* Parenteral, intimate and sexual exposure

A

Viral Hepatitis

36
Q

➢ Virus can last for up to 7 days on an infected surface
➢ Incubation period: 90 days average
➢ Chronicity:
o90% for infants
o25-50% in children (1-5)
o<5% in adults
➢ Vaccination
o3 doses (initial, 1 month, 6 months)
oSeroconversion necessary - What does this mean?
➢ Reactivation
➢ Peg- interferon or antivirals such as entecavir and tenofovir

A

Hepatitis B (Hep B; HBV)

37
Q

➢ Average prevalence in injection drug user = 53%
➢ Baby boomers should be screened, higher risk of having the virus
➢ 15-25% of untreated patients clear the virus
➢ Has high risk for becoming chronic (75-85%)
o10-20% develop cirrhosis (takes 20-30 years)
oIncreased risk for hepatocellular carcinoma (HCC)
oIncreased risk of death
➢ HCV has higher needlestick transmission rate than HIV
➢ No vaccine
➢ Cure = undetectable HCV RNA levels after 12 weeks of recommended protease
inhibitor therapy
oMavyret (glecaprevir/pibrentasvir)
oEpclusa (sofosbuvir/velpatasvir)
oHarvoni (ledipasvir/sofosbuvir)

A

Hepatitis C (Hep C; HCV)

38
Q

➢ Usually coinfection with HBV
➢ More severe than HBV alone
➢ Higher risk of fulminant hepatitis
oMassive hepatocellular destruction

A

• Hepatitis D (Hep D; HDV)

39
Q

➢ Infectious hepatitis, fecal-oral transmission
➢ Highly contagious and transmissible
➢ Vaccination available for HAV

A

Hepatitis A and E

40
Q

• Most carriers of ___, ____, and _____ are unaware they have hepatitis
• Hepatitis can be contracted by the dentist from an infected patient
• Chronic, active, hepatitis patients may have chronic liver dysfunction
➢ Increased bleeding
➢ Altered drug metabolism

A

HBV, HCV, HDV

41
Q

_____ is most likely viral hepatitis to be transmitted occupationally to a dental
health care worker, followed by ______

A

Hep B; Hep C

42
Q

Little to no risk exists for transmission of ____ and _____, and non-A-E hepatitis viruses

A

HAV, HEV

43
Q

Which hep has a higher needlestick transmission rate than HIV?

A

HCV

44
Q

➢ in the 1990s with public attention to higher population incidences of Hep B, dentists
(and other healthcare workers at risk) got the vaccine (3 doses (initial, 1 month, 6
months); then 5 - 10 years later, the HBIg booster was recommended
➢ Most youth get the vaccine today, so there is less public concern;
but standard/universal precautions universal precautions have helped control this
risk

A

➢ HBV vaccination

45
Q

How do you treat a pt with active hep?

A 
Defer elective TX
If emergency, 
Consult Med
Determine severity and risk
Consider referral
Isolate well
46
Q 
\_\_\_\_\_\_\_ Oral Manifestations
• Bleeding
• Mucosal jaundice
• Glossitis
• Angular cheilosis
• Extrahepatic immunologic disorders with chronic HCV
➢ Oral lichen planus 
➢ Lymphocytic sialadenitis (Sjögren-like syndrome)
A

Viral Hepatitis

47
Q

____ is a liver issue that is hard to diagnose

- Seen more in children than adults while it is more severe

A

Autoimmune Hepatitis

48
Q

• May be a cause as well as consequence of liver disease
• Myriad of drugs may cause liver disease (e.g. APAP, clindamycin, etc.)
• Mechanisms
➢ Direct toxicity to hepatocytes
➢ Production of hepatotoxic metabolites
➢ Accumulation of drug due to altered metabolism

A

Drug-Induced Liver Disease

49
Q

______ is liver disease that shows decreased hepatic function due to hepatic atrophy

  • accumulation of abnormal fats in the liver
  • not alcohol based
A

Nonalcoholic fatty liver diseas

50
Q

• Alcohol as well as its metabolite are hepatotoxic
• Causes inflammation which compounds the liver damage
• Typically takes 10 years of excessive alcohol intake to develop
➢ Patients first develop fatty liver –reversible
➢ Continual alcohol use and ensuing inflammation can lead to irreversible changes
and necrosis
➢ Eventually with continual use, fibrosis and cirrhosis develop –irreversible -
leading to hepatic failure

A

Alcoholic liver disease

51
Q 
• Complications of \_\_\_\_\_\_
➢ Bleeding tendencies –alcohol can impair platelet function 
➢ Unpredictable drug metabolism
➢ Potential impaired immune function
➢ Peripheral neuropathies 
➢ Dementia and psychosis
➢ Anorexia
A

Alcoholic Liver disease

52
Q 
• Complications of \_\_\_\_\_\_\_
➢ Ascites –hepatorenal syndrome
➢ Esophageal varices –GI bleed
➢ Jaundice 
➢ Hepatosplenomegaly 
oEnlarged spleen due to portal hypertension
oDecreased platelet function 
oLeads to thrombocytopenia 
➢ Coagulation disorders
oDecreased synthesis of clotting factors
oImpaired clearance of anticoagulants 
oDecreased vitamin K absorption (requires biliary excretion)
➢ Hypoalbuminemia 
➢ Anemia 
oIron deficiency 
oMacrocytosis
➢ Neutropenia
➢ Encephalopathy –neurotoxins not removed from liver
A

cirrhosis

53
Q

Severe or mild? liver dysfunction, drug metabolism may conversely be hindered and drug
toxicity is a concern

A

Severe

54
Q

mild or severe? dysfunction: Liver enzyme induction may increase metabolism of
prescribed drugs, limiting their effect

A

Early on/mild

55
Q

The following signs are signs of _____ leading to _____:

  • Spider naevi
  • Increased risk of HCC
  • Coagulopathy
  • Ascites
  • Encephalopathy
  • Asterixis
  • Portal hypertension
A

Cirrhosis leading to Chronic Liver Disease

56
Q

Patients with, suspected, active, untreated alcoholic liver disease are or are not
candidates for routine, elective dental treatment?

A

Are not

57
Q

_______ is common in those who abuse alcohol
➢ Pts should demonstrate interest and the ability to care for their dentition before
any significant treatment is provided

A

Oral neglect

58
Q

AST: ALT ratio ≥__ and ______ GGT are suggestive of alcoholic liver disease

A

2; elevated

59
Q 
\_\_\_\_\_\_\_ Oral Manifestations
• Neglect 
• Bleeding
• Ecchymoses
• Petechiae
• Glossitis
• Angular cheilosis
• Alcohol odor
• Parotid enlargement (from lymphocytic infiltrate)
• Xerostomia
A

Alcoholic Liver Disease

60
Q

Alcohol abuse is a strong risk factor

for oral

A

Squamous cell carcinoma

61
Q

________ is the number one abused drug in terms of emergency room visits, hospital
admission, family violence, and other social problems

A

Alcohol Abuse

62
Q

In Active liver disease, how do we treat?

A

➢ Treat patient on emergency basis only
➢ Consult physician to determine status
➢ If severe liver disease and requires emergency treatment: consider referral

63
Q

What is the most important factor mentioned in peri/intra tx of a pt with liver disease?

A

Control bleeding well

64
Q 
The following are used for \_\_\_\_\_
❖ Surgicel, Gelfoam
❖ Topical thrombin
❖ Tranexamic acid
❖ Bone wax,
❖ Electrocautery
❖ Silver nitrate sticks
❖ Aminocaproic acid (Amicar) rinse
A

Bleeding control

65
Q

Can you prescribe NSAIDs to liver disease pts?

A

No

66
Q

can you prescribe acetaminophen to liver disease pts?

A

Yes; must give proper dose

67
Q

Generally, Antibiotic prophylaxis prior to procedures is or is not required if no oral infection is
present in liver disease pts?

A

not required

68
Q

Patients with ____ LIVER DISEASE may need antibiotic prophylaxis (coverage)
for invasive/surgical procedures due to decreased immune function

A

SEVERE

69
Q

Why are local anesthetics problematic for liver disease pt?

A

Not metabolized in liver

70
Q

What types of local anesthetics can be used in liver pts due to the fact that it is not as long acting and not as effective but don’t affect liver as much?

A

Esters

71
Q

Why are NSAIDs not used in liver pts?

A

Prolonged bleeding

72
Q

What opioid can be used in liver disease pts?

Which opioid should NOT be used in liver disease pts?

A

Hydromorphone

Hydrocodone

73
Q

Can you use Benzodiazepines in liver disease pts? Why or why not?

A

No; less metabolism of drug in liver leaving more drug to take effect longer

74
Q

What sedative can be used in liver disease pts? Why?

A

Lorazepam; Half of the half life of normal BZD so it sticks around for less time in blood stream to take effect

75
Q

Why are most antimicrobials contraindicated in liver disease pts?

A

Not metabolized properly by liver

76
Q

Why are most antimicrobials not recommended to drink alcohol with?

A

Severe nausea: Disulfram effect

77
Q

_________ is a complication of cirrhosis
oBP can be significantly elevated with portal hypertension
oLimit epinephrine (epi)
oDo not use retraction cord with epinephrine
othrombocytopenia (from platelet sequestration in the spleen)

A

Portal hypertension

Dental Mgmt of Medically Compromised Pts (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions