Hepatic Lecture FINAL

Question 1

what is acute cholecystitis often caused by?

Answer 1

-gallstones and obstruction

Question 2

cholecystitis is present in ___% of the US population

Answer 2

10-20%

Question 3

can acute cholecystitis become chronic?

Answer 3

yes

Question 4

most gallstones are made of ___. what are other gallstones made of?

Answer 4

• most are made from cholesterol

- other varieties include pigmented types, made from bilirubinate or hemolysis

Question 5

what are 5 types of liver disease?

Answer 5

• fatty liver
• hepatitis
• biliary disease
• metabolic disease
• vascular

Question 6

what can liver diseases progress to?

Answer 6

cirrhosis

Question 7

what is fatty liver caused by?

Answer 7

alcohol, obesity, and diabetes melitus

Question 8

what is hepatitis caused by?

Answer 8

virus, drug, or autoimmune

Question 9

what 3 things make up the liver?

Answer 9

• hepatocytes
• duct cells
• blood vessels

Question 10

what do the portal tracts in the liver contain?

Answer 10

the triad of bile ducts, portal veins, and hepatic artery (from the heart)

Question 11

what do portal veins do?

Answer 11

bring blood from the gut with nutrients and recently consumed drugs

Question 12

what is the function of hepatocytes in the liver?

Answer 12

metabolism

Question 13

what is the number 1 cause of liver toxicity?

Answer 13

drugs

Question 14

what is the worst destruction caused by fatty liver, and what can it lead to?

Answer 14

• fibrosis is the worst destruction
• leads to a collagen scar and permanent injury
• end stage is cirrhosis

Question 15

what is another name for fatty liver?

Answer 15

steatosis

Question 16

in fatty liver, what happens when hepatocytes die in large sheets?

Answer 16

• the areas fill up with blood

- blood can build up due to heart failure and backflow

Question 17

how can a patient with cholestasis become jaundiced?

Answer 17

cannuliculi in the liver fill with bile

Question 18

what is hepatitis?

Answer 18

inflammation of the liver

Question 19

is hepatitis contagious?

Answer 19

yes, if it is caused by a virus

Question 20

what are the causes of hepatitis?

Answer 20

• toxins and drugs

- hepatitis viruses

Question 21

what are examples of toxins and drugs that can cause hepatitis?

Answer 21

alcohol and acetaminophen

Question 22

T or F:

chronic hepatitis usually resolves itself

Answer 22

• false

- acute hepatitis can often resolve itself, but chronic is less likely to recover

Question 23

why is chronic hepatitis less likely to resolve itself?

Answer 23

• fibrosis is often a part of chronic hepatitis

- increase is fibrosis worsens prognosis

Question 24

what is acute hepatitis caused by?

Answer 24

-hepatitis A, B, C, E, and rarely D

Question 25

do acute hepatitis infections caused by hep A and E tend to progress to chronic?

Answer 25

no

Question 26

describe the progression of hepatitis caused by hep B, C, and D viruses

Answer 26

- start with as acute hepatitis - frequently progress to chronic - can lead to cirrhosis and even hepatocellular carcinoma - less likely with hep D

Question 27

what is the timeline for acute vs chronic hepatitis infections?

Answer 27

- acute <6 months | - chronic >6 months

Question 28

what type of inflammation is characteristic of acute hepatitis infections? what about chronic?

Answer 28

- acute - lobular inflammation (surrounding hepatocytes) | - chronic - portal inflammation (necroinflammatory, and hepatocytes are the target)

Question 29

which type of hepatitis (acute or chronic) has fibrosis?

Answer 29

- chronic | - fibrosis bridges to cirrhosis

Question 30

which hepatitis viruses are characteristic of acute hepatitis infections?

Answer 30

- hep A (picornavirus) and hep E (calicivirus) | - heps B, C, and D start out as acute, but typically progress to chronic

Question 31

which hepatitis viruses are characteristic of chronic hepatitis infections?

Answer 31

- hep B (hepadnavirus), C (flavivirus), and D (deltavirus - this is rarely expressed) - these begin as acute infections and progress to chronic

Question 32

what are the sources of hepatitis A virus?

Answer 32

- close personal contact - contaminated water or food - blood exposure

Question 33

hep C is easily transmitted by ___ and ___

Answer 33

blood and needles

Question 34

during the ___ stage, hep C usually shows no symptoms

Answer 34

acute

Question 35

is the incidence of hep C infection high or low in the US?

Answer 35

- low (1-2 million) | - very high in places like China

Question 36

hep C virus is found in how many carriers worldwide?

Answer 36

>170 million

Question 37

what is the treatment for hepatitis C infection?

Answer 37

-combination of antivirals (usually including ribavirin)

Question 38

can hepatitis C infection be prevented?

Answer 38

-currently there are no immunizations available to prevent

Question 39

is hepatitis C infection treatment effective?

Answer 39

yes (also very expensive)

Question 40

hepatitis B infection is transmitted by ___ and ___

Answer 40

blood and needles

Question 41

which stage does hep B infection not show symptoms?

Answer 41

acute

Question 42

___% of the population is infected with hepatitis B

Answer 42

2-10%

Question 43

what is the most common blood-borne infection in health care workers (including dental personnel)?

Answer 43

hepatitis B infection

Question 44

1/2 of hepatocellular carcinomas are associated with ___ infections

Answer 44

hepatitis B viral infections

Question 45

what is the treatment of hepatitis B infections?

Answer 45

- immunization (pre/post exposure) to prevent infection | - antivirals

Question 46

what are the antivirals used to treat hepatitis B infections?

Answer 46

-lamivudine and adefovir

Question 47

related to dentistry, what are the vectors of hepatitis B virus?

Answer 47

blood, saliva, and nasopharyngeal secretions

Question 48

where in the mouth is the highest concentration of hepatitis B virus?

Answer 48

gingival sulcus

Question 49

what are the oral manifestations of hepatitis B virus infection?

Answer 49

- lichen planus - periodontal disease - candidiasis - increased oral bleeding - increased incidence of type II diabetes - sjogren's syndrome

Question 50

what is cirrhosis?

Answer 50

- regenerative hepatocyte nodules | - fibrosis surrounding nodules

Question 51

is autoimmune hepatitis common?

Answer 51

no

Question 52

what population is autoimmune hepatitis most common?

Answer 52

obese middle-aged females

Question 53

what is the treatment for autoimmune hepatitis?

Answer 53

steroids

Question 54

autoimmune hepatitis often goes on to advanced ___

Answer 54

fibrosis

Question 55

in fatty liver disease, the liver tends to appear what color?

Answer 55

yellow

Question 56

which fatty liver disease type is described as fat accumulation in the liver that is temporary and does not have any cellular damage?

Answer 56

steatosis

Question 57

which fatty liver disease type is characterized by damage to the liver with fibrosis present (chronic)?

Answer 57

steatohepatitis

Question 58

metabolic disease is often associated with ___ overload, and can progress to ___

Answer 58

- iron | - cirrhosis

Question 59

what is a metabolic disease characterized by a copper metabolic defect that goes on to hepatitis and then cirrhosis?

Answer 59

wilson's disease

Question 60

hepatocellular injury causes accumulation of ___ pigment in liver ___ cells

Answer 60

- ceroid (lipid residue of lysosomal digestion) | - kupffer

Question 61

___ is the destruction of bile ducts, causing bile to back up in the liver and cause inflammatory cells to surround ducts

Answer 61

biliary disease

Question 62

biliary disease may form ___

Answer 62

granulomas

Question 63

what are the main causes of chronic hepatitis?

Answer 63

- infection (hepatitis B and C most common, rarely D) - drugs - autoimmune diseases

Question 64

how is accidental hepatitis B exposure managed?

Answer 64

- carefully wash wound - DON'T RUB (imbeds virus) - use antiviral disinfectant (iodine or chlorine formulations) - initiate HBV vaccine series

Question 65

what are the 2 objectives of managing hepatitis C virus?

Answer 65

- eliminate the virus | - prevent progression to fibrosis and cancer

Question 66

what are the guidelines of hepatitis C viral infection treatment?

Answer 66

- >18 years of age - compensated liver disease meaning no encephalopathy or ascites - willingness by patient to adhere to treatment requirements

Question 67

___% of those treated for hepatitis C viral infection remain virus free for 1 year

Answer 67

92%

Question 68

___% of those treated for hepatitis C viral infection have severe side effects

Answer 68

2%

Question 69

treatment of hepatitis C viral infection is contraindicated in what patients and why?

Answer 69

- patients with severe liver disease | - due to metabolism problems

Question 70

what is the cost in the US to treat hepatitis C viral infection?

Answer 70

- $90,000/12 week regimen | - much cheaper in some other countries