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Summer 2017-Oral Medicine Final > Hepatology > Flashcards

Hepatology Flashcards

1
Q

Hep A

A
  1. infectious hepatitis
  2. endemic world-wide
  3. high incidence in low SE areas
  4. transmission routes
    * *FECAL-ORAL
    * *sexually
    * *close personal contact
    * *body fluids, including saliva
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2
Q

Hep A Clinical Features

A
  1. 2-6 week incubation
  2. fatigue, nausea, vomiting, abdominal pain, anorexia, fever, jaundice, itching
  3. uneventful recovery
  4. long-lasting immunity
  5. HAV VACCINE available
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3
Q

Hep B

A
  1. serum hepatitis
  2. affects 1/3 of population
  3. Outcomes
    * *lifelong infection
    * *cirrhosis
    * *liver cancer
    * *liver failure
    * *fulminant hepatitis–>death
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4
Q

Hep B Transmission Routes

A
  1. parenteral (IVDU and tattooing/piercing)
  2. unsafe sex
  3. perinatal
  4. survives in dried blood (1 week)
  5. easily transmissible in health care settings
  6. transmission declined after HBV VACCINE
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5
Q

Clinical Features of Hep B

A
  1. carrier state (5-10%)
    * *asymptomatic
    * *can develop chronic liver disease
  2. infection and recovery=IMMUNITY
  3. 2-6 month incubation
  4. acute mortality <2%
  5. most patients recover uneventfully
  6. Prodrome (1-2 weeks)
    * *anorexia
    * *malaise
    * *nausea
  7. 30% are asymptomatic
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6
Q

HBsAg

A
  1. serological marker for Hep B
  2. acute infection–>20-120 days post-infection
  3. chronic infection–>13 weeks post-jaundice
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7
Q

Anti-HBs

A
  1. serological marker for Hep B
  2. two possibilities
    * *recovery and immunity
    * *successful vaccination
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8
Q

HBcAg

A
  1. serological marker for Hep B

2. current or recurrent infection

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9
Q

Anti-HBc

A
  1. serological marker for Hep B
  2. with anti-HBs–>recovery and immunity
  3. without anti-HBs–>carrier/chronic hepatitis
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10
Q

HBeAg

A
  1. serological marker for Hep B

2. ongoing infectivity

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11
Q

Anti-HBe

A
  1. serological marker for Hep B
  2. inactive state
  3. complete recovery if HBeAg absent
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12
Q

General Management for Hep B

A
  1. HBV vaccination
    * *NO NEED for testing
    * *NO NEED for booster dose
  2. infection control
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13
Q

Dental Aspects for Hep B

A
  1. all dental professionals should be vaccinated
  2. HBV in saliva from gingival exudate
    * *LOW transmission risk
  3. needlestick injury
    * *HIGH transmission risk
    * *post-exposure prophy
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14
Q

Hep C

A 
1. non A/non B hepatitis
2 #2 cause of liver disease (#1 ETOH)
3. common in IVDUs
4. similar incubation to Hep B
5. often asymptomatic
6. elevated liver function tests
7. chronic liver disease (85%)
8. mortality (3%)
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15
Q

General Management of Hep C

A
  1. serological confirmation of infection
  2. 50% spontaneous resolution
  3. NO vaccines
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16
Q

Dental Aspects of Hep C

A
  1. transmission in health care clinics
  2. found in saliva
  3. transmitted by human bite
  4. hep c positive–>avoid exposure prone procedures
  5. associated with lichen planus??
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17
Q

Drug-induced Hep

A
  1. alcohol
  2. NSAIDs
  3. antimicrobials
  4. herbs/nutritional supplements
  5. acetaminophen
  6. aspirin (children with viral infections)
    * *REYE SYNDROME
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18
Q

Cirrhosis

A

scarring of the liver

  1. inflammation
  2. necrosis
  3. fibrosis
  4. vascular derangement
  5. decreased function
  6. obstructed blood flow
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19
Q

Clinical Features of Cirrhosis

A
  1. obstructed portal circulation
    * *portal hypertension
    * *esophageal varices
    * *GI hemorrhage
    * *heamtemesis
    * *anemia
  2. splenomegaly–>thrombocytopenia
  3. decreased clotting factors
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20
Q

Symptoms of Cirrhosis

A
  1. encephalopathy
  2. jaundice
  3. spider naevi
  4. ascites peritonitis (retention of fluid)
  5. sialosis–>enlargement of salivary glands
  6. periontitis
  7. peptic ulcers
  8. finger clubbing
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21
Q

General Management of Cirrhosis

A
  1. dietary alterations
  2. diuretics
  3. beta-blockers
  4. ligation/shunting
  5. liver transplant
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22
Q

Dental Aspects of Cirrhosis

A
  1. bleeding problems
  2. drug contraindications
  3. viral transmission risk
  4. pre-procedure vitamin K
  5. pre-procedure transfuion
  6. hematology consult appropriate
  7. NO sedative, hypnotics
  8. N2O preferable to conscious sedation
  9. NO aspirin
  10. ONLY narrow-spectrum antibiotics
  11. increased risk of periotonitis with invasive dental procedures
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23
Q

Symptoms of Hep B

A
  1. jaundice
  2. pruritus
  3. pale stool
  4. dark urine
  5. enlarged, tender liver
  6. myalgia
  7. arthralgia
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24
Q

Infectious Hep

A

Hep A

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25
Transmitted fecal-orally, sexually, bodily
Hep A
26
2-6 week incubation
Hep A
27
Uneventful recovery
Hep A
28
Long-lasting immunity
Hep A
29
Serum Hep
Hep B
30
Affects 1/3 of population
Hep B
31
Can cause lifelong infection, cirrhosis, liver cancer, liver failure, fulminant hep
Hep B
32
Transmitted IVDU tattoo/piercing
Hep B and Hep C
33
Survives in dried blood for 1 week
Hep B (B=blood)
34
Easily transmissible in health care settings
Hep B
35
Has a carrier state (5-10%)
Hep B
36
2-6 month incubation
Hep B
37
30% are asymptomatic
Hep B (Hep C is also often asymptomatic)
38
#2 cause of liver disease
Hep C
39
Elevated liver function tests
Hep C
40
Obstructed portal circulation
Cirrhosis
41
Portal hypertension
Cirrhosis
42
Esophageal varices
Cirrhosis
43
GI hemorrhage
Cirrhosis
44
Heamtemesis
Cirrhosis
45
Splenomegaly
Cirrhosis
46
Decreased clotting factors
Cirrhosis
47
Spider naevi
Cirrhosis
48
Ascites periontitis (retention of fluid)
Cirrhosis
49
Sialosis
Cirrhosis
50
Periontitis
Cirrhosis
51
Peptic Ulcers
Cirrhosis
52
Finger Clubbing
Cirrhosis
53
Pre-procedural Vitamin K and transfusion
Cirrhosis
54
Hematology consult appropriate
Cirrhosis
55
NO aspirin
Cirrhosis
56
ONLY narrow-spectrum antibiotics
Cirrhosis
57
Pale stool
Hep B
58
Dark urine
Hep B
59
Enlarged, tender liver
Hep B
60
Myalgia
Hep B
61
Arthralgia
Hep B

Summer 2017-Oral Medicine Final (17 decks)

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