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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
Q

Transmitted fecal-orally, sexually, bodily

A

Hep A

26
Q

2-6 week incubation

A

Hep A

27
Q

Uneventful recovery

A

Hep A

28
Q

Long-lasting immunity

A

Hep A

29
Q

Serum Hep

A

Hep B

30
Q

Affects 1/3 of population

A

Hep B

31
Q

Can cause lifelong infection, cirrhosis, liver cancer, liver failure, fulminant hep

A

Hep B

32
Q

Transmitted IVDU tattoo/piercing

A

Hep B and Hep C

33
Q

Survives in dried blood for 1 week

A

Hep B (B=blood)

34
Q

Easily transmissible in health care settings

A

Hep B

35
Q

Has a carrier state (5-10%)

A

Hep B

36
Q

2-6 month incubation

A

Hep B

37
Q

30% are asymptomatic

A

Hep B (Hep C is also often asymptomatic)

38
Q

2 cause of liver disease

A

Hep C

39
Q

Elevated liver function tests

A

Hep C

40
Q

Obstructed portal circulation

A

Cirrhosis

41
Q

Portal hypertension

A

Cirrhosis

42
Q

Esophageal varices

A

Cirrhosis

43
Q

GI hemorrhage

A

Cirrhosis

44
Q

Heamtemesis

A

Cirrhosis

45
Q

Splenomegaly

A

Cirrhosis

46
Q

Decreased clotting factors

A

Cirrhosis

47
Q

Spider naevi

A

Cirrhosis

48
Q

Ascites periontitis (retention of fluid)

A

Cirrhosis

49
Q

Sialosis

A

Cirrhosis

50
Q

Periontitis

A

Cirrhosis

51
Q

Peptic Ulcers

A

Cirrhosis

52
Q

Finger Clubbing

A

Cirrhosis

53
Q

Pre-procedural Vitamin K and transfusion

A

Cirrhosis

54
Q

Hematology consult appropriate

A

Cirrhosis

55
Q

NO aspirin

A

Cirrhosis

56
Q

ONLY narrow-spectrum antibiotics

A

Cirrhosis

57
Q

Pale stool

A

Hep B

58
Q

Dark urine

A

Hep B

59
Q

Enlarged, tender liver

A

Hep B

60
Q

Myalgia

A

Hep B

61
Q

Arthralgia

A

Hep B

Summer 2017-Oral Medicine Final (17 decks)

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