Hepatology Flashcards
Hep A
- infectious hepatitis
- endemic world-wide
- high incidence in low SE areas
- transmission routes
* *FECAL-ORAL
* *sexually
* *close personal contact
* *body fluids, including saliva
Hep A Clinical Features
- 2-6 week incubation
- fatigue, nausea, vomiting, abdominal pain, anorexia, fever, jaundice, itching
- uneventful recovery
- long-lasting immunity
- HAV VACCINE available
Hep B
- serum hepatitis
- affects 1/3 of population
- Outcomes
* *lifelong infection
* *cirrhosis
* *liver cancer
* *liver failure
* *fulminant hepatitis–>death
Hep B Transmission Routes
- parenteral (IVDU and tattooing/piercing)
- unsafe sex
- perinatal
- survives in dried blood (1 week)
- easily transmissible in health care settings
- transmission declined after HBV VACCINE
Clinical Features of Hep B
- carrier state (5-10%)
* *asymptomatic
* *can develop chronic liver disease - infection and recovery=IMMUNITY
- 2-6 month incubation
- acute mortality <2%
- most patients recover uneventfully
- Prodrome (1-2 weeks)
* *anorexia
* *malaise
* *nausea - 30% are asymptomatic
HBsAg
- serological marker for Hep B
- acute infection–>20-120 days post-infection
- chronic infection–>13 weeks post-jaundice
Anti-HBs
- serological marker for Hep B
- two possibilities
* *recovery and immunity
* *successful vaccination
HBcAg
- serological marker for Hep B
2. current or recurrent infection
Anti-HBc
- serological marker for Hep B
- with anti-HBs–>recovery and immunity
- without anti-HBs–>carrier/chronic hepatitis
HBeAg
- serological marker for Hep B
2. ongoing infectivity
Anti-HBe
- serological marker for Hep B
- inactive state
- complete recovery if HBeAg absent
General Management for Hep B
- HBV vaccination
* *NO NEED for testing
* *NO NEED for booster dose - infection control
Dental Aspects for Hep B
- all dental professionals should be vaccinated
- HBV in saliva from gingival exudate
* *LOW transmission risk - needlestick injury
* *HIGH transmission risk
* *post-exposure prophy
Hep C
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%)
General Management of Hep C
- serological confirmation of infection
- 50% spontaneous resolution
- NO vaccines
Dental Aspects of Hep C
- transmission in health care clinics
- found in saliva
- transmitted by human bite
- hep c positive–>avoid exposure prone procedures
- associated with lichen planus??
Drug-induced Hep
- alcohol
- NSAIDs
- antimicrobials
- herbs/nutritional supplements
- acetaminophen
- aspirin (children with viral infections)
* *REYE SYNDROME
Cirrhosis
scarring of the liver
- inflammation
- necrosis
- fibrosis
- vascular derangement
- decreased function
- obstructed blood flow
Clinical Features of Cirrhosis
- obstructed portal circulation
* *portal hypertension
* *esophageal varices
* *GI hemorrhage
* *heamtemesis
* *anemia - splenomegaly–>thrombocytopenia
- decreased clotting factors
Symptoms of Cirrhosis
- encephalopathy
- jaundice
- spider naevi
- ascites peritonitis (retention of fluid)
- sialosis–>enlargement of salivary glands
- periontitis
- peptic ulcers
- finger clubbing
General Management of Cirrhosis
- dietary alterations
- diuretics
- beta-blockers
- ligation/shunting
- liver transplant
Dental Aspects of Cirrhosis
- bleeding problems
- drug contraindications
- viral transmission risk
- pre-procedure vitamin K
- pre-procedure transfuion
- hematology consult appropriate
- NO sedative, hypnotics
- N2O preferable to conscious sedation
- NO aspirin
- ONLY narrow-spectrum antibiotics
- increased risk of periotonitis with invasive dental procedures
Symptoms of Hep B
- jaundice
- pruritus
- pale stool
- dark urine
- enlarged, tender liver
- myalgia
- arthralgia
Infectious Hep
Hep A
Transmitted fecal-orally, sexually, bodily
Hep A
2-6 week incubation
Hep A
Uneventful recovery
Hep A
Long-lasting immunity
Hep A
Serum Hep
Hep B
Affects 1/3 of population
Hep B
Can cause lifelong infection, cirrhosis, liver cancer, liver failure, fulminant hep
Hep B
Transmitted IVDU tattoo/piercing
Hep B and Hep C
Survives in dried blood for 1 week
Hep B (B=blood)
Easily transmissible in health care settings
Hep B
Has a carrier state (5-10%)
Hep B
2-6 month incubation
Hep B
30% are asymptomatic
Hep B (Hep C is also often asymptomatic)
2 cause of liver disease
Hep C
Elevated liver function tests
Hep C
Obstructed portal circulation
Cirrhosis
Portal hypertension
Cirrhosis
Esophageal varices
Cirrhosis
GI hemorrhage
Cirrhosis
Heamtemesis
Cirrhosis
Splenomegaly
Cirrhosis
Decreased clotting factors
Cirrhosis
Spider naevi
Cirrhosis
Ascites periontitis (retention of fluid)
Cirrhosis
Sialosis
Cirrhosis
Periontitis
Cirrhosis
Peptic Ulcers
Cirrhosis
Finger Clubbing
Cirrhosis
Pre-procedural Vitamin K and transfusion
Cirrhosis
Hematology consult appropriate
Cirrhosis
NO aspirin
Cirrhosis
ONLY narrow-spectrum antibiotics
Cirrhosis
Pale stool
Hep B
Dark urine
Hep B
Enlarged, tender liver
Hep B
Myalgia
Hep B
Arthralgia
Hep B