Brainscape's Knowledge GenomeTM

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


See full index

Dental Management of the Medically Complex Patient > Lecture 3- Hepatic Disease > Flashcards

Lecture 3- Hepatic Disease Flashcards

1
Q

Where is the liver located?

A

upper right quadrant

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

Largest internal organ:

A

liver

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

Describe the blood supply to the liver:

A

Dual supply
~20% hepatic artery
~80% portal vein

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

The hepatic artery delivers:

A

oxygenated blood

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

The portal vein delivers:

A

nutrients

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

Left and right hepatic ducts form the:

A

common hepatic duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The common hepatic duct is responsible for:

A

draining bile from liver and transports wastes from the liver and aids in digestion (by releasing bile)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Carries bile from the liver and the gallbladder thorough the pancreas and into the duodenum:

A

Common bile duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Where does the common bile duct carry bile? (pathway)

A
  1. liver
  2. gallbladder
  3. pancreas
  4. duodenum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

The common bile duct is part of the:

A

biliary duct system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

The biliary duct system is formed where:

A

the ducts from the liver and gallbladder are joined

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

Where the ducts and liver and gallbladder join:

A

biliary duct system (common bile duct is part of this)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

the hepatic portal vein goes from the ___ to the ___

A

GI system to the liver

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

Drains 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
15
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
16
Q

Delivers substances absorbed by the GI tract (stomach, intestine, spleen, & 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
17
Q

Cells of the liver=

A

hepatocytes

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

What is the function of the hepatocytes?

A

synthesize proteins

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

Hepatocytes are responsible for synthesizing proteins such as:

A
  1. immunoglobulins
  2. albumin
  3. coagulation factors
  4. carrier proteins
  5. growth factors
  6. hormones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

In addition to synthesizing proteins, hepatocytes also synthesize:

A

bilirubin

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

Made from the breakdown of RBCs:

A

bilirubin

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

How is bilirubin transported to the liver?

A

by being bound to albumin in its unconjugated form

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

considered the unconjugated form of bilirubin:

A

bilirubin bound to albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

The liver conjugates bilirubin by unbinding the protein (albumin) & binding it to ____

A

glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Bilirubin + albumin =

Bilirubin + glucose =

A

UNconjugated form

conjugated form

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

The hepatocytes produce bile for:

A

digestion

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

The hepatocytes produce ____ for fat storage

A

cholesterol

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

Bilirubin levels can escalate from:

A
  1. blood disorders
  2. chronic liver disease
  3. blockage of bile ducts
  4. Hepatitis (etoH, viral, drug induced)
  5. cirrhosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Blood disorders that increase bilirubin levels include:

A
  1. hemolytic anemia
  2. sickle cell anemia
  3. inadequate transfusions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Increased bilirubin results in:

A
  1. jaundice
  2. fatigue
  3. cutaneous itch
  4. discolored urine
  5. discolored feces
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

A function of hepatocytes is to regulate ____.

A

nutrients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Which nutrients are the hepatocytes responsible for regulating?

A
  1. glucose
  2. glycogen
  3. lipids
  4. amino acids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Hepatocytes prepare ___ for excretion

A

drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Responsible for drug conjugation and metabolism:

A

hepatocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Types of liver damage include:

A
  1. hepatocellular (infiammation and injury)
  2. cholestatic (obstructive)
  3. mixed
  4. cirrhosis (fibrotic, end-stage), acute or crhonic
  5. neoplastic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Damage of the liver caused by inflammation & injury:

A

hepatocellular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Damage to the liver caused by obstruction:

A

cholesstatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Fibrotic or end-stage liver damage that may be acute or chronic:

A

cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Scarring of the liver in which you start losing hepatocytes:

A

cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

T/F: Hepatocellular carcinoma may be an increased risk in patients who have had many viral diseases

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Signs of liver diseases include:

A
  1. jaundice
  2. ascites
  3. edema
  4. GI bleed
  5. dark urine
  6. light stool
  7. mental confusion
  8. xanthelasma
  9. spider angiomas
  10. palmar erythema
  11. asaterixis
  12. hyperpigmentation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Symptoms of liver disease include:

A
  1. appetite loss
  2. bloating
  3. nausea
  4. RUQ pain
  5. fatigue
  6. mental confusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is both a sign and symptoms of liver disease?

A

mental confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is seen in the following image?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Fatty cholesterol deposits in the skin that is a good indicator the patient has some sort of liver disease

A

xanthelasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is seen in the following image?

A

spider angiomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Capillary fragility seen in the skin due to lack of clotting factors; increased peripheral endothelial vasculature:

A

spider angiomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

When liver is not metabolizing ammonia from the body, (usually converts ammonia to ammonium so it can be excreted), the ammonia builds up, getting to the brain and causes:

A

asterixis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Asterixis is also known as:

A

flapping tremor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is a classic sing of hepatic encephalopathy (HE)

A

asterixis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Described asterixis:

A

jerky movements when the hands are extended at wrists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What can be seen in the following image?

A

asterixis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Sign associated with poor ammonium metabolism:

A

Asterixis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

A syndrome of altered neurologic function related to dysregulation of metabolism seen almost exclusively in patient with severe liver disease:

A

Hepatic encephalopathy (HE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

HE can be a chronic problem in patients with ___, managed medically to varying degrees of success, punctuated with occasion exacerbations

A

cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

T/F: Although acute exacerbations of HE are rarely fatal, they are a frequent cause of hospitalizations among patients with cirrhosis

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What are some blood test that determine general liver function:

A
  1. CBC
  2. CMP (comprehensive metabolic panel)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

List some SPECIFIC liver function tests:

A
  1. lipid panel
  2. VDRL
  3. PSA (prostate specific antigen)
  4. SARS antigen & antibody
  5. HIV
  6. HEP B
  7. Bleeding times
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Test that evaluates the cells that circulate in the blood:

A

CBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What cells are evaluated on a CBC?

A
  1. RBCs
  2. WBCs
  3. PLTs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

A CBC is an indicator of:

A

overall health

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

A CBC may detect a variety of diseases and conditions including:

A
  1. infection
  2. anemia
  3. leukemia
  4. lymphoma
  5. neutropenia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

CMP:

A

Comprehensive metabolic panel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

A CMP may also be called:

A

chemical screen or SMAC 14 (sequential multiple analysis - computer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

A CMP consists of ___ blood tests which serve as:

A

14 blood tests; initial broad medical screening tool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

A CMP includes:

A
  1. general tests
  2. kidney function assessment
  3. electrolytes
  4. protein tests
  5. liver function assessment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Why are CMPs (chemical screen/SMACs) a good general test for the patients overall health?

A

Because they look at multiple organ systems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

In terms of assessing liver function, the following proteins are good indicators of liver health:

A
  1. bilirubin
  2. alkaline phosphatase (ALP)
  3. Transaminases
  4. albumin
  5. globlulin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Bilirubin is a product of:

A

heme breakdown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Increased total bilirubin = increased:

A

severity of liver injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

bilirubin that is insoluble, bound to albumin, not filtered by kidney:

A

unconjugated (indirect)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

T/F: With unconjugated bilirubin, increased SERUM is not really indicative or liver disease

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Form of bilirubin that 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
73
Q

T/F: With conjugated bilirubin, increased SERUM levels is NOT really indicative of liver disease

A

False- this is indicative of liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

The form of bilirubin that is water soluble and excreted by the kidney:

A

conjugated (direct)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

All ____ bilirubin is conjugated

A

urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

A protein involved with bone metabolism that is not specific to liver disease but may indicate cholestatic disease

A

Alkaline phosphatase (high)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

This protein is altered in multiple disease conditions, but especially bone neoplasms:

A

alkaline phosphatases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

AST, ALT, and GGT are all:

A

transaminases (liver enzymes) needed for protein synthesis & specific to liver function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

High levels of transaminases (AST, ALT, GGT) indicates:

A

damage to hepatocytes from hepatocellular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

T/F: High levels of transaminases (AST, ALT, GGT) are individually proportionally reflective of severity of liver damage

A

False- not individually proportionally reflective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What transaminase is more indicative of cholestatic disease (blockage) and alcoholic liver disease?

A

GGT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

AST: ALT ratios are more informative; the ____ the ratio, there specific an indicator of hepatic disease

A

lower

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Synthesized exclusively by hepatocytes:

A

Albumin

84
Q

What is the half life of albumin?

A

18-20 days

85
Q

Hypoalbuminemia is more indicative of ____ but not specific to ____

A

chronic liver disease; liver disease

86
Q

Hypoalbuminemia is not specific to liver disease as it is also involved in:

A
  1. malnutrition
  2. chronic infection
  3. gut disease
87
Q

What are two liver function tests?

A
  1. albumin
  2. prothrombin time
88
Q

The prothrombin time test measures;

A

extrinsic & common pathway

89
Q

The liver produces all coagulation factors except for:

A

VIII (vascular endothelial cells)

90
Q

PT measures factors:

A

1, 2, 5, 7, 10

91
Q

What are the vitamin K dependent coagulation factors?

A

2, 7, 9,10

92
Q

INR is actually

A

PT INR

93
Q

What are the 4 A’s that are measured on a CMP?

A
  1. albumin
  2. alkaline phosphatase
  3. ALT
  4. AST
94
Q

What is the B that is measured on a CMP?

A

BUN

95
Q

What are the 4 C’s that are measured on a CMP?

A
  1. calcium
  2. chloride
  3. CO2
  4. creatinine
96
Q

What is the G measured on a CMP?

A

Glucose

97
Q

What is the P measured on a CMP?

A

Potassium

98
Q

What is the S that is measured on a CMP?

A

Sodium

99
Q

What are the two Ts measured on a CMP?

A
  1. Total bilirubin
  2. Total protein
100
Q

All hepatitis viruses are RNA viruses except for ____ which is an enveloped DNA virus

A

Hep B (HBV)

101
Q

Where does the hepatocellular damage from hepatitis viruses come from?

A

host immune response to viral antigens (rather than direct cytopathic effect from virus)

(think of this like an autoimmune disease)

102
Q

List some components of viral hepatitis that cause hepatocellular damage: (think about the host response)

A
  1. cytotoxic T-cells
  2. Proinflammatory cytokines
  3. NK cell response
  4. Antibody-dependent cellular cytotoxicity
103
Q

Viral hepatitis infection may be ___ /___ and ___/___

A

asymptomatic or symptomatic; acute or chronic

104
Q

Chronic hepatitis can lead to:

A
  1. cirrhosis
  2. liver failure
  3. hepatocellular carcinoma
105
Q

What is the risk factor for hepatitis leading to hepatocellular carcinoma?

A

immunosuppression

106
Q

T/F: A patient with hepatitis can have a chronic infection yet be asymptomatic deeming them in the carrier state (low levels)

A

true

107
Q

Viral hepatitis is also called _____, and is a ____ pathogen

A

serum hepatitis; blood-borne

108
Q

Describe the transmission of viral hepatitis:

A
  1. parenteral
  2. intimate
  3. sexual
109
Q

The hep B virus can last up to ___ on an infected surface

A

7 days

110
Q

What is the incubation period for Hep B?

A

90 days average

111
Q

Describe the chronicity of Hep B:

A
  • 90% infants
  • 25-50% 1-5
  • Less than 5% adults
112
Q

Is there a vaccination for hep B? If so describe

A

Yes- 3 doses (1 initial, 1 month, 6 months)

113
Q

For the Hep B vaccination, seroconversion is necessary meaning:

A

your body has to have time to develop specific antibodies as a result of immunization

114
Q

In the chronic state of Hep B, the ___ is always present in the body

A

surface antigen

115
Q

What is another name for hep C?

A

cytomegalovirus

116
Q

Dentistry has adopted the ___ against blood borne diseases which has dramatically decreased the incidence of viral spread

A

universal/standard precautions

117
Q

Patients with chronic hep C must stay on ___ for a long time

A

immunosuppression drugs

118
Q

Hepatitis virus where the average prevalence in injection drug users is 53%

A

Hep C

119
Q

What population should be screened due to a higher risk of having the hep C virus?

A

baby boomers

120
Q

___% of untreated hep C patients are able to clear the virus

A

15-25%

121
Q

Hep C has a high risk for becoming ____ (75-85%)

A

chronic

122
Q

10-20% of patients who have chronic hep C develop:

A

cirrhosis (takes 20-30 years)

123
Q

Patients who have chronic hep C are at an increased risk for: (2)

A
  1. hepatocellular carcinoma (HCC)
  2. death
124
Q

T/F: HIV has a higher needle stick transmission rate than HCV

A

False- HCV higher

125
Q

Is there a vaccine for Hep C? If so describe

A

No

126
Q

What is considered a “cure” for HCV?

A

undetectable HCV RNA levels after 12 weeks of recommended protease inhibitor therapy

127
Q

List some examples of the protease inhibitor therapy (immunosuppression drugs) used to treat hep C:

A
  1. Mavyret
  2. Epclusa
  3. Harvoni
128
Q

T/F: There are chronic carriers associated with hep C

A

True

129
Q

Form of hepatitis that usually presents coinfection with Hep B:

A

Hep D (HDV)

130
Q

Compare the severity of Hep B versus Hep B+D

A

Hep B+D is more severe than Hep B alone

131
Q

With Hep D, one is at risk for ____ which results in:

A

fulminant hepatits; massive hepatocellular destruction

132
Q

What hepatitis viruses are considered blood borne?

A

Hep B, C, D

133
Q

What hepatitis viruses are considered fecal-oral borne?

A

Hep A & Hep E

134
Q

Infectious hepatitis, fecal-oral transmission:

A

Hep A & E

135
Q

Hep A and Hep E are considered highly ___ & ___

A

contagious and transmissable

136
Q

Is there a vaccine for Hep A or Hep E? If so describe:

A

Yes for hep A; not for hep E

137
Q

T/F: Most carries of HBV, HCV, and HDV are unaware they have hepatitis

A

True

138
Q

T/F: Hepatitis can be contracted by the dentist from an infected patient

A

True

139
Q

Chronic, active hepatitis patients may have chronic liver dysfunction such as:

A
  1. increased bleeding
  2. altered drug metabolism
140
Q

Hep ___ is the most likely viral hepatitis to be transmitted occupationally to a dental health care worker followed by Hep ___.

A

Hep B; Hep C

141
Q

T/F: There is little to no risk exists for transmission, for HAV, HEV, and non-A-E hepatitis viruses

A

True

142
Q

When we consider ALL patients infectious:

A

Universal precautions

143
Q

If active hep disease status, a risk for dental care in patients with hep virus is:

A

they likely are not making the blood clotting factors

144
Q

How would you respond to the following situation?

Patients with ACTIVE hepatitis (acute or chronic)

A
  1. defer all elective dental treatment
  2. if emergency treatment
    - consult physician
    - determine severity of disease
    - determine dental treatment risk
    - consider referral to specialized center
    - isolation may be necessary
145
Q

How would you respond to the following situation?

Patients with history of hepatitis (resolved, chronic inactive)

A
  1. consider risk factors
  2. consult physician to determine liver status
146
Q

How would you respond to the following situation?

Needle stick

A
  1. consult the physician
  2. consider hepatitis B immunoglobulin
147
Q

What are some viral hepatitis oral manifestations?

A
  1. bleeding
  2. mucosal jaundice
  3. glossitis
  4. angular cheilosis
148
Q

What is an oral manifestation we may see in a patient with chronic HCV?

A
  1. oral lichen Plans
  2. lymphocytic sialadenitis
149
Q

An oral manifestation of hepatitis viruses that is usually part of the immune suppression from the lack of production of immunoglobulins that presents clinically as a fungal or bacterial infection at the corners of the mouth:

A

angular cheilosis

150
Q

Viral hepatitis oral manifestation in which the patient has enlarged parotid glands (Sjogren-like syndrome). What is this due to?

A

Lymphocytic sialodenitis; lymphocytic infiltration and edema in the parotid glands

151
Q

Type of hepatitis in which there is no virus inducing the response:

A

autoimmune hepatitis

152
Q

What is the cause of autoimmune hepatitis?

A

Idiopathic

153
Q

Autoimmune hepatitis is more severe in what population?

A

children

154
Q

What is one of the main contributors to drug induced liver disease?

A

alcohol

155
Q

List some mechanisms that result in drug-induced liver disease?

A
  1. DIRECT toxicity to hepatocytes
  2. Production of hepatotoxic metabolites
  3. Accumulation of drug due to altered metabolism
156
Q

Degeneration of the liver caused by atrophy of hepatocytes; where scarring and connective take over the liver:

A

Non-alcoholic fatty liver disease (not caused by drugs or alcohol)

157
Q

alcohol and its metabolite are :

A

hepatotoxic

158
Q

alcohol causes ____ which compounds the liver damage

A

inflammation

159
Q

It typically takes ___ of excessive alcohol intake to develop alcoholic liver disease

A

10 years

160
Q

What is the first stage of alcoholic liver disease? Describe

A

Patients first develop fatty liver disease; reversible

161
Q

When a patient has developed fatty liver disease from alcohol and continues alcohol use, this can lead to:

A

irreversible changes & necrosis (due to persistent inflammation)

162
Q

Once a patient has reached the stage of irreversible changes and necrosis of the liver due to alcohol use and continues alcohol use, eventually ____ & ____ develop which is irreversible and leads to ____.

A

fibrosis & cirrhosis; hepatic failure

163
Q

Complications of alcoholic liver disease include:

A
  1. bleeding tendencies
  2. unpredictable drug metabolism
  3. impaired immune function
  4. peripheral neuropathies
  5. dementia & psychosis
  6. anorexia
164
Q

Complications of cirrhosis (due to alcohol) include:

A
  1. ascites
  2. esophageal varices
  3. jaundice
  4. hepatosplenomegaly
  5. coagulation disorders
  6. hypoalbuminemia
  7. anemia
  8. neutropenia
  9. encephalopathy
165
Q

Describe ascites:

A

hepatorenal syndrome (beer belly appearance)

166
Q

Describe esophageal varices:

A

GI bleed

167
Q

Describe hepatosplenomegaly:

A
  1. enlarged spleen due to portal hypertension
  2. decreased platelet function
  3. leads to thrombocytopenia
168
Q

Describe the coagulation disorders associated with cirrhosis (alcohol induced)

A
  1. decreased synthesis of clotting factors
  2. impaired clearance of anticoagulations
  3. decreased vitamin K absorption
169
Q

VItamin K absorption requires:

A

biliary excretion

170
Q

Describe the anemia that is a complication of cirrhosis (alcohol induced):

A
  1. iron deficiency
  2. macrocytosis
171
Q

Describe encephalopathy that is a complication of cirrhosis (alcohol induced):

A

Neurotoxins not removed from the liver

172
Q

How might you identify a patients alcoholism?

A
  1. history
  2. clinical examination
  3. detection of odor on breath
  4. suspicious behavior
  5. info from family/friend
173
Q

What is the BEST way to identify a patients alcoholism?

A

history

174
Q

What is a problem for the dentist with a patient who has early on/mild liver dysfunction caused by alcohol?

A

Liver enzyme induction may increase metabolism of prescribe drugs, limiting their effect

175
Q

What is a problem for the dentist with a patient who has early on/mild liver dysfunction caused by alcohol?

A

Drug metabolism may conversely be hindered and drug toxicity is a concern

176
Q

In many chronic liver diseases, the ratio of AST: ALT is ___ where as in alcoholics the ratio of AST: ALT is much _____

A

low; higher

177
Q

What is the AST: ALT ratio in a patient with alcoholism?

A

Greater than or equal to 2

178
Q

A patient presents with AST: ALT ratio of 2.4 and an elevated GGT. What might you suspect?

A

alcoholic liver disease

179
Q

Total protein-

Hepatitis:

Cirrhosis:

A

Hepatitis: Normal

Cirrhosis: Decreased

180
Q

Albumin-

Hepatitis:

Cirrhosis:

A

Hepatitis: Normal

Cirrhosis: Decreased

181
Q

Globulin-

Hepatitis:

Cirrhosis:

A

Hepatitis: Normal

Cirrhosis: Increased

182
Q

A/G Ratio

Hepatitis:

Cirrhosis:

A

Hepatitis: greater than 1

Cirrhosis: Less than 1

183
Q

Alkaline phosphatase-

Hepatitis:

Cirrhosis:

A

Hepatitis: elevated 1-2 times normal

Cirrhosis: elevated 1-2 times normal

184
Q

ALT-

Hepatitis:

Cirrhosis:

A

Hepatitis: Values increased into the thousands

Cirrhosis: ALT, AST are increase up to a maximum of 300 IU

185
Q

AST-

Hepatitis:

Cirrhosis:

A

Hepatitis: values increased to the thousands but ALT is ALWAYS greater than AST

Cirrhosis: NEVER greater than 300 IU AST is always greater than ALT

186
Q

Alcoholic liver disease oral manifestations include:

A
  1. neglect
  2. bleeding
  3. ecchymoses
  4. petechiae
  5. glossitis
  6. angular cheilosis
  7. alcohol odor
  8. parotid enlargement
  9. xerostomia
187
Q

A patient with jaundice mucosal tissues and a breath that is ___ & ___ is associated with liver failure

A

sweet & musty

188
Q

Alcohol is a STRONG risk factor for:

A

oral squamous carcinoma

189
Q

_____ is the number one abused drug in terms of ER visits, hospital admission, family violence and social problems

A

alcohol abuse

190
Q

Laboratory tests may be needed to evaluate the fitness of the patient for dental treatment(s). If we suspect liver disease, what lab tests may we order?

A
  1. CBC with differential (this includes platelets)
  2. Liver function test which includes
    - AST
    - ALT
    - GGT
    - Albumin
    - Alkaline phosphatase
    - Bilirubin
191
Q

T/F: In a patient with significant liver disease SRP should be done one quadrant at a time, not the full mouth.

A

False- SRP should be one tooth at a time rather an entire quadrant

192
Q

In a patient with significant liver disease, what should you avoid post-op?

A

NO NSAIDS for pain management

193
Q

In a patient with significant liver disease, what CAN you recommend post-op for pain control?

A

acetaminophen up to 2g daily

194
Q

T/F: Antibiotic prophylaxis prior to dental procedures is NOT required if no oral infection is present in a patient with liver disease. Patients with SEVERE LIVER DISEASE may need antibiotic prophylaxis for invasive/surgical procedures due to decreased immune function.

A

Both statements true

195
Q

For patients with liver disease, you should minimize use of drugs metabolized by the liver. These drugs include:

A
  1. local anesthetic
  2. analgesics
  3. sedative
  4. antimicrobials
196
Q

What is a concern with local anesthetics in patients with liver disease?

A

Local anesthetics are not metabolized properly by the liver and may result in encephalopathy

197
Q

What may be a better option as opposed to amide anesthetics in a patient with liver disease?

A

Ester anesthetics (but can be hard to find & not as long last for pain control)

198
Q

Opioids can be used if necessary for post-op pain control in a liver diseased person. Which ones would we avoid? Which should we prescribe?

A

AVOID: hydrocodone & oxycodone

PRESCRIBE: Hydromorphone

199
Q

What sedatives should be avoided in a person with liver disease? Which are acceptable?

A

AVOID: benzodiazepines

Potentially use: Lorazepam due to its shortened half life

N2O is a safer option if possible

200
Q

What antimicrobials should be avoided in a person with liver disease? Which are acceptable?

A

AVOID: Metronidazole, Tetracycline, Doxycycline, Fluconazole – these get broken down in liver

Possible issue with: Clindamycin

201
Q

Disulfiram effect:

A

antimicrobial alcohols take to make them violently ill with alcohol

202
Q

Type of hypertension that is a complication with cirrhosis:

A

portal hypertension

203
Q

What is significantly elevated with portal hypertension?

A

BP

204
Q

With portal hypertension, ___ should be limited as well as no use of retraction cord with ____.

A

Epi; Epi

205
Q

Why do we see thrombocytopenia with portal hypertension?

A

due to platelet sequestration in the spleen

206
Q

What risk ratio should we weigh when deciding to prescribe antibiotics prophylactically

A

impairment of drug metabolism vs. immune impairment

207
Q

T/F: Antibiotic prophylaxis is a consideration in a patient with liver disease

A

True

208
Q
A

Dental Management of the Medically Complex Patient (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions