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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

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2
Q

Largest internal organ:

A

Liver

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3
Q

Describe the blood supply to the liver:

A

dual supply ~20% hepatic artery & 80% portal vein

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4
Q

The hepatic artery delivers:

A

oxygenated blood

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5
Q

The portal vein delivers:

A

nutrients

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6
Q

Left & right hepatic ducts form the:

A

common hepatic duct

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7
Q

The common hepatic duct is responsible for:

A

draining bile from liver & transports waste from the liver & aids in digestion (by releasing bile)

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8
Q

carries bile from the liver & the gallbladder through the pancreas and into the duodenum:

A

common bile duct

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9
Q

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

A
  1. Liver
  2. gallbladder
  3. pancrease
  4. duodenum
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10
Q

The common bile duct is part of the:

A

biliary duct system

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11
Q

The biliary duct system is formed where the:

A

ducts from the liver and gall bladder are joined

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12
Q

Where the ducts of the liver and gallbladder join:

A

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

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13
Q

The hepatic portal vein goes from the ____ to the ____

A

GI system to the liver

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14
Q

Drains venous blood from liver to inferior vena cava and onto the right:

A

hepatic veins

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15
Q

Provides oxygen & nutrition to liver tissues:

A

hepatic artery

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16
Q

Delivers substance absorbed by the GI tract (stomach, intestines, spleen & pancreas) for metabolic conversion and/or removal in the liver:

A

Hepatic portal vein

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17
Q

Cells of the liver:

A

hepatocytes

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18
Q

What is the function of the hepatocytes:

A

synthesize proteins

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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
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20
Q

In addition to synthesizing proteins, hepatocytes also synthesize:

A

bilirubin

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21
Q

Made from the breakdown of RBCs:

A

bilirubin

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22
Q

How is bilirubin transported to the liver?

A

bound to albumin (unconjugated form)

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23
Q

Considered the unconjugated form of bilirubin:

A

bilirubin bound to albumin

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24
Q

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

A

glucose

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25
Q

Bilirubin + albumin =

Bilirubin + glucose =

A

UNconjugated form

Conjugated form

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26
Q

The hepatocytes produce bile for:

A

digestion

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27
Q

The hepatocytes produces ____ for fat storage

A

cholesterol

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28
Q

Bilirubin levels can escalate from:

A
  1. blood disorders
  2. chronic liver disease
  3. blockage of bile ducts
  4. hepatitis (viral, ETOH, drug - induced)
  5. cirrhosis
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29
Q

Blood disorders that increase bilirubin include:

A
  1. hemolytic anemia
  2. sickle cell anemia
  3. inadequate transfusions
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30
Q

Increased bilirubin results in:

A
  1. jaundice
  2. fatigue
  3. cutaneous itch
  4. discolored urine
  5. discolored feces
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31
Q

A function of hepatocytes is to regulate ____

A

nutrients

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32
Q

Which nutrients are the hepatocytes responsible for regulating?

A
  1. glucose
  2. glycogen
  3. lipids
  4. amino acids
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33
Q

Hepatocytes prepares ____ for excretion

A

drugs

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34
Q

Responsible for drug conjugation & metabolism:

A

hepatocytes

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35
Q

Types of liver damage:

A
  1. hepatocellular (inflammation & injury)
  2. cholestatic (obstructive)
  3. mixed
  4. cirrhosis (fibrotic, end-stage, acute or chronic)
  5. neoplastic
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36
Q

Damage to the liver caused by inflammation & injury:

A

hepatocellular

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37
Q

Damage to the liver caused by obstruction:

A

cholestatic

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38
Q

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

A

Cirrhosis

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39
Q

Scarring of the liver in which you start losing hepatocytes:

A

cirrhosis

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40
Q

T/F: Hepatcellular carcinoma may be an increased risk in patient who have had many viral disease

A

True

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41
Q

Signs of liver disease 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. asterixis
  12. hyperpigmentation
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42
Q

Symptoms of liver disease include:

A
  1. appetite loss
  2. bloating
  3. nausea
  4. RUQ pain
  5. fatigue
  6. mental confusion
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43
Q

What is both a sign & symptoms of liver disease?

A

mental confusion

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44
Q

What can be seen in the following image?

A

Xanthelasma (cholesterol deposits in the skin- a good indicator that the patient has chronic liver disease)

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45
Q

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

A

Xanthelasma

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46
Q

What is seen in the following image?

A

Spider angioma

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47
Q

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

A

Spider angioma

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48
Q

When the liver is not metabolism 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

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49
Q

Asterixis is also known as:

A

flapping tremor

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50
Q

What is a classic sign of hepatic encephalopathy (HE)?

A

Asterixis

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51
Q

Describe asterixis:

A

jerky movements when the hands are extended at wrists

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52
Q

What can be seen in the following image?

A

Asterixis

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53
Q

Sign associated with poor ammonium metabolism:

A

Asterixis

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54
Q

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

A

Hepatic encephalopathy (HE)

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55
Q

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

A

cirrhosis

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56
Q

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

A

True

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57
Q

What are some blood tests that can determine general liver function?

A
  1. CBC
  2. CMP (comprehensive metabolic panel)
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58
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
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59
Q

Test that evaluates the cells that circulate in the blood:

A

CBC

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60
Q

What cells are evaluates on a CBC:

A
  1. RBC
  2. WBC
  3. PLTs
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61
Q

A CBC is an indicator of:

A

overall health

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62
Q

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

A
  1. infection
  2. anemia
  3. leukemia
  4. lymphoma
  5. neutropenia
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63
Q

CMP:

A

Comprehensive metabolic panel

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64
Q

A CMP may also be called:

A

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

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65
Q

A CMP consists of _____ blood tests which serve as:

A

14 blood tests; initial broad medical screening tool

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66
Q

A CMP includes:

A
  1. general tests
  2. kidney function assessment
  3. electrolytes
  4. proteins tests
  5. liver function assessment
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67
Q

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

A

Because they look at multiple organ systems

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68
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. globulin
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69
Q

Bilirubin is a product of:

A

heme breakdown

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70
Q

Increased total bilirubin = increased:

A

severity of liver injury

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71
Q

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

A

unconjugated (indirect)

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72
Q

T/F: with unconjugated bilirubin, increased SERUM is not really indicative of liver disease

A

True

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73
Q

Form of bilirubin that indicates hemolysis, ineffective erythropoiesis (thalassemia, vitamin B deficiency, Gilbert syndrome)

A

Unconjugated (indirect)

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74
Q

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

A

False- this is indicative of liver disease

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75
Q

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

A

Conjugated (direct)

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76
Q

All _____ bilirubin is conjugated

A

URINE

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77
Q

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

A

alkaline phosphatase (high)

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78
Q

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

A

Alkaline phosphatases

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79
Q

AST, ALT and GGT are all:

A

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

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80
Q

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

A

Damage to hepatocytes from hepatocellular disease

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81
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

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82
Q

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

A

GGT

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83
Q

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

A

lower

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84
Q

Synthesized exclusively by hepatocytes:

A

albumin

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85
Q

What is the half-life of albumin?

A

18-20 days

86
Q

Hypoalbuminemia is more indicative of _____ but not specific to ____

A

chronic liver disease; liver disease

87
Q

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

A
  1. malnutrition
  2. chronic infection
  3. gut disease
88
Q

What are two liver function tests?

A
  1. albumin
  2. prothrombin time
89
Q

Prothrombin time measures:

A

extrinsic & common pathways

90
Q

The liver produces all coagulation factors except:

A

VIII (vascular endothelial cells)

91
Q

Prothrombin time (PT) measures factors:

A

1, 2, 5, 7, 10

92
Q

What are the vitamin K dependent coagulation factors?

A

2, 7, 9, 10

93
Q

INR is actually:

A

PT-INR

94
Q

What are the four A’s that are measures on a CMP?

A
  1. Albumin
  2. Alkaline phosphatase
  3. ALT
  4. AST
95
Q

What is the B that is measured on a CMP?

A

BUN

96
Q

What are the four C’s measured on a CMP?

A
  1. Calcium
  2. Chloride
  3. CO2
  4. Creatinine
97
Q

What is the G that is measured on a CMP?

A

Glucose

98
Q

What is the P that is measured on a CMP?

A

Potassium

99
Q

What is the S that is measured on a CMP?

A

Sodium

100
Q

What are the two T’s measured on a CMP?

A
  1. Total bilirubin
  2. Total protein
101
Q

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

A

Hep B (HBV)

102
Q

Where does the hepatocellular damage in hepatitis viruses come from?

A

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

(think of it like an autoimmune disease)

103
Q

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

A
  1. cytotoxic T cells
  2. pro inflammatory cytokines
  3. natural killer cell response
  4. antibody-dependent cellular cytotoxicity
104
Q

Viral hepatitis may be _____ / ____ and also ____ / _____

A

asymptomatic or symptomatic; acute or chronic

105
Q

Chronic hepatitis may lead to:

A
  1. cirrhosis
  2. liver failure
  3. hepatocellular carcinoma
106
Q

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

A

Immunosuppression

107
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

108
Q

Viral hepatitis is also called _____ and is a ____ pathogen

A

serum hepatitis; blood-borne

109
Q

Describe the transmission of viral hepatitis:

A
  1. parenteral
  2. intimate
  3. sexual
110
Q

The Hep B virus can last up to _____ on an infected surface

A

7 days

111
Q

What is the incubation period of Hep B?

A

90 days average

112
Q

Describe the chronicity of Hep B:

A

90% infants
25-50% children (1-5)
<5% of adutls

113
Q

Is there a vaccination for Hep B? If so describe:

A

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

114
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 the immunization

115
Q

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

A

surface antigen

116
Q

What is another name for Hep C:

A

Cytomegalovirus

117
Q

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

A

Universal/standard precautions

118
Q

Patients with chronic Hepatitis C must stay on ____ for a long time

A

Immunosuppression drugs

119
Q

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

A

Hep C

120
Q

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

A

Baby boomers

121
Q

_____ % of untreated Hep C patients are able to clear the virus

A

15-25

122
Q

Hepatitis C has a high risk for becoming _____ (75-85%)

A

Chronic

123
Q

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

A

cirrhosis (takes 20-30 years)

124
Q

Patients who have chronic hep C are at increased of ____ & ____

A
  1. Hepatocellular carcinoma (HCC)
  2. Death
125
Q

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

A

False- HCV higher

126
Q

Is there a vaccine for Hep C? If so describe

A

No

127
Q

What is considered a “cure” for HCV?

A

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

128
Q

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

A
  1. mavyret
  2. epclusa
  3. harvoni
129
Q

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

A

True

130
Q

Form of hepatitis that usually presents as a coinfection with hepatitis B:

A

Hepatitis D (HDV)

131
Q

Compare the severity of Hep B versus Hep B+D:

A

Hep B+D is more severe than Hep B alone

132
Q

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

A

fulminant hepatitis; massive hepatocellular destruction

133
Q

What hepatitis viruse(s) are considered blood-borne?

A

Hep B, C, D

134
Q

What hepatitis viruse(s) are not blood-borne and are rather fecal-oral borne:

A

Hep A, E

135
Q

Infectious hepatitis, feca-oral transmission:

A

Hep A & E

136
Q

Hep A & Hep E are considered highly ____ & ____

A

contagious & transmissible

137
Q

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

A

Yes for Hep A not for Hep E

138
Q

T/F: Most carriers of HBV, HCV & HDV are unaware they have it

A

True

139
Q

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

A

True

140
Q

Chronic, active hepatits patients may have liver dysfunction such as:

A
  1. increased bleeding
  2. altered drug metabolism
141
Q

Hep ____ is the most likely viral hepatitis to be transmitted occupationally to a dental healthcare worker, followed by Hep ____

A

B; C

142
Q

T/F: Little to no risk exists for transmission of Hep A, Hep E & non-A-E hepatitis viruses

A

True

143
Q

When we consider ALL patients infectious:

A

Universal precautions

144
Q

If active disease status, a risk for dental care in a patient with hepatitis virus is:

A

They likely are not making the blood clotting factors

145
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 risks
    -consider referral to specialized center
    -isolation may be necessary
146
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
147
Q

How would you respond to the following situation:

Needlestick

A
  1. consult the physician
  2. consider hepatitis B immunoglobulin
148
Q

What are some viral hepatitis oral manifestations?

A
  1. bleeding
  2. mucosal jaundice
  3. glossitis
  4. angular cheilosis
149
Q

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

A
  1. Oral lichen planus
  2. lymphocytic sialodenitis (Sjogren-like syndrome)
150
Q

An oral manifestation of Hepatitis viruses that is really 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

151
Q

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

A

Lymphocytic sailadenitis; due to lymphocytic infiltration & edema of the parotid glands

152
Q

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

A

autoimmune hepatitis

153
Q

What is the cause of autoimmune hepatitis?

A

Idiopathic

154
Q

Autoimmune hepatitis is more severe in:

A

children

155
Q

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

A

alcohol

156
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
157
Q

Degeneration of the liver caused by atrophy of hepatitis resulting; where scarring & connective tissue take over the liver:

A

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

158
Q

Alcohol as well as its metabolite are:

A

hepatotoxic

159
Q

Alcohol causes _____ which compounds the liver damage

A

inflammation

160
Q

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

A

10

161
Q

What is the first stage of alcoholic liver disease? Describe

A

Patients first develop fatty liver disease; reversible

162
Q

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

A

irreversible changes & necrosis (due to persistent inflammation)

163
Q

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

A

fibrosis; cirrhosis; hepatic failure

164
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
165
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
166
Q

Describe ascites:

A

hepatorenal syndrome (beer belly appearance)

167
Q

Describe esophageal varies:

A

GI bleed

168
Q

Describe hepatospenomegaly:

A
  1. Enlarged spleen due to portal hypertension
  2. decreased platelet function
  3. leads to thrombocytopenia
169
Q

Describe coagulation disorders associated cirrhosis (alcohol induced):

A
  1. decreased synthesis of clotting factors
  2. impaired clearance of anticoagulants
  3. decreased vitamin K absorption
170
Q

Vitamin K absorption requires:

A

biliary excretion

171
Q

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

A
  1. iron deficiency
  2. macrocytosis
172
Q

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

A

neurotoxins not removed from the liver

173
Q

How might you identify a patients alcoholism?

A
  1. history
  2. clinical examination
  3. detection of odor on breath
  4. suspicious behavior
  5. information from family/friend
174
Q

What is the best way to identify a patients alcoholism?

A

history

175
Q

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

A

Liver enzyme infection may increase metabolism of prescribed drugs, limiting their effect

176
Q

What is problem for the dentist, with a patient who has severe liver dysfunction caused by alcohol?

A

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

177
Q

In many chronic liver disease the ratio of AST:ALT is ______ whereas in alcoholics the ratio is much _____

A

lower; higher

178
Q

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

A

Greater than or equal to 2

179
Q

A patients presents with an AST: ALT ratio of 2.4 and an elevated GGT, what might you suspect?

A

Alcoholic liver disease

180
Q

Total protein-

Hepatitis:
Cirrhosis:

A

Hepatitis: normal
Cirrhosis: decreased

181
Q

Albumin-

Hepatitis:
Cirrhosis:

A

Hepatitis: normal
Cirrhosis: decreased

182
Q

Globulin-

Hepatitis:
Cirrhosis:

A

Hepatitis: normal
Cirrhosis: increased

183
Q

A/G Ratio-

Hepatitis:
Cirrhosis:

A

Hepatitis: greater than 1
Cirrhosis: less than 1

184
Q

Alkaline phosphatase-

Hepatitis:
Cirrhosis:

A

Hepatitis: elevated 1-2x normal
Cirrhosis: elevated 1-2x normal

185
Q

ALT-

Hepatitis:
Cirrhosis:

A

Hepatitis: vlaues increase into the thousands
Cirrhosis: ALT & AST are increased up to a maximum of 300 IU

186
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

187
Q

In cirrhosis ____> ___

A

AST > ALT

188
Q

In hepatitis ____ > _____

A

ALT > AST

189
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
190
Q

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

A

sweet & musty

191
Q

Alcohol abuse is a STRONGG risk factor for:

A

oral squamous cell carcinoma

192
Q

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

A

alcohol abuse

193
Q

Laboratory tests may be needed to evaluate the fitness of the patient for dental treatment, if we suspect liver disease, what labs tests may we order?

A
  1. CBC with differential (this includes platelets)
  2. Liver function tests which includes:
    -AST
    -ALT
    -GGT
    -Albumin
    -Alkaline phosphatase
    -Bilirubin
194
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 done one tooth at a time rather than an entire quadrant

195
Q

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

A

NO NSAIDs for pain management

196
Q

In a patient with significant liver disease what can you recommend post-operatively for pain control?

A

Acetaminophen up to 2g daily in most cases

197
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 functions

A

Both statements true

198
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. sedatives
  4. antimicrobials
199
Q

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

A

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

200
Q

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

A

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

201
Q

Opioids can be used in necessary for post-op pain control in a liver disease patient. Which ones would we avoid and which could we prescribe?

A

AVOID: Hydrocodone & Oxycodone

PRESCRIBE: Hydromorphone

202
Q

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

A

AVOID: Benzodiazepines

Potentially use: Lorazepam (due to its shortened half-life)

N2O is a safer option if possible

203
Q

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

A

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

Possible issue with: Clindamycin

204
Q

Disulfram affect:

A

antimicrobial alcoholics take to make them violently ill with alcohol

205
Q

Type of hypertension that is a complication of cirrhosis:

A

Portal hypertension

206
Q

What is significantly elevated with portal hypertension?

A

BP

207
Q

With portal hypertension _____ should be limited as well as no use of retraction cord with ____

A

Epi, Epi

208
Q

Why do we see thrombocytopenia with portal hypertension?

A

Due to platelet sequestration in the spleen

209
Q

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

A

Impairment of drug metabolism vs. immune impairment

210
Q

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

A

True

211
Q
A

Dental management of the Medically Complex Patient (5 decks)

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