Lecture 3b: Liver disease Flashcards
Length of preicteric phase
3 - 10 days
4 clinical manifestations of the preicteric phase
Fatigue
Nausea
Poor appetite
Vague R Upper quadrant pain
4 clinical manifestations of icteric phase
Production of dark urine
Jaundice appears
Hepatic tenderness
Symptoms worse
4 general manifestations of liver disease relating to oral health
Anorexia
Dysgeusia
Weight loss
Easy bruising/petechia
Risk of acquiring hepatitis as a dentist relative to general population
3 - 10 times
To whom are HBV booster doses given?
Only to people who did not respond to the primary vaccination series
HBV exposure protocol for vaccinated care provider (i.e. if stuck by a contaminated needle)
Should be tested for adequate titer of anti-HBs if levels are unknown
• Adequate –> nothing further is required
• Inadequate –> immediately receive an injection of HBIG and vaccine booster dose (30 % risk of contracting HBV infection from HBV carriers)
HBV exposure protocol for unvaccinated persons
Immediate HBIG injection and vaccine
HCV exposure protocol
- No postexposure protocol or vaccine is available
- Source person = baseline testing for anti HCV
- Exposed persons receive baseline and f/u testing at 6 mo for anti HCV and liver enzyme activity
4 analgesics to avoid in patient with liver disease
NSAIDs (incl. acetaminophen, aspirin)
Codeine
Meperidine
2 antibiotics to avoid in patient with liver disease
Metronidazole
Vancomycin
Antibiotic prophylaxis recommendations for patients with liver disease
Not recommended
However, patients with severe liver disease may be more susceptible tor infection
Anesthesia recommendations for patients with liver disease
Higher doses may be required to achieve adequate anesthesia in presence of alcoholic liver disease (must know liver function)
Epinephrine (1:100,000, no more than 2 carpules) for local generally not associated with problems, but monitor closely (especially if portal hypertension)
Anti-anxiety medication to avoid in patient with liver disease
Benzodiazepines
Bleeding considerations for patient with liver disease
May need vitamin K and/or platelet or clotting factor replacement to reduce risk of post-surgical bleeding
9 drugs to avoid in patient with liver disease
Acetaminophen Aspirin Ibuprofen Codeine Meperidine Diazepam Barbiturates Metronidazole Vancomycin
Protocol for patient with history of alcohol abuse
MD consult for liver status
Reason for increased risk of infection in patient with alcoholic liver disease
Impairment of Kupffer cell function and T cell response
Antibiotic prophylaxis recommendation for patient with alcoholic liver disease
Not needed IF oral infection is absent
Dental management of patient with ACTIVE hepatitis (5 points)
- No dental treatment other than urgent care (ABSOLUTELY NECESSARY WORK), unless patient has attained clinical and biochemical recovery
- If urgent care, provided only in an isolated operatory with strict adherence to standard precautions
- Aerosols should be minimized
- Drug metabolized in liver should be avoided if possible
- If sx – preop PT, if abnormal MD consult
2 points of dental management for patient with signs or symptoms of hepatitis
- No elective dental treatment
* Refer to MD consult
10 types of patients with substantial risk for Hep B and who should get the vaccine
Health care workers Public safety workers Hemodialysis patients Recipients of certain blood products Household contacts and sex partners of HBV carriers Adoptees from countries where HBV infection is endemic International travellers Illicit drug users Sexually active people Prisoners
4 local anesthetics metabolized by the liver
Lidocaine
Mepivacaine
Prilocaine
Bupivacaine
Drug administration protocol for patient with chronic active hepatitis, carrier of Hep B or C, impaired liver function, alcohol liver disease
➢ Dose of drugs metabolized by liver should be decreased (1/2 dose? ) or avoid if possible
➢ MD’s advise needed – lab tests
Anesthetic considerations for patient with chronic active hepatitis, carrier of Hep B or C, impaired liver function, alcohol liver disease
One procedure dose of 3 cartridges of 2 % lidocaine is considered relatively limited amount
3 complications of liver disease
Abnormal bleeding
Platelet count
Chronic viral hepatitis –> risk of HCC
5 manifestations of abnormal bleeding associated with liver disease
- Abnormal synthesis of blood clotting factors
- Abnormal polymerization of fibrin
- Inadequate fibrin stabilization
- Excessive finbrinolysis
- Thrombocytopenia associated with splenomegaly accompanying chronic liver disease
3 types of disorders and diseases that are extrahepatic manifestations of liver disease
Immune complex-mediated disease
Autoimmune disorders
Immunological disorders
2 immune complex-mediated diseases associated with liver disease
Vasculitis
Polyarteritis nodosa
5 autoimmune disorder associated with liver disease
RA Glomerulonephritis Thrombocytopenic purpura Thyroiditis Pulmonary fibrosis
2 immunologic disorders associated with liver disease
- Lichen planus
* Sjogren like syndrome (lymphocytic sialadenitis)
13 oral complications of alcoholic liver disease
Poor oral hygiene (caries, gingivitis, periodontitis) Glossitis Angular or labial cheilosis Candidiasis Oral cancer Petechiae and ecchymoses Jaundiced mucosa Parotid gland enlargement Alcohol (sweet musty) breath odor Impaired healing Bruxism Dental attrition Xerostomia
