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Systemic Disease in Dentistry > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

What is hepatitis?

A

Inflammation of the liver

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2
Q

Describe the 3 important components of LFTs when diagnosing hepatitis

A
  1. Bilirubin
  2. AST
  3. ALT
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3
Q

Name 5 potential causes of hepatitis

A
  1. Viral
  2. Alcohol / Drugs
  3. Ischaemia
  4. Toxins
  5. Autoimmune
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4
Q

What are the 4 major types of viral hepatitis?

A

A
B
C
E

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5
Q

Name 3 causes of viral hepatitis outside the major 4

A
  1. Delta
  2. EBV
  3. Yellow fever
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6
Q

Describe 3 clinical features of a person with acute viral hepatitis

A
  1. Jaundice
  2. Malaise
  3. Liver dysfunction (rarely failure)
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7
Q

Describe hepatitis A

A
  • In decline due to vaccine and sanitation
  • Faecal oral transmission
  • Incubation is 2-7 weeks
  • Usually recover within 3 months
  • Does not cause chronic liver disease
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8
Q

Describe 3 components of prevention of Hep A

A
  1. Sanitation
  2. Pre-Exposure (vaccination and immunoglobulin)
  3. Post-Exposure (give immunoglobulin and vaccinate)
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9
Q

Describe Hepatitis E

A
  • Transmitted via faecal oral route
  • Contaminated water is common source in developing countries
  • Zoonotic route is common source in developed countries
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10
Q

What is zoonotic route of tranmission?

A

Consumption of meat, usually pork

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11
Q

Name 3 methods of transmission of Hep B

A
  1. Sexual
  2. Blood
  3. Bodily fluids
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12
Q

What is the earliest indicator of Hep B?

A

HBsAg (surface antigen) positive

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13
Q

Describe the progression of acute Hep B to chronic Hep B

A
  • 5-10% adults fail to clear HBsAg from system
  • Suffer from chronic Hep B
  • Vertical transmission common as 90%+ of neonates cannot clear HBsAg
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14
Q

Describe chronic Hep B status for patients with active disease

A
  • HBsAg positive for over 6 months
  • Raised LFTs
  • Raised HBV DNA
  • Liver damage
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15
Q

Describe chronic Hep B status for patients who are chronic carriers

A
  • HBsAg positive for over 6 months
  • Normal LFTs
  • Negative HBV DNA
  • Risk of damage and passing on infection
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16
Q

What 2 regions of the world are most common for Hep B cases?

A
  1. Far East Asia

2. Sub-Saharan Africa

17
Q

Describe the treatment of chronic Hep B

A
  • Prevention most important
  • Screening for hepatocellular cancer
  • Could be eradicated with vaccination
  • Antiviral agents
  • Liver transplantation may be used
18
Q

Describe 4 transmission methods of Hep C

A
  1. IV drug use
  2. Blood products
  3. Body piercings / Vertical / Sexual (uncommon methods)
19
Q

Describe the clinical course of acute Hep C infection

A
  • Mild symptoms
  • < 20% are jaundiced
  • HCV antibodies present
20
Q

Describe the clinical course of long term sequelae in Hep C

A
  • 80% of patients fail to clear virus (remain PCR positive)
  • Over 50% develop liver disease
  • 20-30% develop cirrhosis
21
Q

Describe Hep C treatment

A
  • Prevention is most important (no vaccination)
  • Oral medication for 8-12 weeks clears in 98% of people
  • Patients remain HCV antibody positive but PCR negative (not infectious)
22
Q

Describe 3 types of non-infection hepatitis

A

Alcoholic - Jaundice and coagulopathy
Autoimmune - Usually on long term immunosuppression
Drug Induced - Common in flucloxacillin

23
Q

Describe needle stick injuries and transmission of hepatitis A, B and C

A

Hep A - No risk of transmission
Hep B - 30% of transmission
Hep C - 3% of transmission

24
Q

Describe the 2 classifications of jaundice

A
  1. Traditional - Pre-hepatic, hepatic, post-hepatic

2. Biochemical - Unconjugated v Conjugated

25
Q

Describe 2 common causes of jaundice

A
  1. Obstruction (malignancy, gallstones)

2. Liver damage (alcohol, hepatitis)

26
Q

Describe the history taking for a person with suspected liver dysfunction

A
  • Always ask about alcohol intake
  • Drug / toxins
  • Assess hepatitis risk
  • Any oversea travels
  • Family history
  • Previous surgery
27
Q

Describe the examination for a person with suspected liver dysfunction

A
  • Jaundice
  • Pyrexia
  • Chronic liver disease
  • Xanthomas
  • K-F rings
28
Q

Describe common liver screening blood tests when concerned about liver dysfunction

A
  • Repeat LFTs
  • FBP / Coag screen
  • Hepatitis screen
  • Autoimmune screen
  • Immunoglobulins
  • Iron studies
29
Q

Describe 4 types of radiology which can be used to assess liver dysfunction

A
  1. Ultrasound on Abdomen (first go to)
  2. CT Scan (gives better view of specific aspects e.g pancreas)
  3. MRI / MRCP
  4. PTC
30
Q

Describe the trend in alcohol related deaths in the UK since 1991

A
  • Deaths increasing in all age groups
  • Rising consumption of alcohol
  • Highest in 55-74 age group
  • 85% of deaths due to cirrhosis
31
Q

Describe the consequences of alcohol

A
  • Intoxication
  • Pleasure
  • Road deaths
  • Violence
  • Financial strain on NHS
  • Medical consequences
32
Q

Describe 6 things which may be seen in liver damage caused by alcohol

A
  1. Nothing to find
  2. Raised liver enzymes
  3. Fatty hepatitis
  4. Liver fibrosis / cirrhosis
  5. Fatty liver
  6. Decompensated liver disease
33
Q

Name 3 complications of cirrhosis

A
  1. Liver decompensation
  2. Hepatocellular carcinoma
  3. Reduced life expectancy
34
Q

Name 5 features of liver decompensation

A
  1. Jaundice
  2. Encephalopathy
  3. Ascites
  4. Hypoalbuminaemia
  5. Coagulopathy
35
Q

What classification is used to determine if someone with liver disease is at risk of complications if dental treatment is carried out?

A

Child-Pugh Classification

36
Q

Describe 3 liver functions

A
  1. Protein / Carbohydrate and Lipid metabolism
  2. Bile formation
  3. Hormone inactivation
37
Q

Describe acute liver failure

A

Combination of Jaundice, Encephalopathy and Coagulopathy occuring within 24 weeks of illness onset

38
Q

Describe the aetiology of acute liver failure

A
  • Toxins (paracetamol and others)
  • Hepatitis viruses
  • Vascular (PV thrombosis, ischaemia)
  • Metabolic (Acute Fatty Liver)
  • Malignancy
39
Q

Describe 6 clinical features of acute liver failure

A
  1. Jaundice
  2. Encephalopathy
  3. Cerebral oedema
  4. Bleeding
  5. Hypotension and tachycardia
  6. Sepsis

Systemic Disease in Dentistry (22 decks)

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