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Internal Medicine > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

Chronic viral hepatitis leads to ___% of primary liver cancers and ___% of cirrhosis.

A

78; 57

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2
Q

What types of viral hepatitis are infectious, spread through fecal-oral route and self-limited?

A

A & E

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3
Q

What forms of viral hepatitis spread via serum, body fluids and cause a chronic infection leading to cirrhosis and hepatocellular CA?

A

B,C and D

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4
Q

Since the clinical manifestations of all 5 forms of viral hepatitis are similar, how do they differ?

A

only in serologic assays

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5
Q

T/F. None of the 5 viruses are directly cytopathic. Hepatocyte damage is caused by inflammatory changes secondary to immune activation.

A

True.

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6
Q

what are the clinical manifestations of acute hepatitis?

A

Highly variable
Transient, asymptomatic
Severe disease

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7
Q

How is acute viral hepatitis diagnosed?

A

Antigen-antibody serologic tests to identify virus
Blood tests to assess the effect on the liver & amount of damage
Liver enzymes & bilirubin

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8
Q

Viral antigen & liver enzymes are monitored for ___ months to follow resolution of acute hepatitis.

A

6

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9
Q

With hepatic failure in acute hepatitis patients, hepatic failure cause Hep ___ → Hep ___, massive hepatocellular destruction, ___% mortality rate. It is treated with antivirals or liver transplant.

A

B; C; 80

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10
Q

Patients who are carriers with chronic hepatic infection have >___ mo. (low) virus level in liver and serum viral antigens.

A

6

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11
Q

T/F. Chronic infection (carrier) has NO signs of liver disease, 6-10% HBV and 70-90% HCV, and can persist or progress to chronic active hepatitis.

A

True.

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12
Q

Describe chronic ACTIVE hepatitis.

A

Active viral replication, serum viral antigens, symptoms of liver disease, elevation of liver enzymes > 6 months
3-5% HBV; 40-50% HCV
20% progress to cirrhosis
1-5% hepatocellular carcinoma

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13
Q

How is chronic ACTIVE hepatitis treated?

A

interferon (6mo-1yr)
Better response with early therapy
Adverse effects common, 15% discontinue therapy

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14
Q

When there is an occupational exposure, who gives blood and what is it test for?

A

blood drawn from source and exposed person

tested for Hep B, Hep C and HIV

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15
Q

___ (ethanol metabolite) is fibrinogenic.

A

Acetylaldehyde

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16
Q

Earliest change
Fatty engorgement of hepatocytes, enlargement of liver
Reversible

A

Fatty liver

17
Q

Which disease has the following:

Diffuse inflammation of the liver
Destructive cellular changes, some of which are irreversible and lead to necrosis
Effects can range from reversible to fatal (Depends on patient’s nutritional status (protein to repair cells); Amount of damage)

A

Alcoholic hepatitis

18
Q

___ is due to chronic injury and insult from ethanol. It is an ___ & progressive fibrosis with abnormal regeneration of liver architecture that leads to liver failure & deterioration of the metabolic and excretory functions.

A

Cirrhosis; irreversible

19
Q

What is 2/3rds of cirrhosis caused by?

A

alcohol, HCV, or both

20
Q

What are some systemic complications of cirrhosis?

A 
Esophagitis, gastritis, pancreatitis
Malnutrition, weight loss
Protein deficiency
Impairment of urea & glucose metabolism
Encephalopathy 
Renal failure
Portal hypertension (ascites & esophageal varices)
Jaundice
21
Q

Match the following diseases with their clinical presentations.

  1. no signs
  2. nonspecific
  3. asymptomatic until enough damage has occurred

A. fatty liver
B. alcoholic hepatitis
C. cirrhosis

A

1 - A
2 - B
3 - C

22
Q

How is alcoholism medically managed?

A
  1. identification
  2. intervention
  3. rehabilitation
23
Q

When consulting with a physician, what information will you need to treat patients with liver disease?

A

Cause of liver disease (Responsible virus)
Severity of liver dysfunction (Blood tests: evaluate liver function and coagulation status)
Adjustment of drug dosage based on LFT’s
Recommendations for medical management of increased coagulation times

24
Q

Why do liver disease patients have a predisposition to bleeding?

A

because there could be a deficiency of Vit K-dependent coagulation factors, which are stored in the liver and converted to an enzymatic cofactor that assists in the synthesis of prothrombin-dependent coagulation factors (II, VII, IX, X)

25
Q

T/F. A liver disease patient requires preoperative coagulation studies (PT) and may need to be treated in hospital if labs are abnormal or local/systemic hemostatic measures (infusion of platelets, vit k, fresh frozen plasma) are needed.

A

True.

26
Q

What occurs with mild-moderate liver disease?

A

enzyme induction
Increased tolerance
Larger doses needed to achieve effect

27
Q

With severe liver disease, enzyme activity is diminished. Why is this important?

A

Increased, unexpected drug effect

Acetaminophen…severe/fatal hepatocellular disease

28
Q

What drugs should have their dosage adjusted because they are metabolized in the liver?

A
  1. Local anesthetics (Lidocaine)
  2. Analgesics (Acetaminophen)
  3. Ibuprofen (Antibiotics)
29
Q

T/F. Carriers can be identified by history.

A

False, they are NOT identified by history

30
Q

T/F. Most people know if they have HBV/HCV infections.

A

False, 65-75% of those with HBV/HCV unaware of infection

31
Q

Dentists should follow the ___/___ guidelines, receive the Hep ___ vaccine and take ___ precautions.

A

CDC/ADA; B; universal

32
Q

T/F. If a patient has active hepatitis, routine treatment is ok. This is not the case with chronic hepatitis.

A

False, NO routine treatment. Urgent care only in consultation with treating physician.

with chronic, routine treatment IS OK but usually requires a physician consult

33
Q

___ ___ ___ can be seen with alcoholics, which can cause ___ in addition to decrease coagulation factors leading to increased bleeding. Additionally, they may have decreased ___ production/function leading to increased infection risk.

A

Bone Marrow Suppression; thrombocytopenia; WBC

34
Q

What test should be ordered if you suspect bone marrow suppression in an alcoholic patient?

A
  1. pre-op platelet count (CBC)

2. > 50,000/uL for minor oral surgery

35
Q

What should be considered due to the increased risk of dental infections with elective surgical procedures and the fact that these patients are prone to developing cellulitis?

A

consider antibiotics for elective surgical cases

consult with physician for antibiotic regimen

Internal Medicine (21 decks)

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