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Medically Complex Patient > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

Who should be screened for HepC?

A

Anyone born from 1940-1965, high rate of undiagnosed HCV

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2
Q

Stages of liver disease;

A

inflammation, fibrosis, cirrhosis

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3
Q

TF? All stages of liver disease are reversible.

A

F. cirrhosis is irreversible

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4
Q

Cirrhosis can lead to:

A

chronic or acute liver failure, liver cancer

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5
Q

Infectious causes of Hepatitis:

A

viral hep, infectious mono, syphilis, TB

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6
Q

Noninfectious causes of Hep:

A

excessive or prolonged use of toxic substances: acetaminophen, ketoconazole, alcohol

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7
Q

Replication of viral hep occurs here:

A

in hepatocytes

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8
Q

Viral hep leads to:

A

degeneration and necrosis of liver celss

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9
Q

Jaundice is most commonly seen in what type of Hep?

A

HepA

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10
Q

Cause of jaundice:

A

build-up of bilirubin in plasma

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11
Q

TF? Jaundice in a newborn is of high concern.

A

F. not concerning

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12
Q

Jaundice of the eye:

A

icterus-sclera

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13
Q

Most common observable finding of a pt with Hep

A

icterus-sclera, orange mucosa in textbooks, rarely seen

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14
Q

Phases of viral Hep:

A

prodromal phase, icteric phase, posticteric phase, chronic phase

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15
Q

Signs and symptoms of prodromal phase of viral hep::

A

flu-like, anorexia, N, V, F, fatigue, malaise

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16
Q

Jaundice would be seen if a pt is in this phase of viral Hep:

A

icteric phase

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17
Q

Signs and symptoms of the icteric phase of viral hep:

A

Gi symptoms, hepatomegaly, splenomegaly (palpation n exam, normally can’t palpate)

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18
Q

Length of posticteric phase:

A

wks to mos

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19
Q

How long after onset of jaundice does the posticteric phase begin?

A

about 4mo

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20
Q

TF? All forms of Hep can be chronic.

A

F. not Hep A

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21
Q

Which Hep’s have a carrier state?

A

B and C

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22
Q

2 states of chronic Hep:

A

carrier state, active state

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23
Q

Active state of Hep:

A

spreading virus, feeling sick

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24
Q

This is the convalescent or recovery phase of Viral Hep:

A

posticteric

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25
Q

Progression of Hep A if otherwise healthy:

A

benign progression

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26
Q

Heps w oral-fecal route spread:

A

A, E

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27
Q

Hep’s spread via blood and body fluids:

A

B (D), C

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28
Q

Other Heps besides A-E

A

transfusion related viruses: F, G, SENV

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29
Q

This Hep is only seen with Hep B:

A

Hep D, super infection, deadlier course, never by itself

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30
Q

TF? Infants should receive HAV vaccination.

A

T

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31
Q

TF? A person can convert to Hep A percutaneously.

A

F

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32
Q

Hep w highest risk of spread:

A

Hep B, longest incubation period

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33
Q

how effective is the Hep B vaccination?

A

95%

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34
Q

How effective is the Hep C vaccine.

A

There is none

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35
Q

This group presents w thhe highest risk of HepC infection:

A

Baby boomers

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36
Q

TF? If you vaccinate against B, pt will never get D.

A

T.

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37
Q

All Heps are RNA viruses except:

A

B, DNA

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38
Q

Incubation periods, longest to shortest:

A

B, C, E, D, A

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39
Q

How else can you protect against Hep A or B infection besides vaccination?

A

immune globulin

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40
Q

TF? There is a vaccine for Hep D?

A

T. Through Hep B vaccine (tricky..)

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41
Q

These Heps can be chronic.

A

B (2-10%) and C (85%)

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42
Q

What determines whether Interferon +/- ribavirin- can be curative in HCV infection?

A

genotype, 1-6 new nucleotide analogue inhibitors and protease inhibitor

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43
Q

Tx for HBV:

A

nucleoside reverse transcriptase inhibitor

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44
Q

How to dx HBV:

A

HBV DNA/ HBsAg, anti-HBs/ HBcAg, anti-HBc/ HBeAg, antiHBe/ Dane particle: HBsAg and HBcAg

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45
Q

WHat is the Dane particle?

A

HBsAg and HBcAg (HBV), combo of surface and core antigen, no clinical sig

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46
Q

When does the e antigen present?

A

early

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47
Q

How to test for HepC:

A

Test for the RNA or the antibody to it

48
Q

Which Hep mutates a lot, like HIV?

A

C

49
Q

Test results for a pt susceptible to HBV infection:

A

HBsAg (-), antiHBc (-), anti-HBs (-) NEGATIVE FOR ALL

50
Q

Test results for a pt immune to HBV infection due to natural infection:

A

HBsAg (-), anti-HBc(+), anti-HBs (+) POSITIVE FOR BOTH anti-HBc and anti-HBs

51
Q

Test results for a pt immune to HBV infection due to HepB vaccination:

A

HBsAg (-), anti-HBc(-), anti-HBs (+) POSITIVE ONLY FOR anti-HBs

52
Q

Which antigen is the viral particle?

A

surface antigen

53
Q

Test results for a pt acutely infected w HepB:

A

HBsAg (+), anti-HBc(+), IgM anti-HBc (+), anti-HBs (-) (IgM PRESENT)

54
Q

Test results for a pt chronically infected w HepB:

A

HBsAg (+), anti-HBc(+), IgM anti-HBc (-), anti-HBs (-) (IgM NOT PRESENT)

55
Q

Test results unclear for Hep B results;

A

HBsAg (-), anti-HBc (+), anti-HBs(-)

56
Q

4 reasons for why results may be unclear for HepB testing:

A

resolved infection, false + anti-HBc, thus susceptible, “low level” chronic infection, resolving acute infection

57
Q

+ surface antigen (HBsAg) =

A

infected, infectious

58
Q

Anti-HBc (+) means:

A

had or have the virus

59
Q

Anti-HBs (+) means:

A

immune doe to vaccine or natural infection

60
Q

This Hep is aka as “serum hep”

A

Hep B

61
Q

Is it better to monitor HBV DNA levels or HBeAg levels for an infected healthcare worker?

A

DNA levels

62
Q

When to notify pts of an infected healthcare worker of provider infection;

A

only if blood bourne exposure occured

63
Q

Most dental proc are categorizes as:

A

Category II, low to no risk

64
Q

What to do if performing exposure prone proc’s

A

monitor levels

65
Q

TF? Fracture reduction OMFS surgery is Category II.

A

F. not low to no risk. Don’t know actual category

66
Q

What determines how infectious a pt w Hep is?

A

viral load

67
Q

What is fracture reduction?

A

passing wire through bloody field, accidental injury to dr., blood transfer

68
Q

% Rate of infection, HBV:

A

30%

69
Q

TF? Viral Hep has low levels of pernicity.

A

T

70
Q

What are ALT and AST?

A

serum transaminases, markers of liver problems

71
Q

Markers of liver problems

A

ALT, AST, bilirubin

72
Q

Viral markers:

A

HBsAg, HBeAg, Anti-HBc (IgM, IgG), Anti-HBe and anti-HBs, Anti-HCV

73
Q

Drugs that are metabolized by liver:

A

LA, analgesics (relieve pain), antibiotics, sedatives

74
Q

TF? penicillin family is generally ok to Rx for pt w viral Hep.

A

T

75
Q

Risk benefits to weight when deciding whether to Rx analgesics or not:

A

liver toxicity vs bleeding risk

76
Q

TF? LA should be avoided completely for pts w viral Hep.

A

F. avoid excessive amts

77
Q

What to check for pts w viral Hep:

A

platelet counts, INR levels

78
Q

how can viral Hep lead to thrombocytopenia?

A

sequestration in spleen

79
Q

Where is Vit k stored and converted?

A

liver

80
Q

Vit K dependent factors;

A

II, VII, IX, X (2, 7, 9, 10)

81
Q

If this drug is taken w 3-4 alcoholic drinks it is toxic to the liver:

A

acetaminophen

82
Q

THis class of drugs (not anticoagulants) tends to promote bleeding:

A

NSAIDS

83
Q

TF? You might want to call PCP of pt w viral Hep and ask what they recommend for the tx of mild pain for dental proc.

A

T

84
Q

Small % of ppl with HepC can get these conditions:

A

DM, glomerulonephritis

85
Q

Inc likelihood of a pt getting DM if they have viral Hep

A

3 X more likely

86
Q

What is glomerulonephritis?

A

a kidney disease caused by inflammation of kidney

87
Q

What is believed responsible for the acquiring of other conditions secondary to Viral Hep infection?

A

body’s immune response to HCV infection

88
Q

Alcoholism is defined as:

A

3+ drinks/d

89
Q

Alcoholism is now known as:

A

alcohol use disorder

90
Q

If you score __ out of 11, you may have an alcohol use disorder.

A

2 / 11

91
Q

% of heavy alcoholics that develop cirrhosis:

A

10-15%

92
Q

A man drinking this much daily for 5-10y can develop alcoholic cirrhosis:

A

pint of whiskey, several quarts of wine, 1/2-3/4 case of beer

93
Q

A woman drinking this much daily for 5-10y can develop alcoholic cirrhosis:

A

More than 1 glass of wine per day over a long period of time

94
Q

Stages of alcoholic liver disease:

A

fatty infiltrate (liver), alcoholic hep, cirrhosis

95
Q

What is alcoholic Hep?

A

Diffuse inflammatory condition of liver

96
Q

What is cirrhosis?

A

progressive fibrosis of liver

97
Q

What type of disease is non-alcoholic fatty liver/

A

metabolic disease

98
Q

Cirrhosis inc a pts risk for:

A

bleeding, liver failure, liver cancer, inc risk of infection

99
Q

TF? Alcoholic liver disease and Viral Hep have the same sequelae.

A

T

100
Q

This is scar tissue in liver:

A

fibrosis

101
Q

Why do pts w cirrhosis have a tendency to bleed?

A

Vit K dependent factors, dec ability to store and convert Vit K, Thrombocytopenia may develop

102
Q

How to detect alcoholic liver disease:

A

MxHx, Cx exam, alcohol on breath

103
Q

What to ask a PCP of a pt w alcoholic liver disease:

A

concerns with drug dosages, concerns w bleeding, verify hx, current status, check meds, check lab values, discuss management

104
Q

When might you need to alter dosage schedule for alcoholics?

A

if the drug is metabolized by the liver

105
Q

Mild to moderate liver disease may have caused:

A

enzyme induction

106
Q

Drugs to avoid w pts w alcoholic liver disease;

A

LA, analgesics, sedatives, antibiotics, acetaminophen containing meds (narcotic and acetaminophen preps)

107
Q

Why do we need to know if a pt w alcoholic liver disease is taking meds with any level of acetaminophen in it?

A

they may be over using the drug

108
Q

Possible signs of alcoholic liver disease:

A

enlargement of parotid, alcohol breath, jaundice (sclera, mucosa), traumatic or unexplained injuries, attention and memory deficits, advanced periodontal disease, poor oral hygiene, spider angiomas

109
Q

Unilateral enlargement of parotid gland:

A

tumor

110
Q

biiateral enlargement of parotid gland:

A

alcohol use disorder

111
Q

TF? Spider angiomas are aka rosacea.

A

F, rosacea - both check and nose blush due to bv enlargement

112
Q

Dental concerns for pts w alcoholic liver disease;

A

consent issues (if intoxicated, or dementia if chronic), bleeding issues (could be undiagnosed), what we can prescribe

113
Q

Oral complications of alcoholic liver disease:

A

oral neglect, glossitis (nutritional deficiencies), glossy tongue, angular cheilitis, candidiasis (dry mouth), gingival bleeding, petechiae, oral cancer (esp smoking in combo w alcohol), impaired healing, attrition, xerostomia

114
Q

Test values indicating advanced liver disease:

A

21,000/mm^3 platelets, AAST > 10X normal, ALT > 3X normal, bilirubin >2 X normal

115
Q

Normal platelet count:

A

150,000-450,000/mm^3

116
Q

Thrombocytopenia is a platelet count less than:

A

150,000/ mm^3

Medically Complex Patient (4 decks)

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