Liver Disease Flashcards
Who should be screened for HepC?
Anyone born from 1940-1965, high rate of undiagnosed HCV
Stages of liver disease;
inflammation, fibrosis, cirrhosis
TF? All stages of liver disease are reversible.
F. cirrhosis is irreversible
Cirrhosis can lead to:
chronic or acute liver failure, liver cancer
Infectious causes of Hepatitis:
viral hep, infectious mono, syphilis, TB
Noninfectious causes of Hep:
excessive or prolonged use of toxic substances: acetaminophen, ketoconazole, alcohol
Replication of viral hep occurs here:
in hepatocytes
Viral hep leads to:
degeneration and necrosis of liver celss
Jaundice is most commonly seen in what type of Hep?
HepA
Cause of jaundice:
build-up of bilirubin in plasma
TF? Jaundice in a newborn is of high concern.
F. not concerning
Jaundice of the eye:
icterus-sclera
Most common observable finding of a pt with Hep
icterus-sclera, orange mucosa in textbooks, rarely seen
Phases of viral Hep:
prodromal phase, icteric phase, posticteric phase, chronic phase
Signs and symptoms of prodromal phase of viral hep::
flu-like, anorexia, N, V, F, fatigue, malaise
Jaundice would be seen if a pt is in this phase of viral Hep:
icteric phase
Signs and symptoms of the icteric phase of viral hep:
Gi symptoms, hepatomegaly, splenomegaly (palpation n exam, normally can’t palpate)
Length of posticteric phase:
wks to mos
How long after onset of jaundice does the posticteric phase begin?
about 4mo
TF? All forms of Hep can be chronic.
F. not Hep A
Which Hep’s have a carrier state?
B and C
2 states of chronic Hep:
carrier state, active state
Active state of Hep:
spreading virus, feeling sick
This is the convalescent or recovery phase of Viral Hep:
posticteric
Progression of Hep A if otherwise healthy:
benign progression
Heps w oral-fecal route spread:
A, E
Hep’s spread via blood and body fluids:
B (D), C
Other Heps besides A-E
transfusion related viruses: F, G, SENV
This Hep is only seen with Hep B:
Hep D, super infection, deadlier course, never by itself
TF? Infants should receive HAV vaccination.
T
TF? A person can convert to Hep A percutaneously.
F
Hep w highest risk of spread:
Hep B, longest incubation period
how effective is the Hep B vaccination?
95%
How effective is the Hep C vaccine.
There is none
This group presents w thhe highest risk of HepC infection:
Baby boomers
TF? If you vaccinate against B, pt will never get D.
T.
All Heps are RNA viruses except:
B, DNA
Incubation periods, longest to shortest:
B, C, E, D, A
How else can you protect against Hep A or B infection besides vaccination?
immune globulin
TF? There is a vaccine for Hep D?
T. Through Hep B vaccine (tricky..)
These Heps can be chronic.
B (2-10%) and C (85%)
What determines whether Interferon +/- ribavirin- can be curative in HCV infection?
genotype, 1-6 new nucleotide analogue inhibitors and protease inhibitor
Tx for HBV:
nucleoside reverse transcriptase inhibitor
How to dx HBV:
HBV DNA/ HBsAg, anti-HBs/ HBcAg, anti-HBc/ HBeAg, antiHBe/ Dane particle: HBsAg and HBcAg
WHat is the Dane particle?
HBsAg and HBcAg (HBV), combo of surface and core antigen, no clinical sig
When does the e antigen present?
early
How to test for HepC:
Test for the RNA or the antibody to it
Which Hep mutates a lot, like HIV?
C
Test results for a pt susceptible to HBV infection:
HBsAg (-), antiHBc (-), anti-HBs (-) NEGATIVE FOR ALL
Test results for a pt immune to HBV infection due to natural infection:
HBsAg (-), anti-HBc(+), anti-HBs (+) POSITIVE FOR BOTH anti-HBc and anti-HBs
Test results for a pt immune to HBV infection due to HepB vaccination:
HBsAg (-), anti-HBc(-), anti-HBs (+) POSITIVE ONLY FOR anti-HBs
Which antigen is the viral particle?
surface antigen
Test results for a pt acutely infected w HepB:
HBsAg (+), anti-HBc(+), IgM anti-HBc (+), anti-HBs (-) (IgM PRESENT)
Test results for a pt chronically infected w HepB:
HBsAg (+), anti-HBc(+), IgM anti-HBc (-), anti-HBs (-) (IgM NOT PRESENT)
Test results unclear for Hep B results;
HBsAg (-), anti-HBc (+), anti-HBs(-)
4 reasons for why results may be unclear for HepB testing:
resolved infection, false + anti-HBc, thus susceptible, “low level” chronic infection, resolving acute infection
+ surface antigen (HBsAg) =
infected, infectious
Anti-HBc (+) means:
had or have the virus
Anti-HBs (+) means:
immune doe to vaccine or natural infection
This Hep is aka as “serum hep”
Hep B
Is it better to monitor HBV DNA levels or HBeAg levels for an infected healthcare worker?
DNA levels
When to notify pts of an infected healthcare worker of provider infection;
only if blood bourne exposure occured
Most dental proc are categorizes as:
Category II, low to no risk
What to do if performing exposure prone proc’s
monitor levels
TF? Fracture reduction OMFS surgery is Category II.
F. not low to no risk. Don’t know actual category
What determines how infectious a pt w Hep is?
viral load
What is fracture reduction?
passing wire through bloody field, accidental injury to dr., blood transfer
% Rate of infection, HBV:
30%
TF? Viral Hep has low levels of pernicity.
T
What are ALT and AST?
serum transaminases, markers of liver problems
Markers of liver problems
ALT, AST, bilirubin
Viral markers:
HBsAg, HBeAg, Anti-HBc (IgM, IgG), Anti-HBe and anti-HBs, Anti-HCV
Drugs that are metabolized by liver:
LA, analgesics (relieve pain), antibiotics, sedatives
TF? penicillin family is generally ok to Rx for pt w viral Hep.
T
Risk benefits to weight when deciding whether to Rx analgesics or not:
liver toxicity vs bleeding risk
TF? LA should be avoided completely for pts w viral Hep.
F. avoid excessive amts
What to check for pts w viral Hep:
platelet counts, INR levels
how can viral Hep lead to thrombocytopenia?
sequestration in spleen
Where is Vit k stored and converted?
liver
Vit K dependent factors;
II, VII, IX, X (2, 7, 9, 10)
If this drug is taken w 3-4 alcoholic drinks it is toxic to the liver:
acetaminophen
THis class of drugs (not anticoagulants) tends to promote bleeding:
NSAIDS
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.
T
Small % of ppl with HepC can get these conditions:
DM, glomerulonephritis
Inc likelihood of a pt getting DM if they have viral Hep
3 X more likely
What is glomerulonephritis?
a kidney disease caused by inflammation of kidney
What is believed responsible for the acquiring of other conditions secondary to Viral Hep infection?
body’s immune response to HCV infection
Alcoholism is defined as:
3+ drinks/d
Alcoholism is now known as:
alcohol use disorder
If you score __ out of 11, you may have an alcohol use disorder.
2 / 11
% of heavy alcoholics that develop cirrhosis:
10-15%
A man drinking this much daily for 5-10y can develop alcoholic cirrhosis:
pint of whiskey, several quarts of wine, 1/2-3/4 case of beer
A woman drinking this much daily for 5-10y can develop alcoholic cirrhosis:
More than 1 glass of wine per day over a long period of time
Stages of alcoholic liver disease:
fatty infiltrate (liver), alcoholic hep, cirrhosis
What is alcoholic Hep?
Diffuse inflammatory condition of liver
What is cirrhosis?
progressive fibrosis of liver
What type of disease is non-alcoholic fatty liver/
metabolic disease
Cirrhosis inc a pts risk for:
bleeding, liver failure, liver cancer, inc risk of infection
TF? Alcoholic liver disease and Viral Hep have the same sequelae.
T
This is scar tissue in liver:
fibrosis
Why do pts w cirrhosis have a tendency to bleed?
Vit K dependent factors, dec ability to store and convert Vit K, Thrombocytopenia may develop
How to detect alcoholic liver disease:
MxHx, Cx exam, alcohol on breath
What to ask a PCP of a pt w alcoholic liver disease:
concerns with drug dosages, concerns w bleeding, verify hx, current status, check meds, check lab values, discuss management
When might you need to alter dosage schedule for alcoholics?
if the drug is metabolized by the liver
Mild to moderate liver disease may have caused:
enzyme induction
Drugs to avoid w pts w alcoholic liver disease;
LA, analgesics, sedatives, antibiotics, acetaminophen containing meds (narcotic and acetaminophen preps)
Why do we need to know if a pt w alcoholic liver disease is taking meds with any level of acetaminophen in it?
they may be over using the drug
Possible signs of alcoholic liver disease:
enlargement of parotid, alcohol breath, jaundice (sclera, mucosa), traumatic or unexplained injuries, attention and memory deficits, advanced periodontal disease, poor oral hygiene, spider angiomas
Unilateral enlargement of parotid gland:
tumor
biiateral enlargement of parotid gland:
alcohol use disorder
TF? Spider angiomas are aka rosacea.
F, rosacea - both check and nose blush due to bv enlargement
Dental concerns for pts w alcoholic liver disease;
consent issues (if intoxicated, or dementia if chronic), bleeding issues (could be undiagnosed), what we can prescribe
Oral complications of alcoholic liver disease:
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
Test values indicating advanced liver disease:
21,000/mm^3 platelets, AAST > 10X normal, ALT > 3X normal, bilirubin >2 X normal
Normal platelet count:
150,000-450,000/mm^3
Thrombocytopenia is a platelet count less than:
150,000/ mm^3
