Liver Disease Flashcards
why are the numbers of acute viral hepatitis declining?
vaccines and decrease in high-risk behaviors
what percent of ppl with chronic viral hepatitis has primary liver cancer?
78%
what percent of ppl with chronic viral hepatitis has cirrhosis?
57%
5 forms of viral hepatitis
A, B, C, D, E
which forms of viral hepatitis is infectious and transmitted via fecal-oral route?
A&E
what is the txtment for hepatitis A & E
they’re self-limited
how is hepatitis B, C, D transmitted?
via serum, body fluids
T/F: clinical manifestations of hepatitis B, C, D are similar and differ only in serologic assays
true
what type of infections are hepatitis B, C, D?
chronic
what can hepatitis B, C, D lead to?
- cirrhosis of liver
- hepatocellular carcinoma
pathophysiology of liver disease secondary to viral hepatitis
- not well understood
- none of 5 viruses are directly cytopathic
- hepatocyte damage caused by inflammatory changes secondary to immune activation
clinical presentation of acute viral hepatitis
highly variable, asymptomatic
*is a severe disease
diagnosis of acute viral hepatitis
- antigen-antibody serologic tests to identify virus
- blood tests to assess the effect on the liver and amount of damage
treatment of acute viral hepatitis
palliative and supportive
what is monitored in pts with acute viral hepatitis?
viral antigen and liver enzymes to follow resolution
how long are pts with acute viral hepatitis monitored?
6 months to watch for signs of acute liver failure
can pts with acute viral hepatitis take Tylenol?
NO
syms of chronic viral infection (carrier)
no signs of liver disease
what percent of chronic viral infection is caused by HBV?
6-10%
what percent of chronic viral infection is caused by HCV?
70-90%
can chronic viral infection persist or progress to chronic active hepatitis?
yes
chronic active viral hepatitis
- active viral replication
- elevated serum viral antigens
- syms of liver disease
- elevation of liver enzymes
what does it mean if a pt has a more elevated liver fxn test?
the more severe the disease is
what percent of chronic active viral hepatitis is caused by HBV?
3-5%
what percent of chronic active viral hepatitis is caused by HCV?
40-50%
what percent of chronic active viral hepatitis leads to cirrhosis?
20%
what percent of chronic active viral hepatitis leads to hepatocellular carcinoma?
1-5%
what drug is used to treat chronic active viral hepatitis?
interferon
how long would pts with chronic active viral hepatitis have to take interferon?
6 months to a year
what percent of pts on interferon discontinue therapy?
15%
*due to adverse effects
T/F: Hep C causes more live failure than Hep B
false
- Hep B>Hep C
liver failure
massive hepatocellular destruction
what is the mortality rate of liver failure?
80%
what is the txtment for liver failure?
antivirals or liver transplant
almost all alcohol ingested is metabolized by which organ?
liver
pathophysiology of liver disease secondary to alcoholism
- ethanol is hepatotoxic
- acetylaldehyde (ethanol metabolite) is fibrinogenic
how many stages are there in liver disease progression secondary to alcoholism
3 stages
what are the three stages are there in liver disease progression secondary to alcoholism
- fatty liver
- alcoholic hepatitis
- cirrhosis
fatty liver
fatty engorgement of hepatocytes, enlargement of liver
is fatty liver reversible or irreversible?
reversible
alcoholic hepatitis
- diffuse inflammation of liver
- destructive cellular changes, some of which are irreversible and lead to necrosis
the effects of alcoholic hepatitis can range from?
reversible to fatal
the effects of alcoholic hepatitis depends on what?
- depends on pt’s nutritional status (protein to repair cells)
- amount of damage
cirrhosis
consequence of long-term damage to liver
is cirrhosis reversible or irreversible?
irreversible and has progressive fibrosis
what does cirrhosis lead to?
liver failure and dysfunction
if an alcoholic is abusing Tylenol, what can lead to their OD?
Tylenol
*liver can’t conjugate Tylenol metabolites and will build up in liver –> lead to necrosis of liver tissue
liver fxns
- removes potentially toxic byproducts of certain meds
- prevents shortages of nutrients by storing vitamins, minerals and sugar
- metabolizes nutrients from food to produce energy when needed
- produces most proteins needed by body
- helps your body fight infection by removing bacteria from blood
- produces most of substances that regulate blood clotting
- produces bile, compound needed to digest fat and to absorb vitamins A, D, E, and K.
consultation with physician to find out what information?
- cause of liver disease
- severity of liver dysfunction
- adjustments of drug dosage based on liver fxt tests
- recommendations for medical management of increased coagulation times
what does blood tests evaluate?
liver fxn and coagulation status
what are pts with liver disease bad bleeders?
coagulation factors are low
pts that are predisposed to bleeding
pts with deficient Vitamin-K dependent coagulation factors
where is Vitamin K stored?
in liver
why is Vitamin K important?
it is converted to an enzymatic cofactor that assists in synthesis of prothrombin-dependent coagulation factors (II, VII, IX, X)
what effect does mild-moderate liver disease have on enzymes?
enzyme induction
mild-moderate liver disease leads to
- increased tolerance
- larger doses needed to achieve effect
what effect does severe liver disease have on enzymes?
enzyme activity diminished
severe liver disease leads to
increased, unexpected drug effect
should pts with liver disease take acetaminophen?
NO, can cause severe/fatal hepatocellular disease
dose adjustments for dental drugs
- local anesthetics
- analgesics
- antibiotics
can pts with liver disease take ibuprofen?
no, although not metabolized in liver but connected to causing liver damage in already damaged liver
how do you treat pts who have liver disease and an infection?
- consider antibiotics for elective surgical cases
- consider consultation with physician for antibiotic regimen
clinical consequences of liver dysfunction
- bleeding
- altered drug metabolism
- infection
how can you detect pts with chronic liver disease?
history
can you txt pts with active hepatitis?
no routine txtment; urgent care only in consultation with treating physician
can you txt pts with chronic hepatitis?
- routine txtment okay
- usually require physician consultation
T/F: bone marrow suppression is secondary to alcoholism?
true
bone marrow suppression can lead to what?
- thrombocytopenia
- decrease in coagulation factor
- decreased WBC production/fxn
thrombocytopenia and decrease in coagulation factors in alcoholics leads to what?
increased bleeding
what platelet count (CBC) would you want pts to have for minor oral surgery?
> 50,000/uL
what is a normal platelet count for a healthy person?
3-400,000/uL
decreased WBC production anf fxn leads to what?
increased infection risk
which type of pts are we worried about bleeding?
- pts on coumadin
- pts w/ liver disease
- pts with low platlets b/c of bone marrow suppression
