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SU18: Internal med final > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

why are the numbers of acute viral hepatitis declining?

A

vaccines and decrease in high-risk behaviors

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2
Q

what percent of ppl with chronic viral hepatitis has primary liver cancer?

A

78%

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3
Q

what percent of ppl with chronic viral hepatitis has cirrhosis?

A

57%

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4
Q

5 forms of viral hepatitis

A

A, B, C, D, E

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5
Q

which forms of viral hepatitis is infectious and transmitted via fecal-oral route?

A

A&E

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6
Q

what is the txtment for hepatitis A & E

A

they’re self-limited

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7
Q

how is hepatitis B, C, D transmitted?

A

via serum, body fluids

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8
Q

T/F: clinical manifestations of hepatitis B, C, D are similar and differ only in serologic assays

A

true

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9
Q

what type of infections are hepatitis B, C, D?

A

chronic

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10
Q

what can hepatitis B, C, D lead to?

A
  • cirrhosis of liver

- hepatocellular carcinoma

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11
Q

pathophysiology of liver disease secondary to viral hepatitis

A
  • not well understood
  • none of 5 viruses are directly cytopathic
  • hepatocyte damage caused by inflammatory changes secondary to immune activation
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12
Q

clinical presentation of acute viral hepatitis

A

highly variable, asymptomatic

*is a severe disease

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13
Q

diagnosis of acute viral hepatitis

A
  • antigen-antibody serologic tests to identify virus

- blood tests to assess the effect on the liver and amount of damage

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14
Q

treatment of acute viral hepatitis

A

palliative and supportive

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15
Q

what is monitored in pts with acute viral hepatitis?

A

viral antigen and liver enzymes to follow resolution

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16
Q

how long are pts with acute viral hepatitis monitored?

A

6 months to watch for signs of acute liver failure

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17
Q

can pts with acute viral hepatitis take Tylenol?

A

NO

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18
Q

syms of chronic viral infection (carrier)

A

no signs of liver disease

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19
Q

what percent of chronic viral infection is caused by HBV?

A

6-10%

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20
Q

what percent of chronic viral infection is caused by HCV?

A

70-90%

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21
Q

can chronic viral infection persist or progress to chronic active hepatitis?

A

yes

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22
Q

chronic active viral hepatitis

A
  • active viral replication
  • elevated serum viral antigens
  • syms of liver disease
  • elevation of liver enzymes
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23
Q

what does it mean if a pt has a more elevated liver fxn test?

A

the more severe the disease is

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24
Q

what percent of chronic active viral hepatitis is caused by HBV?

A

3-5%

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25
Q

what percent of chronic active viral hepatitis is caused by HCV?

A

40-50%

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26
Q

what percent of chronic active viral hepatitis leads to cirrhosis?

A

20%

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27
Q

what percent of chronic active viral hepatitis leads to hepatocellular carcinoma?

A

1-5%

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28
Q

what drug is used to treat chronic active viral hepatitis?

A

interferon

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29
Q

how long would pts with chronic active viral hepatitis have to take interferon?

A

6 months to a year

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30
Q

what percent of pts on interferon discontinue therapy?

A

15%

*due to adverse effects

31
Q

T/F: Hep C causes more live failure than Hep B

A

false

- Hep B>Hep C

32
Q

liver failure

A

massive hepatocellular destruction

33
Q

what is the mortality rate of liver failure?

A

80%

34
Q

what is the txtment for liver failure?

A

antivirals or liver transplant

35
Q

almost all alcohol ingested is metabolized by which organ?

A

liver

36
Q

pathophysiology of liver disease secondary to alcoholism

A
  • ethanol is hepatotoxic

- acetylaldehyde (ethanol metabolite) is fibrinogenic

37
Q

how many stages are there in liver disease progression secondary to alcoholism

A

3 stages

38
Q

what are the three stages are there in liver disease progression secondary to alcoholism

A
  1. fatty liver
  2. alcoholic hepatitis
  3. cirrhosis
39
Q

fatty liver

A

fatty engorgement of hepatocytes, enlargement of liver

40
Q

is fatty liver reversible or irreversible?

A

reversible

41
Q

alcoholic hepatitis

A
  • diffuse inflammation of liver

- destructive cellular changes, some of which are irreversible and lead to necrosis

42
Q

the effects of alcoholic hepatitis can range from?

A

reversible to fatal

43
Q

the effects of alcoholic hepatitis depends on what?

A
  • depends on pt’s nutritional status (protein to repair cells)
  • amount of damage
44
Q

cirrhosis

A

consequence of long-term damage to liver

45
Q

is cirrhosis reversible or irreversible?

A

irreversible and has progressive fibrosis

46
Q

what does cirrhosis lead to?

A

liver failure and dysfunction

47
Q

if an alcoholic is abusing Tylenol, what can lead to their OD?

A

Tylenol

*liver can’t conjugate Tylenol metabolites and will build up in liver –> lead to necrosis of liver tissue

48
Q

liver fxns

A
  1. removes potentially toxic byproducts of certain meds
  2. prevents shortages of nutrients by storing vitamins, minerals and sugar
  3. metabolizes nutrients from food to produce energy when needed
  4. produces most proteins needed by body
  5. helps your body fight infection by removing bacteria from blood
  6. produces most of substances that regulate blood clotting
  7. produces bile, compound needed to digest fat and to absorb vitamins A, D, E, and K.
49
Q

consultation with physician to find out what information?

A
  • 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
50
Q

what does blood tests evaluate?

A

liver fxn and coagulation status

51
Q

what are pts with liver disease bad bleeders?

A

coagulation factors are low

52
Q

pts that are predisposed to bleeding

A

pts with deficient Vitamin-K dependent coagulation factors

53
Q

where is Vitamin K stored?

A

in liver

54
Q

why is Vitamin K important?

A

it is converted to an enzymatic cofactor that assists in synthesis of prothrombin-dependent coagulation factors (II, VII, IX, X)

55
Q

what effect does mild-moderate liver disease have on enzymes?

A

enzyme induction

56
Q

mild-moderate liver disease leads to

A
  • increased tolerance

- larger doses needed to achieve effect

57
Q

what effect does severe liver disease have on enzymes?

A

enzyme activity diminished

58
Q

severe liver disease leads to

A

increased, unexpected drug effect

59
Q

should pts with liver disease take acetaminophen?

A

NO, can cause severe/fatal hepatocellular disease

60
Q

dose adjustments for dental drugs

A
  • local anesthetics
  • analgesics
  • antibiotics
61
Q

can pts with liver disease take ibuprofen?

A

no, although not metabolized in liver but connected to causing liver damage in already damaged liver

62
Q

how do you treat pts who have liver disease and an infection?

A
  • consider antibiotics for elective surgical cases

- consider consultation with physician for antibiotic regimen

63
Q

clinical consequences of liver dysfunction

A
  • bleeding
  • altered drug metabolism
  • infection
64
Q

how can you detect pts with chronic liver disease?

A

history

65
Q

can you txt pts with active hepatitis?

A

no routine txtment; urgent care only in consultation with treating physician

66
Q

can you txt pts with chronic hepatitis?

A
  • routine txtment okay

- usually require physician consultation

67
Q

T/F: bone marrow suppression is secondary to alcoholism?

A

true

68
Q

bone marrow suppression can lead to what?

A
  • thrombocytopenia
  • decrease in coagulation factor
  • decreased WBC production/fxn
69
Q

thrombocytopenia and decrease in coagulation factors in alcoholics leads to what?

A

increased bleeding

70
Q

what platelet count (CBC) would you want pts to have for minor oral surgery?

A

> 50,000/uL

71
Q

what is a normal platelet count for a healthy person?

A

3-400,000/uL

72
Q

decreased WBC production anf fxn leads to what?

A

increased infection risk

73
Q

which type of pts are we worried about bleeding?

A
  1. pts on coumadin
  2. pts w/ liver disease
  3. pts with low platlets b/c of bone marrow suppression

SU18: Internal med final (25 decks)

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