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Dentistry Human Disease > Liver Disease/ Infectious Disease > Flashcards

Liver Disease/ Infectious Disease Flashcards

1
Q

Why does liver disease cause impaired clotting? Give two reasons.

A
  1. Deficient clotting factors
  2. Reduced platelets
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2
Q

What are the three main considerations for dentists if a patient has liver disease?

A
  1. Impaired wound healing
  2. Impaired clotting
  3. Risk of blood borne viruses
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3
Q

What is a main physical sign of liver disease?

A

Jaundice

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4
Q

What is jaundice?

A

Clinically apparent hyperbilrubinaemia

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5
Q

What is the normal range of bilirubin in the body?

A

<17

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6
Q

When is bilirubin clinically detectable (jaundice)?

A

> 40

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7
Q

What causes an increase in bilirubin production?

A
  1. Obstruction to bile ducts due to tumoural gallstone
  2. Failure of liver tissue
  3. Muscle damage
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8
Q

What types of liver disease cause jaundice?

A
  • acute liver disease
  • chronic liver disease
  • jaundice secondary to biliary obstruction
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9
Q

What does NAFLD stand for?

A

Non-alcoholic fatty liver disease

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10
Q

What are clinical signs of liver disease?

A
  • spider naevi
  • palm erythema (chronic liver disease)
  • leukonychia (white nails)
  • acites (fluid filled stomach)
  • jaundice
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11
Q

What would signs of acites and jaundice combined be suggestive of?

A

Liver failure

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12
Q

What type of tests measure liver function? Give three example.

A

True liver function tests:
- bilirubin
- albumin
- prothrombin

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13
Q

What tests measures liver damage?

A

Liver function tests:
- ALT/AST
- alkaline phosphotase (ALP)
- GGT

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14
Q

Why do patients with liver cirrhosis have bleeding probelms?

A

The proteins that control balance of bleeding to clot are reduced considerably.

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15
Q

What are the 5 types of hepatitis virus?

A

Hep:
- A
- B
- C
- D
- E

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16
Q

Which hepatitis virus is known as a partial virus, depending on the presence of another hepatitis virus?

A

Hepatitis D

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17
Q

Which hepatitis virus are BBV’s?

A
  • hep B
  • hep C
  • hep D
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18
Q

What are transmission routes of hep A?

A
  1. Faecal- oral spread
  2. Poor hygiene/ overcrowding
  3. Food/water contamination
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19
Q

What is the management of Hep A?

A

Since it is an acute illness and is usually self-limiting, management includes:
1. Rest
2. Low fat diet
3. Alcohol avoidance

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20
Q

What are the transmission routes of hepatitis B?

A
  • blood
  • sex
  • vertical transmission (mother to child)
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21
Q

What is the management of vertical transmission of hep B?

A

Treating the mother during her third trimester with suppressive therapy will prevent risk of baby contracting hep B during birth

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22
Q

Name 3 HBV treatment options?

A
  • PEG alpha- interferon injections
  • tenofovir
  • entocovir
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23
Q

Is there a vaccine for hepatitis C? Yes or no?

A

No

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24
Q

What laboratory tests confirms whether HCV is active or not?

A

PCR testing

25
Q

What are the three drug classes that block key proteins in the life cycle of hep C?

A
  1. NS3/4A protease inhibitors
  2. NS5A inhibitors
  3. NS5B polymerase inhibitors
26
Q

What are the main oral manifestations of liver failure?

A
  • jaundice in mucous membranes

Sometimes:
- parotids can swell (particularly in alcohol related cirrhosis)

27
Q

Which hepatitis virus has an associated link with lichen planus?

A

Hep C

28
Q

What are 8 key risk factors for STI’s?

A
  1. <25 years old
  2. Change sexual partner
  3. Non condom use
  4. MSM (men who have sex with men)
  5. Past history of STI
  6. Large urban areas
  7. Social deprivation
  8. Black ethnicity
29
Q

What 4 STI’s are important to remember that affect the mouth?

A
  1. Treponema pallium (syphilis)
  2. Herpes simplex virus (HSV)
  3. Human papillomavirus (HPV)
  4. HIV
30
Q

What two STI’s are both carried in the oropharynx and can be transmitted by oral sex particularly?

A
  1. Chlamydia trachomatis
  2. Neisseria gonorrhea
31
Q

What virus causes syphilis?

A

Treponema pallium

32
Q

What is the main clinical sign of primary syphilis?

A
  • chancre at the site of infection (ulcer)
33
Q

At what stage of incubation does primary syphilis usually occur?

A

10-90 days

34
Q

At what stage of incubation does secondary syphilis occur?

A

<2 years (usually 3-6 weeks)

35
Q

What are systemic symptoms of secondary syphilis?

A
  • low grade fever
  • sore throat
  • headache
  • lymphadenopathy
  • rash
36
Q

What oral manifestations would suggest secondary syphilis?

A
  • white glistening patches (snail track ulcers) on soft palate, hard palate, buccal mucosa or tongue.
37
Q

If syphilis is described as late latent, how long has somebody usually had the virus for?

A

> 2 years

38
Q

If syphilis is left untreated for more than 10 years what develops?

A

Tertiary syphilis

39
Q

How is syphilis diagnosed?

A

Lesion: Swab treponema pallium by PCR
Venous blood: syphilis antibody and confirmatory tests

40
Q

What is the first line treatment for syphilis?

A

Benzathene penicillin

41
Q

What groups are at higher risk of HIV?

A
  • MSM
  • high prevalence countries
  • injecting drugs
  • sexual contact
42
Q

When is the onset of symptoms of primary HIV infection?

A

2-4 weeks after infection

43
Q

What oral lesions are suggestive of HIV?

A
  • mucosal candidiasis
  • apthous ulcers
  • gingivitis (absence of plaque/calculus)
  • kaposi’s sarcoma (HHV8)
  • oral hairy leukoplakia
44
Q

What type of herpes virus is oral hairy leukoplakia suggestive of?

A

EBV

45
Q

What skin condition that presents on the face is suggestive of HIV?

A

Seborrhoeic dermatitis

46
Q

How long does it take after primary infection to detect and therefore reliably exclude HIV from a blood test?

A

4-12 weeks (later the more reliable)

47
Q

Describe the process of post-exposure prophylaxis.

A

4 week course combination anti-retro viral drugs

48
Q

How many tyoes of herpes virus is there?

A

2

49
Q

What are oral signs of primary HSV infection?

A
  • gingivostomatitis
  • pharyngitis
50
Q

How is HSV transmitted?

A

Kissing or oral sex

51
Q

How are HSV and HIV linked?

A

If patient also has HIV:
- HSV is more frequently recurring
- HSV lesions are more extensive and hypertrophic

52
Q

What is the managment of oralabial herpes?

A
  • usually no treatment as self-limiting 7-10 days
  • avoid kissing and oral sex
  • wash hands after touching
53
Q

What type of HSV causes genital herpes?

A

HSV-2

54
Q

What type of HSV increases the risk of hIV transmission?

A

HSV-2

55
Q

How do you treat genital herpes?

A

With oral aciclovir

56
Q

What strains of HPV cause the majority of cases of genital warts?

A

HPV 6 and 11

57
Q

What strains of HPV are oncogenic?

A

HPV16 and HPV18

58
Q

A 27 year old male presents to your surgery with intermittent bilateral parotid gland swelling , dry mouth and obvious mild pseudomembranous candidiasis of palate and orophraynx. He has never smoked and reports being well otherwise.

Can you give at least two underlying conditions which might explain the above findings?

A
  1. Lymphoma
  2. HIV
59
Q

What conditions predispose you to oral thrush?

A
  1. Diabetes
  2. Lymphoma
  3. HIV
  4. Steroid/ steroid inhaler use
  5. Smoking

Dentistry Human Disease (29 decks)

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