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Internal Medicine > TB/Liver Disease > Flashcards

TB/Liver Disease Flashcards

1
Q

TB - —- most common cause of infectious death worldwide —- is 1

A

2nd

AIDS is 1.

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2
Q

WHO estimates — of world population infected with latent TB

A

1/3

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3
Q

BCG vaccine is for

A

TB - only in high risk people.

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4
Q

Mycobacterium tuberculosis spread by

A

inhalation of infected droplets

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5
Q

Mycobacterium tuberculosis

Deposition in lungs results in:

A
  1. Immediate clearance of organism
  2. Primary disease
  3. Latent infection
  4. Reactivation disease
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6
Q

TB Primary disease - symptoms - only occurs in —- of pts who inhale TB (first couple days/weeks this occurs). This is like a lot of infectious diseases - lung symptoms don’t come around until later (like a flu). 90% asymptomatic.

A

5-10%

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7
Q

Latent infection - TB

—— ingest, body walls off in granulomas in lungs. Eventually, bacteria replicate and granuloma keeps it back.

A

Alveolar macrophages

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8
Q

TB

Clinical manifestations

A 
Cough >2-3 weeks’ duration
Lymphadenopathy 
Fevers 
Night sweats 
Weight loss
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9
Q

TB Epidemiological factors

A

History of prior TB infection
Known TB exposure
Residence or travel to areas where TB is endemic

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10
Q

Diagnosis of Pulmonary Tuberculosis

A

Patient’s meeting clinical criteria/history get chest radiography, if suggestive then
3 sputum specimens to run for isolation of M. tuberculosis
Tuberculin skin test as an adjunct

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11
Q

International Standards for Tuberculosis Management

A

Prompt diagnosis
Standard chemotherapeutic treatment regimens
Eradicate infection Prevent transmission Prevent relapse
Supervised treatment Monitored treatment response Public health measures

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12
Q

Chemo for TB - Two phases of drug therapy
Intensive phase ——-
Continuation phase——–

A

(2 months of daily dosing)—isoniazid, rifampin, pyrazinamide & ethambutol

(4-7 months of daily dosing) —isoniazid & rifampin

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13
Q

Active Pulmonary Infection

No —- dental treatment

A

elective outpatient

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14
Q

TB treatment drugs have adverse effects
Isoniazid, rifampin, & pyrazinamide————–
Rifampin———–

A

hepatotoxic

thrombocytopenia and leukopenia

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15
Q

Positive Tuberculin Skin Test

Patient should report that they had a ——-
Routine dental care with standard universal precautions

A

medical examination and chest x-rays

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16
Q

Positive Tuberculin Skin Test

Patient should report that they had a ——-
Routine dental care with standard universal precautions

A

medical examination and chest x-rays

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17
Q

Chronic viral hepatitis

\

A

78% of primary liver cancer

57% of cirrhosis (receive inadequate treatment)

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18
Q

HEP A & E =

A

infectious, fecal-oral route self-limited

•

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19
Q

HEP B, C, D =

A

serum, body fluids chronic infection

-cirrhosis & hepatocellular CA

20
Q

HEP Pathophysiology
Not well understood
None of the 5 viruses are directly —–
Hepatocyte damage caused by —— secondary to immune activation.

A

cytopathic

inflammatory changes

21
Q

Acute Viral Hepatitis

Clinical presentation:

A

highly variable, asymptomatic—severe disease

22
Q

Acute Viral Hepatitis

Diagnosis

A

Antigen-antibody serologic tests to identify virus

Blood tests to assess the effect on the liver & amount of damage

23
Q

Acute Viral Hepatitis

Tx

A

Palliative & supportive

Viral antigen & liver enzymes monitored for 6 months to follow resolution Watch for signs of acute liver failure

24
Q

Chronic Viral Infection (Carrier)
—- signs of liver disease
6-10% HBV; 70-90% HCV
Can ——

A

No

persist or progress to chronic active hepatitis

25
Q

Chronic Active Viral Hepatitis

A

Active viral replication, serum viral antigens, symptoms of liver disease, elevation of liver enzymes
3-5% HBV; 40-50% HCV
20% progress to cirrhosis
1-5% hepatocellular carcinoma
Interferon (6mo-1yr)
-Better response with early therapy
-Adverse effects common, 15% discontinue therapy

26
Q

Liver Failure

A

Hep B > Hep C

Massive hepatocellular destruction 80% mortality rate

27
Q

Liver failure

Treatment:

A

antivirals or liver transplant

28
Q

Acetylaldehyde (ethanol metabolite) is

A

fibrinogenic

29
Q

Liver disease secondary to alcoholism

—– of disease progression

A

3 stages

30
Q

Liver disease secondary to alcoholism

Fatty Liver

A

Earliest change

Fatty engorgement of hepatocytes, enlargement of liver Reversible

31
Q

Liver disease secondary to alcoholism

Alcoholic Hepatitis

A

2nd stage

Diffuse inflammation of the liver
Destructive cellular changes, some of which are irreversible and lead to necrosis
Effects can range from reversible to fatal
Depends on patient’s nutritional status (protein to repair cells)
Amount of damage

32
Q

Liver disease secondary to alcoholism

Cirrhosis

A

3rd stage

Consequence of long-term damage to liver Irreversible & progressive fibrosis
Leads to liver failure & dysfunction

33
Q

—– helps cells repair - drinking, not eating, for severe alcoholics.

A

Protein

34
Q

If liver failure, Adjustment of drug dosage based on ’s

A

LFT

35
Q

Predisposition to Bleeding

Deficiency of

A

Vitamin K-dependent coagulation factors

36
Q

Vitamin K? Stored in the liver, converted to an enzymatic cofactor that assists in the synthesis of

A

prothrombin-dependent coagulation factors (II, VII, IX, X)

37
Q

Mild-moderate liver disease:

A

enzyme induction Increased tolerance

Larger doses needed to achieve effect

38
Q

drug effect
Acetaminophen…—–

A

diminished

Increased, unexpected

severe/fatal hepatocellular disease

39
Q

Common Dental Drugs That May Need Dosage Adjustment

A

Local anesthetics Lidocaine
Analgesics Acetaminophen
Ibuprofen Antibiotics

40
Q

Liver helps —–

A

sequester bacteria.

41
Q

Clinical consequences of liver dysfunction

A

Bleeding

Altered drug metabolism Infection

42
Q

Active hep - dental

A

No routine treatment; urgent care only in consultation with treating physician

43
Q

Chronic hep - dental

A

Routine treatment ok

Usually require a physician consultation

44
Q

Chronic hep - dental

A

Routine treatment ok

Usually require a physician consultation

45
Q

Bone Marrow Suppression

—— in addition to decrease in —- factors = increased ——-

A

Thrombocytopenia

coagulation

bleeding

46
Q

Platelet count for minor surgery

A

> 50,000/uL for minor oral surgery

Internal Medicine (12 decks)

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