TB/Liver Disease Flashcards
TB - —- most common cause of infectious death worldwide —- is 1
2nd
AIDS is 1.
WHO estimates — of world population infected with latent TB
1/3
BCG vaccine is for
TB - only in high risk people.
Mycobacterium tuberculosis spread by
inhalation of infected droplets
Mycobacterium tuberculosis
Deposition in lungs results in:
- Immediate clearance of organism
- Primary disease
- Latent infection
- Reactivation disease
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.
5-10%
Latent infection - TB
—— ingest, body walls off in granulomas in lungs. Eventually, bacteria replicate and granuloma keeps it back.
Alveolar macrophages
TB
Clinical manifestations
Cough >2-3 weeks’ duration Lymphadenopathy Fevers Night sweats Weight loss
TB Epidemiological factors
History of prior TB infection
Known TB exposure
Residence or travel to areas where TB is endemic
Diagnosis of Pulmonary Tuberculosis
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
International Standards for Tuberculosis Management
Prompt diagnosis
Standard chemotherapeutic treatment regimens
Eradicate infection Prevent transmission Prevent relapse
Supervised treatment Monitored treatment response Public health measures
Chemo for TB - Two phases of drug therapy
Intensive phase ——-
Continuation phase——–
(2 months of daily dosing)—isoniazid, rifampin, pyrazinamide & ethambutol
(4-7 months of daily dosing) —isoniazid & rifampin
Active Pulmonary Infection
No —- dental treatment
elective outpatient
TB treatment drugs have adverse effects
Isoniazid, rifampin, & pyrazinamide————–
Rifampin———–
hepatotoxic
thrombocytopenia and leukopenia
Positive Tuberculin Skin Test
Patient should report that they had a ——-
Routine dental care with standard universal precautions
medical examination and chest x-rays
Positive Tuberculin Skin Test
Patient should report that they had a ——-
Routine dental care with standard universal precautions
medical examination and chest x-rays
Chronic viral hepatitis
\
78% of primary liver cancer
57% of cirrhosis (receive inadequate treatment)
HEP A & E =
infectious, fecal-oral route self-limited
•
HEP B, C, D =
serum, body fluids chronic infection
-cirrhosis & hepatocellular CA
HEP Pathophysiology
Not well understood
None of the 5 viruses are directly —–
Hepatocyte damage caused by —— secondary to immune activation.
cytopathic
inflammatory changes
Acute Viral Hepatitis
Clinical presentation:
highly variable, asymptomatic—severe disease
Acute Viral Hepatitis
Diagnosis
Antigen-antibody serologic tests to identify virus
Blood tests to assess the effect on the liver & amount of damage
Acute Viral Hepatitis
Tx
Palliative & supportive
Viral antigen & liver enzymes monitored for 6 months to follow resolution Watch for signs of acute liver failure
Chronic Viral Infection (Carrier)
—- signs of liver disease
6-10% HBV; 70-90% HCV
Can ——
No
persist or progress to chronic active hepatitis
Chronic Active Viral Hepatitis
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
Liver Failure
Hep B > Hep C
Massive hepatocellular destruction 80% mortality rate
Liver failure
Treatment:
antivirals or liver transplant
Acetylaldehyde (ethanol metabolite) is
fibrinogenic
Liver disease secondary to alcoholism
—– of disease progression
3 stages
Liver disease secondary to alcoholism
Fatty Liver
Earliest change
Fatty engorgement of hepatocytes, enlargement of liver Reversible
Liver disease secondary to alcoholism
Alcoholic Hepatitis
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
Liver disease secondary to alcoholism
Cirrhosis
3rd stage
Consequence of long-term damage to liver Irreversible & progressive fibrosis
Leads to liver failure & dysfunction
—– helps cells repair - drinking, not eating, for severe alcoholics.
Protein
If liver failure, Adjustment of drug dosage based on ’s
LFT
Predisposition to Bleeding
Deficiency of
Vitamin K-dependent coagulation factors
Vitamin K? Stored in the liver, converted to an enzymatic cofactor that assists in the synthesis of
prothrombin-dependent coagulation factors (II, VII, IX, X)
Mild-moderate liver disease:
enzyme induction Increased tolerance
Larger doses needed to achieve effect
drug effect
Acetaminophen…—–
diminished
Increased, unexpected
severe/fatal hepatocellular disease
Common Dental Drugs That May Need Dosage Adjustment
Local anesthetics Lidocaine
Analgesics Acetaminophen
Ibuprofen Antibiotics
Liver helps —–
sequester bacteria.
Clinical consequences of liver dysfunction
Bleeding
Altered drug metabolism Infection
Active hep - dental
No routine treatment; urgent care only in consultation with treating physician
Chronic hep - dental
Routine treatment ok
Usually require a physician consultation
Chronic hep - dental
Routine treatment ok
Usually require a physician consultation
Bone Marrow Suppression
—— in addition to decrease in —- factors = increased ——-
Thrombocytopenia
coagulation
bleeding
Platelet count for minor surgery
> 50,000/uL for minor oral surgery
