Lecture 3b: Liver disease Flashcards Preview

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Flashcards in Lecture 3b: Liver disease Deck (32)
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1
Q

Length of preicteric phase

A

3 - 10 days

2
Q

4 clinical manifestations of the preicteric phase

A

Fatigue
Nausea
Poor appetite
Vague R Upper quadrant pain

3
Q

4 clinical manifestations of icteric phase

A

Production of dark urine
Jaundice appears
Hepatic tenderness
Symptoms worse

4
Q

4 general manifestations of liver disease relating to oral health

A

Anorexia
Dysgeusia
Weight loss
Easy bruising/petechia

5
Q

Risk of acquiring hepatitis as a dentist relative to general population

A

3 - 10 times

6
Q

To whom are HBV booster doses given?

A

Only to people who did not respond to the primary vaccination series

7
Q

HBV exposure protocol for vaccinated care provider (i.e. if stuck by a contaminated needle)

A

Should be tested for adequate titer of anti-HBs if levels are unknown
• Adequate –> nothing further is required
• Inadequate –> immediately receive an injection of HBIG and vaccine booster dose (30 % risk of contracting HBV infection from HBV carriers)

8
Q

HBV exposure protocol for unvaccinated persons

A

Immediate HBIG injection and vaccine

9
Q

HCV exposure protocol

A
  • No postexposure protocol or vaccine is available
  • Source person = baseline testing for anti HCV
  • Exposed persons receive baseline and f/u testing at 6 mo for anti HCV and liver enzyme activity
10
Q

4 analgesics to avoid in patient with liver disease

A

NSAIDs (incl. acetaminophen, aspirin)
Codeine
Meperidine

11
Q

2 antibiotics to avoid in patient with liver disease

A

Metronidazole

Vancomycin

12
Q

Antibiotic prophylaxis recommendations for patients with liver disease

A

Not recommended

However, patients with severe liver disease may be more susceptible tor infection

13
Q

Anesthesia recommendations for patients with liver disease

A

Higher doses may be required to achieve adequate anesthesia in presence of alcoholic liver disease (must know liver function)

Epinephrine (1:100,000, no more than 2 carpules) for local generally not associated with problems, but monitor closely (especially if portal hypertension)

14
Q

Anti-anxiety medication to avoid in patient with liver disease

A

Benzodiazepines

15
Q

Bleeding considerations for patient with liver disease

A

May need vitamin K and/or platelet or clotting factor replacement to reduce risk of post-surgical bleeding

16
Q

9 drugs to avoid in patient with liver disease

A
Acetaminophen
Aspirin
Ibuprofen
Codeine
Meperidine
Diazepam
Barbiturates
Metronidazole
Vancomycin
17
Q

Protocol for patient with history of alcohol abuse

A

MD consult for liver status

18
Q

Reason for increased risk of infection in patient with alcoholic liver disease

A

Impairment of Kupffer cell function and T cell response

19
Q

Antibiotic prophylaxis recommendation for patient with alcoholic liver disease

A

Not needed IF oral infection is absent

20
Q

Dental management of patient with ACTIVE hepatitis (5 points)

A
  • No dental treatment other than urgent care (ABSOLUTELY NECESSARY WORK), unless patient has attained clinical and biochemical recovery
  • If urgent care, provided only in an isolated operatory with strict adherence to standard precautions
  • Aerosols should be minimized
  • Drug metabolized in liver should be avoided if possible
  • If sx – preop PT, if abnormal MD consult
21
Q

2 points of dental management for patient with signs or symptoms of hepatitis

A
  • No elective dental treatment

* Refer to MD consult

22
Q

10 types of patients with substantial risk for Hep B and who should get the vaccine

A
Health care workers
Public safety workers
Hemodialysis patients
Recipients of certain blood products
Household contacts and sex partners of HBV carriers
Adoptees from countries where HBV infection is endemic
International travellers
Illicit drug users
Sexually active people
Prisoners
23
Q

4 local anesthetics metabolized by the liver

A

Lidocaine
Mepivacaine
Prilocaine
Bupivacaine

24
Q

Drug administration protocol for patient with chronic active hepatitis, carrier of Hep B or C, impaired liver function, alcohol liver disease

A

➢ Dose of drugs metabolized by liver should be decreased (1/2 dose? ) or avoid if possible
➢ MD’s advise needed – lab tests

25
Q

Anesthetic considerations for patient with chronic active hepatitis, carrier of Hep B or C, impaired liver function, alcohol liver disease

A

One procedure dose of 3 cartridges of 2 % lidocaine is considered relatively limited amount

26
Q

3 complications of liver disease

A

Abnormal bleeding
Platelet count
Chronic viral hepatitis –> risk of HCC

27
Q

5 manifestations of abnormal bleeding associated with liver disease

A
  • Abnormal synthesis of blood clotting factors
  • Abnormal polymerization of fibrin
  • Inadequate fibrin stabilization
  • Excessive finbrinolysis
  • Thrombocytopenia associated with splenomegaly accompanying chronic liver disease
28
Q

3 types of disorders and diseases that are extrahepatic manifestations of liver disease

A

Immune complex-mediated disease
Autoimmune disorders
Immunological disorders

29
Q

2 immune complex-mediated diseases associated with liver disease

A

Vasculitis

Polyarteritis nodosa

30
Q

5 autoimmune disorder associated with liver disease

A
RA
Glomerulonephritis
Thrombocytopenic purpura
Thyroiditis
Pulmonary fibrosis
31
Q

2 immunologic disorders associated with liver disease

A
  • Lichen planus

* Sjogren like syndrome (lymphocytic sialadenitis)

32
Q

13 oral complications of alcoholic liver disease

A
Poor oral hygiene (caries, gingivitis, periodontitis)
Glossitis
Angular or labial cheilosis
Candidiasis
Oral cancer
Petechiae and ecchymoses
Jaundiced mucosa
Parotid gland enlargement
Alcohol (sweet musty) breath odor
Impaired healing
Bruxism
Dental attrition
Xerostomia