Liver Disease Flashcards
(116 cards)
1
Q
Who should be screened for HepC?
A
Anyone born from 1940-1965, high rate of undiagnosed HCV
2
Q
Stages of liver disease;
A
inflammation, fibrosis, cirrhosis
3
Q
TF? All stages of liver disease are reversible.
A
F. cirrhosis is irreversible
4
Q
Cirrhosis can lead to:
A
chronic or acute liver failure, liver cancer
5
Q
Infectious causes of Hepatitis:
A
viral hep, infectious mono, syphilis, TB
6
Q
Noninfectious causes of Hep:
A
excessive or prolonged use of toxic substances: acetaminophen, ketoconazole, alcohol
7
Q
Replication of viral hep occurs here:
A
in hepatocytes
8
Q
Viral hep leads to:
A
degeneration and necrosis of liver celss
9
Q
Jaundice is most commonly seen in what type of Hep?
A
HepA
10
Q
Cause of jaundice:
A
build-up of bilirubin in plasma
11
Q
TF? Jaundice in a newborn is of high concern.
A
F. not concerning
12
Q
Jaundice of the eye:
A
icterus-sclera
13
Q
Most common observable finding of a pt with Hep
A
icterus-sclera, orange mucosa in textbooks, rarely seen
14
Q
Phases of viral Hep:
A
prodromal phase, icteric phase, posticteric phase, chronic phase
15
Q
Signs and symptoms of prodromal phase of viral hep::
A
flu-like, anorexia, N, V, F, fatigue, malaise
16
Q
Jaundice would be seen if a pt is in this phase of viral Hep:
A
icteric phase
17
Q
Signs and symptoms of the icteric phase of viral hep:
A
Gi symptoms, hepatomegaly, splenomegaly (palpation n exam, normally can’t palpate)
18
Q
Length of posticteric phase:
A
wks to mos
19
Q
How long after onset of jaundice does the posticteric phase begin?
A
about 4mo
20
Q
TF? All forms of Hep can be chronic.
A
F. not Hep A
21
Q
Which Hep’s have a carrier state?
A
B and C
22
Q
2 states of chronic Hep:
A
carrier state, active state
23
Q
Active state of Hep:
A
spreading virus, feeling sick
24
Q
This is the convalescent or recovery phase of Viral Hep:
A
posticteric
25
Progression of Hep A if otherwise healthy:
benign progression
26
Heps w oral-fecal route spread:
A, E
27
Hep's spread via blood and body fluids:
B (D), C
28
Other Heps besides A-E
transfusion related viruses: F, G, SENV
29
This Hep is only seen with Hep B:
Hep D, super infection, deadlier course, never by itself
30
TF? Infants should receive HAV vaccination.
T
31
TF? A person can convert to Hep A percutaneously.
F
32
Hep w highest risk of spread:
Hep B, longest incubation period
33
how effective is the Hep B vaccination?
95%
34
How effective is the Hep C vaccine.
There is none
35
This group presents w thhe highest risk of HepC infection:
Baby boomers
36
TF? If you vaccinate against B, pt will never get D.
T.
37
All Heps are RNA viruses except:
B, DNA
38
Incubation periods, longest to shortest:
B, C, E, D, A
39
How else can you protect against Hep A or B infection besides vaccination?
immune globulin
40
TF? There is a vaccine for Hep D?
T. Through Hep B vaccine (tricky..)
41
These Heps can be chronic.
B (2-10%) and C (85%)
42
What determines whether Interferon +/- ribavirin- can be curative in HCV infection?
genotype, 1-6 new nucleotide analogue inhibitors and protease inhibitor
43
Tx for HBV:
nucleoside reverse transcriptase inhibitor
44
How to dx HBV:
HBV DNA/ HBsAg, anti-HBs/ HBcAg, anti-HBc/ HBeAg, antiHBe/ Dane particle: HBsAg and HBcAg
45
WHat is the Dane particle?
HBsAg and HBcAg (HBV), combo of surface and core antigen, no clinical sig
46
When does the e antigen present?
early
47
How to test for HepC:
Test for the RNA or the antibody to it
48
Which Hep mutates a lot, like HIV?
C
49
Test results for a pt susceptible to HBV infection:
HBsAg (-), antiHBc (-), anti-HBs (-) NEGATIVE FOR ALL
50
Test results for a pt immune to HBV infection due to natural infection:
HBsAg (-), anti-HBc(+), anti-HBs (+) POSITIVE FOR BOTH anti-HBc and anti-HBs
51
Test results for a pt immune to HBV infection due to HepB vaccination:
HBsAg (-), anti-HBc(-), anti-HBs (+) POSITIVE ONLY FOR anti-HBs
52
Which antigen is the viral particle?
surface antigen
53
Test results for a pt acutely infected w HepB:
HBsAg (+), anti-HBc(+), IgM anti-HBc (+), anti-HBs (-) (IgM PRESENT)
54
Test results for a pt chronically infected w HepB:
HBsAg (+), anti-HBc(+), IgM anti-HBc (-), anti-HBs (-) (IgM NOT PRESENT)
55
Test results unclear for Hep B results;
HBsAg (-), anti-HBc (+), anti-HBs(-)
56
4 reasons for why results may be unclear for HepB testing:
resolved infection, false + anti-HBc, thus susceptible, "low level" chronic infection, resolving acute infection
57
+ surface antigen (HBsAg) =
infected, infectious
58
Anti-HBc (+) means:
had or have the virus
59
Anti-HBs (+) means:
immune doe to vaccine or natural infection
60
This Hep is aka as "serum hep"
Hep B
61
Is it better to monitor HBV DNA levels or HBeAg levels for an infected healthcare worker?
DNA levels
62
When to notify pts of an infected healthcare worker of provider infection;
only if blood bourne exposure occured
63
Most dental proc are categorizes as:
Category II, low to no risk
64
What to do if performing exposure prone proc's
monitor levels
65
TF? Fracture reduction OMFS surgery is Category II.
F. not low to no risk. Don't know actual category
66
What determines how infectious a pt w Hep is?
viral load
67
What is fracture reduction?
passing wire through bloody field, accidental injury to dr., blood transfer
68
% Rate of infection, HBV:
30%
69
TF? Viral Hep has low levels of pernicity.
T
70
What are ALT and AST?
serum transaminases, markers of liver problems
71
Markers of liver problems
ALT, AST, bilirubin
72
Viral markers:
HBsAg, HBeAg, Anti-HBc (IgM, IgG), Anti-HBe and anti-HBs, Anti-HCV
73
Drugs that are metabolized by liver:
LA, analgesics (relieve pain), antibiotics, sedatives
74
TF? penicillin family is generally ok to Rx for pt w viral Hep.
T
75
Risk benefits to weight when deciding whether to Rx analgesics or not:
liver toxicity vs bleeding risk
76
TF? LA should be avoided completely for pts w viral Hep.
F. avoid excessive amts
77
What to check for pts w viral Hep:
platelet counts, INR levels
78
how can viral Hep lead to thrombocytopenia?
sequestration in spleen
79
Where is Vit k stored and converted?
liver
80
Vit K dependent factors;
II, VII, IX, X (2, 7, 9, 10)
81
If this drug is taken w 3-4 alcoholic drinks it is toxic to the liver:
acetaminophen
82
THis class of drugs (not anticoagulants) tends to promote bleeding:
NSAIDS
83
TF? You might want to call PCP of pt w viral Hep and ask what they recommend for the tx of mild pain for dental proc.
T
84
Small % of ppl with HepC can get these conditions:
DM, glomerulonephritis
85
Inc likelihood of a pt getting DM if they have viral Hep
3 X more likely
86
What is glomerulonephritis?
a kidney disease caused by inflammation of kidney
87
What is believed responsible for the acquiring of other conditions secondary to Viral Hep infection?
body's immune response to HCV infection
88
Alcoholism is defined as:
3+ drinks/d
89
Alcoholism is now known as:
alcohol use disorder
90
If you score __ out of 11, you may have an alcohol use disorder.
2 / 11
91
% of heavy alcoholics that develop cirrhosis:
10-15%
92
A man drinking this much daily for 5-10y can develop alcoholic cirrhosis:
pint of whiskey, several quarts of wine, 1/2-3/4 case of beer
93
A woman drinking this much daily for 5-10y can develop alcoholic cirrhosis:
More than 1 glass of wine per day over a long period of time
94
Stages of alcoholic liver disease:
fatty infiltrate (liver), alcoholic hep, cirrhosis
95
What is alcoholic Hep?
Diffuse inflammatory condition of liver
96
What is cirrhosis?
progressive fibrosis of liver
97
What type of disease is non-alcoholic fatty liver/
metabolic disease
98
Cirrhosis inc a pts risk for:
bleeding, liver failure, liver cancer, inc risk of infection
99
TF? Alcoholic liver disease and Viral Hep have the same sequelae.
T
100
This is scar tissue in liver:
fibrosis
101
Why do pts w cirrhosis have a tendency to bleed?
Vit K dependent factors, dec ability to store and convert Vit K, Thrombocytopenia may develop
102
How to detect alcoholic liver disease:
MxHx, Cx exam, alcohol on breath
103
What to ask a PCP of a pt w alcoholic liver disease:
concerns with drug dosages, concerns w bleeding, verify hx, current status, check meds, check lab values, discuss management
104
When might you need to alter dosage schedule for alcoholics?
if the drug is metabolized by the liver
105
Mild to moderate liver disease may have caused:
enzyme induction
106
Drugs to avoid w pts w alcoholic liver disease;
LA, analgesics, sedatives, antibiotics, acetaminophen containing meds (narcotic and acetaminophen preps)
107
Why do we need to know if a pt w alcoholic liver disease is taking meds with any level of acetaminophen in it?
they may be over using the drug
108
Possible signs of alcoholic liver disease:
enlargement of parotid, alcohol breath, jaundice (sclera, mucosa), traumatic or unexplained injuries, attention and memory deficits, advanced periodontal disease, poor oral hygiene, spider angiomas
109
Unilateral enlargement of parotid gland:
tumor
110
biiateral enlargement of parotid gland:
alcohol use disorder
111
TF? Spider angiomas are aka rosacea.
F, rosacea - both check and nose blush due to bv enlargement
112
Dental concerns for pts w alcoholic liver disease;
consent issues (if intoxicated, or dementia if chronic), bleeding issues (could be undiagnosed), what we can prescribe
113
Oral complications of alcoholic liver disease:
oral neglect, glossitis (nutritional deficiencies), glossy tongue, angular cheilitis, candidiasis (dry mouth), gingival bleeding, petechiae, oral cancer (esp smoking in combo w alcohol), impaired healing, attrition, xerostomia
114
Test values indicating advanced liver disease:
21,000/mm^3 platelets, AAST > 10X normal, ALT > 3X normal, bilirubin >2 X normal
115
Normal platelet count:
150,000-450,000/mm^3
116
Thrombocytopenia is a platelet count less than:
150,000/ mm^3
