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Question 1
What are some complications dentists should consider when treating patients with liver disease?
Excessive bleeding, acquiring infections, complications with drug metabolism (local anesthetics and pain meds), acquiring and transmission of Hepatitis B & C, and end stage liver disease/hepatocellular carcinoma/liver transplantation.
Question 2
What is the largest internal organ?
Liver
Question 3
What is the term for the capsule of fibrous connective tissue surrounding the liver?
Glisson's capsule
Question 4
What are the main functions of hepatocytes?
•
Production
of bile, plasma proteins, and amino acids, albumin •
metabolism
of fat, carbohydrate, and protein •
storage
of glucose, vitamins, and iron •
breakdown
of metabolic waste products, drugs, and toxins
Question 5
What is jaundice?
yellowing of the skin and eyes due to elevated bilirubin levels
Question 6
List the clinical manifestations of liver failure.
Jaundice, hypoglycemia, weight loss, peripheral edema, encephalopathy, prolonged/excessive bleeding, ascites, and organomegaly.
Question 7
What is the primary cause of jaundice?
The retention of bilirubin.
Question 8
What symptom is associated with excessive bilirubin deposition?
Pruritis (itchy skin).
Question 9
Types of jaundice
Prehepatic Intrahepatic Posthepatic
Question 10
What is pre-hepatic jaundice?
Increased destruction of RBCs
Question 11
What causes intra-hepatic jaundice?
Liver disease
Question 12
What is post-hepatic jaundice?
Decrease in bile released from the liver due to blockage
Question 13
What is peripheral edema?
Swelling in the lower extremities, especially the ankles and feet.
Question 14
What is ascites?
Accumulation of fluid in the abdominal cavity.
Question 15
What is the term for the dark, bruise-like area in the image on the left?
Ecchymosis
Question 16
What is the term for the red, spider-like pattern in the image on the right?
Spider angioma
Question 17
Types of hepatic diseases
• viral hepatitis • cirrhosis • drug induced liver failure • Hepatocellular Carcinoma
Question 18
Types of Cirrhosis
• Alcohol- Induced • Non-Alcoholic Fatty Liver Disease
Question 19
What is Viral Hepatitis?
A group of liver infections caused by viruses, including Hepatitis A, B, C, D, and E.
Question 20
WHat types of liver disease is associated with Hep A and E
acute liver disease
Question 21
What types of liver disease is associated with Hep B/C/D
acute and can become chronic
Question 22
Which hepatitis viruses can cause hepatocellular carcinoma?
Hepatitis B and C
Question 23
What are the common symptoms of Hepatitis A, B, and C?
Diarrhea, impaired appetite, fever, pain or discomfort in the abdomen, skin rash, joint pain, nausea, vomiting
Question 24
What are the common symptoms of Hepatitis D?
Fatigue, loss of appetite, jaundice
Question 25
What are the two vaccines for hepatitis A&B?
Hepatitis A and B vaccines
Question 26
What are the three steps to avoid high-risk behavior for viral hepatitis?
Good hygiene practices, don’t share needles, practicing responsible sexual activity
Question 27
Treatment for viral hepatitis?
Self-limiting Medical treatment with antivirals Transplant with chronic disease
Question 28
What percentage of chronic liver disease in the Western world is caused by excessive alcohol consumption?
60%
Question 29
What are the characteristics of cirrhosis?
Formation of fibrous bands and scars parenchymal nodules encircled by fibrous tissue disruption of the liver architecture
Question 30
What is steatosis?
Accumulation of fat in liver cells
Question 31
What are Mallory bodies?
Fibrous protein aggregates in liver cells
Question 32
What is portal hypertension
Increased resistance to portal blood flow
Question 33
What is the dominant intrahepatic cause of portal hypertension?
Cirrhosis
Question 34
What is fibrosis and where is it deposited in the liver?
deposition of connective tissue in the perisinusoidal areas & central veins causes compression and resistance to portal blood flow
Question 35
What are esophageal varices?
Dilated veins that develop within the lining of the lower esophagus.
Question 36
What is the most common complication of esophageal varices?
Variceal bleeding.
Question 37
What is the cause of esophageal varices?
A direct complication of portal hypertension.
Question 38
What is Non-Alcoholic Fatty Liver Disease
Excessive lipid storage in the liver
NOT
associated with alcohol consumption
Question 39
What is the progression of NAFLD from healthy liver to hepatocellular carcinoma?
Healthy Liver → NAFL → Nonalcoholic Steatohepatitis → Liver Cirrhosis → Hepatocellular Carcinoma
Question 40
What are the risk factors shown in the slide?
Type 2 diabetes, high cholesterol, high blood pressure, smoking, obesity, poor diet, and low activity levels.
Question 41
What is the most common cause of drug-induced acute liver failure?
Acetaminophen
Question 42
Which class of drugs is commonly associated with hepatotoxicity?
• Analgesics/Antipyretics - Tylenol • Anticancer drugs • Anesthetics • Antibiotics • Antituberculosis drugs • Antiretrovirals • Cardiac medications
Question 43
What is hepatocellular carcinoma?
A malignant disease of the liver
Question 44
What physical examination finding is associated with hepatocellular carcinoma?
A palpable mass
Question 45
What are the symptoms of hepatocellular carcinoma?
Abdominal pain, weakness, weight loss, increased risk of bleeding
Question 46
What is the purpose of a liver transplant?
To treat patients with end-stage liver disease
Question 47
What are some conditions that can lead to a liver transplant?
Autoimmune hepatitis, drug-induced hepatitis, viral hepatitis, malignancy
Question 48
How do viral hepatitis and malignancy typically fare with liver transplant?
Fare less well
Question 49
What is cholestasis?
Systemic retention of bilirubin, bile salts, and cholesterol.
Question 50
What are the symptoms of cholestasis?
Jaundice and intense itching due to bile salt deposition.
Question 51
What is xanthelasma?
Cholesterol deposits from impaired excretion.
Question 52
What is the term for gallstones?
Cholelithiasis
Question 53
What is the female predilection for gallstones?
Female predilection
Question 54
At what age does gallstones typically occur?
25 years of age and up
Question 55
Symptoms and treatment of Cholelithiasis
stomach pain Gall bladder removal to resolve the disorder
Question 56
What tests should be requested for med consult of liver diseases
• Aspartate aminotransferase test (AST) • Alanine transaminase test (ALT) • serum albumin • serum alkaline phosphatase • Hepatitis Anti-body serum test • CBC w/diff • Bilirubin levels
Question 57
What is the primary focus of dental modifications?
Infection control
Question 58
What precautions should be taken with patients who have liver transplants?
Patients are taking immunosuppressant medications