Hepatitis A:
- Transmitted mainly by? ____ transmission can also occur. ____ and ___ ____ contribute to spread
- inclubation period?
- ___ ____ symptoms followed by ____, ____, ____ and _____
- infection produces antibodies that?
- no _____ state
- fecal-oral route; sexual; crowding and poor sanitation
- ~30 days
- mild flu-like symptoms; jaundice, nausea, vomitting, and malaise
- confer life-long immunity
- carrier
Hepatitis B:
- transmitted via ____ _____; via ___ or ____ introduction of infected ___,___,___, or ____; possible transfer via ___ ___;
- people at greatest risk are? (6)
- lifetime risk for dentist =?
- incubation period?
- clinical onset similar to hepatitis ___ but more ____
- disease is usually ______ with resolution w/i ___ months: ___% adults become chronic carries, __% children become chronic carriers, _____% infected neonates become chronic carriers
- chronic carries remain ____ and continue to suffer ____ damage
- parenteral route; direct of indirect, serum, plasma, saliva or semen; inanimate objects
- IV drug users, blood transfer reciepients, hemodyalisis, med/dent hcw, homosexuals, pep w/ multiple sexual parters
- 13-28%
- 40-80 days
- A, more insidious
- self-limiting, 6 months, 3%, 20%, 80-90%
- infectious, hepatocellular
Hepatitis C:
-transmitted via ____ route
-individs at greatest risk same as hep ___ (accounts for ___% of post transfusion hepatitis)
-____ day incubation period
-up to ___% of cases are anicteric and asymptomatic
___% ptns develop chronic hep C
-HCV appears to be ___ to hepatocytes
- parentural
- hep B, 90-95%
- 30-180 days
- 80%
- 90%
- cytopathic
Hepatitis D:
- highly pathogenic form that results in ____ ___ of hepatic function which may require liver transplant
- transmission similar to hep ___
- requires _____ to replicate
- 2 patterns of infection:
1) _____ - acute simultaneous infection of ___ and HDV, of results in ____ infection, survivors rarely develop ____ infection
2) ______-result of a delta ___ infectin a ____ __ ____, usually results in a rapidly _____ ____ hepatitis
- rapid deterioation
- hep BBB
- HBsAg
1) co-infection- HBV, fulminant, chronic
2) super-infection- progressive chronic
Hepatitis E:
- transmission via ___ rout
- similar to hep ___
- usually a mild ____ disease, managed with ___ ___
- Exception: ___% mortality rate for?
- no ____ state
- fecal-oral
- hep A
- self-limiting, supportive care
- 20%, women in 3rd trimester
- carrier
Chronic HBV:
- estimated _____ hbv carriers in US
- ______ deahts per year from chronic dx
- treatment for healthy carrier?
- treatment for chronic active dx?
- 1,250,000
- 5000-6000
- monitor
- interferon
Chronic HCV:
- estimated ____ million carriers in US
- progression is ____: ___% develop cirrhosis, ___% risk of hepatoma
- treatment for healthy carrier?
- treatment for chronic active dx?
- 3.9 million
- variable: 20-30%, 20%
- monitor
- interferon
Fulminate viral hepatitis- a rare manifestation of hepatitis infection, occuring in less than ___% of icteric patients. Patients display rapid progression of extensive liver _____. There is marked increase in ____ that does not improve with ___ __ administration. Fatality approaches ___%
1% necrosis PT vit K 80%
Blood tests for Hepatitis:
- A normal (or negative) result means no ____ ____ are found in the blood sample
- A positive finding means? (3)
- Note: antibodies to the core or specific surface antigen differentiate b/t ____ or ___ infection or denote ____ due to an _____
- hepatitis antibodies
1) you currently have hepatitis infection
2) had a hepatitis infection in the past but are no longer infectious
3) recieved hepatitis immunization in the past - active or chronic, immunity, immunization
Signs of liver dx? (8)
1) Jaundice- yellowing of skin and conjunctiva
2) Palmar erythema- blotchy erythema secondary to local vasodialiation
3) Ascitis- accum of fluid in abdomen secondary to blockage of portal circulation
4) spider angiomas- arteriovenous anastomese of neck, face, and upper thorax
5) Hepatic encephalopathy- confusion and coma due to accum of toxic waste
6) peripheral edema- accum of fluid secondary to blockage of portal circ
7) prolonged INR- insufficient coag factors and/or vit k def
8) bilirubinemia- build up of bilirubin in blood due to impaired coag
Hemostatic defect in liver disease?
1) reduced syn of ___ ___, ___ __ ___, inhibitors of ____ and ____ components
2) abnorm syn of ___ and ____ ___
3) _____ _____ ______
4) enhanced _____ activity
5) ____ and ____ ___ defects
- clotting factors, vit k factors, coagulation, and fibrinolytic
- fibrinogen and clotting proteins
- disseminated intravascular coag (DIC)
- fibrinolyic
- quantitative and qualitative plt
Liver function tests- designed to give info about ___ of patients ____
1) -3)?
4) Albumin- a ___ made specifically by liver, levels are ____ in chronic liver dx such as cirrhosis, reference range = ____ to ___ g/dL
5) Bilirubin (total)- is the breakdown product of ___, the liver is responsible for ___ bilirubin, increased levels of bilirubin signify ____ liver function. clinically a ptn with ____ total bilirubin may appear jaundiced
* Biomarkers of liver injury such as ___/___ may be included
1) INR
2) PT
3) aPPT
4) protein, decreased, 3.5-5.3
5) heme, clearing, decreased, increased
* AST/ALT
Dental Tx consideration for Liver disease:
1) Complete ___ _____ review. If unsure of patients level of ____ ____ consult with their physician recommeded
2) ______ concerns: 3 tests?
3) Pharmacologic considerations: some ptns with liver disease have altered hepatic ____ and care should be taken to avoid drugs ____ by the liver:
- chronic alcohol intake results in _____ ___ ___
- acute alcohol intake results in ___ ___ levels of ____ administered drugs
- ______ and ____ are generally safe to use. _____ (____) is primarily excreted by the ____ (___ ___ by the liver) and used in ptns with ___ ____
- Avoid:
1. ____ containing drugs and ____ ____ due to their effect on ___
2. prescribing more than ___ grams of ______ per day (___ grams acceptable for most people)
3. _____, _____, ______ and _____
4) use _____ ___ and ____ for post-op pain control
5) postpone elective dental tx ___days following ___ ___ of alcohol intake
6) consider pre-procedural _____ ___ ____
7) careful ___ ___ during tx and use of ___ ____ agents when bleeding anticipated
7) close post-op follow up for ptns considered __ ___ for __ ___
1) medical hx; hepatic function
2) hematologic; INR, BT, plt count
3) clerance, metabolized
- increased liver metabolism
- high blood, concomittantly
- penicillin and cephalosporin, clarithromycin (biaxin), kidney (partially metabolized), hepatic compromise
- 1.aspirin, non-selective NSAIDS, plts
2. 4 grams acetominophen, 2grams
3. metronidazole, meperidine, vancomycin, diazepam
4) cox-2 inhibitors or narcotics
4) 4-5, acute episodes
5) anti-fibrinolyic mouth rinses
6) tissue handeling, local hemostatic
7) high risk, excessive bleeding
