Podcast
Questions and Answers
What is the primary consequence of liver damage?
What is the primary consequence of liver damage?
Which of the following is NOT a common liver disease?
Which of the following is NOT a common liver disease?
What is the primary route of transmission for hepatitis A?
What is the primary route of transmission for hepatitis A?
What is the consequence of liver failure that leads to altered renal function?
What is the consequence of liver failure that leads to altered renal function?
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What is the primary mechanism of liver failure in chronic liver disease?
What is the primary mechanism of liver failure in chronic liver disease?
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What is the primary symptom of hepatitis A that a dentist may inquire about?
What is the primary symptom of hepatitis A that a dentist may inquire about?
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What is the incubation period of Hepatitis C?
What is the incubation period of Hepatitis C?
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What percentage of people with Hepatitis B have Hepatitis D in the UK?
What percentage of people with Hepatitis B have Hepatitis D in the UK?
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Why is Hepatitis C described as a severe infection that is often fatal?
Why is Hepatitis C described as a severe infection that is often fatal?
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What is the percentage of people with Hepatitis C who contract acute Hepatitis as opposed to a clear infection?
What is the percentage of people with Hepatitis C who contract acute Hepatitis as opposed to a clear infection?
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Which of the following is NOT a transmission route for Hepatitis C?
Which of the following is NOT a transmission route for Hepatitis C?
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Which Hepatitis has a higher risk of transmission via a sharps injury?
Which Hepatitis has a higher risk of transmission via a sharps injury?
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How is hepatitis E typically acquired?
How is hepatitis E typically acquired?
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What is the incubation period of hepatitis A?
What is the incubation period of hepatitis A?
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Where is hepatitis E most common?
Where is hepatitis E most common?
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What is the mortality rate of pregnant women to hepatitis E?
What is the mortality rate of pregnant women to hepatitis E?
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How is hepatitis B spread?
How is hepatitis B spread?
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What is the incubation period of hepatitis B?
What is the incubation period of hepatitis B?
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What percentage of the UK has hepatitis B?
What percentage of the UK has hepatitis B?
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What is the ratio of carriers to being positive with hepatitis B?
What is the ratio of carriers to being positive with hepatitis B?
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What determines if hepatitis B is a chronic infection?
What determines if hepatitis B is a chronic infection?
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How is saliva infectious with hepatitis B?
How is saliva infectious with hepatitis B?
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Study Notes
Hepatitis and Liver Failure in Dentistry
- Hepatitis and liver failure can lead to various complications, including:
- Haemorrhagic tendencies
- Impaired drug metabolism
- Transmission of viral hepatitis
- Cutaneous manifestations (purpura, telangiectasia, finger clubbing)
- Sialadenosis
- Sjogren's syndrome
Common Liver Diseases
- 6 common liver diseases:
- Alcohol cirrhosis
- Non-alcoholic fatty liver disease (obesity)
- Viral hepatitis
- Drug toxicity
- Liver cancer
- Autoimmune liver disease (primary biliary cirrhosis)
Response to Liver Damage
- Hepatocytes are lost and fibrosis occurs, leading to scarring
- Eventually, hepatocytes are replaced by fibrosis, causing liver failure
Causes of Liver Failure
- Chronic liver damage
- Massive necrosis of hepatocytes
Consequences of Liver Failure
- 7 consequences:
- Jaundice
- Encephalopathy
- Bleeding tendency
- Portal hypertension, ascites, hepatomegaly, and arteriovenous shunts
- Secondary renal failure
- Anorexia, weight loss, and weakness
- Pruritis
Hepatitis
- Hepatitis is a viral infection of the liver, leading to swelling and inflammation
- In chronic conditions, it can progress to cirrhosis and liver failure
- Caused by various viruses, each with different incubation times and transmission routes
Hepatitis A
- Acquired through contaminated food or water via the faeco-oral route
- Questions to ask if suspected:
- Change in taste or smell?
- Travel to endemic areas?
- Consumption of raw shellfish?
- Incubation period: 2-6 weeks
- Symptoms: Jaundice
- Recovery time: 3 months (spontaneous recovery)
- Mortality rate: 0.2% (rarely any complications)
- Vaccine available: Yes
Hepatitis E
- Acquired through contaminated food or water via the faeco-oral route
- Incubation period: 4-6 weeks
- Most common in: India
- Mortality rate in pregnant women: 20%
- Spread: From animal reservoirs
Hepatitis B
- 6 diagrammatic features:
- HBV DNA
- Core protein
- Polymerase
- Lipid
- Hep B surface Antigen
- E antigen
- Life cycle:
- Binds Sodium/Bile acid co-transporting peptide
- Endocytosed, membranes fuse, core released
- DNA travels to nucleus, and polymerase transcribes the RNA
- The virus assembles in the cytoplasm via RNA to DNA reverse transcription
- The virus is released
- Spread:
- Vertically at birth or horizontally in families
- In the UK, via sexual contact or through infected blood
- Minute traces of body fluids can transmit infection
- Questions to ask if suspected:
- Sexual practices
- Anal receptive?
- Prostitute?
- Sexual transmitted diseases?
- Multiple partners?
- 100 times more infectious than hepatitis C
- Transmission in healthcare: 30% of sharps injuries to unvaccinated healthcare workers
- Mucocutaneous exposure risk: 0.1%
- Saliva infectious through blood content
- Incubation period: 2-6 months
- Infectious individuals: All those with chronic hepatitis
- Ratio of carriers to being positive: 1:4
- Factor giving carriers a greater chance of being positive: Circulating e-antigen
Hepatitis B Infection
- 5 signs determining acute infection:
- HBsAg levels increase and decline at 12 weeks
- HBV DNA levels increase and decline at 12 weeks
- HBeAg levels increase and decline at 12 weeks
- These all decline at 12 weeks with acute infections
- Anti-Hbs and Anti-HBo increase after acute infection (after 12 weeks) to provide lifelong immunity
- Sign determining chronic infection:
- HBsAg and HBeAg increase and stay high
Hepatitis B Vaccination
- 3 injections into the deltoid muscle
- 6 months required for adequate protection
- Side effects: Mild and rare
- Vaccination need to be repeated: If the person is obese
- Protection: 95%
Hepatitis D
- Defective RNA virus
- Can only infect in the presence of HBsAg
- Therefore, can only be transmitted with hepatitis B
- Most common in: Middle East, Africa, and parts of South America
- Percentage of people with hepatitis B who have hepatitis D in the UK: 2%
- Mortality: High
- Protection: The hepatitis B vaccine
Hepatitis C
- Initial symptoms: Hidden initially
- Type of virus: RNA virus
- Incubation period: 9 weeks
- Percentage of people with acute hepatitis as opposed to clear infection: 15% acute hepatitis, 20% clear infection
- Why it's a severe infection: The virus mutates faster than the immune response can respond
- Transmission:
- By blood
- Needle sharing by IVDU or tattooing
- Overseas blood transfusions
- Questions to ask if suspected:
- Working area?
- Surgeon in trauma unit?
- Body piercing?
- Tattoos?
- Cocaine use?
- Alcohol use; amount used?
- Darker urine?
- Percentage of people with hepatitis C in the USA and worldwide: 2% in the USA, 3% worldwide
- Other virus commonly associated with hepatitis C: HIV
- Risk of transmission via a sharps injury: Lower than hepatitis B
- Vaccine availability: No vaccine available
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Description
Explore the significance of hepatitis and liver failure in dentistry, including the potential complications and risks associated with liver disease. Learn about the different types of liver disease and their implications for dental care.
