Hepatitis and Liver Failure in Dentistry

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Questions and Answers

What is the primary consequence of liver damage?

  • Hepatocytes become inflamed and swollen
  • Hepatocytes undergo necrosis and apoptosis
  • Hepatocytes are lost and fibrosis occurs (correct)
  • Hepatocytes are replaced by fibrosis

Which of the following is NOT a common liver disease?

  • Alcohol cirrhosis
  • Autoimmune thyroid disease (correct)
  • Viral hepatitis
  • Non-alcoholic fatty liver disease

What is the primary route of transmission for hepatitis A?

  • Vertical transmission
  • Faeco-oral route (correct)
  • Sexual transmission
  • Parenteral route

What is the consequence of liver failure that leads to altered renal function?

<p>Secondary renal failure (C)</p> Signup and view all the answers

What is the primary mechanism of liver failure in chronic liver disease?

<p>Chronic liver damage (B)</p> Signup and view all the answers

What is the primary symptom of hepatitis A that a dentist may inquire about?

<p>Change in taste or smell (D)</p> Signup and view all the answers

What is the incubation period of Hepatitis C?

<p>9 weeks (A)</p> Signup and view all the answers

What percentage of people with Hepatitis B have Hepatitis D in the UK?

<p>2% (A)</p> Signup and view all the answers

Why is Hepatitis C described as a severe infection that is often fatal?

<p>Because the virus mutates faster than the immune response can respond (D)</p> Signup and view all the answers

What is the percentage of people with Hepatitis C who contract acute Hepatitis as opposed to a clear infection?

<p>15% acute hepatitis, 85% clear infection (C)</p> Signup and view all the answers

Which of the following is NOT a transmission route for Hepatitis C?

<p>Airborne transmission (B)</p> Signup and view all the answers

Which Hepatitis has a higher risk of transmission via a sharps injury?

<p>Hepatitis B (C)</p> Signup and view all the answers

How is hepatitis E typically acquired?

<p>Via contaminated food or water via faeco-oral route (A)</p> Signup and view all the answers

What is the incubation period of hepatitis A?

<p>2-6 weeks (C)</p> Signup and view all the answers

Where is hepatitis E most common?

<p>India (B)</p> Signup and view all the answers

What is the mortality rate of pregnant women to hepatitis E?

<p>20% (C)</p> Signup and view all the answers

How is hepatitis B spread?

<p>Vertically at birth or horizontally in families (B)</p> Signup and view all the answers

What is the incubation period of hepatitis B?

<p>2-6 months (B)</p> Signup and view all the answers

What percentage of the UK has hepatitis B?

<p>0.3% (C)</p> Signup and view all the answers

What is the ratio of carriers to being positive with hepatitis B?

<p>1:4 (D)</p> Signup and view all the answers

What determines if hepatitis B is a chronic infection?

<p>HBsAg and HBeAg increase and stay high (A)</p> Signup and view all the answers

How is saliva infectious with hepatitis B?

<p>Through blood content (A)</p> Signup and view all the answers

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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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