75 Questions
What are the functions of the liver?
Biosynthesis (albumin, globulins, lipoproteins, etc.), metabolic regulation (carbohydrates, lipids, and protein metabolism), detoxification, secretion (water soluble end products, bile salts, etc.), and storage (fat soluble vitamins and water soluble as B12).
What is hepatitis?
Hepatitis is inflammation of the liver.
Name the five distinctive types of hepatitis viruses.
Hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and hepatitis E virus (HEV).
What are the infectious causes of hepatitis?
Viral hepatitis, infectious mononucleosis, secondary syphilis, and tuberculosis.
How are hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis D virus (HDV) primarily spread?
They are spread largely by parenteral routes and less commonly by intimate or sexual exposure.
What distinguishes hepatitis A virus (HAV) and hepatitis E virus (HEV) from hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis D virus (HDV)?
HAV and HEV are forms of infectious hepatitis, spread largely by the fecal–oral route, associated with poor sanitary conditions, highly contagious, occur in outbreaks as well as sporadically, and cause self-limited hepatitis only.
What are the three phases of acute hepatitis?
Prodromal, icteric, convalescent
How is hepatitis B (HBV) primarily transmitted?
Percutaneous injury or mucosal surfaces
What is the incubation period for hepatitis C (HCV)?
2-6 months
What is the risk of infection after needle-stick injury for hepatitis C (HCV)?
2-8%
What are the symptoms of acute hepatitis?
Abdominal pain, anorexia, intermittent nausea, vomiting, fatigue, myalgia, malaise, fever, jaundice, hepatomegaly, splenomegaly
What is the main mode of prevention for hepatitis C (HCV)?
Avoidance of high-risk behaviors and standard precautions
Why should aerosols be minimized in dental settings?
To reduce the risk of spreading hepatitis viruses and other infections
What is the recommended action for dentists who are hepatitis virus carriers?
Follow exposure-prone procedure guidelines or not perform such procedures at all
Why is screening for HBsAg and Anti-HCV recommended for certain patients?
To identify patients at high risk of HBV or HCV infection
What is the risk of HBV infection after percutaneous or permucosal exposure to blood?
30%
Why should drugs metabolized in the liver be avoided for patients undergoing surgery?
To minimize the risk for patients with chronic active hepatitis or hepatitis carrier status
What are some factors that can cause abnormal bleeding in hepatitis patients?
Abnormal clotting factors, excessive fibrinolysis, and thrombocytopenia
What are the considerations for dental treatment in patients with alcoholic liver disease?
Bleeding tendencies, unpredictable drug metabolism, risk of infection
What are the signs of alcoholic liver disease that a dentist should look for during clinical examination?
Alcohol odor on breath, signs and symptoms of alcoholic liver disease
What tests can a dentist request before surgical procedures for patients with signs and symptoms of alcoholic liver disease?
Complete blood count (CBC) with differential, AST, ALT, platelet count, thrombin time, PT and INR
When should a patient with untreated alcoholic liver disease be referred to a physician?
When the patient is not a candidate for elective, outpatient dental care
What are the manifestations of oral complications in patients with alcoholic liver disease?
Poor oral hygiene, impaired gustatory function, nutritional deficiency, bleeding tendencies, alcohol breath odor, jaundiced mucosal tissues
What information should a dentist gather from a patient with a history of alcohol abuse?
Type, quantity, frequency, pattern and consequences of alcohol use, family history of alcoholism
What medications should be avoided in patients with cirrhosis or alcoholic hepatitis?
Drugs metabolized in the liver, or half dose if aminotransferases level is 4 times more than normal, serum bilirubin is more than 2mg/dl, serum albumin lower than 35g/L, with signs of ascites and encephalopathy or malnutrition
Viral hepatitis can only be spread through intimate or sexual exposure
False
Hepatitis A virus (HAV) and hepatitis E virus (HEV) are forms of infectious hepatitis and cause self-limited hepatitis only
True
Alcohol is a common noninfectious cause of hepatitis
True
Hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis D virus (HDV) are forms of serum hepatitis
True
The clinical manifestations of the five forms of viral hepatitis are quite different
False
The liver does not play a role in metabolic regulation of carbohydrates, lipids, and protein metabolism
False
Patients showing signs and symptoms of hepatitis should always receive emergency dental care.
False
Dentists who are hepatitis virus carriers should not perform exposure-prone procedures at all.
False
HBV vaccine provides 90% protection after the second dose
False
The risk of HBV infection after percutaneous or permucosal exposure to blood is 30%.
True
Hepatitis C (HCV) is primarily transmitted through fecal-oral route
False
Alcohol is hepatotoxic and can lead to fatty liver, alcoholic hepatitis, and cirrhosis.
True
Hepatitis carriers require standard infection control precautions, and liver function tests may not be necessary.
False
Hepatitis B (HBV) can survive on environmental surfaces for a month
False
Aerosols in dental settings do not need to be minimized due to their minimal impact on hepatitis transmission.
False
There is a means of prevention for hepatitis C aside from avoidance of high-risk behaviors and standard precautions
False
Acute hepatitis has four phases: prodromal, icteric, convalescent, and chronic
False
Treatment for viral hepatitis is mainly curative
False
Patients with alcoholic liver disease are not suitable candidates for elective, outpatient dental care and should be referred to a physician.
True
A patient's family history of alcoholism is not relevant when detecting potential alcoholic liver disease.
False
Antibiotic prophylaxis is always necessary for patients with reduced reticuloendothelial capacity and altered cell mediated immune function.
False
Patients with alcoholic liver disease may require larger doses of local anesthetics, sedatives, and hypnotics to attain desirable effects.
True
Bleeding tendencies in patients with alcoholic liver disease can be managed with local hemostatic agents, fresh frozen plasma, vitamin K, platelets, and antifibrinolytic agents.
True
Patients with alcoholic liver disease are at a reduced risk of infection or spread of infection due to their altered immune function.
False
A dentist can request screening tests such as complete blood count (CBC) with differential, AST, ALT, platelet count, thrombin time, PT, and INR for patients with signs and symptoms of alcoholic liver disease.
True
Viral hepatitis can be caused by five distinctive types of hepatitis viruses: A, B, C, D, and ______
E
Hepatitis A virus (HAV) and hepatitis E virus (HEV) are forms of infectious hepatitis and are spread largely by the ______ route
fecal-oral
Hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis D virus (HDV) are forms of ______ hepatitis
serum
Alcohol is a common noninfectious cause of ______
hepatitis
The liver plays a major role in the metabolic regulation of ______, lipids, and protein metabolism
carbohydrates
Hepatitis is inflammation of the ______
liver
HBV vaccine is given in three doses, producing 30-50% protection after the first, 50-75% after the second, and 90% after the ______ dose
third
Hepatitis C (HCV) is caused by an enveloped virus with a single-stranded RNA genome, primarily transmitted ______
percutaneously
Incubation period for hepatitis C is 2-6 months, with a 2-8% risk of infection after needle-stick injury and soap and water cleansing is ______
recommended
No means of prevention for hepatitis C aside from avoidance of high-risk behaviors and standard ______
precautions
Acute hepatitis has three phases: prodromal, icteric, and convalescent, with symptoms including abdominal pain, anorexia, intermittent nausea, vomiting, fatigue, myalgia, malaise, fever, jaundice, hepatomegaly, and ______
splenomegaly
Dental management involves identifying potential carriers, implementing standard precautions, and providing dental care only for urgent situations with strict adherence to infection control ______
protocols
Patients with signs and symptoms of hepatitis should receive only ______ dental care
emergency
Dentists who are hepatitis virus carriers should follow exposure-prone procedure guidelines or not perform such procedures at ______
all
After percutaneous or permucosal exposure to blood, the risk of HBV infection is ______%, and postexposure protocols vary depending on vaccination status
30
Drugs metabolized by the liver should have their dosages decreased or be avoided for patients with chronic active hepatitis or hepatitis carrier ______
status
The risk of hepatocellular carcinoma is increased with chronic viral hepatitis, although jaw metastases ______ rare
are
Alcohol is hepatotoxic and can lead to fatty liver, alcoholic hepatitis, and ______
cirrhosis
Patients with alcoholic liver disease may require larger doses of ______, sedatives, and hypnotics to attain desirable effects
local anesthetics
The unpredictable metabolism of drugs in patients with alcoholic liver disease can lead to increased tolerance to ______, sedatives, hypnotics and GA
local anesthetics
Alcoholic liver disease can cause bleeding tendencies, which can be managed with the assistance of a physician and may entail the use of local hemostatic agents, fresh frozen plasma, ______, platelets, and antifibrinolytic agents
vitamin K
In patients with alcoholic liver disease, the risk of infection or spread of infection is increased due to reduced reticuloendothelial capacity and altered cell mediated immune function, but antibiotic prophylaxis is not needed unless there is an ongoing ______
infection
The dentist can request some screening tests before surgical procedures for patients with signs and symptoms of alcoholic liver disease, including complete blood count (CBC) with differential, AST, ALT, platelet count, thrombin time, PT and ______
INR
In cirrhosis or alcoholic hepatitis, drugs that are metabolized in the liver should be avoided, or a half dose used, particularly if aminotransferases level (AST and ALT) is 4 times more than normal, serum bilirubin is more than 2mg/dl, serum albumin lower than 35g/L, with signs of ascites and encephalopathy or ______
malnutrition
Patients with alcoholic liver disease have a risk of impaired gustatory function, poor oral hygiene and caries due to neglect, and nutritional deficiencies which can result in anemia causing glossitis, loss of papillae, angular and labial cheilitis, as well as spontaneous gingival bleeding, mucosal ecchymoses and ______
petechiae
Study Notes
-
Aerosols should be minimized in dental settings.
-
Drugs metabolized in the liver should be avoided for patients undergoing surgery.
-
Hepatitis carriers are difficult to identify, so clinical asepsis is crucial for all patients.
-
Screening for HBsAg and Anti-HCV is recommended for patients at high risk of HBV or HCV infection.
-
Hepatitis carriers require standard infection control precautions, and liver function tests may be necessary.
-
Patients showing signs and symptoms of hepatitis should receive only emergency dental care.
-
Dentists who are hepatitis virus carriers should follow exposure-prone procedure guidelines or not perform such procedures at all.
-
After percutaneous or permucosal exposure to blood, the risk of HBV infection is 30%, and postexposure protocols vary depending on vaccination status.
-
Drugs metabolized by the liver should have their dosages decreased or be avoided for patients with chronic active hepatitis or hepatitis carrier status.
-
Abnormal bleeding in hepatitis patients can be caused by several factors, including abnormal clotting factors, excessive fibrinolysis, and thrombocytopenia.
-
The risk of hepatocellular carcinoma is increased with chronic viral hepatitis, although jaw metastases are rare.
-
Alcohol is hepatotoxic and can lead to fatty liver, alcoholic hepatitis, and cirrhosis.
-
Alcoholic liver disease involves an influx of endotoxins from the gut, leading to chemokine release and liver damage.
-
Alcoholic liver disease clinical presentation can include features such as nausea, jaundice, and spider angiomas, with cirrhosis being the most serious form.
-
Viral hepatitis leads to chronic infection, cirrhosis, and hepatocellular carcinoma.
-
Immune responses, specifically T-cell responses, play a major role in liver injury during acute infection.
-
Hepatitis B (HBV) is a DNA virus with a nuclear capsule and outer lipid layer containing HBsAg. It can survive on environmental surfaces for a week.
-
Hepatitis B transmission can occur through percutaneous injury or mucosal surfaces, with a risk of 6-30% for healthcare workers.
-
HBV vaccine is given in three doses, producing 30-50% protection after the first, 50-75% after the second, and 90% after the third dose.
-
Hepatitis C (HCV) is caused by an enveloped virus with a single-stranded RNA genome, primarily transmitted percutaneously.
-
Incubation period for hepatitis C is 2-6 months, with a 2-8% risk of infection after needle-stick injury and soap and water cleansing is recommended.
-
No means of prevention for hepatitis C aside from avoidance of high-risk behaviors and standard precautions.
-
Acute hepatitis has three phases: prodromal, icteric, and convalescent, with symptoms including abdominal pain, anorexia, intermittent nausea, vomiting, fatigue, myalgia, malaise, fever, jaundice, hepatomegaly, and splenomegaly.
-
Treatment for viral hepatitis is mainly palliative and supportive, including bedrest, fluids, nutritious diet, and virus monitoring.
-
Dental management involves identifying potential carriers, implementing standard precautions, and providing dental care only for urgent situations with strict adherence to infection control protocols.
-
Aerosols should be minimized in dental settings.
-
Drugs metabolized in the liver should be avoided for patients undergoing surgery.
-
Hepatitis carriers are difficult to identify, so clinical asepsis is crucial for all patients.
-
Screening for HBsAg and Anti-HCV is recommended for patients at high risk of HBV or HCV infection.
-
Hepatitis carriers require standard infection control precautions, and liver function tests may be necessary.
-
Patients showing signs and symptoms of hepatitis should receive only emergency dental care.
-
Dentists who are hepatitis virus carriers should follow exposure-prone procedure guidelines or not perform such procedures at all.
-
After percutaneous or permucosal exposure to blood, the risk of HBV infection is 30%, and postexposure protocols vary depending on vaccination status.
-
Drugs metabolized by the liver should have their dosages decreased or be avoided for patients with chronic active hepatitis or hepatitis carrier status.
-
Abnormal bleeding in hepatitis patients can be caused by several factors, including abnormal clotting factors, excessive fibrinolysis, and thrombocytopenia.
-
The risk of hepatocellular carcinoma is increased with chronic viral hepatitis, although jaw metastases are rare.
-
Alcohol is hepatotoxic and can lead to fatty liver, alcoholic hepatitis, and cirrhosis.
-
Alcoholic liver disease involves an influx of endotoxins from the gut, leading to chemokine release and liver damage.
-
Alcoholic liver disease clinical presentation can include features such as nausea, jaundice, and spider angiomas, with cirrhosis being the most serious form.
Test your knowledge of medical precautions and patient safety with this quiz. Learn about minimizing aerosol exposure, avoiding drugs metabolized in the liver, and implementing clinical asepsis for patients with a history of hepatitis.
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