Podcast
Questions and Answers
Which of these is NOT a function of the liver?
Which of these is NOT a function of the liver?
- Detoxification of harmful substances.
- Role in blood glucose and cholesterol metabolism.
- Synthesis of Vitamin K dependent clotting factors.
- Production of erythropoietin. (correct)
A patient with liver disease is about to undergo a surgical procedure. What is the most important consideration to mitigate the risk of complications?
A patient with liver disease is about to undergo a surgical procedure. What is the most important consideration to mitigate the risk of complications?
- Administering prophylactic antibiotics.
- Monitoring blood glucose levels closely.
- Ensuring adequate hydration perioperatively.
- Careful assessment and adjustment of drug prescriptions. (correct)
How is Hepatitis A typically transmitted?
How is Hepatitis A typically transmitted?
- Vertical transmission
- Sexual contact
- Parenteral transmission
- Faeco-oral route (correct)
Which of the following statements is correct regarding Hepatitis A?
Which of the following statements is correct regarding Hepatitis A?
A patient is diagnosed with Hepatitis B. Which characteristic of the Hepatitis B virus allows it to persist and potentially cause long-term complications?
A patient is diagnosed with Hepatitis B. Which characteristic of the Hepatitis B virus allows it to persist and potentially cause long-term complications?
What does the presence of Hepatitis B surface antigen (HBsAg) indicate?
What does the presence of Hepatitis B surface antigen (HBsAg) indicate?
A patient tests positive for anti-HBsAg. What does this serological marker indicate?
A patient tests positive for anti-HBsAg. What does this serological marker indicate?
Which of the following statements is most accurate regarding Hepatitis C?
Which of the following statements is most accurate regarding Hepatitis C?
Which is the primary route of transmission for Hepatitis C?
Which is the primary route of transmission for Hepatitis C?
What is a primary focus in the management of Hepatitis C?
What is a primary focus in the management of Hepatitis C?
Which of the following differentiates Hepatitis E from other hepatitis viruses?
Which of the following differentiates Hepatitis E from other hepatitis viruses?
What advice regarding food preparation and handling should be given to patients to avoid Hepatitis E?
What advice regarding food preparation and handling should be given to patients to avoid Hepatitis E?
What is the maximum recommended daily dose of paracetamol to avoid liver damage?
What is the maximum recommended daily dose of paracetamol to avoid liver damage?
A patient with a history of IV drug use is diagnosed with insidious liver damage. Which hepatitis virus is most likely the cause?
A patient with a history of IV drug use is diagnosed with insidious liver damage. Which hepatitis virus is most likely the cause?
Which of the following factors distinguishes chronic Hepatitis B from Hepatitis A?
Which of the following factors distinguishes chronic Hepatitis B from Hepatitis A?
Which of the following is the most accurate statement regarding drug prescriptions and liver disorders?
Which of the following is the most accurate statement regarding drug prescriptions and liver disorders?
Why does cirrhosis lead to liver failure?
Why does cirrhosis lead to liver failure?
A patient has serological markers indicating past infection of Hepatitis B and is now protected. Which combination of markers would be present?
A patient has serological markers indicating past infection of Hepatitis B and is now protected. Which combination of markers would be present?
What is the main goal of therapy for patients with chronic Hepatitis B?
What is the main goal of therapy for patients with chronic Hepatitis B?
What represents a risk factor for Hepatitis C?
What represents a risk factor for Hepatitis C?
Which of the following is a notable clinical feature observed in Hepatitis B?
Which of the following is a notable clinical feature observed in Hepatitis B?
What does the term 'carrier status' mean in the context of Hepatitis B?
What does the term 'carrier status' mean in the context of Hepatitis B?
How does Hepatitis B have significantly different outcomes between patients?
How does Hepatitis B have significantly different outcomes between patients?
What is a major implication of having a viral hepatitis?
What is a major implication of having a viral hepatitis?
What is one of the ways serological markers can be used for Hepatitis B
What is one of the ways serological markers can be used for Hepatitis B
Which of the following clotting factors is NOT synthesized by the liver, dependent on vitamin K?
Which of the following clotting factors is NOT synthesized by the liver, dependent on vitamin K?
What is the primary function of thrombopoietin produced by the liver?
What is the primary function of thrombopoietin produced by the liver?
A patient with viral hepatitis is undergoing a surgical procedure. What is the main implication that needs to be considered?
A patient with viral hepatitis is undergoing a surgical procedure. What is the main implication that needs to be considered?
Which of the following viral hepatitis types are transmitted through the parenteral route?
Which of the following viral hepatitis types are transmitted through the parenteral route?
Which of the following statements accurately describes a key characteristic of Hepatitis B?
Which of the following statements accurately describes a key characteristic of Hepatitis B?
What does the presence of Hepatitis B e antigen (HBeAg) indicate in a patient's serological markers?
What does the presence of Hepatitis B e antigen (HBeAg) indicate in a patient's serological markers?
A patient tests positive for both anti-HBsAg and anti-HBcAg. What does this serological marker combination likely signify?
A patient tests positive for both anti-HBsAg and anti-HBcAg. What does this serological marker combination likely signify?
Which statement is correct about Hepatitis C's ability to establish chronic infections?
Which statement is correct about Hepatitis C's ability to establish chronic infections?
What is true about the high-risk groups for Hepatitis C?
What is true about the high-risk groups for Hepatitis C?
What is the advantage of Interferon concerning Hepatitis B?
What is the advantage of Interferon concerning Hepatitis B?
What advice should be given to prevent Hepatitis E transmission?
What advice should be given to prevent Hepatitis E transmission?
What is the upper daily limit of Paracetamol intake to minimize liver damage?
What is the upper daily limit of Paracetamol intake to minimize liver damage?
Which of the following statements concerning viral hepatitis and anesthesia/sedation is most accurate?
Which of the following statements concerning viral hepatitis and anesthesia/sedation is most accurate?
An individual tests positive for Hepatitis B surface antibody (anti-HBs). What does this indicate?
An individual tests positive for Hepatitis B surface antibody (anti-HBs). What does this indicate?
What distinguishes chronic Hepatitis B from Hepatitis A?
What distinguishes chronic Hepatitis B from Hepatitis A?
Which factor determines the different outcomes between patients with Hepatitis B?
Which factor determines the different outcomes between patients with Hepatitis B?
What does 'carrier status' mean in the context of Hepatitis B?
What does 'carrier status' mean in the context of Hepatitis B?
How is Hepatitis B's acute form characterized?
How is Hepatitis B's acute form characterized?
Which type of Viral Hepatitis can lead to fulminant liver failure in pregnant women?
Which type of Viral Hepatitis can lead to fulminant liver failure in pregnant women?
Which is a viral cause of hepatitis?
Which is a viral cause of hepatitis?
What is a notable clinical feature of Hepatitis B?
What is a notable clinical feature of Hepatitis B?
Which of the following may cause direct liver damage?
Which of the following may cause direct liver damage?
Which of the following factors is LEAST likely to cause acute hepatitis?
Which of the following factors is LEAST likely to cause acute hepatitis?
Why is it important to inquire about a patient's history of IV drug use when evaluating liver disease?
Why is it important to inquire about a patient's history of IV drug use when evaluating liver disease?
Why is it important to assess alcohol intake in a patient presenting with possible liver dysfunction?
Why is it important to assess alcohol intake in a patient presenting with possible liver dysfunction?
What is the clinical significance of identifying spider naevi during a physical examination?
What is the clinical significance of identifying spider naevi during a physical examination?
A patient with known liver disease presents with increased bruising and bleeding. What is the most likely underlying cause?
A patient with known liver disease presents with increased bruising and bleeding. What is the most likely underlying cause?
Which of these examination findings suggests chronic liver disease rather than acute?
Which of these examination findings suggests chronic liver disease rather than acute?
What is the underlying cause of asterixis (liver flap) in patients with liver failure?
What is the underlying cause of asterixis (liver flap) in patients with liver failure?
Sialosis, or the enlargement of salivary glands, is sometimes associated with liver disease. What is the likely mechanism?
Sialosis, or the enlargement of salivary glands, is sometimes associated with liver disease. What is the likely mechanism?
Hyperpigmentation and scratch marks due to pruritus are commonly observed in liver disease. What causes this itching?
Hyperpigmentation and scratch marks due to pruritus are commonly observed in liver disease. What causes this itching?
Why is the history of known infections important in patients with possible liver condition?
Why is the history of known infections important in patients with possible liver condition?
Upon examination, a patient with liver disease exhibits gynecomastia. What is the most likely explanation for this finding?
Upon examination, a patient with liver disease exhibits gynecomastia. What is the most likely explanation for this finding?
What key information can be gained from liver function tests (LFTs) in diagnosing liver disorders?
What key information can be gained from liver function tests (LFTs) in diagnosing liver disorders?
Which of the following is MOST likely to be raised in obstructive jaundice?
Which of the following is MOST likely to be raised in obstructive jaundice?
A patient presents with elevated ALT and AST levels. Which condition is LEAST likely to cause this pattern?
A patient presents with elevated ALT and AST levels. Which condition is LEAST likely to cause this pattern?
Why would a physician order a liver ultrasonography as part of the investigation for acute hepatitis?
Why would a physician order a liver ultrasonography as part of the investigation for acute hepatitis?
Why is FFP used in the perioperative management of patients with liver disease?
Why is FFP used in the perioperative management of patients with liver disease?
What is the main purpose of hand hygiene in preventing the spread of hepatitis A and E?
What is the main purpose of hand hygiene in preventing the spread of hepatitis A and E?
In managing a patient with chronic liver disease, what is the significance of monitoring for encephalopathy?
In managing a patient with chronic liver disease, what is the significance of monitoring for encephalopathy?
Why is it important to wear appropriate personal protective equipment (PPE) in a healthcare setting?
Why is it important to wear appropriate personal protective equipment (PPE) in a healthcare setting?
What is the primary reason to avoid needlestick injuries in a healthcare setting?
What is the primary reason to avoid needlestick injuries in a healthcare setting?
When assessing a patient suspected of having liver disease, what is the role of inquiring about their sexual history?
When assessing a patient suspected of having liver disease, what is the role of inquiring about their sexual history?
Which of the following best describes why a patient with chronic liver disease may experience a reduced attention span?
Which of the following best describes why a patient with chronic liver disease may experience a reduced attention span?
A patient with chronic liver disease experiences muscle wasting, particularly in the shoulder area. What is the most likely reason?
A patient with chronic liver disease experiences muscle wasting, particularly in the shoulder area. What is the most likely reason?
What is the most important consideration regarding cross-infection control for Hepatitis A and E?
What is the most important consideration regarding cross-infection control for Hepatitis A and E?
Which of the following criteria raises concern for increased Clotting (surrogate) times.
Which of the following criteria raises concern for increased Clotting (surrogate) times.
Which of the following is NOT a typical cause of acute hepatitis?
Which of the following is NOT a typical cause of acute hepatitis?
In the context of chronic liver disease, what is the primary mechanism leading to a reduced attention span in affected individuals?
In the context of chronic liver disease, what is the primary mechanism leading to a reduced attention span in affected individuals?
What are the typical causes of acute hepatitis?
What are the typical causes of acute hepatitis?
A patient with chronic liver disease is exhibiting a reverse sleeping pattern. What is the most likely underlying cause?
A patient with chronic liver disease is exhibiting a reverse sleeping pattern. What is the most likely underlying cause?
Which of the following is a common sign found during the examination of a patient with liver disease?
Which of the following is a common sign found during the examination of a patient with liver disease?
A patient presents with jaundice, bruising, and spider naevi. Which condition is MOST likely?
A patient presents with jaundice, bruising, and spider naevi. Which condition is MOST likely?
Apart from jaundice, what other integumentary signs may be evident during a physical examination indicating possible liver dysfunction?
Apart from jaundice, what other integumentary signs may be evident during a physical examination indicating possible liver dysfunction?
Why is it important to check for bleeding disorders in the history of a patient presenting with possible liver dysfunction?
Why is it important to check for bleeding disorders in the history of a patient presenting with possible liver dysfunction?
Which of the following would be LEAST useful when evaluating a patient that presents with possible liver dysfunction?
Which of the following would be LEAST useful when evaluating a patient that presents with possible liver dysfunction?
During an examination of a patient, the doctor notices the presence of palmar erythema. What condition might this indicate?
During an examination of a patient, the doctor notices the presence of palmar erythema. What condition might this indicate?
What classic sign on a physical examination may suggest the presence of chronic liver disease?
What classic sign on a physical examination may suggest the presence of chronic liver disease?
What is the primary reason hand washing is emphasized in preventing the spread of certain types of hepatitis?
What is the primary reason hand washing is emphasized in preventing the spread of certain types of hepatitis?
Why might a physician consider ordering liver ultrasonography tests as part of the investigation for acute hepatitis?
Why might a physician consider ordering liver ultrasonography tests as part of the investigation for acute hepatitis?
What aspect of a patient's history is particularly pertinent in evaluating possible liver dysfunction?
What aspect of a patient's history is particularly pertinent in evaluating possible liver dysfunction?
What is the role of assessing a patient's sexual history in the examination of liver disease?
What is the role of assessing a patient's sexual history in the examination of liver disease?
Why might fresh frozen plasma (FFP) be administered perioperatively to a patient with liver disease?
Why might fresh frozen plasma (FFP) be administered perioperatively to a patient with liver disease?
What is suggested by loss of lean body mass, particularly in the shoulder area, in a patient with chronic liver disease?
What is suggested by loss of lean body mass, particularly in the shoulder area, in a patient with chronic liver disease?
What does the term 'coagulopathy' refer to in the context of chronic liver disease?
What does the term 'coagulopathy' refer to in the context of chronic liver disease?
What is suggested by observing scratch marks on the skin of a patient with liver disease?
What is suggested by observing scratch marks on the skin of a patient with liver disease?
What is the significance of observing gynaecomastia during the physical examination of a male patient?
What is the significance of observing gynaecomastia during the physical examination of a male patient?
What does the presence of asterixis (liver flap) suggest in a patient with liver disease?
What does the presence of asterixis (liver flap) suggest in a patient with liver disease?
What liver function tests (LFTs) would be most useful to determine surrogate clotting times?
What liver function tests (LFTs) would be most useful to determine surrogate clotting times?
What would concern a healthcare professional about a patient's hand hygiene?
What would concern a healthcare professional about a patient's hand hygiene?
What would be a reason to avoid needle stick injuries?
What would be a reason to avoid needle stick injuries?
A patient with known liver disease shows signs of sialosis. What is the likely underlying mechanism for the enlargement of their salivary glands?
A patient with known liver disease shows signs of sialosis. What is the likely underlying mechanism for the enlargement of their salivary glands?
What is a key consideration regarding local anesthetics (LA) for patients with cirrhosis?
What is a key consideration regarding local anesthetics (LA) for patients with cirrhosis?
Why is caution advised when considering general anesthesia (GA) for a patient with severe jaundice?
Why is caution advised when considering general anesthesia (GA) for a patient with severe jaundice?
In the context of ARLD, what is the recommended weekly alcohol consumption for both males and females to minimize liver damage?
In the context of ARLD, what is the recommended weekly alcohol consumption for both males and females to minimize liver damage?
Why are nonsteroidal anti-inflammatory drugs (NSAIDs) generally avoided in patients with liver disease?
Why are nonsteroidal anti-inflammatory drugs (NSAIDs) generally avoided in patients with liver disease?
Which of the following is a potential risk associated with prophylactic beta-blocker use (e.g., propranolol) in alcoholic patients?
Which of the following is a potential risk associated with prophylactic beta-blocker use (e.g., propranolol) in alcoholic patients?
What is the percentage risk of transmission of Hepatitis B (HBV) from a needlestick injury?
What is the percentage risk of transmission of Hepatitis B (HBV) from a needlestick injury?
What is the estimated risk of transmission of HIV from a needlestick injury?
What is the estimated risk of transmission of HIV from a needlestick injury?
What is the estimated risk of transmission of Hepatitis C (HCV) from a needlestick injury?
What is the estimated risk of transmission of Hepatitis C (HCV) from a needlestick injury?
Which of the following is the LEAST likely sign or symptom of Alcohol-Related Liver Disease (ARLD)?
Which of the following is the LEAST likely sign or symptom of Alcohol-Related Liver Disease (ARLD)?
A patient with a history of alcohol abuse presents with sudden hematemesis. What is the most likely underlying cause?
A patient with a history of alcohol abuse presents with sudden hematemesis. What is the most likely underlying cause?
Why would a patient with Alcohol-Related Liver Disease (ARLD) be at higher risk from GI bleeds?
Why would a patient with Alcohol-Related Liver Disease (ARLD) be at higher risk from GI bleeds?
Which of the following pre-existing co-morbidities increases the risk of Alcohol-Related Liver Disease (ARLD)?
Which of the following pre-existing co-morbidities increases the risk of Alcohol-Related Liver Disease (ARLD)?
What is the role of liver biopsy in evaluating liver disease?
What is the role of liver biopsy in evaluating liver disease?
What does the CAGE questionnaire assess?
What does the CAGE questionnaire assess?
Which of the following imaging methods are used to assess the liver?
Which of the following imaging methods are used to assess the liver?
What is the possible consequence of low doses of sedation used in patients with cirrhosis?
What is the possible consequence of low doses of sedation used in patients with cirrhosis?
Which of the following drugs should be avoided entirely in patients with liver abnormalities?
Which of the following drugs should be avoided entirely in patients with liver abnormalities?
Which of the following is a possible complication as a result of Alcohol-Related Liver Disease (ARLD)?
Which of the following is a possible complication as a result of Alcohol-Related Liver Disease (ARLD)?
Why does a patient with Portal Hypertension have risk of bleeding?
Why does a patient with Portal Hypertension have risk of bleeding?
Which of the following signs may show on a patient with Alcohol-Related Liver Disease (ARLD)?
Which of the following signs may show on a patient with Alcohol-Related Liver Disease (ARLD)?
What is the approximate risk of Hepatitis C (HCV) transmission from a needlestick injury?
What is the approximate risk of Hepatitis C (HCV) transmission from a needlestick injury?
What is the estimated risk of HIV transmission from a needlestick injury?
What is the estimated risk of HIV transmission from a needlestick injury?
Which of the following best describes why a patient with chronic liver disease has an increased susceptibility to infection?
Which of the following best describes why a patient with chronic liver disease has an increased susceptibility to infection?
A patient with Alcohol-Related Liver Disease (ARLD) develops sudden hematemesis. What is the most likely underlying cause?
A patient with Alcohol-Related Liver Disease (ARLD) develops sudden hematemesis. What is the most likely underlying cause?
Why are patients with portal hypertension at risk of bleeding?
Why are patients with portal hypertension at risk of bleeding?
In the context of Alcohol-Related Liver Disease (ARLD), what is the recommended weekly alcohol consumption for both males and females to minimize liver damage?
In the context of Alcohol-Related Liver Disease (ARLD), what is the recommended weekly alcohol consumption for both males and females to minimize liver damage?
What is the role of the CAGE questionnaire?
What is the role of the CAGE questionnaire?
Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided for what reason?
Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided for what reason?
Which imaging method can be used to assess the liver?
Which imaging method can be used to assess the liver?
Which statement best explains why low doses of sedation should be avoided in patients with cirrhosis?
Which statement best explains why low doses of sedation should be avoided in patients with cirrhosis?
A patient is taking prophylactic beta blockers. What is a potential risk for alcoholic patients?
A patient is taking prophylactic beta blockers. What is a potential risk for alcoholic patients?
Which of the following drugs is contraindicated (CI) for patients with liver abnormalities?
Which of the following drugs is contraindicated (CI) for patients with liver abnormalities?
Which of the following symptoms may indicate a patient has Alcohol-Related Liver Disease (ARLD)?
Which of the following symptoms may indicate a patient has Alcohol-Related Liver Disease (ARLD)?
Which of the following is NOT a possible other type of liver disease?
Which of the following is NOT a possible other type of liver disease?
How does the liver contribute to the digestive process?
How does the liver contribute to the digestive process?
What is the role of the liver in glucose metabolism?
What is the role of the liver in glucose metabolism?
How does Hepatitis A typically present?
How does Hepatitis A typically present?
Which characteristic is exclusive to Hepatitis B?
Which characteristic is exclusive to Hepatitis B?
When testing for Hepatitis B, what does the presence of Hepatitis B e antigen (HBeAg) indicate?
When testing for Hepatitis B, what does the presence of Hepatitis B e antigen (HBeAg) indicate?
For Hepatitis B, what does the detection of Anti Hep B c Ag and Anti Hep B s Ag signify?
For Hepatitis B, what does the detection of Anti Hep B c Ag and Anti Hep B s Ag signify?
Which of the following statements is true for Hepatitis C?
Which of the following statements is true for Hepatitis C?
Within Hepatitis C, What can an inadequate host response lead to?
Within Hepatitis C, What can an inadequate host response lead to?
Which of the following groups is considered high risk for Hepatitis C?
Which of the following groups is considered high risk for Hepatitis C?
What is the primary means of preventing Hepatitis C?
What is the primary means of preventing Hepatitis C?
What is a recommendation on food preparation and handling to avoid Hepatitis E transmission?
What is a recommendation on food preparation and handling to avoid Hepatitis E transmission?
Beyond viral causes, what is a common cause of hepatitis?
Beyond viral causes, what is a common cause of hepatitis?
What dose of paracetamol can cause acute liver damage?
What dose of paracetamol can cause acute liver damage?
What is the outcome of ingesting 25g of paracetamol?
What is the outcome of ingesting 25g of paracetamol?
What is the main goal of managing someone with acute hepatitis?
What is the main goal of managing someone with acute hepatitis?
A patient with chronic liver disease has a loss of attention span, what is the reason for this?
A patient with chronic liver disease has a loss of attention span, what is the reason for this?
A patient with bleeding issues is about to be operated on, what should occur pre-operatively?
A patient with bleeding issues is about to be operated on, what should occur pre-operatively?
A patient appears with jaundice, what should occur in the history taking?
A patient appears with jaundice, what should occur in the history taking?
A patient with bleeding issues is about to be operated on, what should occur during the examination?
A patient with bleeding issues is about to be operated on, what should occur during the examination?
Which group of blood borne viruses can be transfered via the parenteral route?
Which group of blood borne viruses can be transfered via the parenteral route?
What is the treatment used for Hepatitis B?
What is the treatment used for Hepatitis B?
Which of the following is important to establish on examination?
Which of the following is important to establish on examination?
Which type of Hepatitis is hand washing important for?
Which type of Hepatitis is hand washing important for?
Why is it important to avoid needle stick injuries?
Why is it important to avoid needle stick injuries?
Which local anesthetic should be used with caution in patients with cirrhosis?
Which local anesthetic should be used with caution in patients with cirrhosis?
Undergoing GA with severe jaundice may lead to
Undergoing GA with severe jaundice may lead to
Which drug is contraindicated (CI) for patients with liver abnormalities?
Which drug is contraindicated (CI) for patients with liver abnormalities?
Which of the following should be avoided in patients with liver GI bleeds?
Which of the following should be avoided in patients with liver GI bleeds?
Which of the following Beta Blockers may lead to hypotension for alcoholic patients?
Which of the following Beta Blockers may lead to hypotension for alcoholic patients?
What is the recommended alcohol intake for both males and females with Alcohol-Related Liver Disease (ARLD)?
What is the recommended alcohol intake for both males and females with Alcohol-Related Liver Disease (ARLD)?
What is the likely cause of an alcoholic patient having Hematemesis?
What is the likely cause of an alcoholic patient having Hematemesis?
Which of the following questions are NOT relevant to the CAGE questionnaire?
Which of the following questions are NOT relevant to the CAGE questionnaire?
Why do individuals with portal hypertension face an increased risk of bleeding?
Why do individuals with portal hypertension face an increased risk of bleeding?
What is the risk percentage transmission from a needlestick injury of HIV?
What is the risk percentage transmission from a needlestick injury of HIV?
What is the risk percentage transmission from a needlestick injury of Hepatitis B (HBV)?
What is the risk percentage transmission from a needlestick injury of Hepatitis B (HBV)?
Which of the following is NOT a stage of Alcohol-Related Liver Disease (ARLD)?
Which of the following is NOT a stage of Alcohol-Related Liver Disease (ARLD)?
How can a liver biopsy be conducted?
How can a liver biopsy be conducted?
Which of the following conditions can cause acute hepatitis?
Which of the following conditions can cause acute hepatitis?
The risk of re-infection is high when undergoing transplant for
The risk of re-infection is high when undergoing transplant for
In the context of liver function, how does the liver contribute to maintaining adequate blood clotting?
In the context of liver function, how does the liver contribute to maintaining adequate blood clotting?
Which of the following is the most accurate description of the liver’s role in detoxification?
Which of the following is the most accurate description of the liver’s role in detoxification?
How does the liver influence platelet formation?
How does the liver influence platelet formation?
Which of the following best describes the implications of liver disorders for anesthesia and sedation?
Which of the following best describes the implications of liver disorders for anesthesia and sedation?
What is a primary concern regarding drug prescriptions for patients with liver disorders?
What is a primary concern regarding drug prescriptions for patients with liver disorders?
Why is cross-infection a significant implication in patients with liver disorders?
Why is cross-infection a significant implication in patients with liver disorders?
What distinguishes Hepatitis B virus (HBV) from Hepatitis C virus (HCV) in terms of their genetic material?
What distinguishes Hepatitis B virus (HBV) from Hepatitis C virus (HCV) in terms of their genetic material?
Why are the outcomes of Hepatitis B infection significantly different among patients?
Why are the outcomes of Hepatitis B infection significantly different among patients?
What does the term 'carrier status' specifically imply in the context of Hepatitis B?
What does the term 'carrier status' specifically imply in the context of Hepatitis B?
How does Hepatitis A typically manifest, and what is a key characteristic of its progression?
How does Hepatitis A typically manifest, and what is a key characteristic of its progression?
What does the presence of anti-Hep B s Ag indicate in a patient's serological markers?
What does the presence of anti-Hep B s Ag indicate in a patient's serological markers?
If a person has positive serological markers for both Anti Hep B s Ag and Anti Hep B c Ag, what does this signify?
If a person has positive serological markers for both Anti Hep B s Ag and Anti Hep B c Ag, what does this signify?
What is the aim of therapy for patients with chronic Hepatitis B?
What is the aim of therapy for patients with chronic Hepatitis B?
What is a normal host response for Hepatitis C?
What is a normal host response for Hepatitis C?
What is one of the high risk groups for Hepatitis C?
What is one of the high risk groups for Hepatitis C?
What should be avoided when preventing Hep C?
What should be avoided when preventing Hep C?
Which of the following is most likely to have acute episodes and fulminant liver failure during Hepatitis E?
Which of the following is most likely to have acute episodes and fulminant liver failure during Hepatitis E?
What is the advice on handling or preparing food in order to prevent Hepatitis E?
What is the advice on handling or preparing food in order to prevent Hepatitis E?
Which of the following levels of drug consumption may lead to acute liver damage?
Which of the following levels of drug consumption may lead to acute liver damage?
Which of the following is a sign that can be found on the skin of a patient with examination?
Which of the following is a sign that can be found on the skin of a patient with examination?
Which of the following best describes the liver's role in maintaining blood glucose levels?
Which of the following best describes the liver's role in maintaining blood glucose levels?
A patient presents with jaundice, fatigue, and abdominal pain. Serological tests reveal the presence of Hepatitis B surface antigen (HBsAg) and Hepatitis B e antigen (HBeAg).. What does this indicate?
A patient presents with jaundice, fatigue, and abdominal pain. Serological tests reveal the presence of Hepatitis B surface antigen (HBsAg) and Hepatitis B e antigen (HBeAg).. What does this indicate?
A patient tests positive for anti-Hep B s Ag. What does Anti-Hep B s Ag signify in their serological markers?
A patient tests positive for anti-Hep B s Ag. What does Anti-Hep B s Ag signify in their serological markers?
Which of the following accounts for the differences in outcomes for patients with Hepatitis B?
Which of the following accounts for the differences in outcomes for patients with Hepatitis B?
A patient tests positive for both Anti Hep B s Ag and Anti Hep B core Ag, what does this signify?
A patient tests positive for both Anti Hep B s Ag and Anti Hep B core Ag, what does this signify?
A patient with Hepatitis C has has a normal host response to the infection, what is a likely outcome?
A patient with Hepatitis C has has a normal host response to the infection, what is a likely outcome?
Which statement is true regarding chronic Hepatitis C infections?
Which statement is true regarding chronic Hepatitis C infections?
Which option demonstrates a means of Hepatitis C prevention?
Which option demonstrates a means of Hepatitis C prevention?
Which of the following is a key characteristic of Hepatitis E infections?
Which of the following is a key characteristic of Hepatitis E infections?
Beyond its association with viral infections, what represents another relatively common cause of hepatitis?
Beyond its association with viral infections, what represents another relatively common cause of hepatitis?
What paracetamol dosage may lead to liver damage?
What paracetamol dosage may lead to liver damage?
What represents the main goal in managing a patient with acute hepatitis?
What represents the main goal in managing a patient with acute hepatitis?
What is a key diagnostic step in identifying the cause of acute hepatitis?
What is a key diagnostic step in identifying the cause of acute hepatitis?
A person with chronic liver disease has issues with attention span, what is the reason for this?
A person with chronic liver disease has issues with attention span, what is the reason for this?
Which of the following is NOT an examination finding that may indicate liver disease?
Which of the following is NOT an examination finding that may indicate liver disease?
Which aspects of a patient's history is LEAST likely to be relevant when evaluating possible liver dysfunction?
Which aspects of a patient's history is LEAST likely to be relevant when evaluating possible liver dysfunction?
What is the main reason to avoid needle stick injuries?
What is the main reason to avoid needle stick injuries?
Which of the following statements is most accurate regarding local anesthetics (LA) and patients with liver cirrhosis?
Which of the following statements is most accurate regarding local anesthetics (LA) and patients with liver cirrhosis?
Why is extreme caution advised when considering general anesthesia (GA) for a patient with severe jaundice and potential liver dysfunction?
Why is extreme caution advised when considering general anesthesia (GA) for a patient with severe jaundice and potential liver dysfunction?
Which of the following is NOT an appropriate action to take when trying to prevent cross infection?
Which of the following is NOT an appropriate action to take when trying to prevent cross infection?
Which of the following is a likely outcome of an Alcoholic patient taking prophylactic beta blockers?
Which of the following is a likely outcome of an Alcoholic patient taking prophylactic beta blockers?
Which of the following is contraindicated (CI) for patients with liver abnormalities?
Which of the following is contraindicated (CI) for patients with liver abnormalities?
Which of the following questions are relevant to ask in the CAGE questionnaire?
Which of the following questions are relevant to ask in the CAGE questionnaire?
A patient with Alcohol-Related Liver Disease (ARLD) develops sudden hematemesis (vomiting blood). What is the mechanism?
A patient with Alcohol-Related Liver Disease (ARLD) develops sudden hematemesis (vomiting blood). What is the mechanism?
What is the risk percentage for Hepatitis B (HBV) transmission via a needlestick injury?
What is the risk percentage for Hepatitis B (HBV) transmission via a needlestick injury?
How is a liver biopsy typically conducted?
How is a liver biopsy typically conducted?
Which of the following types of liver diseases is autoimmune in origin??
Which of the following types of liver diseases is autoimmune in origin??
Which type of hepatic disease has a genetic origin causing copper accumulation?
Which type of hepatic disease has a genetic origin causing copper accumulation?
After liver transplant for Hepatitis B, what is a major consideration for post-transplant management?
After liver transplant for Hepatitis B, what is a major consideration for post-transplant management?
Which of the following serological markers indicates active Hepatitis B viral replication and high infectivity?
Which of the following serological markers indicates active Hepatitis B viral replication and high infectivity?
How does the liver assist with clotting?
How does the liver assist with clotting?
Why is it important to use caution when prescribing to patients with liver disorders?
Why is it important to use caution when prescribing to patients with liver disorders?
During the examination of a patient with jaundice, bruising, and spider naevi, what is an important additional integumentary sign to assess?
During the examination of a patient with jaundice, bruising, and spider naevi, what is an important additional integumentary sign to assess?
Which liver function test (LFT) results would cause concern for increased clotting times?
Which liver function test (LFT) results would cause concern for increased clotting times?
Why is it important to ask about bleeding disorders during history taking when assessing a patient with possible liver dysfunction?
Why is it important to ask about bleeding disorders during history taking when assessing a patient with possible liver dysfunction?
What does Dupuytren's contracture refer to?
What does Dupuytren's contracture refer to?
Patients with the following condition require a smaller does of Flucanazole?
Patients with the following condition require a smaller does of Flucanazole?
What is the underlying mechanism by which cirrhosis leads to an increased risk of bleeding?
What is the underlying mechanism by which cirrhosis leads to an increased risk of bleeding?
In a patient with liver disease, which serological marker indicates active viral replication of Hepatitis B?
In a patient with liver disease, which serological marker indicates active viral replication of Hepatitis B?
What is the main goal of antiviral therapy in patients with chronic Hepatitis B?
What is the main goal of antiviral therapy in patients with chronic Hepatitis B?
What distinguishes Hepatitis B virus (HBV) from Hepatitis C virus (HCV) regarding their genetic composition?
What distinguishes Hepatitis B virus (HBV) from Hepatitis C virus (HCV) regarding their genetic composition?
Why does a history of intravenous drug use increase the risk of Hepatitis C infection?
Why does a history of intravenous drug use increase the risk of Hepatitis C infection?
How does the liver contribute to maintaining stable blood glucose levels?
How does the liver contribute to maintaining stable blood glucose levels?
What is the significance of detecting both Anti-HBcAg and Anti-HBsAg in a patient's serological markers?
What is the significance of detecting both Anti-HBcAg and Anti-HBsAg in a patient's serological markers?
Why is risk avoidance, rather than vaccination, the primary method of prevention for Hepatitis C?
Why is risk avoidance, rather than vaccination, the primary method of prevention for Hepatitis C?
What is the most likely cause of sudden hematemesis (vomiting blood) in a patient with a history of alcohol abuse?
What is the most likely cause of sudden hematemesis (vomiting blood) in a patient with a history of alcohol abuse?
What is the recommended maximum daily dose of paracetamol to avoid acute liver damage?
What is the recommended maximum daily dose of paracetamol to avoid acute liver damage?
What is the mechanism by which portal hypertension increases the risk of bleeding?
What is the mechanism by which portal hypertension increases the risk of bleeding?
What is the significance of observing Dupuytren's contracture during the physical examination of a patient?
What is the significance of observing Dupuytren's contracture during the physical examination of a patient?
What is the recommended upper limit of weekly alcohol consumption for individuals with Alcohol-Related Liver Disease (ARLD)?
What is the recommended upper limit of weekly alcohol consumption for individuals with Alcohol-Related Liver Disease (ARLD)?
Which of the following best represents the role of the CAGE questionnaire in identifying potential liver dysfunction?
Which of the following best represents the role of the CAGE questionnaire in identifying potential liver dysfunction?
Why is it important to exercise caution when using sedatives in patients with cirrhosis?
Why is it important to exercise caution when using sedatives in patients with cirrhosis?
Which feature indicates past Hepatitis B infection with developed immunity?
Which feature indicates past Hepatitis B infection with developed immunity?
A patient with chronic Hepatitis C has no host response, what is a likely outcome?
A patient with chronic Hepatitis C has no host response, what is a likely outcome?
Which of the following is a common sign of liver disease on examination?
Which of the following is a common sign of liver disease on examination?
What explains the high infectivity but low risk in a carrier status patient with Hepatitis B
What explains the high infectivity but low risk in a carrier status patient with Hepatitis B
What is the estimated risk of transmission of Hepatitis B through a needlestick injury from an infected source?
What is the estimated risk of transmission of Hepatitis B through a needlestick injury from an infected source?
Flashcards
Liver Functions
Liver Functions
Synthesis of vitamin K dependent clotting factors, detoxification, digestion, blood glucose/cholesterol regulation, and platelet formation.
Implications of Liver Disorders
Implications of Liver Disorders
Compromised liver function can lead to cross-infection risks, bleeding tendencies, anesthesia/sedation complications, and altered drug prescriptions.
Viral Hepatitis Types
Viral Hepatitis Types
Types include Hepatitis A, B, C, D, E, CMV, EBV, and Herpes Simplex.
Parenteral Hepatitis Transmission
Parenteral Hepatitis Transmission
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Enteral Hepatitis Transmission
Enteral Hepatitis Transmission
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Hepatitis A
Hepatitis A
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Hepatitis B
Hepatitis B
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Hepatitis B Clinical Features
Hepatitis B Clinical Features
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Hep B Serological Markers
Hep B Serological Markers
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Hepatitis B Prevention & Treatment
Hepatitis B Prevention & Treatment
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Hepatitis C
Hepatitis C
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Hepatitis C Risks
Hepatitis C Risks
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Hepatitis C: Prevention and Treatment
Hepatitis C: Prevention and Treatment
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Hepatitis E
Hepatitis E
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Hepatitis E: Prevention & Treatment
Hepatitis E: Prevention & Treatment
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Cirrhosis Defined
Cirrhosis Defined
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Causes of Hepatitis
Causes of Hepatitis
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Paracetamol Overdose
Paracetamol Overdose
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Chronic Hepatitis B Marker
Chronic Hepatitis B Marker
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Anti Hep B c Ag Significance
Anti Hep B c Ag Significance
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Hep B e Ag
Hep B e Ag
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Normal Host Response Hepatitis C
Normal Host Response Hepatitis C
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Inadequate host response Hepatitis C
Inadequate host response Hepatitis C
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Hepatitis B Carrier Status
Hepatitis B Carrier Status
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Acute Hepatitis Defined
Acute Hepatitis Defined
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LFTs (Liver Function Tests)
LFTs (Liver Function Tests)
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Tests to Determine Hepatitis Cause
Tests to Determine Hepatitis Cause
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Chronic Liver Disease Features
Chronic Liver Disease Features
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Causes of Chronic Liver Disease
Causes of Chronic Liver Disease
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Signs/Symptoms in Chronic Liver Disease
Signs/Symptoms in Chronic Liver Disease
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Reduced Liver Cell Mass Problems
Reduced Liver Cell Mass Problems
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Loss of Lean Body Mass
Loss of Lean Body Mass
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Accumulation of Body Water
Accumulation of Body Water
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Coagulopathy in Liver Disease
Coagulopathy in Liver Disease
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Jaundice Defined
Jaundice Defined
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Bruising Explained
Bruising Explained
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Spider Naevi
Spider Naevi
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Liver Flap (Asterixis)
Liver Flap (Asterixis)
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Scratch Marks (Bile Salts)
Scratch Marks (Bile Salts)
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Sialosis
Sialosis
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Dupuytren's Contracture
Dupuytren's Contracture
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Palmar Erythema
Palmar Erythema
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Gynaecomastia
Gynaecomastia
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ALT (Alanine Transaminase)
ALT (Alanine Transaminase)
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AST (Aspartate Transaminase)
AST (Aspartate Transaminase)
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Clotting (Surrogate)
Clotting (Surrogate)
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Gamma Glutamyl Transpeptidase
Gamma Glutamyl Transpeptidase
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Alkaline Phosphatase
Alkaline Phosphatase
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Bleeding Management
Bleeding Management
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Liver Ultrasonography
Liver Ultrasonography
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Cirrhosis Onset
Cirrhosis Onset
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Liver Fibrosis
Liver Fibrosis
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Reduced Liver Cell Mass
Reduced Liver Cell Mass
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Portal Hypertension
Portal Hypertension
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Encephalopathy
Encephalopathy
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Reverse Sleeping Pattern
Reverse Sleeping Pattern
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Jaundice (in history)
Jaundice (in history)
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Alcohol Intake (History)
Alcohol Intake (History)
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Known Infections (History)
Known Infections (History)
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History of Drug Intolerance
History of Drug Intolerance
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Bleeding Disorders (History)
Bleeding Disorders (History)
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IVDU (History)
IVDU (History)
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Sexual History (in liver exam)
Sexual History (in liver exam)
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Jaundice (examination)
Jaundice (examination)
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Bruising (examination)
Bruising (examination)
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Spider Naevi (examination)
Spider Naevi (examination)
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Liver Flap aka Asterixis (examination)
Liver Flap aka Asterixis (examination)
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Scratch Marks (examination)
Scratch Marks (examination)
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Sialosis (examination)
Sialosis (examination)
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Dupuytren's Contracture (examination)
Dupuytren's Contracture (examination)
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Palmar Erythema (examination)
Palmar Erythema (examination)
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Gynaecomastia (examination)
Gynaecomastia (examination)
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Hand Washing
Hand Washing
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Avoidance of Needlestick
Avoidance of Needlestick
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Needlestick Injury Risk
Needlestick Injury Risk
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HBV Needlestick Risk
HBV Needlestick Risk
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HCV Needlestick Risk
HCV Needlestick Risk
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HIV Needlestick Risk
HIV Needlestick Risk
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Jaundice & General Anesthesia
Jaundice & General Anesthesia
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Amide Anesthetics & Liver
Amide Anesthetics & Liver
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Sedation & Cirrhosis Risk
Sedation & Cirrhosis Risk
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Miconazole and Fluconazole
Miconazole and Fluconazole
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Antibiotics to Avoid
Antibiotics to Avoid
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NSAIDs and Liver Dysfunction
NSAIDs and Liver Dysfunction
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Alcohol & Bleeding Risk
Alcohol & Bleeding Risk
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Beta Blockers & Alcohol
Beta Blockers & Alcohol
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Alcohol & Platelet Count
Alcohol & Platelet Count
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Alcohol-Related Liver Disease
Alcohol-Related Liver Disease
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Liver Regeneration and Advice
Liver Regeneration and Advice
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3 Stages of ARLD
3 Stages of ARLD
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Other ARLD Risk Factors
Other ARLD Risk Factors
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ARLD Signs/Symptoms
ARLD Signs/Symptoms
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Other Liver Diseases
Other Liver Diseases
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Liver Imaging Techniques
Liver Imaging Techniques
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CAGE Questionnaire
CAGE Questionnaire
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Liver Biopsy
Liver Biopsy
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Other types of liver diseases
Other types of liver diseases
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Complications of ARLD
Complications of ARLD
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Cross Infection
Cross Infection
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CAGE Questions
CAGE Questions
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ARLD Other Complications
ARLD Other Complications
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ARLD Complications
ARLD Complications
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Acute Hepatitis
Acute Hepatitis
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Liver Biopsy Under Guidance
Liver Biopsy Under Guidance
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Sexual History
Sexual History
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Alcohol Intake
Alcohol Intake
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Bruising
Bruising
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Drug Allergies
Drug Allergies
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Transfusion History
Transfusion History
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Infection History
Infection History
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Alcohol Usage
Alcohol Usage
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PPE
PPE
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Fluid Accumulate
Fluid Accumulate
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Encephalopathy Explained
Encephalopathy Explained
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Chronic liver disease.
Chronic liver disease.
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Study Notes
Functions of the Liver
- Synthesis of vitamin K dependent clotting factors includes factors II, VII, IX, X, Proteins C and S.
- Liver function includes detoxification.
- The digestive function of the liver is important.
- Blood glucose and cholesterol metabolism are regulated by the liver.
- Platelet formation is regulated by the liver via thrombopoietin.
Implications of Liver Disorders
- The liver disorders come with cross-infection risk.
- Possible bleeding complications are a feature of liver disorders.
- Anesthesia/Sedation requires careful consideration when there are liver disorders.
- Drug prescriptions may need adjustments in liver diseases.
Types of Viral Hepatitis
- Some types are Hepatitis A, B, C, D, and E.
- Some alternate types include CMV, EBV, and Herpes Simplex.
Viral Hepatitis Transmission
- Hepatitis B, C, and D have parenteral ways of transmission.
- Hepatitis A and E transmission is through enteral routes.
Hepatitis A
- Can be acute and self-limiting; usually does not need inpatient hospital care.
- Hepatitis A does not have a chronic form.
- There is no carrier status in Hepatitis A.
- Prevention means vaccination and hygiene, to avoid faeco-oral transmission.
Hepatitis B
- This DNA virus integrates into the host genome.
- Patient outcomes depend on the host response.
- The disease comes in a chronic form.
Hepatitis B: Acute vs. Chronic
- Acute form is self-limiting in nature.
- Chronic form occurs in >6 months in 5% of cases and features Hepatitis B surface antigen (+/- e Antigen), ongoing liver damage, abnormal liver function tests (LFTs), and high cancer risk.
- Carrier status means high infectivity but low risk.
Hepatitis B: Clinical Features
- Incubation period lasts up to 6 weeks.
- Like flu for 1-2 weeks.
- Jaundice lasts 2-4 weeks; other symptoms either improve or become chronic.
- Chronic hepatitis has risks of cirrhosis and hepatocellular cancer.
Cirrhosis
- Scarring of the liver happens after long-term damage.
- Scar tissue replaces functioning tissue.
- Is irreversible.
- Can lead to liver failure.
Serological Markers for Hepatitis B
- Hep B s Ag signals the first manifestation of infection, and ongoing infectivity.
- Anti Hep B s Ag signifies protection from infection.
- Detection of Hep B c Ag is by development of antibodies.
- The scenario where Hep B s Ag is negative, but Hep B c Ag is positive means donor infectivity.
- Anti Hep B s Ag and Anti Hep B c Ag denote previous infection.
- Hep B e Ag is only found if HB s Ag is positive, which is an index of infectivity and indicates active viral replication.
Hepatitis B: Prevention & Treatment
- Prevention through vaccination.
- The primary goal of therapy is to clear HBV in patients with chronic hepatitis through using antiviral or immuno-stimulation: Interferon.
- Transplantation has a high-risk of re-infection.
Hepatitis C
- It is an RNA virus that does not integrate.
- Clinical outcome is chronic disease.
Hepatitis C: Host Response
- Normal host response is when below 20% experience the viral clearance with a resolution and no acute illness.
- Inadequate host response means it will become chronic hepatitis.
- In a no host response situation, there is no carrier state.
Hepatitis C: Risks & Prevention
- Insidious, long-term liver damage increases the risk of chronic liver disease and hepatocellular cancer.
- High-risk groups like IV drug abusers and recipients of blood products.
- Prevention is based on risk avoidance; casual transmission is rare.
Hepatitis C: Treatment
- Use Interferon for 12 months +/- Ribavirin (antiviral).
- This has up to 50% viral clearance in the long term.
Hepatitis E
- Transmitted via the faeco-oral route.
- It includes an acute episode of hepatitis and can be severe in pregnant women, which results in fulminant liver failure.
- Diagnose with Hepatitis E serology and really elevated ALT.
- Requires no vaccination, but avoid risk.
- Advice means hygiene, care with undercooked food.
- Treatment is supportive; rarely, transplant.
Causes of Hepatitis: Common
- Causes can be by viral infections.
- Hepatitis can be triggered by drug reactions, particularly paracetamol.
- Dosage of 4g is the Maximum / 24hrs.
- The dosage of 10-15g leads to acute liver damage.
- Taking 25g is invariably fatal.
Acute Hepatitis
- Self-limiting liver inflammation.
- Causes are viral, acute alcoholic hepatitis, drugs, toxins, medications.
Acute Hepatitis Investigations
- LFTs help check levels of hepatic enzymes.
- Tests to determine cause, using a viral serology, immunoglobulin, and autoantibody profile.
- Liver ultrasonography.
Chronic Liver Disease
- Clinical features of cirrhosis seen with initial compensation.
- Causes are Chronic Hep C and alcohol abuse.
- Signs/Symptoms are from these: Liver fibrosis, Reduced liver cell mass, and Portal hypertension.
Chronic Liver Disease: Problems
- Several liver cell mass problems include encephalopathy, reduced attention span, and a reverse sleeping pattern.
Chronic Liver Disease: Signs
- Loss of lean body mass occurs from the shoulders.
- Accumulation of body water.
- Coagulopathy.
History and Examination: History
- Enquire about the patient's jaundice status
- Take into account the patient's alcohol intake
- Ask about Known Infections
- Take note of a History of drug intolerance
- Consider Bleeding Disorders
- Ask about IVDU
- Discuss Sexual History
Blood Borne Virus Infection Risk: Questions
- Determine if the patient has ever been told they are positive for HIV/AIDS or hepatitis B/C infection
- In the case of a male patient, ask if they have ever had sex, even safe sex, with another man
- Ask is the patient injected themself with drugs, including body building drugs
- Consider if they Lived in or ever visited Africa or a Far Eastern and had relations with men or women living there or received medical treatment
- Enquire if they had a blood transfusion outside the UK
- Check if they have ever been a prostitute
- Determine if they Have had relations with a person in the above groups
Examination: Signs
- Jaundice
- Bruising
- Spider Naevi
- Liver Flap aka Asterixis
- Scratch Marks stemming from Bile salts
- Sialosis shows the non-inflammatory & non-neoplastic enlargement of salivary glands
- Dupuytren's Contracture
- Palmar Erythema
- Gynaecomastia
Liver Function Tests (LFT's)
- ALT (Alanine Transaminase) is tested
- AST (Aspartate Transaminase)
- Clotting (surrogate)
- Gamma Glutamyl Transpeptidase
- Alkaline Phosphatase can feature in the presence of obstructive jaundice
Bleeding
- Check Patient History.
- Find any Clues during examination.
- The patient may need FFP peri-operatively.
Cross Infection: Prevention
- Hand washing must be done to avoid Hepatitis A & E, and MRSA.
- The healthcare professional must avoid needlestick injuries.
- Masks, spectacles, and double gloves are necessary.
Blood-borne Viruses
- Estimated risk of transmission by needlestick injury:
- HBV: has a 30% (5-40%) infection risk.
- HCV: a 3% (3-10%) infection risk.
- HIV: only has a 0.3% (0.2-0.5%) chance of infecting.
- Prevalence of infection and risk is higher than average in people who:
- For HBV: are intravenous drug users, men who have sex with men (MSM), or are from developing countries can all contribute to the spread.
- For HCV: multiple blood transfusions, dialysis patients, and intravenous drug users are all at risk.
- For HIV: if they are any MSM, intravenous drug users, or are from areas where the condition is endemic.
Anesthesia/Drugs
- Severe jaundice undergoing general anesthesia may lead to hepato-renal syndrome, renal failure secondary to liver failure.
- For Local Anesthetics, Amide biotransforms in liver.
- Articaine and Prilocaine might be better options.
- Limit lidocaine to just 2 cartridges.
- For Sedation in cases stemming from Cirrhosis is best avoided, as small doses may lead to coma.
- Miconazole is contraindicated and should not be used.
- Fluconazole should be taken as a decreased dose.
- Erythromycin, Metronidazole, and Tetracycline should be avoided.
- NSAIDs are best avoided because they can cause GI bleeds.
- Be careful with doses of Paracetamol.
Alcoholic Patients
- They run the risk of hematemesis because of portal hypertension.
- Many patients take prophylactic beta blockers, such as Propranolol.
- Reduced plasma clearance of epinephrine can occur.
- There could be unopposed alpha adrenergic effects
- There is risk of hypertensive crisis
- Potential bleeding.
- Risk of low platelet count.
Alcohol-Related Liver Disease (ARLD)
- The liver has good regenerative potential.
- Advice states to consume less than 14 units/week for both males and females to have healthy livers.
- Stages are 3 for ARLD:
- Firstly, alcoholic fatty liver disease.
- Then alcoholic hepatitis follows (longer period).
- And ultimately, cirrhosis.
ARLD - Other Risk Factors
- Obesity.
- Patient being female.
- Pre-existing liver condition.
- Possible genetic factors.
Signs/Symptoms of ARLD
- Easy bruising happens.
- Possible bouts of Nausea.
- A patient might experience Weight loss.
- Anorexia is possible.
- The patient experiences Jaundice.
- Potential Swelling in legs/ascites.
- Confusion is possible.
- A patient might present with Haematemesis/melaena.
- The patient might experience Finger clubbing.
- Palmar erythema.
Other Types of Liver Disease
- Non-alcoholic fatty liver disease linked to obesity.
- Haemochromatosis is inherently genetic.
- Primary biliary cirrhosis comes from the Autoimmune system.
- Wilson disease originates inherited, in such that copper accumulates in liver, brain, and eyes.
Liver Imaging
- Using US, MRI, and CT.
Liver Biopsy
- Under image guidance.
- A fine needle is used to enable cell sampling, with use of local anesthesia.
- Use Endoscopy if looking for varices.
Complications of ARLD
- Coagulation defects are possible.
- Care with taking prescriptions is necessary (consult BNF).
- The patient experiences Jaundice, angular cheilitis, xerostomia, and bruxism.
Other Complications ARLD
- Portal Hypertension could lead to varices and a resultant risk of bleeding.
- Occurrence of Ascites is probable.
- Risk Liver cancer.
- Potential Encephalopathy.
- Increased susceptibility to infection is there.
- The person will likely experience Withdrawal symptoms.
- Malnutrition.
CAGE Questionnaire
- Ask the patient if they Have you ever thought that you should CUT down on your drinking?
- Check with them if they Have people been ANNOYED by you or by your drinking?
- Consider Did they Have you ever felt GUILTY about your drinking?
- Also enquire about 'EYE-OPENER moments .
Summary
- Be aware of the Cross infection implications that could feature in liver disease patients.
- Potential Bleeding or other long-term sequelae.
- Determine Issues relating to anaesthesia/drugs when treating.
Further Reading
- Try and follow the General Medicine and surgery for Dental Practitioners 3rd Edition pp. 63-68. for a patient plan
- Be aware that it was Authored by M Greenwood & J G Meechan.
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