Liver Disorders

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Questions and Answers

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?

  • 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?

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

Which of the following statements is correct regarding Hepatitis A?

<p>It can be prevented through vaccination. (A)</p> Signup and view all the answers

A patient is diagnosed with Hepatitis B. Which characteristic of the Hepatitis B virus allows it to persist and potentially cause long-term complications?

<p>Its integration into the host's genome. (C)</p> Signup and view all the answers

What does the presence of Hepatitis B surface antigen (HBsAg) indicate?

<p>Active or chronic Hepatitis B infection. (B)</p> Signup and view all the answers

A patient tests positive for anti-HBsAg. What does this serological marker indicate?

<p>Protection from Hepatitis B infection. (B)</p> Signup and view all the answers

Which of the following statements is most accurate regarding Hepatitis C?

<p>It often leads to chronic infection and liver damage. (B)</p> Signup and view all the answers

Which is the primary route of transmission for Hepatitis C?

<p>Parenteral transmission. (D)</p> Signup and view all the answers

What is a primary focus in the management of Hepatitis C?

<p>Eradicating the virus. (C)</p> Signup and view all the answers

Which of the following differentiates Hepatitis E from other hepatitis viruses?

<p>It poses a higher risk of fulminant liver failure in pregnant women. (D)</p> Signup and view all the answers

What advice regarding food preparation and handling should be given to patients to avoid Hepatitis E?

<p>Ensuring thorough cooking of food. (B)</p> Signup and view all the answers

What is the maximum recommended daily dose of paracetamol to avoid liver damage?

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

A patient with a history of IV drug use is diagnosed with insidious liver damage. Which hepatitis virus is most likely the cause?

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

Which of the following factors distinguishes chronic Hepatitis B from Hepatitis A?

<p>Risk of developing cirrhosis. (B)</p> Signup and view all the answers

Which of the following is the most accurate statement regarding drug prescriptions and liver disorders?

<p>Drug prescriptions should be carefully assessed due to potential altered metabolism. (B)</p> Signup and view all the answers

Why does cirrhosis lead to liver failure?

<p>Scar tissue replaces functional liver tissue. (B)</p> Signup and view all the answers

A patient has serological markers indicating past infection of Hepatitis B and is now protected. Which combination of markers would be present?

<p>HBsAg negative, Anti-HBsAg positive (D)</p> Signup and view all the answers

What is the main goal of therapy for patients with chronic Hepatitis B?

<p>Clearing HBV in patients with chronic hepatitis. (D)</p> Signup and view all the answers

What represents a risk factor for Hepatitis C?

<p>Recipients of blood products (B)</p> Signup and view all the answers

Which of the following is a notable clinical feature observed in Hepatitis B?

<p>An incubation period of up to six weeks. (B)</p> Signup and view all the answers

What does the term 'carrier status' mean in the context of Hepatitis B?

<p>The patient has high infectivity but low risk. (D)</p> Signup and view all the answers

How does Hepatitis B have significantly different outcomes between patients?

<p>Due to differences in host response. (A)</p> Signup and view all the answers

What is a major implication of having a viral hepatitis?

<p>Cross-infection. (A)</p> Signup and view all the answers

What is one of the ways serological markers can be used for Hepatitis B

<p>First manifestation of infection (A)</p> Signup and view all the answers

Which of the following clotting factors is NOT synthesized by the liver, dependent on vitamin K?

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

What is the primary function of thrombopoietin produced by the liver?

<p>Promotion of platelet formation (D)</p> Signup and view all the answers

A patient with viral hepatitis is undergoing a surgical procedure. What is the main implication that needs to be considered?

<p>Increased risk of cross-infection (B)</p> Signup and view all the answers

Which of the following viral hepatitis types are transmitted through the parenteral route?

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

Which of the following statements accurately describes a key characteristic of Hepatitis B?

<p>It is a DNA virus that integrates into the genome. (D)</p> Signup and view all the answers

What does the presence of Hepatitis B e antigen (HBeAg) indicate in a patient's serological markers?

<p>Active viral replication and high infectivity (A)</p> Signup and view all the answers

A patient tests positive for both anti-HBsAg and anti-HBcAg. What does this serological marker combination likely signify?

<p>Past Hepatitis B infection (D)</p> Signup and view all the answers

Which statement is correct about Hepatitis C's ability to establish chronic infections?

<p>Chronic infection is directly related to the hosts response (A)</p> Signup and view all the answers

What is true about the high-risk groups for Hepatitis C?

<p>Organ transplant recipients (D)</p> Signup and view all the answers

What is the advantage of Interferon concerning Hepatitis B?

<p>Clearing HBV in patients with chronic hepatitis (B)</p> Signup and view all the answers

What advice should be given to prevent Hepatitis E transmission?

<p>Care with undercooked food (D)</p> Signup and view all the answers

What is the upper daily limit of Paracetamol intake to minimize liver damage?

<p>4g (B)</p> Signup and view all the answers

Which of the following statements concerning viral hepatitis and anesthesia/sedation is most accurate?

<p>Viral hepatitis can alter the metabolism and effects of certain anesthetic drugs (A)</p> Signup and view all the answers

An individual tests positive for Hepatitis B surface antibody (anti-HBs). What does this indicate?

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

What distinguishes chronic Hepatitis B from Hepatitis A?

<p>Hepatitis B can become chronic, while Hepatitis A typically does not. (A)</p> Signup and view all the answers

Which factor determines the different outcomes between patients with Hepatitis B?

<p>Differences in host response (B)</p> Signup and view all the answers

What does 'carrier status' mean in the context of Hepatitis B?

<p>High infectivity but low risk (D)</p> Signup and view all the answers

How is Hepatitis B's acute form characterized?

<p>Self Limiting Illness (C)</p> Signup and view all the answers

Which type of Viral Hepatitis can lead to fulminant liver failure in pregnant women?

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

Which is a viral cause of hepatitis?

<p>All of the above (D)</p> Signup and view all the answers

What is a notable clinical feature of Hepatitis B?

<p>Jaundice -2-4 weeks (A)</p> Signup and view all the answers

Which of the following may cause direct liver damage?

<p>10-15g of paracetamol / 24hrs (B)</p> Signup and view all the answers

Which of the following factors is LEAST likely to cause acute hepatitis?

<p>Excessive alcohol intake over many years (C)</p> Signup and view all the answers

Why is it important to inquire about a patient's history of IV drug use when evaluating liver disease?

<p>IV drug use is a major risk factor or HIV and Hepatitis C. (D)</p> Signup and view all the answers

Why is it important to assess alcohol intake in a patient presenting with possible liver dysfunction?

<p>Alcohol is a direct hepatotoxin and a common cause of liver disease. (A)</p> Signup and view all the answers

What is the clinical significance of identifying spider naevi during a physical examination?

<p>They can be diagnostic of liver dysfunction and portal hypertension (A)</p> Signup and view all the answers

A patient with known liver disease presents with increased bruising and bleeding. What is the most likely underlying cause?

<p>Impaired synthesis of clotting factors by the liver (C)</p> Signup and view all the answers

Which of these examination findings suggests chronic liver disease rather than acute?

<p>Palmar erythema and Dupuytren's contracture (B)</p> Signup and view all the answers

What is the underlying cause of asterixis (liver flap) in patients with liver failure?

<p>Accumulation of toxins like ammonia affecting brain function (D)</p> Signup and view all the answers

Sialosis, or the enlargement of salivary glands, is sometimes associated with liver disease. What is the likely mechanism?

<p>Disturbed hormone regulation and metabolic changes (B)</p> Signup and view all the answers

Hyperpigmentation and scratch marks due to pruritus are commonly observed in liver disease. What causes this itching?

<p>Accumulation of bile salts in the skin (A)</p> Signup and view all the answers

Why is the history of known infections important in patients with possible liver condition?

<p>To identify hepatitis B an C which causes liver damage. (D)</p> Signup and view all the answers

Upon examination, a patient with liver disease exhibits gynecomastia. What is the most likely explanation for this finding?

<p>Impaired metabolism of estrogen (A)</p> Signup and view all the answers

What key information can be gained from liver function tests (LFTs) in diagnosing liver disorders?

<p>They indicate liver inflammation, damage and function (B)</p> Signup and view all the answers

Which of the following is MOST likely to be raised in obstructive jaundice?

<p>Alkaline phosphatase (ALP) (D)</p> Signup and view all the answers

A patient presents with elevated ALT and AST levels. Which condition is LEAST likely to cause this pattern?

<p>Irritable bowel syndrome (IBS) (D)</p> Signup and view all the answers

Why would a physician order a liver ultrasonography as part of the investigation for acute hepatitis?

<p>To evaluate the structure of the liver and rule out other causes. (C)</p> Signup and view all the answers

Why is FFP used in the perioperative management of patients with liver disease?

<p>To provide clotting factors and reduce bleeding risk. (B)</p> Signup and view all the answers

What is the main purpose of hand hygiene in preventing the spread of hepatitis A and E?

<p>To minimize fecal-oral transmission of of the diseases. (C)</p> Signup and view all the answers

In managing a patient with chronic liver disease, what is the significance of monitoring for encephalopathy?

<p>Encephalopathy indicates toxin build up in the blood. (C)</p> Signup and view all the answers

Why is it important to wear appropriate personal protective equipment (PPE) in a healthcare setting?

<p>To prevent transmission of blood borne viruses and other illness. (D)</p> Signup and view all the answers

What is the primary reason to avoid needlestick injuries in a healthcare setting?

<p>To prevent the transmission of bloodborne pathogens. (B)</p> Signup and view all the answers

When assessing a patient suspected of having liver disease, what is the role of inquiring about their sexual history?

<p>Sexual history can reveal risk factors for viral hepatitis. (C)</p> Signup and view all the answers

Which of the following best describes why a patient with chronic liver disease may experience a reduced attention span?

<p>Buildup of toxins from the liver affecting brain function. (A)</p> Signup and view all the answers

A patient with chronic liver disease experiences muscle wasting, particularly in the shoulder area. What is the most likely reason?

<p>Malnutrition and impaired protein metabolism. (D)</p> Signup and view all the answers

What is the most important consideration regarding cross-infection control for Hepatitis A and E?

<p>Emphasis on proper handwashing techniques. (C)</p> Signup and view all the answers

Which of the following criteria raises concern for increased Clotting (surrogate) times.

<p>History of known clotting disorder (B)</p> Signup and view all the answers

Which of the following is NOT a typical cause of acute hepatitis?

<p>Autoimmune disorder (C)</p> Signup and view all the answers

In the context of chronic liver disease, what is the primary mechanism leading to a reduced attention span in affected individuals?

<p>Reduced liver cell mass (A)</p> Signup and view all the answers

What are the typical causes of acute hepatitis?

<p>Viral infections, acute alcoholic hepatitis, drugs, toxins, and medications (B)</p> Signup and view all the answers

A patient with chronic liver disease is exhibiting a reverse sleeping pattern. What is the most likely underlying cause?

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

Which of the following is a common sign found during the examination of a patient with liver disease?

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

A patient presents with jaundice, bruising, and spider naevi. Which condition is MOST likely?

<p>Chronic liver disease (C)</p> Signup and view all the answers

Apart from jaundice, what other integumentary signs may be evident during a physical examination indicating possible liver dysfunction?

<p>Spider naevi (D)</p> Signup and view all the answers

Why is it important to check for bleeding disorders in the history of a patient presenting with possible liver dysfunction?

<p>The liver synthesizes clotting factors (B)</p> Signup and view all the answers

Which of the following would be LEAST useful when evaluating a patient that presents with possible liver dysfunction?

<p>Family history of diabetes (B)</p> Signup and view all the answers

During an examination of a patient, the doctor notices the presence of palmar erythema. What condition might this indicate?

<p>Chronic liver disease (C)</p> Signup and view all the answers

What classic sign on a physical examination may suggest the presence of chronic liver disease?

<p>Dupuytren's contracture (C)</p> Signup and view all the answers

What is the primary reason hand washing is emphasized in preventing the spread of certain types of hepatitis?

<p>To eliminate the virus that may be present on surfaces (A)</p> Signup and view all the answers

Why might a physician consider ordering liver ultrasonography tests as part of the investigation for acute hepatitis?

<p>To evaluate the liver's structure and identify any structural abnormalities (C)</p> Signup and view all the answers

What aspect of a patient's history is particularly pertinent in evaluating possible liver dysfunction?

<p>Alcohol intake (A)</p> Signup and view all the answers

What is the role of assessing a patient's sexual history in the examination of liver disease?

<p>To identify risk factors for viral hepatitis transmission (B)</p> Signup and view all the answers

Why might fresh frozen plasma (FFP) be administered perioperatively to a patient with liver disease?

<p>To supply clotting factors (C)</p> Signup and view all the answers

What is suggested by loss of lean body mass, particularly in the shoulder area, in a patient with chronic liver disease?

<p>Inability of the liver to synthesize proteins (A)</p> Signup and view all the answers

What does the term 'coagulopathy' refer to in the context of chronic liver disease?

<p>A bleeding or clotting abnormality (C)</p> Signup and view all the answers

What is suggested by observing scratch marks on the skin of a patient with liver disease?

<p>Pruritus secondary to elevated bile salts (C)</p> Signup and view all the answers

What is the significance of observing gynaecomastia during the physical examination of a male patient?

<p>Liver's inability to metabolize hormones efficiently (B)</p> Signup and view all the answers

What does the presence of asterixis (liver flap) suggest in a patient with liver disease?

<p>Brain dysfunction related to liver failure (B)</p> Signup and view all the answers

What liver function tests (LFTs) would be most useful to determine surrogate clotting times?

<p>Prothrombin time and international normalized ratio (C)</p> Signup and view all the answers

What would concern a healthcare professional about a patient's hand hygiene?

<p>Hand washing with soap while wearing artificial nails (B)</p> Signup and view all the answers

What would be a reason to avoid needle stick injuries?

<p>Potential transmission of bloodborne diseases (C)</p> Signup and view all the answers

A patient with known liver disease shows signs of sialosis. What is the likely underlying mechanism for the enlargement of their salivary glands?

<p>Changes in fluid and electrolyte balance (B)</p> Signup and view all the answers

What is a key consideration regarding local anesthetics (LA) for patients with cirrhosis?

<p>Amide-based LA's may require dosage adjustment due to liver biotransformation. (A)</p> Signup and view all the answers

Why is caution advised when considering general anesthesia (GA) for a patient with severe jaundice?

<p>It may lead to hepato-renal syndrome, which can cause renal failure secondary to liver failure (C)</p> Signup and view all the answers

In the context of ARLD, what is the recommended weekly alcohol consumption for both males and females to minimize liver damage?

<p>Less than 14 units per week. (C)</p> Signup and view all the answers

Why are nonsteroidal anti-inflammatory drugs (NSAIDs) generally avoided in patients with liver disease?

<p>They increase the risk of gastrointestinal bleeding. (A)</p> Signup and view all the answers

Which of the following is a potential risk associated with prophylactic beta-blocker use (e.g., propranolol) in alcoholic patients?

<p>Reduced plasma clearance of epinephrine, leading to unopposed alpha-adrenergic effects and hypertensive crisis. (A)</p> Signup and view all the answers

What is the percentage risk of transmission of Hepatitis B (HBV) from a needlestick injury?

<p>30% (5-40%) (D)</p> Signup and view all the answers

What is the estimated risk of transmission of HIV from a needlestick injury?

<p>0.3% (0.2-0.5%) (B)</p> Signup and view all the answers

What is the estimated risk of transmission of Hepatitis C (HCV) from a needlestick injury?

<p>3% (3-10%) (B)</p> Signup and view all the answers

Which of the following is the LEAST likely sign or symptom of Alcohol-Related Liver Disease (ARLD)?

<p>Increased appetite. (B)</p> Signup and view all the answers

A patient with a history of alcohol abuse presents with sudden hematemesis. What is the most likely underlying cause?

<p>Portal hypertension leading to varices. (B)</p> Signup and view all the answers

Why would a patient with Alcohol-Related Liver Disease (ARLD) be at higher risk from GI bleeds?

<p>Decreased platelet count (D)</p> Signup and view all the answers

Which of the following pre-existing co-morbidities increases the risk of Alcohol-Related Liver Disease (ARLD)?

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

What is the role of liver biopsy in evaluating liver disease?

<p>To sample cells for analysis. (C)</p> Signup and view all the answers

What does the CAGE questionnaire assess?

<p>Alcohol dependance (C)</p> Signup and view all the answers

Which of the following imaging methods are used to assess the liver?

<p>Ultrasound (D)</p> Signup and view all the answers

What is the possible consequence of low doses of sedation used in patients with cirrhosis?

<p>Coma (D)</p> Signup and view all the answers

Which of the following drugs should be avoided entirely in patients with liver abnormalities?

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

Which of the following is a possible complication as a result of Alcohol-Related Liver Disease (ARLD)?

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

Why does a patient with Portal Hypertension have risk of bleeding?

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

Which of the following signs may show on a patient with Alcohol-Related Liver Disease (ARLD)?

<p>Palmar erythema (C)</p> Signup and view all the answers

What is the approximate risk of Hepatitis C (HCV) transmission from a needlestick injury?

<p>3% (D)</p> Signup and view all the answers

What is the estimated risk of HIV transmission from a needlestick injury?

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

Which of the following best describes why a patient with chronic liver disease has an increased susceptibility to infection?

<p>Impaired immune function. (C)</p> Signup and view all the answers

A patient with Alcohol-Related Liver Disease (ARLD) develops sudden hematemesis. What is the most likely underlying cause?

<p>Esophageal varices due to portal hypertension. (C)</p> Signup and view all the answers

Why are patients with portal hypertension at risk of bleeding?

<p>Increased pressure in the portal venous system leading to varices. (D)</p> Signup and view all the answers

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?

<p>Less than 14 units per week. (C)</p> Signup and view all the answers

What is the role of the CAGE questionnaire?

<p>To screen for alcohol use disorders. (C)</p> Signup and view all the answers

Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided for what reason?

<p>Increased risk of gastrointestinal bleeding. (A)</p> Signup and view all the answers

Which imaging method can be used to assess the liver?

<p>MRI. (D)</p> Signup and view all the answers

Which statement best explains why low doses of sedation should be avoided in patients with cirrhosis?

<p>In these patients, it can easily cause coma. (C)</p> Signup and view all the answers

A patient is taking prophylactic beta blockers. What is a potential risk for alcoholic patients?

<p>Hypertensive crisis. (A)</p> Signup and view all the answers

Which of the following drugs is contraindicated (CI) for patients with liver abnormalities?

<p>Miconazole. (D)</p> Signup and view all the answers

Which of the following symptoms may indicate a patient has Alcohol-Related Liver Disease (ARLD)?

<p>Easy Bruising (D)</p> Signup and view all the answers

Which of the following is NOT a possible other type of liver disease?

<p>Lyme disease (D)</p> Signup and view all the answers

How does the liver contribute to the digestive process?

<p>Performing a digestive function (D)</p> Signup and view all the answers

What is the role of the liver in glucose metabolism?

<p>It plays a key role in blood glucose metabolism (B)</p> Signup and view all the answers

How does Hepatitis A typically present?

<p>As a self-limiting acute infection (A)</p> Signup and view all the answers

Which characteristic is exclusive to Hepatitis B?

<p>It has a chronic form (C)</p> Signup and view all the answers

When testing for Hepatitis B, what does the presence of Hepatitis B e antigen (HBeAg) indicate?

<p>Replication of the virus (A)</p> Signup and view all the answers

For Hepatitis B, what does the detection of Anti Hep B c Ag and Anti Hep B s Ag signify?

<p>Previous infection (D)</p> Signup and view all the answers

Which of the following statements is true for Hepatitis C?

<p>It is an RNA virus that does not integrate into the human genome (D)</p> Signup and view all the answers

Within Hepatitis C, What can an inadequate host response lead to?

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

Which of the following groups is considered high risk for Hepatitis C?

<p>Recipients of blood products (C)</p> Signup and view all the answers

What is the primary means of preventing Hepatitis C?

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

What is a recommendation on food preparation and handling to avoid Hepatitis E transmission?

<p>Care with undercooked food (A)</p> Signup and view all the answers

Beyond viral causes, what is a common cause of hepatitis?

<p>Drug reaction (D)</p> Signup and view all the answers

What dose of paracetamol can cause acute liver damage?

<p>10-15g (B)</p> Signup and view all the answers

What is the outcome of ingesting 25g of paracetamol?

<p>Invariably fatal (A)</p> Signup and view all the answers

What is the main goal of managing someone with acute hepatitis?

<p>Self-limiting liver inflamation (A)</p> Signup and view all the answers

A patient with chronic liver disease has a loss of attention span, what is the reason for this?

<p>Reduced liver cell mass (B)</p> Signup and view all the answers

A patient with bleeding issues is about to be operated on, what should occur pre-operatively?

<p>May need FFP (B)</p> Signup and view all the answers

A patient appears with jaundice, what should occur in the history taking?

<p>Assess alcohol intake (B)</p> Signup and view all the answers

A patient with bleeding issues is about to be operated on, what should occur during the examination?

<p>Check for bruising (D)</p> Signup and view all the answers

Which group of blood borne viruses can be transfered via the parenteral route?

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

What is the treatment used for Hepatitis B?

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

Which of the following is important to establish on examination?

<p>Is there jaundice (B)</p> Signup and view all the answers

Which type of Hepatitis is hand washing important for?

<p>Hepatitis A and E (D)</p> Signup and view all the answers

Why is it important to avoid needle stick injuries?

<p>Cross infection (D)</p> Signup and view all the answers

Which local anesthetic should be used with caution in patients with cirrhosis?

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

Undergoing GA with severe jaundice may lead to

<p>Hepato-renal syndrome (C)</p> Signup and view all the answers

Which drug is contraindicated (CI) for patients with liver abnormalities?

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

Which of the following should be avoided in patients with liver GI bleeds?

<p>NSAIDs (D)</p> Signup and view all the answers

Which of the following Beta Blockers may lead to hypotension for alcoholic patients?

<p>Propranolol (D)</p> Signup and view all the answers

What is the recommended alcohol intake for both males and females with Alcohol-Related Liver Disease (ARLD)?

<p>Less than 14 units (C)</p> Signup and view all the answers

What is the likely cause of an alcoholic patient having Hematemesis?

<p>Portal hypertension (C)</p> Signup and view all the answers

Which of the following questions are NOT relevant to the CAGE questionnaire?

<p>Do you have any pets? (C)</p> Signup and view all the answers

Why do individuals with portal hypertension face an increased risk of bleeding?

<p>Leading to risk of varices (A)</p> Signup and view all the answers

What is the risk percentage transmission from a needlestick injury of HIV?

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

What is the risk percentage transmission from a needlestick injury of Hepatitis B (HBV)?

<p>30% (D)</p> Signup and view all the answers

Which of the following is NOT a stage of Alcohol-Related Liver Disease (ARLD)?

<p>Alcoholic foot (C)</p> Signup and view all the answers

How can a liver biopsy be conducted?

<p>Under image guidance (B)</p> Signup and view all the answers

Which of the following conditions can cause acute hepatitis?

<p>Paracetamol overdose (A)</p> Signup and view all the answers

The risk of re-infection is high when undergoing transplant for

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

In the context of liver function, how does the liver contribute to maintaining adequate blood clotting?

<p>By synthesizing vitamin K-dependent clotting factors such as II, VII, IX, and X, as well as Proteins C and S. (B)</p> Signup and view all the answers

Which of the following is the most accurate description of the liver’s role in detoxification?

<p>The liver neutralizes toxins, converting them into less harmful substances that can be excreted. (D)</p> Signup and view all the answers

How does the liver influence platelet formation?

<p>By synthesizing thrombopoietin, a hormone that stimulates platelet production. (B)</p> Signup and view all the answers

Which of the following best describes the implications of liver disorders for anesthesia and sedation?

<p>Liver disorders can impair the metabolism of anesthetic drugs, increasing the risk of prolonged sedation or coma, necessitating careful drug selection and dosing. (B)</p> Signup and view all the answers

What is a primary concern regarding drug prescriptions for patients with liver disorders?

<p>Many drugs are metabolized by the liver, and impaired liver function can lead to drug accumulation and toxicity, requiring careful selection and dose adjustment. (C)</p> Signup and view all the answers

Why is cross-infection a significant implication in patients with liver disorders?

<p>Patients with liver disorders are more prone to infections, making them a higher risk for spreading infections to others and contracting new ones. (C)</p> Signup and view all the answers

What distinguishes Hepatitis B virus (HBV) from Hepatitis C virus (HCV) in terms of their genetic material?

<p>HBV is a DNA virus that integrates into the host's genome, whereas HCV is an RNA virus that does not integrate. (B)</p> Signup and view all the answers

Why are the outcomes of Hepatitis B infection significantly different among patients?

<p>Variations in the host immune response and other host-related factors greatly influence the outcomes of Hepatitis B infection. (B)</p> Signup and view all the answers

What does the term 'carrier status' specifically imply in the context of Hepatitis B?

<p>The patient is infected with Hepatitis B, has high infectivity, but may have a low risk of liver damage. (C)</p> Signup and view all the answers

How does Hepatitis A typically manifest, and what is a key characteristic of its progression?

<p>It typically presents as a self-limiting illness, and inpatient hospitalization is generally not required. (B)</p> Signup and view all the answers

What does the presence of anti-Hep B s Ag indicate in a patient's serological markers?

<p>Past or resolved Hepatitis B infection with protection from future infection. (D)</p> Signup and view all the answers

If a person has positive serological markers for both Anti Hep B s Ag and Anti Hep B c Ag, what does this signify?

<p>The person has a previous Hepatitis B infection and now has immunity. (A)</p> Signup and view all the answers

What is the aim of therapy for patients with chronic Hepatitis B?

<p>To clear HBV and prevent disease progression, reducing the risk of cirrhosis and hepatocellular cancer. (C)</p> Signup and view all the answers

What is a normal host response for Hepatitis C?

<p>Under 20% show viral clearance with clinical resolution and no acute illness. (A)</p> Signup and view all the answers

What is one of the high risk groups for Hepatitis C?

<p>Intravenous drug abusers. (A)</p> Signup and view all the answers

What should be avoided when preventing Hep C?

<p>Sharing needles during IV drug use. (D)</p> Signup and view all the answers

Which of the following is most likely to have acute episodes and fulminant liver failure during Hepatitis E?

<p>Pregnant women. (D)</p> Signup and view all the answers

What is the advice on handling or preparing food in order to prevent Hepatitis E?

<p>Avoid all undercooked foods. (C)</p> Signup and view all the answers

Which of the following levels of drug consumption may lead to acute liver damage?

<p>10-15 grams of paracetamol. (C)</p> Signup and view all the answers

Which of the following is a sign that can be found on the skin of a patient with examination?

<p>Bruising. (C)</p> Signup and view all the answers

Which of the following best describes the liver's role in maintaining blood glucose levels?

<p>Maintaining glucose homeostasis through glycogenesis, glycogenolysis, and gluconeogenesis. (C)</p> Signup and view all the answers

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?

<p>Chronic Hepatitis B infection with high infectivity. (C)</p> Signup and view all the answers

A patient tests positive for anti-Hep B s Ag. What does Anti-Hep B s Ag signify in their serological markers?

<p>Protection against Hepatitis B infection. (C)</p> Signup and view all the answers

Which of the following accounts for the differences in outcomes for patients with Hepatitis B?

<p>Variances in individual host immune response. (C)</p> Signup and view all the answers

A patient tests positive for both Anti Hep B s Ag and Anti Hep B core Ag, what does this signify?

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

A patient with Hepatitis C has has a normal host response to the infection, what is a likely outcome?

<p>The infection is cleared with clinical resolution in under 20% instances (C)</p> Signup and view all the answers

Which statement is true regarding chronic Hepatitis C infections?

<p>It has a high risk of liver cancer and liver disease (A)</p> Signup and view all the answers

Which option demonstrates a means of Hepatitis C prevention?

<p>Risk Avoidance (C)</p> Signup and view all the answers

Which of the following is a key characteristic of Hepatitis E infections?

<p>It is transmitted through the faeco-oral route (A)</p> Signup and view all the answers

Beyond its association with viral infections, what represents another relatively common cause of hepatitis?

<p>Drug reactions particularly paracetamol. (B)</p> Signup and view all the answers

What paracetamol dosage may lead to liver damage?

<p>10-15g per day (C)</p> Signup and view all the answers

What represents the main goal in managing a patient with acute hepatitis?

<p>Address or treat the symptoms the patient is presenting (B)</p> Signup and view all the answers

What is a key diagnostic step in identifying the cause of acute hepatitis?

<p>Liver function tests (LFTs) (A)</p> Signup and view all the answers

A person with chronic liver disease has issues with attention span, what is the reason for this?

<p>Build up of toxins (C)</p> Signup and view all the answers

Which of the following is NOT an examination finding that may indicate liver disease?

<p>Low Blood Sugar (C)</p> Signup and view all the answers

Which aspects of a patient's history is LEAST likely to be relevant when evaluating possible liver dysfunction?

<p>Previous Broken Bones (C)</p> Signup and view all the answers

What is the main reason to avoid needle stick injuries?

<p>Reduces risk of cross infection (B)</p> Signup and view all the answers

Which of the following statements is most accurate regarding local anesthetics (LA) and patients with liver cirrhosis?

<p>Amide local anesthetics undergo bio-transformation in the liver (B)</p> Signup and view all the answers

Why is extreme caution advised when considering general anesthesia (GA) for a patient with severe jaundice and potential liver dysfunction?

<p>There is a high risk of kidney and renal issues as a result (A)</p> Signup and view all the answers

Which of the following is NOT an appropriate action to take when trying to prevent cross infection?

<p>Re-capping a needle once used. (A)</p> Signup and view all the answers

Which of the following is a likely outcome of an Alcoholic patient taking prophylactic beta blockers?

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

Which of the following is contraindicated (CI) for patients with liver abnormalities?

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

Which of the following questions are relevant to ask in the CAGE questionnaire?

<p>Have people ANNOYED you by criticising your drinking? (A)</p> Signup and view all the answers

A patient with Alcohol-Related Liver Disease (ARLD) develops sudden hematemesis (vomiting blood). What is the mechanism?

<p>Esophageal varices rupture due to portal hypertension. (C)</p> Signup and view all the answers

What is the risk percentage for Hepatitis B (HBV) transmission via a needlestick injury?

<p>30% (D)</p> Signup and view all the answers

How is a liver biopsy typically conducted?

<p>Using a fine needle under image guidance to collect cells (D)</p> Signup and view all the answers

Which of the following types of liver diseases is autoimmune in origin??

<p>Primary biliary cirrhosis (A)</p> Signup and view all the answers

Which type of hepatic disease has a genetic origin causing copper accumulation?

<p>Wilson’s disease. (D)</p> Signup and view all the answers

After liver transplant for Hepatitis B, what is a major consideration for post-transplant management?

<p>Continual monitoring for reinfection (B)</p> Signup and view all the answers

Which of the following serological markers indicates active Hepatitis B viral replication and high infectivity?

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

How does the liver assist with clotting?

<p>Synthesizing vitamin K dependent clotting factors (C)</p> Signup and view all the answers

Why is it important to use caution when prescribing to patients with liver disorders?

<p>Drug doses may need to be altered. (D)</p> Signup and view all the answers

During the examination of a patient with jaundice, bruising, and spider naevi, what is an important additional integumentary sign to assess?

<p>Scratch marks (D)</p> Signup and view all the answers

Which liver function test (LFT) results would cause concern for increased clotting times?

<p>Reduced Albumin (A)</p> Signup and view all the answers

Why is it important to ask about bleeding disorders during history taking when assessing a patient with possible liver dysfunction?

<p>Liver disease can impair clotting factor synthesis. (D)</p> Signup and view all the answers

What does Dupuytren's contracture refer to?

<p>Thickening and contraction of palmar fascia (C)</p> Signup and view all the answers

Patients with the following condition require a smaller does of Flucanazole?

<p>Liver Abnormalities (A)</p> Signup and view all the answers

What is the underlying mechanism by which cirrhosis leads to an increased risk of bleeding?

<p>Decreased synthesis of clotting factors by the liver. (A)</p> Signup and view all the answers

In a patient with liver disease, which serological marker indicates active viral replication of Hepatitis B?

<p>HBeAg (D)</p> Signup and view all the answers

What is the main goal of antiviral therapy in patients with chronic Hepatitis B?

<p>To suppress viral replication and minimize liver damage. (B)</p> Signup and view all the answers

What distinguishes Hepatitis B virus (HBV) from Hepatitis C virus (HCV) regarding their genetic composition?

<p>HBV is a DNA virus that integrates into the host genome, while HCV is an RNA virus that does not typically integrate. (C)</p> Signup and view all the answers

Why does a history of intravenous drug use increase the risk of Hepatitis C infection?

<p>Sharing needles and syringes can transmit the virus directly into the bloodstream. (D)</p> Signup and view all the answers

How does the liver contribute to maintaining stable blood glucose levels?

<p>By storing glucose as glycogen and releasing it when needed. (D)</p> Signup and view all the answers

What is the significance of detecting both Anti-HBcAg and Anti-HBsAg in a patient's serological markers?

<p>Past Hepatitis B infection with developed immunity. (D)</p> Signup and view all the answers

Why is risk avoidance, rather than vaccination, the primary method of prevention for Hepatitis C?

<p>A vaccine for Hepatitis C has not yet been developed. (D)</p> Signup and view all the answers

What is the most likely cause of sudden hematemesis (vomiting blood) in a patient with a history of alcohol abuse?

<p>Ruptured esophageal varices due to portal hypertension. (D)</p> Signup and view all the answers

What is the recommended maximum daily dose of paracetamol to avoid acute liver damage?

<p>4g. (A)</p> Signup and view all the answers

What is the mechanism by which portal hypertension increases the risk of bleeding?

<p>Development of fragile varices in the esophagus and stomach. (B)</p> Signup and view all the answers

What is the significance of observing Dupuytren's contracture during the physical examination of a patient?

<p>Chronic liver disease, especially alcoholic liver disease. (D)</p> Signup and view all the answers

What is the recommended upper limit of weekly alcohol consumption for individuals with Alcohol-Related Liver Disease (ARLD)?

<p>14 units. (D)</p> Signup and view all the answers

Which of the following best represents the role of the CAGE questionnaire in identifying potential liver dysfunction?

<p>Identifying individuals with potential alcohol dependence or abuse. (C)</p> Signup and view all the answers

Why is it important to exercise caution when using sedatives in patients with cirrhosis?

<p>Patients with cirrhosis are hyper-sensitive to sedatives. (C)</p> Signup and view all the answers

Which feature indicates past Hepatitis B infection with developed immunity?

<p>HBsAg negative, Anti-HBsAg positive. (B)</p> Signup and view all the answers

A patient with chronic Hepatitis C has no host response, what is a likely outcome?

<p>Development of cirrhosis. (A)</p> Signup and view all the answers

Which of the following is a common sign of liver disease on examination?

<p>Palmar erythema. (A)</p> Signup and view all the answers

What explains the high infectivity but low risk in a carrier status patient with Hepatitis B

<p>High viral load and a lack of symptoms means patients can unknowingly transfer the virus. (A)</p> Signup and view all the answers

What is the estimated risk of transmission of Hepatitis B through a needlestick injury from an infected source?

<p>30% (D)</p> Signup and view all the answers

Flashcards

Liver Functions

Synthesis of vitamin K dependent clotting factors, detoxification, digestion, blood glucose/cholesterol regulation, and platelet formation.

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

Types include Hepatitis A, B, C, D, E, CMV, EBV, and Herpes Simplex.

Parenteral Hepatitis Transmission

Hepatitis B, C, and D are transmitted through blood or bodily fluids.

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Enteral Hepatitis Transmission

Hepatitis A and E are typically transmitted through contaminated food or water.

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Hepatitis A

It is usually a self-limiting illness, has no chronic form or carrier state, and is preventable with vaccination and hygiene.

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Hepatitis B

It is a DNA virus that integrates into the host genome and can result in significantly different outcomes and a chronic form.

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Hepatitis B Clinical Features

Symptoms include jaundice, flu-like symptoms, and risk of cirrhosis and hepatocellular cancer in chronic cases.

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Hep B Serological Markers

Hep B s Ag indicates the first manifestation of infection. Anti-Hep B s Ag indicates protection from infection.

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Hepatitis B Prevention & Treatment

Vaccination is key to prevention. Therapy aims to clear HBV, but transplantation carries a high risk of re-infection.

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Hepatitis C

It is an RNA virus that doesn't integrate into human genome, often leading to chronic disease.

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Hepatitis C Risks

It is insidious, causing ongoing liver damage and increasing the risk of chronic liver disease and hepatocellular cancer, especially in IV drug abusers and recipients of blood products.

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Hepatitis C: Prevention and Treatment

Prevention focuses on risk avoidance, not vaccination. Treatment usually involves interferon and ribavirin.

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Hepatitis E

Transmitted via the faeco-oral route, presenting as an acute hepatitis episode and potentially leading to fulminant liver failure, especially dangerous for pregnant women.

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Hepatitis E: Prevention & Treatment

Management involves risk avoidance via hygiene and care with food, with supportive treatment and, rarely, liver transplant.

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Cirrhosis Defined

Scarring of the liver, irreversible process after long-term damage.

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Causes of Hepatitis

Common causes include viral infections and drug reactions, particularly paracetamol overdose.

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Paracetamol Overdose

4g is the maximum safe daily dosage, 10-15g can cause acute liver damage, and 25g is often fatal.

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Chronic Hepatitis B Marker

Surface Antigen presence indicates an ongoing infection, potentially leading to liver damage and elevating cancer risk.

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Anti Hep B c Ag Significance

This marker signifies previous Hepatitis B infection and subsequent immunity.

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Hep B e Ag

This marker indicates active viral replication in Hepatitis B.

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Normal Host Response Hepatitis C

In less than 20% of cases, the virus is cleared without an acute illness.

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Inadequate host response Hepatitis C

The host’s response doesn’t properly combat the virus, leading to ongoing liver inflammation.

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Hepatitis B Carrier Status

The virus is present but does not cause noticeable issues, but transmission is still possible.

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Acute Hepatitis Defined

Self-limiting liver inflammation caused by viruses, alcohol, drugs, toxins or medications.

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LFTs (Liver Function Tests)

LFTs measure hepatic enzymes to assess liver inflammation or damage.

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Tests to Determine Hepatitis Cause

Viral serology, immunoglobulins, and autoantibody profile.

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Chronic Liver Disease Features

Clinical signs of cirrhosis even during initial compensation.

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Causes of Chronic Liver Disease

Chronic Hepatitis C and Alcohol Abuse.

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Signs/Symptoms in Chronic Liver Disease

Liver fibrosis, reduced liver cell mass, and portal hypertension.

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Reduced Liver Cell Mass Problems

Encephalopathy, reduced attention, reverse sleep.

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Loss of Lean Body Mass

Liver disease leads to loss of lean body mass, especially in shoulders.

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Accumulation of Body Water

Fluid accumulation in the body due to liver disease

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Coagulopathy in Liver Disease

Impaired blood clotting due to liver dysfunction

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Jaundice Defined

A medical condition characterized by yellowing of skin/eyes.

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Bruising Explained

Due to clotting factor deficiencies caused by liver disfunction.

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Spider Naevi

Small, spider-like blood vessels visible on skin.

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Liver Flap (Asterixis)

Involuntary flapping tremor; wrist extension when arms extended.

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Scratch Marks (Bile Salts)

Skin abrasions resulting from intense itching due to elevated bile salts.

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Sialosis

Non-inflammatory & non-neoplastic salivary gland enlargement.

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Dupuytren's Contracture

Finger contracture that affects hands, more in males.

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Palmar Erythema

Reddening of palms due to increased blood flow.

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Gynaecomastia

Enlargement of male breast tissue.

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ALT (Alanine Transaminase)

ALT measures liver cell damage. Elevated in hepatitis.

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AST (Aspartate Transaminase)

Enzyme released when tissues/organs (like the liver) are damaged.

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Clotting (Surrogate)

Clotting ability is impacted when the condition of the liver is compromised.

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Gamma Glutamyl Transpeptidase

Enzyme in liver/bile ducts, indicates liver disease or bile duct obstruction.

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Alkaline Phosphatase

Elevated ALP may suggest blockage of the biolary ducts.

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Bleeding Management

Bleeding history, examination clues, and possible FFP peri-operatively.

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Liver Ultrasonography

A liver ultrasound is conducted to inspect the liver's structure and identify any abnormalities.

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Cirrhosis Onset

Clinical indications of cirrhosis are present during initial compensation.

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Liver Fibrosis

Liver stiffness progression caused by long-term liver cell damage

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Reduced Liver Cell Mass

Results from the gradual reduction of functioning liver cells.

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Portal Hypertension

Elevated blood pressure in the portal venous system.

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Encephalopathy

A neurological disorder caused by liver disease, resulting in altered mental status and cognitive decline.

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Reverse Sleeping Pattern

Disruption in normal sleep patterns.

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Jaundice (in history)

Inquired about to gather relevant medical context.

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Alcohol Intake (History)

Inquired about as a significant factor in liver conditions.

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Known Infections (History)

Investigated to identify potential infections affecting the liver.

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History of Drug Intolerance

History of unfavorable reactions or intolerances to specific drugs.

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Bleeding Disorders (History)

Clotting abnormalities or conditions affecting the ability to form blood clots, separate from liver disease causes.

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IVDU (History)

Intravenous drug use.

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Sexual History (in liver exam)

Assessed to identify risk factors or potential exposures related to liver diseases.

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Jaundice (examination)

Manifestation of high bilirubin levels.

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Bruising (examination)

The occurrence of skin lesions.

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Spider Naevi (examination)

Spider-like network of swollen blood vessels on the skin.

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Liver Flap aka Asterixis (examination)

Involuntary flapping tremor observed when the wrist is extended with arms outstretched, associated with liver dysfunction.

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Scratch Marks (examination)

Skin abrasions resulting from intense itching caused by elevated bile salts deposited on the skin.

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Sialosis (examination)

Non-inflammatory and non-neoplastic enlargement of the salivary glands.

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Dupuytren's Contracture (examination)

Hand deformity where fingers bend towards the palm.

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Palmar Erythema (examination)

Reddening of the palms caused by increased blood flow.

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Gynaecomastia (examination)

Enlargement of male breast tissue.

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Hand Washing

Essential infection control practices.

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Avoidance of Needlestick

Preventive measures to minimize the hazard of accidental needle injuries.

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Needlestick Injury Risk

Estimated risk of transmission of blood-borne viruses (HBV, HCV, HIV) via needlestick injury, expressed as a percentage.

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HBV Needlestick Risk

30% (5-40%) estimated risk of transmission by needlestick injury

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HCV Needlestick Risk

3% (3-10%) estimated risk of transmission by needlestick injury

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HIV Needlestick Risk

0.3% (0.2-0.5%) estimated risk of transmission by needlestick injury

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Jaundice & General Anesthesia

Severe jaundice undergoing general anesthesia may lead to hepato-renal syndrome (renal failure secondary to liver failure).

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Amide Anesthetics & Liver

Amide local anesthetics (LA) are biotransformed in the liver; limit lidocaine and consider articaine or prilocaine.

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Sedation & Cirrhosis Risk

Sedation in cirrhosis patients requires specialized units because small doses may induce coma.

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Miconazole and Fluconazole

Miconazole is contraindicated in patients with liver issues, while Fluconazole requires a decreased dose

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Antibiotics to Avoid

Avoid erythromycin, metronidazole, and tetracycline in patients with liver issues.

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NSAIDs and Liver Dysfunction

Avoid NSAIDs due to risk of gastrointestinal bleeding; paracetamol is noted as an alternative.

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Alcohol & Bleeding Risk

Alcoholic patients have increased risk of bleeding due to portal hypertension.

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Beta Blockers & Alcohol

Alcoholic patients often take prophylactic beta blockers like propranolol, which can cause hypertensive crisis.

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Alcohol & Platelet Count

Alcoholic patients may have bleeding tendencies and low platelet count.

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Alcohol-Related Liver Disease

A liver condition caused by excessive alcohol consumption, progressing through stages like fatty liver, hepatitis, and cirrhosis.

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Liver Regeneration and Advice

Good regenerative potential is important and advice is to keep < 14 units/week consumption

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3 Stages of ARLD

ARLD: Alcoholic fatty liver disease, Alcoholic hepatitis and Cirrhosis

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Other ARLD Risk Factors

Risk factors include obesity, being female, pre-existing liver conditions, and genetics.

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ARLD Signs/Symptoms

Easy bruising, nausea, weight loss, anorexia, jaundice, swelling in legs/ascites, confusion, haematemesis/melaena, finger clubbing, palmar erythema

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Other Liver Diseases

Non-Alcoholic Fatty Liver Disease (obesity), Haemochromatosis (genetic), Primary Biliary Cirrhosis (autoimmune), Wilson disease (inherited: copper).

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Liver Imaging Techniques

Includes Ultrasound, MRI, and CT scans.

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CAGE Questionnaire

A questionnaire designed to screen for alcohol-related problems; assesses Cutting down, Annoyance by criticism, Guilt, and Eye-openers.

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Liver Biopsy

Sampling liver tissue for diagnostic evaluation, often guided by imaging techniques and utilizing fine needles.

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Other types of liver diseases

Other forms of liver disease include Non-alcoholic fatty liver disease (NAFLD- which is associated with obesity), Haemochromatosis (genetic- iron overload), Primary biliary cirrhosis (autoimmune), Wilson disease (inherited: copper accumulation).

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Complications of ARLD

Problems clotting ability linked to liver damage resulting in Coagulation defects so be careful with prescriptions (BNF)

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Cross Infection

HAND WASHING, Avoidance of Needlestick, MASKS, SPECTACLES, GLOVES (double)

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CAGE Questions

Have you ever felt you should Cut down? Have people Annoyed you? Have you ever felt Guilty? Eye-opener?

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ARLD Other Complications

Portal Hypertension leading to varices and risk of bleeding Ascites, Liver cancer, Encephalopathy, Increased susceptibility to infection, Withdrawal symptoms, Malnutrition

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ARLD Complications

Coagulation defects, Care with prescriptions (BNF), Jaundice, angular cheilitis, xerostomia, bruxism

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Acute Hepatitis

Self-limiting liver inflammation

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Liver Biopsy Under Guidance

Under image guidance.

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Sexual History

Inquired about to see risk factors or transmission.

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Alcohol Intake

Alcohol intake as an element that causes liver damage.

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Bruising

Look for bruising or skin lesions.

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Drug Allergies

Inquire about any pre-existing allergies to medications.

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Transfusion History

Assess the risk of blood product exposure.

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Infection History

Ask about any abnormalities or known issues.

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Alcohol Usage

Inquired about it's effects on mental health following consumption.

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PPE

Essential PPE to prevent pathogens travelling around.

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Fluid Accumulate

Fluid accumulate in body through various mechanisms.

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Encephalopathy Explained

A neurological disorder involving liver dysfunction.

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Chronic liver disease.

Irreversible liver structure.

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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.
  • 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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