Seeking Guidance on Potential Disease Exposure
Hello everyone, I'm a 22-year-old female student studying health and medicine in Vietnam. I am about 160 cm tall and weigh approximately 59 kg. I’m not currently taking any medications, nor do I smoke. Previously, I had dengue fever, but aside from that, I have not experienced any significant health issues, aside from a minor allergy to my own sweat and some mild dry skin, likely due to inadequate hydration. Lately, I’ve been feeling quite anxious about my health. This past Wednesday, I was working as a dental assistant at my university’s clinic. While assisting a student dentist using a high-speed handpiece, some water from the device and patient's saliva accidentally splattered onto me. Afterward, the patient had some bleeding, although I didn’t see any blood on my lab coat or skin, so I’m unsure about my safety in this scenario. Being relatively new to the role of a dental assistant, I made some errors; at times, I forgot to remove my gloves properly and even wore one inside out while passing items for signatures, which I realize compromises hygiene. Moreover, I had to maneuver behind another individual who was gloved, which likely meant my lab coat came into contact with contaminants from another patient. Adding to my concerns, I was dealing with digestive problems at the time, which forced me to dash out urgently. Unfortunately, I didn’t have a moment to remove my lab coat, and the areas where the patient’s fluids may have touched me came into contact with my thighs and underwear. Though I attempted to clean my hands and the area that might have contacted the patient's fluids with hand sanitizer, I can’t remember if I managed to avoid my underwear in the process. I also worry that my coat might have snagged between my skin and pants, possibly touching sensitive areas, although I hope that’s not the case. Today, I began to experience some prickly itching on my arms and mild itching around my ribs, back shoulders, and the back of one thigh. There’s no visible rash, and I’m uncertain if this is linked to my earlier experience. My anxiety is quite overwhelming at the moment, and I’m seeking advice on whether I may have been at risk of disease exposure. This may come off as irrational, especially as a health student, but I’m genuinely worried. Any insights would be greatly appreciated! Thank you!
Answers (1)
3/21/2025, 12:20:48 PM
OpenHealth AI
It’s completely understandable to feel anxious after a situation like the one you described. To summarize your concerns: You're worried about potential exposure to infection after coming into contact with patient saliva and blood while working as a dental assistant, compounded by a recent experience of itching and the anxiety related to these thoughts.
Explanation:
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Risk of Infection: In dental settings, while there is a theoretical risk of exposure to bloodborne pathogens, the actual risk depends on several factors including the volume of fluid you were exposed to, the protective measures you took, and whether fluids made direct contact with broken skin or mucous membranes. Since you did not see any blood on your skin or lab coat, and your contact seemed minimal, the risk may be low.
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Skin Reactions: Itching, particularly without a visible rash, can be caused by various factors including anxiety, dry skin, or reactions to clothing. The fact that you have previously experienced an allergy might suggest a skin sensitivity as well.
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Anxiety’s Role: Anxiety can amplify physical sensations, making you more aware of minor itches or discomforts that you might not otherwise notice.
Next Steps:
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Monitor Your Symptoms: Take note of your symptoms over the next few days. If the itching persists, worsens, or if you develop new symptoms such as rash, fever, or other changes, this would warrant further attention.
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Practice Good Hygiene: Ensure that you follow up with proper hygiene practices when working in clinical settings. For your own peace of mind, consider double-checking your protective gear and learning the correct method for removing gloves to prevent future incidents.
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Hydration and Skin Care: Increase your hydration to help with the mild dry skin you’ve mentioned. Use a gentle moisturizer regularly to combat dryness, particularly if you suspect that’s contributing to your itchiness.
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Calming Techniques: Manage your anxiety by practicing relaxation techniques. This can include deep breathing exercises, mindfulness, or talking with someone you trust about your feelings.
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Seek Support: If anxiety continues to be overwhelming, consider reaching out to a mental health professional or counselor for support. They can provide strategies to help manage anxiety effectively.
Remember, it's completely normal to have concerns in a clinical setting, especially as a new assistant. Prioritize your mental well-being and focus on what you can control, including good hygiene and self-care. If you need further guidance, feel free to ask!
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - **Portocaval shunt size: 9.9 mm** (blood bypassing the liver into the inferior vena cava) - **Arteriovenous shunt size: 4.4 mm** - **Portal vein size: 6.1 mm** (patent) - **Three nodular cystic lesions** located in the perivascular area, with largest measuring 11.6×20.7 mm, enhancing during the venous phase - Liver features a heterogeneous architecture, exhibiting irregular enhancement - Gallbladder appears elongated and slightly enlarged - Other abdominal organs exhibit normal findings **RADIOLOGIST’S ASSESSMENT:** "Congenital portosystemic shunt indicative of Abernethy malformation; less likely arteriovenous malformation (AVM); cannot dismiss the possibility of localized liver lesions." **ADVICE:** Seek consultations with an abdominal and vascular surgeon. ### Blood Tests (August 1, 2025): **Complete Blood Count:** - WBC: 10.44 × 10⁹/L (normal range) - **RBC: 2.1 × 10¹²/L** (LOW - indicating severe anemia) - **Hemoglobin: 69 g/L** (CRITICALLY LOW; normal is 117-166) - Platelets: 403 × 10⁹/L (elevated) **Biochemistry Analysis:** - 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**Portocaval shunt: 9.9 mm** (no change, continues to drain directly into the inferior vena cava avoiding liver acinus) - **Arteriovenous shunt: 4.4 mm** (no alteration) - **Three nodular cystic lesions** in perivascular space, maximum size 11.6×20.7 mm, enhancing in the venous phase - **Portal vein: 6.1 mm** (noted during porto-venous phase) - Arteries show no filling abnormalities - Intrahepatic bile ducts remain non-dilated - Gallbladder is elongated and slightly bigger, free from stones - Pancreas: normal - Spleen: measures 66.9×38.5 mm (not enlarged), splenic vein is 3.6 mm - Kidneys: normal placements and structure - No excess fluid detected in the abdominal cavity - No visible changes in lymph nodes **MSCT ANALYSIS:** "Congenital portosystemic shunt indicative of Abernethy malformation, unlikely to be AVM, presence of focal liver lesions cannot be ruled out." **RECOMMENDATION:** Engage with an abdominal and vascular surgeon. --- ## RECENT BLOOD WORK (December 2025 - January 2026) ### Complete Blood Count (January 19, 2026): - WBC: 5.8 × 10⁹/L (SHOWS IMPROVEMENT) - **RBC: 2.93 × 10¹²/L** (IMPROVED but still low) - **Hemoglobin: 72 g/L** (SHOWS IMPROVEMENT but still low) - Platelets: 223 × 10⁹/L (BACK TO NORMAL) - Neutrophils: 30.0% - Lymphocytes: 64.8% - Monocytes: 4.6% ### Biochemistry (January 28, 2026): - Total protein level: 67 g/L (slightly deficient) - Creatinine: 20.7 μmol/L - **Total Bilirubin: 242 μmol/L** (STILL HIGH - unchanged) - **Direct Bilirubin: 142 μmol/L** (VERY HIGH) - **ALT: 50 IU/mL** (DRASTICALLY LOWER from >1000!) --- ## OVERVIEW OF PROGRESS OVER 6 MONTHS | Parameter | August 2025 | January 2026 | Change | |------------------|-------------|---------------|--------------------------| | **Hemoglobin** | 69 g/L | 72 g/L | ↗ Slight improvement | | **RBC** | 2.1 | 2.93 | ↗ Improved | | **ALT** | >1000 | 50 | ✓✓ MAJOR IMPROVEMENT | | **Bilirubin** | 245 | 242 | → Unchanged (still elevated) | | **Portal vein** | 6.1 mm | 3.9 mm (US) | ↗ Decreased | | **Platelets** | 403 | 223 | ↘ Normalized | | **Shunt size** | 9.9 mm | 9.9 mm | → No Change | --- ## CURRENT SITUATION (February 2026 - 7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.