Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3rd BDS IHD > Hepatic > Flashcards

Hepatic Flashcards

1
Q

why is liver disease relevant to dentistry

A

liver is main production site for clotting factors 2, 7, 9, 10 = reduced clotting = more bleeding
chronic liver disease often accompanies hep B and C blood borne disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

where does the main blood flow come from to the liver

A

hepatic portal venous system
all blood from gut goes to liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

where does the main blood flow come from to the liver

A

hepatic portal venous system
all blood from gut goes to liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what organ will be enlarged in haemolytic anaemia and why and what is a possible side effect of this

A

the spleen
splenomegaly
The RBC’s are stored and broken down in the spleen so it gets enlarged
pre-hepatic jaundice, yellow eyes and skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the main cause of ‘too little liver’

A

cirrhosis
end stage liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how would cirrhosis present histologically

A

regenerating cells seperated by bands of fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what causes cirrhosis (3) and give the process (2)

A

constant liver abuse, viruses such as hepatitis, alcohol
usually after liver cells are damaged = inflammation = regeneration
under constant, prolonged abuse, the cells will heal by fibrosis (scarring)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

name 6 viruses that cause cirrhosis

A

Hep B, C, D, E
Cytomegalovirus
Epstein Barr Virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

why does Hep A not cause cirrhosis

A

this is an acute attack on the liver, not chronic (unline B, C, D, E, EBV,)
may kill patient but if recover, the virus is cleared completely from the liver and doesn’t cause chronic damage and fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the consequences of cirrhosis (4)

A

liver failure = jaundice
Portal hypertension = raised BP in portal venous system
Ascites =
Hepatocellular cancer =

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are varices and what causes them

A

Varices are dilated veins in the distal oesophagus or proximal stomach caused by elevated pressure in the portal venous system, typically from cirrhosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is a treatment for varices

A

Varices are dilated veins in the distal oesophagus or proximal stomach caused by elevated pressure in the portal venous system, typically from cirrhosis.

inject sclerosing agent or place rubber band over it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the only symptom of varices and how would we diagnose

A

massive bleeding and being sick with blood
endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

explain the blood flow through the liver

A

from the gut, the portal vein takes blood to the liver and this goes to capillary level
blood then leaves via the hepatic vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

give 2 reasons why fibrosis from cirrhosis causes problems in the liver and what does this lead to

A

fibrosis may disrupt blood supply = death of tissue and difficulty pushing blood through liver
hepatocytes are aligned along blood vessels in health but under cirrhosis, the cells form in nodules leading to th cells being harder to get to for the blood

This leads to portal vein hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is ascites and what causes this (explain mechanism (2))

A

a build up of fluid in the abdomen causing bloating and swollen abdomen
cirrhosis
Reduced albumin production = reduced fluid absorption into blood = increased external fluid
portal hypertension = high pressures in the gut = swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how would ascites present and what is its cause

A

large swollen abdomen which is dull to tap and would show up as high volume liquid under a scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is albumin and where is it produced

A

most abundant serum protein helping regulate osmosis and blood content and also helps carry proteins and hromones
absorbs fluid back into the blood at venous end of capillaries
produced in the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

how might we vaccinate against hepatocellular carcinomas

A

vaccine against hepatitis B
stops hep B infection
stops cirrhosis therefor no fibrosis
reduces turnover of hepatocytes
reduces risk of hepatocellular carcinomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the major cause of bile flow blockage

A

gall stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are the main signs and symptoms of jaundice

A

yellow skin
yellow eyes
itchiness
pale stool
dark urine
high Bilirubin levels in blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what affects does gall bladder blockage have on the skin

A

this can cause jaundice = yellow skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

if a patient never drinks alcohol or doesn’t have hepatitis but suddenly gets pain and jaundice, what is the likely cause?

A

gall stone in bile duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

if a patient rarely drinks alcohol, doesnt have hepatitis and has no pain but comes in with jaundice, what is the liekly cause

A

a cancer in the bile duct or pancreatic/duodenal cancer that is blocking the bile duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

why does bile blockage cause jaundice

A

if the bile cannot exit the gall bladder/liver, this causes a build up of bile in the liver
causes overflow into the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is hepatitis

A

inflammation of the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what can cause hepatitis

A

infections e.g. viral, bacterial, fungal
non infectious = alcohol, drugs, autoimmunity, metabolic problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is the general pathway of drestuction of the liver (3)

A

hepatitis (inflammation
Cirrhosis = permanent damage
hepatocellular carcinoma - HCC - with cirrhoisis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is HCC

A

hepatocellular carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

symptoms of hepatitis

A

jaundice
pale fatty stools
dark urine
malaise
serum biochemical tests/ serological tetss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

how do we diagnose hepatitis

A

symptoms
serum biochemistry and serological tests

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what is a virion

A

complete virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what are the major types of hepatitis virus

A

A-E

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what are the two main ways of classifying hepatitis viruses

A

Genome = All RNA apart from Hep B - DNA (vaccine)
Route of transmission = A and E oro-faecal route
BCD are all parental route e.g. saliva, blood, needles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

which types of hepatitis virus are oral facieses route

A

A and E
spread through food contamination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

whcih hepatitis virus is DNA and RNA

A

B = DNA
ACDE = RNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

how many types of Hep A are there, which ones are relevent (3)

A

I-VII
I-III and VII are human viruses
I is 80% relevant and III is very common too

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

how does Hep A and E get into the faeces (3)

A

enters through stomach and intestine
absorbed in the blood and makes way to liver causes hepatitis
secreted from liver in bile into the intestine = faeces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what type of vaccine do we have for hep A

A

whole formalin killed virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what is the infection and serum levels rates for Hep A (3)

A

2 week incubation (no serum antibodies)
4-10 day prodrome period (symptoms but general also Ig start showing)
resolves in a few weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what age group is often asymptomatic for Hep A

A

3-5 year olds
risk as they are not very hygienic and add to spread

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

would we see antibodies in the blood, or pathogen in the faeces first and why is this relevent for Hep A

A

pathogen in faeces first
this is a problem as the patient is shedding and contagious before we can detect disease and prevent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

why is Hep B more dangerous than Hep A

A

most Hep A patients recover in 2 weeks
2.5% of Hep B patients go into chronic hepatitis
either persistant (‘health’) hepatitis or active hepatitis which is very damaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what happens to 2.5 percent of hepatitis B surfferers

A

they develop chronic carrier state, being either
Chronic persistent hepatitis (‘healthy carrier’) - just spread
Chronic active hepatitis (damaging and spread)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

how does Hep B become chronic in some patients

A

HBV integrates into hepatocyte DNA so constantly produces antigens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

compare chronic persistant hepatitis and chronic active hepatitis

A

both 2.5% of Hep B patients, both very infective, both HBV integrated DNA
CPH - non symptomatic and no damage
CAH - symptomatic, cirrhosis, very damaging, very infecitious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

describe the structure of Hepatitis B virus dane particle (4)

A

full particle = ‘dane particle’
DNA with DNA polymerase
plasmid with HBcAg (core antigen)
Capsule with HBsAg (surface antigen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what 3 forms does Hep B come in

A

Dane particle = whole = infectious
Filamentous = non infectious
sphere = non infectious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

what is the hep B core made up of (3)

A

dsDNA
DNA polymerase
HBcAg core antigen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what would we see in a serology of acute hep B (2)

A

HBsAg
and IgM of HBcAg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what 4 genes are in HBV

A

S protein = surface antigen
C protein = core antigen
P = polymerase antigen
X = unknown, reguatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

which antigen is causing illness in Hep B

A

E antigen
HBeAg - breakdown of HBcAg core protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

what is HBeAg and when is it seen in serology

A

a breakdown molecule of HBcAg - hepatitis B core antigen
seen when there are high levels of antigen and very infectious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what would be a serological diagnosis of Chronic Hep B infection

A

characterized by the persistence of HBsAg for at least 6 months (with or without concurrent HBeAg). Persistence of HBsAg is the principal marker of risk for developing chronic liver disease and liver cancer (hepatocellular carcinoma) later in life.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

how much chronic hep B leads to chronic liver disease

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what increases chances of getting chronic hep B

A

getting it earlier in life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what antigen is genetically engineered for vaccine for Hepatitis B

A

HbsAg surface antigen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

what do we need before we can get Hepatitis D

A

Hepatitis B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

which hepatitis viruses are related

A

hepatitis D needs hepatitis B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

what percent of Hep B carriers also carry HepD

A

5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

why can a pt not be ONLY infected by Hepatitis D (3)

A

Hep D is caused by a ‘defective’ RNA virus which coexists with HBV
Outer coat derived from HBsAg – cannot survive without HBV.
~5% HBV carriers are HDV positive.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

what is the structure of hep D

A

RNA surrounded by Delta antigen
Surface formed from HBsAg

63
Q

what do we use to detect HDV

A

hep D virus
Delta antigen found at the core of Hep D

64
Q

what is the effect if having Hep D

A

rarely progressive
‘supervirus’ makes Hep B more likely to be chronic and destructive

65
Q

what percent of IV drug users are infected by Hepatitis C

A

80%

66
Q

what hepatitis virus is very common in IV drug users

A

hep C

67
Q

how is Hepatitis C transferred

A

IV drug abuse needle sticks, tattoos, ear piercing
80% iv drug users infected
Previously
blood products, haemodialysis, transplantation
minor routes - saliva; sexual; vertical

68
Q

when does the Hep C antigen show up

A

6 weeks to 6 months (97% by 6 month)

69
Q

is acute Hep C serious

A

very mild acute infection
1% get jaundice

70
Q

describe Hepatitis C chronicity

A

50 - 85% become chronic
50% fatigue (10y); 25% cirrhosis (20y); 5% HCC(30y)
350 000 to 500 000 people die each year from hepatitis C-related liver diseases.

71
Q

what percent of HCV get cirrhosis after chronicity

A

25% after 10 years

72
Q

what percent of HCV get HCC after chronicity

A

5%

73
Q

if a patient is on interferon alpha and Ribavirin

A

hep C (outdated)

74
Q

what drugs have historically been used for Hep C

A

Ribavirin and Alpha Interferon

75
Q

which hep virus has there been recent cures and targets for elimination by

A

hep C

76
Q

how can we reduce Hep C (4)

A

safe IV drug use with good hygeien control
cures
more screening and protection
find a vaccine

77
Q

which hep virus has a large 10 gene genome

A

Hep C

78
Q

which antigen is responsible for Hep C attachment to host cells

A

E2

79
Q

which hepatitis virus causes epidemics in middle aged patients

A

Hep E

80
Q

whats the incubation period for Hep E

A

6 weeks

81
Q

which group has particularly high mortality/chronicity with hep E

A

pregnancy and immunocomprimsied

82
Q

which hepatitis virus has high mortality with pregnancy

A

hep E

83
Q

how is Hep E mainly spread

A

food contamination epidemics

84
Q

how do we diagnose Hep E

A

PCR or IgM or IgG serology

85
Q

how do we reduce Hep E

A

good hygiene, cooking food thouroughly, no vaccine, observe for liver problems

86
Q

where is the liver positioned

A

mid right abdomen to upper left abdomen
Infront of stomach and bile duct

87
Q

what vessels provide oxygenated and non-oxygenated blood to the liver

A

proper hepatic artery = oxygenated
hepatic portal vein = deoxygenated

88
Q

what does the portal vein carry and from where

A

deoxygenated blood from
SI, LI, pancreas and spleen
oxygen been used in these organs and blood travels through liver

89
Q

how does fat stimulate biliary secretion

A

fat detected in liver = release of CCK
CCK causes gall bladder constriction
presses out bile into the small intestine

90
Q

what shape are hepatocytes

A

hexagonal

91
Q

what is the structure of liver tissue

A

haxagonal hepatocytes
surrounded by portal triads in the corner
with branch of bile duct, portal vein and portal artery

92
Q

what are portal triads

A

triad of hepatic portal vein, hepatic artery and bile duct
found in corners of hepatocytes

93
Q

the liver have ~500 functions, give the main ones

A

Detoxification: Filters & cleans blood of waste products (drugs, hormones) - ammonia (excess = swelling brain = confusion, first function that goes with liver disease)
Immune functions: Fights infections and diseases (RE system)
Involved in Synthesis of clotting factors, proteins, enzymes, glycogen and fats
Production of bile & breakdown of bilirubin
Energy storage (glycogen and fats)
Regulation of fat metabolism
Ability to regenerate

94
Q

how might liver failure result in confusion

A

liver is responsible for detoxification of ammonia
if not occurring, ammonia builds up
causes swelling of the brain
presses on parts of the brain = confusion

95
Q

what is one of the first signs of liver failure

A

build-up of ammonia = confusion

96
Q

give 2 ways that liver failure means a pt is more prone to bleeding

A

1: cirrhosis = portal hypertension = splenomegaly = increased platelet destruction = less platelets = reduced primary haemoastasis

2: liver is site of vitamin K dependant clotting factor production = reduced this = reduced clotting factors = reduced Extrinisc and intrinsic pathways of secondary haemostasia

97
Q

give 4 ways liver disease is classified

A

By time line: Acute vs chronic
By pattern: Hepatic vs cholestatic (more to do with bile ducts) vs mixed
By presentation: asymptomatic vs symptoms
By severity: cirrhotic vs non-cirrhotic

98
Q

compare hepatic and cholestatic liver disease

A

h = liver tissue
c = more to do with bile ducts
most are mixed

99
Q

give 4 ways we might get acute liver injury

A

Hepatitis A, B or E
Epstein Barr Virus
drug overdose = paracetamol
vascular problems e.g., hepatic thrombosis

100
Q

compare acute liver damage and acute liver failure

A

damage = recovery is likely
failure = complete lack of function = need transplant

101
Q

give some causes of chronic liver damage, and what might this lead to

A

alcohol
viral (hep B,C)
autoimmune
Vascular
metabolic = NAFLD, iron, copper
leads to cirrhosis and chronic liver failure

102
Q

give some examples of presenting factors of acute liver injury

A

Asymptomatic (mainly)
abnormal LFTs &coagulopathy
Malaise, nausea, anorexia
Jaundice
Confusion – think ALF !
Bleeding - rare
Upper right Liver pain - rare

103
Q

give some signs and symptoms of chronic liver damage

A

abnormal LFTs
hepatomegaly,
malaise, abdo discomfort
itching
Ascites, oedema
Haematemesis (varices)
Easy bruising (coagulopathy)
Jaundice
Confusion
Anorexia, wasting

104
Q

give some important markers tested in LFTs (5)

A

LFT = liver function tests
Albumin
ALT – Alanine Aminotransferase
AST – Aspartate Aminotransferase
Bilirubin
Globulin

105
Q

what is indicative of ALT and AST increase to 1000’s from blood tests

A

liver failure

106
Q

what two proteins found in the blood would be in the thousands with liver failure

A

ALT and AST

107
Q

what two liver enzymes are increased when drinking alcohol

A

ALT and AST

108
Q

what 2 blood tests can be done, other than enzyme/protein markers, to test for ALF

A

platelet count
INR

109
Q

what is jaundice (2)

A

yellow pigmented sclera and skin
due to build of unconjugated bilirubin in the blood

110
Q

what 2 things can be the cause of jaundice

A

increased breakdown on RBC = increased bilirubin
liver failure = reduced conjugation of bilirubin

111
Q

what does pale faces and dark urine mean

A

reduced steroicobilogen
reduced bilirubin conjugation = liver failure

112
Q

briefly explain the breakdown of haemoglobin and metabolism of bilirubin

A

haemoglobin = haem and globin (in spleen)
haem = iron and bilirubin (liver or spleen)
unconjugated biliburin attached to albumin is conjugated in liver
travels down intestine, 10% reabsorbed, most is converted to sterocobiligen = brown pigment in feces
of the re-absorbed 10%, half is metabolised in kidney as urobiligen (yellow pigment in urine)

113
Q

why does dark urine and pale feces indicate liver disease

A

post-hepatic jaundice
reduced conjugated bilirubin = reduced sterocobiligen= brown pigment in faeces

reduced liver metabolism of bilirubin = increased renal metabolism = increased urobiligen = darker urine

114
Q

what is and what causes pre-hepatic jaundice

A

jaundice caused by things other than liver
increased substrate = more RBC breakdown
splenomegaly, thallasaemia, sickle cell
Haemolytic anaemia
Gilbert’s syndrome
Criggler-Najjar syndrome

115
Q

what causes hepatic jaundice

A

Cirrhosis
Infiltration of the liver by tumours
Acute hepatitis
(viral, alcoholic, autoimmune, drug-induced)

116
Q

what causes post-hepatic jaundice

A

Post-hepatic, or obstructive jaundice, happens when bilirubin can’t be drained properly into the bile ducts or digestive tract because of a blockage therefor overflows into blood (and gets metabolised in kidneys more = dark urine)

117
Q

give some causes of post-hepatic jaundice

A

Gallstones
External compression:
-pancreatitis
-pancreatic tumour
-ampullary tumour

118
Q

what are the most common causes of chronic liver disease

A

NAFLD & NASH
Alcohol
Viral hepatitis (B, C - cause chronic)

119
Q

what are NAFLD and NASH

A

NAFLD = non-alcoholic fatty liver disease
NASH = nonalcoholic steatohepatitis

120
Q

compare NAFLD and NASH

A

both caused by fatty diets and have fatty liver
NAFLD = little, no inflammation
NASH = inflamationa and pre-cirrhotic hepatitis

121
Q

what is wilsons disease involved with

A

copper deposits on the liver = chronic liver damage

122
Q

give some risk factors of NAFLD

A

Hypertension, diabetes, high alcohol, obesity

123
Q

what autoimmune disease can affect the liver and who is more likely to get this

A

autoimmune hepatitis - affect more women ~ middle-aged 10:1

124
Q

what can an ultrasound of the liver look at

A

bile duct blockage
cirrhosis
big spleen
portal hypertension
Metastasis

125
Q

how many units of alcohol class as binge drinking, safe limit, hazerdous drinking

A

> 10 in one sitting = binge
<14 over three days = safe
28 = hazardous

126
Q

how many units of alcohol class as binge drinking, safe limit, hazerdous drinking

A

> 10 in one sitting = binge
<14 over three days = safe
28 = hazardous

127
Q

what is the commonest, and rising commonest cause of liver disease

A

alcoholic liver disease
NAFLD is on the rise and is often un-recognised

128
Q

why does fat cause liver damage

A

fat deposits on the liver = more likely to get blood clots
enlarged liver = need more blood supply
hypertension
cirrhosis

129
Q

what hepatitis viruses cause chronic liver damage and how many people worldwide have this

A

Only hepatitis B and C generally can cause chronic hepatitis = 500 million people worldwide are infected with Hepatitis B or C

130
Q

how can we reduce HCV

A

PREVENTION = screening blood donations, no IV drug use, wear gloves and cross contamination control

treat = 90% of pts within 8-12 weeks

no vaccine

131
Q

how can we reduce HCV

A

PREVENTION = screening blood donations, no IV drug use, wear gloves and cross contamination control

treat = 90% of pts within 8-12 weeks

no vaccine

132
Q

what year did blood donations start getting screened for e.g. hep C

A

1991

133
Q

what are the three stages of scarring of the liver

A

NCPH = non-cirrhotic portal hypertension
Often due to vascular problems in the liver
Tolerating bleeding well and clotting generally intact;
Relatively rare (patients generally aware)

Pre-cirrhotic
No effect on dental work
May be asymptomatic

Liver cirrhosis
Compensated & decompensated

134
Q

compare compensated and uncompensated cirrhosis

A

compensated= Invisible
Blood can be normal
Risk low

uncompensated= Visible
Big belly, thin limbs
Jaundice
high alcohol take
Abnormal blood tests
Risks high

135
Q

what is ascites

A

bloating and swollen tummy (liver cirrhosis)

136
Q

as time goes on, what changes with liver disease and how do we use these to score liver disease

A

bilirubin increases
albumin decreases
risk of ascites and encephalopathy increase
INR increases
used in child pugh scoring

137
Q

what is the child pugh score

A

bilirubin
albumin
INR
Ascites
Encephalopathy
use of all these factors to classify grade of cirrhosis

138
Q

what is the implication of a child-pugh score of C

A

mortality increases to 50% in two years if child-pugh C

139
Q

what is the major cancer found in liver

A

hepatocellular carcinoma

140
Q

what is palmer erythema and what is it related to

A

red palms of hands
many diseases - liver disease

141
Q

what are and what causes spider navaei

A

red marks on skin = small clumps of blood vessels which appear on the surface of the skin

found in many diseases, late cirrhosis

142
Q

what are and what causes spider navaei

A

red marks on skin = small clumps of blood vessels which appear on the surface of the skin

found in many diseases, late cirrhosis

143
Q

what does >10 spider naevi above the chest =?

A

high risk of hypertension

144
Q

why might liver damage cause Gynaecomastia

A

liver is involved in testosterone production
testosterone inhibits oestrogen
if testorone reduces and oestrogen increases, breatss may form
Gynecomastia is men growing breasts

145
Q

what is gynaecomastia

A

men growing breasts due to low testosterone and high oestrogen

146
Q

what does hypoalbuminemia cause

A

white nail beds
sign of liver disease

147
Q

what is a cause of white nail beds

A

hypoalbuminaemia
could be due to liver disease

148
Q

how might we tests for decompensation liver failure encephalopathy

A

pt will be confused
Pt may struggle with sleep cycle, change in personality, not able to concentrate, worse with infection = confusion
ask to count back from 100 in 7sor draw 5 sided star

OR test for albumin levels

149
Q

how do we treat the symptoms of liver disease (3)

A

Diuretics = removes ascites
Nutrition support
Supplements
Propranolol = reduced portal hypertension

150
Q

how does liver disease effect us as dentists

A

possible contamination of hep B
prescribing drugs metabolised in the liver
increased toxicity of drugs metabolised in the liver

151
Q

what drugs must we avoid with liver failure patients

A

NSAIDs, anticoagulants or antiplatelets - any drug that cause coagulopathies
increased DILI with Flucloxacillin and Co-Amoxyclav

152
Q

what two antibiotics ahve increased DILI

A

drug induced liver injury
Flucloxacillin and Co-Amoxyclav

153
Q

how much paracetamol is safe for patient siwht liver disease

A

3g a day, not 4

3rd BDS IHD (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions