Liver

Question 1

liver function

Answer 1

processes blood and breaksdown, balances and creates nutrients. metabolises drugs and produces clotting factors

Question 2

acute liver failure

Answer 2

sudden insult to liver, function lost is rapid

Question 3

aetiology of acute liver failure

Answer 3

paracetomol poisoning, toxins, cancer

Question 4

consequences of acute liver failure

Answer 4

rapid death from bleeding, encephalopathy [impairement of brain function due to high toxin level in blood]

Question 5

treatment for acute liver function

Answer 5

acetylcystein to block alternative pathways
recover over time, transplant only option

Question 6

chronic liver failure

Answer 6

occurs over many years

Question 7

aetiology of chronic liver failure

Answer 7

hepatitis, alcohol abuse, toxins, autoimmune disease

Question 8

consequences of chronic liver failure

Answer 8

cirrhosis, ascites, oesophageal varices

Question 9

cirrhosis

Answer 9

damage, fibrosis and regeneration of liver structure, portion of liver lost each recovery
gradual loss of liver, loss of normal function

Question 10

cirrhosis aetiology

Answer 10

alcohol, biliary cirrhosis, viral disease, autoimmune, hepatitis, haemocrhomatosis, cystic fibrosis
more than one cause

Question 11

cirrhosis signs/symptoms

Answer 11

often none, acute bleed, jaundice, oedema, ascities, encephalopathy
spider naevi + palmar erythema [redness]
portal hypeetension, hepatic dysfunction

Question 12

ascites

Answer 12

fluid accumulating in peritoneal, around bowel
high portal venous pressure, low plasma protein synthesis
needs manual draining
cause - build up of fluid moving into tissue

Question 13

oesophageal varices

Answer 13

dilations of little veins at end of oesophagus
build-up of blood products, could rupture when swallowing, internal bleeding = death

Question 14

hepatitis

Answer 14

inflammation of liver, function affected
through virus, toxins, medications
fever, weight loss, jaundice, none
conseq - cirrhosis, malfunction, jaundice

Question 15

liver function tests

Answer 15

hepatic cell enzyme levels [ALT, GGT] = raised in liver inflammation
INR = synthesis of clotting factor, if not 1, significant liver dysfunction, not enough clotting factors [not on warfarin]

Question 16

management of liver failure

Answer 16

very little, identify risk, reduce damage
supportive, transplant [need abstainance]
- risky, high change of bleed/death
artificial liver systems

Question 17

consequences of liver failure

Answer 17

too much fluid in brain, cerebral oedema
drug metabolism different
clotting factors too little, bleeding problems
infections, kidney failure

Question 18

liver disease and dental aspecta

Answer 18

end stage - clotting disorder and abnormal drug metabolism [extractions]
prolonged sedative effect, avoid IV
reduce drug dose - careful antifungals, use paracetmol, NSAIDS INCREASE BLEEDING RISK
bleeding increased
more prone to infections
no issues with LA

Question 19

extractions and liver disease

Answer 19

lower clotting ability, higher chance of bleeding
apply pressure, haemostatic gauze, suture gums
prescribe paracetomol not NSAIDS

Question 20

jaundice

Answer 20

skin, whites of eyes turn yellow. sign of liver disease
accumulation of bilirubin in the skin, not metabolised properly

Question 21

haem circulation + bilirubin

Answer 21

haem from RBC is converted t bilirubin.
needs conjugated and secreted from liver to form bile, if not, it will go into blood and skin and present as jaundice
if conjugated - into bile

Question 22

3 classifications of jaundice

Answer 22

pre-hepatic - incrased haem load [autoimmune, spleen, abnormal RBC]
hepatic - liver cell failure [cirrhosis, hepatitis]
post-hepatic - biliary, gall bladder, pancreatic disease

Question 23

pre-hepatic jaundice

Answer 23

excess bilirubin, accumulation in blood
due to factors before liver metabolism
haemolytic anaemia, post transfusion, neonatal

Question 24

hepatic jaundice

Answer 24

issues with hepatic cell, not conjugated passed into bowel or blood. no pigment in stool/urine
due to liver failure - cirrhosis, drug induced
no metabolism of RBC

Question 25

post-hepatic jaundice

Answer 25

bilirubin conjugated, blockage causes backflow, pale stools/dark urine
obstruction - biliary sclerosis, gall stones, pancreatic carcinoma

Question 26

clinical features of jaundice

Answer 26

colour changes in urine / faeces
pale stool/dark urine = post hepatic
urine/stool normal = pre hepatic

Question 27

gall bladder

Answer 27

accumulation site for bile being produced, stored until needed

Question 28

gall stones

Answer 28

block biliary tree, cause jaundice, inflammation

Question 29

acute cholecystis

Answer 29

inflammation of gall bladder

Question 30

symptoms of gall stones

Answer 30

pain in shoulder tip, abdominal pain on right radiating to back, pain by eating fatty food

Question 31

investigations for jaundice

Answer 31

ultrasound - bile channels, biliary tree
radiograph - shows gall stones
ERCP - cannula, dye injected, contrast of biliarybtree

Question 32

cholangiocarcinoma and pancreatic cancer

Answer 32

tumour blocking biliary tree / pancreas
both obstructing biliary tree

Question 33

pancreatic disease

Answer 33

secretions blocking pancreatic pathways
cystic fibrosis, diabetes
pancreatic maligancy = poor prognosis

Question 34

management of jaundice

Answer 34

pre hep - identify and treat cause
post - remove obstruction
biliary tree stent
prevent gall stone recurrence - remove gall bladder, low cholesterol diet

Question 35

neonatal jaundice

Answer 35

birth trauma, premature, brain-blood barrier not formed
serious
managed by phototherpay to break down bilirubin and pass through kidney, blue light

Question 36

hepatitis C in mouth

Answer 36

bleeding issues, predisposed to white/red ulcerations in mouth
strogen syndrome