Liver and Biliary System Disease Flashcards
What are the main functions of the liver?
Digestion: Bile production
Storage: Glycogen, vitamins (A, B12, D, E, K), copper, iron
Synthesis: Coagulation factors, albumin, thrombopoietin, IGF-1
Breakdown: Drugs, alcohol, toxins, ammonia, bilirubin
Immune: Blood filtration, Kupffer cells
Metabolism: Carbohydrate, protein, lipids
Regeneration capacity
What is the blood supply to the liver?
Hepatic artery (25%)
Hepatic portal vein (75%): Carries nutrient-rich blood from GI tract
What are the main components of liver lobules?
Hepatocytes
Portal triad (arteriole, venule, bile duct)
Central vein
List causes of acute liver failure.
Paracetamol overdose
Viral hepatitis (A, B, E)
What are the symptoms of liver disease?
Cachexia
Encephalopathy
Jaundice
Excoriations
Coagulopathy
Bruising
Ascites
Peripheral oedema
Palmar erythema
Gynaecomastia
How is paracetamol overdose managed?
Critical care
NAC (N-acetylcysteine)
Supportive measures: IV fluids, glucose, vitamin K, blood products
Liver transplant consideration
What is the maximum daily dose of paracetamol for an adult?
4000 mg in 24 hours (2 tablets every 4-6 hours)
Body weight <50kg =2000 mg in 24 hours (1 tablet every 4-6 hours)
What are the symptoms of paracetamol overdose?
Nausea and vomiting (first 24 hours)
Right upper abdominal pain (2-3 days)
Signs of acute liver failure (3-4 days)
What are the causes of chronic liver failure?
Alcohol
Non-alcoholic fatty liver disease (NAFLD)
Viral hepatitis (B, C)
Other causes (haemochromatosis, autoimmune, Wilson’s disease)
What is cirrhosis?
Cirrhosis is characterized by chronic inflammation and damage to liver cells, leading to fibrosis and loss of function
What is the Child-Pugh classification used for?
The Child-Pugh classification grades the severity of cirrhosis
It helps in assessing prognosis and treatment options.
What is portal hypertension?
Increased resistance to hepatic portal vein blood flow leading to back pressure in the portal system
What is non-alcoholic fatty liver disease (NAFLD)?
Excessive fat deposition in liver tissue resulting in impaired hepatocyte function
Name the most common infectious causes of chronic liver disease.
Hepatitis B (vaccine available, antiviral treatment)
Hepatitis C (effective antiviral treatment, no vaccine)
Mention other causes of chronic liver disease
Haemochromatosis: Inherited condition causing “iron overload” in the liver and other organs.
Autoimmune Hepatitis: Immune system attacks hepatocytes with antibodies.
Wilson’s Disease: Inherited condition leading to “copper overload” in the liver and other organs.
What are the dental implications of liver disease?
Bleeding risk
Reduced coagulation factor production
Impaired drug metabolism
Oral cancer risk
What blood tests are commonly used to assess liver disease?
Full Blood Count (FBC)
Liver Function Test (LFT)
Coagulation screen
INR
True or False: Hepatitis B has an available vaccine.
True
Fill in the blank: Chronic liver failure can progress to _______.
cirrhosis
Cirrhosis represents the end-stage of chronic liver disease.
What is the primary function of the biliary system?
Production and delivery of bile and pancreatic enzymes
What is bile?
Fluid that emulsifies lipids to aid in digestion and absorption of fat from diet
Which organ produces bile?
Liver
What is the role of the gallbladder?
Stores and concentrates bile, releases bile when fat is detected in small intestine
What does the common bile duct do?
Carries bile to duodenum
What enzymes does the pancreas produce?
Lipase
Amylase
Trypsin
What is the duodenum?
First part of small intestine
What are the main components of bile?
Water (97%)
Bile pigments (conjugated bilirubin)
Bile salts
Cholesterol
Phospholipids
What happens when there is a blockage to the flow of bile?
Build up of bilirubin in blood circulation resulting in jaundice
How is bilirubin formed?
From breakdown of haem in RBCs (120 days)
What role do hepatocytes play in bilirubin processing?
Conjugate bilirubin and then excrete it in bile
How does bilirubin exit the body?
Excreted into duodenum
Exits body in faeces as stercobilin
Small percentage exits in urine as urobilin
What is jaundice?
Yellowish discoloration of skin or sclera due to high levels of bilirubin in blood
What are the causes of jaundice?
Pre-hepatic
Intra-hepatic
Post-hepatic
What are examples of pre-hepatic causes of jaundice?
Increased RBC breakdown
Hemolytic anemia
Malaria
What are examples of intra-hepatic causes of jaundice?
Alcoholic hepatitis
Viral hepatitis
Cirrhosis
HCC (Hepatocellular carcinoma)
What are examples of post-hepatic causes of jaundice?
Gallstones
Pancreatic cancer
What are symptoms associated with jaundice?
Pale stools
Dark urine
What are gallstones?
Small stones that form in gallbladder and can block flow of bile
What do gallstones form from?
Concentrated bile salts
What are the risk factors for gallstones?
Fair
Female
Forty
Fat
What are the symptoms of gallstones?
Can be asymptomatic or painful
What can happen if gallstones block the flow of bile?
Pain (especially after fatty foods)
Jaundice
Pancreatitis
What imaging techniques are used for gallstones?
Ultrasound
CT scan
ERCP (Endoscopic Retrograde Cholangio-Pancreatography)
What is the treatment for gallstones?
Laparoscopic cholecystectomy
What is the primary organ located deep within the upper abdomen?
Pancreas
The pancreas has both exocrine and endocrine functions.
What are the exocrine functions of the pancreas?
Into pancreatic duct:
Lipase
Amylase
Trypsin
These enzymes aid in digestion.
What are the endocrine functions of the pancreas?
Into bloodstream:
Insulin
Glucagon
These hormones regulate blood sugar levels.
What type of cancer is most commonly associated with the pancreas?
Adenocarcinoma
This type accounts for the majority of pancreatic cancer diagnoses.
What age group is most commonly diagnosed with pancreatic cancer?
60 - 80 years old
This age range accounts for 80% of diagnoses.
What is the prognosis for pancreatic cancer?
Poor due to late detection and early metastatic spread.
What can be a symptom of pancreatic cancer related to bile duct compression?
Post-hepatic jaundice
This occurs due to the compression of the common bile duct.
What are the management options for pancreatic cancer?
Management options include:
Palliative care (stent)
Chemotherapy
Surgery (Whipple’s procedure)
