Liver and Biliary System Disease

Question 1

What are the main functions of the liver?

Answer 1

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

Question 2

What is the blood supply to the liver?

Answer 2

Hepatic artery (25%)
Hepatic portal vein (75%): Carries nutrient-rich blood from GI tract

Question 3

What are the main components of liver lobules?

Answer 3

Hepatocytes
Portal triad (arteriole, venule, bile duct)
Central vein

Question 4

List causes of acute liver failure.

Answer 4

Paracetamol overdose
Viral hepatitis (A, B, E)

Question 5

What are the symptoms of liver disease?

Answer 5

Cachexia
Encephalopathy
Jaundice
Excoriations
Coagulopathy
Bruising
Ascites
Peripheral oedema
Palmar erythema
Gynaecomastia

Question 6

How is paracetamol overdose managed?

Answer 6

Critical care
NAC (N-acetylcysteine)
Supportive measures: IV fluids, glucose, vitamin K, blood products
Liver transplant consideration

Question 7

What is the maximum daily dose of paracetamol for an adult?

Answer 7

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)

Question 8

What are the symptoms of paracetamol overdose?

Answer 8

Nausea and vomiting (first 24 hours)
Right upper abdominal pain (2-3 days)
Signs of acute liver failure (3-4 days)

Question 9

What are the causes of chronic liver failure?

Answer 9

Alcohol
Non-alcoholic fatty liver disease (NAFLD)
Viral hepatitis (B, C)
Other causes (haemochromatosis, autoimmune, Wilson’s disease)

Question 10

What is cirrhosis?

Answer 10

Cirrhosis is characterized by chronic inflammation and damage to liver cells, leading to fibrosis and loss of function

Question 11

What is the Child-Pugh classification used for?

Answer 11

The Child-Pugh classification grades the severity of cirrhosis

It helps in assessing prognosis and treatment options.

Question 12

What is portal hypertension?

Answer 12

Increased resistance to hepatic portal vein blood flow leading to back pressure in the portal system

Question 13

What is non-alcoholic fatty liver disease (NAFLD)?

Answer 13

Excessive fat deposition in liver tissue resulting in impaired hepatocyte function

Question 14

Name the most common infectious causes of chronic liver disease.

Answer 14

Hepatitis B (vaccine available, antiviral treatment)
Hepatitis C (effective antiviral treatment, no vaccine)

Question 15

Mention other causes of chronic liver disease

Answer 15

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.

Question 16

What are the dental implications of liver disease?

Answer 16

Bleeding risk
Reduced coagulation factor production
Impaired drug metabolism
Oral cancer risk

Question 17

What blood tests are commonly used to assess liver disease?

Answer 17

Full Blood Count (FBC)
Liver Function Test (LFT)
Coagulation screen
INR

Question 18

True or False: Hepatitis B has an available vaccine.

Answer 18

True

Question 19

Fill in the blank: Chronic liver failure can progress to _______.

Answer 19

cirrhosis

Cirrhosis represents the end-stage of chronic liver disease.

Question 20

What is the primary function of the biliary system?

Answer 20

Production and delivery of bile and pancreatic enzymes

Question 21

What is bile?

Answer 21

Fluid that emulsifies lipids to aid in digestion and absorption of fat from diet

Question 22

Which organ produces bile?

Answer 22

Liver

Question 23

What is the role of the gallbladder?

Answer 23

Stores and concentrates bile, releases bile when fat is detected in small intestine

Question 24

What does the common bile duct do?

Answer 24

Carries bile to duodenum

Question 25

What enzymes does the pancreas produce?

Answer 25

Lipase Amylase Trypsin

Question 26

What is the duodenum?

Answer 26

First part of small intestine

Question 27

What are the main components of bile?

Answer 27

Water (97%) Bile pigments (conjugated bilirubin) Bile salts Cholesterol Phospholipids

Question 28

What happens when there is a blockage to the flow of bile?

Answer 28

Build up of bilirubin in blood circulation resulting in jaundice

Question 29

How is bilirubin formed?

Answer 29

From breakdown of haem in RBCs (120 days)

Question 30

What role do hepatocytes play in bilirubin processing?

Answer 30

Conjugate bilirubin and then excrete it in bile

Question 31

How does bilirubin exit the body?

Answer 31

Excreted into duodenum Exits body in faeces as stercobilin Small percentage exits in urine as urobilin

Question 32

What is jaundice?

Answer 32

Yellowish discoloration of skin or sclera due to high levels of bilirubin in blood

Question 33

What are the causes of jaundice?

Answer 33

Pre-hepatic Intra-hepatic Post-hepatic

Question 34

What are examples of pre-hepatic causes of jaundice?

Answer 34

Increased RBC breakdown Hemolytic anemia Malaria

Question 35

What are examples of intra-hepatic causes of jaundice?

Answer 35

Alcoholic hepatitis Viral hepatitis Cirrhosis HCC (Hepatocellular carcinoma)

Question 36

What are examples of post-hepatic causes of jaundice?

Answer 36

Gallstones Pancreatic cancer

Question 37

What are symptoms associated with jaundice?

Answer 37

Pale stools Dark urine

Question 38

What are gallstones?

Answer 38

Small stones that form in gallbladder and can block flow of bile

Question 39

What do gallstones form from?

Answer 39

Concentrated bile salts

Question 40

What are the risk factors for gallstones?

Answer 40

Fair Female Forty Fat

Question 41

What are the symptoms of gallstones?

Answer 41

Can be asymptomatic or painful

Question 42

What can happen if gallstones block the flow of bile?

Answer 42

Pain (especially after fatty foods) Jaundice Pancreatitis

Question 43

What imaging techniques are used for gallstones?

Answer 43

Ultrasound CT scan ERCP (Endoscopic Retrograde Cholangio-Pancreatography)

Question 44

What is the treatment for gallstones?

Answer 44

Laparoscopic cholecystectomy

Question 45

What is the primary organ located deep within the upper abdomen?

Answer 45

Pancreas ## Footnote The pancreas has both exocrine and endocrine functions.

Question 46

What are the exocrine functions of the pancreas?

Answer 46

Into pancreatic duct: Lipase Amylase Trypsin ## Footnote These enzymes aid in digestion.

Question 47

What are the endocrine functions of the pancreas?

Answer 47

Into bloodstream: Insulin Glucagon ## Footnote These hormones regulate blood sugar levels.

Question 48

What type of cancer is most commonly associated with the pancreas?

Answer 48

Adenocarcinoma ## Footnote This type accounts for the majority of pancreatic cancer diagnoses.

Question 49

What age group is most commonly diagnosed with pancreatic cancer?

Answer 49

60 - 80 years old ## Footnote This age range accounts for 80% of diagnoses.

Question 50

What is the prognosis for pancreatic cancer?

Answer 50

Poor due to late detection and early metastatic spread.

Question 51

What can be a symptom of pancreatic cancer related to bile duct compression?

Answer 51

Post-hepatic jaundice ## Footnote This occurs due to the compression of the common bile duct.

Question 52

What are the management options for pancreatic cancer?

Answer 52

Management options include: Palliative care (stent) Chemotherapy Surgery (Whipple's procedure)