Liver and Gall Bladder Disease

Question 1

What is principle blood flow - arterial and venous

Answer 1

Arterial: heart –> abdo artery –> hepatic artery –> liver
Venous: liver –> hepatic veins –> inferior vena cava –> heart

Question 2

What is portal circulation?

Answer 2

Venous blood carried from GI tract to liver - supply liver w/ metabolic substance

Question 3

Function of liver?

Answer 3

1. Detoxification
2. Conjugation bile
3. Synthesis clotting factors
4. Others: immune function, regulation fat metabolism

Question 4

Acute vs chronic liver injury?

Answer 4

Acute: viral, drugs, vascular
Chronic: viral, alcohol, autoimmune, vascular

Question 5

Differences in presentation between chronic and acute liver injury?

Answer 5

Acute - may be asymptomatic - abnormal LFTs and coagulopathy - may malaise, nausea, jaundice

Chronic - abnormal LFTs, malaise, abdo discomfort, ascites, jaundice, confusion

Question 6

What does LFT measure?

Answer 6

Albumin levels
Bilirubin
Protein levels

Question 7

What is jaundice?

Answer 7

Increase bilirubin causing yellowing skin/ sclera

Question 8

What is bilirubin and how is it metabolised/ excreted?

Answer 8

Breakdown of haemoglobin

Metabolised in liver excreted via intestine (then renally)

Question 9

Causes pre, post and intra-hepatic jaundice?

Answer 9

Pre - haemolysis
Intra- cirrhosis, hepatitis, infiltration by tumour
Post - blockage bile duct - gall stones

Question 10

Common cause chronic liver disease?

Answer 10

Alcohol, non-alcohol steatohepatits (NASH), viral hepatits

Less common - autoimmune, metabolic, vascular (budd-chiari)

Question 11

Cause chronic viral hepatits?

Answer 11

B and C

Question 12

Differences between hep B and C

Answer 12

Hep B: DNA virus, persist in liver even if cleared blood- reactivated, vertical/ sexual transmission, vaccine available, long term tx available

Hep C: RNA virus, transmitted IVDA, once cleared = clear, poss reinfection as no immunity, no vaccination, time limited tx

Question 13

What is cirrhosis of the liver and what does it cause?

Answer 13

Chronic damage to liver - cause irreversible changes - scar tissue replaced healthy tissue
Cause portal hypertension due to increase resistance to blood through via liver

Question 14

Difference between compensated and uncompensated liver disease?

Answer 14

Compensated - invisible. blood normal, low risk

Uncompensated - visible, abnormal blood test, high risk

Question 15

Complication of chronic liver disease?

Answer 15

GI bleed due portal hypertension 
Jaundice
Hepatic encephalopathy
Renal impairment 
Coagulopathy
Infection

Question 16

Signs of chronic liver disease?

Answer 16

Jangle C
Jaundice
Ascites
Spider Naevi
Gynaecomastia 
Leukconychia 
Palmar erythemia
Clubbing

Question 17

Relationship between portal hypertension and platelet?

Answer 17

Cause splenic sequestration of platelets = thrombocytopenia

Question 18

What is hepatic encephalopathy - how is it recognised and how test?

Answer 18

Symptom of decompensation -confusion
Signs: confusion, change personality
Testing: 5-star draw, number connection test

Question 19

Tx liver disease?

Answer 19

Diuretic, supplement, propanolol (beta blocker)

Specific: antiviral, immunosuppression

Question 20

How does liver disease impact dentistry?

Answer 20

Potential for increased bleeding risk
Be aware of infection risks 
Caution prescribing medication metabolised in the liver
Anaesthetics careful 
Avoid NSAIDs