Liver Disease Flashcards
Is the liver the first, second or third largest organ?
Second
Where is the liver located?
In the upper right quadrant (right hypochondrium)
Where is the liver located?
What are the main functions of the liver?
- Drug metabolism and breakdown and excretion (ammonia, urea, bilirubin, hormones and alcohol)
- Production of clotting factors
- Production of bile
- Stores for glycogen and fat soluble vitamins (A, D, E and K)
What are the causes of liver disease?
1) Infections: including viral, bacterial and parasites: hep A-E, EBV and CMV
2) Toxins and drugs: paracetamol, ecstasy, alcohol (leading to hepatitis or stenosis)
3) Metabolic: non alcoholic fatty liver disease (obesity, type 2 diabetes, hypertension), wilsons disease, hereditory haemochromatosis
4) Autoimmune (SLE, primary biliary cirrhosis, primary sclerosing cholangitis)
What is the difference between a compensated and a decompensated liver?
Compensated = liver is coping with working at reduced capacity
Decompensated = liver is failing to cope with normal functioning demands
Signs and symptoms of acute liver disease?
Weight loss Tiredness Jaundice Right upper quadrant pain Confusion Nausea and vomiting Tremors Pruritus
Signs and symptoms of chronic liver disease
- Spider naevi (dilated arterioles close to the skin)
- Palmar erythema
- Clubbing
- Jaundice
- Oedoma
- Signs of upper GI bleeding
- Confusion due to herpatic encephalopathy
What is jaundice?
What are the three types?
Yellow skin and sclera due to the build up of bilirubin (more than 2-3mg per deci litre).
- Pre-hepatic = excessive RBC breakdown
- Intra-hepatic = liver cells lose their ability to conjugate bilirubin to bile
- Post-hepatic = obstruction of biliary drainage preventing loss of bilirubin through urine
What are the main liver failure symptoms?
- Bleeding/bruising
- Hypoglycaemia (no breakdown of glycogen)
- Infection
- Ascites (high blood flow to liver leading to too much plasma coming out the hepatic artery causing swelling)
- Encephalopathy (loss of consciousness, dizziness - due to failure to excrete nitrogenous waste)
What is cirrhosis and what are the main causes?
Cirrhosis = irreversible necrosis of liver cells leading to fibrosis and nodule formation
Main 2 causes = alcohol and virus hepatitis (B and C)
What are the main investigations for liver disease?
- Blood test (liver function tests, gamma GT)
- Ultrasound
- Fibro-scans
- CT and MRI
Is there any treatment for alcohol related liver disease?
No
What are the 4 stages of non alcohol related fatty liver disease?
What are the main causes?
- Steatosis
- Non alcoholic steatohepatitis
- Fibrosis
- Cirrhosis
Main causes = obesity, type 2 diabetes, hypertension, hypercholesterolaemia
How is most at risk of gall stones?
- Female
- Forty
- Fertile
- Fat
- Fair
What are the investigations for gall stones?
1) Blood tests = looking for raised alkaline phosphatase and gamma GT
2) Ultrasonic scans
What is the treatment for gall stones?
Depends on the severity of the disease
Often patients need to avoid fatty food and if pain occurs they will undergo gall bladder surgery (to remove the gall bladder) or a coleosectomy
What is hep b and how does it affect the liver?
- DNA virus which is transmitted by contact with blood and other body fluids
- Inflammation of the liver
Symptoms = flu like symptoms, feeing sick, lack of appetite, weight loss, jaundice
What is the dental relevance of liver disease?
1) Risk of spreading the hep b to health care workers
2) Altered drug metabolism - reduce dosage given
3) Post operative haemorrhage - due to lack of clotting factors produced
4) Delayed wound healing
5) Oral manifestations (systemic lupus presenting as an oral lichenoid reaction, secondary sjorgens syndrome)
