Liver Disease

Question 1

Is the liver the first, second or third largest organ?

Answer 1

Second

Question 2

Where is the liver located?

Answer 2

In the upper right quadrant (right hypochondrium)

Question 2

Where is the liver located?

Question 3

What are the main functions of the liver?

Answer 3

• 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)

Question 4

What are the causes of liver disease?

Answer 4

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)

Question 5

What is the difference between a compensated and a decompensated liver?

Answer 5

Compensated = liver is coping with working at reduced capacity

Decompensated = liver is failing to cope with normal functioning demands

Question 6

Signs and symptoms of acute liver disease?

Answer 6

Weight loss
Tiredness
Jaundice
Right upper quadrant pain
Confusion
Nausea and vomiting 
Tremors
Pruritus

Question 7

Signs and symptoms of chronic liver disease

Answer 7

• Spider naevi (dilated arterioles close to the skin)
• Palmar erythema
• Clubbing
• Jaundice
• Oedoma
• Signs of upper GI bleeding
• Confusion due to herpatic encephalopathy

Question 8

What is jaundice?

What are the three types?

Answer 8

Yellow skin and sclera due to the build up of bilirubin (more than 2-3mg per deci litre).

1. Pre-hepatic = excessive RBC breakdown
2. Intra-hepatic = liver cells lose their ability to conjugate bilirubin to bile
3. Post-hepatic = obstruction of biliary drainage preventing loss of bilirubin through urine

Question 9

What are the main liver failure symptoms?

Answer 9

• 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)

Question 10

What is cirrhosis and what are the main causes?

Answer 10

Cirrhosis = irreversible necrosis of liver cells leading to fibrosis and nodule formation

Main 2 causes = alcohol and virus hepatitis (B and C)

Question 11

What are the main investigations for liver disease?

Answer 11

• Blood test (liver function tests, gamma GT)
• Ultrasound
• Fibro-scans
• CT and MRI

Question 12

Is there any treatment for alcohol related liver disease?

Answer 12

No

Question 13

What are the 4 stages of non alcohol related fatty liver disease?

What are the main causes?

Answer 13

• Steatosis
• Non alcoholic steatohepatitis
• Fibrosis
• Cirrhosis

Main causes = obesity, type 2 diabetes, hypertension, hypercholesterolaemia

Question 14

How is most at risk of gall stones?

Answer 14

• Female
• Forty
• Fertile
• Fat
• Fair

Question 15

What are the investigations for gall stones?

Answer 15

1) Blood tests = looking for raised alkaline phosphatase and gamma GT
2) Ultrasonic scans

Question 16

What is the treatment for gall stones?

Answer 16

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

Question 17

What is hep b and how does it affect the liver?

Answer 17

• 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

Question 18

What is the dental relevance of liver disease?

Answer 18

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)