Liver Disease Flashcards
Liver is the:
How many lobes does liver have?
Where is it located?
What is its blood supply?
Second largest organ in the body
Has Four lobes
Located in right hypochondrium
Blood supply - portal and hepatic vein and hepatic artery
First pass metabolism centre
What are the four lobes of the liver?
Right lobe
Left lobe
Caudate lobe
Quadrate lobe
What are the functions of the liver?
(4)
Metabolism, breakdown and excretion of drugs + endogenous products
Production of albumin, blood clotting factors, complement, transporter proteins, cholesterol + bile components
Storage of substances eg vitamin A, D, E + K, B12, folate
Maintenance of body homeostasis by regulating glucose and cholesterol blood levels
Liver disease
Causes problems + interferes with liver function
Many causes
5th common cause of death
Liver disease
CAUSES?
(4)
1) infections - viral - Hep A,B,C,D,E , EBV, CMV
Bacterial - TB, syphilis
Parasitic - malaria
2) toxic and drugs - drug misuse -paracetamol + ecstasy
- alcohol
3) Metabolic:
Non alcoholic fatty liver disease (overweight/obese, type 2 diabetes, HBP, hypercholesterolaemia)
Wilson’s disease
Haemochromatosis
4) Autoimmune - SLE , Primary biliary cirrhosis (PBC)
Liver disease
Acute and chronic
What is compensated liver disease?
What is decompensated liver disease?
COMPENSATED = liver is coping with working at a reduced capacity
DECOMPENSATED = liver is failing to cope with functional demands
Liver disease
Signs and symptoms of ACUTE LIVER DISEASE
Loss of appetite
Weight loss
Jaundice
Liver disease
Signs and symptoms of CHRONIC LIVER DISEASE
Spider naevi
Palmar erythema
Clubbing
Jaundice
Oedema / ascites ( swelling of tummy )
What is Jaundice?
What are the three types of jaundice?
Yellowing of skin and sclerae due to build up of bilirubin in the blood and body’s tissues
Types of jaundice:
1) Pre-hepatic - Sickle cell anaemia, Thalassaemia
2) Intra-hepatic - Hepatitis, alcohol, glandular fever, drug misuse, cirrhosis, Gilbert’s syndrome
3) Post-hepatic - Gallstones, tumours
What are the symptoms of LIVER FAILURE?
Bleeding/ Bruising
Hypoglycaemia
Infections
Ascites
encephalopathy
Cirrhosis
What does it result from?
What are the causes of cirrhosis?
Results from necrosis of liver cells followed by fibrosis and nodule formation -> interference of blood flow through liver and loss of liver function
Cirrhosis is a histological diagnosis made by biopsy
Causes :
Common - alcohol, viral - hep B and C
Less common - autoimmune, drugs, haemochromatosis, Wilson’s disease
Investigations for liver cirrhosis
Blood tests - LFT’s - ALT, AST, GGT, bilirubin, albumin
Imaging tests ( USS - ultrasound, CT, MRI)
Liver biopsy
Alcohol-related liver disease
What are the complications?
Signs and symptoms?
Complications = Alcoholic hepatitis + cirrhosis
Signs and symptoms - feeling sick
weight loss
loss of appetite
jaundice
Swelling in tummy and ankles
Confusion and drowsiness
Vomiting blood or passing blood in stools
Non alcoholic fatty liver disease
What are the four stages?
Similar to ARLD
Build up of fat within liver cells ( overweight, obese, HBP, hypercholesterolaemia, type 2 diabetes )
4 stages:
1) Steatosis
2) Non alcoholic steatohepatitis
3) Fibrosis
4) Cirrhosis
Gallstones
RISKS
What are the risks for getting gallstones?
Five Fs
Gallstones signs and symptoms
Central tummy pain (intermittent or persistent)
Jaundice
Fever
Gallstones diagnosis
Bloods,
USS
Other imaging
Gallstones differential diagnoses
Treatment
Treatment - depends on severity of disease
Hepatitis B
What does hepatitis mean?
Is it an acute or chronic disease?
Can hepadnavirus survive outside body?
How is Hep B transmitted?
How prevented?
Hepatitis = inflammation of liver
Hep B is both acute and chronic disease
VIRAL hepatitis
Hepadnavirus can survive outside body for at least 7 days
Hep B transmitted through contact of blood or other bodily fluids of an infected person
Important occupational hazard for health workers
Prevention : vaccine
Hepatitis C
Is acute or chronic?
Are hep B or Hep C more likely to develop chronic infection?
How is Hep C transmitted?
Treatment?
Hep C can be acute or chronic
VIRAL hepatitis
80% of people are asymptomatic
People with Hep C are more likely to develop chronic infection than hep B
Transmitted through contact with blood or other bodily fluids of an infected person
Important occupational hazard for health workers
NO VACCINE But anti viral medicines can cure 90% of hep C peopel
Are hep B or Hep C more likely to develop chronic infection?
Is Hep B or Hep C more common?
People with Hep C are more likely to develop chronic infection than hep B
HEP B IS MORE COMMON THAN HEP C
Symptoms of Hep B and Hep C?
Flu like symptoms
Feeling sick
Lack of appetite
Jaundice
Dental Relevance of liver disease
Cross infection risk ( Needle-stick injury )
Altered drug metabolism
Post op haemorrhage ( vitamin K and clotting factor deficiency )
Delayed wound healing
LA is safe , relative anaesthetic is preferable to iv sedation with benzodiazepine
Dental relevance of liver disease
liver disease due to SLE?
Liver disease due to PBC?
Non alcoholic fatty liver disease due to type 2 diabetes or HBP?
Liver disease due to SLE :
Sjogren’s syndrome
Lichenoid reaction
Liver disease due to PBC :
Sjogren’s syndrome
Non alcoholic fatty liver disease due to type 2 diabetes or HBP:
Dry mouth???
Lichenoid reaction???
Dental relevance of liver disease
Disorders associated with an early rise in conjugated bilirubin serum levels eg Rhesus disease?
Dental hypoplasia
Green discolouration of teeth
