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Diseases of human systems > Liver disease > Flashcards

Liver disease Flashcards

1
Q

What organ can repair itself

A

Liver

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2
Q

What are some of the functions of the liver

A

Digestion (production of bile)​

Storage (glycogen, copper, iron, vitamins A, B12, D, E, K)​

Synthetic (coagulation factors, albumin, thrombopoietin, IGF-1)​

Breakdown (drugs, alcohol, toxins, ammonia, bilirubin)​

Immune (filtration of blood, Kupffer cells, “sieve”)​

Metabolism (carbohydrate, protein, lipids)

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3
Q

What things does the liver synthesise

A

Coagulation factors
Albumin
Thrombopoietin
IGF-1

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4
Q

What is the blood supply to the liver

A

Hepatic artery (25%)
Hepatic portal vein (75%)

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5
Q

What is the main cell within the liver

A

Hepatocytes

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6
Q

What shape are liver cells

A

Hexagonal shaped

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7
Q

What is the portal triad

A

Arteriole (hepatic artery)
Venule (Hepatic portal vein)
Bile duct (flows into common bile duct)

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8
Q

What does the bile duct transport

A

Bilirubin

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9
Q

What is the pathology of liver disease

A

Result of damage to the hepatocytes which leads to loss of functions

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10
Q

What can cause acute liver failure

A

Paracetamol overdose ​

Viral hepatitis (A, B, E)

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11
Q

What things cause chronic liver failure

A

Alcohol​

Viral hepatitis (B, C)​

Non-alcoholic fatty liver disease (NAFLD)​

Other (haemochromatosis, autoimmune, Wilson’s disease, cystic fibrosis…)

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12
Q

What is cachexia

A

wasting of body and muscles due to impaired metabolic function

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13
Q

What is Encephalopathy

A

Brain disfunction (caused by build up of ammonia with liver failure)

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14
Q

What are some symptoms and signs of liver disease

A

Cachexia – wasting of body and muscles due to impaired metabolic function​

Encephalopathy (brain disturbance) – build up of ammonia​

Jaundice – build up of bilirubin​

Excoriations – scratches on skin due to itching​

Coagulopathy (easy bleeding) – loss of TPO and coagulation factors​

Bruising – due to easy bleeding​

Ascites (fluid in abdomen) – reduced albumin production (decreased oncotic pressure of blood)​

Peripheral oedema – fluid in legs due to reduced albumin production (decreased oncotic pressure)​

Palmar erythema – red palms due to elevated oestrogen levels​

Gynaecomastia – development of breast tissue in males

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15
Q

How is acute liver failure treated and managed

A

Critical care (patients very unwell)​

Supportive measures and invasive monitoring​

IV fluids, IV glucose, vitamin K, blood products​

NAC (N-acetylcysteine) if paracetamol overdose​

Liver transplant – early consideration

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16
Q

How is a paracetemol overdose treated

A

NAC (N-acetylcysteine)
IV fluids/glucose
liver transplant if severe

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17
Q

What is the max paracetemol dose

A

4000mg in 24 hrs (2 tablets every 4-6 hours)

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18
Q

Why does excess paracetemol cause liver failure

A

The breakdown product (NAPQI) causes hepatocyte necrosis

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19
Q

What is NAC

A

N-acytylcysteine

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20
Q

Why is NAC given to patients who have overdosed on paracetemol

A

Prevents hepatocyte necrosis

21
Q

What are the symptoms of paracetemol overdose

A

First 24 hours: nausea and vomiting​

2-3 days: right upper abdominal pain, recurrence of nausea and vomiting​

3-4 days: signs of acute liver failure

22
Q

What is end stage liver failure called

23
Q

What is the manifestation of cirrhosis

A

Chronic inflammation and damage to liver cells​

Damaged cells are replaced with scar tissue (fibrosis)​

50% five-year survival rate

24
Q

What is HCC

A

Hepatocellular carcinoma
liver cancer

25
Can the liver repair itself once cirrhosis is reached
No
26
What can cirrhosis of the liver cause within the rest of the body
The fibrosis in the liver means increased resistance to hepatic portal vein blood flow​ ​ This results in the back pressure of blood in the portal system - portal hypertension​ ​ Causes varices (swollen blood vessels) - often at the lower part of oesophagus
27
What are the stages of the liver from healthy to cirrhosis due to liver disease
Normal Fatty liver Steatohopatitis Fibrosis Cirrhosis
27
What are the liver stages from healthy to cirrhosis with excessive alcohol use
Normal Alcoholic fatty liver Alcoholic hepatitis Cirrhosis
28
Why does hep b and c cause liver disease
They infect hepatocytes, resulting in damage and loss of function
29
What diseases cause liver failure
Hep B and C Haemochromatosis (Fe overload in liver) Autoimmune hepatitis (antibodies against hepatocytes) Wilson's disease (Cu overload in liver)
30
What are the dental implications of liver disease
**Bleeding risk ​** -Reduced coagulation factor production ​ -Reduced thrombopoietin (TPO) = thrombocytopenia​ -Increased spleen breakdown of platelets (portal hypertension) ​ **Impaired drug metabolism​** -Careful with advanced/end-stage liver disease​ -Less plasma proteins for drug binging (more free drug in blood)​ -BNF -Paracetamol safe (but consider half dose)​ -Avoid NSAIDs (antiplatelet action)​ -Intravenous sedation – avoid in severe impairment​ **Alcohol (many implications)​** -Consent​ -Oral cancer risk​ -NCTSL​ -Interaction with metronidazole = "disulfiram-like reaction"
31
What tests can be carried out to assess liver disease
Full Blood Count (FBC) -Platelet count <50 x 10*9 /L needs discussed with a senior doctor​ -? Platelet infusion Liver Function Test (LFT)​ -Bilirubin, albumin and liver enzymes (ALT, AST, ALP)​ -Gives a picture of acute inflammation in liver​ -Normal does not always mean normal liver Coagulation screen​ -Gives information about intrinsic and extrinsic pathways of coagulation cascade​ -Useful in assessing liver's synthetic function​ INR​ -Information about liver's synthetic function
32
What is the function of the biliary system
Production and delivery of bile and pancreatic enzymes
33
What is the function of the gallbladder
stores and concentrates bile, releases bile when fat is detected in small intestine
34
What is bile
fluid which emulsifies lipids to aid in the digestion and absorption of fat from diet
35
What is the composition of bile
Water (97%)​ Bile pigments (conjugated bilirubin)​ Bile salts​ Cholesterol​ Phospholipids​
36
What causes jaundice
Blockage to flow of bile = build up of bilirubin in blood circulation resulting in jaundice
37
How is bilirubin formed
Breakdown of haem
38
How is bilirubin excreted
Exits body in faeces as stercobilin​ Gives faeces brown colour​ ​ Small percentage exits body in urine as urobilin​ Gives urine yellow colour
39
What is the definition of jaundice
yellowish discolouration of skin or sclera due to high levels of bilirubin in blood
40
What diseases cause jaundice
**Pre-hepatic​** Increased RBC breakdown​ Haemolytic anaemia​ Malaria **Intra-hepatic​** Alcoholic hepatitis​ Viral hepatitis​ Cirrhosis​ HCC **Post-hepatic​** Gallstones​ Pancreatic cancer
41
What are the types of jaundice
Prehepatic Hepatic Posthepatic
42
What are the risk factors for gallstones
Fair​ Female​ Forty​ Fat
43
What are gallstones
Small stones that form in gallbladder and can block flow of bile​ Form from concentrated bile salts
44
What are some potential consequences of gallstones
​ If block flow of bile = back pressure on flow​ Pain (fatty foods = contraction of gallbladder)​ Jaundice​ Pancreatitis
45
How are gallstones treated
Ultrasound ​ CT scan​ ERCP (Endoscopic Retrograde Cholangio-Pancreatography)​ Treatment​ Laparoscopic cholecystectomy​ "lap chole"
46
Why is there a poor prognosis for pancreatic cancer
Late detection (deep in abdomen = asymptomatic)​ Early metastatic spread​ Can present as post-hepatic jaundice​ Compression of common bile duct
47
How is pancreatic cancer treated
Palliative care (stent)​ Chemotherapy​ Surgery – Whipple's procedure​
48
What age range is primarily affected by pancreatic cancer
Majority are adenocarcinoma 80% of diagnosis 60 - 80-year-olds

Diseases of human systems (9 decks)

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