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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

A

Cirrhosis

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
Q

Can the liver repair itself once cirrhosis is reached

A

No

26
Q

What can cirrhosis of the liver cause within the rest of the body

A

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
Q

What are the stages of the liver from healthy to cirrhosis due to liver disease

A

Normal
Fatty liver
Steatohopatitis
Fibrosis
Cirrhosis

27
Q

What are the liver stages from healthy to cirrhosis with excessive alcohol use

A

Normal
Alcoholic fatty liver
Alcoholic hepatitis
Cirrhosis

28
Q

Why does hep b and c cause liver disease

A

They infect hepatocytes, resulting in damage and loss of function

29
Q

What diseases cause liver failure

A

Hep B and C
Haemochromatosis (Fe overload in liver)
Autoimmune hepatitis (antibodies against hepatocytes)
Wilson’s disease (Cu overload in liver)

30
Q

What are the dental implications of liver disease

A

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
Q

What tests can be carried out to assess liver disease

A

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
Q

What is the function of the biliary system

A

Production and delivery of bile and pancreatic enzymes

33
Q

What is the function of the gallbladder

A

stores and concentrates bile, releases bile when fat is detected in small intestine

34
Q

What is bile

A

fluid which emulsifies lipids to aid in the digestion and absorption of fat from diet

35
Q

What is the composition of bile

A

Water (97%)​

Bile pigments (conjugated bilirubin)​

Bile salts​

Cholesterol​

Phospholipids​

36
Q

What causes jaundice

A

Blockage to flow of bile = build up of bilirubin in blood circulation resulting in jaundice

37
Q

How is bilirubin formed

A

Breakdown of haem

38
Q

How is bilirubin excreted

A

Exits body in faeces as stercobilin​

Gives faeces brown colour​

​

Small percentage exits body in urine as urobilin​

Gives urine yellow colour

39
Q

What is the definition of jaundice

A

yellowish discolouration of skin or sclera due to high levels of bilirubin in blood

40
Q

What diseases cause jaundice

A

Pre-hepatic​
Increased RBC breakdown​
Haemolytic anaemia​
Malaria

Intra-hepatic​
Alcoholic hepatitis​
Viral hepatitis​
Cirrhosis​
HCC

Post-hepatic​
Gallstones​
Pancreatic cancer

41
Q

What are the types of jaundice

A

Prehepatic
Hepatic
Posthepatic

42
Q

What are the risk factors for gallstones

A

Fair​

Female​

Forty​

Fat

43
Q

What are gallstones

A

Small stones that form in gallbladder and can block flow of bile​

Form from concentrated bile salts

44
Q

What are some potential consequences of gallstones

A

​

If block flow of bile = back pressure on flow​

Pain (fatty foods = contraction of gallbladder)​

Jaundice​

Pancreatitis

45
Q

How are gallstones treated

A

Ultrasound ​
CT scan​
ERCP (Endoscopic Retrograde Cholangio-Pancreatography)​

Treatment​
Laparoscopic cholecystectomy​
“lap chole”

46
Q

Why is there a poor prognosis for pancreatic cancer

A

Late detection (deep in abdomen = asymptomatic)​

Early metastatic spread​

Can present as post-hepatic jaundice​

Compression of common bile duct

47
Q

How is pancreatic cancer treated

A

Palliative care (stent)​

Chemotherapy​

Surgery – Whipple’s procedure​

48
Q

What age range is primarily affected by pancreatic cancer

A

Majority are adenocarcinoma

80% of diagnosis 60 - 80-year-olds

Diseases of human systems (7 decks)

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