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BDS2 BAMS Diseases of Human Systems > Liver disease > Flashcards

Liver disease Flashcards

understand the roles of the liver and implications and signs of liver disease

1
Q

where is the liver in the abdonmen?

A

upper right quadrant (left hypochondriac)

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2
Q

what are the functions of the liver?

6

A
  1. digestion (produces bile)
  2. storage (glycogen, copper, iron, vitamins A,B12, D, E, K)
  3. synthetic (coagulation factors, albumin, thrombopoeitin, IGF-1)
  4. breakdown (drugs, alcohol, toxins, ammonia, bilirubin)
  5. immune (filtration of blood, kupffer cells)
  6. metabolism (carbohydrate, protein, lipids)
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3
Q

what is the blood supply to the liver?

2

A
  • hepatic artery (25%)
  • hepatic portal vein (75% from GI tract)
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4
Q

where does the blood from the liver drain to?

A

hepatic vein

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5
Q

describe the structure of the liver

A
  • arranged into lobules (functional unuits)
  • portal triad (arteriole, venule, bile duct)
  • central vein in centre of lobule
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6
Q

what are the main cells called in the liver lobules?

A

hepatocytes

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7
Q

what is the portal triad in the liver comprised of?

3

A
  • arteriole from hepatic artery
  • venule from hepatic portal vein
  • bile duct leaving liver to bile duct
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8
Q

what are the functional units of the liver called?

A

lobules

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9
Q

how does liver disease occur?

A

damage to the hepatocytes

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10
Q

what is liver failure?

A

the loss of important functions of the liver

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11
Q

what can cause acute liver failure?

2

A
  • paracetamol overdose
  • viral hepatitis (A,B,E)
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12
Q

what can cause chronic liver failure?

4

A
  • alcohol
  • viral hepatitis (B,C)
  • non-alcohol fatty liver disease (NAFLD)
  • other - haemochromatosis, autoimmune hepatitis, Wilson’s disease, cystic fibrosis
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13
Q

what are some signs and symptoms of liver disease?

10

A
  • cachexia - wasting of body and muscles due to impaired metabolic funciton
  • encephalopathy - brain disturbance due to build up of ammonia
  • jaundice - build up of bilirubin
  • excoriations - scratches on skin due to itching
  • coagulopathy - easy bleeded due to loss of TPO and coagulation factors
  • bruising - due to easy bleeding
  • ascites - fluid in abdomen due to reduced albumin production = decreased oncotic pressure
  • 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 (increased oestrogen levels)
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14
Q

how do you manage acute liver failure?

4

A
  • critical care (very unwell)
  • supportive measures and invavsive monitoring (Iv fluids, IV glucose, vitamin K, blood products)
  • NAC (N-acetylcystein) if paracetamol overdose (prevents hepatocyte necrosis)
  • liver transplant - early consideration
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15
Q

what is the maximum dose of paracetamol you can take in 24 hours if adult body weight >50kg?

A

4000mg = 8 500mg tablets (2 tablets every 4-6 hours)

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16
Q

what is the maximum dose of paracetamol you can take in 24 hours if adult body weight <50kg?

A

2000mg = 4 500mg tablets (1 tablet every 4-6 hours)

17
Q

what is the product of broken down paracetamol, what can it cause and what drug can prevent it?

2

A

NAPQI
* causes hepatocyte necrosis (NAC prevents this)

18
Q

what are the symptoms of paracetamol overdose after 24 hours, 2-3 days and 3-4 days?

A
  • 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
19
Q

what is cirrhosis?

A

end stage chronic liver failure
* chronic inflammation and damage to liver cells
* damaged cells are replaced with scar tissue (fibrosis)

20
Q

what are the stages of chronic liver disease?

5

A
  1. healthy
  2. staetosis inflammation
  3. fibrosis
  4. cirrhosis
  5. HCC (HepatoCellular Carcinoma)
21
Q

until what stage of chronic liver disease can the liver repair itself?

A

until fibrosis of the liver

22
Q

how do you measure the severity of chronic liver disease? what are the different classes?

A

Child’s-Pugh classification
* A, B, C (C is most severe)

23
Q

what does fibrosis of the liver lead to?

A
  • increased resistance to the hepatic portal vein blood blow
  • results in back pressure of blood in the portal system - portal hypertension
  • causes varices (swollen blood vessels) - often at lower part of oesophagus
  • high risk of vessel bursting = variceal bleed
24
Q

what are the stages of alcohol related liver disease?

3

A
  1. alcohol fatty liver
  2. alcohol hepatitis
  3. cirrhosis
25
Q

what are the dental implications of alcohol?

6

A
  • oral cancer
  • tooth erosion (NCTSL - non-carious tooth surface loss)
  • staining
  • trauma risk
  • caries
  • oral hygiene
26
Q

what are the other health risks of alcohol-related liver disease?

7

A
  • alcohol dependence and withdrawal
  • cardiovascular disease
  • stroke
  • oesophageal, stomach and bowel cancer
  • dementia
  • depression
  • pancreatitis
27
Q

what is non-alcoholic fatty liver disease?

A

exessive fat deposition in liver tissue leading to impaired hepatocyte function

28
Q

what are the stages of non-alcoholic fatty liver disease?

5

A
  1. healthy
  2. fatty liver
  3. steatohepatitis
  4. fibrosis
  5. cirrhosis
29
Q

what is factors are associated with non-alcoholic fatty liver disease?

6

A
  • obesity
  • type 2 diabetes
  • poor diet
  • sedentary lifestyle
  • smoking
  • hypertension
30
Q

how is non-alcoholic fatty liver disease managed?

3

A
  • weight loss
  • control of cholesterol
  • reducing alcohol intake
31
Q

what is viral hepatitis? how does it affect the liver?

A

blood borne viruses that can be transmitted sexually, vertically (mother to child) and IV drug use
* causes chronic liver disease by infecting hepatocytes, damaging them, resulting in loss of function

32
Q

what are the dental implications of liver disease?

3

A
  • increased bleeding risk = reduced coagulation factor and thrombopoietin (TPO), and increased breakdown of platelets in spleen
  • impaired drug metabolism = less plasma proteins for drug binding, more free drug in blood
  • alcohol = oral cancer risk, non-carious tooth surface loss (NCTSL), interaction with metronidazole
33
Q

what blood tests can be used to assess liver disease patients?

4

A
  • full blood count (FBC) - platelet count <50x10^9/L bad
  • liver function test (LFT) - bilirubin, albumin and liver enzymesn (for liver inflammation)
  • coagulation screen - intrinsic and extrinsic pathways of coagulation cascade
  • INR - time taken for blood to clot

BDS2 BAMS Diseases of Human Systems (16 decks)

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