liver disease

Question 1

what does the liver do?

Answer 1

The patient with liver disease presents a signi cant management challenge for the dentist because the liver plays a vital role in metabolic functions, including the secretion of bile needed for fat absorption, conversion of sugar to glyco- gen, and excretion of bilirubin, a waste product of hemo- globin metabolism Impairment of liver function can lead to abnormalities in the metabolism of amino acids, ammonia, protein, carbohydrates, and lipids (triglycer- ides and cholesterol). Many biochemical functions per- formed by the liver, such as synthesis of coagulation factors and drug metabolism, may be adversely affected in the dental patient with acute or chronic liver disease. Along with impaired drug metabolism, therefore, signi - cant bleeding may be a problem to be addressed in the dental treatment plan.1-5 In many cases, the liver dysfunc- tion will continue to progress over time. Ultimately, serious end-stage liver dysfunction or cirrhosis may result.

Question 2

what is cirrhosis?

Answer 2

Cirrhosis is the consequence of long-term damage to the liver tissues. This condition is irreversible and leads to brosis, resulting in jaundice, ascites, and portal hypertension, as well as signi cant liver dysfunction. The potential causes of viral hepatitis related cirrhosis are listed in Table 10-1

Question 3

what is hepatitis?

Answer 3

Hepatitis is in ammation of the liver that may result from infectious or other causes. Examples of hepatitis with infectious causes are viral hepatitis and that associ- ated with infectious mononucleosis, secondary syphilis, and tuberculosis. Also, noninfectious hepatitis can result from excessive or prolonged use of toxic substances: drugs (i.e., acetaminophen, alcohol, halothane, ketoconazole, methyldopa, and methotrexate) or, more commonly, alcohol.2,7-10

Question 4

what is meant by viral hepatitis?

Answer 4

Viral hepatitis is a collective term describing liver in ammation or hepatitis caused by a group of several different viruses. Three viruses, hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis C virus (HCV), cause most cases of viral hepatitis in the United States. Because hepatitis A is transmitted primarily in unsani- tary conditions, the number of annual cases has declined signi cantly in the United States in recent years as a result of vaccination programs and food safety efforts.
Unlike HAV hepatitis, infections by HBV and HCV are bloodborne and/or often persist for years, resulting in ongoing (chronic) but usually asymptomatic liver in ammation and, in some cases, scarring (cirrhosis) that leads to liver failure and/or liver cancer. Chronic hepati- tis is a major cause of liver cancer and chronic liver disease globally and in the United States.2,11

Question 5

what are normal lab tests?

Answer 5

• ALT = 7-56 IU/L
• AST = 10-40 IU/L
• Thrombin time = 15-19 s
• Prothrombin Time = 9.5-13.5 s
• INR = 0.8-1.2
• Bilirubin

Question 6

With his permission, you contact the specialist who states his hematocrit is low, INR 1.8, albumin 18 and bilirubin 139. Moreover, the ALT and GGT levels are 10 fold increased. How would you interpret these results? Howe do they affect your decision to offer dental treatment?

Answer 6

• His INR is above the 0.8-1.2 range and his hematocrit is low, indicating an increased risk of bleeding.
• His albumin (normal range is 3.4 to 5.4 g/dL) and bilirubin levels are quite high. Elevated albumin level is indicative of severe dehydration whereas high bilirubin levels may be a sign of cirrhosis or hepatitis.
• The increased ALT and GGT levels contribute to a diagnosis of liver damage.
• After interpreting the results I would postpone treatment until his condition is better controlled. If treatment was necessary, I would limit the amount/number of medications that are metabolized in the liver due its decreased function.