Liver Diseases Flashcards
1
Q
What are some functions of the Liver?
A
- Fight infection
- clean blood
- food digestion
- energy storage
- can regenerate when damaged
2
Q
What is the functional unit of the liver?
A
Hepatocyte
3
Q
What does the liver excrete/secrete?
A
- Bile Acids
- Bilirubin
4
Q
What does the liver synthesize/metabolize?
A
- Glucose-Glycogen
- Lipids
- Proteins
- Bilirubin
- Hormones
- Coagulation factors
5
Q
What does the liver detoxify?
A
- Bilirubin
- Ammonia
- Drugs
- Chemicals
6
Q
What does the liver store?
A
- Glycogen
- Lipids
- Amino acids
- Fe (iron)
- Vitamins
7
Q
What is the liver’s immunologic response?
A
- Phagocytosis
- Antibody Production
- IgA Secretion
8
Q
Bilirubin Metabolism
A
- RBCs burst and release hemoglobin (H)
- Macrophages take up Hemoglobin
- convert H to bilirubin
- Bilirubin released into plasma=Free bilirubin (bound to albumin)
- Blood passes through liver
- Hepatocytes absorb free bilirubin
- conjugate w/glucuronic acid
- Conjugated bilirubin is excreted in the bile
9
Q
Classification of Liver Diseases:
A
- Toxic injury to liver
- Infectious Agents and Parasites
- Immune Disorder
- Tumors
- Inherited
10
Q
Liver Diseases: Toxic injury to Liver
A
- Drug induced
- industrial and Enviromental toxin
- alcoholic
- Post-op hepatic dysfunction
11
Q
Liver Diseases: Infectious agents and parasites
A
- Hepatitis Virus
- Bacterial and other pathogenic agents
- parasites
12
Q
Liver Diseases: Immune Disorder
A
- Autoimmune
- Primary Biliary Cholangitis (PBC)
13
Q
Liver Diseases: Tumors
A
- Primary Malignant Tumors
- Metastatic Malignant tumors
- Benign hepatic tumors
- Tumor-like lesion
14
Q
Liver Diseases: Inherited
A
- Wilson’s Disease
- Hemochromatosis
- Inborn errors
- Alpha-1-antitrypsin deficiency
- Cyst
15
Q
Drug-Induced Liver Injury (DILI)
A
- due to prescription, OTC, and herbal
- major cause of liver disease in US and world
16
Q
Alcohol-related liver disease (ARLD)
A
- Caused by:
- Binge drinking
- causes:
- fatty liver disease
- alcoholic hepatitis
- causes:
- Chronic alcohol abuse
- causes: (more serious)
- hepatitis
- cirrhosis
- reduces ability to regenerate=permanent liver damage
- causes: (more serious)
- Binge drinking
- The more you drink above recommended limits=higher risk
- recommend:
- no more than 14 units per week (1 unit=10 mL)
- Spread across 3 or more days
- recommend:
17
Q
Post-op hepatic dysfunction
A
- Halothane
- cause hepatotoxicity by a toxic metabolite
- modern inhaled agents are:
- metabolized less by liver
- less liver injury
- Halothane hepatotoxicity
- fever or jaundice
- 7-14 days after 1 exposure
- 5-7 days after multiple
- AST & ALT 10x normal (above)
- Severe injury:
- elevated:
- serum bilirubin
- prolonged prothrombin time (PT)
- Eosinophilia
- renal insufficiency
- elevated:
- Risk factors:
- females
- >40 y.o.
- multiple exposures
- obesity
- family hx
18
Q
Primary Biliary Cholangitis (PBC)
A
- chronic liver disease
- progressive destruction of intrahepatic bile ducts
- Bile builds up in liverr→ inflammation & scarring
- Normal fxn= bile to small intestine to help digest fat and fat-soluble vitamins (A,D,E,K)
- Leads to cirrhosis
- seen w/sjogrens syndrome
19
Q
Wilson’s disease
A
- inherited
- most common sign:
- Kayser-Fleischer ring:
- Rusty brown ring around cornea
- Kayser-Fleischer ring:
- the body retains excess copper→liver does NOT release Cu into bile→ Cu builds up in liver→ damages liver→ Liver Bursts & Cu released in blood→entire body→ damages: kidneys, brain, eyes
- if not treated:
- severe brain damage
- liver failure
- death
20
Q
What is the most characteristic sign of Wilsons Disease?
A
- Kayser-Fleischer ring:
- Rusty brown ring around cornea
21
Q
Hemochromatosis
A
- most common genetic disorder in US
- Inherited condition
- body absorbs and stores to much iron
- Symptoms:
- Joint pain (most common)
- Fatigue
- lack of energy
- abdominal pain
- No sex drive
- heart problems
- iron builds up in the liver (& other organs) and causes damage
- No tx=organ failure
*
- No tx=organ failure
22
Q
If hemochromatosis is not detected and treated early enough, what serious problems can occur?
A
- Arthritis
- Liver disease
- cirrhosis, enlarged liver, liver cancer, liver failure
- Pancreas Damage
- cause diabetes
- Heart Abnormalities:
- irregular heart rhythms
- congestive heart failure
- Impotence
- early menopause
- Abnormal skin pigmentation
- gray or bronze
- Pituitary damage
- Adrenal gland damage
23
Q
What causes hemochromatosis?
A
- Defective HFE gene
- regulates the amount of iron absorbed from food
- Inherits from both parents→may develop hemochromatosis
- Inherits from only one parent→carrier
24
Q
Stages of Liver Damage
A
- Inflammation: Fatty Liver
- liver becomes:
- inflamed
- long time-permanent damage
- might cause no discomfort
- goes away if dx and treated
- tender
- enlarged
- inflamed
- liver becomes:
- Fibrosis
- scar tissue forms & replaces healthy liver tissue
- if dx and treated successfully=chance liver can heal itself
- Cirrhosis
- damage cant be reversed
- leads to liver cancer
25
Signs of Cirrhosis
* Bleed or bruise easily
* water builds up in legs or abdomen
* Jaundice
* skin and eyes are yellow
* Itchy skin
* Blood vessels leading to the liver burst bc of blockage
* more sensitive to medications & their side effects
* Toxins build up in brain
* problems with:
* concentration
* memory
* sleeping
26
What is the treatment plan when the patient is diagnosed with cirrhosis?
* Prevent condition from getting worse
* stop or slow liver damage
* Protect the remaining healthy liver tissue
27
Liver Cancer
* can develop at any stage of liver disease
* Primary Liver Cancer:
* cancer that starts in the liver
* risk factors:
* Cirrhosis
* Hepatitis B
* Males 2:1
28
What causes Liver Cancer
* Long term Hep B & C infection bc they lead to cirrhosis
* Hep B→ Liver cancer w/o cirrhosis
* Excessive alcohol use
* Obesity & Diabetes
* associated with Non-alcoholic fatty liver disease (NAFLD)
* increase the risk of liver cancer
* Inherited Metabolic diseases
* Enviromental exposure to aflatoxins
29
What are some symptoms of liver cancer?
* Fatigue
* Bloating
* Pain on the Right side of:
* upper abdomen
* back
* shoulder
* Nausea
* Loss of appetite
* Feeling full
* Weight Loss
* Weakness
* Fever
* Jaundice
30
What does liver cancer treatment depend on?
* Livers condition
* size, location, and number of tumors
* cancer has spread outside the liver
* Age
* Overall Health
31
Liver cancer Treatment Option: Has not spread and rest of liver is healthy:
* **Transplant**
* **Surgery**
* partial hepatectomy
* **Radio-frequency ablation**
* special problems to destroy cancer cells with heat
* Other options if Surgery and Transplant aren't options:
* **Cryosurgery**
* metal probe to freeze and destroy cancer cells
* **Bland embolization or chemoembolization**
* block blood supply to the tumor
* chemoembolization-after giving cancer drugs
* bland embolization: without give cancer drugs
* **Radiation Therapy:**
32
Liver Cancer Treatment Options: Spread outside the liver
* oral medication
* some cases of hepatocellular carcinoma (most common primary liver cancer)
* Clinical Trials
33
Prognosis of Tx:
* Liver Transplant
* cure liver cancer
* option for only small percentage of patients
* Surgical resections
* successful in only ⅓ of cases
34
Liver Diseases: Dental Considerations:
* Impaired Drug metabolism
* accumulation of drugs and metabolites
* toxic effect adds to hepatic damage
* Bleeding Problems-→Hemostasis
* Thrombocytopenia
* Decreased coagulation factors
* abnormal coagulation test:
* talk to physician before starting surgical tx
* avoid NSAIDs
* Substance Abuse
* Tolerance to narcotic analgesic
* Avoid addictive substances
* Diminished Liver Fxn:
* minimize/avoid drugs that are metabolized in liver
* decrease dose & increase interval if you have to use
* encephalopathy→avoid CNS depressants
