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Week 85 > Liver Diseases > Flashcards

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
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2
Q

What is the functional unit of the liver?

A

Hepatocyte

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3
Q

What does the liver excrete/secrete?

A
  • Bile Acids
  • Bilirubin
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4
Q

What does the liver synthesize/metabolize?

A
  • Glucose-Glycogen
  • Lipids
  • Proteins
  • Bilirubin
  • Hormones
  • Coagulation factors
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5
Q

What does the liver detoxify?

A
  • Bilirubin
  • Ammonia
  • Drugs
  • Chemicals
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6
Q

What does the liver store?

A
  • Glycogen
  • Lipids
  • Amino acids
  • Fe (iron)
  • Vitamins
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7
Q

What is the liver’s immunologic response?

A
  • Phagocytosis
  • Antibody Production
  • IgA Secretion
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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
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9
Q

Classification of Liver Diseases:

A
  • Toxic injury to liver
  • Infectious Agents and Parasites
  • Immune Disorder
  • Tumors
  • Inherited
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10
Q

Liver Diseases: Toxic injury to Liver

A
  • Drug induced
  • industrial and Enviromental toxin
  • alcoholic
  • Post-op hepatic dysfunction
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11
Q

Liver Diseases: Infectious agents and parasites

A
  • Hepatitis Virus
  • Bacterial and other pathogenic agents
  • parasites
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12
Q

Liver Diseases: Immune Disorder

A
  • Autoimmune
  • Primary Biliary Cholangitis (PBC)
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13
Q

Liver Diseases: Tumors

A
  • Primary Malignant Tumors
  • Metastatic Malignant tumors
  • Benign hepatic tumors
  • Tumor-like lesion
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14
Q

Liver Diseases: Inherited

A
  • Wilson’s Disease
  • Hemochromatosis
  • Inborn errors
  • Alpha-1-antitrypsin deficiency
  • Cyst
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15
Q

Drug-Induced Liver Injury (DILI)

A
  • due to prescription, OTC, and herbal
  • major cause of liver disease in US and world
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16
Q

Alcohol-related liver disease (ARLD)

A
  • Caused by:
    • Binge drinking
      • causes:
        • fatty liver disease
        • alcoholic hepatitis
    • Chronic alcohol abuse
      • causes: (more serious)
        • hepatitis
        • cirrhosis
      • reduces ability to regenerate=permanent liver damage
  • 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
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
  • 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
  • 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
      *
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
  1. Inflammation: Fatty Liver
    1. liver becomes:
      1. inflamed
        1. long time-permanent damage
        2. might cause no discomfort
        3. goes away if dx and treated
      2. tender
      3. enlarged
  2. Fibrosis
    1. scar tissue forms & replaces healthy liver tissue
    2. if dx and treated successfully=chance liver can heal itself
  3. Cirrhosis
    1. damage cant be reversed
    2. leads to liver cancer
25
Q

Signs of Cirrhosis

A
  • 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
Q

What is the treatment plan when the patient is diagnosed with cirrhosis?

A
  • Prevent condition from getting worse
    • stop or slow liver damage
  • Protect the remaining healthy liver tissue
27
Q

Liver Cancer

A
  • 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
Q

What causes Liver Cancer

A
  • 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
Q

What are some symptoms of liver cancer?

A
  • Fatigue
  • Bloating
  • Pain on the Right side of:
    • upper abdomen
    • back
    • shoulder
  • Nausea
  • Loss of appetite
  • Feeling full
  • Weight Loss
  • Weakness
  • Fever
  • Jaundice
30
Q

What does liver cancer treatment depend on?

A
  • Livers condition
  • size, location, and number of tumors
  • cancer has spread outside the liver
  • Age
  • Overall Health
31
Q

Liver cancer Treatment Option: Has not spread and rest of liver is healthy:

A
  • 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
Q

Liver Cancer Treatment Options: Spread outside the liver

A
  • oral medication
    • some cases of hepatocellular carcinoma (most common primary liver cancer)
  • Clinical Trials
33
Q

Prognosis of Tx:

A
  • Liver Transplant
    • cure liver cancer
    • option for only small percentage of patients
  • Surgical resections
    • successful in only ⅓ of cases
34
Q

Liver Diseases: Dental Considerations:

A
  • 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

Week 85 (8 decks)

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