Liver Failure Flashcards
What are the two types of liver failure?
Acute
Chronic
What causes acute liver failure? Give examples
A large insult to the liver that causes sudden failure.
e.g. paracetamol poisoning or other drug reactions
What are the outcomes of acute liver failure?
Regeneration
Sudden loss of function = Rapid death from;
Bleeding - lose ability to make clotting factors
Encephalopathy - brain damage caused by accumulation of toxins.
What causes chronic failure?
Alcohol abuse Fat accumulation Hepatitis Haemochromatosis - excess of iron Cystic fibrosis
What functions are lost in liver failure?
Metabolic function
Reduced drug metabolism
Reduced detoxifying of body fluids
Reduced conjugation of bilirubin
Synthetic function
Lack of clotting factors
Lack of plasma proteins
What are the consequences of chronic liver failure?
Cirrhosis of the liver
Cancer;
both primary - usually caused by the hepatitis virus
Secondary form metastases
What occurs in cirrhosis? (consequence of chronic failure)
Cirrhosis is a combination of healing and scarring.
Eventually, there is more damaged/fibrotic tissue in the liver than healthy tissue so the liver loses the hepatocyte architecture and therefore it’s functional abilities.
What are the signs and symptoms of cirrhosis (consequence of chronic failure)/liver failure?
None
Jaundice - less hepatocytes present to conjugate bilirubin.
Encephalopathy - inability to remove urea from the blood = brain damage.
Ascites - fluid retention
Palmar erythema
Spider naevi
Acute bleeding from oesophageal varies. Oesophageal varies occur in portal hypertension.
What tests are carried out to asses liver function?
INR
Measuring plasma protein levels
Hepatic cell enzyme levels
How do you treat liver failure?
Transplant is the only ‘cure’
Only given in exceptional circumstances so are very uncommon as they are risky procedures.
Only need a small part of a transplanted liver and it will regenerate over time.
Supportive care
In terms of dental treatment; What must be considered when treating a patient with end stage liver disease?
That they will have reduced clotting factors - prone to bleeding.
That they will not metabolise drugs effectively - prolonged effects of drugs esp sedatives.
In terms of dental treatment; what measures must you take when giving a patient medication (metabolic consequences)?
Avoid IV sedation
Reduce drug dosages
Caution when prescribing antifungals and analgesics
