Liver Failure Flashcards
what is acute liver failure?
sudden loss of liver function
how can rapid death occur in someone suffering from acute liver failure?
- bleeding
* encephalopathy
why does excessive bleeding occur in liver failure patients?
the ability to make proteins and clotting factors is reduced/stops
why is meant by encephalopathy?
body has no ability to decontaminate blood toxins which leads to IMPAIRMENT OF BRAIN FUNCTION
what are examples of diseases that fall under the ‘chronic’ liver disease spectrum?
- cirrhosis
- primary liver cancer
- secondary liver cancer
what can cause cirrhosis of the liver?
- alcohol
- Primary Biliary Cirrhosis (autoimmune)
- viral disease
- autoimmune chronic hepatitis
- cystic fibrosis
what are the signs and symptoms of cirrhosis?
- often NONE
- acute bleeding
- jaundice
- oedema & ascites
- encephalopathy
- spider naïve
what is meant by ascites?
fluid accumulation in the peritoneal area
what can happen due to ascites?
- high portal venous pressure
* low plasma protein synthesis
what are osophageal varices?
dilation of little veins at the bottom end of oesophagus
what functions of the liver are lost during liver failure?
- loss of synthetic function
* loss of metabolic function
what tests are used to detect liver failure?
• International Normalised Ratio (INR)
what will rise in the presence of liver failure?
hepatic cell enzyme levels (ALT, GGT)
• raised in liver inflammation
what does the INR test?
measures PROTHROMBIN time against a control (lab worker)
what is the normal INR value and how does this differ with other diseases/medications?
- normal value = 1
* if on warfarin the therapeutic range = 2.0-4.0
what is signified if the INR value is not normal?
SIGNIFICANT liver synthetic dysfunction (e.g. not enough clotting factors)
what occurs in patients that suffer from liver failure?
- ascites
- raised INR & prolonged bleeding
- portal hypertension
- inability to remove “waste”
- build up of haem breakdown products
what is portal hypertension & what can it lead to?
- inability of GI blood to re-enter the vena cava
* leads to oesophageal vein dilation (Varices)
what treatment options are there for liver failure patients?
- supportive treatment (end stage disease)
- transplantation
- artificial liver systems
what is an example of an artificial liver system?
Molecular Adsorbent Recirculating System (MARS)
how can end stage liver disease affect dentistry?
- patients have clotting disorders
- patients have abnormal drug metabolism
- reduced ‘gamma globulin’ so more prone to infection
what analgesics are suitable for liver failure patients? which are NOT?
- paracetamol probably safest option
* NSAIDs increase bleeding risk so NO
does local anaesthetic effect liver failure patients?
NO! metabolised in the plasma, not the liver
