Liver Failure

Question 1

what is acute liver failure?

Answer 1

sudden loss of liver function

Question 2

what can cause acute failure?

Answer 2

paracetamol poisoning

Question 3

what can acute liver failure result in?

Answer 3

rapid death from bleeding or encephalopathy

Question 4

what is the only option to treat acute liver failure

Answer 4

transplant

Question 5

what are the different types of chronic liver failure?

Answer 5

cirrhosis, primary liver cancer, secondary liver cancer (metastases)

Question 6

what is cirrhosis?

Answer 6

mixed picture of damage, fibrosis, and regeneration of liver structure

Question 7

what is the multifactorial aetiology of cirrhosis?

Answer 7

alcohol, primary biliary cirrhosis, viral disease (chronic active hepatitis), autoimmune chronic hepatitis, haemachromatosis, cystic fibrosis

Question 8

what are the signs and symptoms of cirrhosis?

Answer 8

non, acute bleed, jaundice, oedema and ascites (abdominal fluid), encephalopathy, spider naevi, palmar erythema

Question 9

what is spider naevi?

Answer 9

small prominent arterioles developing near the skin, enlarged and can produce centre arteriole

Question 10

what is palmar erythema?

Answer 10

pattern of pale palm surrounded by erythema around hand margins

Question 11

what is palmar erythema caused by?

Answer 11

high oestrogen levels caused by reduced metabolism

Question 12

what is ascites caused by?

Answer 12

high portal venous pressure, low plasma protein synthesis (lower oncotic pressure)

Question 13

what is the cause of oesophageal varices?

Answer 13

blood which enters the portal system in the liver cannot exit as the portal vein cannot communicate with hepatic vein due to portal triad distortion in liver cirrhosis, instead the blood passes through to lower oesophagus forcing the veins to dilate and become fragile. The veins can protrude into the oesophageal lumen which is then easy to rupture which food and lead to bleed

Question 14

what are the two components that are lost in liver failure?

Answer 14

synthetic function and metabolic function

Question 15

what is the synthetic function of the liver which is lost to liver failure?

Answer 15

production of plasma proteins (transporting and gamma globulins) and production of clotting factors

Question 16

what is the metabolic function of the liver which is lost to liver failure?

Answer 16

drug metabolism, detoxification, conjugation of RBC breakdown products

Question 17

what are the tests used for liver function?

Answer 17

hepatic cell enzyme levels, INR

Question 18

what are the enzymes which are looked for in hepatic cell enzyme level tests?

Answer 18

ALT, GGT (raised in liver inflammation and fall in end stage liver disease)

Question 19

what does INR measure?

Answer 19

prothrombin to thrombin rate

Question 20

what is the normal value for INR

Answer 20

1

Question 21

what is the warfarin INR value?

Answer 21

2-4

Question 22

what does it mean if INR is not 1

Answer 22

there is significant liver synthetic dysfunction

Question 23

what is the effect of liver failure?

Answer 23

ascites (fluid retention), raised INR and prolonged bleeding, portal hypertension, inability to remove waste urea, build up of haem breakdown products (jaundice)

Question 24

what is portal hypertension?

Answer 24

inability of GI blood to re-enter the vena cava

Question 25

what does portal hypertension lead to?

Answer 25

oesophageal vein dilation (varices)

Question 26

what is the treatment for liver failure?

Answer 26

supportive for end stage and acute failure, transplantation, artificial liver systems

Question 27

what must the patient take after getting a liver transplant?

Answer 27

immunosuppressants

Question 28

in what situation is liver transplant not an option?

Answer 28

when the patient is an alcoholic - they must be off alcohol for a substantial amount of time before getting a transplant

Question 29

what is the result of end stage liver disease?

Answer 29

clotting disorders, abnormal drug metabolism

Question 30

what are the metabolic consequences with liver failure that dentists should be aware of?

Answer 30

prolonged sedative effect, avoid certain antifungals, discuss with physician whether to reduce drug doses, avoid ibuprofen and other NSAIDs - paracetamol is safest

Question 31

what synthetic consequences of liver failure should the dentist be aware of?

Answer 31

reduced clotting factor synthesis so bleeding tendency, reduced plasma transport protein synthesis so drug doses need reduced, reduced gamma globulin synthesis so more prone to infections

Question 32

what is the option which helps with reduced clotting factor synthesis?

Answer 32

fresh frozen plasma given to the patient