Liver Pathology Flashcards
Where does the liver get its blood supply from?
Portal vein - 70% - from bowel
Hepatic artery - 30% - from stomach/intestine
What are the 7 main functions of the liver?
Protein metabolism - albumin
Carb metabolism - glycogen store
Lipid metabolism - triglycerides store
Bile acid metabolism - production of bile
Protein degradation - ammonia from kidney
Drug and hormone metabolism
Immunological - kupffers cells
What are the main causes of liver disease?
Alcohol
Hepatitis
TB, AIDS
Autoimmunity
Drugs
Iron/copper overload
Obstruction
What are clinical features of liver disease?
Jaundice
Spider veins
Palmar erythema
Clubbing
Bruises
Delayed healing
Confusion
What is hepatitis?
Inflammation of the liver
Causes enlargement, tenderness, deranged function
What is hepatitis caused by?
Viral infection - A B C D E
EBV HIV and rubella too
What is cirrhosis?
Necrosis of liver cells
Fibrosis
Nodule formation
What does cirrhosis cause?
Disruption of blood flow
Loss of liver function
What are the causes of cirrhosis?
Alcohol
Hep B and C
Autoimmune
Wilsons - copper
What is the dental relevance of liver disease?
Drugs can affect liver function
Post op haemorrhage
Cross infection hep B C
Portal hypertension
Avoid IV
How are gall stones formed?
Imbalance of bile pigments, salts and cholesterol
What are complications of gallstones?
Gallbladder - colic, infected cholecystitis
Bile ducts - jaundice, pancreatitis
Gut - gallstone ileus
How much of the cardiac output to kidneys receive?
25%
What are the 4 main functions of the kidney?
Excretion of waste
Homeostasis
Blood pressure
Hormone synthesis
What are the main causes of renal failure and damage?
Diabetes
Hypertension
What is the dental relevance of renal disease?
Renal failure
Dialysis
Transplant
What are the clinical features of renal problems?
Painful pee
Haematuria
Urinary retention
Urine volume
When does renal failure occur?
Kidneys have a reduced GFR
What is acute renal failure caused by?
Over a few hours or days
Pre-renal - blood
Renal - glomerulonephritis
Post-renal - obstruction
What is the treatment for acute renal failure?
Treat underlying cause
Fluid balance and dialysis
What are the difference in clinical features between acute and chronic renal failure?
Acute - due to uraemia - polyuria, weakness, fatigue
Chronic - anaemia, hypertension, disturbed urine
What is the treatment for chronic renal failure ?
Dialysis
Kidney transplant
What are the 2 types of dialysis?
Haemodialysis - AV fistula in forearm, 4/5 hours 3x a week
Peritoneal -permanent catheter or intermittent in bed
What is the dental relevance of renal failure?
Avoid NSAIDs
Hypertension
Dialysis - treat on non dialysis days
Ulcers, candidiasis, Lytic lesions on jaw - hyperparathyroidism
What is chronic renal failure and how is it caused?
End stage renal disease
Caused by diabetes, hypertension, glomerulonephritis
What is dialysis?
Removal of waste products from blood
Toxins diffuse across semi permeable membrane
What are complications of dialysis?
Peritonitis
Sepsis
Endocarditis
CV disease
What is pyelonephritis, the cause and treatment?
Ascending infection of kidney
Obstruction, calculi, tumours
Treat with antibiotics
What is glomerulonephritis, the cause and treatment?
Infection of glomerulus
Step infection, HIV, infective endocarditis, NSAIDs
Treat with antipyretics, diuretics
What are renal calculi and their treatment?
Kidney stones
Treat with analgesia, retrieval, surgery
What are the 2 types of urinary tract infection?
Bacteriuria - bacteria in urine
Pyuria - pus in urine
Treat with antibiotics
What are the carcinomas of the bladder and kidney in children vs adults?
Wilms tumour - nephroblastoma in children
Adenocarcinoma - adults
What are the 4 types of syphilis?
Primary - painless ulceration
Secondary - symptomatic, snail ulcers in mouth, warts on genitals
Latent - asymptomatic tissue damage
Tertiary - lesions, tissue destruction, neuro, cardio
What is the dental relevance of syphilis?
Chancre on lip (sore)
Snail track ulcers
What is the treatment for syphilis?
Penicillin
What are the clinical features of gonorrhoea?
Discharge
Dysuria
Eye infection
Skin lesions
What is the treatment for gonorrhoea ?
Antibiotics
Where does chlamydia infect?
Urethra
Cervix
Eye - reciters syndrome
Uterus
Similar symptoms to gonorrhoea
What is the treatment for chlamydia?
Tetracycline
What is the treatment for HPV?
Vaccine
What are the 2 types of herpes?
Type 1 - sex
Type 2 - saliva
What are the clinical features of herpes?
Painful lesions
Ulcer
Tender lymph nodes
Painful urine
What is the treatment for herpes?
Acyclovir
