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BDS2 BAMS > Liver disease > Flashcards

Liver disease Flashcards

1
Q

What are 4 examples of liver issues?

A
  • Viral liver disease (Hep virus)
  • Jaundice
  • Cirrhosis
  • Liver failure
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2
Q

What is jaundice caused by?

A
  • Accumulation of bilirubin in the skin (causes pigmentation and itch in the skin)
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3
Q

What is another term for jaundice?

A
  • Icteric
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4
Q

What is the sclera of the eye?

A
  • The white of the eye
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5
Q

Where is the first place that jaundice will be obvious?

A
  • In the sclera (white) of the eye
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6
Q

What 3 stages can jaundice be divided into?

A
  • PRE-hepatic
  • Hepatic
  • POST-hepatic
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7
Q

What can cause PRE-hepatic jaundice? (3 points)

A
  • Autoimmune, spleen, abnormal RBC’s
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8
Q

What can cause ‘hepatic’ jaundice? (2 points)

A
  • Cirrhosis

- Hepatitis

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9
Q

What can cause POST-hepatic jaundice? (3 points)

A
  • Biliary, gall bladder and pancreatic disease
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10
Q

What happens in normal bilirubin metabolism?

A
  • There are small amounts of unconjugated bilirubin in the blood
  • This is passed into the endoplasmic reticulum of hepatocytes
  • Then moves into the bile duct as conjugated bilirubin
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11
Q

What is pre-hepatic jaundice usually caused by? (5 points)

A
  • Excessive quantities of RBC breakdown products:
  • Haemolytic anaemia
  • Post transfusion (bad match)
  • Neonatal (maternal RBC induced)

This results in too much bilirubin in the blood so much so that you overload the livers ability to conjugate

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12
Q

What is the name of the disease caused by prehepatic jaundice?

A
  • Gilbert’s disease
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13
Q

What is hepatic jaundice caused by? (4 points)

A

Due to ‘liver failure’:

  • Cirrhosis
  • Drug induces liver dysfunction

Prevents metabolism of RBC breakdown products

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14
Q

What is post-hepatic jaundice caused by?

A
  • Obstruction to bile outflow
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15
Q

Post-hepatic jaundice is caused by obstruction to bile outflow. How can this occur? (3 points)

A

Intrahepatic biliary system:

  • Primary biliary sclerosis

Extrahepatic biliary system:

  • Gall bladder (gall stones)
  • Common bile duct (pancreatic carcinoma, cholangiocarcinoma)
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16
Q

What is Cholangiocarcinoma?

A

Bile duct cancer

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17
Q

What are the clinical features of jaundice? (4 points)

A
  • Conjugated bilirubin is excreted in the urine and faeces
  • Colour changes with cause of jaundice
  • Pale stool & dark urine suggests POST-hepatic cause (conj B causing the jaundice)
  • Normal in haemolytic (excess B is unconjugated)
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18
Q

How can gall stones cause obstructive jaundice?

A
  • By blocking the biliary tree

- Can cause inflammation

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19
Q

Where do gall stones form?

A
  • In the gall bladder
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20
Q

What is acute cholecystits?

A

Inflammation of the gall bladder

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21
Q

What are the symptoms of gall stones? (4 points)

A
  • Pain in shoulder tip
  • Abdominal pain right side (radiates tot he back)
  • Pain brought on by eating fatty food (stimulates bile release by contraction of the gall bladder)
  • Usually gall stones (rarely cholangiocarcinoma (bile duct cancer))
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22
Q

How do gall stones form?

A

Because you have bile that is super saturated - forms crystals and stones in some

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23
Q

What categories of the population can be more prone to getting gall stones? (5 points)

A
  • Fair hair
  • Fertile window
  • Female
  • Fat
  • Forty
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24
Q

What are the possible options of imaging a jaundiced patient? (3 points)

A
  • Ultrasound
  • Plain radiographs
  • ERCP
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25
Q

An ultrasound is one way of imaging a jaundiced patient. What does this show? (2 points)

A
  • Detects dilated bile channels WITHIN the liver

- Also dilated biliary tree

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26
Q

A plain radiograph is one way of imaging a jaundiced patient. What does this show?

A
  • Shows radiopaque gall stones
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27
Q

ERCP is a method of imaging the jaundices patient. What does this stand for and how does it work?

A
  • Endoscopic Retrograde Cholangiopancreatography

- Contrast radiograph of biliary tree (inject dye into the bile tree to see if there is a blockage)

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28
Q

What is a consequence of chronic pancreatic disease?

A

Diabetes

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29
Q

What is pancreatitis?

A

Inflammation of the pancreas

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30
Q

If a patient has pancreatitis and cystic fibrosis what would they need to do?

A
  • Need oral pancreatic enzyme supplements
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31
Q

Does alcohol have a aetiological role in chronic pancreatitis?

A
  • Yes
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32
Q

How would you manage pre-hepatic jaundice?

A
  • Identify and treat the cause
33
Q

How would you manage post-hepatic jaundice? (3 points)

A

Remove the obstruction:

  • Gall stones via ERCP
  • Gall stones via lithotripsy (ultrasound)
  • Force open channel with a stent
34
Q

What is lithotripsy?

A

Using sonic waves to break down the gall stones (removes the obstruction)

35
Q

What is a biliary tree stent?

A
  • Little bit of metal mesh which opens up the duct to allow the bile to flow through
  • Takes away obstructive jaundice
36
Q

If a patient has a tumour, is a biliary tree stent a permanent solution?

A

No, the tumour will get bigger and will eventually squash the stent

37
Q

How can you manage jaundice by the prevention of gall stone recurrence? (3 points)

A
  • Remove the gall bladder (cholecystectomy)
  • Prevent build up of bile acid (Ursodeoxycholic acid, or low calorie and low cholesterol diet)
  • Prevent bile acid reabsorption from the GIT (Colestyramine)
38
Q

What is the name of the procedure that removes the gall bladder?

A
  • Cholecystectomy
39
Q

What can neonatal jaundice cause? (3 points)

A
  • Increased haem breakdown (birth trauma, ABO & Rhesus incompatibility)
  • Poor liver function on neonate (worse if <37 weeks gestation)
  • Risk of KERNICTERUS (brain damage from bilirubin)
40
Q

Neonatal jaundice can cause a risk of KERNICTERUS. What does this mean?

A
  • Brain damage from high levels of bilirubin in the brain
41
Q

If a baby has neonatal jaundice, what is the treatment option for this?

A
  • Phototherapy

- Blue wave length light - energy is enough to break down the B that is in the skin

42
Q

What can cause acute liver failure?(2 points)

A
  • Paracetamol poisoning (any med could potentially do this)

- Other drug reactions

43
Q

What can acute liver failure lead to? (2 points)

A
  • Sudden loss of liver function

- Rapid death (bleeding, encephalopathy)

44
Q

What is encephalopathy?

A

Damage to the brain due to the presence of toxic materials

45
Q

How many paracetamol tablets in one go is enough to push a patient into the toxic area?

A
  • 20 tablets
46
Q

what are 3 examples of chronic liver failure?

A
  • Cirrhosis
  • Primary liver cancer
  • Secondary liver cancer (metastasis)
47
Q

What is Cirrhosis?

A
  • Mixed picture of damage, fibrosis & regeneration of liver structure
48
Q

What is the possible aetiology of cirrhosis? (6 points)

A

Multifactorial aetiology:

  • Alcohol
  • Primary biliary cirrhosis
  • Viral disease - chronic active hepatitis
  • Autoimmune chronic hepatitis
  • Haemachromatosis
  • Cystic fibrosis
49
Q

What are possible signs and symptoms of cirrhosis? (6 points)

A
  • Large or small liver
  • Acute bleed - portal hypertension (oesophageal varices)
  • Jaundice
  • Oedema & ascites (abdominal fluid)
  • Encephalopathy
  • Spider naevi, palmar erythema (high oestrogen levels from reduced metabolism)
50
Q

What is ascites?

A
  • The accumulation of fluid in the peritoneal cavity
51
Q

What is spider naevi?

A

A spider nevus is a collection of small, dilated arterioles (blood vessels) clustered very close to the surface of the skin. The cluster of vessels is web-like, with a central spot and radiating vessels

52
Q

What is palmar erythema?

A

A reddening of the palms, especially around the base of the little finger and thumb

53
Q

What does ascites cause? (2 points)

A
  • High portal venous pressure

- Low plasma protein synthesis (lower oncotic pressure)

54
Q

What are oesophageal varices and when do they develop? (2 points)

A
  • Abnormal, enlarged veins in the tube that connects the throat to the stomach
  • Develop when normal blood flow to the liver is blocked by a clot or scar tissue in the liver
55
Q

What are the 2 functions of the liver that are lost when someone has liver failure?

A
  • Loss of SYNTHETIC function

- Loss of METABOLIC function

56
Q

In liver failure the liver looses its synthetic function. What is this?(2 points)

A
  • Stops producing plasma proteins (transport proteins and gamma globulin)
  • Stops making clotting factors (bleeding from loss of this)
57
Q

In liver failure the liver looses its metabolic function. What is this?(3 points)

A
  • Drug metabolism (esp. 1st pass metabolism)
  • Detoxification
  • Conjugation of RBC breakdown products
58
Q

When using liver function tests, what are you actually testing?

A
  • Testing liver inflammation
59
Q

What is the most useful test for liver function?

A
  • International normalised ratio (INR)
60
Q

What was traditionally used to test liver function?

A
  • Typically use hepatic cell enzyme levels (ALT, GTT)
  • Raised in liver inflammation
  • Proportional to the number of hepatic cells (falls in end stage liver disease)
61
Q

What does an INR measure?

A
  • Measures PROTHROMBIN time against a control

- Prothrombin -> thrombin

62
Q

What is the normal value for an INR?

A
  • 1
63
Q

If on WARFARIN, what should the therapeutic value of an INR be?

A

Range should be 2.0-4.0

64
Q

If the INR of a patient is not 1 then what does this indicate in relation to liver function?

A
  • Shows there is a SIGNIFICANT liver synthetic dysfunction (i.e. not enough clotting factors)
65
Q

If someone has liver failure it is likely that they will have fluid retention. What is the name for this?

A
  • Ascites
66
Q

If someone has liver failure they will have a raised INR and prolonged bleeding. What is considered high for a non warfarin patient?

A
  • 1.3 is considered HIGH
67
Q

If someone has liver failure it is likely that they will have portal hypertension. What causes this? (2 points)

A
  • Inability of GI blood to re-enter the vena cava

- Leads to oesophageal vein dilation (varices)

68
Q

Liver failure can lead to the inability of the body to remove ‘waste’. What can this lead to?

A

Encephalopathy

69
Q

Liver failure can lead to a build up of breakdown products. What does this lead to?

A
  • Jaundice
70
Q

When is ‘supportive’ treatment of liver failure given? (2 points)

A
  • End stage disease

- (not?)Acute failure - recovery likely

71
Q

Is an artificial liver a treatment for liver failure?

A
  • Not really a solution - it is at the experimental stage
72
Q

What is the only ‘cure’ possible for liver failure?

A

A liver transplant

73
Q

Why can a liver transplant procedure be risky?

A
  • As vascular anatomy is a bit unpredictable so can be risky as the patient can die on the table
74
Q

How many chunks can the liver be split into but still function?

A

3

75
Q

Is alcohol cessation useful in reducing severity of liver failure?

A
  • Yes
76
Q

What are metabolic consequences that dentist need to be aware of in patients with liver disease? (3 points)

A
  • The prolonged effect of sedatives (avoid IV sedation)
  • Reduce drug doses (care with antifungals - avoid miconazole, erythromycin and tetracycline)
  • Suitable analgesics? (paracetamol probably safest, NSAID’s INCREASE bleeding risk)
77
Q

What are synthetic consequences that dentist need to be aware of in patients with liver disease? (3 points)

A
  • Reduced clotting factor synthesis - bleeding tendency
  • Reduced plasma transport protein synthesis - drug binding reduce so dose may need reduced
  • Reduced ‘gamma globulin’ synthesis - more prone to infections?
78
Q

Do patients with hepatic disease have a problem with LA?

A
  • No, as metabolised in the plasma, not the liver

BDS2 BAMS (57 decks)

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