liver Flashcards
what can paracetemol poisoning cause?
can cause acute liver failure from damage to the hepatocytes
> 4g/24h
why can we use a blood sample to asses if there was paracetemol poisoning?
paracetemol is zero order, linear graph, can extrapolate
effects of liver failure
- cannot make plasma proteins so oedema
- no clotting factors
- cannot metabolise drugs and toxins
- jaundice
- bleeding
- encephalopathy (toxins in brain
- portal hypertension
treatment for liver failure
transaplant
what causes chronic liver failure?
cirrhosis
liver cancer
what is cirrhosis
mixture of damage, fibrosis and regenerated liver structure
partial loss of function each time there is damage and regeneration
regenerated parts cannot work fully and properly -> loss of function gradual
cirrhosis causes chronic liver failure. what causes cirrhosis then
- alcohol
- autoimmune diseases – primary biliary cirrhosis, chronic hepatitis
- viral diseases – hepatits
- genetic – CF, haemachromatosis (Scottish people higher prevalence of this gene)
Signs and symptoms of cirrhosis
- inflamed large liver or small, shrunken and fibrosed liver
- acute bleeding from oseophageal varices (portal hypertension)
- jaundice
- oedema and ascites
- encephalopathy
- spider naevi and palmar erythema
what causes oesophageal varices
portal hypertension. pressure rises in the portal system, blood cannot drain from the veins so causes the blood to back up and flow through smaller blood vessels, including those in the esophagus
what is ascites
swollen stomach ; FLUID ACCUMULATION IN PERITONEUM
why does cirrhosis cause oedema?
- low synthesis of plasma proteins
- low plasma oncotic pressure
- fluids leave bv and accumulate in tissues
cause of encephalopathy
toxins in blood not filtered out in liver lead to brain damage and death
functions of liver
How to test for liver function?
INR normal 1.0
hepatic cell enzyme levels
o ALT, GGT raised
what is ALT GGT
alanine transaminase
Gamma-glutamyl Transferase
liver enzymes that can leak into your blood if your liver or bile duct is damaged
Treatment of liver failure
transplant
stop alcohol
artificial liver systems like MARS
managing hepatitis or autoimmune liver diseases
Hepatic disease in dentistry importance
reduce drug dosage
avoid IV sedation
NO NSAIDs
paracetemol is fine
care with antifungals
check INR before extractions due to bleeding tendency
can you use LA on liver failure patients?
yes since LA is metabolised in the plasma
is paracetemol okay for liver disease patients?
yes. even though it seems contradictory that paracetemol poisoning causes acute liver failure
jaundice arises due to?
build up of bilirubin in the skin
what does a patient with jaundice look like?
- pigmentation – yellow orange
- significant itch
- sclera of eye turns yellow
what is bilirubin
heme -> bilirubin -> CONJUGATED bilirubin-> bile
conjugated then can then be excreted from the large intestines or the kidneys
3 types of jaundice + short description
pre hepatic - increased haem load so excess unconjugated bilirubin
hepatic - Endoplasmic reticulum of the cells cannot process bilirubin
post hepatic - blocked and obstructed biliary tree/ ducts cause conjugated bilirubin to backflow
what is Pre hepatic jaundice caused by?
increased haem load beyond liver’s capacity to conjugate it
increase due to abnormal RBCs, autoimmune, wrong blood type, neonatal
