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BDS2 BAMS > liver > Flashcards

liver Flashcards

1
Q

what can paracetemol poisoning cause?

A

can cause acute liver failure from damage to the hepatocytes

> 4g/24h

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2
Q

why can we use a blood sample to asses if there was paracetemol poisoning?

A

paracetemol is zero order, linear graph, can extrapolate

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3
Q

effects of liver failure

A
  • cannot make plasma proteins so oedema
  • no clotting factors
  • cannot metabolise drugs and toxins
  • jaundice
  • bleeding
  • encephalopathy (toxins in brain
  • portal hypertension
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4
Q

treatment for liver failure

A

transaplant

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5
Q

what causes chronic liver failure?

A

cirrhosis
liver cancer

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6
Q

what is cirrhosis

A

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

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7
Q

cirrhosis causes chronic liver failure. what causes cirrhosis then

A
  • alcohol
  • autoimmune diseases – primary biliary cirrhosis, chronic hepatitis
  • viral diseases – hepatits
  • genetic – CF, haemachromatosis (Scottish people higher prevalence of this gene)
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8
Q

Signs and symptoms of cirrhosis

A
  • 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
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9
Q

what causes oesophageal varices

A

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

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10
Q

what is ascites

A

swollen stomach ; FLUID ACCUMULATION IN PERITONEUM

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11
Q

why does cirrhosis cause oedema?

A
  • low synthesis of plasma proteins
  • low plasma oncotic pressure
  • fluids leave bv and accumulate in tissues
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12
Q

cause of encephalopathy

A

toxins in blood not filtered out in liver lead to brain damage and death

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13
Q

functions of liver

A
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14
Q

How to test for liver function?

A

INR normal 1.0

hepatic cell enzyme levels
o ALT, GGT raised

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15
Q

what is ALT GGT

A

alanine transaminase
Gamma-glutamyl Transferase

liver enzymes that can leak into your blood if your liver or bile duct is damaged

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16
Q

Treatment of liver failure

A

transplant

stop alcohol

artificial liver systems like MARS

managing hepatitis or autoimmune liver diseases

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17
Q

Hepatic disease in dentistry importance

A

reduce drug dosage
avoid IV sedation
NO NSAIDs
paracetemol is fine
care with antifungals
check INR before extractions due to bleeding tendency

18
Q

can you use LA on liver failure patients?

A

yes since LA is metabolised in the plasma

19
Q

is paracetemol okay for liver disease patients?

A

yes. even though it seems contradictory that paracetemol poisoning causes acute liver failure

20
Q

jaundice arises due to?

A

build up of bilirubin in the skin

21
Q

what does a patient with jaundice look like?

A
  • pigmentation – yellow orange
  • significant itch
  • sclera of eye turns yellow
22
Q

what is bilirubin

A

heme -> bilirubin -> CONJUGATED bilirubin-> bile

conjugated then can then be excreted from the large intestines or the kidneys

23
Q

3 types of jaundice + short description

A

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

24
Q

what is Pre hepatic jaundice caused by?

A

increased haem load beyond liver’s capacity to conjugate it

increase due to abnormal RBCs, autoimmune, wrong blood type, neonatal

25
Q

what is hepatic jaundice caused by?

A

ER of the cells damaged from
- liver failure
- cirrhosis
- hepatitis

26
Q

are stools and urine normal in pre hepatic jaundice?

A

yes

27
Q

are stools and urine normal in hepatic jaundice?

A

no. both lack pigment due to ZERO conjugated bilirubin formed

rmb that UNCONGJUGATED BILIRUBIN CANNOT BE EXCRETED IN STOOLS AND URINE

28
Q

post hepatic jaundice caused by?

A

blocked biliary ducts from
i. gall stone
ii. pancreatic cancer
iii. cholangiocarcinoma
iv. autoimmune disease that destroys the biliary tree within the liver

29
Q

are the stools and urine in post hepatic jaundice normal?

A

no. pale stools have no pigment , urine is dark with pigment

the backflow of conjugated bilirubin from the biliary tree to the kidneys causes conjugated bilirubin to be removed via urine so its dark

30
Q

what is an inflammed gall bladder called?

A

acute cholecystitis

31
Q

how does pain arise from eating fatty foods in gall bladder inflammation?

A

increase fatty food => increase in bile stimulation => more contraction => more pain

32
Q

how to investigate jaundice

A

use ultrasound or ERCP to see where there is a blockage in the biliary tree

33
Q

ERCP

A

endoscopic retrograde cholangiopancreatography

INJECT DYE

34
Q

what is cholangiocarcinoma

A

bile duct cancer

35
Q

how does pancreatic cancer cause post hepatic jaundice

A

head of the pancreas swells and presses on the biliary tree

36
Q

how does Cystic Fibrosis link to liver

A
  • pancreatitis
  • diabetes
  • blocked ducts
  • gall stones
  • fibrosis
    -cirrhosis
37
Q

Management of pre heaptic jaundice

A

treat the root cause of increased haem load (autoimmune? abnormal rbcs?)

38
Q

Management of post heaptic jaundice

A

1 remove gall stone or bladder
2 put a stent to open the ducts
3 remove cancer tumour in the bile ducts or in the pancreas

39
Q

what medication can we use to prevent the build up of bile acid and thus jaundice?

A

o ursodeoxycholic acid
o low calorie and low cholesterol diet

40
Q

how to treat neonatal jaundice?

A
  • use blue light (phototherapy) to treat babies
41
Q
A

BDS2 BAMS (27 decks)

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