Liver

Question 1

Functions of the liver

Answer 1

synthesises clotting factors
detoxification
Immune function
Production of bile
Energy storage
Regulation of fat metabolism
Can regenerate itself

Question 2

Metabolic role

Answer 2

Maintains continuous supply of energy by controlling the metabolism of carbohydrates and fats
Role varies during fasting, absorption, digestion, metabolism
Regulated by endocrine glands; pancreatic enzymes, adrenal, thyroid hormones and nerves

Question 3

Acute liver failure

Answer 3

Sudden failure, when previously healthy

Question 4

Chronic liver failure

Answer 4

pre-existing chronic liver failure, but this is acute on chronic failure

Question 5

Acute liver failure; viral causes

Answer 5

Viral hep A, B, E, EBV

Question 6

Chronic liver failure: viral causes

Answer 6

Viral Hep B and C

Question 7

Other acute liver causes

Answer 7

drugs i.e paracetamol overdose

Vascular (e.g. Budd chiari syndrome)

Question 8

Other chronic liver causes

Answer 8

Alcohol, autoimmune, vascular, metabolic

Question 9

How does acute liver present

Answer 9

Confusion (most worrying sign)
Malaise, anorexia, fever
Abnormal liver function tests
Jaundice
bleeding and liver pain - rare

Question 10

How does chronic liver present

decompensated = you have symptoms

Answer 10

abnormal LFT
hepatomegaly
malaise, abdominal discomfort
itching, anorexia/wasting
Ascites, oedema
Haematemesis
Easy bruising
Jaundice
Confusion

Question 11

Liver serum function test LFT’s

Answer 11

Bilirubin and Albumin (assess actual function)
ALP - alanine aminotransferase and AST Aspartate aminotransferase (liver inflammation)
ALP- alkaline phosphatase -bile fluid and GGT- relates to alcohol
Globulin - liver synthesis

Question 12

Jaundice is raised….?

Answer 12

Bilirubin

Question 13

How is jaundice classified?

Answer 13

conjugated or unconjugated or by site

Question 14

Is bilirubin normally conjugated or unconjugated

Answer 14

is conjugated in the liver to become water soluble
Excreted via bile in the GI tract or 10% is reabsorbed. If this process is disrupted - the unconjugated cant leave the system.

Question 15

3 types of jaundice

Answer 15

Hepatic
Pre hapatic
Post hepatic

Question 16

Prehaptic jaundice

Answer 16

excessive RBC breakdown (haemolysis) which the conjugated system cant deal with

Question 17

Hepatic jaundice

Answer 17

dysfunction with the liver itself, it cant conjugate bilirubin
Cirrhosis
Viral infections hep A, B, C CMV, AND EBV
Drugs

Question 18

Post hepatic jaundice

Answer 18

refers to obstruction of the biliary drainage.
why? Gall stones, external compression: pancreatitis, tumours, lymphadenopathy, ampullary tumours ( entrance of bile duct

Question 19

Chronic liver disease: autoimmune causes (3)

Answer 19

Autoimmune hepatitis (attacks the liver)
Primary biliary sclerosis - attacks the ducts
Primary sclerosing cholangitis (cirrhosis- bile ducts decrease in size due to inflow and fibrosis)

Question 20

Chronic liver disease: metabolic cause (3)

Answer 20

Haemochromatosis (increase absorption of iron)
Wilsons (rare inherited- copper accumulates)
Alfa I antitrypsin deficiency (synthesised in liver, problems with lungs)

Question 21

Chronic liver disease: Vascular (3)

Answer 21

Budd Chiari- cause of cirrhosis- occlusion of hepatic vein

Portal vein thrombosis: blockage of portal vein

Question 22

Alcohol liver disease: safe amounts of alcohol

Answer 22

> 14 safe, 15-28 harmful >28 hazardous

Question 23

Non alcohol fatty liver disease/ Non Alcoholic Steatohepatitis NASH risk factors

Answer 23

risk factors: diabetes, obesity, hypertension, dyslipidaemia

Question 24

Fatty liver disease: can be

Answer 24

non alcoholic or alcoholic

Question 25

Complications of acute liver disease

Answer 25

GI bleeding, ascites, jaundice, hepatic encephalopathy, renal impairment, coagulopathy, infection

Question 26

Complications of CHRONIC liver disease

Answer 26

Malnutrition and bone disease

Question 27

Portal hypertension symptoms

Answer 27

Ascites Splenomegaly: which may lead to lower platelet counts Varices ( swollen veins)

Question 28

Hepatocellular carcinoma

Answer 28

Complicates liver cirrhosis and can occur in Hep B in pre-cirrhotic liver disease

Question 29

Signs and symptoms of hepatocellular carcinoma

Answer 29

``` Jaundice Ascites Finger clubbing Leuconychia ( white nails) Gynaecomastia -man boobs Palmer erythema Spider naevi ```

Question 30

Treatment of liver disease for symptomatic

Answer 30

Diuretics, nutritional support, supplements and propranolol (reduces pressure and risk of bleeding)

Question 31

Specific treatment for liver disease

Answer 31

``` Alcohol --> detox hep B/C antivirals autoimmune hep--> immunosuppression cancer/stones --> relieve obstruction iron overload --> venesection (removal of blood ```

Question 32

What is liver encephalopathy

Answer 32

liver disease with increased ammonia.

Question 33

Symptoms of liver encephalopathy

Answer 33

Confusion can be disabling COMA, history of liver disease, altered behaviour indicates underlying problem: bleed, infection, constipation

Question 34

Test of liver encephalopathy

Answer 34

Baby hippos 5 star drawing count down from 100 in 7s Ammonia test

Question 35

which one has a vaccine B or C. Which one is RNA and DNA

Answer 35

B (dna). C (rna)doesn't but can be cured | c mainly in drug users

Question 36

Chronic viral hep B and C | prevalence

Answer 36

0.3%

Question 37

3 stages of liver disease

Answer 37

Non cirrhotic liver disease Pre Cirrhotic Liver cirrhosis

Question 38

Symptoms of decompensated and compensated liver disease

Answer 38

Compensated: asymptomatic, blood is normal, risk is low Decompensated: visible, abnormal blood tests, risks high

Question 39

Liver disease in dentistry

Answer 39

``` FBC, PTT, LFT's Contact consultant Patients with high bleeding risk- hospital risk of infection- double glove Hep B vaccine Stop antiplatelets 7 days before avoid NSAIDS Give opiods Avoid metronidazole and tetracylines ```