Liver Disease Flashcards Preview

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Flashcards in Liver Disease Deck (19)
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1
Q

Where is the liver found during expiration?

A

Underneath the ribcage in the upper right quadrant.

2
Q

What are the two ducts leaving the liver called and what do they join to form?

A

Extrahepatic ducts

Common bile duct

3
Q

What is the common bile duct formed from?

A

The common hepatic duct and the cystic duct from the gall bladder.

4
Q

Where does the common bile duct exit into?

A

The first part of the duodenum

5
Q

How does the liver produce bile from billirubin?

A

Bilirubin is the product of RBC breakdown.
Unconjugated bilirubin is released from the spleen and then circulates the blood until it reaches the liver.
In the liver, the bilirubin gets conjugated and is then used to produce bile.

6
Q

Where is bile secreted from and where does it get concentrated?

A

Secreted from the liver via the hepatic ducts and then concentrated in the gall bladder.

Bile then exits into the duodenum where it is needed for digestion and absorption of fat soluble vitamins.

7
Q

What are the main functions of the liver?

A
  • Protein synthesis (produces clotting factors from Vitamin K)
  • Drug metabolism
  • Bile production (needed or absorption of fat soluble vitamins)
  • Conjugated bilirubin which is excreted in bile
  • Carbohydrate metabolism (stores glucose and glycogen)
8
Q

What are the 3 types of liver disease?

A
  1. Hepatitis
    - Necrosis of liver cells with inflammatory infiltrate
    - Leads to an enlarged liver
  2. Cirrhosis
    - Irreversible destruction of the liver by fibrosis and scarring
  3. Malignancy
    - can be primary or secondary
9
Q

What are the two main causes of liver disease?

A

1) Alcohol
- starts with a alcoholic steatosis (fatty infiltrate into the liver impairing function)
- Gradually becomes alcoholic hepatitis which inflammatory cell infiltrate
- Further consumption becomes cirrhosis

2) Viral hepatitis
- Hep B and C

10
Q

What are the 3 main autoimmune diseases causing liver disease?

A

1) Autoimmune hepatitis
- Common indication to have a liver transplant if you have this

2) Primary biliary cirrhosis
- auto antibodies to the intrahepatic ducts so the ducts becomes scarred

3) Primary sclerosing cholangitis
- autoimmune disease where the auto antibodies are to the intra and extra hepatic ducts

11
Q

What are some other diseases other than alcohol and hepatitis which leads to liver disease?

A
  • Obesity - leading to non-alcoholic steatohepatitis
  • Hereditary haemochromatosis - iron cannot be excreted so gets deposited around the vital organs
  • Wilsons disease - impaired copper metabolism building up in the liver
  • Pregnancy can lead to fatty liver or obstertic chloestasis
  • Drugs impairing liver function
12
Q

What are the two types of liver cancer?

A

Primary =

  • hepatocellular carcinoma (mainly due to alcohol or viral hepatitis)
  • cholangiocarcinoma (cancer of the biliary tree)

Secondary =
- Metastases from carcinoma of breast, bronchus, stomach and colon

13
Q

What are the main ways that liver disease affects dentistry?

A
  • Increase in bleeding tendency due to decrease in clotting factor synthesis
  • Decrease in platelets as a result of hypospleenism
  • Impaired drug metabolism - decrease the dose of lidocaine given, articaine may be a better choice, paracetamol given, avoid giving metronidazole
  • Immune dysfunction so reduction in neutrophils and lymphocytes
14
Q

What tests does a patient with liver disease need to have before an extraction?

A

Need to have a full blood count before any treatment and a coagulation screen to keep for clotting.

Local haemostatic measures needed also.

15
Q

What are the 4 main tests needed before an extraction for a patient with liver disease?

A

1) Full blood count (platelets, wbc, haemoglobin)
2) Coagulation screens (INR and APTT to check for clotting defects)
3) Liver biochemistry (to see the degree of liver impairment)
4) Renal screen (using urine to look for any kidney impairment)

16
Q

What is the INR?

A

The ratio of prothrombin to normal.
1 is in health.
It checks the extrinsic part of the coagulation cascade and common final pathway.

17
Q

What test checks the intrinsic pathway?

A

APTT - activated partial thromboplastin time

18
Q

What 3 things are we analysing when looking at liver biochemistry tests?

A

1) Alkaline phosphatase
- produced by bile ducts and increases due to pathology blocking bile outflow such as carcinoma

2) Aspartase transaminase - enzyme produced by liver that is increased in hepatocellular damage
3) Gamma GT - increases with an increase in alkaline phosphatase or alcohol intake

Increase in alkaline phosphatase indicates a pathology below the liver in the biliary tree.
Increase in aspartate transaminase indicates pathology of the liver itself.

19
Q

If a patient comes back with normal liver biochemistry results but low coagulation factors, what does this suggest?

A

Vitamin K deficiency