Liver Disease

Question 1

Why do dentists need to know about liver disease?

What is the function of the liver?

Answer 1

• impaired wound healing
• impaired clotting: deficient clotting factors, reduced platelets
• risk of BBVs

Liver function: metabolism

• protein, carbohydrate, lipid, bile, bilirubin, hormone and drug metabolism
• immunological defence

Question 2

What is jaundice?

Types of liver disease causing jaundice?

Answer 2

Jaundice - clinically apparent hyperbilirubineamia

• bilirubin normal range <17
• bilirubin clinically detectable >40

Types of liver disease causing jaundice:

• acute liver disease
• chronic liver disease
• jaundice secondary to biliary obstruction - gall stones, malignancy

Question 3

Clinical features of jaundice?

What goes wrong when you get jaundice?

Answer 3

Jaundice clinical features:

• jaundice
• pale stools
• dark urine
• itch
• lethargy, malaise
• anorexia
• features of underlying disease

Increased production of bilirubin, exceeding capacity of liver for excretion

Failure of excretion - defective conjugation (hepatocyte), defective delivery to cannuliculus, blockage of bile ducts

Question 4

What are some liver function tests which measure damage?

True liver function tests?

Answer 4

LFTs - liver damage

• ALT/AST
• alkaline phosphatase (ALP)
• GGT

True liver function tests:

• bilirubin
• albumin
• prothrombin time - measures clotting

Question 5

How is Hep B transmitted?

How is it treated?

Answer 5

• blood, sex, mother to child, rates of chronic carriage vary between ethnic groups, chronic carriage more likely to result if first exposure is in childhood

Treatment:

• PEG alpha-interferon
• tenofovir
• entecovir

Question 6

How is Hep C transmitted?

How is Hep C controlled?

Answer 6

Transmission:

• similar to Hep B, sexual transmission less common
• infection results in chronic infection on 80% of cases

Control:

• no vaccine
• minimise exposure