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2 - Diseases Of The Human System > Liver Diseases > Flashcards

Liver Diseases Flashcards

(57 cards)

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1
Q

What is jaundice?

A

Accumulation of bilirubin in the skin
* Pigmentation yellow/orange
* Significant Itch

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2
Q

Where is jaundice most noticeable?

A

sclera of the eye

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3
Q

What is the pathway for haem breakdown?

A

erythrocytes > heme > biliverdin > bilirubin > conjugated bilirubin

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4
Q

What will happen if the bilirubin is not conjugated?

A

it will not be excreted and therefore it will accumulate

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5
Q

What is bilirubin excreted as in urine?

A

urobilin

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6
Q

What is bilirubin excreted as in stool?

A

stercobilin

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7
Q

What are the 3 classifications of jaundice?

A

pre-hepatic
hepatic
post-hepatic

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8
Q

Why would there be excess bilirubin due to pre-hepatic causes?

A

increased haem load (excess breakdown of RBCs)
due to
autoimmune
spleen issues
abnormal RBCs

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9
Q

Why would there be excess bilirubin due to hepatic causes?

A

liver cell failure
due to
cirrhosis
hepatitis

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10
Q

Why would there be excess bilirubin due to post-hepatic causes?

A

biliary, gall bladder and pancreatic disease causing obstruction

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11
Q

What are the reasons there may be excessive quantities of RBC breakdown products?

A
  • Haemolytic anaemia
  • Post transfusion (bad match)
  • Neonatal (maternal RBC induced)
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12
Q

Why does hepatic failure cause jaundice?

A

Prevents metabolism of RBC breakdown products - no conjugation

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13
Q

What colour is the stool/urine in hepatic jaundice?

A

pale stool/urine

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14
Q

What can cause a obstruction to the intrahepatic biliary system?

A

primary biliary cirrhosis

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15
Q

What can cause a obstruction to the extrahepatic biliary system? (gall bladder and common bile duct)

A

Gall bladder
- Gall stones

Common bile duct
- Pancreatic carcinoma
- Cholangiocarcinoma

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16
Q

What can gall stones do?

A
  • Can block biliary tree - obstructive jaundice
  • Can cause inflammation
  • Can move out to biliary tree
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17
Q

What is inflammation of the gall bladder called?

A

cholecystitis

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18
Q

What are symptoms of gall bladder diseases?

A
  • Pain in SHOULDER tip - due to relation with diaphragm and C 3,4,5 nerves
  • Abdominal Pain Right side
  • Pain brought on by eating Fatty food
  • Stimulates bile release by contraction of the gall bladder.
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19
Q

What is gall bladder disease usually caused by?

A
  • Usually Gall stones
  • Rarely Cholangiocarcinoma (bile duct cancer)
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20
Q

How can jaundice be imaged? And what does it show?

A
  • Ultrasound - Detects dilated bile channels WITHIN the
    liver, also dilated biliary tree
  • Plain Radiographs - Show RADIOPAQUE gall stones
  • ERCP -Endoscopic Retrograde Cholangio Pancreatography - Contrast radiograph of biliary tree
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21
Q

How is a ERCP carried out?

A

using an endoscope to put a cannula into the biliary tree from duodenum

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22
Q

Where is a cholangiocarcinoma tumour most severe?

A

extra hepatic

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23
Q

What are the two causes of pancreatitis?

Study These Flashcards
A

role of alcohol in chronic pancreatitis
role of mumps virus – usually temporary

24
Q

What common disease is usually a consequence of chronic pancreatic disease?

25
What do patients with cystic fibrosis require?
oral pancreatic enzyme supplements
26
How is jaundice managed at pre-hepatic?
identify and treat the cause - spleen, anaemia, autoimmune
27
How is jaundice managed at post-hepatic?
Remove obstruction * Gall stones via ERCP * Gall Stones via lithotripsy (ultrasound to break stones) * Force open channel with a stent (biliary tree stent) * Prevention of Gall stone recurrence - remove gall bladder (cholecystectomy)
28
How can build up of bile acid be prevented?
* Ursodeoxycholic Acid tablets * Low calorie & low cholesterol diet
29
How can bile acid resorption form the GIT be prevented?
cholestyramine sachets
30
What is neonatal jaundice due to?
* Increased Haem breakdown - Birth trauma - ABO & Rhesus incompatibility * Poor liver function in neonate
31
What is the risk of neonatal jaundice?
kernicterus brain damage from bilirubin as brain-blood barrier not fully developed
32
What is the treatment for neonatal jaundice?
phototherapy - blue light cause bilirubin to breakdown and get excreted
33
What is acute liver failure and what can it cause?
Sudden loss of liver function Rapid death from: * Bleeding * Encephalopathy
34
What is the cause of acute liver failure?
paracetamol poisoning free radical damage to hepatocytes caused by processing paracetamol through alternative pathway due to blockage/overloading of normal pathway
35
What is the treatment for acute liver failure?
liver will usually recover given time if patient can be kept alive transplant often the only option
36
What are the causes of chronic liver failure?
* Cirrhosis * Primary liver cancer * Secondary liver cancer (metastases from bowel tumours)
37
What is cirrhosis?
damage, fibrosis & regeneration of liver structure standard triad may be damaged
38
What are the causes of cirrhosis?
* Alcohol * Primary Biliary Cirrhosis * viral disease - chronic active hepatitis * autoimmune chronic hepatitis * Haemachromatosis (too much iron irratites the liver) * Cystic fibrosis
39
What does a small liver mean and what does a large liver mean?
small = shrunken and fibrinoid large = inflammation
40
What are the signs and symptoms of cirrhosis?
* Acute bleed - portal hypertension and oesophageal varices * Jaundice * Oedema & ascites (abdominal fluid from portal vein to peritoneum) * Encephalopathy (toxic materials reach brain as liver can't remove them) * Spider naevi, palmar erythema due to high oestrogen levels from reduced metabolism
41
Why does ascites occur?
* High portal venous pressure * Low plasma protein synthesis * Lower oncotic pressure Fluid leaks out
42
How do oseophageal varices occur?
Disordered portal triads in liver cirrhosis cause portal hypertension * Blood engorges as passes through vessels at the end of the embryological gut – lower oesophagus – getting from left gasric vein to portal vein to the systemic circulation * Veins dilated and fragile – thin walled * Protrude into oesophageal lumen – easy to rupture and can lead to catastrophic bleed
43
What synthesis functions are lost in liver failure?
* plasma proteins * Transporting proteins * Gamma globulin * clotting factors (rupture of varices can be fatal) * hormones
44
What metabolic functions are lost in liver failure?
* drug metabolism (esp. 1st pass) * detoxification * conjugation of RBC breakdown products
45
What enzymes escape liver cells if they are damaged or inflamed?
ALT GGT
46
What tests are done for liver function?
hepatic cell enzyme levels (raised in liver inflammation) INR
47
What does the INR measure?
Measures PROTHROMBIN time against a control (lab worker!) * Prothrombin > Thrombin
48
Why is the INR measured in liver disease?
prothrombin and vitamin K (essential in blood clotting) are produced in the liver
49
What is the normal INR value?
1
50
What is the range of INR id on warfarin?
2-4
51
What does it mean if the INR is not 1?
SIGNIFICANT liver synthetic dysfunction
52
What are the effects of liver failure?
- fluid retention – ascites * Portal Hypertension - Oesophageal Varices * inability to remove ‘waste’ - urea * Encephalopathy * build up of haem breakdown products - JAUNDICE
53
What is the INR for liver failure?
* raised INR and prolonged bleeding * 1.3 is HIGH for non warfarin patient due inadequate liver synthesis of clotting factors
54
What is the treatment of liver failure?
transplantation possibly artificial liver systems similar to dialysis (MARS)
55
How much of the liver can be used?
each liver has 3 lobes that can be transplanted for a different patient
56
What are the metabolic considerations for liver failure in dentistry?
Prolonged effect of sedatives - Avoid intravenous sedation!! Care with antifungals * avoid miconazole, erythromycin and tetracycline (toxic injury Suitable analgesics - Paracetamol probably the safest - NSAIDS increase bleeding risk
57
What are the synthetic considerations for liver failure in dentistry?
Reduced clotting factor synthesis - Bleeding tendency - Work with Haematologist - fresh frozen plasma? * Reduced plasma transport protein synthesis - Drug binding reduced - dose may need reduced * Reduced ‘gamma globulin’ synthesis - More prone to infections? NO problem with Local Anaesthetics -Metabolised in the plasma, not the liver!

2 - Diseases Of The Human System (19 decks)

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