Chronic Liver Disease Quiz

Hepatology

• Alcoholic liver disease and deaths from liver disease are increasing.
• Viral hepatitis is common, increasing, and transmissible in healthcare facilities.
• Healthcare professionals should be immunized against hepatitis B virus.
• Liver disease can cause bleeding and drug intolerance.

Liver Anatomy and Function

• The liver, composed of hepatocytes, interacts with blood vessels (sinusoids) and bile ducts.
• It regulates sugar, protein, and fat metabolism, storing nutrients and removing toxins.
• Bile is produced and, after storage in the gallbladder, is released into the small intestine.
• Kupffer cells, part of the lymphatic system, remove bacteria, fungi, parasites, and cellular debris.
• Glucose is converted to glycogen and stored in the liver, maintaining stable blood sugar levels.
• Excess carbohydrates and proteins are converted to fat. The liver produces blood proteins, clotting factors, albumin, hormones, transporters, and complements.
• The liver is vital for normal blood clotting due to the production of clotting factors, bile salts aiding vitamin K absorption, and thrombopoietin.
• Bile is crucial for fat digestion and vitamin absorption (A, D, E, and K).
• Bilirubin, produced from haemoglobin breakdown, is processed and secreted through bile to the colon and urine.
• Drugs and waste products are metabolized in the liver and transported via the portal circulation.

Drug Metabolism in the Liver

• Many drugs are metabolized and excreted by the liver.
• Oral drugs are absorbed in the digestive system; first-pass metabolism modifies, activates, or inactivates the drugs before entering the bloodstream.

Liver Function Tests

• Liver function tests help diagnose liver disease by measuring various substances in the blood.
• Analyzing bilirubin, enzyme levels (like ALT and AST), alkaline phosphatase, and albumin levels helps in the diagnostic process.
• Elevated bilirubin can lead to jaundice.
• Alkaline phosphatase levels may increase due to biliary obstruction and vary with age.

Acquired Liver Diseases

• Liver disease is increasing due to alcohol use, obesity and infections.
• Hepatitis A, B, C, D, and E viruses affect the liver.
• Chronic diseases may result from viruses, alcohol, and drugs.
• Cirrhosis is a significant outcome of chronic liver disease.
• Many viral hepatitis cases initially present with mild symptoms but could develop into life-threatening complications.
• Infections from diseases like Hepatitis, especially HBV, HCV, and HDV, are primarily transmitted through blood or blood products, but also sexual transmission is recognized. Transmission occurs via contaminated blood and blood products during procedures in healthcare settings or through unsafe injection practices, reuse of needles, and non-sterile devices.

Congenital Liver Disease

• Transient neonatal jaundice is common in newborns, typically due to haemoglobin breakdown.
• More severe cases of jaundice (e.g., due to prematurity, rhesus incompatibility, biliary atresia) can lead to serious complications, such as kernicterus (brain damage).
• Rare familial enzyme disorders can trigger jaundice.
• Discoloration of teeth or dental hypoplasia can be associated with some types of early-onset jaundice.

Acquired Liver Disease- Hepatitis Viruses

• Hepatitis viruses (HAV, HBV, HCV) cause inflammation of the liver and may lead to chronic liver disease, liver cancer, or liver failure.
• HAV is transmitted faeco-orally.
• HBV is primarily transmitted through blood exposure and sexual contact.
• HCV predominantly spreads via blood or blood products.
• Hepatitis A is less severe than other types. HBV presents a greater threat in terms of severity.
• The severity of the illness and potential for complications vary among the hepatitis viral infections.

Dental Aspects

• Patients with liver disease may have increased risk of bleeding complications during dental procedures.
• Several drugs routinely used in dentistry may need adjusted dosage for patients with liver dysfunction to avoid potentially harmful side effects.