Esophageal Varices and Liver Conditions Quiz

Esophageal Varices and Liver Conditions

• Jaundice, bleeding tendencies, and poor oral hygiene are prevalent in liver cirrhosis patients.
• Hepatotoxic drugs should be avoided; physician consultation is necessary before invasive procedures.
• Liver biopsy is the gold standard for diagnosing cirrhosis; additional tests include CBC, viral serology, clotting studies, albumin, platelets, and bilirubin.
• Endoscopy is utilized to assess esophageal varices.
• Cirrhosis is irreversible, but liver transplantation is an option for end-stage patients.

Liver Cancer (Hepatocellular Carcinoma)

• Malignant liver tumors are among the most common globally.
• Major risk factors include chronic hepatitis B and C infections, and cirrhosis.
• Symptoms often present with abdominal pain, weight loss, jaundice, ascites, and hepatomegaly (male to female ratio: 3:1).
• Oral manifestations may include jaundice; metastasis to oral tissue is rare.
• Diagnosis typically requires liver biopsy, alpha-fetoprotein score, ultrasound, and CT scan.
• Treatment options include surgical resection, liver transplant, chemotherapy, and opiates for pain relief.

Jaundice

• Jaundice is characterized by yellow discoloration of tissues, primarily the skin and sclera, with noticeable effects when bilirubin levels exceed 3 mg/L.
• Three primary causes:
  • Prehepatic jaundice (e.g., hereditary spherocytosis, sickle cell disease, G6PD deficiency).
  • Hepatic jaundice (e.g., viral hepatitis, drugs like paracetamol, toxins, autoimmune disorders, end-stage liver disease).
  • Cholestatic jaundice (e.g., drugs like chlorpromazine, gallstones, cholangitis).
• Symptoms include yellowish skin, abdominal pain, and signs of liver failure such as spider nevi and palmar erythema.
• Diagnosis involves blood tests, liver function tests (LFTs), ultrasound, and CT scans.
• Management focuses on identifying and eliminating the underlying cause of jaundice.

Ascites

• Ascites refers to excess free fluid accumulation in the peritoneal cavity, often linked to liver cirrhosis and cardiac failure.
• Symptoms include abdominal discomfort, increased girth, and potential shortness of breath due to diaphragm compression.
• No unique oral manifestations of ascites exist, but dental considerations should be noted.
• Diagnosis relies on patient history, physical examination, and elevated liver enzymes in blood tests.

Alcoholic Liver Disease (ALD)

• Alcoholic liver disease resulting from excessive alcohol consumption can manifest in three stages:
  • Fatty liver—mildest reversible injury.
  • Alcoholic hepatitis—marked by hepatocellular damage and symptoms like jaundice and ascites.
  • Cirrhosis—characterized by fibrosis and irreversible damage.
• Patients may exhibit signs such as jaundice, ascites, edema, and potential memory deficits.
• Diagnosis involves clinical evaluation and history of alcohol use.
• Dental management includes consultation with physicians, avoiding hepatotoxic drugs, and providing alcohol prevention information.
• Laboratory tests for liver function and bleeding parameters are crucial before surgical procedures.

Learning Objectives

• Understand epidemiology, manifestations, complications, and management of hepatology disorders affecting dental health.
• Develop skills to interpret clinical signs and laboratory investigations related to hepatology disorders.
• Create evidence-based management plans for dental patients with hepatology issues.
• Identify emergency situations and maintain patient homeostasis.

Liver Diseases of Dental Interest

Viral Hepatitis

• General: Inflammation of the liver caused by viruses, can be acute or chronic.
• Hepatitis A:
  • RNA virus, transmitted via fecal-oral route.
  • Incubation: 15-50 days; no carrier state; lifelong immunity after infection.
  • Prophylaxis includes immunoglobulin and vaccination.
• Hepatitis B:
  • DNA virus, transmitted through blood, sexual contact, and perinatal routes.
  • Incubation: 30-180 days; carrier state present.
  • Prophylaxis includes Hepatitis B immunoglobulin and vaccination; immunity likely lifelong.
• Hepatitis C:
  • RNA virus, primarily via blood.
  • Incubation: 15-160 days; significant carrier state (50-80%).
  • No vaccine or prophylaxis available.
• Hepatitis D:
  • Defective RNA virus, requires co-infection with Hepatitis B.
  • Incubation: 21-140 days; carrier state exists; no effective prophylaxis.
• Hepatitis E:
  • Defective RNA virus, transmit via fecal-oral route.
  • Incubation: 15-64 days; no carrier state; may confer lifelong immunity.

Clinical Features of Viral Hepatitis

• Early symptoms resemble flu (anorexia, fatigue, myalgia).
• Three stages:
  • Preicteric: Anorexia, malaise, fever, nausea.
  • Icteric: Jaundice, upper quadrant pain, hepatomegaly.
  • Posticteric: Jaundice resolves, but hepatomegaly may persist.

Oral Manifestations and Dental Management

• Jaundice visible in oral mucosa during icteric phase.
• All patients considered potentially infectious; standard precautions required.
• Urgent dental treatment only for patients with active hepatitis.
• No hepatotoxic medications for hepatitis patients.
• High-risk patients should be screened for HBsAg prior to treatment.

Alcoholic Liver Disease (ALD)

• Results from excessive alcohol consumption leading to liver damage.
• Classification:
  • Fatty Liver: Mild, reversible.
  • Alcoholic Hepatitis: Inflammation, jaundice, fever, ascites.
  • Cirrhosis: Irreversible fibrosis and nodule formation.

Symptoms and Signs of ALD

• Symptoms: Oedema, jaundice, cognitive impairments, ascites.
• Diagnosis: History, clinical findings, breath tests for alcohol.
• Dental considerations: Consultation required, avoid liver-metabolized drugs, address bleeding risks.

Liver Cirrhosis

• Chronic liver disease characterized by fibrosis and loss of function.
• Causes include chronic hepatitis, alcohol use, and toxins.
• Symptoms: Fatigue, jaundice, ascites, signs of liver failure.
• Diagnosis: Liver biopsy, blood tests, endoscopy for varices.

Oral Manifestations and Dental Management in Cirrhosis

• Jaundice in the oral cavity, potential for bleeding.
• Avoid hepatotoxic drugs; physician consultation mandatory before invasive procedures.

Liver Cancer (Hepatocellular Carcinoma)

• Malignant liver tumor, frequently arising in patients with chronic HBV/HCV or cirrhosis.
• Symptoms: Abdominal pain, weight loss, ascites, jaundice.
• Diagnosis: Liver biopsy, elevated alpha-fetoprotein, imaging studies.
• Management: Surgical resection, chemotherapy, palliative care for pain.

Jaundice

• Characterized by yellow discoloration of skin/sclera due to bilirubin deposition.
• Causes categorized as prehepatic, hepatic, or cholestatic.
• Symptoms: Yellow skin, family history in prehepatic cases, liver tenderness in hepatic causes.

Oral Manifestations and Dental Management for Jaundice

• Oral mucosa may appear yellow; bleeding risks must be managed.
• Avoid hepatotoxic drugs; ensure infection control practices for viral hepatitis patients.

Ascites

• Condition involving excess fluid accumulation in the peritoneal cavity, commonly due to liver cirrhosis.
• Symptoms: Abdominal discomfort, increased girth, respiratory issues.
• Dental considerations: No specific oral manifestations, but ensure patient assessment prior to treatment.