Liver Disease Non-Hepatitis

Liver Disease Overview

• Liver disease is a significant health concern, impacting oral health.
• It's a key area of study for dental hygienists/therapists.
• The liver is the largest internal organ in the body, located below the diaphragm in the right upper abdominal quadrant.

GDC Learning Outcomes

• Explain general and systemic diseases, linking them to oral health.
• Understand physiology relevant to patient management.
• Describe the properties of medicines and therapies, applying them to patient care.

Liver Functions

• Filters and cleanses blood.
• Processes sugar, proteins, and fats.
• Stores vitamins (A, D, E, K, B12).
• Produces bile aiding fat digestion and absorption.
• Stores minerals (iron, copper).
• Removes metabolic waste and toxins.
• Fights infection (bacteria, fungi, parasites).
• Removes damaged blood cells and cellular debris.
• Converts glucose to glycogen for storage.
• Regulates blood sugar and cholesterol levels.
• Produces essential proteins (blood clotting factors, albumin, hormones).
• Underlying normal blood clotting (haemostasis).
• Produces platelets promoting blood clotting.
• Processes many drugs (alcohol, analgesics, antimicrobials, sedatives, etc.).
• Processes cholesterol, proteins, sex steroids.

Liver Damage Causes

• Alcohol abuse (alcohol-related liver damage)
• Viral infections (Hepatitis A-E)
• Non-alcoholic fatty liver disease (NAFLD)
• Autoimmune issues (primary biliary cirrhosis)
• Tumors and cysts
• Inherited conditions (hemochromatosis)

Alcohol-Related Liver Disease

• The liver filters alcohol, processing it & removing it.
• Liver cell death occurs during the process, requiring regeneration time.
• Excessive alcohol use over extended periods inhibits liver recovery and leads to damage.

Stages of Alcohol-Related Liver Disease

• Alcoholic fatty liver disease (reversible)
• Alcoholic hepatitis (reversible with cessation of alcohol)
• Cirrhosis (irreversible) potentially leading to liver failure.

Symptoms of Cirrhosis

• Initially asymptomatic
• Tiredness and weakness
• Nausea and loss of appetite
• Weight loss
• Palmar erythema (redness of palms)
• Spider naevi (spider-like blood vessels)
• Finger clubbing
• Sialosis
• Jaundice (bile pigment buildup)
• Itching
• Dark urine, tarry stools
• Bleeding/bruising easily
• Loss of libido
• Swollen abdomen/legs (ascites)
• Gynecomastia/testicular atrophy
• Esophageal varices

Treatment for Cirrhosis

• Lifestyle changes: stopping alcohol use, healthy diet, low protein/salt diet, lose weight, stop smoking.
• Medicines: diuretics, beta-blockers (reduce skin itching)
• Liver transplant (in severe cases)

Non-Alcoholic Fatty Liver Disease (NAFLD)

• Fat buildup in the liver, not caused by alcohol.
• Often associated with obesity, diabetes, and hypertension.
• NAFLD has 4 stages, progressing over time, sometimes asymptomatic in early stages.
• Symptoms of liver fibrosis: abdominal pain, tiredness and weight loss.
• Symptoms of cirrhosis: similar to alcoholic cirrhosis, see above.

Treatment for NAFLD

• Lifestyle changes: healthy choices, losing weight, healthy diet, exercise, manage diabetes/hypertension.
• Treat complications (e.g., diabetes and high cholesterol)
• Liver transplant (in severe cases)

Other Liver Damage Causes

• Primary biliary cirrhosis (immune response attacks bile ducts)
• Tumours and cysts (various types of liver cancer)
• Haemochromatosis (inherited condition causing iron overload).