Hepatitis and Liver Disease medium

Liver Disease

• The liver is the largest internal organ in the body, located below the diaphragm in the right upper abdominal quadrant.
• It is the largest gland in the body, secreting bile that is stored in the gallbladder.
• The liver can regenerate (entirely) from as little as 25% of the original liver tissue.
• The liver filters and cleanses the blood; it makes and breaks down sugars, proteins, and fats; it stores vitamins A, D, E, K, and B12; it produces bile, essential for fat digestion; it stores minerals such as iron and copper; it removes metabolic products and toxins from the blood; and it fights infection, capturing and digesting bacteria, fungi, parasites, and cellular debris.
• It turns glucose into glycogen, regulates glucose and cholesterol levels, makes essential proteins (e.g., clotting factors, albumin, hormones, transporter proteins, complement), underlies normal haemostasis, and produces thrombopoietin that stimulates bone marrow to produce platelets.
• The liver breaks down haemoglobin, cholesterol, proteins, sex steroids, and many medicines (e.g., alcohol, LA, analgesics, antimicrobials, sedatives).

GDC Learning Outcomes

• Explain general and systemic disease relevance to oral health.
• Describe relevant and appropriate physiology and explain its application to patient management.
• Describe the properties of relevant medicines and therapeutic agents, and discuss their application to patient management.

Aim

• Outline liver disease and its relevance to hygienists/therapists.

Learning Outcomes

• List the liver's functions.
• Describe how a diseased liver functions.
• Recognize liver disease symptoms.
• Explain the relevance of liver disease to dental hygienists/therapists.
• State how a dental treatment plan might need to be modified due to liver disease.

Liver Damage

• The liver can renew and repair itself to a point.
• Damaged by alcohol, viral infections (Hepatitis A-E), non-alcoholic fatty liver disease, primary biliary cirrhosis, tumors, and haemochromatosis.

Alcohol Related Liver Damage

• The liver filters alcohol to remove it from the body.
• Each time this happens, some liver cells die.
• The liver needs time to regenerate and make new cells if alcohol intake is excessive.
• Excessive alcohol intake over long periods can prevent liver recovery, leading to serious and permanent damage.

Three Stages of Alcohol Related Liver Disease

• Alcoholic fatty liver disease (usually no symptoms, reversible)
• Alcoholic hepatitis (inflammation of the liver, potentially reversible with complete cessation of alcohol use)
• Cirrhosis (scarring of the liver, irreversible, preventing normal function)
• Liver failure (complete liver dysfunction).

Symptoms of Cirrhosis

• Often no symptoms until significant liver damage.
• Early symptoms can include tiredness/weakness, nausea/loss of appetite, weight loss, palmar erythema (liver palms), spider nevi, finger clubbing, and sialosis.
• Later symptoms include jaundice (due to bile pigment buildup), itchy skin, dark urine, and tarry-looking feces; easily bleeding or bruising; loss of libido; swollen legs or abdomen (ascites); gynecomastia or testicular atrophy; esophageal varices; encephalopathy (leading to confusion); and liver cancer.

Treatment of Cirrhosis

• Not curable, but symptoms and complications can be managed.
• Lifestyle changes, including stopping alcohol consumption, a healthy diet (low protein and low salt), weight loss, and smoking cessation.
• Medicines such as diuretics, beta-blockers, and creams can help to reduce skin itching.
• Liver transplant may be an option.

Non-Alcoholic Fatty Liver Disease

• Build-up of fat in the liver, not caused by alcohol.
• Often related to obesity.
• Has four stages, progressing over many years.
• Early stages are typically symptom-free.
• Symptoms of fibrosis include abdominal pain, tiredness, and weight loss.
• Symptoms of cirrhosis are similar but more severe.

Treatment of Non-Alcoholic Fatty Liver Disease

• Healthy lifestyle choices, including weight loss, a healthy diet, exercise, and quitting alcohol and smoking.
• Treatment of complications (e.g., diabetes, hypertension, high cholesterol).
• Liver transplant if cirrhosis develops.

Other Causes of Liver Damage

• Primary biliary cirrhosis: Immune system attacks bile ducts, leading to bile buildup, liver cirrhosis, and potential long-term complications.
• Tumors and cysts: include primary liver (hepatocellular carcinoma, often preceded by cirrhosis) or secondary liver cancer (from other organs such as breast, bowel, lung, ovary) and liver cysts.
• Haemochromatosis: An inherited condition leading to iron overload, damaging the liver, pancreas, and heart, increasing the risk of liver cancer.

Viral Hepatitis

• Viral infection of the liver, (A, B, C, D, E).
• Hepatitis A (faecal-oral route, infection with contaminated food/drink).
  • Symptoms usually last a few months.
  • No specific treatment other than pain, nausea, and itching relief.
  • Prevented by vaccination.
• Hepatitis B (spread through blood, sexual contact, needles, shared razors/toothbrushes).
  • 5% become chronic carriers.
  • Can lead to cirrhosis and liver cancer.
  • Vaccination available.
• Hepatitis C (transmission through blood, needlestick injury).
  • Often asymptomatic.
  • Can lead to chronic hepatitis, liver failure, liver cancer.
  • No vaccine.
• Hep D (only infects people with Hep B—leads to liver issues and complications).
• Hep E (faeco-oral route—similar to Hep A).

Dental Aspects of Liver Disease

• Dental neglect: Often seen in alcoholic cirrhosis due to poorly controlled OH, dental erosion, gastric reflux. Increased incidence of caries, periodontal disease, and lack of dental care.
• Sialosis: Enlarged parotid glands, sometimes after liver transplant.
• Gingival overgrowth: Possible side effect of anti-rejection drugs taken post-liver transplant.
• Delayed or discoloured teeth: Possible in children awaiting liver transplants.
• Dental management: increased bleeding risk, risk of poor wound healing, issues with drug metabolism, require universal precautions, possibly antibiotic cover for invasive procedures, and avoid elective procedures for 6 months following transplant.
• Drug considerations: Reduced dose of LA (local anesthetic), use of articaine instead of lidocaine, avoid NSAIDS, and possibly issues metabolising some drugs.
• Prevention and OHI: Importance of good oral hygiene, diet analysis, fluoride supplements, alcohol and smoking cessation.

Diagnosis

• Blood tests (serological tests, Hep B antigens, Hep B antibodies) are used to diagnose liver conditions.

Treatment

• Hepatitis B treatment with rest, analgesia, symptom-relief medication (e.g., metoclopromide for nausea), peginterferon alfa-2a (for chronic cases), antiviral drugs (tenofovir/entecavir).
• Hepatitis C treatment with direct-acting antiviral medications.

This quiz explores the essential functions of the liver, the largest internal organ in the human body. Learn about its role in metabolism, detoxification, and its remarkable ability to regenerate. Test your knowledge on how the liver combats infection and maintains overall health.