Liver Disease Overview for Dental Health

Liver Disease Overview

• Liver is the largest internal organ, located below the diaphragm in the right upper quadrant.
• It's the largest gland, secreting bile stored in the gallbladder.
• The liver can regenerate, even from as little as 25% of its original tissue.

GDC Learning Outcomes

• Explain the relevance of general and systemic diseases to oral health.
• Describe relevant physiology and its application to patient management.
• Discuss the properties of relevant medicines and therapeutic agents related to patient management.

Aim

• Outline liver diseases and their relevance to dental hygienists/therapists.

Learning Outcomes

• List liver functions.
• Describe a diseased liver and its symptoms.
• Identify the relevance of liver disease to dental hygienists/therapists.
• Detail how a dental treatment plan might need modification due to liver disease.

Liver Functions

• Filters and cleans blood.
• Makes and breaks down sugars, proteins, and fats.
• Stores vitamins A, D, E, K, and B12.
• Produces bile for fat digestion and absorption of fat-soluble vitamins.
• Stores minerals like iron and copper.
• Removes metabolic products and toxins from the blood.
• Fights infections and eliminates waste material (bacteria, fungi, parasites, cellular debris).
• Converts glucose to glycogen for storage.
• Regulates glucose and cholesterol levels.
• Produces essential proteins (blood clotting factors, albumin, hormones, transporter proteins, complement).
• Produces thrombopoietin to stimulate platelet production.
• Breaks down hemoglobin, cholesterol, proteins, sex steroids and many drugs (alcohol, analgesics, antimicrobials).

Liver Damage Causes

• Alcohol
• Viral infections (Hepatitis A-E)
• Non-alcoholic fatty liver disease
• Autoimmune conditions (primary biliary cirrhosis)
• Tumors and cysts
• Haemochromatosis

Alcohol Related Liver Disease

• Liver filters alcohol to remove it from the body.
• Each filtering process causes some liver cells to die.
• The liver needs breaks to regenerate and create new cells.
• Excessive alcohol consumption prevents liver recovery, leading to serious and potentially permanent damage.
• Three stages of alcohol-related liver disease include fatty liver disease (usually reversible), alcoholic hepatitis (reversible with abstinence in early stages), and cirrhosis (irreversible scarring of the liver).

Symptoms of Cirrhosis

• Often no symptoms until liver damage is severe.
• Tiredness, weakness.
• Nausea, loss of appetite.
• Weight loss.
• Palmar erythema (reddening of palms).
• Spider naevi (small dilated blood vessels).
• Finger clubbing.
• Sialosis (swelling of the salivary glands).
• Jaundice (yellowing skin and eyes)
• Itchy skin.
• Dark urine, tarry stools.
• Bleeding or bruising easily.
• Loss of libido.
• Swollen legs or abdomen (ascites).
• Gynecomastia, testicular atrophy.
• Esophageal varices.
• Encephalopathy (confusion).
• Liver cancer.

Treatment of Cirrhosis

• Lifestyle changes (stop drinking alcohol, healthy diet, low protein and low salt diet).
• Lose weight.
• Stop smoking.
• Medications like diuretics or beta-blockers to manage symptoms.
• Liver transplant.
• The treatment focuses on managing the symptoms of the disease and preventing further complications, rather than a cure.

Non-Alcoholic Fatty Liver Disease (NAFLD)

• Fat buildup in the liver, not caused by alcohol.
• Often associated with obesity, diabetes, and hypertension.
• Stages progress from fatty liver, to liver inflammation (reversible if lifestyle changes happen), fibrosis, and cirrhosis (irreversible).
• NAFLD symptoms include abdominal pain, tiredness, weight loss, and, if progressed to cirrhosis, symptoms of cirrhosis (see above).

Treatment for NAFLD

• Lifestyle modifications (healthy diet, exercise, weight management), and abstinence from excessive alcohol.
• Controlling associated conditions (diabetes, hypertension, high cholesterol).
• Liver transplant in severe cases, when cirrhosis develops.

Other Causes of Liver Damage

• Primary Biliary Cirrhosis:

  • Immune system attacks bile ducts.
  • Bile builds up, leading to cirrhosis.
  • Symptoms: bone and joint pain, fatigue, itching, dry eyes/mouth, abdominal pain.
  • Treatment: Ursodeoxycholic Acid, other meds for itching.

• Tumors and Cysts:

  • Primary liver cancer (Hepatocellular Carcinoma): Most common type; more common if pre-existing cirrhosis.
  • Secondary liver cancer: Metastatic cancer spread from other organs (e.g., breast, bowel).
  • Liver cysts: Congenital or due to infection, caused mainly by a parasitic worm (echinococcus).

• Haemochromatosis:

  • Inherited condition, iron overload.
  • Damages liver, joints, pancreas, heart.
  • More susceptible to liver cancer.
  • Treatment: Bloodletting (phlebotomy) and chelating agents.