Liver Disease PDF

Liver Disease Rhona Mann Biomedical Science GDC learning outcomes Explain general and systemic disease and 1.1.3 their relevance to oral health Describe relevant and appropriate physiology 1.1.6 and explain its application to patient mana...

Liver Disease Rhona Mann Biomedical Science GDC learning outcomes Explain general and systemic disease and 1.1.3 their relevance to oral health Describe relevant and appropriate physiology 1.1.6 and explain its application to patient management Describe the properties of relevant medicines 1.1.8 and therapeutic agents and discuss their application to patient management Aim Outline liver disease and explain its relevance to the dental hygienist/therapist Learning outcomes List the functions of the liver Describe how a liver becomes diseased Recognise the symptoms of liver disease Explain the relevance of liver disease to the dental hygienist/therapist State how a dental treatment plan may have to be modified because of liver disease Liver Largest internal organ in body Located below the diaphragm in right upper abdominal quadrant Largest gland in body – secretes bile which is stored in gall bladder Can regenerate (whole liver from as little as 25%) Posterior and anterior view of liver The many functions of the liver Essential for life Filters and cleans the blood Makes and breaks down sugar, proteins and fats Stores vitamins A,D,E,K and B12 Produces bile – essential for fat digestion and absorption of fat soluble vitamins Stores minerals e.g. iron, copper Removes metabolic products and toxins from blood Fights infection - captures and digests bacteria, fungi, parasites, redundant blood cells and cellular debris Functions of the liver contin/ Turns glucose into glycogen which is stored in the liver Regulates glucose and cholesterol levels Makes essential proteins e.g. blood clotting factors, albumin, hormones, transporter proteins and complement Underlies normal haemostasis as it also produces hormone thrombopoietin which stimulates bone marrow to produce platelets Breaks down haemoglobin, cholesterol, proteins, sex steroids and many drugs e.g. alcohol, LA, analgesics, antimicrobials, sedatives What causes liver damage? Liver damage Able to renew and repair itself up to a point Damaged by Alcohol Viral infections – Hepatitis A-E Non alcoholic fatty liver disease Body’s own immune system – primary biliary cirrhosis Tumours and cysts Haemochromatosis Alcohol related liver damage Alcohol related liver disease The liver has to filter alcohol in order to break it down and remove it from the body. Each time, some liver cells die during this process The liver needs a break from alcohol to allow it to regenerate and make new cells. Drinking too much alcohol over a long period of time means the liver can’t recover. This can result in serious and permanent damage. Three stages of alcohol related liver disease Alcoholic fatty liver disease usually no symptoms, reversible Alcoholic hepatitis inflammation of liver, reversible in early stages if stop drinking permanently permanent damage in later stages Cirrhosis scarring (fibrosis) of liver prevents normal function Irreversible Liver failure Symptoms of cirrhosis Often no symptoms until liver severely damaged Tiredness and weakness Nausea and loss of appetite Weight loss Palmar erythema Spider naevi Finger clubbing Sialosis Symptoms of cirrhosis contin/ Jaundice (due to build up of bile pigments) Itching of skin Dark urine and tarry-looking faeces Bleeding or bruising easily Loss of libido Swollen legs or abdomen (ascites) Gynaecomastia or testicular atrophy Oesophageal varices Encephalopathy (leading to confusion) Liver cancer Treatment of cirrhosis Not possible to cure, only deal with symptoms and complications Lifestyle Stop drinking alcohol altogether Healthy diet to reduce malnutrition Low protein and low salt diet Lose weight Stop smoking Medicines (diuretics, beta-blockers, creams to reduce skin itching) Liver transplant Non-Alcoholic fatty liver disease Non alcoholic fatty liver disease Build up of fat in liver Not caused by alcohol Usually related to obesity 4 stages – over many years Early stages often symptom free and no harm Liver inflammation Fibrosis Cirrhosis Symptoms of fibrosis – abdominal pain, tiredness, weight loss, weakness Symptoms of cirrhosis – see above Non alcoholic fatty liver disease High levels of fat in liver are associated with diabetes, hypertension, liver disease Treatment Healthy lifestyle choices, lose weight, healthy diet, exercise, stop smoking, stop alcohol Treat complications e.g. diabetes, hypertension, high cholesterol Liver transplant if cirrhosis develops Other causes of liver damage Primary biliary cirrhosis Immune system mistakenly attacks bile ducts Bile builds up in the liver, leads to liver cirrhosis after decades Symptoms include bone and joint aches, fatigue, itchy skin, dry eyes and mouth, abdominal pain Treatment includes ursodeoxycholic acid and obeticholic acid and medications to relieve symptoms e.g. itching It untreated can also be associated with osteoporosis, portal hypertension, ascites, vitamin deficiencies, liver cancer Tumours and cysts Primary liver cancer Hepatocellular carcinoma most common More common if pre-existing cirrhosis Secondary liver cancer Metastatic cancer from another organ e.g. breast, bowel, lung, ovary Liver cysts Simple cyst related to malformation of bile duct Congenital – polycystic liver disease Caused by parasite echinococcus Haemachromotosis Inherited condition Iron overload Damages liver, joints, pancreas and heart More likely to develop liver cancer Treated with phlebotomy and chelating agents (deferasirox)