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 applica;on to pa;ent manage...

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 applica;on to pa;ent management Describe the proper;es of relevant medicines 1.1.8 and therapeu;c agents and discuss their applica;on to pa;ent management Aim Outline liver disease and explain its relevance to the dental hygienist/therapist Learning outcomes List the func;ons 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 modiEed 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 liJle as 25%) Posterior and anterior view of liver The many func@ons of the liver Essen;al 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 – essen;al for fat diges;on and absorp;on of fat soluble vitamins Stores minerals e.g. iron, copper Removes metabolic products and toxins from blood Fights infec;on - captures and digests bacteria, fungi, parasites, redundant blood cells and cellular debris Func@ons of the liver con@n/ Turns glucose into glycogen which is stored in the liver Regulates glucose and cholesterol levels Makes essen;al proteins e.g. blood cloYng factors, albumin, hormones, transporter proteins and complement Underlies normal haemostasis as it also produces hormone thrombopoie;n which s;mulates bone marrow to produce platelets Breaks down haemoglobin, cholesterol, proteins, sex steroids and many drugs e.g. alcohol, LA, analgesics, an;microbials, seda;ves 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 Elter alcohol in order to break it down and remove it from the body. Each ;me, 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 ;me means the liver can’t recover. This can result in serious and permanent damage. Three stages of alcohol related liver disease Alcoholic faJy liver disease usually no symptoms, reversible Alcoholic hepa;;s in\amma;on of liver, reversible in early stages if stop drinking permanently permanent damage in later stages Cirrhosis scarring (Ebrosis) of liver prevents normal func;on Irreversible Liver failure Symptoms of cirrhosis O]en no symptoms un;l liver severely damaged Tiredness and weakness Nausea and loss of appe;te Weight loss Palmar erythema Spider naevi Finger clubbing Sialosis Symptoms of cirrhosis con@n/ 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) Gynaecomas;a or tes;cular atrophy Oesophageal varices Encephalopathy (leading to confusion) Liver cancer Treatment of cirrhosis Not possible to cure, only deal with symptoms and complica;ons Lifestyle Stop drinking alcohol altogether Healthy diet to reduce malnutrition Low protein and low salt diet Lose weight Stop smoking Medicines (diure;cs, beta-blockers, creams to reduce skin itching) Liver transplant Non-Alcoholic faJy liver disease Non alcoholic faJy liver disease Build up of fat in liver Not caused by alcohol Usually related to obesity 4 stages – over many years Early stages o]en symptom free and no harm Liver in\amma;on Fibrosis Cirrhosis Symptoms of Ebrosis – abdominal pain, ;redness, weight loss, weakness Symptoms of cirrhosis – see above Non alcoholic faJy 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 aJacks bile ducts Bile builds up in the liver, leads to liver cirrhosis a]er decades Symptoms include bone and joint aches, fa;gue, itchy skin, dry eyes and mouth, abdominal pain Treatment includes ursodeoxycholic acid and obe;cholic acid and medica;ons to relieve symptoms e.g. itching It untreated can also be associated with osteoporosis, portal hypertension, ascites, vitamin deEciencies, liver cancer Tumours and cysts Primary liver cancer Hepatocellular carcinoma most common More common if pre-exis;ng cirrhosis Secondary liver cancer Metasta;c cancer from another organ e.g. breast, bowel, lung, ovary Liver cysts Simple cyst related to malforma;on of bile duct Congenital – polycys;c liver disease Caused by parasite echinococcus Haemachromotosis Inherited condi;on Iron overload Damages liver, joints, pancreas and heart More likely to develop liver cancer Treated with phlebotomy and chela;ng agents (deferasirox)