Hepatic disease

2. is the branch of medicine that
involves the study of liver, gallbladder, biliary tree,
and pancreas as well as management of their disorders.
• Diseases and complications related to viral hepatitis and
alcohol are the main reason for seeking specialist
advice. Up to 80% of liver cancer can be attributed to
either B or C Hepatitis virus.

3. • Liver is a vital organ. It is a reddish brown organ with
four lobes of unequal size and shape.
• A human liver normally weighs 1.44–1.66 kg , a soft
triangular organ. It is both the largest internal organ
and the largest gland in the human body.
• It is located in the right upper
quadrant of the abdominal cavity,
resting just below the diaphragm.
• It is connected to two large blood
vessels, one called the hepatic
artery and the other is portal vein.

4. • decomposition of red blood
cells.
• glycogen storage.
• plasma protein synthesis.
• hormone production.
• and detoxification.

5. Is a collection of
conditions, disorders,
and infections that affect
cells, structures, and
tissues of the liver,
causing liver damage or
stop liver functioning
altogether.

6. • Cells can become inflamed (such as in hepatitis).
• Bile flow can be obstructed (such as in cholestasis).
• Cholesterol or triglycerides can accumulate (fat accumulation).
• Blood flow to the liver may be compromised.
• Liver tissue can be damaged by chemicals and minerals, or
infiltrated by abnormal cells.

8. Paracetamol toxicity : is caused by excessive use or overdose
of the analgesic drug. Which is equal to 1gm (20 tablets per 24
hr.) of Paracetamol
paracetamol toxicity is one of the most common cause of acute
liver failure.
Damage to the liver, or hepatotoxicity, results not from
paracetamol itself, but from one of its metabolites, N-acetyl-p-
benzoquinonemine (NAPQI).
Which depletes the liver's natural Antioxidant
glutathione and directly damages cells in the
liver, leading to liver failure.

9. Alcohol is directly toxic to liver
cells and can cause liver
inflammation, referred to as
alcoholic hepatitis.
Alcoholic liver disease
usually develops after years
of excessive alcohol intake.

10.  Liver Cirrhosis is generally considered to be the
4th stage of Alcoholic Liver Disease, a progressive
condition causing liver damage.
 Cirrhosis is characterized by the replacement of
healthy tissue with fibrous tissue, regenerative
nodules, and liver scarring.
 The resulting hardening of the liver interferes
with blood circulation, eventually leading to
irreversible liver damage and a complete loss of
liver function.

12. Also known as a hepatic cyst, a simple liver cyst is a
thin-walled bubble, a fluid-filled cavity in the liver. A
common liver problem, liver cysts are normally benign
and pose no problems or health risks.
In some cases, however, liver cysts may grow large
enough to cause pain or discomfort in the upper right
part of the abdomen, liver enlargement, bile duct
infection, or obstruction of the bile ducts, causing the
cyst itself to become infected. In these cases, it is
necessary to drain and/or remove the cyst.

14.  "fatty liver" describes as the accumulation of fat within
the liver that can cause inflammation of the liver and a
gradual decrease in liver function.

16.  Liver Fibrosis is generally considered to be the 3rd stage of
Alcoholic Liver Disease, a progressive liver damaging
condition.
 Liver fibrosis is characterized by the formation of fibroids or
fibrous tissue, regenerative nodules, and liver scarring, all of
which impede blood circulation, and lead to progressive loss
of liver function.
 Commonly caused by alcoholism and hepatitis C.

18. • Viral Hepatitis is a medical condition defined by the
inflammation of the liver and characterized by the
presence of inflammatory cells in the tissue of the
organ. The name is meaning "inflammation". It has
many types:
• Hepatitis A
• Hepatitis B
• Hepatitis C
• Hepatitis D
• Hepatitis E

19.  Hepatitis A :
Is a viral infection that is spread primarily through the feco-oral
route, contaminated water & food .
Hepatitis A causes an acute infection of the liver which generally
resolves spontaneously within 2 weeks.
The hepatitis A vaccine can prevent this infection.
Perfect hand washing, especially when preparing food is the best
way to prevent the spread of hepatitis A.

20.  Hepatitis B :
Is spread by exposure to body fluids (needles from
drug abusers, contaminated blood, and sexual contact)
and can cause an acute infection, but can also progress
to cause chronic infection (chronic hepatitis) that can
lead to cirrhosis and liver cancer.
The hepatitis B vaccine can prevent this infection.

21.  Hepatitis C :
causes chronic hepatitis.
An infected individual may not recall any acute illness.
Hepatitis C is spread by exposure to body fluids
(needles from drug abusers, contaminated blood, and
sexual contact). Chronic hepatitis C may lead to
cirrhosis and liver cancer.
At present, there is no vaccine against this virus.

22.  Hepatitis D :
Is a virus that requires concomitant infection
with hepatitis B to survive, and is spread via
body fluid exposure (needles from drug abusers,
contaminated blood, and sexual contact).
Its mostly affected pregnant women.

23.  Hepatitis E :
It is rare and illness is self limited .
Endemic area are India and Burma.
Hepatitis E is a virus that is spread via exposure to
contaminated food and water.

25. Iron overload : is a metabolic disorder that
leads to abnormally elevated iron stores in the
body.
The excess iron may accumulate in the tissues
of the liver, pancreas, and heart and can lead
to inflammation, cirrhosis, liver cancer, and
liver failure. Hemochromatosis is an inherited
disease.

27. Is another inherited disease that affects the
body's ability to metabolize copper.
Wilson's disease may lead to cirrhosis and
liver failure.

28.  In Gilbert's Disease there is an abnormality in
bilirubin metabolism in the liver.
 It is relatively a common disease. There are no
symptoms and it is usually diagnosed incidentally
when an elevated bilirubin level is found on
routine blood tests.
Gilbert's disease is a benign condition and
requires no treatment.

29. Cholangitis : is inflammation of the bile ducts
of the liver. Sclerosing is inflammation that
leads to the extensive formation of fibrous
and scar tissue.
 In primary sclerosing cholangitis (PSC), the
bile ducts inside and outside the liver have
become inflamed and scarred.

31.  Budd Chiari syndrome is a disease in which blood
clots form in the hepatic vein and prevent blood from
leaving the liver. This can increase pressure within the
blood vessels of the liver, especially the portal vein.
 This pressure can cause liver cells to die and lead to
cirrhosis and liver failure.
 Causes of Budd Chiari syndrome include :
polycythemia (abnormally elevated red blood cell
count), inflammatory bowel disease, sickle cell disease,
and pregnancy.

32. Primary cancers of the liver arise from liver
structures and cells.
Two examples include hepatocellular carcinoma
and cholangiocarcinoma.
Metastatic cancer (secondary cancer of the liver)
begins in another organ and spreads to the liver,
usually through the blood stream. Common
cancers that spread to the liver begin in
the lung, breast, large intestine,stomach,
and pancreas.

33. Classic symptoms of liver disease include:
I. Nausea.
II. Vomiting.
III. right upper quadrant abdominal pain.
IV. jaundice (yellowish discoloration of the skin and whites of the
eyes (sclerae) caused by the abnormal buildup of bilirubin in the
blood). bilirubin is part of bile; it forms in the liver as a by product
of old blood cells. When there are too many red blood cells dying
for the liver to cope with, yellow pigment builds up in the body
resulting in jaundice, which is a visible sign of liver problems.
V. Fatigue, weakness and weight loss may also be occur.

35. • All type of hepatitis produce similar oral manifestation.
• The most common feature is deposition of the bile pigments
in the oral mucosa . This discoloration best visualized in the
posterior palate and floor of the mouth along the lingual
frenum.
• Sever liver disease may also induce intra oral bleeding , or
ecchymosis .
• No specific treatment of the oral tissues
is needed because the tissue returns to
normal on the resolution of the diseases.

36.  The precise diagnosis of liver disease involves a history and
physical examination performed by the health care professional.
 Blood tests are helpful in assessing liver inflammation and
function.
 Specific liver function blood tests include:
1. AST and ALT ( transaminase chemicals released with liver cell
inflammation)
2. GGT and alkaline phosphatase (chemicals released by cells lining
the bile ducts)
3. Bilirubin level.
4. protein and albumin levels.

37. Computerized tomography (CT or CAT
Endoscopic (ERCP) combines the use of X-rays
and an endoscope (a long, flexible, lighted
tube) to diagnose and treat problems in the
liver, gallbladder, bile ducts, and pancreas
Magnetic resonance imaging (MRI)
Stool tests to measure the amount of fat in
feces
Ultrasound

38. 1. Medical consultation.
2. all patient with a history of hepatitis must be
managed as they are potentially infectious
3. No dental treatment other than urgent care
(absolutely necessary work) should be rendered for
a patient with acute viral hepatitis.
4. sedation should be minimized
and drugs metabolized in the
liver avoided as much as
possible.

39. 1. Local anesthetics (appear safe
for use during liver disease
when used in appropriate
amounts):
· Lidocaine
· Mepivacaine
· Prilocaine
· Bupivacaine
2. Anelgesics:
· Aspirin
· Codein
· Ibuprofen
· Acetaminophen
3. Sedatives :
· Diazepam
· Barbiturates
4. Antibiotics :
. Ampicillin
. Tetracycline
. Metronidazole
. Vancomycin

40.  HBV vaccination for all clinical staff - 0, 1, 6 month
 Use of infection control manuals
 Hand washing before treating patients
 Routine use of gloves and protective eyewear
 Using masks and uniforms to protect against splatter of
blood and saliva
 Heat-sterilizing hand pieces between patients
 Turbine and individuals instruments for every patients
 All patient with a history of viral hepatitis must be managed
as though they are potentially infectious.

41. 1. Impaired drug detoxification e.g. sedative,
analgesics, general anesthesia.
2. Bleeding disorders ( decrease clotting
factors, excess fibrinolysis, impaired vitamin
K absorption).
3. Transmission of viral hepatitis.