Liver Failure

Question 1

what is acute liver failure?

Answer 1

sudden loss of liver function

Question 2

how can rapid death occur in someone suffering from acute liver failure?

Answer 2

• bleeding

* encephalopathy

Question 3

why does excessive bleeding occur in liver failure patients?

Answer 3

the ability to make proteins and clotting factors is reduced/stops

Question 4

why is meant by encephalopathy?

Answer 4

body has no ability to decontaminate blood toxins which leads to IMPAIRMENT OF BRAIN FUNCTION

Question 5

what are examples of diseases that fall under the ‘chronic’ liver disease spectrum?

Answer 5

• cirrhosis
• primary liver cancer
• secondary liver cancer

Question 6

what can cause cirrhosis of the liver?

Answer 6

• alcohol
• Primary Biliary Cirrhosis (autoimmune)
• viral disease
• autoimmune chronic hepatitis
• cystic fibrosis

Question 7

what are the signs and symptoms of cirrhosis?

Answer 7

• often NONE
• acute bleeding
• jaundice
• oedema & ascites
• encephalopathy
• spider naïve

Question 8

what is meant by ascites?

Answer 8

fluid accumulation in the peritoneal area

Question 9

what can happen due to ascites?

Answer 9

• high portal venous pressure

* low plasma protein synthesis

Question 10

what are osophageal varices?

Answer 10

dilation of little veins at the bottom end of oesophagus

Question 11

what functions of the liver are lost during liver failure?

Answer 11

• loss of synthetic function

* loss of metabolic function

Question 12

what tests are used to detect liver failure?

Answer 12

• International Normalised Ratio (INR)

Question 13

what will rise in the presence of liver failure?

Answer 13

hepatic cell enzyme levels (ALT, GGT)

• raised in liver inflammation

Question 14

what does the INR test?

Answer 14

measures PROTHROMBIN time against a control (lab worker)

Question 15

what is the normal INR value and how does this differ with other diseases/medications?

Answer 15

• normal value = 1

* if on warfarin the therapeutic range = 2.0-4.0

Question 16

what is signified if the INR value is not normal?

Answer 16

SIGNIFICANT liver synthetic dysfunction (e.g. not enough clotting factors)

Question 17

what occurs in patients that suffer from liver failure?

Answer 17

• ascites
• raised INR & prolonged bleeding
• portal hypertension
• inability to remove “waste”
• build up of haem breakdown products

Question 18

what is portal hypertension & what can it lead to?

Answer 18

• inability of GI blood to re-enter the vena cava

* leads to oesophageal vein dilation (Varices)

Question 19

what treatment options are there for liver failure patients?

Answer 19

• supportive treatment (end stage disease)
• transplantation
• artificial liver systems

Question 20

what is an example of an artificial liver system?

Answer 20

Molecular Adsorbent Recirculating System (MARS)

Question 21

how can end stage liver disease affect dentistry?

Answer 21

• patients have clotting disorders
• patients have abnormal drug metabolism
• reduced ‘gamma globulin’ so more prone to infection

Question 22

what analgesics are suitable for liver failure patients? which are NOT?

Answer 22

• paracetamol probably safest option

* NSAIDs increase bleeding risk so NO

Question 23

does local anaesthetic effect liver failure patients?

Answer 23

NO! metabolised in the plasma, not the liver