is the branch of medicine thatinvolves the study of liver, gallbladder, biliary tree,and pancreas as well as management of their disorders.• Diseases and complications related to viral hepatitis andalcohol are the main reason for seeking specialistadvice. Up to 80% of liver cancer can be attributed toeither B or C Hepatitis virus.
• Liver is a vital organ. It is a reddish brown organ withfour lobes of unequal size and shape.• A human liver normally weighs 1.44–1.66 kg , a softtriangular organ. It is both the largest internal organand the largest gland in the human body.• It is located in the right upperquadrant of the abdominal cavity,resting just below the diaphragm.• It is connected to two large bloodvessels, one called the hepaticartery and the other is portal vein.
• decomposition of red bloodcells.• glycogen storage.• plasma protein synthesis.• hormone production.• and detoxification.
Is a collection ofconditions, disorders,and infections that affectcells, structures, andtissues of the liver,causing liver damage orstop liver functioningaltogether.
• 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, orinfiltrated by abnormal cells.
Paracetamol toxicity : is caused by excessive use or overdoseof the analgesic drug. Which is equal to 1gm (20 tablets per 24hr.) of Paracetamolparacetamol toxicity is one of the most common cause of acuteliver failure.Damage to the liver, or hepatotoxicity, results not fromparacetamol itself, but from one of its metabolites, N-acetyl-p-benzoquinonemine (NAPQI).Which depletes the livers natural Antioxidantglutathione and directly damages cells in theliver, leading to liver failure.
Alcohol is directly toxic to livercells and can cause liverinflammation, referred to asalcoholic hepatitis.Alcoholic liver diseaseusually develops after yearsof excessive alcohol intake.
Liver Cirrhosis is generally considered to be the4th stage of Alcoholic Liver Disease, a progressivecondition causing liver damage. Cirrhosis is characterized by the replacement ofhealthy tissue with fibrous tissue, regenerativenodules, and liver scarring. The resulting hardening of the liver interfereswith blood circulation, eventually leading toirreversible liver damage and a complete loss ofliver function.
Also known as a hepatic cyst, a simple liver cyst is athin-walled bubble, a fluid-filled cavity in the liver. Acommon liver problem, liver cysts are normally benignand pose no problems or health risks.In some cases, however, liver cysts may grow largeenough to cause pain or discomfort in the upper rightpart of the abdomen, liver enlargement, bile ductinfection, or obstruction of the bile ducts, causing thecyst itself to become infected. In these cases, it isnecessary to drain and/or remove the cyst.
"fatty liver" describes as the accumulation of fat withinthe liver that can cause inflammation of the liver and agradual decrease in liver function.
Liver Fibrosis is generally considered to be the 3rd stage ofAlcoholic Liver Disease, a progressive liver damagingcondition. Liver fibrosis is characterized by the formation of fibroids orfibrous tissue, regenerative nodules, and liver scarring, all ofwhich impede blood circulation, and lead to progressive lossof liver function. Commonly caused by alcoholism and hepatitis C.
• Viral Hepatitis is a medical condition defined by theinflammation of the liver and characterized by thepresence of inflammatory cells in the tissue of theorgan. The name is meaning "inflammation". It hasmany types:• Hepatitis A• Hepatitis B• Hepatitis C• Hepatitis D• Hepatitis E
Hepatitis A :Is a viral infection that is spread primarily through the feco-oralroute, contaminated water & food .Hepatitis A causes an acute infection of the liver which generallyresolves spontaneously within 2 weeks.The hepatitis A vaccine can prevent this infection.Perfect hand washing, especially when preparing food is the bestway to prevent the spread of hepatitis A.
Hepatitis B :Is spread by exposure to body fluids (needles fromdrug abusers, contaminated blood, and sexual contact)and can cause an acute infection, but can also progressto cause chronic infection (chronic hepatitis) that canlead to cirrhosis and liver cancer.The hepatitis B vaccine can prevent this infection.
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, andsexual contact). Chronic hepatitis C may lead tocirrhosis and liver cancer.At present, there is no vaccine against this virus.
Hepatitis D :Is a virus that requires concomitant infectionwith hepatitis B to survive, and is spread viabody fluid exposure (needles from drug abusers,contaminated blood, and sexual contact).Its mostly affected pregnant women.
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 tocontaminated food and water.
Iron overload : is a metabolic disorder thatleads to abnormally elevated iron stores in thebody.The excess iron may accumulate in the tissuesof the liver, pancreas, and heart and can leadto inflammation, cirrhosis, liver cancer, andliver failure. Hemochromatosis is an inheriteddisease.
Is another inherited disease that affects thebodys ability to metabolize copper.Wilsons disease may lead to cirrhosis andliver failure.
In Gilberts Disease there is an abnormality inbilirubin metabolism in the liver. It is relatively a common disease. There are nosymptoms and it is usually diagnosed incidentallywhen an elevated bilirubin level is found onroutine blood tests.Gilberts disease is a benign condition andrequires no treatment.
Cholangitis : is inflammation of the bile ductsof the liver. Sclerosing is inflammation thatleads to the extensive formation of fibrousand scar tissue. In primary sclerosing cholangitis (PSC), thebile ducts inside and outside the liver havebecome inflamed and scarred.
Budd Chiari syndrome is a disease in which bloodclots form in the hepatic vein and prevent blood fromleaving the liver. This can increase pressure within theblood vessels of the liver, especially the portal vein. This pressure can cause liver cells to die and lead tocirrhosis and liver failure. Causes of Budd Chiari syndrome include :polycythemia (abnormally elevated red blood cellcount), inflammatory bowel disease, sickle cell disease,and pregnancy.
Primary cancers of the liver arise from liverstructures and cells.Two examples include hepatocellular carcinomaand cholangiocarcinoma.Metastatic cancer (secondary cancer of the liver)begins in another organ and spreads to the liver,usually through the blood stream. Commoncancers that spread to the liver begin inthe lung, breast, large intestine,stomach,and pancreas.
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 theeyes (sclerae) caused by the abnormal buildup of bilirubin in theblood). bilirubin is part of bile; it forms in the liver as a by productof old blood cells. When there are too many red blood cells dyingfor the liver to cope with, yellow pigment builds up in the bodyresulting in jaundice, which is a visible sign of liver problems.V. Fatigue, weakness and weight loss may also be occur.
• All type of hepatitis produce similar oral manifestation.• The most common feature is deposition of the bile pigmentsin the oral mucosa . This discoloration best visualized in theposterior palate and floor of the mouth along the lingualfrenum.• Sever liver disease may also induce intra oral bleeding , orecchymosis .• No specific treatment of the oral tissuesis needed because the tissue returns tonormal on the resolution of the diseases.
The precise diagnosis of liver disease involves a history andphysical examination performed by the health care professional. Blood tests are helpful in assessing liver inflammation andfunction. Specific liver function blood tests include:1. AST and ALT ( transaminase chemicals released with liver cellinflammation)2. GGT and alkaline phosphatase (chemicals released by cells liningthe bile ducts)3. Bilirubin level.4. protein and albumin levels.
Computerized tomography (CT or CATEndoscopic (ERCP) combines the use of X-raysand an endoscope (a long, flexible, lightedtube) to diagnose and treat problems in theliver, gallbladder, bile ducts, and pancreasMagnetic resonance imaging (MRI)Stool tests to measure the amount of fat infecesUltrasound
1. Medical consultation.2. all patient with a history of hepatitis must bemanaged as they are potentially infectious3. No dental treatment other than urgent care(absolutely necessary work) should be rendered fora patient with acute viral hepatitis.4. sedation should be minimizedand drugs metabolized in theliver avoided as much aspossible.
1. Local anesthetics (appear safefor use during liver diseasewhen used in appropriateamounts):· Lidocaine· Mepivacaine· Prilocaine· Bupivacaine2. Anelgesics:· Aspirin· Codein· Ibuprofen· Acetaminophen3. Sedatives :· Diazepam· Barbiturates4. Antibiotics :. Ampicillin. Tetracycline. Metronidazole. Vancomycin
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 ofblood 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 managedas though they are potentially infectious.
1. Impaired drug detoxification e.g. sedative,analgesics, general anesthesia.2. Bleeding disorders ( decrease clottingfactors, excess fibrinolysis, impaired vitaminK absorption).3. Transmission of viral hepatitis.