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Liver Disease |
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Liver disorders are important to the dentist due to a potential bleeding tendency, intolerance to drugs e.g. general anaesthetics, benzodiazepines and the possibility of underlying infective causes for the liver dysfunction. Signs of liver disease include jaundice, spider naevi, leuconychia, finger clubbing, palmar erythema, Dupuytren's contracture, sialosis and gynaecomastia. The general anaesthetic agent halothane (now used infrequently) should not be given twice to the same patient within 3 months. A 'halothane hepatitis' is likely to result. Dental sedation should only be performed in specialist units for patients with significant liver disease as small doses can lead to coma.
Functions of the Liver
¨ It metabolises drugs and endogenous substances and contributes to their excretion by the body. ¨ Synthesis of Plasma proteins ¨ Acts as a storage organ for glycogen and vitamin B12. ¨ Produces clotting factors for normal haemostatic function.
Chronic liver disease (defined as liver disease present for more than 6 months) can enter an acute phase if unrecognised e.g. after the administration of sedation. Acute liver failure itself may be precipitated by any type of viral hepatitis, the anaesthetic agent halothane, paracetomol overdose or Reye's Syndrome (see later).
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