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Human Diseases > Dental and oral complications of bleeding disorders > Flashcards

Dental and oral complications of bleeding disorders Flashcards

1
Q

What 4 components do bleeding disorders generally involve one or more of the following?

A

Vascular - vessel walls
Platelets
Coagulation Factors
Fibrin

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2
Q

How can vascular bleeding disorders be catagorised?

A

Congenital

Acquired

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3
Q

Example of congenital vascular problems?

A

Ehler’s Danlos syndrome

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4
Q

What is Ehlers Danlos syndrome?

A

Collagen disorder - effecting collagen in BV walls

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5
Q

Example of acquired vascular bleeding disorder?

A

Scurvy

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6
Q

What causes Scurvy?

A

Vit C deficiency

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7
Q

How can platelet disorders be catagorised?

A

Disorder/function (congenital/acquired) or change in numbers through increased/decreased production/destruction

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8
Q

Example of functional congenital platelet disorder?

A

Von Willebrand’s disease

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9
Q

Effect of Von Willebrand’s disease?

A

Low plasma levels of VWF or low function of VWF = decreased aggregation and factor 8

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10
Q

Examples of acquired functional platelet disorders?

A

Aspirin induced or renal function induced (inhibits initial aggregation)

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11
Q

2 examples of platelet disorders - change in number?

A

Thrombocytopenia

Thrombocytosis

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12
Q

What is thrombocytopenia?

A

Decreased number of platelets

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13
Q

What is thrombocytosis?

A

Increased number of platelets

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14
Q

Mechanism of action of thrombocytopenia?

A

Abnormal bone marrow causes decreased formation

Normal bone marrow with autoimmune process can cause increased destruction

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15
Q

Causes thrombocytopenia?

A

Alcoholic liver disease, malignancy

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16
Q

What are the effects of thrombocytosis?

A

If you have too many platelets and they all work well = too much clotting
If you have too many and they don’t work well = bleeding

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17
Q

What 3 things can thrombocytosis result from?

A

Reactive or secondary thrombocytosis (result as result of a reaction)
Familial (genetic)
Clonal - can’t explain

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18
Q

How can coagulation bleeding disorders be catagorised?

A

Intrinsic defects

Extrinsic defects

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19
Q

What is meant by intrinsic or extrinsic coagulation disorders?

A

Effects intrinsic or extrinsic pathways

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20
Q

What effect do intrinsic coagulation disorders have?

A

Prolonged APTT (activated partial thromboplastin time)

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21
Q

How can intrinsic coagulation disorders be categorised further? give an example of both.

A

Congential - haemophilia A and B

Acquired - heparin induced

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22
Q

what effect does extrinsic coagulation disorders have?

A

Prolong prothrombin time (PT time)

23
Q

How do extrinsic coagulation disorders generally occur?

A

Acquired e.g. liver disease, warfarin

24
Q

What are fibrin disorders a result of?

A

Thrombolytic therapy

Pathological fibrinolysis e.g. tumour

25
Q

How do vascular wall disorders present?

A

Superficial bruise at superficial layer

26
Q

How do platelet disorders present?

A

Superficial bruise at superficial layer
Epistaxis (nosebleed), menorrhagia (mensuration)
Hematemesis (vomiting blood), melena (blood in stool)

27
Q

How do coagulation disorders present?

A

Blood in body fluids (nose bleeds, mensturation, vomit, stool
Brusing at deeper layer

28
Q

Bleeding disorders tend to present as one or more of these manifestations:

a) superficial bruising
b) bleeding from sites e.g. nose bleed, heavy menstruation, vomit, stool
c) deep, spreading bruising

Match each of these disorders to their manifestations

  1. vascular wall disorder
  2. Platelet disorder
  3. Coagulation disorder
A
  1. a
  2. a b
  3. b c
29
Q

What are the key systems in the medical history that relate to bleeding disorders?

A

GIT/liver disease

Coagulation system

30
Q

What evidence may suggest bleeding problems?

A

Regular nose bleeds, bruising, family history

Previous haemostatic challenges - after extraction

31
Q

What is relevant in the social history for bleeding?

A

If they drink alcohol/how much and for how long?

32
Q

What are the 2 functions of the liver?

A

Synthetic - makes clotting factors and albumin

Metabolic- breaks down drugs

33
Q

What is relevant in dental history for bleeding?

A

Previous extractions - what happened

how they were managed

34
Q

What is ecchymosis?

A

Bleeding into subcutaneous tissues - known as bruising, usually due to trauma

35
Q

At what point does ecchymosis suggest bleeding disorders?

A

When the extent of the bruising is not appropriate for the trauma

36
Q

What is purpura?

A

Spontaneous bleeding into skin causing pools of blood within the skin

37
Q

How can purpura be catagorised?

A

Non-thrombocytopenic - not due to low levels of platelets

Thrombocytopenic - due to low levels of platelets

38
Q

What caused non-thrombocytopenic purpura?

A

Ehlers Danlos
Infections
Ageing skins

39
Q

How does thrombocytopenic purpra manifest/

A

Petechiae - small spots on the skin as a result of bleeding

40
Q

Causes of thrombocytopenic purpura?

A

Impaired production of platelets
Excessive platelet destruction
Sequestration of platelets in spleen
Dilution loss following transfusions

41
Q

What can cause impaired production of platelets?

A

Bone marrow failure

Selective reduction in megakaryocytes due to drugs or alcohol

42
Q

What causes excessive platelet destruction?

A

Immune problems - autoimmune or triggered by particular viral infections

Coagulation problems

43
Q

Name 2 types of vascular abnormalities

A

Telangiectasia

Haemangioma

44
Q

What is telangiectasia?

A

Vascular abnormality

Dilation of small veins causing excessive bleeding

45
Q

What are 2 important types of telangiectasia?

A

Spider

Hereditary haemorrhagic

46
Q

Describe spider telangiectasia?

A

Radiate from central sport disappear on pressure

47
Q

Describe herediatry haemorrhagic telangiectasia

A

Large dilated vessels on mucous membrane of mouth and nose

48
Q

What is haemangioma?

A

Vascular abnormality due to abnormality of blood vessels. lumps on face
Blanch on pressure

49
Q

What may be found in the social history that can be a clue for bleeding disorders, why?

A

Alcohol abuse
Liver disease - affects metabolic and synthetic function
Portal venous hypertension
Obstruction of bile duct

50
Q

What visual clues suggest alcohol abuse?

A

Bruising
Jaundice
Spider telangectasia

51
Q

What blood tests can diagnose bleeding disorders?

A

APTT
PT
Full blood count
Liver function tests

52
Q

Most important point in managing bleeding disorders?

A

Liaise with other professionals

53
Q

list 3 local measures for bleeding?

A

More pressure, more LA
Suture
Pack

54
Q

Why do we pack?

A

Temporarily apply pressure

Adjust coagulation process

Human Diseases (37 decks)

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