dental aspects of renal disease Flashcards
what are the main managemetn problems re. renal disease?
bleeding tendancies
prone to infections
hypertension
port op complications
what underlying disease can be associated with renal disease?
diabetes Lupus (SLE) polyarteritis nodosa mylematosis amyloidosis peptic ulceration
why are bleeding tendanciesa problem re. renal disease?
abnormal platelet production
diminished factor 3
defective von willebrands factor
When should a patient with renal disease be treated?
after dialysis- when heparin has worn off
how should you proceed with patients with renal disease?
consult haematologist
atraumatic surgery where possible
good local haemostatic measures
what may be useful to help deal with bleeding tendancies?
cryprecipate or conjugated oestrogens
why are infections an issue with patients with renal disease?
poorly controlled by patients especially if immunosuppressed
often signs of infection can be masked
dialysis predisposed to blood born viruses and TB
with regards to local anaesthesisa, what precautions should be taken?
safe, unless there is a severe bleeding tendancy
if bleeding tendancy, avoid regonal blocks
with regards to conscious sedation or blood taking, what precautinos should be taken?
do not use haemodialysis shunts
do not use forearms or saphenous veins
use veins at or above the elbow
what drug would be preferable re. sedation?
midazolam because of the lower risk of thrombophlebitis
what complications may occur re. general anaesthesia?
renal failure complicated by anaemia
may develop hypotension at moderate levels of anaesthesia
myocardial depression and arythmias are likely
what would contraindicate general anaesthetics
haemoglobin
how is GA establised?
induction with thiopentone followed by very light GA with notrous oxide
What are possible oral manifestations re. renal disease?
osseus lesions- loss of lamina dura secondary hyperparathyroidism may lead to giant cell lesion abnormal bone repair after XLA screen implant patients carefully dry mouth, halitosis, metallic taste salivary gland swelling orla bleeding caluluc formation oral ulceration due to anaemia
what are oral menifestations re. renal disease in children?
jaw growth usually retarded tooth eruption delayed malocclusion brownish tooth discoulration previous tetracylcine staining low caries rte and less perio disease reported
