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Human Systems and Diseases > Liver and Kidney > Flashcards

Liver and Kidney Flashcards

1
Q

What is jaundice?

A

Accumulation of bilirubin in the skin.

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2
Q

What signs and symptoms would someone have if they had jaundice?

A

Yellow sclera of the eye
Yellow skin
Significant itch

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3
Q

How does jaundice occur?

A

RBC are reprocessed by macrophages in the spleen and bone marrow.
Produces haem, converted to bilirubin and then conjugated in the liver.
Must be conjugated to be excreted- into the gall bladder, then SI, then LI.
Reabsorbed bilirubin converted to urobilinogen in the LI and excreted in the kidney.

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4
Q

What is acute liver failure?

A

Sudden insult tot eh liver, which has caused function loss rapidly.

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5
Q

What are examples of causes of acute liver failure?

A

Paracetamol poisoning.

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6
Q

What is chronic liver failure?

A

Insults to the liver over a longer period of time, which as caused function loss.

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7
Q

What are examples of chronic liver failure?

A

Cirrhosis
Primary liver cancer
Secondary liver cancer

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8
Q

What is liver cirrhosis?

A

Damage to hepocytes occurs and then the liver regenerates.
However, every time It regenerates, you have loss of parts of the liver and fibrosis, altered architecture.
These effects are additive over time.
- irreversible liver necrosis and fibrosis.

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9
Q

What can cause liver cirrhosis?

A

Excessive alcohol
Primary biliary cirrhosis- autoimmune
Hepatitis
Haemochomatosis
Cystic fibrosis.

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10
Q

What are signs and symptoms of cirrhosis?

A

Portal hypertension
Oesophageal varices
Jaundice
Oedema
Ascites
Encephalopathy
Spider naevi- small prominent arterioles which develop under the skin
Palmar erythema- palm appears red because of high oestrogen levels.

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11
Q

What are oesophageal varices?

A

Partial triad has become disordered as a result of the cirrhosis.
Blood cannot pass easily to the portal vein, so pressure increases within the portal vein.
Blood gengorges as passes through vessels at the end of the oesophagus.
Veins dilate and are fragile to trauma- cause a large bleed.

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12
Q

What two functions are lost in liver failure?

A

Loss of synthetic function and loss of metabolic function.

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13
Q

What is loss of synthetic function?

A

Less clotting factors- 1, 2, 7, 9, 10, 11.
- Vit K dependent factors.
Less plasma proteins- transporting proteins and gamma globulins.

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14
Q

What is loss of metabolic function?

A

Reduced drug metabolism.
Detoxification.
Lack of conjugation of bilirubin- jaundice.

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15
Q

What tests may be useful to determine someone’s liver function?

A

Full blood count, Coagulation/clotting screen- thrombin.
Liver function tests- ALT and GGT.
Us and Es
INR- anything above 1 in these patients is high and there is significant liver synthetic dysfunction.

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16
Q

What is produced in the liver?

A

Conjugated bilirubin
Clotting factors
Plasma proteins.
Thrombin.
Thrombopoietin

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17
Q

What is a consequence of liver disease?

A

Abnormalities of platelet function.
- Thrombocythaemia.

Abnormality in platelet number (reduced)
- Thrombocytopenia.

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18
Q

Which local anaesthetic would be advised in liver patients?

A

Articaine- only 5-10% metabolised in the liver but 100% of lidocaine is metabolised there.

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19
Q

Which medications should be avoided in someone with liver disease?

A

NSAIDs- can irritate the gastric mucosa and cause a bleed.
Paracetamol- can be hepatotoxic.
Erythromycin.
May need to reduce the dose of metronidazole.
Midazolam for IV sedation

20
Q

What factors may the patient require if they have severe liver disease?

A

Platelet transfusion
Vitamin K replacement
FFP transfusion

21
Q

What first line analgesia would be advised in a liver patient?

A

Paracetamol.

22
Q

When is best to schedule dental treatment for someone on haemodialysis?

A

Day after dialysis.

23
Q

Where is erythropoietin produced?

A

Kidney

24
Q

What does erythropoietin do?

A

Stimulates RBC production in the bone marrow.

25
Q

What tests can be done to determine renal function?

A

Serum urea
Serum creatinine
eGFR
24 hour urine collection.

26
Q

What functions are lost in renal failure?

A

Renal excretory function
Loss of water and electrolyte balance
Loss of acid base balance
Loss of renal endocrine function- EPO, calcium metabolism, renin secretion.

27
Q

What can cause chronic renal failure?

A

Glomerulonephritis
Polycystic kidney disease

Secondary causes- diabetes, hypertension, drug therapy, vasculitis.

28
Q

What is the renin-angiotensin system?

A

Renin is produced in the juxtaglomerular cells when renal blood flow is reduced (low blood pressure).
Renin converts angiotensinogen (produced by the liver) to angiotensin .
Angiotensin 1 is then converted to Angiotensin 2 by ACE.

Angiotensin 2 is a vasoconstrictor and also stimulate the release of aldosterone from the adrenal gland to increase salt and water resorption and excretion of potassium.
- overall increasing blood pressure.

29
Q

Which drugs should not be given to a renal failure patient?

A

NSAIDs.- inhibit glomerular blood flow.
Nephrotoxic drugs- cyclosporin.
Tacrolimus
Azothioprine
Prednisolone

30
Q

What other features will chronic renal failure patients exhibit?

A

High blood pressure
Cardiovascular disease
Anaemia
Disorder mineral metabolism- reduced calcium, reduce EPO.

31
Q

What are the dental implications of chronic renal failure?

A

Consult renal physician before prescribing anything.

Do not prescribe NSAIDs, treatracycline, cyclosporin.

Oral ulceration because of anaemia.

Fungal and viral infections- opportunistic infections.

Bleeding tendencies- platelet dysfunction.

Dry mouth- caused by fluid restrictions.

32
Q

If the patient is undergoing dialysis, what medication are they required to have?

A

Heparin- so will be anti-coagulated.

33
Q

Why would you not want to plan treatment for the same day that a patient has had dialysis?

A

They will have been heparanised- so will be anti-coagulated.

34
Q

What is the half life of heparin?

A

60-90 minutes.

35
Q

Renal failure can occur in 3 different aspects of the renal system, describe these.

A

Pre-renal- sudden and severe drop in blood pressure or interruption to blood flow to the kidneys (aortic aneurysm)

Intrarenal- direct damage to the kidneys in inflammation, toxins, drugs, infection.

Postrenal- sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumour or injury.

36
Q

Describe acute renal failure.

A

Rapid loss of renal function

Anuric initially with volume overload- ankle oedema, sacral oedema, pulmonary oedema, breathlessness, jugular venous pressure increased, weight gain.

Gradually progresses to polyuria.
Gradually develops into high potassium, development of uraemia and acidosis.

37
Q

What is the most common cause of acute renal failure?

A

Usually a pre-renal cause.

38
Q

What value of eGFR does someone need to have to be classed as having end stage renal disease?

A

less than 15ml/min
Creatinine 800-1000 micromole/L.

39
Q

What is the most common form of renal replacement?

A

Renal dialysis- haemodialysis or peritoneal dialysis.

40
Q

Describe the dialysis process?

A

Blood moves out the patient’s fistula, taking into the dialysis machine, electrolytes removed and electrolytes added, the blood is then moved back into the patient’s arm through their fistula.

41
Q

How is the renal endocrine aspect replaced during treatment?

A

EPO injections- maintains red cell Vit D supplementation, bisphosphonates- bone mass maintenance.
Hypertension control- ACE inhibitors?

42
Q

What aspects of renal transplant do you need to consider a a dentist?

A

Know when the patient last had dialysis- work treatment around this.
Patient will be immunosuppressed.
Liaise with their renal physician if you need to prescribe anything.
Increased cancer risk
Steroid side effects

43
Q

How does liver disease affect platelets and coagulation factors?

A

Vit K dependent coagulation factors produced directly in the liver
- Coagulation factors affected.

Thrombin and Thrombopoietin are also produced in the liver- will affect formation of platelets.
- Thrombocytopenia, thrombocythaemia.

44
Q

If you cannot arrest a haemorrhage using the local haemostat measures, what would you do?

A

Contact Max-Facs department or A&E.

45
Q

What levels of platelets need to be present for treatment in practice and in a hospital setting?

A

GDP- greater than 100 x10^9
Hospital- greater than 50x10^9

No treatment if less than that

46
Q

What would warrant you to give antibiotic prophylaxis to a patient?

A

Neutrophils less than 1x10^9
Lymphocytes less than 1x10^9

47
Q

What are the causes of liver disease?

A

Infective- Hep B, Hep C
Alcohol-related
Autoimmune- primary biliary cirrhosis
Drug induced
Haemochromatosis
Hepatocellular carcinoma

Human Systems and Diseases (14 decks)

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