Liver and Kidney Disease Flashcards
What is the function of the liver?
- Metabolizes food by-products
- Drug detoxification
- Converts nitrogenous
substances for kidney excretion - Forms blood clotting factors
- Metabolism of bilirubin
- Processes lipids
- Stores glycogen
What are the causes of liver disease?
- Chronic Hepatitis B or C infection
- Alcoholic liver disease
- Genetic disorders
- Autoimmune hepatitis
- Biliary disorders
- Infections
- Pathologic conditions
- drug use
What is cirrhosis?
Long term damage to liver like hepatitis and alcoholic lover disease
What are the five causes of acute hepatitis?
- Hep A,B,C,D,E
What is Hepatits A?
Hep A virus
What are common symptoms of viral hep?
- Hep A,B and C: diarrhea, impaired appetite, fever, pain or discomfort in abdomen, skin rash, joint pain, nausea, vomiting
- Hep D: Fatique, loss appetite, jaundice
What are the clinical presentation of Hep?
2-20 week range of incubation phases
* Preicteric - Fatigue, nausea,poor appetite, right-
upper quadrant pain, 3-10 day duration
* Icteric- Dark urine, jaundice, fatigue worsens, nausea, dysgeusia, weight loss, 1-3 week duration
What are the medical management for Hep?
- Bed rest
- Good nutrition
- Antiretroviral drugs
- Liver transplant
- Limit sexual contact
- Avoid alcohol
What is the medical management for Hep A/B?
- Immune globulin
- Vaccinations
- Report to the healthdepartment
What is the medical management for Hep C?
- Avoid high-risk behaviors
- Injection drug use
- Standard precautions
What is the medical management for Hep D?
- Prevent Hep. B infection
What is Hepatitis non A-E?
- viral hep that cannot be attributed to hep. A-E because no source of exposure can be identified
- similar clinical features
- no forms of prevention or treatment exist
What are the complications of Hep?
- Fulminant hep
- Chronic infection
What is the dental management if a person has active hep?
Only urgent dental care provided; use isolated operatory with limitedaerosols
What is the dental management if a person has a history of hep?
Follow strict aseptic procedures
What is the dental management if a person is at high risk for Hep B or C?
Screen; but no modifications
What is the dental management if a person is a carrier for hep?
Follow standard precautions; consult with
physician to determine current status
and future risks
What is the dental management signs or symptoms of hep?
No elective dental treatment; refer to physician;
provide urgent care only with limited aerosols
What is a alcoholic liver disease?
Excessive alcohol consumption → Scarring
Fatty Liver Disease
* Nausea, vomiting, anorexia, enlarged liver and spleen,
jaundice, ankle edema, spider angioma
* Ascites - abdominal fluid build-up
What is the medical management for alcoholic liver disease?
- Abstinence from alcohol
- Disulfiram (alcohol rehabilitation)
- Naltrexone and acamprosate (short use, relapse)
What is the dental treatment for alcoholic liver disease ?
- Prothrombin time
- Increased anesthetic and sedative tolerance
- Less ability to metabolize drugs
- Frequent care: biofilm, calculus, inflammation
- Severe → premedication
What is the function of the kidney ?
- Regulate body fluid volume
- Filter waste and toxins
- Maintain blood plasma pH
- Synthesize and release hormones
- Metabolize drugs
- Nephrons- Microscopic structural and functional unit
What are the oral manifestations and compliciations of Alcoholic liver disease?
abnormal bleeding
atrophic glossitis
petechiae
hepatocelluar carcinoma metastes to jaw (premolars, ramus)
oral candidiasis
lichen planus
Angular cheillitis
breathe; sweet, musty
what is the most common cause of kidney disease?
Most Common
* Diabetes Mellitus
* Hypertension
* Chronic Glomerulonephritis
* Polycystic Kidney Disease
What are other causes of kidney disease?
Other causes:
* Tubular interstitial nephritis
* Systemic lupus erythematosus
* Neoplasms
* Obstructive nephropathies
* AIDS
What are happens during each stage of kidney disease?
- Stage 1- normal or slightly increased GFR (normal functiom)
- Stage 2- Slightly decreased GFR ( mild loss of function)
- Stage 3- Moderate decreased GFR (mod loss of function)
- Stage 4- Severly decreased GFR (severe loss of function)
- Stage 5- Renal failure (needs treatment to live)
What does GFR mean?
- Glomerular filtration rate- How much flood passes through the kidneys each minute; indicates how well kidneys are working
What are the clinical presentation of Stage 1 and 2 ESRD?
Very few/mild signs or symptoms
What are the clinical presentation of Stage 3, 4 and 5 ESRD?
Generalized illness
fatigue
weakness
headaches
nausea
loss of appetite
weight loss
Anemia
leg cramps
insomnia
dark urine
nocturia
What are ESRD complications?
Azotemia
Uremia
What is Azotemia?
Nitrogen accumulates in the blood
What is uremia ?
high urea in blood
What are the symptoms of azotemia?
not peeing a lot
feeling confused
shortness of breath (dyspnea)
Swelling in legs ankles and feet
abnormal heartbeat
chest pain
nausea and vomiting
feeling very tired
What is the medical management for kidney disease?
- Hault progression to preserve quality of life
- Decrease waste products in blood
- Control blood pressure, fluid volume
- Balance electrolytes
- Diet low in protein, sodium, potassium
- Lifestyle modifications- Smoking cessation, glycemic control, lower cholesterol, cardiovascular health
What are the prevention measure for kidney failure?
- Waterintake
- avoid smoking
- control blood sugar level
- eat healthy
- do not take over pills
- monitor blood pressure
- exercise
- limit salt intake
What is kidney dialysis?
Hemodialysis- arteriovenous graft (SHUNT)
Heparin given to prevent clotting
What are the common drugs used to stop acute kidney injury?
Diuretics
Acei/arbs
Aminoglycosides
Metformin
Nsaids
DAAMN!
What are the dental management for kidney disease?
Undiagnosed → refer to PCP
* What stage of kidney disease?
Stage 1-3: No consultation or dismissal
Stage 4-5: PCP consult
Hospital setting
Premedication
Excessive bleeding a concern
- Monitor blood pressure
Possibly delay elective treatment
Corticosteroid tx → adrenal insufficiency - Avoid OTC medication recommendations
excreted by kidneys
What are the oral manifestations of Kidney disease?
- Pale gingiva/mucosa (anemia)
- Diminished saliva flow - Increased biofilm and calculus
- Candidiasis
- Petechiae, ecchymosis
- Altered taste (metallic)
- Ammonia odor (urea)
- Uremic stomatitis
- Mucosa red, burning, grey exudate
- Extreme nausea → erosion
- Lamina dura demineralized
- Widened trabeculae, calcifications
What are different treatment planning for patients recieving dialysis?
Prone to infection or bleeding concerns → PCP consult
* Schedule day after dialysis
* Heparin given to thin blood → lasts 3-6 hours after infusion
* Assess for cardiovascular conditions
* Blood pressure taken on arm opposite of shunt
* Care provided when medically stable
* Document medications
* Address oral side effects
* Tailor drug doses to align with dialysis activity
