Liver and Renal Flashcards
what are the potential reasons for being unable to achieve haemostasis
inherited/congenital bleeding disorders
medication induced
haematological disease
infections
liver disease
how does impaired liver function affect clotting
it impacts the hepatic synthesis of clotting factors and proteins involved in fibrinolytic system
in practice how would you manage someone who did not stop bleeding
apply pressure to socket and LA soaked gauze
pack with cellulose
suture
re-evaluate medical history
tranexamic mouthwash
cautery
bone wax
phone local maxfax
what does a UKELD score of 49 mean
on list for liver transplant
>9% mortality rate within 12 months
if a patient has UKELD 49 score what other features may they present with
jaundice, finger clubbing, palmar erythema, spider naevi, ascites
what are the causes of liver disease
infective - hepatitis
autoimmune - primary cirrhosis
alcohol related
non alcoholic fatty liver disease
haemochromatosis
drug induced
hepatocellular carcinoma
what are the stages of liver disease
hepatitis
liver cirrhosis
liver failure
what special investigations are required from someone with liver disease
FBC
coagulation, clotting screen
INR
LFTS
urea and electrolytes
OPT and intraorals
FMPPC
what does reduced red blood cells, Hb and haematocrit with increased MCV suggest
anaemia, vit b12/folate deficiency
what anaesthetic is fully metabolised in the liver
lidocaine
what anaesthetic is only 5-10% metabolised in liver and the rest in the plasma
articaine
what anaesthetic is safest for someone with liver disease
articaine
what type of analgesic is avoided in patients with liver disease
NSAIDs
what drugs do we need to be careful with for patients with liver disease
anaesthetic
analgesics
antibiotics
IV sedation midazolam
what antibiotic should be safe to give patients with liver disease
amoxicillin
