Liver and renal Flashcards
What is liver Cirrhosis?
- Chronic liver disease in which normal liver tissue is replaced by scar tissue
Why is a person most likely to be on Heparin?
- Dialysis
- Inhibits formation of fibrin which is involved formation of blood clots
What are the Liver disease?
- Alcoholic liver disease
- Liver Cirrhosis
- Hepatitis B or C infection
- Primary biliary cirrhosis
- Hepatocellular carcinoma
What clotting factors does impaired liver function have a impact on?
- Vitamin K dependent coagulation proteins
- II, VII, IX, X
What is Thrombocytopenia?
- AKA thrombopenia
- Abnormally low level of platelets
What is thrombocythaemia?
- excess platelets resulting in abnormal clotting or bleeding
What is the UKELD score?
- United Kingdom End stage Liver disease score
- Need a score of 49 to be considered for liver transplant
- May impact what dental treatment we are to give and how we give it
What are some features of advancing liver disease?
- Jaundice
- Leukonychia
- Clubbing
- Palmar erythema
- Spider naevi
- Ascites
- Tremors or cognitive impairment if alcohol related
What are the stages of liver disease?
- Hepatitis
- Liver Cirrhosis
- Liver failure
What is Hepatitis?
- Inflammation of the liver which may or may not be reversible depending on disease
What is Liver cirrhosis>
- Irreversible liver necrosis and fibrosis
What is liver failure?
- Failure of normal liver function
What blood tests can you request for someone who has liver disease?
- FBC
- Coagulation/clotting screen
- INR
- LFTS
- Us and Es
What is included in the coagulation/clotting screen?
- PT + ration (Prothrombin)
- APTT + ratio (Activated partial thrombin time)
- Thrombin time
- TCT ratio (Thrombin clotting time)
What local anaesthetic would you use for pt with liver impairment?
- Articaine as only 5-10% metabolised in liver and majority is metabolised in plasma
- Decreases metabolic demand on liver
Why should you not prescribe NSAID’s in pt with liver impairments?
- Increase bleeding risk which can result in mucosal bleeding
- Risk of hepatorenal syndrome syndrome due to inhibition of prostaglandins which lead to decrease in renal perfusion, reduced GFR and sodium retention
Should paracetamol be prescribed to pt with impaired liver function?
- Carries risk as can be hepatotoxic
- Risks less than NSAIDs
- Consult hepatology team
What are some methods available to pt in hospital setting if any dental treatment is being done which may result in bleeding?
- Vitamin K replacement
- FFP transfusion
- +/- platelets transfusion
Where should a pt be treated if not suited to be treated in primary care environment?
- Treated in hospital associated with hepatology unit
What hepatic condition is Strongly associated with obesity and diabetes type II
- Non-alcoholic steatohepatitis / non alcoholic fatty liver disease
What hepatic condition has circular RNA?
- Hep D
What hepatic condition is halothane responsible for?
- Drug induced hepatitis
The dane particle is found in serum of pt infected with?
- Hep B
The faeco-oral route is the main route of transmission for what hepatic condition?
- Hep A
Sofosbuvir is a treatment given to clear what virus ?
- Hep C
What does the proximal convoluted tubule do?
- Actively reabsorbs glucose, amino acids, uric acid and inorganic salts
What dose the loop of henle do?
- Water leaves by osmosis
What does the distal convoluting tubule do?
- Na+ is reclaimed by active transport, with water loss by osmosis
What does the collecting tubule do?
- Surplus or waste ions and molecules flow out as urine
