Liver and Renal Tutorial

Question 1

What are the medical reasons for inability to achieve haemostasis in Case 1?

Answer 1

Potential reasons include liver disease impairing clotting factor synthesis, thrombocytopenia, excessive alcohol consumption, bleeding disorders, stroke, medication and stroke

Question 2

How would you manage inability to achieve haemostasis?

Answer 2

Apply pressure with haemostatic agents (LA), use sutures, assess for systemic factors with blood tests, and refer to emergency care if needed (MAXFAX)

Question 3

What is normal platelet count and what is apropriate for a dental extraction?

Answer 3

normal = 150 x 109 / L
dental extraction = more or equal to 50 x109 / L

Question 4

What physical signs might indicate liver disease?

Answer 4

Jaundice, ascites, spider naevi, palmar erythema, fatigue, clubbing and confusion.

Question 5

What are the causes of liver disease?

Answer 5

alcoholism
hepatitis (viral and autoimmune)
tumours (hepatocellular carcinoma)
fibrosis

Question 6

What is the UKELD score, and why is it important?

Answer 6

UKELD predicts liver disease survival; scores >49 indicate poor prognosis and prioritises need for liver transplant.

Question 7

What dental and medical investigations are required for safe patient management?

Answer 7

Dental: Comprehensive oral exam and radiographs.
Medical: FBC, coagulation profile (INR), LFTs, and viral serology to assess bleeding risk and liver status.

Question 8

What are the dental implications of asthma?

Answer 8

Dry mouth from inhaler use, potential triggers, and avoiding NSAIDs during treatment.

Question 9

What are the considerations for treating a patient with chronic kidney disease (CKD)?

Answer 9

Avoid nephrotoxic drugs, manage bleeding risks, and schedule treatments around dialysis.

Question 10

How does CKD affect oral health?

Answer 10

Can cause xerostomia, uraemic stomatitis, and delayed healing due to anaemia.

Question 11

What blood tests are essential for assessing CKD patients

Answer 11

FBC, U&E, LFT, INR, calcium/phosphate levels to monitor anaemia, electrolytes, and bleeding risk.

Question 12

What steps should be included in a treatment plan for a CKD patient?

Answer 12

Provide preventive care, prioritize restorations, avoid extractions unless necessary, and coordinate with medical teams.

Question 13

What arrangements are needed for CKD patient dental care?

Answer 13

Schedule post-dialysis, provide transport support if needed, and communicate with renal team for safe care.

Question 14

The safest local anaesthetic drug to use, utilising an infiltration technique, for a patient with advanced liver disease in order to remove tooth 35 is:

Question 1

Select one:

a.
Prilocaine

b.
Articiane

c.
Lignocaine

d.
Bupvicaine

e.
Halothane

Answer 14

B. Articaine

Question 15

When providing instructions on first line simple analgesia for a patient with liver cirrhosis, which analgesic medication should be recommended

Question 2

Select one:

a.
Naproxen

b.
Paracetamol

c.
Codeine

d.
Morphine

e.
Ibuprofen

Answer 15

B. Paracetamol

Question 16

The liver is responsible for the production of which clotting factors involved in the coagulation cascade?

Question 3

Select one:

a.
II, V, VIII, IX, XI,XI

b.
I,II,III, IV, V and X

c.
I, II, V, IX and X

d.
I, V, and X

e.
I,II,VII, IX, X and XI

Answer 16

e

Question 17

Other than clotting factors, which product of the liver is essential in achieving haemostasis?

Question 4

Select one:

a.
Thrombocytes

b.
Erythrocytes

c.
Albumin

d.
Erythropoietin

e.
Thrombopoietin

Answer 17

e

Question 18

What is the minimum UKELD score for an individual to be placed on a liver transplant list?

Answer 18

49

Question 19

An arteriovenous fistula is provided in which situations

a.
Above the elbow for peritoneal dialysis

b.
Above the elbow for haemodialysis

c.
Above the wrist for peritoneal dialysis

d.
In the abdominal cavity for peritoneal dialysis

e.
Above the wrist for haemodialysis

Answer 19

c

Question 20

Match the descriptors with the most appropriate form of hepatic conidition:

Has circular RNA

Characterized by liver cell necrosis and inflammation, followed by replacement with fibrotic tissue and regenerating nodules of hepatocytes, and vascular derangement

Strongly associated with obesity and diabetes type II

The faeco-oral route is the main route of transmission for

Sofosbuvir is a treatment given to clear the virus

Halothane can be responsible for

Primary malignancy of the liver

The Dane Particle is found in the serum of patients infected with

Answer 20

Has circular RNA → Hepatitis D,

Characterized by liver cell necrosis and inflammation, followed by replacement with fibrotic tissue and regenerating nodules of hepatocytes, and vascular derangement → Cirrhosis

Strongly associated with obesity and diabetes type II → Non-alochoholic steatohepatitis / Non-alcoholic fatty liver disease

The faeco-oral route is the main route of transmission for → Hepatitis A

Sofosbuvir is a treatment given to clear the virus → Hepatitis C

Halothane can be responsible for → Drug-induced Hepatitis,

Primary malignancy of the liver → Hepatocellular carcinoma

The Dane Particle is found in the serum of patients infected with → Hepatitis B

Question 21

Match the renal anatomical structure with the most appropriate function

Na+ is reclaimed by active transport, with water loss by osmosis

Actively reabsorbs glucose, amino acids, uric acid and inorganic salts

Surplus or waste ions and molecules flow out as urine

Water leaves by osmosis

Answer 21

Na+ is reclaimed by active transport, with water loss by osmosis → Distal convoluted tubule

Actively reabsorbs glucose, amino acids, uric acid and inorganic salts → Proximal convoluted tubule

Surplus or waste ions and molecules flow out as urine → Collecting tubule

Water leaves by osmosis → Loop of Henle

Question 22

On which day of the week would it be best to schedule dental treatment for a patient who receives dialysis every Monday and Friday?

Answer 22

Tuesday

Question 23

Which anticoagulant is commonly used in the management of patients who require renal dialysis?

Answer 23

heparin