Liver and Renal Tutorial Flashcards
What are the medical reasons for inability to achieve haemostasis in Case 1?
Potential reasons include liver disease impairing clotting factor synthesis, thrombocytopenia, excessive alcohol consumption, bleeding disorders, stroke, medication and stroke
How would you manage inability to achieve haemostasis?
Apply pressure with haemostatic agents (LA), use sutures, assess for systemic factors with blood tests, and refer to emergency care if needed (MAXFAX)
What is normal platelet count and what is apropriate for a dental extraction?
normal = 150 x 109 / L
dental extraction = more or equal to 50 x109 / L
What physical signs might indicate liver disease?
Jaundice, ascites, spider naevi, palmar erythema, fatigue, clubbing and confusion.
What are the causes of liver disease?
alcoholism
hepatitis (viral and autoimmune)
tumours (hepatocellular carcinoma)
fibrosis
What is the UKELD score, and why is it important?
UKELD predicts liver disease survival; scores >49 indicate poor prognosis and prioritises need for liver transplant.
What dental and medical investigations are required for safe patient management?
Dental: Comprehensive oral exam and radiographs.
Medical: FBC, coagulation profile (INR), LFTs, and viral serology to assess bleeding risk and liver status.
What are the dental implications of asthma?
Dry mouth from inhaler use, potential triggers, and avoiding NSAIDs during treatment.
What are the considerations for treating a patient with chronic kidney disease (CKD)?
Avoid nephrotoxic drugs, manage bleeding risks, and schedule treatments around dialysis.
How does CKD affect oral health?
Can cause xerostomia, uraemic stomatitis, and delayed healing due to anaemia.
What blood tests are essential for assessing CKD patients
FBC, U&E, LFT, INR, calcium/phosphate levels to monitor anaemia, electrolytes, and bleeding risk.
What steps should be included in a treatment plan for a CKD patient?
Provide preventive care, prioritize restorations, avoid extractions unless necessary, and coordinate with medical teams.
What arrangements are needed for CKD patient dental care?
Schedule post-dialysis, provide transport support if needed, and communicate with renal team for safe care.
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
B. Articaine
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
B. Paracetamol
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
e
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
e
What is the minimum UKELD score for an individual to be placed on a liver transplant list?
49
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
e
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
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
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
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
On which day of the week would it be best to schedule dental treatment for a patient who receives dialysis every Monday and Friday?
Tuesday
Which anticoagulant is commonly used in the management of patients who require renal dialysis?
heparin
