Liver & Renal Flashcards
What are possible reasons for inability to achieve haemostasis?
- inherited/congenital bleeding disorders
- haemophilia A (factor VIII) and B (factor Xa)
- Von Willebrand’s disease
- medication induced
- antiplatelets
- aspirin
- clopidogrel - anticoagulants
- heparin
- warfarin - DOAGs (thrombin, factor Xa)
- apixaban
- rivaroxaban - other
- antimicrobials (rifampin)
- anti- seizure (phenytoin, valproic)
- quinine
- antiplatelets
- haematological disease
- leukemia
- myeloma
- immune thrombocytopenia purpura (ITP)
- infection
- HIV
- hepatitis C
- liver diseases
- alcoholic liver disease
- liver cirrhosis
- hepatitis B or C
- primary biliary cirrhosis
- hepatocellular carcinoma
How does liver disease result in coagulation issues?
- hepatic synthesis altered
- clotting factors and proteins involved in fibrinolytic system
- vitamin K dependent coagulation factor proteins
- factor II
- factor VII
- factor IX
- factor X
How does renal disease result in coagulation issues?
- abnormalities in platelet function
- thought to be due to adhesion, secretion and storage
How is challenge to achieve haemostasis managed in
- apply pressure to socket with gauze
- can soak gauze in local anaesthetic
- pack socket with suitable material
- oxidised cellulose
- collagen sponge
- suture surgical site
- re-evaluate medical history
- tranexamic mouthwash
- cautery
- sliver nitrate sticks
- bone wax
At what point does anti-platelet medication need to be altered for dental treatment?
- when patient is taking 3 routine should be altered
- aspirin has effects for 7-10 days
What is a normal platelet count and what levels can be treated in dental practice?
- 150x10^9/l - 400x10^9/l
- dental practice
- > 100x10^9/l
- hospital
- <50x10^9/l
- supplements required
What is UKELD?
- United Kingdom model for End stage Liver Disease
- 49% minimum level for transplant assessment
What are the features of a patient with liver disease?
- jaundice
- leukonychia
- clubbing
- palmar erythema
- spider naevi
- oesophageal varices
- ascites
- peritonitis
- tremors (alcohol related)
- congenital impairment (alcohol related)
What are the causes of liver disease?
- infective
- hepatitis A, B, C and D
- non-infective
- auto-immune (primary biliary cirrhosis)
- alcohol related
- non-alcohol fatty liver disease
- haemochromatosis
- drug induced
- hepatocellular carcinoma
What are the basic stages of liver disease?
- hepatitis
- inflammation of the liver
- may be reversible
- liver cirrhosis
- irreversible liver necrosis and fibrosis
- liver failure
- failure of normal liver function
How does local anaesthetic affect the liver?
- lignocaine is fully metabolised in the liver
- articaine goes through 5-10% metabolism in the liver
- remaining metabolised by the plasma
Why are NSAIDs avoided for all but the most mild cases of liver disease?
- can increase bleeding risk
- can inhibit prostaglandins
- reduced renal perfusion
- reduced glomerular filtration rate and sodium retention
- hepatorenal syndrome
How can treatment be facilitated for patients with liver disease?
- delivery of products
- vitamin K replacement
- FFP transfusion
- +/- platelet transfusion
What factors are produced by the liver?
- factor I
- factor II
- factor VII
- factor IX
- factor X
- factor XI