Liver & Renal Flashcards

1
Q

What are possible reasons for inability to achieve haemostasis?

A
  • 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
  • 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
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2
Q

How does liver disease result in coagulation issues?

A
  • 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
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3
Q

How does renal disease result in coagulation issues?

A
  • abnormalities in platelet function
    • thought to be due to adhesion, secretion and storage
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4
Q

How is challenge to achieve haemostasis managed in

A
  • 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
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5
Q

At what point does anti-platelet medication need to be altered for dental treatment?

A
  • when patient is taking 3 routine should be altered
  • aspirin has effects for 7-10 days
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6
Q

What is a normal platelet count and what levels can be treated in dental practice?

A
  • 150x10^9/l - 400x10^9/l
  • dental practice
    • > 100x10^9/l
  • hospital
    • <50x10^9/l
    • supplements required
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7
Q

What is UKELD?

A
  • United Kingdom model for End stage Liver Disease
    • 49% minimum level for transplant assessment
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8
Q

What are the features of a patient with liver disease?

A
  • jaundice
  • leukonychia
  • clubbing
  • palmar erythema
  • spider naevi
  • oesophageal varices
  • ascites
  • peritonitis
  • tremors (alcohol related)
  • congenital impairment (alcohol related)
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9
Q

What are the causes of liver disease?

A
  • 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
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10
Q

What are the basic stages of liver disease?

A
  • hepatitis
    • inflammation of the liver
    • may be reversible
  • liver cirrhosis
    • irreversible liver necrosis and fibrosis
  • liver failure
    • failure of normal liver function
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11
Q

How does local anaesthetic affect the liver?

A
  • lignocaine is fully metabolised in the liver
  • articaine goes through 5-10% metabolism in the liver
    • remaining metabolised by the plasma
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12
Q

Why are NSAIDs avoided for all but the most mild cases of liver disease?

A
  • can increase bleeding risk
  • can inhibit prostaglandins
    • reduced renal perfusion
    • reduced glomerular filtration rate and sodium retention
    • hepatorenal syndrome
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13
Q

How can treatment be facilitated for patients with liver disease?

A
  • delivery of products
    • vitamin K replacement
    • FFP transfusion
    • +/- platelet transfusion
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14
Q

What factors are produced by the liver?

A
  • factor I
  • factor II
  • factor VII
  • factor IX
  • factor X
  • factor XI
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