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YR 3 - CSB > ORAL SURG - Abnormal Bleeding > Flashcards

ORAL SURG - Abnormal Bleeding Flashcards

1
Q

give instances of which there may be bleeding in a patient.

A
  • extraction
  • surgery
  • biopsies
  • trauma
  • perio, probing
  • exposure of vital pulp
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2
Q

give effects of blood loss

A
  • patient distress
  • blood in the tissues - bruise, infection
  • blood in the stomach - vomiting
  • blood in airway - obstruction
  • hypovolaemic - shock
  • reduced O2 carrying capacity
  • reduced proteins - oedema, water not kept in blood
  • reduced platelet
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3
Q

what must be checked as part of the history?

A

the bleeding/clotting history
- if there are any previous issues or medications which affect bleeding
- any liver problems

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4
Q

what local measures can be used to stop bleeding?

A
  • applying pressure
  • suturing - stitch up
  • haemostatic gel
  • surgicel - gel wrapped in gauze
  • tell patient to wait and then check
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5
Q

what MUST be delivered after a bleeding episode?

A

post-op care
follow up with the patient

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6
Q

what comes under Virchows Triad?

A
  • coagulation factors
  • blood flow
  • vessel wall
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7
Q

what happens if blood flow is too slow? when would this happen?

A

more likely to develop blood clots

  • people who dont use leg muscles
  • sat too much
  • airplanes
  • pools in lower leg
    = DVT
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8
Q

give 2 abnormalities that may be in a vessel wall

A

artificial heart valve
atherosclerotic plaque

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9
Q

what happens when a vessel wall ruptures?

A
  • VWF in the vessel wall exposed to collagen in the blood
  • platelets bind to VWF
  • platelets change shape
  • attract more platelets
  • aggregation
    -platelet plug
  • other blood proteins join
  • fibrin meshwork
    = clot
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10
Q

what if there are too many coagulation factors?

A

likely to form blood clots

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11
Q

what type of medicine is warfarin?

A

anti-coagulant

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12
Q

how does warfarin work?

A

stops liver metabolising Vitamin K
thereby liver doesn’t produce coagulation factors 2,7,9,10
- prevents the intrinsic coagulation pathway from activating

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13
Q

what is the purpose of haemostasis?

A

to prevent blood loss

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14
Q

what are the 4 steps of haemostasis?

A
  • vascular spams
  • platelet plug
  • blood coagulation
  • growth of fibrous tissue in the hole
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15
Q

what happens during a vascular spasm?

A

smooth muscle contracts
reduce diameter of lumen
reduce speed of blood flow
- helps blood to flow

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16
Q

describe the formation of a platelet plug.

A
  • platelets exposed to collagen
  • platelets release Thromboxane A2
  • aggregation
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17
Q

what does the release of Thromboxane A2 do?

A

change shape of platelets and increase the stickiness
.. more and more stick baaaahhh

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18
Q

what factor does the platelet plug activate and what does it do?

A

FACTOR 10
- activates coagulation cascade

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19
Q

give 2 anti-platelet drugs

A

aspirin
clopidrogel

20
Q

how does aspirin and clopidrogel interact with platelets in the same way?

A

they irreversibly bind

  • they’re bound until the full life cycle of the platelet
21
Q

how long is the life of a regular, non-medicated platelet?

A

10 days

22
Q

how long is the life of a platelet when bound to aspirin?

A

a few weeks

23
Q

what are the indications for patients who take anti-platelet drugs, aspirin or clopidrogel?

A
  • vascular disease
  • IHD
  • thromboembolic disease
  • stroke
  • those likely to have p aggregations within the vascular system
24
Q

what post-op advice should be given to patients who take aspirin?

A
  • don’t stop taking aspirin
  • risk of stopping>risk of continuing
25
Q

what are the two pathways for the clotting cascade?

A

intrinsic pathway
extrinsic pathway

26
Q

describe the intrinsic and extrinsic pathway

A

the clotting cascade

intrinsic
- internal vessel wall damage
- exposed collagen and platelet activation
- F12, F11, F9, F8
- F10 activates into F10a

extrinsic
- tissue damage
- F7
- F10 activates into F10a

both of them:
- F10a activates prothrombin into thrombin
- thrombin activates fibrinogen into fibrin

27
Q

what is the main role of most anti-coagulations?

A

to inhibit the action of F10

28
Q

what 3 tests are used to test bleeding? describe each

A

INR - international normalised ratio
- patients prothrombin time:control prothrombin time
- assess’ warfarin anticoagulation

APTT - activated partial thromboplastin time
- assess’ heparin anti-coagulation

Platelet Count
- normal is 200-400x10^9/L

29
Q

what is the prothrombin time?

A

the time taken for prothrombin to activate

30
Q

what platelet count is a problem?

A

if it is lower than 100 x 10^9

31
Q

what are the indications for patients who take warfarin?

A
  • atrial fibrillation
  • heart valve abnormalities or replacement
  • thromboembolic disease
32
Q

how long does it take for warfarin to work and why?

A

7 days

because there are already coagulation factors present, it just prevents more being produced

33
Q

which antibiotic enhances the effect of warfarin?

A

metronidazole

34
Q

what clotting factors does warfarin affect?

A

2,7,9,10

35
Q

what INR level is safe to perform an extraction?

A

<4

36
Q

with unstable INR and a stable INR, when would you want to check the readings prior to extraction?

A

unstable - 72 hour window
stable - 24 hour window

37
Q

timing wise, when would it be good to extract a tooth with a patient with abnormal bleeding?

A

early in the week
early in the day

38
Q

with a low INR of 2-3, how many teeth can you extract at a given time?

A

all extractions one side at a time

39
Q

with a INR of 3-4, how many teeth can you extract at a given time?

A

consider one quadrant at a time
and consider the inferior dental block
- possibility of hitting the inferior artery

40
Q

what’s wrong with warfarin?

A
  • difficult to get stable anti-coagulation
  • interacts with different drugs
  • can be affected by food
  • constant monitoring required
41
Q

4 pros and 2 cons of new anticoagulants.

A
  1. single point of action
  2. predictable
  3. no need to monitor INR
  4. doesn’t interact with food
  5. no antidote
  6. half life up to 17 hrs
42
Q

give the name of a 4 new anticoagulants and what factor of the coagulation cascade they work on.

A

warfarin - affects F7, 9

apixaban - affects F10
rivaroxaban - affects F10
edoxaban - affects F10
dabigatran - affects fibrinogen into fibrin

43
Q

indications for new anti-coagulants

A

artial fibrillation
thromboembolic disease
stroke
heart valve replacements

44
Q

how does surgicel appear?

A

white gauze soaks up the blood
oxidised cellulose denatures blood and turns it black

45
Q

what prevents the breakdown of a fibrin clot?

A

tranexamic acid mouthwash

YR 3 - CSB (38 decks)

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