ORS03 - Lecture 7 - Renal and Liver disease

Question 1

What is the dental relevance of liver disease? (3:5)

Answer 1

Increased bleeding (3)

↓ Vit K absorption (due to cholastsis ->↓ bile flow)

↓ Clotting factor synthesis

↓ Platelets

Impaired drug metabolism (5)

↓ Dose of Midazolam (makes you sleepy -> treats anxiety)

↓ Dose of lignocaine (<2-3 cartridges) -> articaine and prilocaine safer to use

Avoid NSAIDs -> paracetmaol safer to use

Avoid metronidazole & erythromycin -> amoxicillin is safer to use

Avoid sedation -> coma

Question 2

What 4 blood tests are required for liver disease?

Answer 2

Full blood count (FBC) (platelets, WBCs, Hb)

Liver biochemistry (liver function test - LFTs)

Renal screen (U&E)

Coagulation screen (INR. aPPT)

Question 3

What is the dental relevance of renal (kidney) disease? (3:5)

Answer 3

Increased bleeding

↓ Platelets

↓ VWF

↓ TXA2 (clotting factor)

Medication

↓ Dose of amoxicillin and erythromycin

Steroids -> hypertension (risk of haemorrhage)

Bisphosphonates -> osteonecrosis of jaw/wound healing

Avoid NSAIDs

Be careful with IV sedation (they have enhanced sedative effects)

Question 4

What tests are used to investigate renal disease? (2)

Answer 4

FBC -> platelets, WBCs, neutrophils, lymphocytes

U&Es (renal screen) -> glomerular filtration rate (GFR)