SC- Liver disease Flashcards
What are the features of a patient with liver disease?
Bruises
Jaundice
Clubbing
Palmar erythema.
Oedema/Ascites
Spider navi
List some causes of liver disease?
Infective- Hep B/C/D
Non-infective- Autoimmune (e.g. primary biliary cirrhosis)
Alcohol related.
Non-alcoholic fatty liver disease (obesity)
Haemochromoatosis.
Drug induced (paracetamol overdose)
What is the UKELD score and how do we interpret it?
This grades the patient’s chronic liver disease prognosis.
if a patient is >=49 then they are eligible for a liver transplant.
In a patient’s Blood tests, what are we looking for in the white blood cell count.
If there are high WBC cells, there is a significant infection.
In a patient’s Blood tests, what are we looking for in the platelet count.
If there are low platelet levels, the patient will struggle to stop bleeding.
What platelet level is seen as safe to remove a tooth?
>50x109l in a special care setting.
>100- 150 x109 in a primary care setting.
How does a liver disease affect LA treatment?
We chose articaine as it is mostly metabolised in the plasma compared to lignocaine (which is metabolised in the liver)
How are analgesics affected by liver disease.
We avoid NSAIDs as they can cause mucosal bleeding (increase bleeding risk)
Paracetamol is a better option but it is hepatoxic.
How is antibiotic use impacted by liver disease?
The dose has to be altered.
Amoxicillin should be safe to prescribe.
Metronidazole dose should be altered in moderate and severe liver disease.
Erythomycin should not be prescribed routinely.
How is antifungal prescription impacted by liver disease?
Most antifungals are metabolised in the liver.
Nystatin is more local.
What treatment planning considerations have to be made for patients with liver disease?
They should be assessed and treated in a hospital.
May need a hospital bed to watch the patient overnight for haemostasis.
They may need supplement cover to ensure bleeding stops (e.g. vitamin K, platelet transfusions)
