Special Care - Liver and Renal Flashcards

1
Q

What reasons are there for inability to achieve haemostasis?

A

Inherited bleeding disorders - haemophilia and VW disease

medication

  • anticoagulants: warfarin, heparins
  • antiplatelets: aspirin, clopidogrel
  • side effects of some chemotherapy as it suppresses bone marrow
  • anti seizures: phenytoin

Haematological diseases: leukaemia and myeloma

infections - HIV or HEP C

liver disease - ALD, Cirrhosis, cancer

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2
Q

How do we manage inability to achieve haemostasis after an extraction?

A

Apply pressure to the socket with a damp gauze +/- LA soaked gauze for 20 mins

pack the socket with a haemostat agent - gelatine sponges

suture the site

transexamic mouthwash if available

if the bleeding doesn’t stop contact a local OMFS or oral surgery department or A&E

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3
Q

What should platelet levels be for extractions etc in primary care setting?

A

50-100 x 10(to the power of) 9/L = health

anything less than 50x 10(to the power of) 9/L = don’t touch in primary care

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4
Q

What are symptoms of end stage liver disease?

A
Jaundice 
clubbing 
palmar erythema 
ascites 
oesophageal varicies 
increased bleeding 
encephalopathy
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5
Q

What are the causes of liver disease?

A

Infection:
Hepatitis A, B, C and D

Non-infectious:
ALD
Non-ALD 
malignancy 
haemochromatosis 
drug induced
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6
Q

What are the stages of liver disease?

A

Hepatitis - inflammation

Cirrhosis - irreversible necrosis

failure of normal function

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7
Q

What is the UKELD score?

A

The United Kingdom model for end stage liver disease

a system which predicts a persons prognosis in chronic liver disease
guide to determining the need for transplant

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8
Q

What UKELD score indicated the need for a transplant?

A

49

= > 9% risk of mortality within the year

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9
Q

What tests are required for a patient with liver disease (end stage) before treatment? (3)

A

liaise with herpetology unit;

FBC

Coagulation screen - APTT, PT

INR

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10
Q

If a patient has a safe platelet count but has other defects in their haemostat mechanisms can they be treated in primary care?

A

no

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11
Q

An individual with severe liver disease has reduced metabolism, what are the implications for this in terms of LA? (2)

A

Preferred use of articaine as only 5-10% of this drug is metabolised in the liver

(all of lignocaine is metabolised in the liver)

also preferred use of infiltrations to prevent the formation of a haematoma

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12
Q

What medications should u be cautious with in a patient with liver disease? (3)

A
  1. AVOID NSAIDS - can increase bleeding risks
  2. Paracetamol - hepatotoxic but less risky than NSAIDS
  3. Antibiotics:
    Altered (smaller) dose
    Can use amoxicillin
    Can use metronidazole but alter the dose

Avoid erythromycin - antibiotic

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13
Q

What considerations are required when treating a patient with severe liver disease?

A

Where should they be treated?

Do they require agents that will allow haemostasis?

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