Liver and Kidney Disease

Question 1

What is the function of the liver?

Answer 1

• Metabolizes food by-products
• Drug detoxification
• Converts nitrogenous
  substances for kidney excretion
• Forms blood clotting factors
• Metabolism of bilirubin
• Processes lipids
• Stores glycogen

Question 2

What are the causes of liver disease?

Answer 2

• Chronic Hepatitis B or C infection
• Alcoholic liver disease
• Genetic disorders
• Autoimmune hepatitis
• Biliary disorders
• Infections
• Pathologic conditions
• drug use

Question 3

What is cirrhosis?

Answer 3

Long term damage to liver like hepatitis and alcoholic lover disease

Question 4

What are the five causes of acute hepatitis?

Answer 4

• Hep A,B,C,D,E

Question 5

What is Hepatits A?

Answer 5

Hep A virus

Question 6

What are common symptoms of viral hep?

Answer 6

• Hep A,B and C: diarrhea, impaired appetite, fever, pain or discomfort in abdomen, skin rash, joint pain, nausea, vomiting
• Hep D: Fatique, loss appetite, jaundice

Question 7

What are the clinical presentation of Hep?

Answer 7

2-20 week range of incubation phases
* Preicteric - Fatigue, nausea,poor appetite, right-
upper quadrant pain, 3-10 day duration
* Icteric- Dark urine, jaundice, fatigue worsens, nausea, dysgeusia, weight loss, 1-3 week duration

Question 8

What are the medical management for Hep?

Answer 8

• Bed rest
• Good nutrition
• Antiretroviral drugs
• Liver transplant
• Limit sexual contact
• Avoid alcohol

Question 9

What is the medical management for Hep A/B?

Answer 9

• Immune globulin
• Vaccinations
• Report to the healthdepartment

Question 10

What is the medical management for Hep C?

Answer 10

• Avoid high-risk behaviors
• Injection drug use
• Standard precautions

Question 11

What is the medical management for Hep D?

Answer 11

• Prevent Hep. B infection

Question 12

What is Hepatitis non A-E?

Answer 12

• viral hep that cannot be attributed to hep. A-E because no source of exposure can be identified
• similar clinical features
• no forms of prevention or treatment exist

Question 13

What are the complications of Hep?

Answer 13

• Fulminant hep
• Chronic infection

Question 14

What is the dental management if a person has active hep?

Answer 14

Only urgent dental care provided; use isolated operatory with limitedaerosols

Question 15

What is the dental management if a person has a history of hep?

Answer 15

Follow strict aseptic procedures

Question 16

What is the dental management if a person is at high risk for Hep B or C?

Answer 16

Screen; but no modifications

Question 17

What is the dental management if a person is a carrier for hep?

Answer 17

Follow standard precautions; consult with
physician to determine current status
and future risks

Question 18

What is the dental management signs or symptoms of hep?

Answer 18

No elective dental treatment; refer to physician;
provide urgent care only with limited aerosols

Question 19

What is a alcoholic liver disease?

Answer 19

Excessive alcohol consumption → Scarring

Fatty Liver Disease
* Nausea, vomiting, anorexia, enlarged liver and spleen,
jaundice, ankle edema, spider angioma
* Ascites - abdominal fluid build-up

Question 20

What is the medical management for alcoholic liver disease?

Answer 20

• Abstinence from alcohol
• Disulfiram (alcohol rehabilitation)
• Naltrexone and acamprosate (short use, relapse)

Question 20

What is the dental treatment for alcoholic liver disease ?

Answer 20

• Prothrombin time
• Increased anesthetic and sedative tolerance
• Less ability to metabolize drugs
• Frequent care: biofilm, calculus, inflammation
• Severe → premedication

Question 20

What is the function of the kidney ?

Answer 20

• Regulate body fluid volume
• Filter waste and toxins
• Maintain blood plasma pH
• Synthesize and release hormones
• Metabolize drugs
• Nephrons- Microscopic structural and functional unit

Question 20

What are the oral manifestations and compliciations of Alcoholic liver disease?

Answer 20

abnormal bleeding
atrophic glossitis
petechiae
hepatocelluar carcinoma metastes to jaw (premolars, ramus)
oral candidiasis
lichen planus
Angular cheillitis
breathe; sweet, musty

Question 21

what is the most common cause of kidney disease?

Answer 21

Most Common
* Diabetes Mellitus
* Hypertension
* Chronic Glomerulonephritis
* Polycystic Kidney Disease

Question 22

What are other causes of kidney disease?

Answer 22

Other causes:
* Tubular interstitial nephritis
* Systemic lupus erythematosus
* Neoplasms
* Obstructive nephropathies
* AIDS

Question 23

What are happens during each stage of kidney disease?

Answer 23

• Stage 1- normal or slightly increased GFR (normal functiom)
• Stage 2- Slightly decreased GFR ( mild loss of function)
• Stage 3- Moderate decreased GFR (mod loss of function)
• Stage 4- Severly decreased GFR (severe loss of function)
• Stage 5- Renal failure (needs treatment to live)

Question 24

What does GFR mean?

Answer 24

• Glomerular filtration rate- How much flood passes through the kidneys each minute; indicates how well kidneys are working

Question 25

What are the clinical presentation of Stage 1 and 2 ESRD?

Answer 25

Very few/mild signs or symptoms

Question 26

What are the clinical presentation of Stage 3, 4 and 5 ESRD?

Answer 26

Generalized illness
fatigue
weakness
headaches
nausea
loss of appetite
weight loss
Anemia
leg cramps
insomnia
dark urine
nocturia

Question 27

What are ESRD complications?

Answer 27

Azotemia
Uremia

Question 28

What is Azotemia?

Answer 28

Nitrogen accumulates in the blood

Question 29

What is uremia ?

Answer 29

high urea in blood

Question 30

What are the symptoms of azotemia?

Answer 30

not peeing a lot
feeling confused
shortness of breath (dyspnea)
Swelling in legs ankles and feet
abnormal heartbeat
chest pain
nausea and vomiting
feeling very tired

Question 31

What is the medical management for kidney disease?

Answer 31

• Hault progression to preserve quality of life
• Decrease waste products in blood
• Control blood pressure, fluid volume
• Balance electrolytes
• Diet low in protein, sodium, potassium
• Lifestyle modifications- Smoking cessation, glycemic control, lower cholesterol, cardiovascular health

Question 32

What are the prevention measure for kidney failure?

Answer 32

• Waterintake
• avoid smoking
• control blood sugar level
• eat healthy
• do not take over pills
• monitor blood pressure
• exercise
• limit salt intake

Question 33

What is kidney dialysis?

Answer 33

Hemodialysis- arteriovenous graft (SHUNT)
Heparin given to prevent clotting

Question 34

What are the common drugs used to stop acute kidney injury?

Answer 34

Diuretics
Acei/arbs
Aminoglycosides
Metformin
Nsaids

DAAMN!

Question 35

What are the dental management for kidney disease?

Answer 35

Undiagnosed → refer to PCP
* What stage of kidney disease?
Stage 1-3: No consultation or dismissal
Stage 4-5: PCP consult
Hospital setting
Premedication
Excessive bleeding a concern

• Monitor blood pressure
  Possibly delay elective treatment
  Corticosteroid tx → adrenal insufficiency
• Avoid OTC medication recommendations
  excreted by kidneys

Question 36

What are the oral manifestations of Kidney disease?

Answer 36

• Pale gingiva/mucosa (anemia)
• Diminished saliva flow - Increased biofilm and calculus
• Candidiasis
• Petechiae, ecchymosis
• Altered taste (metallic)
• Ammonia odor (urea)
• Uremic stomatitis
• Mucosa red, burning, grey exudate
• Extreme nausea → erosion
• Lamina dura demineralized
• Widened trabeculae, calcifications

Question 37

What are different treatment planning for patients recieving dialysis?

Answer 37

Prone to infection or bleeding concerns → PCP consult
* Schedule day after dialysis
* Heparin given to thin blood → lasts 3-6 hours after infusion
* Assess for cardiovascular conditions
* Blood pressure taken on arm opposite of shunt
* Care provided when medically stable
* Document medications
* Address oral side effects
* Tailor drug doses to align with dialysis activity