Liver And Renal

Question 1

Which local should be used in those with liver disease? Why?

Answer 1

Articane as it is metabolised in the plasma, lido is metabolised in liver.

Question 2

Which simple analgesia can be given to a patient with liver cirrhosis? Why?

Answer 2

Paracetamol as no nephrotoxicity

NSAIDS can further liver damage and reduce kidney function

Reduce dose

Question 3

What factors in the clotting cascade does the liver produce? What other essential product does it produce?

Answer 3

1, 2, 7, 9, 10, 11

Thrombopoeitin

Question 4

Which anticoagulant is given to those who undergo dialysis?

Answer 4

Heparin

Question 5

Give reasons for haemostasis being unsuccessful

Answer 5

Inherited / congenital bleeding disorders
- haemophilia

Medication induced
- anti-platelet - aspirin
- anti-coagulant - heparin

Other medicine
- chemotherapy
- HIV tx suppresses bone marrow

Haematological disease
- leukaemia

Liver disease
- alcoholic liver disease
- cirrhosis etc

Question 6

What are Vit K dependant coagulation proteins?

Answer 6

2, 7, 9, 10

Question 7

What platelet levels are single tooth extractions ok in primary and secondary care?

Answer 7

Primary = 100 x 10^9

Secondary = 50 x 10^9

Question 8

What is the UKELD score? Level of significance?

Answer 8

United Kingdom model level for end stage liver disease

• 49 or more = liver transplant and >9% mortality in 12 months

Question 9

Stages of liver disease?

Answer 9

Hepatitis

Liver cirrhosis
- irreversible liver necrosis and fibrosis

Liver failure

Question 10

Main causes of liver disease?

Answer 10

Infective
- hepatitis

Non-infective
- alcohol related
- non-alcohol fatty liver disease
- drug induced
- hepatocellular carcinoma

Question 11

What features may someone present with with a UKELD score of 49 / liver disease?

Answer 11

Jaundice

Poor blood clotting / bruising

Clubbed fingers

Ascites

Question 12

What special investigations are required to safely manage someone with liver disease

Answer 12

LIASE WITH HEPATOLOGY UNIT

Blood tests
- FBC
- coagulation screen
- liver function tests?

Question 13

What is APTT?

Answer 13

Activated partial thromboplastin time

• time takes blood to clot after blood sample mixed with activator

Question 14

What is PT?

Answer 14

Prothrombin time

• time for blood to clot

Question 15

What common drugs should i not recommend in liver disease pts?

Answer 15

NSAIDS - risk of bleeding in GIT and oesophageal varices

Paracetamol - can be hepatotoxic, consult hepatology clinic

Metronidazole - may require dose adjustment

Question 16

How might we render / plan to render someone dentally fit for a liver transplant?

Answer 16

Remove foci of infection - periapical pathology or other pathology etc

Remove teeth of poor long term prognosis

Establish preventative plan