Liver and Renal Flashcards
what are some potential medical reasons for your inability to achieve haemostasis?
- Inherited / Congenital Bleeding Disorders:
Haemophilia A and B
Von Willebrand’s Disease - medication induced:
antiplatelet - aspiring
anticoagulatant
new or novel oral anticoagulant
coumarin anticoagulant
other drugs like - chemo and HIV stuff - Haematological Disease:
Leukaemia
Immune Thrombocytopenia Purpura (ITP)
Myeloma - Infections:
Viral infections such as HIV or Hep C - Liver Disease:
Alcoholic liver Disease
Liver Cirrhosis
Hepatitis B or C infection
Primary Biliary Cirrhosis
Hepatocellular carcinoma
what does impaired liver function have an impact upon?
hepatic synthesis of clotting factors and proteins
involved in the fibrinolytic system including the vitamin K dependent coagulation proteins (II, VII –
prolonger PT, shortest half life), IX, X).
what is also a feature of liver disease?
Thrombocytopenia and thrombocythaemia
- Splenic sequestration
- Impaired hepatic synthesis and / or inc
what has a direct effect to suppress bone marrow and thus impair production of cells?
alcohol
what should you do if youre unable to arrest a haemorrhage?
If you are unable to arrest a haemorrhage you should consider phoning your local oral
surgery or Oral and Maxillofacial Department. If you are in a rural place of work you may well
wish to contact your local A and E department if there is no OMFS or oral surgery unit
what are signs of liver disease?
Skin: Jaundice, leukonychia, clubbing, palmar erythema, Dupuytren’s contracture, spider naevi
Other signs in advancing liver disease: bleeding, oesophageal varices, ascites, peritonitis,
encephalopathy or hepatorenal syndrome.
what are infective causes of liver disease?
Hepatitis Viruses: A (rarely has significant consequences) B,C and D
what are non-infective causes of liver disease?
Autoimmune – Primary Biliary Cirrhosis
Alcohol related
Non-alcoholic fatty liver disease
Haemochromatosis
Drug induced
Hepatocellular carcinoma
what are stages of liver disease?
Hepatitis: Inflammation of the liver which may or may not be reversible depending on the
disease
→ Liver cirrhosis
Irreversible liver necrosis and fibrosis
→ Liver failure
Failure of normal liver function
what is hepatitis?
Inflammation of the liver which may or may not be reversible depending on the
disease
what is liver cirrhosis?
Irreversible liver necrosis and fibrosis
what is significance of UKELD?
The United Kingdom Model for End Stage Liver Disease (UKELD) is a system which predicts
a person’s prognosis in chronic liver disease and is used as to guide determine the need for
liver transplant.
Current guidelines in Scotland advise that a UKELD score of 49 is the minimum level at
which a patient should be assessed for a liver transplant. This score also equates to > 9%
mortality rate within 12 months.
From a dental perspective we can now determine that this person has a significant level of
liver disease which will have implications on the rest of the body. This may interfere with the
way in which we provide any dental treatment and subsequently significant planning will be
required to facilitate his treatment.
what is min level a pt should be assessed for liver transplant?
49
what special investigations are required for someone who has liver disease?
- It is important to liaise with the hepatology unit to establish the medical condition of this
gentleman and to be able to work together to ensure this gentleman receives appropriate
medical care to facilitate safe dental treatment in the correct environment. - Blood tests: FBC, Coagulation/clotting screen (PT + ration, APTT + ratio, thrombin
time,TCT ratio) +/- INR , LFTS , Us and Es - Appropriate radiographs: OPT +/- intraoral views as required, full mouth pocket chart if
required after bloods.
what LA should you use if liver disease?
articaine - metabolised in the plasma. descreases metabolic demand on liver
