1 - Renal and Hepatic Conditions

what are the 3 renal considerations in dentistry

renal failure

renal dialysis

renal transplants

this condition is characterized by the kidney not being able to filter waste and excess fluid from the blood

renal failure

with renal failure, dangerous levels of fluid, waste, and _____ build up in the body

electrolytes

renal failure is preceded by

chronic kidney disease (turns into this)

causes of chronic kidney disease

uncontrolled Type I and Type II Diabetes

poorly controlled hypertension

inflammation of glomeruli

inflammation of kidney tubules

urinary tract obstruction

recurrent kidney infections

drug related: NSAIDS, antibiotics, ace inhibitors etc

complications of chronic kidney disease

fluid retention in arms, legs, lungs

hypertension

increased K levels

Anemia

weak bones

CNS damage

decreased immune resonse (lack of proteins - instead being excreted in urine)

what are the 3 types of tests to determine kidney disease

blood tests

urinalysis

imaging - ultrasound, CT

In a blood test for kidney disease, levels of ____ and ____ are examines

creatinine and urea

urinalysis for kidney disease detects presence of ____ or ___ in the urine that should not be there

glucose

protein

the Blood Urea Nitrogen (BUN) test measures the amount of ____ in your blood that comes from the wate product ______

nitrogen

urea

urea is a byproduct of ____ ____, it is made in the liver and excreted in the urine

protein metabolism

higher than normal BUN levels may indicate ____ ____

kidney disease (higher than 24mg/dl)

the creatinine test measures the amount of _____ in your blood, which is a byproduct of _____ ____ and is removed from the blood via the kidney

creatinine

protein metabolism

higher than normal creatinine levels may indicate ____ ____

kidney disease (higher than 1.3mg/dl)

as kidney disease progresses, GFR ______

decreases

for management of individuals with on renal dialysis, we want to avoid drugs that depend on ____ ____ or excretion. If needed adjust dosage to prevent toxicity

renal metabolism

for patients on renal dialysis, we want to avoid the use of _____ drugs

nephrotoxic - NSAIDS, aminoglycoside, - injures the kidneys

for patients on dialysis, we want to defer oral surgery until ____ after dialysis

one day

condition is optimized and heparin is removed

renal transplant patients usually take _______ and _____ drugs to prevent transplant rejection

corticosteroids

immunosupressive

for patients that have undergone renal transplant we shoudl consult their physician regarding need of adjustment of ______

corticosteroids

for patients with renal transplant history we want to provide ______ coverage to decrease risk of infection due to immunosupression drugs

antibiotics

for patients with history of renal transplant, they may have _____ ____ secondary to their immunosupressive drugs

gingival hypertrophy - swelling of the gums

for patients with renal transplant history we want to beware of
________

hypertension

what can be the causes for hepatic disese

1. infectious disease (viral hepatitis)

2. alcohol/drug abuse

   1. vscular congestion (CHF, chronci hypertension)

this is the biliary blickage that can lead to elevated bilirubin the blood

Jaundice

individuals with Hepatic disease will have reduced production of ____ ___ dependent clotting factors (II, VI, IX, X)

vitamin K

individuals with Hepatic disease will have decreased ____ ____

drug metabolism - easy for these patients to overdose

individuals with Hepatic disease will have decreased ____ and ____ ___ production

carbohydrate

amino acid

• due to liver disease and can lead to hypoglycemia and hypoproteinemia

individuals with Hepatic disease may experience ______ secondary to portal hypertension and can cause thrombocytopenia

hypersplenism

individuals with Hepatic disease have decreased ______ which leads to ____ bleeding time

platelets

increased

what liver enzymes will be elevated if sever liver disease is suspected (3)

ALT

AST

ALP

if a patient is suspected to have severe liver disease, their ____ will be elevated due to breakdown of RBC

bilirubin

____ and ___ ____ will be decreased in patients with severe liver disease

albumin and total protein

causes for patients with seizure disorder

alcohol withdrawl

high fever

hypoglycemia

TBI

unknown cause

for patients with seizures we want to reduce ____ as much as possible and want to keep procedures ___

stress - can increase risk of a seizure

short

this condition is characterized by excess amounts of circulating T3 and T4

hyperthyroidism

this is the most common type of hyperthyroidism and is an autoimmune disease and has enlargement of the entire gland. Most common in 20-40 year old women

Graves Disease

this form of hyperthyroidism is an abnormal growth of cells which form a lumo or lumos in an enlarge thyoid gland. More common in older women and is the most common thyroid lesion

nodular goiter

a small percentage of nodular goiters produce ______

hyperthyroidism

this is a well defined lump in the thryoid gland

thyroid adenoma

symptoms of hyperthyroidism

fine, brittle hair

sweating, heat intolerance

tachycardia, palpations, afib

weight loss

emotional liability, mood swings

exophthalmos - buldging eyes

hyperthyroidism creates a ____ state

hypermetabolic

• why there is weight loss

for patients with hyperthyroidism we should delay treatment until the thyroid dysfunction is ____ ____

well controlled

for hyperthyroid patients do we need to limit epi?

yes

this is a sudden release of thyroid hormones subsequent to stress/catecholamine, infection

thyroid storm

• restlessness

• fever

• delerium

• high systolic BP
  increased HR
  cardiac failure

for pregnant patients do we need to delay tx?

yes, until after delivery if possible - otherwise second trimester is the preferred time to perform surgery

for pregnant patients keep _____ to a minimum

radiograhs

for pregnant patients we want to avoid the ____ position to prevent inferior vena cava compression and bladder compression

supine

vena cava compression can cause ____ and _____

hypotension and tachycardia