MANAGEMENT OF PATIENTS WITH RENAL AND HEPATIC CONDITIONS.pptx
- 1. MANAGEMENT OF PATIENTS WITH RENAL AND HEPATIC CONDITIONS
- 3. RENAL PROBLEMS Renal failure Renal/Other organ transplantation
- 4. RENAL FAILURE History Consultation Hemodynamics Dialysis
- 5. DENTAL MANAGEMENT Time of oral surgery in dialysis patients One day after dialysis Atrioventricular shunt
- 6. Screening for Hepatitis B virus Monitor vital signs Consider the use of prophylactic antibiotics
- 7. Avoid the use of nephrotoxic drugs Avoid/ modify drugs that depend on renal metabolism/ excretion Look for signs of secondary hyperparathyroidism
- 8. DENTAL MANAGEMENT OF ORGAN TRANSPLANT PATIENTS Consultation with primary care physician Patients on immunosuppressive drugs Need for prophylactic antibiotics
- 9. Aggressive management of infections Monitoring of vital signs Avoid the use of nephrotoxic drugs
- 10. Use of supplemental steroids Screening of Hepatitis B virus Index of suspicion for Cyclosporine induced gingival hyperplasia Advocate importance of oral hygiene
- 11. MANAGEMENT OF PATIENTS WITH HEPATIC DISORDERS History Causes Consultation with primary physician
- 12. Avoid/ modify the dose of drugs metabolized/ eliminated by liver Carry out platelet count, PT, PTT and bleeding time in patients with severe liver disease Avoid situations in which patient might swallow a large amount of blood Ensure adequate hemostasis at the end of the procedure using local hemostatic measures
Editor's Notes
- #5: This allows the heparin used during dialysis to disappear and the patient to be in the best physiologic status Surgically created junction b/w artery and vein Never use atrioventricular shunt for venous access except in a life threatening condition The BP cuff should never be used on the arm which has AV shunt
- #6: Take the necessary precautions if unable to do screening
- #7: NSAIDS, certain antibiotics like vancomycin, gentamicin A condition in which PTH is continuously produced in response to chronic low levels of serum calcium associated with chronic renal disease. The kidney processes vit D, in pts with chronic renal disease, active Vit D is not produced resulting in lower calcium levels. Osseous changes occur in bones manifested in maxillofacial region as radiolucencies of mandible and maxilla
- #8: Supplemental corticosteroids and other immunosuppressive drugs to preserve function of transplanted tissue. Cyclosporine an IS agent can cause gingival hyperplasia.
- #11: Causes: infectious diseases, ethanol abuse, vascular and biliary congestion. Attempt to learn the cause of liver disease if the cause is Hep B take usual precautions
- #12: The production of nearly all coagulation factors, as well as protein C and S, may be depressed in severe liver disease resulting in potential for heavy blood loss. Thrombopoietin which is produced in the liver is also reduced in severe liver disease resulting in thrombocytopenia Because of the decreased ability to metabolize the nitrogen in swallowed blood which can result in encephalopathy