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Microbiology > M33- Viral hepatitis in dentistry > Flashcards

M33- Viral hepatitis in dentistry Flashcards

1
Q

what is the chief /sole clinical manifestations of hepatitis viruses?

A

liver disease

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2
Q

what is the liver involved in?

A

in the breakdown and excretion of toxins and synthesis of glucose and some proteins

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3
Q

what colour is bilirubin?

A

yellow

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4
Q

what are the different types of hepatitis viruses?

A 
Hepatitis A virus
Hepatitis B virus
Hepatitis C virus
Hepatitis D virus
Hepatitis E virus
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5
Q

who are the only people infected by hep D?

A

Infection only occurs in people already infected with Hepatitis B virus
(co infection of B and D at the same time or superinfection , of B first , then D)

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6
Q

what does the infection of hep D do to the prognosis of hep B?

A

worsens the prognosis

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7
Q

what are the 2 types of hepatitis?

A
  • acute

- chronic

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8
Q

what is acute hepatitis?

A

recent onset ( few weeks )

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9
Q

what hep types can be acute?

A

Hep A, Hep B, Hep C, Hep E

In UK Hep E has become most common

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10
Q

what effects does acute hepatitis have?

A
  • Jaundice
  • Pale stools
  • Dark urine
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11
Q

what are the complications of acute hepatitis?

A

-Chronic hepatitis
-Acute liver failure :
<1% of clinical cases of acute viral hepatitis

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12
Q

what is chronic hepatitis?

A

-Months / years:
>definition: at least 6 months of infection
>complications after decades

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13
Q

what hep types can be chronic?

A
  • Hep B and Hep C, never Hep A, Hep E only if immunocompromised
  • In UK Hep C is most common cause
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14
Q

what can chronic hepatitis be in the early years?

A

asymptomatic

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15
Q

when is chronic hepatitis picked up?

A

screening

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16
Q

what are the complications of chronic hepatitis?

A
  • Cirrhosis chronic liver failure
  • primary liver cancer
  • > 30% cases of chronic viral hepatitis will develop serious complication if left untreated for decades
17
Q

who is a patient with hepatitis referred to?

A
  • physician

- notifiable

18
Q

what is the summary of Hepatitis A?

A
  • Faecal oral spread
  • Not blood borne
  • More common in developing world
  • Vaccine preventable
  • Causes acute never chronic hepatitis
19
Q

what is the summary of hepatitis E?

A
  • Faecal oral spread
  • Not blood borne
  • More common in developing world
  • Not vaccine preventable
  • Causes acute never chronic hepatitis (in immunocompetent)
  • Can be caught in UK from some animals / meats (pigs, deer, rabbits)
20
Q

How is hep b virus and hep C virus transmitted?

A 
-Blood borne spread:
>injecting drug use
>blood products
>needlestick and blood splash
-Sex :
>more for Hep B than Hep C
-Mother to child
21
Q

Name the risk groups for Hep B and Hep C in the UK.

A

-Injecting drug users (past or current)
-Greater number of sexual partners : at least for HBV
-Babies of infected mothers
-Born in areas of higher prevalence in pre-vaccine era
-Blood product exposure
: especially in unscreened blood pre-1991

22
Q

How can hepatitis be prevented?

A
  • Reduce exposure

- Use vaccination

23
Q

Describe hepatitis B prevention.

A
  • Clean needles and syringes for injecting drug users
  • Safe sex
  • Screen blood transfusions
  • Vaccinate high risk groups and health care workers
  • Treatment as prevention?
24
Q

Describe hepatitis C prevention.

A
  • Reduce exposure as for Hep B
  • No vaccine is available
  • Treatment as prevention?
25
Q

what is the treatment of chronic viral hep B?

A

Numerous antivirals now available, they are suppressive rather than curative, so lifelong therapy required. Fairly safe therapy.

26
Q

what is the treatment of chronic viral hep C?

A

-Combination of 2 or 3 antivirals will cure >90%:
>precise antivirals used depends on genotype of virus (1 to 6)
>rapidly developing field, many new antivirals in recent years
-Significant side effects of early regimes being reduced by new combinations
-Antivirals given in short courses a few months long
-Reinfection possible

27
Q

what does the decision to treat what patient depend on?

A

Which patients to treat depends on clinical evaluation to determine who is at most risk of progressing to complications of chronic infection

28
Q

what is important to remember in reducing exposure during health care?

A
  • Standard precautions

- Unreasonable to expect to identify all individuals with a blood borne virus infection

29
Q

what actions are used to reduce exposure during health care?

A
  • Wear gloves
  • Mask and eye protection may be appropriate
  • Correct disposal of sharps
  • Good sterilisation (autoclave) or use of single use devices
  • Vaccination against Hep B
  • Disinfect surfaces (with e.g. hypochlorite)
30
Q

what lab test can be used for hepatitis ?

A

Clotted blood (gold top bottle)

31
Q

what is tested in labs for the presence of Hep B acute or chronic?

A
  • HBsAg (Hepatitis B surface antigen)

- All HBsAg +ve people are best considered to be infectious

32
Q

who is more likely to progress to complications soon in Hep B?

A

those that either present (in addition to HBsAg) Hep B DNA are very infectious

33
Q

what is present in those that have been successfully vaccinated and in those that have completely recovered from acute hep B?

A

Anti-HBs (antibody to HBsAg)

34
Q

who has anti- HCV (antibody to hep C virus)?

A

present in people with acute or chronic infection but also in those who have recovered

35
Q

why are all anti-HCV +ve people considered infectious?

A

Only a minority recover spontaneously

36
Q

what is the lab test for hep C?

A
  • Hep C RNA test (Hep C PCR test)

- Positive in infected anti-HCV +ve people but not in those that have recovered

37
Q

Describe the fitness to practice for hepatitis.

A
  • Must be HBsAg negative :Or if positive must have HBV DNA at very low level (<200 IU/mL) in blood
  • Must be Hepatitis C virus antibody negative :Or if positive must be Hepatitis C RNA negative

Microbiology (30 decks)

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