Dental Implications of managing pt with systemic disease Flashcards
What is hepatitis?
inflammation of liver
What are the causes of hepatitis?
Acute: infection: bacterial or viral Drugs: alcohol, statins, street drugs, paracetemol Pregnancy Chronic: Viral Alcohol, AI: primary sclerosimg cholangits Genetic: wilsons ans haematochoromais
What are the complications of hep?
cirrhosis clotting defect Hepatocellular carcinoma chromic glomernephrits carrier state
What are the hep B antibodies?
HepB surface antigen: infected acute or chronic
HepB surface antibody: recovery from natrual or vaccine infection
HepBe antigen: infected at some time
HebBeantibody: recovery from natrua, or vaccine
HepB core antobody: igM test for core antibody but this is not protective. This indicates previous or ongoing infection
DNA polymerase
Which hep B markers are present in early incubation of hepatitis?
HBs Ag and HBeAg
Which Hep B markers are present during acute hepatitis? And how do you treat it?
HBsAG , HBcAg HBe Ag and AntiHbcAg
LA
Lamuvidine
Adenosine
Which hep B markers are repsent in recovery phase and immunity?
AntiHBsAg
antiHBeA
AntiHBcAg
Which Hep B markers are present in healthy carrers with low risk of infectivity?
HBsAg
Anti HBEAg
AntiiHBcAg
Which Hep markers are present in chronic carriers wth high risk of infectiveity?
HBsAg
HBeAg
AntiHBcAg
More than 6 months
WHat does Hep D do?
this rides on the back of HBV and replicates only in presence og HepB
Hep D is what type of virus?
incomplete RNA
Which Hep virus is usally seen post transfusion?
Hep C 90% of cases
How is Hep C transmitted usually?
paraenteral, IVDU, rarely sexual and vertical and sailva seen in animals
How do you diagnose Hep C?
dectection of anti HCV antibody
How long does seroconversion on Hep C take?
may take sevreal months
How can you diagnose acute HCV infection?
use PCR techniques to amplify HCV RNA
t/F there is a higher incidence of developing HCC with Hep B then with Hep C?
False
other way round
T/F there is a vaccine for Hep C?
false
How do you treat Hep C?
interforn alpha
ribavarin: which has been shown to reduce serum levels of HCV RNA
what percentage of people using interforn alpha for the treatment of HCV regress after 6 months?
50-80%
WHat is the incidence fpr Hep B?
most prevelane: 15-44 years
peak incidence 25-34 years
M:F 1.5:1
What is the incidence for hep c?
most prevelant 25-44
M:F 2:1
What is the risk of seroconversion following a needle stick injury in a HEp C pos pt?
10%
How is Hep A, B, C, D, E F. G transmitted?
A: Faceo-oral B: IV.Sex. Vertical C: IV/Sex/Verical D: With Hep B E: faeco oral F: IV G: IV
what is the incubation period for Hep A, B, C, D, E F. G?
WEEKS A 2-6 B 8-32 C 8-16 D 2-12 E 6-8 F and G unknown
What is the acute mortality rate for Hep A, B, C, D, E F. G?
A 0.1% B 1% C less than 1% D 10-20% E 1-2% F and G uknown
what is the morbidity rate for Hep A, B, C, D, E F. G?
A V low B 20% C 80% D 90% E low f and G unknown
Is there a Carrier state for all the hep viruses?
A No
B, C, D yes
E, No
F and G unknown
is there are vaccine available for the hep viruses?
A B D yes
C, E, F, G No
What are the denral implications of hepatitis?
Liveer function impaired: Bleeding, metaoblism of drugs and liver cancer
assoicated diseases: HIV
Curretn medications
Liver trabsplant issues
What is CJD?
a prion disease
What are prions?
proteinacous infections particles
What are the size of prions?
less than 30nm
T/F prions are unifomly distributed amongst the tissues once infected?
F
T/F PRIONS ARE not resistant to chemical and physical destructon?
F
they are resistant
What can prions cause?
TSE
Transmissible Soingiform Encephalopathies
What is TSE?
groups is diseases which lead to spongiform cahnge in CNS
Where were TSE’s first seen?
sheep
where are TSE more recently seen in?q
cattle
mad cow diseease
What are the human forms of TSE?
- Kuru
- Sporadia CJD
- Familial CJD including fatal familila insomnia and gertsmann-strausller-scheinker
- Iatrogenic CJD
- variant CJD
WHat are the three types of CJD recognised
- Sporadia CJD 85%
- Familial CJD including fatal familila insomnia and gertsmann-strausller-scheinker 10%
- variant CJD
Which type of CJD is linked with BSE?
Variant
How is iatrogenic CJD caused?
by any of the three recognised CJD when they are transmistted directly.
How many cases of iatrogenic CJD are there per year?
accounts for 1%
What are the clinical features of vCJD?
lower age of onset: 20 instead of 60yrs
Longer duratio of illness> 14 months vs 5 months
Earlier psychilatric changes and sensrory and cerebellar signs
How can varian CJD be transmitted?
human to human via dural and corneal grafts infected blood produtct poorly sterilised equip human GH and gonadotrophin Ritual cannabilsm
Since what year has BSE been out of the food chain since?
1996
WHat agents are effective against TSE? and are they guranteed to be effective?
sodium hypocholoite
sodium hydroxide
Non porous load steam steriliser
NO GUARANTEE
What concentration of sodium hypochlorite is needed to be effective agsint TSE agents?
20 000ppm 1 hour
What concentration of sodium hydroxide is needed to be effective agsint TSE agents?
2M 1 hour
How long must you sterlise for and at what temp to be effective against TSE agents?
134=137 degrees for 18 mins holding time of 6 cycles of 3 mins each
How can we prevent trasmission of TSE?
good infection and control
for instuments dealing with CNS tissue, sngle use eg endo files
