Hepatology - liver disease

Question 1

What is acute liver disease and what can cause it?

Answer 1

Liver failure which has occurred rapidly with no history of liver disease previously.

It can be caused by:

• paracetamol overdoses
• viral hepatitis
• drug induced liver injury
• autoimmune hepatitis
• Wilson’s disease

onset of hepatic encephalopathy (HE) <8 weeks from onset of liver dysfunction
HE = (neurotoxins from the gut entering systemic circulation because of not being metabolised by the liver).

Question 2

What is non-alcoholic fatty liver disease?

Answer 2

Build up of fat in the liver, can lead to cirrhosis of the liver in 1% of cases.

associated with metabolic syndrome

Risk factors are T2DM, obesity, hypertension, hyperlipidaemia.

Question 3

What is the route of transmission of hepatitis A?

Answer 3

Faecal-oral

Question 4

Is hepatitis A acute or chronic?

Answer 4

Acute

Question 5

is there a vaccine against hepatitis A?

Answer 5

yes

Question 6

What is the treatment against hep A?

Answer 6

usually self limiting

Question 7

What is the route of transmission of hepatitis B?

Answer 7

Blood-borne transmission
Sexual transmission
Vertical transmission (mother to child)

Question 8

Is hepatitis B acute or chronic?

Answer 8

it can be both

Question 9

How can we treat hepatitis B?

Answer 9

Monitoring/ Long term antiviral

Question 10

What is epidemiology of Hepatitis B?

Answer 10

common in china and southeast asia, africa

Question 11

What is Hep C route of transmission?

Answer 11

Blood borne, common in IV drug users sharing infected needles

Question 12

Is Hep C acute or chronic?

Answer 12

Mainly chronic

Question 13

Is there a vaccine for hep C?

Answer 13

No

Question 14

How can we cure hep C?

Answer 14

newer antiviral

95% cure

Question 15

What is the epidemiology of hep C?

Answer 15

IVDUs
Central & E Asia
Middle East

NEEDLESTICK INJURIES

Question 16

What is the route of transmission for hep E?

Answer 16

faecal-oral

Question 17

Is hep E usually acute or chronic?

Answer 17

usually acute

Question 18

How is hep E treated?

Answer 18

is usually self limiting

Question 19

What is the epidemiology of hep E?

Answer 19

undercooked pork
SE asia
India
Central america

Question 20

What is alcohol hepatitis?

Answer 20

an acute consequence of the very high alcohol consumption often seen on a background of chronic alcohol-related liver disease.

Question 21

What is jaundice cause by?

Answer 21

Jaundice is caused by an increase in bilirubin. Bilirubin originates from the breakdown of haemoglobin as RBCs are turned over.
In liver it is processed into conjugated bilirubin and is excreted in bile through bile duct and out into small bowel.

Question 22

What is decompensated cirrhosis?

Answer 22

pt who experiences complication of cirrhosis - the median survival of decompensated cirrhosis is 2 years compared to compensated cirrhosis which is 12 years.

Complications may include:

• hepatic encephalopathy
• ascites
• variceal bleeding in GI tract due to build up of blood in superficial vessels as less being taken away via hepatic portal vein to liver.

Question 23

What are some outcomes of portal hypertension?

Answer 23

Varices due to build up of blood in GI tract veins

Ascites - build up of fluid in abdominal cavity

Splenomegaly - more blood pooled in spleen (can cause thrombocytopenia as the spleen is responsible for producing platelets).

Question 24

What affect can cirrhosis have on bleeding?

Answer 24

Coagulopathy and thrombocytopenia.

Due to decreased Vitamin K absorption and therefore decreased coagulation factor production

Also reduced thrombopoetin production so reduced platelet number.

Question 25

How can we weigh up the risk of planned surgery with liver cirrhosis?

Answer 25

Weigh up transfusion adverse reactions and risk of infection vs reduced risk of bleeding.

If fibrinogen >1.5 platelets > 50 INR < 1.4 probably ok to do procedure

If fibrinogen < 1.5, platelets <50
INR >1.4 discuss with haematology

Question 26

When would a liver transplant be needed?

Answer 26

acute liver failure
chronic liver disease
liver cancer

Question 27

how do we select who is allocated what liver?

Answer 27

blood group and clinical need i.e. sickest should get transplant first.

We select pts eligible for liver transplant based upon their survival with transplant compared to survival without.

Question 28

What is the follow up therapy after a liver transplant?

Answer 28

long term immunosuppressant to prevent risk of rejection

increased risk of skin cancer

Question 29

What is the most common cause of acute liver failure?

Answer 29

paracetamol overdose most common due to narrow therapeutic range and accessibility.

max dose for adult = 4g/24 hrs

Doses>10g or 200mg/kg can cause toxicity

Accumulation of NAPQI often fatal (usually scavenged by glutathione)

Treatment with N-acetylcysteine effective if given within 8 hrs however far less effective given >24hrs.

If acute liver failure develops it is often fatal without transplant.

Question 30

What is a sign of portal hypertension?

Answer 30

Spiderney - portal. hypertension

Question 31

What is a corticosteroid used in long term immunosuppression after a liver transplant?

Answer 31

Prednisolone

Question 32

What are the causes of chronic liver disease? what is each factor’s treatment?

Answer 32

ALCOHOL = Abstinence
FAT = weight loss
HEP B = antiviral
HEP C = antiviral
AUTOIMMUNE = drug
PBC = drug
PSC = drug
HAEMORCHR. = venesection
WILSON'S = decrease copper

Question 33

Why is chronic liver disease increasing in uk?

Answer 33

Alcohol, obesity, viral hepatitis

Question 34

progressive fibrosis >

Answer 34

cirrhosis