Lecture 22 Liver Symposium Flashcards
Name the enteric hepatitis viruses
A and E
Name the Parental hepatitis virus
B, C and D
What are the self-limiting hepatitis viruses
A and E
What hepatitis viruses cause chronic diseases
B, C and D
Describe the clinical course of Hepatits A
IgG increases throughout and IgM initial increase then decline
How is Hep A transmited
Faecal-oral
Sexual
Blood
High risk groups for Hep A
- Travellers
- Patients with chronic liver disease- IDU (especially with HCV or HBV)
- Haemophiliacs
- Occupational exposure- lab workers
- Men who have sex with men (MSM)
Describe the structure of Hep B
DNA polymers and HBV DNA surrounded by an inner protein core which is surrounded by an outer lipid envelope containing HB surface antigen
Function of Hepatitis surface antigen (HBsAg)
Presence of virus
Function of Hepatitis e antigen (HBeAg)
Active replication
Function of Hepatitis core antigen (HBcAg)
Active replication (not detected in blood)
Function of HBV DNA
Active replication
Treatment for Hepatitis Infections Hep B
Pegylated interferon
Oral anti-viral drugs
Name some oral anti-viral drugs Hep B
Lamivudine Adefovir Entecavir Telbivudine Tenofovir
Describe the structure of Hep C
Single stranded RNA
Envelope glycoproteins(E1 and E2)
Envelope
Nuceocapsid
Can the acute phase of Hep C be resolved
Yes
Can the chronic phase of Hep C be lived with
Yes
When do symptoms appear in Hep C
2-3 months
Non specific drugs for Hep C
- PEG-IFN lamda
- Ribavirin
- PEG-IFN alpha
Name specific drug treatment doe Hep C
- ABT-33
- ABT-450/r
- Ledipasvir
- AbT-267
- Fadaprevir
- Asunaprevir
- Daclatasvir
- Simeprevir
- Sofosbuvir
- Telaprevir
- Boceprevir
What virus may be a co-infection of Hep B
Hep D
What is a self-limiting hepatitis virus that is a common cause of hepatitis in Grmapian
Hep E
Name a variant of Hep B
Hep F
What virus is related to Hep C
Hep G
What viruses cause mildly deranged LFTs only in immunocompromised hosts
EBV and CMV
What virus except for Hep can cause hepatitis
Herpes simplex
What is non-alcoholic fatty over disease
- Umbrella term encompassing three entities
- Simple steatosis
- Non alcoholic steatohepatitis
- Fibrosis and cirrhosis
What metabolic syndromes are associated with NFLD
- Diabetes mellitus
- Obesity
- Hypertriglyceridemia
- Hypertension
What are other risk factors for NFLD
- Age
- Ethnicity (e.g. Hispanics)
- Genetic factors (e.g. PNPLA3 gene)
Diagnosis of NFLD
• Biochemical tests: AST/ALT ratio
• Enhanced liver fibrosis panel (ELF) (hyaluronic acid, TIMP-1, and PIIINP)
• Cytokeratin-18- Mutations in this gene have been linked to cryptogenic cirrhosis.
• Ultrasound
• Fibroscan- a type of ultrasound that can measure the degree of inflammation in your liver. It is a simple, painless test that uses high frequency sound waves
• MR/CT
• MR Spectroscopy: Actually quantify fat
Liver biopsy
What is used to score NAFLD
Age Diabetes IFG BMI AST:ALT Platelet count Albumin
Treatment of NAFLD
- Diet and weight reduction
- Exercise
- Insulin sensitizers e.g. Metformin, Pioglitazone
- Glucagon-like peptide-1 (GLP-1) analogues e.g. Liraglutide
- Farnesoid X nuclear receptor ligand e.g. Obeticholic acid
- Vitamin E
- Weight reduction surgeries
What are the 3 types of antibodies involved in autoimmune hepatitis
- Type 1: ANA, SMA
- Type 2: LKM1
- Type 3: SLA
are male/female more at risk of autoimmune hepatitis
Female
Whats an indication of autoimmune hepatitis
Elevated IgG
How is autoimmune hepatitis diagnosed
Liver biopsy
How is autoimmune hepatitis treated
Steroids
Long-term azathioprine
What is primary biliary cholangitis
Inflammation of the bile duct
Primary biliary cholangitis is predominant in male/female
Female
What antibody is present in primary biliary cholangitis
Anti-mitochondrial antibody
What are common symptoms of primary biliary cholangitis
Pruritus and fatigue common
What is the treatment for primary biliary cholangitis
UDCA
Primary sclerosing cholangitis is more common in male/female
Male
What antibodies are an indication of Primary sclerosing cholangitis
pANCA positive- perinuclear anti-neutrophil cytoplasmic antibodies
What is the purpose of a liver transplant
- Chronic liver disease with poor predicted survival
- Chronic liver disease with associated poor quality of life
- Hepatocellular carcinoma
- Acute liver failure
- Genetic diseases e.g. primary oxaluria, tyrosemia
Contraindications for liver transplantation
Active extrahepatic malignancy
Hepatic malignancy with macrovascular or diffuse tumor invasion
Active and uncontrolled infection outside of the hepatobiliary system
Active substance or alcohol abuse
Severe cardiopulmonary or other comorbid conditions
Psychosocial factors that would likely preclude recovery after
• transplantation
Technical and/or anatomical barriers
Brain death
Acetaminophen-induced ALF is listed for transplantation if
Grade 3 or 4 hepatic encephalopathy
INA more than 6.5
Creatinine more than 300 micro mol/l
Nonacetaminophen-induced ALF is listed for transplantation if
Age less than 10 or more than 40
INR at least 3.5
Serum bilirubin at lease 300 micomol/l
Unfavourable cause (Wilson’s disease)
What is Orthotopic surgery
liver transplantation, in which the previous liver is removed and the transplant is placed at that location in the body.
Name post-operative treatment
- Post operative ICU care
- Multidisciplinary care
- Prophylactic antibiotics and anti-fungal drugs
- Anti-rejection drugs
- Steroids
- Azathioprine
- Tacrolimus/Cyclosporine
