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Alimentary System > Lecture 22 Liver Symposium > Flashcards

Lecture 22 Liver Symposium Flashcards

1
Q

Name the enteric hepatitis viruses

A

A and E

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2
Q

Name the Parental hepatitis virus

A

B, C and D

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3
Q

What are the self-limiting hepatitis viruses

A

A and E

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4
Q

What hepatitis viruses cause chronic diseases

A

B, C and D

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5
Q

Describe the clinical course of Hepatits A

A

IgG increases throughout and IgM initial increase then decline

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6
Q

How is Hep A transmited

A

Faecal-oral
Sexual
Blood

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7
Q

High risk groups for Hep A

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)
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8
Q

Describe the structure of Hep B

A

DNA polymers and HBV DNA surrounded by an inner protein core which is surrounded by an outer lipid envelope containing HB surface antigen

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9
Q

Function of Hepatitis surface antigen (HBsAg)

A

Presence of virus

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10
Q

Function of Hepatitis e antigen (HBeAg)

A

Active replication

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11
Q

Function of Hepatitis core antigen (HBcAg)

A

Active replication (not detected in blood)

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12
Q

Function of HBV DNA

A

Active replication

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13
Q

Treatment for Hepatitis Infections Hep B

A

Pegylated interferon

Oral anti-viral drugs

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14
Q

Name some oral anti-viral drugs Hep B

A 
Lamivudine
Adefovir
Entecavir
Telbivudine
Tenofovir
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15
Q

Describe the structure of Hep C

A

Single stranded RNA
Envelope glycoproteins(E1 and E2)
Envelope
Nuceocapsid

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16
Q

Can the acute phase of Hep C be resolved

A

Yes

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17
Q

Can the chronic phase of Hep C be lived with

A

Yes

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18
Q

When do symptoms appear in Hep C

A

2-3 months

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19
Q

Non specific drugs for Hep C

A
  • PEG-IFN lamda
  • Ribavirin
  • PEG-IFN alpha
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20
Q

Name specific drug treatment doe Hep C

A
  • ABT-33
  • ABT-450/r
  • Ledipasvir
  • AbT-267
  • Fadaprevir
  • Asunaprevir
  • Daclatasvir
  • Simeprevir
  • Sofosbuvir
  • Telaprevir
  • Boceprevir
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21
Q

What virus may be a co-infection of Hep B

A

Hep D

22
Q

What is a self-limiting hepatitis virus that is a common cause of hepatitis in Grmapian

A

Hep E

23
Q

Name a variant of Hep B

A

Hep F

24
Q

What virus is related to Hep C

A

Hep G

25
Q

What viruses cause mildly deranged LFTs only in immunocompromised hosts

A

EBV and CMV

26
Q

What virus except for Hep can cause hepatitis

A

Herpes simplex

27
Q

What is non-alcoholic fatty over disease

A
  • Umbrella term encompassing three entities
  • Simple steatosis
  • Non alcoholic steatohepatitis
  • Fibrosis and cirrhosis
28
Q

What metabolic syndromes are associated with NFLD

A
  • Diabetes mellitus
  • Obesity
  • Hypertriglyceridemia
  • Hypertension
29
Q

What are other risk factors for NFLD

A
  • Age
  • Ethnicity (e.g. Hispanics)
  • Genetic factors (e.g. PNPLA3 gene)
30
Q

Diagnosis of NFLD

A

• 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

31
Q

What is used to score NAFLD

A 
Age
Diabetes
IFG
BMI
AST:ALT
Platelet count
Albumin
32
Q

Treatment of NAFLD

A
  • 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
33
Q

What are the 3 types of antibodies involved in autoimmune hepatitis

A
  • Type 1: ANA, SMA
  • Type 2: LKM1
  • Type 3: SLA
34
Q

are male/female more at risk of autoimmune hepatitis

A

Female

35
Q

Whats an indication of autoimmune hepatitis

A

Elevated IgG

36
Q

How is autoimmune hepatitis diagnosed

A

Liver biopsy

37
Q

How is autoimmune hepatitis treated

A

Steroids

Long-term azathioprine

38
Q

What is primary biliary cholangitis

A

Inflammation of the bile duct

39
Q

Primary biliary cholangitis is predominant in male/female

A

Female

40
Q

What antibody is present in primary biliary cholangitis

A

Anti-mitochondrial antibody

41
Q

What are common symptoms of primary biliary cholangitis

A

Pruritus and fatigue common

42
Q

What is the treatment for primary biliary cholangitis

A

UDCA

43
Q

Primary sclerosing cholangitis is more common in male/female

A

Male

44
Q

What antibodies are an indication of Primary sclerosing cholangitis

A

pANCA positive- perinuclear anti-neutrophil cytoplasmic antibodies

45
Q

What is the purpose of a liver transplant

A
  • 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
46
Q

Contraindications for liver transplantation

A

 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

47
Q

Acetaminophen-induced ALF is listed for transplantation if

A

Grade 3 or 4 hepatic encephalopathy
INA more than 6.5
Creatinine more than 300 micro mol/l

48
Q

Nonacetaminophen-induced ALF is listed for transplantation if

A

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)

49
Q

What is Orthotopic surgery

A

liver transplantation, in which the previous liver is removed and the transplant is placed at that location in the body.

50
Q

Name post-operative treatment

A
  • Post operative ICU care
  • Multidisciplinary care
  • Prophylactic antibiotics and anti-fungal drugs
  • Anti-rejection drugs
  • Steroids
  • Azathioprine
  • Tacrolimus/Cyclosporine

Alimentary System (39 decks)

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