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R - Yr2 Alimentary (Liam Lennox) > Liver Symposium > Flashcards

Liver Symposium Flashcards

1
Q

Define enteric vs parenteral?

A

Enteric - Occuring within the intestines

Parenteral - Occuring outwith the mouth & Alimentary canal

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2
Q

How many hepatitis viruses are there and are they enteric or parenteral?

A

A&E are enteric (normally self-limiting)

B,C,D are parenteral (often cause chronic disease)

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3
Q

How is HEP A transmitted?

A

By Faecal-Oral
Blood
Or Sexually

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4
Q

How do we diagnose HEP A?

A

With an IgM antibody test in the acute stage and IgG detectable for life

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5
Q

Who gets a HEP A immunisation?

A
  • Travellers
  • Chronic Liver Disease Patients
  • Hemophiliacs
  • Those with occupational exposure (E.g. lab workers)
  • Men who have Sex with Men (MSM)
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6
Q

What are the symptoms of hepatitis?

A

Short term hepatitis is often aymptomatic but can lead to:

  • Arthralgia
  • Fever
  • Nausea/Vomiting
  • Fatigue
  • Malaise
  • loss of appetite
  • abdominal pain
  • Pruritis
  • Jaundice
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7
Q

Describe the antigens associated with hepatitis B?

A

Hep Surface antigen - HBsAg - Indicates presence of virus

Hep e antigen - HBeAg - Virus Actively Replicating (found in blood)

Hep Core Antigen - HBcAg - Active Replication (found in liver biopsy)

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8
Q

Describe the antibodies associated with Hep B

A

IgM anti-HBc = Shows acute illness
IgG anti-HBc = Shows chronic or past infection
Anti-HBe = Shows up as virus is being inactivated by treatment
Anti-HBs = Shows infection or immunisation induced immunity (fights HBsAg)

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9
Q

When do people normally clear a HEP B infection and how do we tell if they’re beyond this period?

A

Around 6 months

If they are ill and IgM -ve it means theryre past the acute stage and unlikely to kick it themselves.

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10
Q

Consequence of chronic HEP B?

A

Cirrhosis -> End stage liver disease

Some develop liver cancer

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11
Q

How do we treat HEP B?

A

Pegylated Interferon

Or more recently Oral Antivirals

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12
Q

How does HEP C present differently?

A

Most people have no symptoms acutely but will develop chronic infection.
They dont usually show symptoms until they’re cirrhotic

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13
Q

How do we test for HEP C?

A

Chronic Anti-HCV antibodies

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14
Q

What special about Hepatitis D?

A

Its a small RNA virus and doesnt code for its own protien coat.
So it attaches itself to HEP B and acts as a co-infection.

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15
Q

What do we know about HEP E?

A

Its self limiting
Its the most common acute hepatitis in grampian
We have no treatment or vaccine

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16
Q

Name some other viruses that can cause hepatitis?

A 
EBV or CMV in the immunocompromised
Herpes Simplex (rarely)
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17
Q

What is non-alcoholic fatty liver disease?

A

An umbrella term for:

  • Simple Steatosis (large but harmless fat in liver cells)
  • Non-alcoholic Steatohepatitis (Causing liver inflammation)
  • Fibrosis & Cirrhosis (result after years of NAFLD)

Occuring due to a build up of fat in the liver

18
Q

What are the risk factors or associations with NAFLD?

A 
Diabetes Mellitus
Obesity
Hypertension
Hypercholesterolaemia
Hypertriglyceridemia
Age
Smoking
Ethnicity (hispanics)
Genetic Factors
19
Q

How do we test for NAFLD?

A

Often picked up during a LFT (reduced AST/ALT ratio) or ultrasound.

Follow up with CT/MRI

20
Q

How do we assess a NAFLD patient?

A

With a NAFLD score
Created from a set of criteria based on the patients test results and health/environmental factors to determine whether they are low or high risk

21
Q

What are the treatments for NAFLD?

A
  • Diet & Weight Reduction
  • Weight reduction Surgeries
  • Glucagon-like peptide-1 (GLP-1) analogues for chronic weight management.
  • Control of risk factors (e.g. diabetes, hypertension etc)
  • Vitamin E
  • Insulin Sensitisers for the diabetes.
22
Q

What are the commonest autoimmune liver diseasees?

A
  • Autoimmune hepatitis
  • Primary Biliary Cholangitis (PBC)
  • Primary Sclerosing Cholangitis (PSC)
  • Overlap Syndromes
  • Autoimmune Cholangiopathy
  • IgG 4 Disease
23
Q

How do we classify autoimmune hepatitis?

A

By the type of auto-antibody, split into:

  • Type 1
  • Type 2
  • Type 3
24
Q

How do we diagnose and treat autoimmune hepatitis?

A
  • Liver Biopsy -> Histological
  • Elevated IgG
  • Autoantibodies

Treat with immunosupressants:

  • Steroids (prednisalone)
  • Azathioprine
25
Q

What is primary biliary cholangitis

A

Chronic granulomatous inflammation of the bile ducts

  • > Loss of the intra-hepatic bile ducts
  • > Eventually Cirrhosis

May be down to an environmental trigger + genetic predisposition leading to immune intolerance to self-mitochondirla proteins

26
Q

How do we test for Primary Biliary Cirrhosis? (PBC)

A
  • Elevated Serum Alkaline Phosphatase (ALP)

- Test for antimitochondrial antibodies

27
Q

Which gender is more likely to get Primary Biliary Cholangitis?

A

Women

Whereas Primary Sclerosing Cholangitis is male predominant

28
Q

What are the symptoms of PBC?

A

Fatigue & Pruritis
Eventually Jaundice from backup of bilirubin
Eventually cirrhosis and liver failure

29
Q

How do we treat Primary BIliary Cholangitis?

A

UDCA (Urodeoxycholic acid) - a secondary bile acid - reduces cholestasis & improves LFTs
Otherwise treat symptoms and eventually need a liver transplant.

30
Q

What is primary sclerosing cholangitis? (PSC)

A

Progressive cholestasis with bile duct inflammation & fibrose stricture formation

31
Q

What other conditions are associated with PSC?

A

Associated with IBD

Also increases risk of cholangiocarcinoma

32
Q

Define cholangiocarcinoma?

A

Bile duct cancer (cancer of the epithelial lining of the biliary system).
Usually adenocarcinoma

33
Q

How do we test for Primary Sclerosing Cholangitis?

A

pANCA test. (neutrophil antibodies)

Magnetic Resonance Cholangiopancreatography (MRCP)

34
Q

How does PSC present?

A

Reccurent Cholangitis & Jaundice

Also pruritis & fatigue

35
Q

How do we treat PSC?

A

Liver transplant

Biliary Stents

36
Q

What criteria deserve a liver transplant?

A
  • Chronic liver disease with poor survival prediction
  • Chronic liver disease with poor quality of life
  • Hepatocellular Carcinoma
  • Acute Liver Failure
  • Genetic Diseases e.g. tyrosenimia, primary oxaluria
37
Q

Tyrosenimia? Primary Oxaluria?

A

Tyrosenimia is an inbuilt error of metabolism where you cant break down tyrosine
Primary Oxaluria, inherited condition causing excess oxalate in urine

38
Q

Contraindications of a liver transplant?

A
  • Active extrahepatic malignancy
  • Hepatic malignancy with macrovascular or diffuse invasion
  • Active substance abuse
  • Uncontrolled infection outside hepatobiliary system
  • Severe cardiopulmonary or other cormobid conditions
  • Psychosocial factors that preclude recovery
  • brain death
  • Technical/anatomical barriers
39
Q

We have different protocol for deciding transplants in those with acute liver failure and chronic cirrhosis.
How do we assess someone with chronic cirrhosis for a tansplant?

A

MELD Score - Model for End-Stage Liver Disease

UKELD score

The higher these scores the more likely you are to die without a transplant

40
Q

Liver TRansplant is an orthotopic transplant, what does this mean?

A

It means it occurs at the same spot.

I.e. the original liver must be removed and the new one implanted in its place

41
Q

What post op care is there for a liver transplant?

A 
ICU care with a MDT
Prophylactic antibiotics & antifungals
Anti-rejection meds for life:
- Steroids
- Azathioprine (steroid-sparing immunosuppresant)
- Tacrolimus/Cyclosporin
42
Q

LFT results of NAFLD?

A
  • RAised ALT, AST, ALKP, GGT

- Low AST/ALT ratio

R - Yr2 Alimentary (Liam Lennox) (37 decks)

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