Liver Symposium Flashcards
What are the main liver diseases?
- ALCOHOL RELATED LIVER DISEASE
- Viral Hepatitis
- Non-alcoholic fatty liver disease
- Autoimmune liver diseases
- LIVER TRANSPLANTATION
What are the 5 main types of hepatitis?
ABCD and E
Which strains of hepatitis are enteric viruses and self limiting, acquired through food and water?
Enteric viruses hep A and E
How are Hep B,C and D caused?
Acquired through blood - cause chronic disease
Who often gets Hep A?
5-14 years old is the commonest group
Is Hep A symptomatic?
Asymptomatic cases are very common
How is acute Hepatitis A diagnosed?
By IgM antibodies
Who gets Hep A immunisation?
- Travellers
- Patients with chronic liver disease
- IDU (especially with HCV or HBV)
- Haemophiliacs
- Occupational exposure
- lab workers
- Men who have sex with men (MSM)
What are the three antigens associated with HepB?
Surface antigen
E antigen - secreted out, it interferes with host immune system and prevents destruction by the host
Core antigen
What do the following substances in the blood indicate?
- Hepatitis surface antigen (HBsAg)
- Hepatitis e antigen (HBeAg)
- Hepatitis core antigen (HBcAg)
- HBV DNA Active replication
Surface antigen - presence of virus
E antigen - active replication
Hepatitis core antigen - Active replication (although this is not detected in blood)
HBV DNA - Active replication
What does the presence of the following antibodies indicate?•Anti-HBs
- IgM anti- HBc
- IgG anti HBC
Anti-HBe
- Anti-HBs - Protection
- IgM anti-HBc - Acute infection
- IgG anti HBc - Chronic infection/exposure
Anti-HBe - Inactive virus
What is the approach when a patient maight have detectable levels of Hepatitis surface antigen?
If positive - find out if it is an active infection or chronic
Acitve infection if clinical evidence or known cause exists with corresponding raise in IgM anti HBVc
Chronic infection requires ongoing monitoring and treatment
What is the natural history of chronic hepatitis B?
After cirrhosis it can cause end stage liver disease or Hepatocellular carcinoma
A liver which is fibrotic but not is cirrosed still has a high risk of HCC
What are treatment options for HBV?
- Pegylated interferon
- Oral antiviral drugs
What percentage of HCV patients report jaundice?
10%
When does HCV often become symptomatic?
When the liver becomes cirrhotic
May have normal LFT’s
How is HCV different to the other hepatitis viruses?
Hep C is RNA virus which is different to hepatitis which is a DNA virus
What is the natural progression of Hepatitis C?
When does hepatits D arise?
Only in conjunction with hepatitis B - The small RNA virus is enveloped in the Hepatits B surface antigen
What is the disease progression of Hepatits E?
Self - limiting - no long term sequelae
No specific treatment, no efective vaccine currently available
What is the effect of herpes on the liver?
Rare but can cause acute hepatitis
What does NAFLD encompass? Non alcoholic fatty liver disease
Simple steatosis
Non alcoholic steatohepatits
Fibrosis and cirrhosis