Liver Symposium Flashcards
Which 5 main viruses can cause viral hepatitis?
Hepatitis A, B, C, D and E
Which types of hepatitis’ are enteric viruses?
A and E
Which types of hepatitis’ are parenteral viruses?
B, C, D
Which types of hepatitis’ are self limiting acute viruses?
A and E
Which types of hepatitis’ cause chronic infections?
B,C, D
How is Hep.A initially confirmed?
IgM antibodies
How can hepatitis A be transmitted?
Faecal-oral route
Sexually
Blood
Which age range is most common to get Hep.A?
5-14
What does HepB contain in the inner core which helps it to replicate?
DNA polymerase
What does the HepB surface antigen allow the virus to do?
Avoid the immune system
What happens to the E antigen produced by HepB virus?
Released into blood and modulates the immune system to help the virus survive
If testing and there is Hepatitis B surface antigen, what does this suggest?
Presence of virus
(remember this could be dead or alive!)
If testing and there is Hepatitis B E antigen, what does this suggest?
Active replication of the virus
If testing and there is Hepatitis B core antigen, what does this suggest?
Active replication of the virus but not detected in blood
If testing and there is Hepatitis B DNA antigen, what does this suggest?
Active replication of the virus
What is the function of the anti-surface antibody produced by the body?
Protection
Which antibody is produced by the body in response to an acute HepB infection?
IgM antibody
Which antibody is produced by the body in response to a chronic HepB infection?
IgG antibody
What can chronic hepatitis B cause to happen?
Cirrhosis of liver -> end stage liver disease
Are the vast majority of people infected w HepC symptomatic or asymptomatic?
Asymptomatic
What can HepC cause to happen?
Cirrhosis of liver
->sometimes HepC doesn’t even get diagnosed until this point as so hard to diagnose as mostly asymptomatic
Is HepC DNA or RNA virus?
RNA
How is HepC diagnosed?
First look for HepC antibodies
Then look for HepC or RNA in blood
Is HepD RNA or DNA based?
RNA
What does HepD depend on?
HepB
Parasite of a virus in some ways!
What does HepD rely on HepB for?
Production of protein coat
A patient can also have HepD if they have what?
HepB
Is HepD easy to treat?
No, very resistant to treatment
How are HepB and HepD transmitted?
When bodily fluids for an infected person come into contact with a non-infected person
Describe the treatment for HepE.
No specific treatment
No effective vaccine currently available
What is meant by drug induced liver disease?
When various drugs are taken for various reasons which can cause different patterns and mechanisms of injury to the liver
Name one drug in particular that can cause a lot of liver damage.
Paracetamol
Which three diseases fall under the umbrella term of non-alcoholic fatty liver disease?
Simple steatosis
Non-alcoholic steatohepatitis
Fibrosis and cirrhosis
Non-alcoholic fatty liver disease is associated with many components of metabolic syndrome like what?
Obesity
Diabetes
Hypertriglyceridemia
Hypertension
What are some of the risk factors for non-alcoholic fatty liver disease?
Age
Ethnicity
Genetics
What test is used to confirm the diagnosis of NAFLD?
Blood tests- AST/ALT ratio
Which radiography investigations can confirm NAFLD?
Ultrasound
Fibroscan
MR
CT
Which investigation is the gold-standard of diagnosis?
Liver biopsy because it tells the extent of fibrosis or steatosis
Which scoring system can be used to determine if someone has fibrosis or not?
Fib-4 score
If a score is less than 1.45 for the Fib4 score, what does this suggest?
No advanced fibrosis
If a score is more than 3.45 for the Fib4 score, what does this suggest?
Suggests there is scarring or cirrhosis
What are some of the treatment options for NAFLD?
Diet and weight reduction
Exercise
Weight reduction surgeries
Vitamin E
Insulin sensitizers
Glucagon like peptide-1
Name three more common autoimmune liver diseases.
Autoimmune hepatitis
Primary biliary cholangitis
Primary sclerosing cholangitis
Is autoimmune hepatitis predominantly seen in men or women?
Women
Which antibody is elevated in those with autoimmune hepatitis?
IgG
What is the diagnostic test for autoimmune hepatits?
Liver biopsy
Does autoimmune hepatitis respond well to treatment?
Yes
->steroids and in the long term, azathioprine
Is primary biliary cholangitis predominantly seen in men or women?
Women
Which antibody is elevated in those with primary biliary cholangitis?
IgM
What is usually affected by primary biliary cholnagitis?
Bile ducts
Which two symptoms are common in those with primary biliary cholangitis?
Fatigue
Pruritus (itching)
Is primary sclerosing cholangitis predominantly seen in men or women?
Men
Which antibody group is positive in primary sclerosing cholangitis?
pANCA
What is usually affected by primary sclerosing` cholangitis?
Itra and extrahepatic bile ducts
Which test is used to diagnose primary sclerosing cholangitis?
MRI or MRCP
What do patients with primary sclerosing cholangitis usually present with?
Jaundice or recurrent cholangitis
What is the only treatment for primary sclerosing cholangitis?
Liver transplant
Who would get a liver transplant?
Those who-
-have chronic liver disease w poor survival prediction
-have chronic liver disease w poor life quality
-have hepatocellular carcinoma
-acute liver failure
-have certain genetic diseases
What are some contraindications for a liver transplant?
Active substance or alcohol abuse
Active extrahepatic malignancy
Uncontrolled infection in other part of body
Psychosocial factors which may impact how they recover
Which score is used today to prioritise who gets a liver transplant?
UKELD score
