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The Alimentary Canal > Liver Symposium > Flashcards

Liver Symposium Flashcards

1
Q

Describe hepatitis A and E

A

Enteric viruses
Cause self limiting acute infections

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2
Q

Describe hepatitis B,C and D

A

Parental viruses
Cause chronic disease

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3
Q

How is hepatitis diagnosed?

A

IgM antibodies
5-14 commonest group
Asymptomatic is common

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4
Q

Describe hepatitis A (HAV)

A

Occurs sporadically or in epidemic form
Transmission is faecal, sexual or blood

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5
Q

Who is immunised for HAV?

A

Travellers
Patients with chronic liver disease
Haemophiliacs
Occupational exposure
Men who have sex with men

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6
Q

What are some HBV antigens the presence of virus?

A

Hep surface antigen - HBsAg

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7
Q

What are some HBV antigens which show active replication?

A

Hep e antigen - HBeAg
Hep core antigen - HBcAg
HBV DNA

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8
Q

What are some HBV antibodies?

A

Anti-HB
IgM anti-HB
IgG anti-HBc
Anti-HBe - inactive virus

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9
Q

Describe the natural history of chronic hepatitis B

A

Can lead to cirrhosis or no further progression
Cirrhosis then can lead to hepatocellular carcinoma (HCC) and end stage liver disease (ESLD)

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10
Q

What are the treatment options for HBV?

A

Pegylated interferon
Oral antiviral drugs - Tenofovir is mostly used

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11
Q

Describe hepatitis C

A

Rarely acute, 85% chronic
Most asymptomatic until cirrhotic
May have normal LFTs
RNA virus

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12
Q

Describe the natural history of HCV

A

85% become chronic instead of resolving
Then 20% of them move onto cirrhosis instead of stabilising
Then 25% of them develop HCC and need transplant

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13
Q

What is used to treat HCV?

A

IFN-free combination of direct acting anti-viral drugs

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14
Q

Describe Hepatitis D

A

Small RNA virus which does not code for own protein code and enveloped by HBsAg
Co-infection or super infection with HBV
Very resistant to treatment

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15
Q

Describe Hepatitis E

A

Commonest cause of acute hep in Grampian
Self limiting and no specific treatment or vaccine

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16
Q

What are some other viruses?

A

Hep F, G, GB
EBV, CMV and herpes simplex

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17
Q

What can herpes simplex cause?

A

Rare severe acute hepatitis

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18
Q

What are some mechanisms of injury for drug induced liver disease (DILI)?

A

Toxic necrosis, acute hep, cholestasis, chronic hep, hepatic vein thrombosis, veno-occlusive disease, steatosis, granulomatous hep

19
Q

Describe the treatment for paracetamol induced liver failure

A

N-Acetyl cysteine (NAC) infusion
Follow graph on paracetamol and hours of ingestion

20
Q

What does non alcoholic fatty liver disease include?

A

Simple steatosis
Non alcoholic steatohepatitis
Fibrosis and cirrhosis

21
Q

What are some associated components of NAFLD?

A

Diabetes mellitus
Obesity
Hypertriglyceridemia
Hypertension
Age, ethnicity and genetics

22
Q

What is the natural history of NAFLD?

A

Normal - steatosis - NASH with possible fibrosis - cirrhosis
Increasing CV risk

23
Q

What is used for diagnosis of NAFLD?

A

Liver biopsy is gold standard
Enhanced liver fibrosis panel
Cytokeratin-18
Fibro scan
MR spectroscopy

24
Q

Describe NAFLD score

A

Patients are classed as high risk if 3 or more categories
Includes age, diabetes, BMI, Platelet count, albumin and more

25
Q

Describe the Fib-4 score

A

If less than 1.45 then no advanced fibrosis
If more than 3.25 then cirrhosis
Takes in age, AST, platelet count and ALT

26
Q

What is the non-pharmacological treatment for NAFLD?

A

Diet and weight reduction
Exercise
Weight reduction surgeries

27
Q

What is the pharmacological treatment for NAFLD?

A

Insulin sensitizers - metformin, pioglitazone
Glucagon like peptide-1 (GLP-1) analogues
Farnesoid X nuclear receptor ligand
Vitamin E

28
Q

What are some autoimmune liver diseases?

A

Autoimmune hepatitis
Primary biliary cholangitis
Primary sclerosing cholangitis

29
Q

Describe autoimmune hepatitis

A

Female predominant
Elevated IgG
Liver biopsy diagnosed

30
Q

What are the 3 antibodies in autoimmune hepatitis?

A

Type 1 - ANA, SMA
Type 2 - LKM1
Type 3 - SLA

31
Q

What is the treatment for autoimmune hepatitis?

A

Responds well to steroids
Long term azathioprine

32
Q

Describe primary biliary cholangitis

A

Female predominant
IgM elevation
Intrahepatic bile duct involved
Anti-mitochondrial antibody positive

33
Q

What are the symptoms of primary biliary cholangitis?

A

Pruritus - itching
Fatigue

34
Q

What is the treatment for primary biliary cholangitis?

A

UDCA - helps bile flow

35
Q

Describe primary sclerosing cholangitis

A

Male predominant
pANCA positive
Intra and extra hepatic ducts are involved
Stricturing disease

36
Q

What is the presentations of primary sclerosing cholangitis?

A

Recurrent cholangitis
Jaundice

37
Q

What is the treatment for primary sclerosing cholangitis?

A

Liver transplant
Biliary stents if only one major stricture

38
Q

Who can get a liver transplant?

A

Chronic liver disease with poor predicted survival or poor QoL
Hepatocellular carcinoma
Genetic diseases - primary oxaluria, tyrosemia

39
Q

What are some contraindications for transplant?

A

Active extrahepatic malignancy
Tumour invasion or macrovascular involvement
Active substance or alcohol abuse
Active and uncontrolled infection

40
Q

How do we prioritize liver transplants in cirrhosis?

A

Child’s Pugh scoring A B and C
MELD score - bilirubin, creatine, INR
UKELD- same as above and sodium

41
Q

What is orthotopic surgery?

A

Whole organ taken out and new one put in same place

42
Q

What is the post operative treatment for liver transplant?

A

ICU care, prophylactic antibiotics, anti-fungal drugs, anti-rejection drugs

43
Q

What are some anti-rejection drugs?

A

Steroids
Azathioprine
Tacrolimus/Cyclosporine

The Alimentary Canal (33 decks)

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