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Alimentary System > Liver Symposium > Flashcards

Liver Symposium Flashcards

1
Q

what are the five types of viruses that cause viral hepatitis

A

hepatitis A, B, C, D, E

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2
Q

what type of viruses are hepatitis A and E

A

enteric viruses

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3
Q

what type of viruses are hepatitis B, C, D

A

parenteral

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4
Q

which viruses cause self limiting acute infections

A

Hepatitis A and E

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5
Q

which viruses cause chronic disease

A

Hepatitis B,C and D

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6
Q

how many people die each year from causes of viral hepatitis

A

1 million people

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7
Q

how does Hepatitis A occur

A

sporadically or in epidemic form

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8
Q

in what three ways is hepatitis A transmitted

A

Faecal - oral
sexual
blood

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9
Q

what is the age group most commonly affected by hepatitis A

A

5 - 14 years

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10
Q

Is the prevalence of hepatitis A increasing or decreasing

A

decreasing worldwide

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11
Q

are cases mostly symptomatic or asymptomatic for hepatitis A

A

asymptomatic

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12
Q

how are acute diseases of hepatitis A diagnosed

A

IgM antibodies

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13
Q

who is recommended to be vaccinated for Hepatitis 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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14
Q

Describe the structure of Hepatitis B

A

Egg shaped
DNA polymerase within the core (inner protein core)
Outer lipid envelope containing HB surface antigen

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15
Q

what antigen is produced by HBV structure

A

IgE similar to core antigen, released into blood and modulates immune system to help virus survive

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16
Q

what are the different HBV antigens

A

Hepatitis surface antigen (HBsAg)

Hepatitis e antigen (HBeAg)

Hepatitis core antigen (HBcAg)

HBV DNA

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17
Q

what does the presence of Hepatitis surface antigen (HBsAg) mean

A

Presence of the virus

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18
Q

what does the presence of Hepatitis e antigen (HBeAg) mean

A

Active replication

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19
Q

what does the presence of Hepatitis core antigen (HBcAg) (not detected in blood) mean

A

active replication

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20
Q

what are the different HBV antibodies

A

Anti-HBs Protection

IgM anti-HBc Acute infection
IgG anti HBc Chronic infection/exposure

Anti-HBe Inactive virus

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21
Q

what does the presence of anti-HBs antibodies mean

A

protection

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22
Q

what does the presence of Igm anti-HBcs mean

A

acute infection

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23
Q

what does the presence of IgG anti HBcs mean

A

Chronic infection/exposure

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24
Q

what does the presence of anti-HBes mean

A

Inactive virus

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25
Q

what is the first question to consider for an HBV infection

A

is HBsAg present

positive - chronic / active infection
negative - no active infection (vaccination)

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26
Q

if the patients HBsAg came back positive what is the next question to consider

A

is there clinical evidence of active infection

yes - Igm or anti-HBc?

no - chronic infection (evaluate for chronic infection)

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27
Q

if there is IgM or anti-HBc present what does this mean

A

acute infection

negative - chronic infection

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28
Q

what is the most important clinical consequence of chronic HBV infection

A

liver fibrosis or cirrhosis

Approximately 15% to 40% of chronic hepatitis B patients will progress to cirrhosis, HCC, or liver failure. Approximately 5% to 10% of liver transplantations are related to hepatitis B.

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29
Q

are patients with chronic hepatitis B who do not have progression of fibrosis to cirrhosis at risk for end-stage liver disease

A

no but still are at risk of developing HCC.

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30
Q

what is used to supress HBV replication in chronic cases

A

oral antiviral agents effectively and safely suppress HBV replication during long-term use, and recent data have demonstrated that long-term viral suppression stabilizes or improves liver histology.

31
Q

what are the two treatment options for HBV

A

Pegylated interferon
Oral antiviral drugs

32
Q

what are five oral therapies available for HBV

A

Lamivudine
Adefovir
Entecavir
Telbivudine
Tenofovir

33
Q

when was hepatitis C discovered

A

1989

34
Q

how many people in scotland are affected by HCV

A

1%

35
Q

are patients affected by HCV mainly asymptomatic

A

yes - most asymptomatic until cirrhotic
- may have normal LFTs
10% patients report acute jaundice
Rarely causes acute liver failure

36
Q

what type of virus is HCV

A

RNA virus

37
Q

what are the percentages of people affected by different stages of HCV

A

15% - exposed and resolved
85% - chronic [80% stable]
20% - cirrhosis [75% slowly progressive]
25% - HCC transplant / death

38
Q

how are patients with HCV diagnosed

A

screening tests, look for presence of hep c/rna in blood

39
Q

how is HCV treated

A

combination of drugs 90% clearance rate

40
Q

what are some drugs used for HCV

A

simprevir
faldaprevir
ledipasvir
sofobuvir

41
Q

what is hepatitis D

A

Small RNA virus,
-does not code for its own protein coat
-enveloped by HBsAg

42
Q

what causes a co-infection or super infection with hepatitis D

A

HBV

43
Q

how resistant is HDV to treatment

A

very

44
Q

what is the prevalence of hepatitis E in UK

A

Increasingly recognized in UK
Commonest cause of acute hepatitis in Grampian

45
Q

is there any treatment or vaccine available for hepatitis E

A

no

46
Q

what are some other viruses that may cause viral hepatitis

A

Hepatitis F ?variant of B
Hepatitis G Related to HCV,
Hepatitis GB ? Cause liver disease
EBV Generally cause mildly
CMV deranged LFTs only in immunocompromised hosts
Herpes simplex Rare severe acute hepatitis

47
Q

what is non alcoholic fatty liver disease

A

Umbrella term encompassing three entities

Simple steatosis
Non alcoholic steatohepatitis
Fibrosis and cirrhosis

48
Q

what is non alcoholic fatty liver disease associated with

A

Diabetes mellitus
Obesity
Hypertriglyceridemia
Hypertension

49
Q

what are risk factors for NAFLD

A

Age
Ethnicity (e.g. Hispanics)
Genetic factors (e.g. PNPLA3 gene)

50
Q

what are the stages towards developing cirrhosis with NAFLD

A

steatosis
NASH
cirrhosis

51
Q

what are the different diagnostic methods for NAFDL

A

Biochemical tests: AST/ALT ratio
Enhanced liver fibrosis panel (ELF) (hyaluronic acid, TIMP-1, and PIIINP)
Cytokeratin-18
Ultrasound
Fibroscan
MR/CT
MR Spectroscopy: Actually quantify fat
Liver biopsy - gold standard

52
Q

what is the gold standard procedure for NAFDL

A

liver biopsy

53
Q

what is the NAFLD score

A

Criteria
Low Risk high risk

Age <45 >45

Diabetes or Absent Present
*IFG ≥ 7 mmol/L

BMI <30 >30

AST: ALT <1(AST<ALT) >1(AST>ALT)

Platelet count Normal >150 Low <150

Albumin Normal >34 Low <34
* Impaired fasting glucose

patients are classed as high risk for 3 or more categories

54
Q

what does Fib-4 score measure

A

<1.45 - no advanced fibrosis
> 3.25 - cirrhosis

55
Q

what are treatments available for NAFDL

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

56
Q

what are some autoimmune liver diseases

A

Autoimmune hepatitis
Primary biliary cholangitis (PBC)
Primary sclerosing cholangitis (PSC)
Overlap syndromes
Autoimmune cholangiopathy
IgG 4 disease

57
Q

who does autoimmune hepatitis affect

A

females

58
Q

what is a marker for autoimmune hepatitis

A

Elevated IgG
Three types of antibodies
Type 1: ANA, SMA
Type 2: LKM1
Type 3: SLA

59
Q

what diagnoses autoimmune hepatitis

A

Liver biopsy diagnostic

60
Q

how is autoimmune hepatitis treated

A

Responds well to steroids
Long term azathioprine

61
Q

who does primary biliary cholangitis affect

A

females

62
Q

what is used as a marker for primary biliary cholangitis

A

IgM elevated
Anti-mitochondrial antibody positive
Intrahepatic bile duct involved

63
Q

what symptoms are common for Primary biliary cholangitis

A

Pruritus and fatigue common

64
Q

what is choice of treatment for primary biliary cholangitis

A

UDCA treatment of choice

65
Q

who does primary sclerosing cholangitis affect

A

males

66
Q

what markers are used for primary sclerosing cholangitis

A

pANCA positive
Intra and extrahepatic bile ducts involved
Stricturing disease

67
Q

what is the diagnostic test for primary scleorising cholangitis

A

MRCP test of choice

68
Q

what are common symptoms for primary sclerosing cholarngitis

A

Recurrent cholangitis, jaundice

69
Q

what are the treatment options for primary cholangitits

A

Liver Tx, Biliary stents

70
Q

who receives a 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

71
Q

what are contraindications for a transplant

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

72
Q

how are patients prioritised with cirrhosis

A

Child’s Pugh scoring A, B and C

MELD score ( Bilirubin, Creatinine and INR)

UKELD( Bilirubin, Sodium, Creatinine and INR)

73
Q

what type of surgery is a liver transplant

A

orthotopic

74
Q

what makes up post operative treatment for a liver transplant

A

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

Alimentary System (44 decks)

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