Liver Symposium Flashcards
What are the 5 main types of viruses that cause viral hepatitis?
- A
- B
- C
- D
- E
Which hepatitis viruses are enteric?
- A
- E
Which hepatitis viruses are parenteral?
- B
- C
- D
Which hepatitis viruses cause self limiting infections?
- A
- E
Which hepatitis viruses cause chronic disease?
- B
- C
- D
What is the estimated death toll per year for viral hepatitis?
1 million
Where is HAV most prevalent?
- Africa
- South America
- Asia
- Greenland
Describe the clinical course of HAV.
SLIDE 7
How can HAV occur?
- Sporadically
- Epidemic
How is HAV transmitted?
- Faecal-oral
- Sexual
- Blood
What is the most common infected age group for HAV?
5-14 years old
How is HAV diagnosed?
Acute disease diagnosed by IgM antibodies
What is a common presentation of HAV?
Asymptomatic
Who should receive a HAV immunisation?
- Travellers
- Patients with chronic liver disease
- Haemophiliacs
- Occupational exposure
- Men who have sex with men
Where is HBV most prevalent?
- Parts of Asia
- Parts of South America
- Parts of Canada
- Alaska
- Parts of Greenland
- Parts of South Africa
Describe the structure of HBV.
- Outer lipid envelope containing HB surface antigen
- Inner protein core (HBcAg)
- DNA polymerase
- HBV DNA
What does the inner protein core HBcAG secrete into the blood?
HBeAG
What does HBsAG indicate?
Presence of virus
What are the treatment options for HBV?
- Pegylated interferon
- Oral antiviral drugs
What oral therapies are available for HBV?
- Lamivudine
- Adefovir
- Entecavir
- Telbivudine
- Tenofovir
What does HBeAG indicate?
Active replication
What does HBcAG indicate?
Active replication but cannot be detected in the blood
What does HBV DNA indicate?
Active replication
What does anti-HBs indicate?
Protection
What does IgM anti-HBc indicate?
Acute infection
What does IgG anti-HBc indicate?
Chronic infection/exposure
What does anti-HBe indicate?
Inactive virus
What does negative HBsAG mean?
- No active infection
- Initiate or complete vaccines series
What does positive HBsAG mean?
- Positive IgM anti-HBc: acute infection
- Negative IgM anti-HBc: chronic infection: evaluation for ongoing monitoring and treatment
What is the natural history of chronic hepatitis B?
- Normal liver
- Chronic hep B
- No further progression OR cirrhosis
- Cancer
- ESLD
When are most HCV infected individuals asymptomatic until?
Cirrhotic
What will the LFTs of someone with HCV look like?
May be normal
What are the outcomes of HCV?
- 10% acute jaundice
- Rarely causes acute liver failure
- 85% chronic infection
Describe the structure of HVC.
- Envelope glycoproteins
- Envelope
- Nucleocapsid
- Single stranded RNA
What is the natural history of HCV infection?
- Exposure : Resolved
- Chronic : Stable
- Cirrhosis: slowly progressive
- Cancer
- Transplant
- Death
What are the 2 main drugs in use for HCV?
- Sofosbuvir
- Ledipasivir
What is HDV?
- Small RNA virus
- Does not code for its own protein coat
- Enveloped by HBsAG
- Co-infection with HBV
How is HDV transmitted?
Same as HBV
Why is HDV difficult to get rid of?
Resistant to treatment
Where is HEV most prevalent?
- Asia
- North Africa
- Mexico
- Parts of south Africa
What is the commonest cause of acute hepatitis in Grampian?
HEV
Where was HEV previously though to be limited to?
Tropical countries
What does HEV do in pregnancy?
Fulminant hepatic failure
What is the long term sequelae in HEV??
- No long term sequelae
- Self-limiting
What is the treatment for HEV?
No specific treatment
What does EBV/CMV do?
Generally cause mildly deranged LFTs only in immunocompromised hosts
What can herpes simplex result in?
Rare severe acute hepatitis
What are the 3 entities in NAFLD?
- Simple steatosis
- Non-alcoholic statohepatitis
- Fibrosis and cirrhosis
What components of metabolic syndrome is NAFLD associated with?
- Diabetes mellitus
- Obesity
- Hypertriglyceridemia
- Hypertension
Other than metabolic disorders what other risk factors are there for NAFLD?
- Age
- Ethnicity
- Genetic factors
What is the natural history of NAFLD?
- Normal liver
- Steatosis
- NASH +/- fibrosis
- Cirrhosis
How is a diagnosis of NAFLD made?
- Biochemical test AST/ALT ratio
- Enhanced liver fibrosis panel
- Cytokeratin-18
- Ultrasound
- Fibroscan
- MR/CT
- MR spectrrocopy
- Liver biopsy
To calculate a high risk NAFLD score how many risk categories must be met?
At least 3
What is the low risk category for NAFLD?
- <45 years
- No diabetes
- <30 BMI
- <1 AST/ALT
- Platelet >150
- Albumin >34
What is the high risk category for NAFLD?
- > 45
- Diabetes
- > 30 BMI
- > 1 AST/ALT
- Platelet <150
- Albumin <34
What is the treatment for NAFLD?
- Diet and weight reduction
- Exercise
- Insulin sensitizers
- Glucagon like peptide 1 analogues
- Farnesoid X nuclear receptor ligand
- Vitamin E
- Weight reduction surgeries
What are the 3 main autoimmune liver diseases?
- Autoimmune hepatitis
- Primary biliary cholangitis
- Primary sclerosing cholangitits
Who is mainly affected by autoimmune hepatitis?
Females
What is elevated in autoimmune hepatitis?
IgG
What are the 3 types of antibodies in autoimmune hepatitis?
- Type 1: ANA, SMA
- Type 2: LKM1
- Type 3: SLA
How is autoimmune hepatitis diagnosed?
Liver biopsy
How is autoimmune hepatitis managed?
- Steroids
- Long term asathioprine
Who is mainly affected by primary biliary cholangitis?
Females
What is elevated in primary biliary cholangitis?
IgM
What is positive in primary biliary cholangitis?
Anti-mitochondrial antibody
What is involved in primary biliary cholangitis?
Intrahepatic bile duct
What is common with primary biliary cholangitis?
Pruritus and fatigue
What is the treatment of choice for primary biliary cholangitis?
UDCA
Who is mainly affected by primary sclerosing cholangitis?
Males
What is positive in primary sclerosing cholangitis?
pANCA
What ducts are involved in primary sclerosing cholangitis?
Intra and extrahepatic bile ducts
What type of disease is primary sclerosing cholangitis?
Stricturing disease
What is the test of choice for primary sclerosing cholangitis?
MRCP
What is the treatment for primary sclerosing cholangitis?
- Liver transplant
- Biliary stents
What types of conditions is liver transplantation an option?
- Chronic liver disease with poor predicted survival
- Chronic liver disease with associated poor quality of life
- Hepatocellular carcinoma
- Acute liver failure
- Genetic disease
What are the contraindications for transplant?
- Active extrahepatic malignancy
- Hepatic malignancy with macrovascular or diffuse tumour invasion
- Active and uncontrolled infection outside of the hepatobiliary system
- Active substance or alcohol abuse
- Severe cardiopulmonary or other comorbid conditions
- Psychological factors that would likely preclude recovery after transplantation
- Technical and/or anatomical barriers
- Brain death
How do we prioritise in ALF?
- Acetaminphen-induced ALF categories
- Nonacetaminophen-induced ALF
How do we prioritise in cirrhosis?
- Child’s Pugh scoring A,B,C
- Meld score (Bilirubin, creatinine and INR)
- UKELD(Bilirubin, sodium, creatinine and INR)
Orthotopic surgery
Transplanted organ takes the place of the removed organ
What is the post-operative treatment for liver transplant?
- Post operative ICU care
- Multidisciplinary care
- Prophylactic antibiotics and anti-fungal drugs
- Anti-rejection drugs
Give examples of anti-rejection drugs.
- Steroids
- Azathioprine
- Tacrolimus/cyclosporine
