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Systems: Alimentary AB > Liver Symposium > Flashcards

Liver Symposium Flashcards

1
Q

What are the 5 main types of viruses that cause viral hepatitis?

A
  • A
  • B
  • C
  • D
  • E
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2
Q

Which hepatitis viruses are enteric?

A
  • A

- E

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3
Q

Which hepatitis viruses are parenteral?

A
  • B
  • C
  • D
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4
Q

Which hepatitis viruses cause self limiting infections?

A
  • A

- E

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5
Q

Which hepatitis viruses cause chronic disease?

A
  • B
  • C
  • D
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6
Q

What is the estimated death toll per year for viral hepatitis?

A

1 million

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7
Q

Where is HAV most prevalent?

A
  • Africa
  • South America
  • Asia
  • Greenland
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8
Q

Describe the clinical course of HAV.

A

SLIDE 7

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9
Q

How can HAV occur?

A
  • Sporadically

- Epidemic

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10
Q

How is HAV transmitted?

A
  • Faecal-oral
  • Sexual
  • Blood
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11
Q

What is the most common infected age group for HAV?

A

5-14 years old

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12
Q

How is HAV diagnosed?

A

Acute disease diagnosed by IgM antibodies

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13
Q

What is a common presentation of HAV?

A

Asymptomatic

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14
Q

Who should receive a HAV immunisation?

A
  • Travellers
  • Patients with chronic liver disease
  • Haemophiliacs
  • Occupational exposure
  • Men who have sex with men
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15
Q

Where is HBV most prevalent?

A
  • Parts of Asia
  • Parts of South America
  • Parts of Canada
  • Alaska
  • Parts of Greenland
  • Parts of South Africa
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16
Q

Describe the structure of HBV.

A
  • Outer lipid envelope containing HB surface antigen
  • Inner protein core (HBcAg)
  • DNA polymerase
  • HBV DNA
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17
Q

What does the inner protein core HBcAG secrete into the blood?

A

HBeAG

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18
Q

What does HBsAG indicate?

A

Presence of virus

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19
Q

What are the treatment options for HBV?

A
  • Pegylated interferon

- Oral antiviral drugs

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20
Q

What oral therapies are available for HBV?

A
  • Lamivudine
  • Adefovir
  • Entecavir
  • Telbivudine
  • Tenofovir
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21
Q

What does HBeAG indicate?

A

Active replication

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22
Q

What does HBcAG indicate?

A

Active replication but cannot be detected in the blood

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23
Q

What does HBV DNA indicate?

A

Active replication

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24
Q

What does anti-HBs indicate?

A

Protection

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25
Q

What does IgM anti-HBc indicate?

A

Acute infection

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26
Q

What does IgG anti-HBc indicate?

A

Chronic infection/exposure

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27
Q

What does anti-HBe indicate?

A

Inactive virus

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28
Q

What does negative HBsAG mean?

A
  • No active infection

- Initiate or complete vaccines series

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29
Q

What does positive HBsAG mean?

A
  • Positive IgM anti-HBc: acute infection

- Negative IgM anti-HBc: chronic infection: evaluation for ongoing monitoring and treatment

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30
Q

What is the natural history of chronic hepatitis B?

A
  • Normal liver
  • Chronic hep B
  • No further progression OR cirrhosis
  • Cancer
  • ESLD
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31
Q

When are most HCV infected individuals asymptomatic until?

A

Cirrhotic

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32
Q

What will the LFTs of someone with HCV look like?

A

May be normal

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33
Q

What are the outcomes of HCV?

A
  • 10% acute jaundice
  • Rarely causes acute liver failure
  • 85% chronic infection
34
Q

Describe the structure of HVC.

A
  • Envelope glycoproteins
  • Envelope
  • Nucleocapsid
  • Single stranded RNA
35
Q

What is the natural history of HCV infection?

A
  • Exposure : Resolved
  • Chronic : Stable
  • Cirrhosis: slowly progressive
  • Cancer
  • Transplant
  • Death
36
Q

What are the 2 main drugs in use for HCV?

A
  • Sofosbuvir

- Ledipasivir

37
Q

What is HDV?

A
  • Small RNA virus
  • Does not code for its own protein coat
  • Enveloped by HBsAG
  • Co-infection with HBV
38
Q

How is HDV transmitted?

A

Same as HBV

39
Q

Why is HDV difficult to get rid of?

A

Resistant to treatment

40
Q

Where is HEV most prevalent?

A
  • Asia
  • North Africa
  • Mexico
  • Parts of south Africa
41
Q

What is the commonest cause of acute hepatitis in Grampian?

A

HEV

42
Q

Where was HEV previously though to be limited to?

A

Tropical countries

43
Q

What does HEV do in pregnancy?

A

Fulminant hepatic failure

44
Q

What is the long term sequelae in HEV??

A
  • No long term sequelae

- Self-limiting

45
Q

What is the treatment for HEV?

A

No specific treatment

46
Q

What does EBV/CMV do?

A

Generally cause mildly deranged LFTs only in immunocompromised hosts

47
Q

What can herpes simplex result in?

A

Rare severe acute hepatitis

48
Q

What are the 3 entities in NAFLD?

A
  • Simple steatosis
  • Non-alcoholic statohepatitis
  • Fibrosis and cirrhosis
49
Q

What components of metabolic syndrome is NAFLD associated with?

A
  • Diabetes mellitus
  • Obesity
  • Hypertriglyceridemia
  • Hypertension
50
Q

Other than metabolic disorders what other risk factors are there for NAFLD?

A
  • Age
  • Ethnicity
  • Genetic factors
51
Q

What is the natural history of NAFLD?

A
  • Normal liver
  • Steatosis
  • NASH +/- fibrosis
  • Cirrhosis
52
Q

How is a diagnosis of NAFLD made?

A
  • Biochemical test AST/ALT ratio
  • Enhanced liver fibrosis panel
  • Cytokeratin-18
  • Ultrasound
  • Fibroscan
  • MR/CT
  • MR spectrrocopy
  • Liver biopsy
53
Q

To calculate a high risk NAFLD score how many risk categories must be met?

A

At least 3

54
Q

What is the low risk category for NAFLD?

A
  • <45 years
  • No diabetes
  • <30 BMI
  • <1 AST/ALT
  • Platelet >150
  • Albumin >34
55
Q

What is the high risk category for NAFLD?

A
  • > 45
  • Diabetes
  • > 30 BMI
  • > 1 AST/ALT
  • Platelet <150
  • Albumin <34
56
Q

What is the treatment for NAFLD?

A
  • Diet and weight reduction
  • Exercise
  • Insulin sensitizers
  • Glucagon like peptide 1 analogues
  • Farnesoid X nuclear receptor ligand
  • Vitamin E
  • Weight reduction surgeries
57
Q

What are the 3 main autoimmune liver diseases?

A
  • Autoimmune hepatitis
  • Primary biliary cholangitis
  • Primary sclerosing cholangitits
58
Q

Who is mainly affected by autoimmune hepatitis?

A

Females

59
Q

What is elevated in autoimmune hepatitis?

A

IgG

60
Q

What are the 3 types of antibodies in autoimmune hepatitis?

A
  • Type 1: ANA, SMA
  • Type 2: LKM1
  • Type 3: SLA
61
Q

How is autoimmune hepatitis diagnosed?

A

Liver biopsy

62
Q

How is autoimmune hepatitis managed?

A
  • Steroids

- Long term asathioprine

63
Q

Who is mainly affected by primary biliary cholangitis?

A

Females

64
Q

What is elevated in primary biliary cholangitis?

A

IgM

65
Q

What is positive in primary biliary cholangitis?

A

Anti-mitochondrial antibody

66
Q

What is involved in primary biliary cholangitis?

A

Intrahepatic bile duct

67
Q

What is common with primary biliary cholangitis?

A

Pruritus and fatigue

68
Q

What is the treatment of choice for primary biliary cholangitis?

A

UDCA

69
Q

Who is mainly affected by primary sclerosing cholangitis?

A

Males

70
Q

What is positive in primary sclerosing cholangitis?

A

pANCA

71
Q

What ducts are involved in primary sclerosing cholangitis?

A

Intra and extrahepatic bile ducts

72
Q

What type of disease is primary sclerosing cholangitis?

A

Stricturing disease

73
Q

What is the test of choice for primary sclerosing cholangitis?

A

MRCP

74
Q

What is the treatment for primary sclerosing cholangitis?

A
  • Liver transplant

- Biliary stents

75
Q

What types of conditions is liver transplantation an option?

A
  • Chronic liver disease with poor predicted survival
  • Chronic liver disease with associated poor quality of life
  • Hepatocellular carcinoma
  • Acute liver failure
  • Genetic disease
76
Q

What are the contraindications for transplant?

A
  • 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
77
Q

How do we prioritise in ALF?

A
  • Acetaminphen-induced ALF categories

- Nonacetaminophen-induced ALF

78
Q

How do we prioritise in cirrhosis?

A
  • Child’s Pugh scoring A,B,C
  • Meld score (Bilirubin, creatinine and INR)
  • UKELD(Bilirubin, sodium, creatinine and INR)
79
Q

Orthotopic surgery

A

Transplanted organ takes the place of the removed organ

80
Q

What is the post-operative treatment for liver transplant?

A
  • Post operative ICU care
  • Multidisciplinary care
  • Prophylactic antibiotics and anti-fungal drugs
  • Anti-rejection drugs
81
Q

Give examples of anti-rejection drugs.

A
  • Steroids
  • Azathioprine
  • Tacrolimus/cyclosporine

Systems: Alimentary AB (37 decks)

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