Liver Symposium Flashcards
what are the five main types of viruses that cause viral hepatitis?
A B C D E
what hep. viruses are enteric?
hep a and e
name three parenteral hep viruses
b, c and d
what hep viruses cause self limiting acute infections?
hep. a and e
what hep. viruses cause chronic disease?
hep. b, c and d
how is hepatitis a transmitted?
> faecal oral
sexual
blood
how is acute hep. a diagnosed?
by IgM antibodies
who is immunised against hep. a?
> travellers > patients with chronic liver disease > haemophiliacs > occupational exposure > gay men
does hepatitis b contain DNA or RNA?
DNA
what antigen is excreted by the hep. b virus?
e antigen: HBeAg
in hep. b what antigens are detected and what does their presence mean?
> surface antigen (HBsAg) - shows virus is present
e-antigen - blood test shows active replication
core antigen (HBcAg) - detected only in a liver biopsy shows active replication
HBV DNA: active replication
what is the effect of the e antigen on the host?
it interferes with the hosts immune system preventing it form attacking to virus
what do anti-HB’s provide?
protection form the HBV virus
what are IgM anti-HBc’s a sign of?
an acute HBV infection
in what sort of infection are IgG anti-HBc’s present?
chronic HBV infection/exposure
what antibodies will be present if the HBV virus is inactive?
anti-HBe
describe the natural history of chronic hepatitis B
> no further progression (but increased risk of hepatocellular carcinoma) OR
cirrhosis can develop that then leads on to either end-stage liver disease or hepatocellular carcinoma (then ESLD)
is hep. c more likely to be a chronic infection or an acute infection?
chronic, 85% of cases are chronic
why is hep. c not noticed until late infection?
the patient is normally asymptomatic until cirrhotic and the patient may have normal LFT’s
is hep. c a RNA virus or DNA virus?
RNA virus
describe the natural history of hep. c
Exposure (acute phase) can be resolved or become chronic infection.
Chronic hep c then either stabilises or leads to cirrhosis. Cirrhosis can then either slowly progress/worsen or it may lead to HCC
what hepatitis virus is a co-infection?
hepatitis d, it parasites onto the hep. b virus
describe the hep. d virus
it is a small rna virus that does not code for its own protein coat so is enveloped by HBsAg.
in what animal is hep e endemic?
pigs
what is the commonest cause of acute hepatitis in Grampian?
hepatitis e
is hep e self limiting?
yes
name the three entities encompassed by non-alcoholic fatty liver disease
> simple steatosis
non-alcoholic steatohepatitis
fibrosis and cirrhosis
what are the metabolic syndrome risk factors associated with NAFLD?
> diabetes mellitus
obesity
hypertriglyceridemia
hypertension
what are the risk factors for non-alcohol fatty liver disease?
> age
ethnicity (Hispanic)
genetic factors (PNPLA3 gene)
describe the natural history of NAFLD
Steatosis of the normal liver, of which 12-40% go on to develop NASH +/- fibrosis. Then around 15% of them go on to develop cirrhosis.
in the NAFLD scoring system how many categories are the patients positive for when they are classed as high risk?
3 or more
what treatment can be given for non-alcohol fatty liver disease?
> diet, weight reduction and exercise > insulin sensitizers > glucagon-like peptide 1 analogues > farnesoid x nuclear receptor ligand > vitamin e
what are the main autoimmune disease of the liver?
> autoimmune hepatitis > primary biliary cholangitis > primary sclerosing cholangitis > (autoimmune cholangiopathy) > (IgG 4 disease)
what antibody is elevated in autoimmune hepatitis?
IgG
what three types of antibodies are relevant to autoimmune hepatitis?
Type 1: ANA, SMA
Type 2: LKM1
Type 3: SLA
what treatment is given to autoimmune hepatitis?
> steroids
> long term azathioprine
what antibodies are elevated in primary biliary cholangitis?
IgM
what symptoms are common in primary biliary cholangitis?
pruritus and fatigue
is primary biliary cholangitis anti-mitochondrial antibody positive or negative?
positive
what is the treatment of choice for primary biliary cholangitis?
UDCA (ursideoxycholic acid)
what bile ducts are involved in primary sclerosing cholangitis?
the intra and extrahepatic bile ducts
what sort of disease is primary sclerosing cholangitis?
a stricturing disease
what can recurrent cholangitis lead to?
jaundice
what is the only treatment for primary sclerosing cholangitis
liver transplant
when can you transplant?
> chronic liver disease with poor predicted survival
chronic liver disease with associated poor quality of life
hepatocellular carcinoma
acute liver failure
genetic diseases
what are the contraindications for transplant?
> active extraheptic malignancy > hepatic malignancy with diffuse tumour invasion > uncontrolled infection outside hepatobiliary system > alcohol or substance abuse > comorbid conditions > psychosocial factors > anatomical barriers > brain death
what two scoring systems are used to prioritise liver transplant in cirrhosis?
> MELD score - bilirubin, creatinine and inr
> UKELD - bilirubin, sodium, creatinine and inr
what is post operative treatment for liver transplant?
> prophylactic antibiotics > anti fungal drugs > anti rejection drugs: steroids azathioprine tacrolimus
What criteria is the NAFLD score based on?
Age, presence of DM (or impaired fasting glucose), BMI, AST/ALT ratio, platelet count, and albumin
