Liver symposium Flashcards
What is viral hepatitis caused by?
A, B= enteric viruses
C, D, E= parenteral viruses
What hepatitis viruses cause acute infections?
A, E
What hepatitis viruses cause chronic disease?
B, C, D
Where is Hep A prominent?
Developing countries and Greenland
How is Hep A transmitted?
Faecal oral
Sexual
Blood
What is the most common presentation of Hep A?
Asymptomatic
How is acute Hep A diagnosed?
By IgM antibody presence
Who is given immunisation against Hep A?
Travellers Patients with chronic liver disease Haemophiliacs Occupational exposure i.e. lab Men who have sex with men (MSM)
What is the typical timespan of Hep A?
Presentation 2 weeks after infection
Viremia gone by 6 weeks post infection
Clinical illness lasting 8 weeks post infection
What is the structure of the Hep B virus?
Inner protein core with antigen enclosing DNA
Outer lipid envelope containing surface antigen
What antigens are expressed from HBV?
HBeAg
HBcAg
HBsAg
What is the HBeAg and what does it do?
Antigen that is a sign of active replication
Iterferes with host immune system and prevents them from attacking the virus
What is HBsAg used to detect?
Presence of hep B virus, rather than activity
What is HBcAg used to detect and where is it found?
Active replication of HV
Only found in liver
What antibodies launch a response against HBV?
IgM
IgG
Anti HBe
Anti HBs
What is IgM presence used to detect in HBV?
If the virus has been acquired in the last 6 months
What does IgG indicate in HBV?
Chronic infection
What is the usual progression of HBV?
No progression from chronic virus
What can HBV progress onto?
Cirrhosis
Hepatocellular carcinoma
End stage liver disease
How does Hep C progress?
15% resolution
70% live with chronic
15% progress to cirrhosis, hepatocellular carcinoma and possible death
How is HCV treated?
Direct acting antiviral oral drugs
How is HCV diagnosed?
Test for the anti HCV antibody
WHt is Hep D?
Small RNA virus that can co infect with HBV
Why is HDV a confection with HBV?
HDV cannot support itself, it needs the HBV surface antigen
How is hep B spread?
Blood, semen or other bodily fluids
How is Hep D spread?
Blood, semen or other bodily fluids
How does HDV infect with HBV?
Enveloped by the HB antigen
What is hep E?
Self limiting virus
Most common cause of acute hepatitis in Grampian
What is non alcoholic fatty liver disease>
Umbrella term encompassing simple steatosis, non alcohol steatohepatitis
Fibrosis and cirrhosis
With is non alcoholic fatty liver disease associated with?
Diabetes mellitus
Obesity
Hypertriglyceridaemia
Hypertension
What are th risk factors for non alcoholic fatty liver disease?
Age
Ethnicity
Genetic factors
What is the natural progression of non alcoholic fatty liver disease?
Steatosis–>non alcohol steatohepatitis –> cirrhosis
How is non alcoholic fatty liver disease diagnosed?
LFT
Ultrasound
Fibroscan
Biopsy
How is non alcoholic fatty liver disease treated?
Improve insulin sensitivity i.e., weight loss, exercise
Treat risk factors i.e., diabetes, hypertension
Avoid excessive alcohol
What are the types of autoimmune liver disease?
Autoimmune hepatitis
Primary biliary cholangitis
Primary sclerosis cholangitis
What does autoimmune hepatitis cause?
Elevated IgG
How is autoimmune hepatitis diagnosed and treated?
Liver biopsy
Long term azathioprine steroid
What does primary biliary cholangitis cause?
Elevated IgM
positive antimicrobial antibody
Pruritus and fatigue
What anatomical structure is involved in primary biliary choangitis?
Intrahepatic bile duct
What does primary scleroid cholangitis cause?
pANCA positive
Stricturing
Recurrent cholangitis, jaundice
What anatomical structures are involved in primary sclerosis cholangitis?
Intra and extra hepatic bile ducts
When is a liver transplant considered for patients?
Chronic liver disease with poor predicted survival or quality of life
Hepatocellular carcinoma
Acute liver failure
Genetic diseases
What are the contraindications for liver transplant?
Active extra hepatic malignancy
Active substance or alcohol abuse
Other comorbitities
Brain death
What gets priority on the liver transplant list?
Acute liver failure
What is the prioritisation method for liver transplant?
UKELD scores
What kind of transplant is a liver transplant?
Orthotopic
What treatment is given post liver transplant?
ICU
Antibiotics and antifungals
Antirejections
