Liver symposium Flashcards
What 5 main viruses cause viral hepatitis?
A,B,C,D,E
What 2 hepatitis viruses are enteric? Suggest how they may spread and their duration
A+E
faecal-oral, self limiting
What 3 hepatitis viruses are parenteral? Suggest how they may spread and their duration
B,C,D
blood, chronic
What is hepatitis A infection most commonly due to?
Waste management and disposal
What age is common for hep A infection and what can patients often present with?
young –> 5-14
jaundice
Who would be immunised for hepatitis A?
travellers - Africa, Asia
patients with chronic liver disease
How would you diagnose hepatitis A?
IgM antibodies
In hepatitis B what is the difference between the core antigen and E antigen?
E antigen - blood
core - liver
What does the hep B surface antigen tell us?
presence of virus - not active or inactive however
What do anti-hb antibodies tell us?
protection
What do IgM anti-HBc tell us?
acute infection
What do IgG anti-HBc tell us?
chronic infection
What do anti-HBe tell us?
inactive
What can be the 2 outcomes of chronic hep B?
no further damage
cirrhosis leading to cancer/end stage liver disease
Name 2 treatments for hepatitis B
adefovir - antiviral drugs
PEG interferon
Is hepatitis C an RNA or DNA virus?
RNA
What percentage of infected cases are chronic in hep C?
85
What must be present for hepatitis D?
hep B
Where does hepatitis E come from?
infected pork meat, animals, tropical
What are the 3 entities of NAFLD?
steatosis
non alcoholic steatohepatitis
firbrosis + cirrhosis
What is NAFLD associated with?
diabetes, obesity, hypertension, hypertriglyceridemia
What are risk factors for NAFLD?
age, ethnicity, genetics
List some diagnostic tests for NAFLD
biopsy, AST/ALT ratio, ELF, MR, fibroscan, ultrasound, cytokeratin 18
What is the NAFLD score and what is it used for?
based on parameters such as BMI, age, blood test and help to decide treatment
Treatment for NAFLD?
diet, exercise, weight loss
insulin sensitizers
What are the main 3 autoimmune liver diseases?
autoimmune hepatitis
PBC
PSC
What is cholangitis?
infection of the bile duct which tends to occur if gallstones are present
Compare autoimmune hepatitis and PBC with the elevation of IgG and IgM
ah - IgG
PBC - IgM
What 2 autoimmune liver diseases are female predominant?
autoimmune hepatitis and PBC
How is autoimmune hepatitis diagnosed and treated?
biopsy
steroids, azathioprine
What antibody is diagnostic for PBC?
anti-mitochondrial
What is used to treat PBC?
UDCA
What antibody is positive in PSC?
pANCA
Compare PBC and PSC with the bile ducts involved
PSC invove intra and extra
PBC intra
What may be needed for PSC? Why?
liver transplant
structuring and narrowing
What are some indications for liver transplant?
CLD, cancer, active failure
What is a contraindication for liver transplant?
malignancy spread, alcohol and drug use
What scores are used to decide who gets a transplant first?
MELD, UKELD
What treatment is give post transplant?
ICU, steroids, cyclosporine, antibiotics
What does orthotopic mean?
In the same place - liver is put in same place as the old one
