Liver Symposium Flashcards
What is the transmission for hepatitis A?
Faecal-oral
Where is prevalence for hepatitis A high?
In areas with poor sanitation
Regarding to HAV what does elevated IgM suggest?
Acute infection
Regarding HAV what does elevated IgG suggest?
Chronic infection
Give examples of groups that should be immunised against hepatitis
Travellers Patients with chronic liver disease Haemophiliacs Occupational exposure Men who have sex with men
What does the presence of HBsAg indicate?
Presence of the virus
Does the presence of HBsAg suggest active or non-active replication?
Can be either
What does the presence of HBV e antigen suggest?
Active replication
What does the presence of HBV DNA suggest?
Active replication
Because you find the physical DNA of the virus
What does Anti-HBs in the blood suggest?
Protection against HBV
What does the presence of IgM anti-HBc suggest?
Acute infection
Acquired within the last 6 months
What does the presence of IgG anti-HBc suggest?
Chronic infection/exposure to HBV
What does Anti-HBe suggest?
That the virus is inactive
What is key for the treatment of HBV?
Prevention
What prevention methods are there for HBV?
Immunisation
Safe sex
Using gloves (lab workers)
Avoidance of sharing IV drug abuse
What are the 3 stages of HBV infection?
Replicative stage in which levels of HBV are high and liver damage is being cause
Inflammatroy phase where aminotransferases are elevated, liver biopsy shows chronic infection but replication declines
Patients amy enter inactive phase where viral replication has stopped and there is no ongoing liver inflammation
Do all cases of HBV progress to liver cirrhosis?
No
in most cases hepatitis B does not progress
Is progression to chronic hepatitis more prominent in the HCV or HBV?
HCV
What % of HCV progresses to chronic infection?
85%
What are the symptoms of HCV?
Mostly asymptomatic until cirrhotic
What % of chronic HCV progresses to liver cirrhosis?
20%
What is the route of infection of HCV?
Blood-blood
What is HDV a parasite of?
Hep B
Why is Hep D considered to be a satellite virus?
Because it needs the host to be infected with Hep B also
Is Hep D + Hep B easy to treat?
No it is very resistant to treatment
How is hepatitis B spread?
Blood-blood
What is the transmission route for hepatitis E?
Faecal-oral
Is there a vaccination for HEV?
No
What is co-infection?
When HBV and HDV infect at the same time
What is super-infection?
When HDV infects sometime after HBV has infected
Rx HBV
Pegylated interferon
Oral antiviral drugs:
Lamivudine
Adefovir
Entecavir
Is there a vaccine for HBV?
Yes
Is there a vaccine available for HCV?
No
What is the treatment for hep C?
Pegylated interferon
Ribavirin
What is the treatment for Hep B?
Oral antiviral drugs
e.g lamivudine
Pegylated interferon
What are the 5 main viruses that cause viral hepatitis?
A,B,C,D and E
Which viruses are enteric viruses?
A and E
What is meant by enteric viruses?
Food, water, faecal and oral transmission
What is meant by a parental virus?
Transmission method is by the blood
Which viruses are acute viruses?
A and E
Which hepatitis viruses can become chronic?
B,C and D
How does HAV present?
Fever
high liver enzymes
Diagnosis made by detecting certain antibodies in the blood
What is the diagnostic test for HCV?
Test for HCV antibody
Is there any vaccine available for HEV?
No
Who is NAFLD common in?
Those with: DM Obesity Hypertriglyceridemia Hypertension
What are the other risk factors for NAFLD?
Age
ethnicity
Genetic factors
What are the 3 types of autoimmune liver diseases?
Autoimmune hepatitis
Primary biliary cholangitis
Primary sclerosing cholangitis
Is autoimmune hepatitis more common in M or F?
F
Which antibody is elevated in autoimmune hepatitis?
IgG
How is autoimmune hepatitis diagnosed?
Liver biopsy
and antibody testing
How is autoimmune hepatitis treated?
With steroids
Which gender is predominantly affected with primary biliary cholangitis?
F
Which antibody is elevated in primary biliary cholangitis?
IgM
What would be seen on liver biopsy in primary biliary cholangitis?
Inflammation around the bile ducts
Which bile ducts are affected in primary biliary cholangitis?
Intrahepatic bile duct
What symptoms are common in primary biliary cholangitis?
Pruritus and fatigue
How does primary biliary cholangitis affect the liver?
The bodies immune system attacks the intrahepatic biliary tree
How does primary sclerosing cholangitits `ffect the liver?
The bodies immune system attacks the intra and extra hepatic bile cuts
What can primary sclerosing C. cause?
Jaundice
What are the reasons for liver transplantation?
Chronic liver disease
Hepatocellular carcinoma
Acute liver failure
Genetic diseases
What are contraindications for liver transplant?
Active extra hepatic malignancy Active substance or alcohol abuse Brain death Technical/anatomical barriers Active and uncontrolled infection outside the hepatobiliary system Severe cardiopulmonary or other comorbid conditions
What scores are used to prioritise those with cirrhosis that are suitable for transplantation?
MELD score
UKELD score
What are some components of post-operative treatment of liver transplantation?
Post operative ICU care
Multidisciplinary care
Prophylactic antibiotics and anti-fungal drugs
Anti rejection drugs
Give an example of an anti- rejection drug?
Steroids
Azathioprine
Tacrolimus
What is the gold standard for HCV diagnosis?
HCV RNA PCR
What is autoimmune hepatitis?
Chronic autoimmune disease of the liver
Hows does autoimmune hepatitis come about?
When abnormal T cells and antibodies direct attack against hepatocyte surface antigens
What classifies type 1 AIH?
ANA and SMA antibodies
What classifies type 2 AIH?
LKM1 antibodies
What classifies type 3 AIH?
SLA antibodies
Investigations for AIH?
Antibodies: ANA SMA LKM1 SLA IgG
LFTs
Liver biopsy
RX AIH?
Prednisolone (steroid)
Azathioprine (immunosuppressant)
Liver Tx
