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Alimentary > Liver symposium > Flashcards

Liver symposium Flashcards

1
Q

What tests are done for Hep. A?

A
  • IgM (acute disease)
    • ALT
    • IgG
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2
Q

What tests are done for Hep. B?

A 
• Antibodies
	- Anti-HBs (protection)
	- IgM anti-HBc (acute)
	- IgG anti-HBc (chronic)
	- Anti-HBe (inactive virus)
	• Antigens 
	- HBeAg (active reproduction
	- HBsAg (presence) 
	- HBcAg (active reproduction not in blood)
	- HBV DNA (active replication)
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3
Q

What tests are done for Hep. C?

A
  • ALT
    • Anti HVC
    • LFTs may be normal
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4
Q

What tests are done for Hep. D?

A

HBsAg

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5
Q

What tests are done for Non-alcohol fatty liver?

A 
• Biochemical: AST/ALT ratio
	• Enhanced liver fibrosis panel (ELF)
	- Hyaluronic acid
	- TIMP1
	- PIINP
	• Cytokeratin-18
	• Ultrasound
	• Fibroscan
	• MR/CT
	• MR spectroscopy (quantify fat)
	• Liver biopsy
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6
Q

What tests are done for autoimmune hepatitis?

A 
• Liver biopsy
	• Type 1
	- ANA
	- SMA
	• Type 2
	- LKM1
	• Type 3
	- SLA
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7
Q

What tests are done for biliary cholangitis?

A
  • IgM elevated

* Anti-mitochondrial antibody positive

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8
Q

What tests are done for Primary sclerosing cholangitis

A

pANCA positive

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9
Q

How is Hep. A treated?

A
  • Self limiting

* Vaccines to prevent Hep. A

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10
Q

How is Hep. B treated?

A 
• Oral anti-viral drugs
	- Lamivudine
	- Adefovir 
	- Entecavir
	- Telbivudine
	- Tenofovir
	• PEGylated interferons
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11
Q

How is Hep. C treated?

A
  • PEG-IFN λ

* INF-free combo of direct acting antiviral drugs

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12
Q

How is Hep. D treated?

A

Very resistant to treatment

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13
Q

How is Hep. E treated

A
  • No specific treatment

* No effective vaccine

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14
Q

How is Non-alcohol fatty liver disease treated?

A 
• Diet and weight reduction
	• Exercise
	• Insulin sensitizers
	- Metformin
	- Pioglitazone
	• Glucagon: like peptide 1 (GLP-1) analogues e.g. Liraglutide 
	• Fernasoid X nuclear receptor ligand e.g. obeticholic acid 
	• Vitamin E
	• Weight reduction surgeries
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15
Q

How is autoimmune hepatitis treated?

A
  • Steroids (responds well)

* Long term azathioprine

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16
Q

How is biliary cholangitis treated?

A

UDCA

17
Q

How is primary sclerosing cholangitis treated?

A

• Liver transplant
- Orthopaedic surgeon
- Post operative ICU care
- MDT care
- Prophylactic antibiotics and antifungal drugs
- Anti-rejection drugs: Steroids, Azathioprine, Tacrolimus, cyclosporine
• Biliary stents

18
Q

What are the major causes of liver disease (medical)?

A
  • Alcohol related liver disease
  • Viral hepatitis
  • Non-alcoholic fatty liver disease
  • Autoimmune liver diseases
  • Liver transplantation
19
Q

Explain the background of viral hepatitis

A
  • Caused by 5 main types of viruses A, B, C, D and E
  • Hepatitis A and E are enteric viruses (food and water)
  • Hepatitis B, C and D are parental viruses (blood or blood related products)
  • Hepatitis A and E cause self limiting acute infections
  • Hepatitis B, C and D cause chronic disease
20
Q

What is the clinical course of Hepatitis A

A

People get unwell, get a bit of a fever, then get jaundice and then it goes away. It usually takes 3 months

21
Q

Explain Hepatitis A

A
  • Occurs sporadically or in epidemic form
  • Transmission: faecal-oral, sexual, blood
  • 5-14 years the commonest age group
  • Prevalence decreasing world wide
  • Asymptomatic cases very common
22
Q

Who gets immunised for hepatitis A?

A
  • Travellers
  • Patients with chronic liver disease: IDU (especially withy HCV or HBV)
  • Haemophiliacs
  • Occupational exposure: lab workers
  • Men who have sex with men (MSM)
23
Q

Explain hepatitis C

A
  • 10% of patients report jaundice
  • Rarely causes acute liver failure
  • 85% chronic HCV infection
  • Most asymptomatic until cirrhosis
  • May have normal LFT’s
  • Commonest way of getting it is by sharing needles
24
Q

Explain hepatitis D

A
  • Small RNA virus: does not code for its own protein coat, enveloped by HBsAg
  • Co-infection or super-infection with HBV (needs hep. B for replication)
  • Transmission the same as HBV
  • Very resistant to treatment
25
Q

What are the other viruses?

A
  • Hepatitis F (might be a variant of B)
  • Hepatitis G/ Hepatitis GB (related to HCV, might causes liver disease)
  • EBV CMV (generally causes mildly dangerous LFTs only in immunocompromised hosts
  • Herpes simplex (rare severe acute hepatitis)
26
Q

Non-alcoholic fatty liver is an umbrella term encompassing 3 entities, what are they?

A
  • Simple stenosis
  • Non-alcoholic steatohepatitis
  • Fibrosis and cirrhosis
27
Q

What is non-alcoholic fatty liver associated with?

A
  • Diabetes mellitis
  • Obesity
  • Hypertriglycemia
  • Hypertension
28
Q

What are the risk factors (that are not a disease) that cause NAFLD?

A
  • Age
  • Ethnicity
  • Genetic factors
29
Q

What are the criteria for a NAFLD score?

A
  • Age
  • Diabetes or impaired fasting glucose > 6.9mmol/L
  • BMI
  • AST:ALT
  • Platlet count
  • Albumin
30
Q

What are the autoimmune liver diseases?

A
  • Autoimmune hepatitis (F)
  • Primary biliary cholangitis (F)
  • primary sclerosing cholangitis (M)
  • Overlap syndromes
  • Autoimmune cholangiopathy
  • IgG 4 disease
31
Q

What symptoms are common in primary biliary cholangitis?

A
  • Pruritus

- Fatigue

32
Q

What are the signs of primary sclerosing cholangitis

A
  • Recurring cholangitis

- Jaundice

33
Q

Who do we transplant?

A
  • Chronic liver disease with poor predicted survival
  • Chronic liver disease associated with poor quality of life
  • Hepatocellular carcinoma
  • Acute liver failure
  • Genetic diseases e.f. primary oxaluria, tyrosemia
34
Q

What are the contraindications for transplantation?

A
  • Active extra hepatic malignancy
  • Hepatic malignancy with macro vascular or diffuse tumour invasions
  • Active or uncontrolled infection infection outside of the hepatobiliary system
  • Active substance or alcohol abuse
  • Severe cardiopulmonary or other co morbid conditions
  • Psycho social factors that would likely preclude recovery after transplantation
  • Technical and/or anatomical barriers
  • Brain death
35
Q

How do we prioritise transplantation for patients with cirrhosis

A
  • Child’s Pugh scoring A,B and C
  • MELD score (bilirubin, creatinine and INR)
  • UKELD (bilirubin, sodium, creatinine and INR)
36
Q

What is the post operative treatment for transplantation?

A
  • Post operative ICU care
  • Multidisciplinary care
  • Prophylactic antibiotics and anti fungal drugs
  • Anti-rejection drugs: steroids, azathioprine, tacrolimus cyclosporine

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