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2ND YEAR SYSTEMS: GI > Liver symposium > Flashcards

Liver symposium Flashcards

1
Q

What are the major liver diseases?

A

alcohol related liver disease
viral hepatitis
non-alocholic fatty liver disease
autoimmune liver diseases

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2
Q

which 5 types of viruses cause viral hepatitis?

A

A, B, C, D and E

A and E are enteric + self-limiting acute infections

B, C and D are parenteral (away from mouth or alimentary canal) - cause chronic disease

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3
Q

Hepatitis A: epidemiology

A

Mostly in south America, Africa and Asia
Usually lasts under 8 weeks

asymptomatic cases are very common

acute disease diagnosed by IgM antibodies

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4
Q

transmission of Hep A can be through

A

faecal oral route

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5
Q

Who should Hep A immunisation should be give to?

A

Travellers

Patients with chronic liver disease

Injecting drug user (especially with HCV or HBV)

Haemophiliacs - people who have impaired blood clotting

Occupational exposure
lab workers

Men who have sex with men (MSM)

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6
Q

Hepatitis B epidemiology

A

high prevalence in eastern asia, africa/south africa, canada

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7
Q

describe the Hepatitis B virus structure

A

DNA polymerase

an inner protein core (HBcAg)

HBV DNA

outer lipid envelope containing HB surface antigen

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8
Q

Natural history of chronic hep B

A

chronic hep B - cirrhosis - Hepatocellular carcinoma or End stage liver disease

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9
Q

treatment options for HBV

A

pegylated interferon - contains 3 types of drug

oral antiviral drugs - eg lamivudine, adelovirm entecavir

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10
Q

Hepatitis C - info

A

rarely causes acute liver failure
can be acute or chronic
85% chronic HCV infection

most asymptomatic until cirrhotic

may have normal LFT’s

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11
Q

natural history of Hep C

A

exposure - chronic - cirrhosis - heptaocellular carcinoma - death

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12
Q

treatment of HCV

A

Acute HCV:-
either pegylated interferon-α or non-pegylated IFN
for at least 24 weeks

chronic:- antiviral therapy

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13
Q

Hepatitis D/ delta virus info

A

small RNA virus - doesn’t code for it’s own protein coat - enveloped by HBsAg (hep B surface antigen)

coinfection or super-infection with HBV

Very resistant to treatment

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14
Q

Hepatitis E info

A

high prev. in places like Mexico, India, China, Iran

Commonest cause of acute hepatitis in Grampian

Self-limiting, no long term sequelae ie doesn’t follow on from acute disease

No specific treatment

No effective vaccine currently available

Previously thought to be limited to tropical countries - caused rapid hepatic failure in pregnancy

Increasingly recognised in UK

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15
Q

What does Epstein-Barr virus (EBV) cause

A

Causes glandular fever and can generally cause mildly deranges LFTs only in immunocompromised hosts

common virus

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16
Q

What is Herpes simplex

A

rare severe acute hepatitis

17
Q

What does the term Non- alcoholic fatty liver disease encompass? (3 things)

A

simple steatosis

non-alcoholic steatohepatitis

fibrosis and cirrhosis

18
Q

what other conditions is NAFLD associated with

A

diabetes
obesity hypertriglyceridemia
hypertension

19
Q

what genetic factors go into NAFLD?

what about ethnicity?

A

PNPLA3 gene

hispanics

20
Q

Natural history of non-alcoholic fatty liver disease

A

normal liver — steatosis (accumulation of fat in liver) — non-alcoholic steatohepatitis (NASH- more serious form of NAFLD) with or without fibrosis — Cirrhosis of the liver

as it progresses, patient has an increased CV risk

21
Q

How is NAFLD diagnosed

A

biochemical tests:- AST/ALT ratio

cytokeratin-18 - biomarker that determines whether NAFLD patient has NASH or no NASH

enhanced liver fibrosis panel (ELF) - blood test to determine severity of liver fibrosis

ultrasound, MR/CT, fibroscan
MR Spectroscopy - analyses molecules such as H2 ions or protons

liver biopsy

22
Q

NAFLD scoring system: classes and criteria

A

estimates amount of scarring in the liver if patient answers high risk for 3 or more categories then they have severe liver damage

criteria - age, diabetes or impaired fasting glucose, BMI, AST:ALT, Platelet count, Albumin

23
Q

Treatment options for non-alcoholic fatty liver disease

A

Diet and weight reduction + weight reduction surgeries

Exercise

Insulin sensitizers e.g. Metformin, Pioglitazone
Glucagon-like peptide-1 (GLP-1) - lower blood sugar

Farnesoid X nuclear receptor ligand - regulates many genes involved in lipid and glucose metabolism, liver regeneration, inflammation, and liver cancer e.g. Obeticholic acid

Vitamin E

24
Q

Name some autoimmune liver diseases

A

Autoimmune hepatitis

Primary biliary cholangitis (PBC)

Primary sclerosing cholangitis (PSC)

Overlap syndromes - inflammatory rheumatic conditions that are linked to a number of diseases

Autoimmune cholangiopathy

IgG 4 disease

25
Q

Autoimmune hepatitis

A

female predominant
elevated IgG

three types of antibodies

liver biopsy diagnostic
responds well to steroids

azathioprine long term

26
Q

Primary biliary cholangitis

A

F>M

IgM elevated

anti-mitochondrial antibody positive

rash and fatigue common symptoms

Ursodeoxycholic acid - UDCA treatment of choice - dissolves gallstones

27
Q

Primary sclerosing cholangitis

A

M>F
pANCA positive
intra and extrahepatic bile ducts involved

stricturing disease

MRCP test of choice

Biliary stents - treatment

28
Q

Who do they give liver transplants to? (5)

A

Patients with…

Chronic liver disease with poor predicted survival

Chronic liver disease with associated poor quality of life

Hepatocellular carcinoma

Acute liver failure

Genetic diseases e.g. primary oxaluria, tyrosemia

29
Q

Contraindications for transplant

A

Active substance or alcohol abuse

Active extrahepatic malignancy

Hepatic malignancy with macrovascular or diffuse tumor invasion

Severe cardiopulmonary or other comorbid conditions

30
Q

3 scoring systems for to prioritise patients for liver transplant

A

Child’s Pugh scoring A, B and C

MELD score

UKELD score

31
Q

Meaning of MELD score

and UKELD score

A

Model For End-Stage Liver Disease

United Kingdom Model for End-Stage Liver Disease

32
Q

what is an orthotopic surgery?

A

Orthotopic liver transplantation, in which the previous liver is removed and the transplant is placed at that location in the body.

33
Q

Post liver tranplant op treatment

A

Post operative ICU care

Multidisciplinary care

Prophylactic antibiotics and anti-fungal drugs

Anti-rejection drugs like steroids, Azathioprine
or Tacrolimus/Cyclosporine

2ND YEAR SYSTEMS: GI (38 decks)

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