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
Autoimmune hepatitis
female predominant elevated IgG three types of antibodies liver biopsy diagnostic responds well to steroids azathioprine long term
26
Primary biliary cholangitis
F>M IgM elevated anti-mitochondrial antibody positive rash and fatigue common symptoms Ursodeoxycholic acid - UDCA treatment of choice - dissolves gallstones
27
Primary sclerosing cholangitis
M>F pANCA positive intra and extrahepatic bile ducts involved stricturing disease MRCP test of choice Biliary stents - treatment
28
Who do they give liver transplants to? (5)
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
Contraindications for transplant
Active substance or alcohol abuse Active extrahepatic malignancy Hepatic malignancy with macrovascular or diffuse tumor invasion Severe cardiopulmonary or other comorbid conditions
30
3 scoring systems for to prioritise patients for liver transplant
Child’s Pugh scoring A, B and C MELD score UKELD score
31
Meaning of MELD score | and UKELD score
Model For End-Stage Liver Disease United Kingdom Model for End-Stage Liver Disease
32
what is an orthotopic surgery?
Orthotopic liver transplantation, in which the previous liver is removed and the transplant is placed at that location in the body.
33
Post liver tranplant op treatment
Post operative ICU care Multidisciplinary care Prophylactic antibiotics and anti-fungal drugs Anti-rejection drugs like steroids, Azathioprine or Tacrolimus/Cyclosporine