Liver Symposium

Question 1

Five main types of hepatitis virus?

Answer 1

ABCDE

Question 2

How is Hepatitis A transmitted?

Answer 2

Enteric

Faecal - oral (food & water)
Sexual
Blood

Question 3

How is acute Hep A diagnosed?

Answer 3

Diagnosed by IgM antibodies

Increased transaminases

Question 4

Which hepatitis viruses cause chronic infection? Which cause self limiting acute infection?

Answer 4

B, C & D cause chronic infection

A & E cause acute

Question 5

Who needs Hep A immunisation?

Answer 5

Travellers 
Patients with chronic liver disease 
Haemophiliacs
Occupational exposure (lab workers)
MSM (gay dudes)

Question 6

Mechanism by which Hep B escapes immune system?

Answer 6

When spreading hosts it creates a lot of empty “shells” containing Hep B surface antigens - but without active virus
When transmission occurs the immune system has to find the active virus among the several decoys

Question 7

What are the Hep B antigens and what do they tell us?

Answer 7

Hepatitis surface antigen (HBsAg) - presence of virus
Hepatitis e antigen (HBeAg) - active replication
Hepatitis core antigen (HBcAg) - active replication (not detected in blood)
Hep B DNA - Quantifies viral replication

Question 8

What are the Hep B antibodies and what do they tell us about the infection/host?

Answer 8

IgM anti-HBc - acute infection
IgG anti-HBc chronic infection

Anti-HBs - protection
Anti-HBe - inactive virus

Question 9

What is the normal natural course of Hep B infection?

Answer 9

If you get acute infection 90% will clear the infection

Only about 10% progress to chronic infection

Question 10

How does chronic Hep B infection tend to progress?

Answer 10

Some patients disease is not progressive

Others develop liver cirrhosis which leads to either end stage liver disease or hepatocellular carcinoma

Question 11

Treatment options for Hep B infection?

Answer 11

Pegylated interferon (class of drugs)
Oral antiviral drugs

Question 12

What is the progression of Hep C infection like?

Answer 12

Rarely causes acute liver failure, most people asymptomatic until cirrhotic

About 85% of infected progress to chronic infection

Question 13

What percentage of patients with chronic Hep C infection progress to liver cirrhosis?

Answer 13

20% (according to lecture)
(30% according to green book)

Rest have stable chronic Hep C infection

Question 14

Is Hep C a fatal disease?

Answer 14

Due to advancements in treatment about 95% curable by oral drugs over the course of 3 months

Question 15

When can Hep D infection occur?

Answer 15

With simultaneous Hep B infection - needs to be enveloped by HBsAg

Makes infection very resistant to treatment

Question 16

Does Hep E infection tend to progress to chronic infection?

Answer 16

No. Acute, self limiting. No long term form

Usually resolves within 2-6 weeks

Question 17

Other viruses causing liver disease?

Answer 17

Hepatitis F
Hep G
EBV
CMV (cytomegalovirus)
Herpes simplex

Question 18

What conditions does Non-Alcoholic Fatty Liver Disease encompass?

Answer 18

Simple steatosis
Non - alcoholic steatohepatitis (NASH)
Fibrosis and cirrhosis

Caused by excess fat in the liver

Question 19

Risk factors for non-alcoholic fatty liver disease (NAFLD)?

Answer 19

diabetes mellitus 
Obesity
Hypertriglyceridemia 
Hypertension
Age
Ethnicity
Genetics

Question 20

Natural progression of NAFLD?

Answer 20

Normal liver
Steatosis
Non-alcoholic steatohepatitis (+/- fibrosis)
Cirrhosis

Question 21

Investigations for NAFLD?

Answer 21

*Fibroscan (specialized ultrasound)
Bloods (AST/ALT ratio, cytokeratin-18)
Ultrasound 
MRI/CT
MR spectroscopy (quantify fat)
Liver biopsy

Question 22

Treatment of NAFLD?

Answer 22

Vitamin E
Diet 
Exercise 
Insulin sensitizers 
Bariatric surgery

Question 23

3 main autoimmune liver & biliary system diseases?

Answer 23

Autoimmune hepatitis
Primary biliary cholangitis
Primary sclerosing cholangitis

Question 24

Markers of autoimmune hepatitis? Treatment options?

Answer 24

Elevated IgG

Responds well to steroids
Long term azathioprine (immune suppressant)

Question 25

Serum markers of primary biliary cholangitis? Treatment options?

Answer 25

IgM elevated

UDCA (Ursodeoxycholic acid) drug of choice

Question 26

Which autoimmune liver diseases involve the bile ducts?

Answer 26

Primary biliary cholangitis - intrahepatic bile duct

Primary sclerosing cholangitis - intra and extrahepatic bile ducts

Question 27

Diagnostic test for primary sclerosing cholangitis?

Answer 27

pANCA positive (antibody)

MRCP

Question 28

Symptoms of primary sclerosing cholangitis? Treatment options?

Answer 28

Stricturing disease - recurrent cholangitis and jaundice
(RUQ pain, hepatomegaly, fatigue, weight loss)

Liver transplants/biliary stenting to treat

Question 29

Who is considered for liver transplant?

Answer 29

CLD with poor predicted survival
CLD with poor QOL
Hepatocellular carcinoma 
Acute liver failure 
genetic diseases

Question 30

Contraindications for liver transplant?

Answer 30

Extrahepatic malignancy 
Extrahepatic uncontrolled infection
Substance/alcohol abuse 
Severe comorbid/psychosocial conditions 
Anatomical barriers

Question 31

Criteria for prioritizing for transplant in cirrhosis cases?

Answer 31

Child’s Pugh scoring
MELD score
UKELD results

Question 32

Post operative treatment for liver transplant patients?

Answer 32

ICU care
Prophylactic antibiotics & anti-fungals
Anti-rejection drugs (steroids/azthioprine)