Liver Symposium Flashcards
Five main types of hepatitis virus?
ABCDE
How is Hepatitis A transmitted?
Enteric
Faecal - oral (food & water)
Sexual
Blood
How is acute Hep A diagnosed?
Diagnosed by IgM antibodies
Increased transaminases
Which hepatitis viruses cause chronic infection? Which cause self limiting acute infection?
B, C & D cause chronic infection
A & E cause acute
Who needs Hep A immunisation?
Travellers Patients with chronic liver disease Haemophiliacs Occupational exposure (lab workers) MSM (gay dudes)
Mechanism by which Hep B escapes immune system?
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
What are the Hep B antigens and what do they tell us?
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
What are the Hep B antibodies and what do they tell us about the infection/host?
IgM anti-HBc - acute infection
IgG anti-HBc chronic infection
Anti-HBs - protection
Anti-HBe - inactive virus
What is the normal natural course of Hep B infection?
If you get acute infection 90% will clear the infection
Only about 10% progress to chronic infection
How does chronic Hep B infection tend to progress?
Some patients disease is not progressive
Others develop liver cirrhosis which leads to either end stage liver disease or hepatocellular carcinoma
Treatment options for Hep B infection?
Pegylated interferon (class of drugs) Oral antiviral drugs
What is the progression of Hep C infection like?
Rarely causes acute liver failure, most people asymptomatic until cirrhotic
About 85% of infected progress to chronic infection
What percentage of patients with chronic Hep C infection progress to liver cirrhosis?
20% (according to lecture)
(30% according to green book)
Rest have stable chronic Hep C infection
Is Hep C a fatal disease?
Due to advancements in treatment about 95% curable by oral drugs over the course of 3 months
When can Hep D infection occur?
With simultaneous Hep B infection - needs to be enveloped by HBsAg
Makes infection very resistant to treatment
Does Hep E infection tend to progress to chronic infection?
No. Acute, self limiting. No long term form
Usually resolves within 2-6 weeks
Other viruses causing liver disease?
Hepatitis F Hep G EBV CMV (cytomegalovirus) Herpes simplex
What conditions does Non-Alcoholic Fatty Liver Disease encompass?
Simple steatosis
Non - alcoholic steatohepatitis (NASH)
Fibrosis and cirrhosis
Caused by excess fat in the liver
Risk factors for non-alcoholic fatty liver disease (NAFLD)?
diabetes mellitus Obesity Hypertriglyceridemia Hypertension Age Ethnicity Genetics
Natural progression of NAFLD?
Normal liver
Steatosis
Non-alcoholic steatohepatitis (+/- fibrosis)
Cirrhosis
Investigations for NAFLD?
*Fibroscan (specialized ultrasound) Bloods (AST/ALT ratio, cytokeratin-18) Ultrasound MRI/CT MR spectroscopy (quantify fat) Liver biopsy
Treatment of NAFLD?
Vitamin E Diet Exercise Insulin sensitizers Bariatric surgery
3 main autoimmune liver & biliary system diseases?
Autoimmune hepatitis
Primary biliary cholangitis
Primary sclerosing cholangitis
Markers of autoimmune hepatitis? Treatment options?
Elevated IgG
Responds well to steroids
Long term azathioprine (immune suppressant)
Serum markers of primary biliary cholangitis? Treatment options?
IgM elevated
UDCA (Ursodeoxycholic acid) drug of choice
Which autoimmune liver diseases involve the bile ducts?
Primary biliary cholangitis - intrahepatic bile duct
Primary sclerosing cholangitis - intra and extrahepatic bile ducts
Diagnostic test for primary sclerosing cholangitis?
pANCA positive (antibody)
MRCP
Symptoms of primary sclerosing cholangitis? Treatment options?
Stricturing disease - recurrent cholangitis and jaundice
(RUQ pain, hepatomegaly, fatigue, weight loss)
Liver transplants/biliary stenting to treat
Who is considered for liver transplant?
CLD with poor predicted survival CLD with poor QOL Hepatocellular carcinoma Acute liver failure genetic diseases
Contraindications for liver transplant?
Extrahepatic malignancy Extrahepatic uncontrolled infection Substance/alcohol abuse Severe comorbid/psychosocial conditions Anatomical barriers
Criteria for prioritizing for transplant in cirrhosis cases?
Child’s Pugh scoring
MELD score
UKELD results
Post operative treatment for liver transplant patients?
ICU care
Prophylactic antibiotics & anti-fungals
Anti-rejection drugs (steroids/azthioprine)
