Liver Symposium Flashcards
What are some examples of major liver diseases?
Alcohol related liver disease
Viral hepatitis
Non-alcohol fatty liver disease
Autoimmune liver diseases
What are the 5 main groups of viruses that cause viral hepatitis?
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E
Which of the hepatitis viruses are enteric viruses?
A and E
What are enteric viruses?
Ones transmitted by the faecal-oral route
What hepatitis viruses are parenteral?
Hepatitis B, C and D
What does parenteral mean?
Administered elsewhere than the mouth and alimentary canal
What hepatitis viruses cause self-limiting infections?
A and E
What hepatitis viruses cause chronic infections?
B, C and D
What does transmission of hepatitis A occur by?
Faecal-oral route
Sexual
Blood
What is the most common age group infected with hepatitis A?
5 to 14 years
Is the prevalence of hepatitis A increasing or decreasing worldwide?
Decreasing
What is acute disease caused by hepatitis A diagnosed by?
IgM antibodies
Who are vacines for hepatitis A given to?
Travellers
Patients with chronic liver disease
Haemophiliacs
Occupational exposure (lab workers)
Men who have sex with men
What are examples of hepatitis B antigens?
Hepatitis surface antigen (HBsAg)
Hepatitis e antigen (HBeAg)
Hepatitis core antigen (HBcAg)
HBV DNA
What does hepatitis surface antigen (HBsAg) indicated?
Presence of hep B virus
What does hepatitis e antigen (HBeAg) indicate?
Active replication
What does hepatitis core antigen (HBcAg) indicate?
Active replication
What does HBV DNA indicate?
Active replication
What are examples of HBV antibodies?
Anti-HBs
IgM anti-HBc
IgG anti-HBc
Anti-HBe
What does anti-HBs antibody indicate?
Protection
What does IgM anti-HBc indicate?
Acute infection
What does IgG anti-HBc indicate?
Chronic infection/exposure
What does anti-HBe indicate?
Inactive virus
What can hepatitis B infections possible lead to?
Resolution (no further progress) or cirrhosis
What are treatment options for hepatitis B infections?
Pegylated interferon
Oral antiviral drugs
What oral therapies are available for hepatitis B infections?
Lamivudine
Adefovir
Entecavir
Telbivudine
Tenofovir
What can be said about hepatitis C and symptoms?
Is usually asymptomatic
What are LFTs like with hep C infection?
Can be normal
What is the treatment for hepatitis C infection?
IFN-free combination of direct acting antiviral drugs
What kind of virus is hepatits D?
Small RNA virus
What are consequences of hepatitis D being a small RNA virus?
Does not code for its own protein coat
Enveloped by HBsAg
What can you also be infected with as well as hepatitis D for it to become a superinfection?
HBV
What is the transmission of hepatitis D?
The same as hepatitis B
What can be said about how easy treatment of hepatitis D is?
It is very resistent to treatment
What problems can hepatitis E cause?
Self limiting, no long term problems
What treatments/vaccines are available for hepatitis E?
No specific treatments
No effective vaccine currently available
Other than hepatitis A to E, what are other viruses that affect the liver?
Hepatits F
Hepatitis G
EBV and CMV
Herpes simplex
What is hepatitis G related to?
Hepatitis C
What is hepatitis F a possible variant of?
Hepatitis B
What does EBV stand for?
Epstein-barr virus
What does CMV stand for?
Cytomegalovirus
What does NAFLD stand for?
Non-alcoholic fatty liver disease
What is non-alcoholic fatty liver disease (NAFLD)?
An umbrella term that covers:
simple steatosis
non-alcoholic steatohepatitis
fibrosis and cirrhosis
What is metabolic syndrome?
Cluster of conditions that occur together
What components of metabolic syndrome is non-alcoholic fatty liver disease associated with?
Diabetes mellitus
Obesity
Hypertriaglyceridaemia
Hypertension
What are risk factors for non-alcoholic fatty liver disease?
Age
Ethnicity (such as Hispanics)
Genetic factors (such as PNPLA3 gene)
What gene is associated with non-alcoholic fatty liver disease?
PNPLA3 gene
What do people with non-alcoholic fatty liver disease normally die of?
Cardiovascular problems, not liver problems (only 5% do)
What does diagnosis of non-alcoholic fatty liver disease involve?
Biochemical tests (AST/ALT ratio)
Enhanced liver fibrosis panel (ELF)
Cytokeratin-18
US
Fibroscan
MR/CT
MR spectroscopy
Liver biopsy
What does a enhanced liver fibrosis panel (ELF) measure?
Hyaluronic acid
TIMP-1
PIINP
What is used to classify patients with non-alcoholic fatty liver disease as high or low risk?
NAFLD score
What NAFLD score indicates high risk?
3 or more
What does a NAFLD score consider?
Age
Diabetes
BMI
AST:ALT
Platelet count
Albumin
What is age high risk for NAFLD?
>45
What state of diabetes is high risk for NAFLD?
Present
What BMI is high risk for NAFLD?
>30
What AST:ALT is high risk for NAFLD?
>1 (AST>ALT)
What platelet count is high risk for NAFLD?
Low (<150)
What albumin level is high risk for NAFLD?
Low (<34)
What is the treatment for NAFLD?
Diet and weight reduction
Exercise
Insulin sensitizers
Glucagon like peptide-1 (GLP-1) analogues
Farnesoid X nuclar ligand
Vitamin E
Weight reduction surgeries
What are examples of autoimmune liver disease?
Autoimmune hepatitis
Primary biliary cholangitis (PBC)
Primary sclerosing cholangitis (PSC)
Overlap syndromes
Autoimmune cholangiopathy
IgG 4 disease
What does PBC stand for?
Primary biliary cholangitis
What does PSC stand for?
Primary sclerosing cholangitis
Does autoimmune hepatitis affect more males or females?
Females
What antibody is elevated in autoimmune hepatitis?
IgG
What are the 3 types of antibodies involved in autoimmune hepatitis?
Type 1 (ANA, SMA)
Type 2 (LKM1)
Type 3 (SLA)
What is used to diagnose autoimmune hepatitis?
Liver biopsy
What does autoimmune hepatitis respond well to?
Steroids
What is the treatment for autoimmune hepatitis?
Long term azathioprine
Steroids
Does primary biliary cholangitis (PBC) affect more males or females?
Females
What antibody is elevated in PBC?
IgM
What symptoms are common for PBC?
Pruritus and fatigue
What is the treatmet for PBC?
Ursodeoxycholic acid (UDCA)
Does primary sclerosing cholangitis affect more males or females?
Males
What antibody is active for primary sclerosing cholangitis?
pANCA
What bile ducts are involved with PBC?
Intrahepatic bile duct
What bile ducts are involved with PSC?
Intra and extrahepatic bile ducts
What does PSC lead to?
Stricturing
What is the test of choice for PSC?
MRCP
What is the clinical presentation of PSC?
Recurrent cholangitis
Jaundice
What is the management of PSC?
Liver tests
Biliary stents
Who gets a liver transplant?
Chronic liver disease with poor predicted survival
Chronic liver disease wth associated poor quality of life
Hepatocellular carcinoma
Acute liver failure
Genetic diseases such as primary oxaluria, tyrosemia
What are contraindications for a liver transplant?
Active extrahepatic malignancy
Hepatic malignancy with macrovascular or diffuse tumour invasion
Active and uncontrolled infection outside of the hepatobiliary system
Active substance or alcohol abuse
Severe cardiopulmonary or other comorbid conditions
Psychosocial factors that would proclude recovery after transplantation
Technical and/or anatomical barriers
Brain death
What is used to prioritis cirrhosis for liver transplants?
Child’s Pugh scoring A,B and C (same way as people donate blood to the same blood group)
MELD score (bilirubin, creatinine and INR)
UKELD (bilirubin, sodium, creatinine and INR)
What does the MELD score consider?
Bilirubin
Creatinine
INR
What does the UKELD score consider?
Bilirubin
Sodium
Creatinine
INR
How does survival change as MELD score increases?
Survival decreases
Liver tranplants are put into the same place where the old liver was, what is this called?
Orthotopic
What post-operative treatment is required for liver transplants?
Post-operative ICU care
Multidisciplinary care
Prophylactic antibiotics and anti-fungal drugs
Anti-rejection drugs (steroids, azathoprine, tacrolimus/cyclosporine)
What are some anti-rejection drugs for a liver transplant?
Steroids
Azathioprine
Tacrolimus/cyclosporine
