Liver Symposium Flashcards by Priyanka Bhandari

What are some examples of major liver diseases?

Alcohol related liver disease

Viral hepatitis

Non-alcohol fatty liver disease

Autoimmune liver diseases

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What are the 5 main groups of viruses that cause viral hepatitis?

Hepatitis A

Hepatitis B

Hepatitis C

Hepatitis D

Hepatitis E

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Which of the hepatitis viruses are enteric viruses?

A and E

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What are enteric viruses?

Ones transmitted by the faecal-oral route

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What hepatitis viruses are parenteral?

Hepatitis B, C and D

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What does parenteral mean?

Administered elsewhere than the mouth and alimentary canal

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What hepatitis viruses cause self-limiting infections?

A and E

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What hepatitis viruses cause chronic infections?

B, C and D

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What does transmission of hepatitis A occur by?

Faecal-oral route

Sexual

Blood

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What is the most common age group infected with hepatitis A?

5 to 14 years

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Is the prevalence of hepatitis A increasing or decreasing worldwide?

Decreasing

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What is acute disease caused by hepatitis A diagnosed by?

IgM antibodies

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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

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What are examples of hepatitis B antigens?

Hepatitis surface antigen (HBsAg)

Hepatitis e antigen (HBeAg)

Hepatitis core antigen (HBcAg)

HBV DNA

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What does hepatitis surface antigen (HBsAg) indicated?

Presence of hep B virus

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What does hepatitis e antigen (HBeAg) indicate?

Active replication

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What does hepatitis core antigen (HBcAg) indicate?

Active replication

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What does HBV DNA indicate?

Active replication

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What are examples of HBV antibodies?

Anti-HBs

IgM anti-HBc

IgG anti-HBc

Anti-HBe

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What does anti-HBs antibody indicate?

Protection

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What does IgM anti-HBc indicate?

Acute infection

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What does IgG anti-HBc indicate?

Chronic infection/exposure

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What does anti-HBe indicate?

Inactive virus

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What can hepatitis B infections possible lead to?

Resolution (no further progress) or cirrhosis

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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