Liver Symposium - key features/sparse cards

Question 1

Type of visuses: ABCDE and whyat type of disease do they causde

Answer 1

A and E are enteric viruses causing self limiting infections

B, C and D are parenteral viruses causing chronic disease

Question 2

What test for hep A? How is it tspread?

Answer 2

Hep A Test is IgM (current infection).

Spread faecal, oral, sexual.

Vax for travellers/people in high risk countries (middleearth)

Question 3

wHICH antigens PRESENIN hEP b. How do we test?

Answer 3

HBsAg (surface antigen) - presence of viral shell (may or maynot be active

HBeAg - active replication

HBcAG - detected in liver, C ore antigen - active replication

DNA - active replication

Question 4

wHAT HAPPENS IF YOUHAVE HEP b

Answer 4

Some people kill it all off, some people have chronic infection and are asymptomatic or no further progression, sometimes progresses to cirrosis which can lead to end stage liver disease

Question 5

wHEN DO WE TRAT AND WHAT DO WE TREAT hEP b WITH?

Answer 5

HBeAg greater than 2000 IU/ml

Treated with:
Pegylated interferon and oral antiviral drugs (Tenofovir)

Question 6

hEP c INFECTION PRESENTATION

Answer 6

May only present very late stage with liver cirrhosis

Question 7

Treatment of Hep C

Answer 7

Direct acting anti-vioral drugs

Question 8

What is Hep D?

Answer 8

A parasite of Hep B. Very hard to deal with.

Question 9

Hep E effects

Answer 9

usually self limiting. Increasing recognition in the UK, no treatment or vax available rn.

Question 10

Effect of sulfonamides, rifampicin, penytoin, diclofenac, disulfiram on liver?

Answer 10

Toxic necrosis

Question 11

Effect of Methyldopa, nevirapine, ritonavir and minocycline on liver?

Answer 11

Acute hepititis

Question 12

Oral conraceptine, anabolic steroids and warfarin have what effect on liver?

Answer 12

Cholestasis

Question 13

Macrolide antibiotics, phenytoin, verapamil, chlorpromazine have what effects?

Question 14

MINOCYCLINE, NITROFURANTOIN, FENOFIBRATE, METHYLDOPA, PHENYTOIN DICLOFENAC CAUSE WHAT TO THE LIVER?

Answer 14

Chronic hepititis

Question 15

Oral ontraceptives and dacarbazine can cause what to the liver?

Answer 15

Hepatic vein thrombosis

Question 16

Azathioprine, oral contraceptives, mercaptopurine, tetracycline can cause what to the liver?

Answer 16

Veno-occlusive disease?

Question 17

Corticosteroids, amiodarone, diltiazrm and verapamil can cause what re liver?

Answer 17

Steatosis

Question 18

Amiodarone, carbamazepine, diltiazem, isoniazid, methyldopa, phenytoin and sulfonamides can cause what type of liver injury?

Answer 18

Granulomatous hepatitis

Question 19

What is the antidote for paracetamol induced liver failure?

Answer 19

N-Acetyl cysteine (NAC)
3 stage:
150mg/kg 1st h
50mg/kg over next 4h
100mg/kg over next 16 h

Treatment line is at a lower threshold for patients with liver failure

Question 20

What is NAFLD?

Answer 20

Non-Alcoholic Fatty Liver Disease,

“Umbrella term encompassing three entities:
Simple steatosis (fat in liver cells)
Non alcoholic steatohepatitis (advanced fat in liver cells inc. inflammation)
Fibrosis and cirrhosis”

Question 21

Journey of normal liver to cirrhosis in fld

Answer 21

Normal liver -> steatosis -> steohepititis (non-alcoholic) ->Cirrohsis

Question 22

How is nafld tested for?

Answer 22

AST/ALT (both enzymes found in the liver , aLt only in liver, aSt found elsewhere eg muscles, heart - Systemic) ratio - rules out alcoholic liver disease.

Diagnostic gold standard: Liver Biopsy.

Diagnostic:
Ultrasound

Scarring diagnosis::
Fibroscan

Also:
ELF, Cytokeratin-18

research: MR/CT, MR Spectroscopy (quantifies fat)

Question 23

What is Fib 4 scoring used for? Values to see in clinic?

Answer 23

Used to work out if fibrosis based on ast,alt, platelet and age.

under 1.45 means no advanced fibrosis. Above this may be seen in clinic

over 3.25 = cirrhosis

Question 24

NALFd treatment?

Answer 24

Diet and weight loss, exercise.

May give metaformin, pioglitazone (insulin sensitizers)

Others:
Glucagon-like peptide-1 (GLP-1) analogues e.g. Liraglutide
Farnesoid X nuclear receptor ligand e.g. Obeticholic acid
Vitamin E
Weight reduction surgeries

Question 25

Main 3 autoimmune disease

Answer 25

primary bilary cholangitis (PBC)
primary sclerosing Cholangitis (PSC)
Autoimmune hepititis

ALSO:
Overlap syndromes
Autoimmune cholangiopathy
IgG 4 disease

Question 26

Autoimmune hepitits:
Who mainly?
WHat is found?
What antibodies (Types 1,2,3)
What is the diagnostic test?
What is the treatment?

Answer 26

Mainly females
Raised IgG
Antibodies:
Type 1: ANA, SMA
Type 2: LKM1
Type 3: SLA

Diagnostic test: liver biopsy

Treatment: steroids, azathioprine

Question 27

Primary biliary cholangitis:
WHo found in predominantly?
What is elevaated?
Anti-mitochondrial antibody test result?
Is the intrahepatic bile duct involved?
Common symptoms
What is the treatment?

Answer 27

Predominantly females
elevated IgM
Anti-mitochondrial antibody test positive
intrahepatic bile duct is involved
smptoms include: pruritus (itchy skin) and fatigue
Treatment: Ursodeoxycholic acid (UDCA) - a secondary bile acid

Question 28

Primary sclerosing cholangitis:
Predominantly found in who?
pANCA test positive/negative?
Which bile ducts involved?
What does it cause?
Symptoms and test of choice?

Answer 28

Predominantly males
pANCA test positive
intra and extrahepatic ducts involved
causes stricturing disease
MRCP is test of choice
Symptoms inc. recurrent cholengitis and jaundice
Treatment is liver transplant, biliary stents

Question 29

Reasons for liver transplant?

Answer 29

liver failure

Question 30

Contraindications for liver transplant?

Answer 30

ill mental health, cancer metastases, still drinking alcohol, active infection

Question 31

What scoring system is used to decide who gets prioritized for a liver transplant?

Answer 31

UKELD( Bilirubin, Sodium, Creatinine and INR)