Liver symposium: viral, alcoholic, transplant Flashcards
what types of hepatitis are enteric ?
A
E
what types of hepatitis are parenteral ?
B
C
D
what types of hepatitis are self limiting ?
A
E
what types of hepatitis can cause chronic disease ?
B
C
D
how is hep A transmitted ?
faecal-oral
sexual
blood
how does hep A present ?
usually asymptomatic
acute disease diagnosed by IgM bodies
who is offered immunisation for hep A ?
travellers patients with CLD haemophiliacs occupational risk - lab workers MSM
what is a complication of hep B infection ?
can lead to cirrhosis
what is the treatment for hep B ?
interferons and antivirals
lamivudine, adefovire, entocuvir, telbivudine, tenofovir
what does the IgM anti-HBc antibody show in hep B ?
acute infection
what does the IgG anti-HBc antibody show in hep B ?
chronic infection
what does the anti-HBe antibody show in hep B?
inactive virus
how does hep C present ?
mostly asymptomatic until cirrhosis
how is hep C treated ?
interferons and antivirals
when is hep D usually seen in infection ?
co-infection with hep B
what does hep E commonly cause ?
acute hepatitis
what conditions does non-alcoholic fatty liver disease encompass ?
simple steatosis
non alcoholic steatohepatitis
fibrosis and cirrhosis
what is NAFLD associated with ?
diabetes
obesity
hypertriglyceridemia
hypertension
how is NAFLD diagnosed ?
biochemical test: AST/ALT ratio enhanced liver fibrosis panel (ELF) cytokeratin-18 USS fibroscan MRI/CT MR spectroscopy liver biopsy
what constitutes a high risk score for NAFLD ?
age > 45 diabetic BMI > 30 AST:ALT >1 platelet count low <150 albumin low <34
what is the treatment for NAFLD ?
diet and weight reduction exercise insulin sensitisers GLP-1 analogues fanesoid X nuclear receptor ligand vitamin E weight reduction surgery
what are examples of autoimmune liver disease ?
autoimmune hepatitis
primary biliary cholangitis
primary sclerosing cholangitis
what is a blood feature of autoimmune hepatitis ?
elevated IgG
how is autoimmune hepatitis diagnosed ?
liver biopsy
what is the treatment for autoimmune hepatitis ?
responds to steroids
long term azathioprine
what is a blood feature of primary biliary cholangitis ?
elevated IgM
anti-mitochondrial antibody positive
how does primary biliary cholangitis present ?
pruritus
fatigue
what is the treatment for primary biliary cholangitis ?
UDCA - ursudiol
what is primary sclerosing cholangitis ?
inflammation and stricture/fibrosis of biliary ducts
unknown aeitology but associated with men with UC
how is PSC diagnosed ?
MRCP
what are clinical features of PSC ?
recurrent cholangitis
jaundice
what is the treatment fro PSC ?
liver transplant
biliary stent
who is eligible for liver transplant ?
CLD with poor prognosis CLD with poor quality life hepatocellular carcinoma acute liver failure genetic disease
what are contraindications for a liver transplant ?
extra hepatic malignancy microvascular/diffuse tumour invasion active/uncontrolled extra hepatic infection active substance/alcohol abuse comorbidity psychosocial factors technical/anatomical factors brain death
what are three different scores for liver transplantation ?
Child’s Pugh score
MELD score
UKELD
what is needed for post-op care of a liver transplant
ICU
MDT
antibiotics and antifungals
anti-rejection drugs - steroids azathioprine, cyclosporin
