Liver Symposium: Viral liver disease/alcohol related problems/liver transplantation issues

Question 1

what is viral hepatitis caused by?

Answer 1

5 main types of virus

A, B, C, D and E

Question 2

what viruses are enteric viruses?

Answer 2

hepatitis A and E

Question 3

what viruses are parental viruses?

Answer 3

hepatits B, C and D

Question 4

what viruses cause self limiting acute infections?

Answer 4

hep A and E

Question 5

what viruses cause chronic disease?

Answer 5

hep B, C and D

Question 6

how is hep A transmitted?

Answer 6

Faecal - oral
sexual
blood

Question 7

most likely group to get hep A

Answer 7

5-14 years

Question 8

who get immunised with hep A virus

Answer 8

Travellers
Patients with chronic liver disease
IDU (especially with HCV or HBV)
Haemophiliacs
Occupational exposure
lab workers
Men who have sex with men (MSM)

Question 9

function of hepatitis surface antigen

Answer 9

prescence of virus

Question 10

function of hepatitis e antigen

Answer 10

active replication

Question 11

function of hepatitis core antigen

Answer 11

active replication

Question 12

function of HBV DNA

Answer 12

active replication

Question 13

function of Anti-HBs

Answer 13

protection

Question 14

function of IgM anti-HBc

Answer 14

acute infection

Question 15

function of IgG anti HBc

Answer 15

chronic infction/exposure

Question 16

function of anti HBe

Answer 16

inactive virus

Question 17

what is HDV

Answer 17

Small RNA virus,
-does not code for its own protein coat
-enveloped by HBsAg
Co-infection or super-infection with HBV
Transmission as for HBV
Very resistant to treatment

Question 18

whats the commonest cause of acute hepatitis?

Answer 18

hepatitis E

Question 19

what is hepatitis G

Answer 19

related to HCV

Question 20

what is hepatitis GB?

Answer 20

cause liver disease

Question 21

what is non alcoholic fatty liver disease?

Answer 21

Simple steatosis
Non alcoholic steatohepatitis
Fibrosis and cirrhosis

Question 22

what causes NAFLD?

Answer 22

Diabetes mellitus
Obesity
Hypertriglyceridemia
Hypertension

Question 23

risk factors for NAFLD

Answer 23

age
ethnicity
genetic factors

Question 24

diagnosis of NAFLD

Answer 24

Biochemical tests: AST/ALT ratio
Enhanced liver fibrosis panel (ELF) (hyaluronic acid, TIMP-1, and PIIINP) 
Cytokeratin-18
Ultrasound
Fibroscan
MR/CT
MR Spectroscopy: Actually quantify fat
Liver biopsy

Question 25

high risk NAFLD scores

Answer 25

``` Age >45 Diabetes Present *IFG ≥ 7 mmol/L BMI >30 AST: ALT >1(AST>ALT) Platelet count Low <150 Albumin Low <34 ```

Question 26

treatment of NAFLD

Answer 26

Diet and weight reduction Exercise Insulin sensitizers e.g. Metformin, Pioglitazone 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 27

which antibody is elevated in autoimmune hepatitis?

Answer 27

IgG

Question 28

whos more likely to get autoimmune hepatitis

Answer 28

females

Question 29

what are the three types of antibodies in autoimmune hepatitis

Answer 29

Type 1: ANA, SMA Type 2: LKM1 Type 3: SLA

Question 30

whos more likely to get primary biliary cholangitis

Answer 30

females

Question 31

which antibody is elevated in primary biliary cholangitis

Answer 31

IgM

Question 32

which bile duct is involved in primary biliary cholangitis?

Answer 32

intrahepatic

Question 33

whos more likely to get primary sclerosing cholangitis?

Answer 33

males

Question 34

whixh antibody is positive in primary sclerosing cholangitis?

Answer 34

pANCA

Question 35

which bile ducts are involved in primary sclerosing cholangitis

Answer 35

intra and extrahepatic

Question 36

what is the test of choice for primary biliary cholangitis?

Answer 36

MRCP

Question 37

who do we transplant?

Answer 37

Chronic liver disease with poor predicted survival Chronic liver disease with associated poor quality of life Hepatocellular carcinoma Acute liver failure Genetic diseases e.g. primary oxaluria, tyrosemia

Question 38

contraindications for transplant

Answer 38

Active extrahepatic malignancy Hepatic malignancy with macrovascular or diffuse tumor 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 likely preclude recovery after transplantation Technical and/or anatomical barriers Brain death

Question 39

how do we prioritise cirrhosis?

Answer 39

Child’s Pugh scoring A, B and C MELD score ( Bilirubin, Creatinine and INR) UKELD( Bilirubin, Sodium, Creatinine and INR)

Question 40

what happens after post operative treatment ?

Answer 40

``` Post operative ICU care Multidisciplinary care Prophylactic antibiotics and anti-fungal drugs Anti-rejection drugs Steroids Azathioprine Tacrolimus/Cyclosporine ```