Liver Symposium: Viral liver disease/alcohol related problems/liver transplantation issues Flashcards
what is viral hepatitis caused by?
5 main types of virus
A, B, C, D and E
what viruses are enteric viruses?
hepatitis A and E
what viruses are parental viruses?
hepatits B, C and D
what viruses cause self limiting acute infections?
hep A and E
what viruses cause chronic disease?
hep B, C and D
how is hep A transmitted?
Faecal - oral
sexual
blood
most likely group to get hep A
5-14 years
who get immunised with hep A virus
Travellers Patients with chronic liver disease IDU (especially with HCV or HBV) Haemophiliacs Occupational exposure lab workers Men who have sex with men (MSM)
function of hepatitis surface antigen
prescence of virus
function of hepatitis e antigen
active replication
function of hepatitis core antigen
active replication
function of HBV DNA
active replication
function of Anti-HBs
protection
function of IgM anti-HBc
acute infection
function of IgG anti HBc
chronic infction/exposure
function of anti HBe
inactive virus
what is HDV
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
whats the commonest cause of acute hepatitis?
hepatitis E
what is hepatitis G
related to HCV
what is hepatitis GB?
cause liver disease
what is non alcoholic fatty liver disease?
Simple steatosis
Non alcoholic steatohepatitis
Fibrosis and cirrhosis
what causes NAFLD?
Diabetes mellitus
Obesity
Hypertriglyceridemia
Hypertension
risk factors for NAFLD
age
ethnicity
genetic factors
diagnosis of NAFLD
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
high risk NAFLD scores
Age >45 Diabetes Present *IFG ≥ 7 mmol/L BMI >30 AST: ALT >1(AST>ALT) Platelet count Low <150 Albumin Low <34
treatment of NAFLD
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
which antibody is elevated in autoimmune hepatitis?
IgG
whos more likely to get autoimmune hepatitis
females
what are the three types of antibodies in autoimmune hepatitis
Type 1: ANA, SMA
Type 2: LKM1
Type 3: SLA
whos more likely to get primary biliary cholangitis
females
which antibody is elevated in primary biliary cholangitis
IgM
which bile duct is involved in primary biliary cholangitis?
intrahepatic
whos more likely to get primary sclerosing cholangitis?
males
whixh antibody is positive in primary sclerosing cholangitis?
pANCA
which bile ducts are involved in primary sclerosing cholangitis
intra and extrahepatic
what is the test of choice for primary biliary cholangitis?
MRCP
who do we transplant?
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
contraindications for transplant
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
how do we prioritise cirrhosis?
Child’s Pugh scoring A, B and C
MELD score ( Bilirubin, Creatinine and INR)
UKELD( Bilirubin, Sodium, Creatinine and INR)
what happens after post operative treatment ?
Post operative ICU care Multidisciplinary care Prophylactic antibiotics and anti-fungal drugs Anti-rejection drugs Steroids Azathioprine Tacrolimus/Cyclosporine
