Week 3.4 - Liver Symposium 2

Question 1

What is drug induced liver disease?

Answer 1

drugs taken for many reasons. commonly acetaminophen (paracetamol) leads to necrosis/damage

Question 2

What is treatment for drug induced liver disease?

Answer 2

high risk and normal treatment lines. antidote is N-acetyl cysteine to inhibit pathway.

Question 3

what is NAFLD and associations?

Answer 3

non alcohol fatty liver disease associated with:
- obesity,
- diabetes,
- hypertriglycerideaemia,
- hypertension

Question 4

What is the natural history of NAFLD?

Answer 4

starts normal. risk factors lead to steatosis. these then develop NASH +- fibrosis.

Question 5

What tests do you give for NAFLD?

Answer 5

• AST/ALT ratio tells if its alcohol related
• ELF rules out fibrosis
• ultrasound to diagnose
• fibroscan to study scarring
• MR/CT
• MR spectroscopy to quantify fat
• liver biopsy tells extent

Question 6

What test do you give to determine risk of NAFLD?

Answer 6

NAFLD score or Fib-4 score.commonly NAFLD SCORE. IF 3+ risks then treat

Question 7

What treatment do you give for NAFLD?

Answer 7

weight reduction, diet, exercise, insulin

Question 8

What are some autoimmune liver diseases?

Answer 8

autoimmune hepatitis, PBC, PSC

Question 9

What about autoimmune hepatitis, prevalence, diagnosis, treatment?

Answer 9

• mainly women,
• very high IgG.
• liver biopsy diagnostic.
• treat with long term immunosuppresant azathioprine.

Question 10

What about PBC, prevalence, diagnosis, treatment?

Answer 10

• mainly women,
• IgM raised. antimitochondrial antibodies.
• intrahepatic bile duct involved.
• see pruritis and fatigue.
• treat with UDCA

Question 11

What about PSC, prevalence, diagnosis, treatment?

Answer 11

• mainly men,
• pANCA antibody positive.
• intra and extrahepatic bile ducts affected with strictures.
• see cholangitis and jaundice.
• treatment liver transplant

Question 12

What does UDCA do?

Answer 12

in PBC helps bile flow and reverses immune attack

Question 13

Who gets liver transplant?

Answer 13

• poor survival
• poor QoL
• cancer
• ALF
• genetic disorders

Question 14

What are contraindications of liver transplant?

Answer 14

• extrahepatic malignancy
• diffuse tumour invasion
• substance/alcohol abuse
• active and uncontrolled infection elsewhere
• severe co-morbidity
• psychosocial factors

Question 15

What are scoring systems for cirrhosis?

Answer 15

too determine who gets liver transplant
- Child’s pugh score A B or C
- MELD score (bilirubin, creatinine and INR)
- UKELD - used now. (bilirubin, prothrombin time INR, sodium, creatinine)

Question 16

What is the type of surgery in a liver transplant?

Answer 16

orthotropic - liver out new one in same place. renal different - kidneys stay in.

Question 17

What is post-op treatment for liver transplant?

Answer 17

• ICU
• multidiciplinary
• prophylactic antibiotics
• anti-fungal
• anti rejection (steroids)