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Yr 2 Gastrointestinal > Wk 2 - Symposium 2 (Clinical): Liver Disease > Flashcards

Wk 2 - Symposium 2 (Clinical): Liver Disease Flashcards

1
Q

What is the purpose of biopsies of the liver?

A
  • Aetiology - to exclude second disease process (and also if there are two causes of disease)
  • Staging - architecture of the liver ie how scarred the liver is
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2
Q

What are the categories of ‘medical’ diseases of the liver?

A
  • Fatty liver disease
  • Chronic hepatitis
    • Viral - less common in UK
    • Autoimmune - more common in UK
    • Drugs
  • Biliary disease
  • Iron overload
  • Metabolic disease
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3
Q

What is the difference between cirrhosis and fibrosis of the liver?

A
  • Fibrosis can be partially reversed if the cause is identified and dealt with early enough. Cirrhosis is severe scarring of the liver. Scar tissue replaces the cells that carry out the liver’s normal functions and can block the flow of blood through the liver.
  • Fibrosis itself causes no symptoms, but severe scarring can result in cirrhosis, which can cause symptoms.
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4
Q

What’s the difference between macronodular and micronodular cirrhosis?

A

The main types of cirrhosis are micronodular (esp in fatty liver disease) and macronodular; the former type has most nodules less than 3 mm in diameter and the latter type has most nodules greater that 3 mm in diameter.

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5
Q

Discuss the aetiology of fatty liver disease.

A
  • Alcohol vs. non-alcoholic causes
    • Obesity, diabetes mellitus, drugs
  • Leads to fatty change
  • Then to steatohepatitis
    • Characterised by ballooned cells, Mallory bodies, neutrophils
  • Eventually leading to fibrosis & cirrhosis
    • Classically perivenular & perisinusoidal
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6
Q

Histologically, what is chronic hepatitis characterised by?

A
  • Portal tract chronic inflammation
  • Interface hepatitis
  • Lobular inflammation
  • Acidophil bodies
  • Fibrosis & cirrhosis (final common pathway for many different types of liver disease)
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7
Q

List some biliary tract diseases.

A
  1. Primary sclerosing cholangitis
  2. Primary biliary cholangitis
  3. Portal tract inflammation & expansion
  4. Bile duct damage & loss
  5. Granulomas (PBC)
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8
Q

What are some examples of iron overload diseases?

A
  • Genetic haemochromatosis
    • Common & under diagnosed
    • Very treatable via venesection
    • Cirrhosis if untreated
  • Haemosiderosis
    • Transfusion-related
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9
Q

What is the most important aspect in investigating drug-induced liver disease?

A

Clinical history esp when liver became unwell cross-matched with when they started a drug.

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10
Q

Give an example of a drug that can cause cholestasis (cholangiolytic).

A

Flucloxacillin

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11
Q

Give an example of a drug that can cause hepatic vein thrombosis.

A

Oral contraceptive (contraceptive steroids)

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12
Q

Give an example of a drug that can cause granulomas.

A

Allopurinol (gout drug)

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13
Q

Give an example of a drug that can cause chronic hepatitis.

A
  • Nitrofurantoin (usually for UTI)
  • Etretinate (Vit A drug) –> autoimmune hepatitis
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14
Q

Give some examples of metabolic diseases that could cause liver disease.

A
  • Alpha-1-antitrypsin deficiency
    • Lung & liver
  • Wilson’s disease
    • Central nervous system, eyes & liver
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15
Q

What is the pattern of hepatic injury of viral hepatitis?

A

VIRAL HEPATITIS demonstrates indirect, immune mechanism of damage to hepatocytes

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16
Q

List the clinical features of acute hepatitis.

A
  • Often so similar as to be indistinguishable
  • Onset is insidious
  • ‘Jaundice’ can last few days to months
  • Many non-specific symptoms: Itching and pale stools, weight loss Fatigue – may persist for months
  • Specific diagnosis usually requires laboratory testing
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17
Q

What are the 5 different types of viral hepatitis?

A
  1. Hep A
  2. Hep B
  3. Hep C
  4. Hep D (linked to Hep B)
  5. Hep E
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18
Q

The different hepatitis viruses can cause ____ hepatitis or ____ hepatitis.

A

The different hepatitis viruses can cause chronic hepatitis or acute hepatitis.

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19
Q

What forms of hepatitis causes chronic hepatitis?

A

Hep B, C and D

20
Q

What forms of hepatitis causes acute hepatitis?

A

Hep A, B, C and E

21
Q

What two viral hepatitis cause acute hepatitis ONLY?

A

Hep A and Hep E

22
Q

What is the route of transmission of Hep A?

A

Faecal-oral route

23
Q

What is usually the main reason for high rates of Hep A infection?

A

Poor sanitary conditions are linked to high rates of infection, mainly in developing countries, sometimes get rare sporadic outbreaks in developed countries

24
Q

_____ vaccination can prevent disease up to _____ after contracting _____.

A

Post-exposure vaccination can prevent disease up to 2 weeks after contracting Hep A virus.

25
Q

How is Hep A diagnosed?

A

Typical diagnostic test involves looking for the presence of anti-HAV IgM in a patient’s serology – shows acute viral acute hep A infection at the time of testing

26
Q

How is Hep A virus infection prevented?

A
  • Vaccination with formalin-inactivated HAV particles
  • Public health – improved sanitation
27
Q

Hep B virus is a ___ virus and has ___ genotypes.

A

Hep B virus is a DNA virus and has EIGHT genotypes.

28
Q

What is the relevance of knowing the different genotypes of Hep B?

A

Influences treatment options + disease progression

29
Q

How is Hep B transmitted?

A

Infection acquired through contact with blood as well as sexual and perinatal transmission routes

30
Q

What factor influences whether HBV establishes a chronic infection?

A

Age – younger acquisition more likely to become a chronic disease (hence imp to reduce vertical transmission!)

31
Q

What is the target of anti-HBV nucleoside and nucleotide drugs?

A

Polymerase found intracellularly (replicates the virus genome)

32
Q

What is the principal component of HBV vaccines?

A

Pre-S and S antigen (HBsAg) - antigen on outside of virus particle.

33
Q

What component of the HBV virus does the body develop antibodies to and what does that indicate?

A

HBcAg forms the HBV virus capsid and antibodies to C indicate previous exposure to the virus

34
Q

Discuss the different components of the HBV virus and how they relate to drug therapy, vaccine targets and chronicity staging.

A
  • Polymerase – drug target
  • Pre-S and S antigen (HBsAg) – vaccine component
  • Core (HBcAg) – antibodies develop against this indicate previous exposure
  • Pre-core (HBeAg) – immunomodulatory agent - chronicity/where patient sits
35
Q

Vaccinated individuals will have ____ antibody but NOT ____ antibody.

A

Vaccinated individuals will have anti-HBsAg antibody but NOT anti-HBcAg antibody.

36
Q

How can HBV be treated?

A
  • Only treat chronically infected individuals
  • Treatment can either be with interferon-alpha or nucleoside inhibitors.
  • Treatment can result in resolution of infection in a minority of cases (more so with interferon-alpha treatment).
  • Because of benefit/cost considerations treatment often restricted to periods when the risk of cirrhosis is high.
  • Use of interferon-alpha is not recommended when there are flare-ups.
37
Q

How is HBV prevented?

A
  • Vaccination
  • Public health awareness (e.g. needle exchange programmes + safe sex)
  • Screening programmes to identify chronically infected individuals + education
  • (Treatment of chronically infected individuals to reduce viral loads) inc pregnant women who should be treated with antivirals in 3rd trimester
38
Q

Hep D agent is found only with ____.

A

Hep D agent is found only with Hep B.

Combined HBV + HδV infection is associated with a poorer prognosis than infection with HBV alone.

39
Q

How is Hep E transmitted?

A

Faecal-oral route

40
Q

Hep E virus has high mortality in…

A

High mortality (~20%) in infected pregnant women (probably restricted to genotype 1)

41
Q

What can Hep E be treated with?

A

Ribavirin

42
Q

What is the difference between horizontal and vertical transmission?

A

In general, the transmission of viruses can occur through two pathways: horizontal and vertical transmission. In horizontal transmission, viruses are transmitted among individuals of the same generation (anything that is not vertical), while vertical transmission occurs from mothers to their offspring.

43
Q

What are the three most common causes of liver disease in the UK?

A
  1. Obesity
  2. Alcohol
  3. Viral hepatitis (usually Hep C)

Nb is SE Asia high mortality, as Hep B most common cause (due to vertical transmission)

44
Q

Liver disease is strongly linked to….

A

Deprivation (bc obesity and increased alcohol consumption is also associated with deprivation!)

45
Q

____ is the main driver of increased chronic liver disease in the UK.

A

Alcohol is the main driver of increased chronic liver disease in the UK.

Yr 2 Gastrointestinal (37 decks)

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