Liver Disease

Question 1

What is hepatitis?

Answer 1

Inflammation of the liver

Question 2

Describe the 3 important components of LFTs when diagnosing hepatitis

Answer 2

1. Bilirubin
2. AST
3. ALT

Question 3

Name 5 potential causes of hepatitis

Answer 3

1. Viral
2. Alcohol / Drugs
3. Ischaemia
4. Toxins
5. Autoimmune

Question 4

What are the 4 major types of viral hepatitis?

Answer 4

A
B
C
E

Question 5

Name 3 causes of viral hepatitis outside the major 4

Answer 5

1. Delta
2. EBV
3. Yellow fever

Question 6

Describe 3 clinical features of a person with acute viral hepatitis

Answer 6

1. Jaundice
2. Malaise
3. Liver dysfunction (rarely failure)

Question 7

Describe hepatitis A

Answer 7

• In decline due to vaccine and sanitation
• Faecal oral transmission
• Incubation is 2-7 weeks
• Usually recover within 3 months
• Does not cause chronic liver disease

Question 8

Describe 3 components of prevention of Hep A

Answer 8

1. Sanitation
2. Pre-Exposure (vaccination and immunoglobulin)
3. Post-Exposure (give immunoglobulin and vaccinate)

Question 9

Describe Hepatitis E

Answer 9

• Transmitted via faecal oral route
• Contaminated water is common source in developing countries
• Zoonotic route is common source in developed countries

Question 10

What is zoonotic route of tranmission?

Answer 10

Consumption of meat, usually pork

Question 11

Name 3 methods of transmission of Hep B

Answer 11

1. Sexual
2. Blood
3. Bodily fluids

Question 12

What is the earliest indicator of Hep B?

Answer 12

HBsAg (surface antigen) positive

Question 13

Describe the progression of acute Hep B to chronic Hep B

Answer 13

• 5-10% adults fail to clear HBsAg from system
• Suffer from chronic Hep B
• Vertical transmission common as 90%+ of neonates cannot clear HBsAg

Question 14

Describe chronic Hep B status for patients with active disease

Answer 14

• HBsAg positive for over 6 months
• Raised LFTs
• Raised HBV DNA
• Liver damage

Question 15

Describe chronic Hep B status for patients who are chronic carriers

Answer 15

• HBsAg positive for over 6 months
• Normal LFTs
• Negative HBV DNA
• Risk of damage and passing on infection

Question 16

What 2 regions of the world are most common for Hep B cases?

Answer 16

1. Far East Asia

2. Sub-Saharan Africa

Question 17

Describe the treatment of chronic Hep B

Answer 17

• Prevention most important
• Screening for hepatocellular cancer
• Could be eradicated with vaccination
• Antiviral agents
• Liver transplantation may be used

Question 18

Describe 4 transmission methods of Hep C

Answer 18

1. IV drug use
2. Blood products
3. Body piercings / Vertical / Sexual (uncommon methods)

Question 19

Describe the clinical course of acute Hep C infection

Answer 19

• Mild symptoms
• < 20% are jaundiced
• HCV antibodies present

Question 20

Describe the clinical course of long term sequelae in Hep C

Answer 20

• 80% of patients fail to clear virus (remain PCR positive)
• Over 50% develop liver disease
• 20-30% develop cirrhosis

Question 21

Describe Hep C treatment

Answer 21

• Prevention is most important (no vaccination)
• Oral medication for 8-12 weeks clears in 98% of people
• Patients remain HCV antibody positive but PCR negative (not infectious)

Question 22

Describe 3 types of non-infection hepatitis

Answer 22

Alcoholic - Jaundice and coagulopathy
Autoimmune - Usually on long term immunosuppression
Drug Induced - Common in flucloxacillin

Question 23

Describe needle stick injuries and transmission of hepatitis A, B and C

Answer 23

Hep A - No risk of transmission
Hep B - 30% of transmission
Hep C - 3% of transmission

Question 24

Describe the 2 classifications of jaundice

Answer 24

1. Traditional - Pre-hepatic, hepatic, post-hepatic

2. Biochemical - Unconjugated v Conjugated

Question 25

Describe 2 common causes of jaundice

Answer 25

1. Obstruction (malignancy, gallstones) | 2. Liver damage (alcohol, hepatitis)

Question 26

Describe the history taking for a person with suspected liver dysfunction

Answer 26

- Always ask about alcohol intake - Drug / toxins - Assess hepatitis risk - Any oversea travels - Family history - Previous surgery

Question 27

Describe the examination for a person with suspected liver dysfunction

Answer 27

- Jaundice - Pyrexia - Chronic liver disease - Xanthomas - K-F rings

Question 28

Describe common liver screening blood tests when concerned about liver dysfunction

Answer 28

- Repeat LFTs - FBP / Coag screen - Hepatitis screen - Autoimmune screen - Immunoglobulins - Iron studies

Question 29

Describe 4 types of radiology which can be used to assess liver dysfunction

Answer 29

1. Ultrasound on Abdomen (first go to) 2. CT Scan (gives better view of specific aspects e.g pancreas) 3. MRI / MRCP 4. PTC

Question 30

Describe the trend in alcohol related deaths in the UK since 1991

Answer 30

- Deaths increasing in all age groups - Rising consumption of alcohol - Highest in 55-74 age group - 85% of deaths due to cirrhosis

Question 31

Describe the consequences of alcohol

Answer 31

- Intoxication - Pleasure - Road deaths - Violence - Financial strain on NHS - Medical consequences

Question 32

Describe 6 things which may be seen in liver damage caused by alcohol

Answer 32

1. Nothing to find 2. Raised liver enzymes 3. Fatty hepatitis 4. Liver fibrosis / cirrhosis 5. Fatty liver 6. Decompensated liver disease

Question 33

Name 3 complications of cirrhosis

Answer 33

1. Liver decompensation 2. Hepatocellular carcinoma 3. Reduced life expectancy

Question 34

Name 5 features of liver decompensation

Answer 34

1. Jaundice 2. Encephalopathy 3. Ascites 4. Hypoalbuminaemia 5. Coagulopathy

Question 35

What classification is used to determine if someone with liver disease is at risk of complications if dental treatment is carried out?

Answer 35

Child-Pugh Classification

Question 36

Describe 3 liver functions

Answer 36

1. Protein / Carbohydrate and Lipid metabolism 2. Bile formation 3. Hormone inactivation

Question 37

Describe acute liver failure

Answer 37

Combination of Jaundice, Encephalopathy and Coagulopathy occuring within 24 weeks of illness onset

Question 38

Describe the aetiology of acute liver failure

Answer 38

- Toxins (paracetamol and others) - Hepatitis viruses - Vascular (PV thrombosis, ischaemia) - Metabolic (Acute Fatty Liver) - Malignancy

Question 39

Describe 6 clinical features of acute liver failure

Answer 39

1. Jaundice 2. Encephalopathy 3. Cerebral oedema 4. Bleeding 5. Hypotension and tachycardia 6. Sepsis