Liver Symposium Flashcards
(81 cards)
1
Q
What are the 5 main types of viruses that cause viral hepatitis?
A
- A
- B
- C
- D
- E
2
Q
Which hepatitis viruses are enteric?
A
- A
- E
3
Q
Which hepatitis viruses are parenteral?
A
- B
- C
- D
4
Q
Which hepatitis viruses cause self limiting infections?
A
- A
- E
5
Q
Which hepatitis viruses cause chronic disease?
A
- B
- C
- D
6
Q
What is the estimated death toll per year for viral hepatitis?
A
1 million
7
Q
Where is HAV most prevalent?
A
- Africa
- South America
- Asia
- Greenland
8
Q
Describe the clinical course of HAV.
A
SLIDE 7
9
Q
How can HAV occur?
A
- Sporadically
- Epidemic
10
Q
How is HAV transmitted?
A
- Faecal-oral
- Sexual
- Blood
11
Q
What is the most common infected age group for HAV?
A
5-14 years old
12
Q
How is HAV diagnosed?
A
Acute disease diagnosed by IgM antibodies
13
Q
What is a common presentation of HAV?
A
Asymptomatic
14
Q
Who should receive a HAV immunisation?
A
- Travellers
- Patients with chronic liver disease
- Haemophiliacs
- Occupational exposure
- Men who have sex with men
15
Q
Where is HBV most prevalent?
A
- Parts of Asia
- Parts of South America
- Parts of Canada
- Alaska
- Parts of Greenland
- Parts of South Africa
16
Q
Describe the structure of HBV.
A
- Outer lipid envelope containing HB surface antigen
- Inner protein core (HBcAg)
- DNA polymerase
- HBV DNA
17
Q
What does the inner protein core HBcAG secrete into the blood?
A
HBeAG
18
Q
What does HBsAG indicate?
A
Presence of virus
19
Q
What are the treatment options for HBV?
A
- Pegylated interferon
- Oral antiviral drugs
20
Q
What oral therapies are available for HBV?
A
- Lamivudine
- Adefovir
- Entecavir
- Telbivudine
- Tenofovir
21
Q
What does HBeAG indicate?
A
Active replication
22
Q
What does HBcAG indicate?
A
Active replication but cannot be detected in the blood
23
Q
What does HBV DNA indicate?
A
Active replication
24
Q
What does anti-HBs indicate?
A
Protection
25
What does IgM anti-HBc indicate?
Acute infection
26
What does IgG anti-HBc indicate?
Chronic infection/exposure
27
What does anti-HBe indicate?
Inactive virus
28
What does negative HBsAG mean?
- No active infection
| - Initiate or complete vaccines series
29
What does positive HBsAG mean?
- Positive IgM anti-HBc: acute infection
| - Negative IgM anti-HBc: chronic infection: evaluation for ongoing monitoring and treatment
30
What is the natural history of chronic hepatitis B?
- Normal liver
- Chronic hep B
- No further progression OR cirrhosis
- Cancer
- ESLD
31
When are most HCV infected individuals asymptomatic until?
Cirrhotic
32
What will the LFTs of someone with HCV look like?
May be normal
33
What are the outcomes of HCV?
- 10% acute jaundice
- Rarely causes acute liver failure
- 85% chronic infection
34
Describe the structure of HVC.
- Envelope glycoproteins
- Envelope
- Nucleocapsid
- Single stranded RNA
35
What is the natural history of HCV infection?
- Exposure : Resolved
- Chronic : Stable
- Cirrhosis: slowly progressive
- Cancer
- Transplant
- Death
36
What are the 2 main drugs in use for HCV?
- Sofosbuvir
| - Ledipasivir
37
What is HDV?
- Small RNA virus
- Does not code for its own protein coat
- Enveloped by HBsAG
- Co-infection with HBV
38
How is HDV transmitted?
Same as HBV
39
Why is HDV difficult to get rid of?
Resistant to treatment
40
Where is HEV most prevalent?
- Asia
- North Africa
- Mexico
- Parts of south Africa
41
What is the commonest cause of acute hepatitis in Grampian?
HEV
42
Where was HEV previously though to be limited to?
Tropical countries
43
What does HEV do in pregnancy?
Fulminant hepatic failure
44
What is the long term sequelae in HEV??
- No long term sequelae
| - Self-limiting
45
What is the treatment for HEV?
No specific treatment
46
What does EBV/CMV do?
Generally cause mildly deranged LFTs only in immunocompromised hosts
47
What can herpes simplex result in?
Rare severe acute hepatitis
48
What are the 3 entities in NAFLD?
- Simple steatosis
- Non-alcoholic statohepatitis
- Fibrosis and cirrhosis
49
What components of metabolic syndrome is NAFLD associated with?
- Diabetes mellitus
- Obesity
- Hypertriglyceridemia
- Hypertension
50
Other than metabolic disorders what other risk factors are there for NAFLD?
- Age
- Ethnicity
- Genetic factors
51
What is the natural history of NAFLD?
- Normal liver
- Steatosis
- NASH +/- fibrosis
- Cirrhosis
52
How is a diagnosis of NAFLD made?
- Biochemical test AST/ALT ratio
- Enhanced liver fibrosis panel
- Cytokeratin-18
- Ultrasound
- Fibroscan
- MR/CT
- MR spectrrocopy
- Liver biopsy
53
To calculate a high risk NAFLD score how many risk categories must be met?
At least 3
54
What is the low risk category for NAFLD?
- <45 years
- No diabetes
- <30 BMI
- <1 AST/ALT
- Platelet >150
- Albumin >34
55
What is the high risk category for NAFLD?
- >45
- Diabetes
- >30 BMI
- >1 AST/ALT
- Platelet <150
- Albumin <34
56
What is the treatment for NAFLD?
- Diet and weight reduction
- Exercise
- Insulin sensitizers
- Glucagon like peptide 1 analogues
- Farnesoid X nuclear receptor ligand
- Vitamin E
- Weight reduction surgeries
57
What are the 3 main autoimmune liver diseases?
- Autoimmune hepatitis
- Primary biliary cholangitis
- Primary sclerosing cholangitits
58
Who is mainly affected by autoimmune hepatitis?
Females
59
What is elevated in autoimmune hepatitis?
IgG
60
What are the 3 types of antibodies in autoimmune hepatitis?
- Type 1: ANA, SMA
- Type 2: LKM1
- Type 3: SLA
61
How is autoimmune hepatitis diagnosed?
Liver biopsy
62
How is autoimmune hepatitis managed?
- Steroids
| - Long term asathioprine
63
Who is mainly affected by primary biliary cholangitis?
Females
64
What is elevated in primary biliary cholangitis?
IgM
65
What is positive in primary biliary cholangitis?
Anti-mitochondrial antibody
66
What is involved in primary biliary cholangitis?
Intrahepatic bile duct
67
What is common with primary biliary cholangitis?
Pruritus and fatigue
68
What is the treatment of choice for primary biliary cholangitis?
UDCA
69
Who is mainly affected by primary sclerosing cholangitis?
Males
70
What is positive in primary sclerosing cholangitis?
pANCA
71
What ducts are involved in primary sclerosing cholangitis?
Intra and extrahepatic bile ducts
72
What type of disease is primary sclerosing cholangitis?
Stricturing disease
73
What is the test of choice for primary sclerosing cholangitis?
MRCP
74
What is the treatment for primary sclerosing cholangitis?
- Liver transplant
| - Biliary stents
75
What types of conditions is liver transplantation an option?
- Chronic liver disease with poor predicted survival
- Chronic liver disease with associated poor quality of life
- Hepatocellular carcinoma
- Acute liver failure
- Genetic disease
76
What are the contraindications for transplant?
- Active extrahepatic malignancy
- Hepatic malignancy with macrovascular or diffuse tumour invasion
- Active and uncontrolled infection outside of the hepatobiliary system
- Active substance or alcohol abuse
- Severe cardiopulmonary or other comorbid conditions
- Psychological factors that would likely preclude recovery after transplantation
- Technical and/or anatomical barriers
- Brain death
77
How do we prioritise in ALF?
- Acetaminphen-induced ALF categories
| - Nonacetaminophen-induced ALF
78
How do we prioritise in cirrhosis?
- Child's Pugh scoring A,B,C
- Meld score (Bilirubin, creatinine and INR)
- UKELD(Bilirubin, sodium, creatinine and INR)
79
Orthotopic surgery
Transplanted organ takes the place of the removed organ
80
What is the post-operative treatment for liver transplant?
- Post operative ICU care
- Multidisciplinary care
- Prophylactic antibiotics and anti-fungal drugs
- Anti-rejection drugs
81
Give examples of anti-rejection drugs.
- Steroids
- Azathioprine
- Tacrolimus/cyclosporine
