Liver symposium

Question 1

What is viral hepatitis caused by?

Answer 1

A, B= enteric viruses

C, D, E= parenteral viruses

Question 2

What hepatitis viruses cause acute infections?

Answer 2

A, E

Question 3

What hepatitis viruses cause chronic disease?

Answer 3

B, C, D

Question 4

Where is Hep A prominent?

Answer 4

Developing countries and Greenland

Question 5

How is Hep A transmitted?

Answer 5

Faecal oral
Sexual
Blood

Question 6

What is the most common presentation of Hep A?

Answer 6

Asymptomatic

Question 7

How is acute Hep A diagnosed?

Answer 7

By IgM antibody presence

Question 8

Who is given immunisation against Hep A?

Answer 8

Travellers
Patients with chronic liver disease
Haemophiliacs
Occupational exposure i.e. lab
Men who have sex with men (MSM)

Question 9

What is the typical timespan of Hep A?

Answer 9

Presentation 2 weeks after infection
Viremia gone by 6 weeks post infection
Clinical illness lasting 8 weeks post infection

Question 10

What is the structure of the Hep B virus?

Answer 10

Inner protein core with antigen enclosing DNA

Outer lipid envelope containing surface antigen

Question 11

What antigens are expressed from HBV?

Answer 11

HBeAg
HBcAg
HBsAg

Question 12

What is the HBeAg and what does it do?

Answer 12

Antigen that is a sign of active replication

Iterferes with host immune system and prevents them from attacking the virus

Question 13

What is HBsAg used to detect?

Answer 13

Presence of hep B virus, rather than activity

Question 14

What is HBcAg used to detect and where is it found?

Answer 14

Active replication of HV

Only found in liver

Question 15

What antibodies launch a response against HBV?

Answer 15

IgM
IgG
Anti HBe
Anti HBs

Question 16

What is IgM presence used to detect in HBV?

Answer 16

If the virus has been acquired in the last 6 months

Question 17

What does IgG indicate in HBV?

Answer 17

Chronic infection

Question 18

What is the usual progression of HBV?

Answer 18

No progression from chronic virus

Question 19

What can HBV progress onto?

Answer 19

Cirrhosis
Hepatocellular carcinoma
End stage liver disease

Question 20

How does Hep C progress?

Answer 20

15% resolution
70% live with chronic
15% progress to cirrhosis, hepatocellular carcinoma and possible death

Question 21

How is HCV treated?

Answer 21

Direct acting antiviral oral drugs

Question 22

How is HCV diagnosed?

Answer 22

Test for the anti HCV antibody

Question 23

WHt is Hep D?

Answer 23

Small RNA virus that can co infect with HBV

Question 24

Why is HDV a confection with HBV?

Answer 24

HDV cannot support itself, it needs the HBV surface antigen

Question 25

How is hep B spread?

Answer 25

Blood, semen or other bodily fluids

Question 26

How is Hep D spread?

Answer 26

Blood, semen or other bodily fluids

Question 27

How does HDV infect with HBV?

Answer 27

Enveloped by the HB antigen

Question 28

What is hep E?

Answer 28

Self limiting virus | Most common cause of acute hepatitis in Grampian

Question 29

What is non alcoholic fatty liver disease>

Answer 29

Umbrella term encompassing simple steatosis, non alcohol steatohepatitis Fibrosis and cirrhosis

Question 30

With is non alcoholic fatty liver disease associated with?

Answer 30

Diabetes mellitus Obesity Hypertriglyceridaemia Hypertension

Question 31

What are th risk factors for non alcoholic fatty liver disease?

Answer 31

Age Ethnicity Genetic factors

Question 32

What is the natural progression of non alcoholic fatty liver disease?

Answer 32

Steatosis-->non alcohol steatohepatitis --> cirrhosis

Question 33

How is non alcoholic fatty liver disease diagnosed?

Answer 33

LFT Ultrasound Fibroscan Biopsy

Question 34

How is non alcoholic fatty liver disease treated?

Answer 34

Improve insulin sensitivity i.e., weight loss, exercise Treat risk factors i.e., diabetes, hypertension Avoid excessive alcohol

Question 35

What are the types of autoimmune liver disease?

Answer 35

Autoimmune hepatitis Primary biliary cholangitis Primary sclerosis cholangitis

Question 36

What does autoimmune hepatitis cause?

Answer 36

Elevated IgG

Question 37

How is autoimmune hepatitis diagnosed and treated?

Answer 37

Liver biopsy | Long term azathioprine steroid

Question 38

What does primary biliary cholangitis cause?

Answer 38

Elevated IgM positive antimicrobial antibody Pruritus and fatigue

Question 39

What anatomical structure is involved in primary biliary choangitis?

Answer 39

Intrahepatic bile duct

Question 40

What does primary scleroid cholangitis cause?

Answer 40

pANCA positive Stricturing Recurrent cholangitis, jaundice

Question 41

What anatomical structures are involved in primary sclerosis cholangitis?

Answer 41

Intra and extra hepatic bile ducts

Question 42

When is a liver transplant considered for patients?

Answer 42

Chronic liver disease with poor predicted survival or quality of life Hepatocellular carcinoma Acute liver failure Genetic diseases

Question 43

What are the contraindications for liver transplant?

Answer 43

Active extra hepatic malignancy Active substance or alcohol abuse Other comorbitities Brain death

Question 44

What gets priority on the liver transplant list?

Answer 44

Acute liver failure

Question 45

What is the prioritisation method for liver transplant?

Answer 45

UKELD scores

Question 46

What kind of transplant is a liver transplant?

Answer 46

Orthotopic

Question 47

What treatment is given post liver transplant?

Answer 47

ICU Antibiotics and antifungals Antirejections