Liver Symposium

Question 1

What is the transmission for hepatitis A?

Answer 1

Faecal-oral

Question 2

Where is prevalence for hepatitis A high?

Answer 2

In areas with poor sanitation

Question 3

Regarding to HAV what does elevated IgM suggest?

Answer 3

Acute infection

Question 4

Regarding HAV what does elevated IgG suggest?

Answer 4

Chronic infection

Question 5

Give examples of groups that should be immunised against hepatitis

Answer 5

Travellers 
Patients with chronic liver disease
Haemophiliacs 
Occupational exposure 
Men who have sex with men

Question 6

What does the presence of HBsAg indicate?

Answer 6

Presence of the virus

Question 7

Does the presence of HBsAg suggest active or non-active replication?

Answer 7

Can be either

Question 8

What does the presence of HBV e antigen suggest?

Answer 8

Active replication

Question 9

What does the presence of HBV DNA suggest?

Answer 9

Active replication

Because you find the physical DNA of the virus

Question 10

What does Anti-HBs in the blood suggest?

Answer 10

Protection against HBV

Question 11

What does the presence of IgM anti-HBc suggest?

Answer 11

Acute infection

Acquired within the last 6 months

Question 12

What does the presence of IgG anti-HBc suggest?

Answer 12

Chronic infection/exposure to HBV

Question 13

What does Anti-HBe suggest?

Answer 13

That the virus is inactive

Question 14

What is key for the treatment of HBV?

Answer 14

Prevention

Question 15

What prevention methods are there for HBV?

Answer 15

Immunisation
Safe sex
Using gloves (lab workers)
Avoidance of sharing IV drug abuse

Question 16

What are the 3 stages of HBV infection?

Answer 16

Replicative stage in which levels of HBV are high and liver damage is being cause
Inflammatroy phase where aminotransferases are elevated, liver biopsy shows chronic infection but replication declines
Patients amy enter inactive phase where viral replication has stopped and there is no ongoing liver inflammation

Question 17

Do all cases of HBV progress to liver cirrhosis?

Answer 17

No

in most cases hepatitis B does not progress

Question 18

Is progression to chronic hepatitis more prominent in the HCV or HBV?

Answer 18

HCV

Question 19

What % of HCV progresses to chronic infection?

Answer 19

85%

Question 20

What are the symptoms of HCV?

Answer 20

Mostly asymptomatic until cirrhotic

Question 21

What % of chronic HCV progresses to liver cirrhosis?

Answer 21

20%

Question 22

What is the route of infection of HCV?

Answer 22

Blood-blood

Question 23

What is HDV a parasite of?

Answer 23

Hep B

Question 24

Why is Hep D considered to be a satellite virus?

Answer 24

Because it needs the host to be infected with Hep B also

Question 25

Is Hep D + Hep B easy to treat?

Answer 25

No it is very resistant to treatment

Question 26

How is hepatitis B spread?

Answer 26

Blood-blood

Question 27

What is the transmission route for hepatitis E?

Answer 27

Faecal-oral

Question 28

Is there a vaccination for HEV?

Answer 28

No

Question 29

What is co-infection?

Answer 29

When HBV and HDV infect at the same time

Question 30

What is super-infection?

Answer 30

When HDV infects sometime after HBV has infected

Question 31

Rx HBV

Answer 31

Pegylated interferon Oral antiviral drugs: Lamivudine Adefovir Entecavir

Question 32

Is there a vaccine for HBV?

Answer 32

Yes

Question 33

Is there a vaccine available for HCV?

Answer 33

No

Question 34

What is the treatment for hep C?

Answer 34

Pegylated interferon | Ribavirin

Question 35

What is the treatment for Hep B?

Answer 35

Oral antiviral drugs e.g lamivudine Pegylated interferon

Question 36

What are the 5 main viruses that cause viral hepatitis?

Answer 36

A,B,C,D and E

Question 37

Which viruses are enteric viruses?

Answer 37

A and E

Question 38

What is meant by enteric viruses?

Answer 38

Food, water, faecal and oral transmission

Question 39

What is meant by a parental virus?

Answer 39

Transmission method is by the blood

Question 40

Which viruses are acute viruses?

Answer 40

A and E

Question 41

Which hepatitis viruses can become chronic?

Answer 41

B,C and D

Question 42

How does HAV present?

Answer 42

Fever high liver enzymes Diagnosis made by detecting certain antibodies in the blood

Question 43

What is the diagnostic test for HCV?

Answer 43

Test for HCV antibody

Question 44

Is there any vaccine available for HEV?

Answer 44

No

Question 45

Who is NAFLD common in?

Answer 45

``` Those with: DM Obesity Hypertriglyceridemia Hypertension ```

Question 46

What are the other risk factors for NAFLD?

Answer 46

Age ethnicity Genetic factors

Question 47

What are the 3 types of autoimmune liver diseases?

Answer 47

Autoimmune hepatitis Primary biliary cholangitis Primary sclerosing cholangitis

Question 48

Is autoimmune hepatitis more common in M or F?

Answer 48

F

Question 49

Which antibody is elevated in autoimmune hepatitis?

Answer 49

IgG

Question 50

How is autoimmune hepatitis diagnosed?

Answer 50

Liver biopsy | and antibody testing

Question 51

How is autoimmune hepatitis treated?

Answer 51

With steroids

Question 52

Which gender is predominantly affected with primary biliary cholangitis?

Answer 52

F

Question 53

Which antibody is elevated in primary biliary cholangitis?

Answer 53

IgM

Question 54

What would be seen on liver biopsy in primary biliary cholangitis?

Answer 54

Inflammation around the bile ducts

Question 55

Which bile ducts are affected in primary biliary cholangitis?

Answer 55

Intrahepatic bile duct

Question 56

What symptoms are common in primary biliary cholangitis?

Answer 56

Pruritus and fatigue

Question 57

How does primary biliary cholangitis affect the liver?

Answer 57

The bodies immune system attacks the intrahepatic biliary tree

Question 58

How does primary sclerosing cholangitits `ffect the liver?

Answer 58

The bodies immune system attacks the intra and extra hepatic bile cuts

Question 59

What can primary sclerosing C. cause?

Answer 59

Jaundice

Question 60

What are the reasons for liver transplantation?

Answer 60

Chronic liver disease Hepatocellular carcinoma Acute liver failure Genetic diseases

Question 61

What are contraindications for liver transplant?

Answer 61

``` Active extra hepatic malignancy Active substance or alcohol abuse Brain death Technical/anatomical barriers Active and uncontrolled infection outside the hepatobiliary system Severe cardiopulmonary or other comorbid conditions ```

Question 62

What scores are used to prioritise those with cirrhosis that are suitable for transplantation?

Answer 62

MELD score | UKELD score

Question 63

What are some components of post-operative treatment of liver transplantation?

Answer 63

Post operative ICU care Multidisciplinary care Prophylactic antibiotics and anti-fungal drugs Anti rejection drugs

Question 64

Give an example of an anti- rejection drug?

Answer 64

Steroids Azathioprine Tacrolimus

Question 65

What is the gold standard for HCV diagnosis?

Answer 65

HCV RNA PCR

Question 66

What is autoimmune hepatitis?

Answer 66

Chronic autoimmune disease of the liver

Question 67

Hows does autoimmune hepatitis come about?

Answer 67

When abnormal T cells and antibodies direct attack against hepatocyte surface antigens

Question 68

What classifies type 1 AIH?

Answer 68

ANA and SMA antibodies

Question 69

What classifies type 2 AIH?

Answer 69

LKM1 antibodies

Question 70

What classifies type 3 AIH?

Answer 70

SLA antibodies

Question 71

Investigations for AIH?

Answer 71

``` Antibodies: ANA SMA LKM1 SLA IgG ``` LFTs Liver biopsy

Question 72

RX AIH?

Answer 72

Prednisolone (steroid) Azathioprine (immunosuppressant) Liver Tx