Liver Symposium Flashcards
(32 cards)
Five main types of hepatitis virus?
ABCDE
How is Hepatitis A transmitted?
Enteric
Faecal - oral (food & water)
Sexual
Blood
How is acute Hep A diagnosed?
Diagnosed by IgM antibodies
Increased transaminases
Which hepatitis viruses cause chronic infection? Which cause self limiting acute infection?
B, C & D cause chronic infection
A & E cause acute
Who needs Hep A immunisation?
Travellers Patients with chronic liver disease Haemophiliacs Occupational exposure (lab workers) MSM (gay dudes)
Mechanism by which Hep B escapes immune system?
When spreading hosts it creates a lot of empty “shells” containing Hep B surface antigens - but without active virus
When transmission occurs the immune system has to find the active virus among the several decoys
What are the Hep B antigens and what do they tell us?
Hepatitis surface antigen (HBsAg) - presence of virus
Hepatitis e antigen (HBeAg) - active replication
Hepatitis core antigen (HBcAg) - active replication (not detected in blood)
Hep B DNA - Quantifies viral replication
What are the Hep B antibodies and what do they tell us about the infection/host?
IgM anti-HBc - acute infection
IgG anti-HBc chronic infection
Anti-HBs - protection
Anti-HBe - inactive virus
What is the normal natural course of Hep B infection?
If you get acute infection 90% will clear the infection
Only about 10% progress to chronic infection
How does chronic Hep B infection tend to progress?
Some patients disease is not progressive
Others develop liver cirrhosis which leads to either end stage liver disease or hepatocellular carcinoma
Treatment options for Hep B infection?
Pegylated interferon (class of drugs) Oral antiviral drugs
What is the progression of Hep C infection like?
Rarely causes acute liver failure, most people asymptomatic until cirrhotic
About 85% of infected progress to chronic infection
What percentage of patients with chronic Hep C infection progress to liver cirrhosis?
20% (according to lecture)
(30% according to green book)
Rest have stable chronic Hep C infection
Is Hep C a fatal disease?
Due to advancements in treatment about 95% curable by oral drugs over the course of 3 months
When can Hep D infection occur?
With simultaneous Hep B infection - needs to be enveloped by HBsAg
Makes infection very resistant to treatment
Does Hep E infection tend to progress to chronic infection?
No. Acute, self limiting. No long term form
Usually resolves within 2-6 weeks
Other viruses causing liver disease?
Hepatitis F Hep G EBV CMV (cytomegalovirus) Herpes simplex
What conditions does Non-Alcoholic Fatty Liver Disease encompass?
Simple steatosis
Non - alcoholic steatohepatitis (NASH)
Fibrosis and cirrhosis
Caused by excess fat in the liver
Risk factors for non-alcoholic fatty liver disease (NAFLD)?
diabetes mellitus Obesity Hypertriglyceridemia Hypertension Age Ethnicity Genetics
Natural progression of NAFLD?
Normal liver
Steatosis
Non-alcoholic steatohepatitis (+/- fibrosis)
Cirrhosis
Investigations for NAFLD?
*Fibroscan (specialized ultrasound) Bloods (AST/ALT ratio, cytokeratin-18) Ultrasound MRI/CT MR spectroscopy (quantify fat) Liver biopsy
Treatment of NAFLD?
Vitamin E Diet Exercise Insulin sensitizers Bariatric surgery
3 main autoimmune liver & biliary system diseases?
Autoimmune hepatitis
Primary biliary cholangitis
Primary sclerosing cholangitis
Markers of autoimmune hepatitis? Treatment options?
Elevated IgG
Responds well to steroids
Long term azathioprine (immune suppressant)
