Liver Symposium

Question 1

What forms of hepatitis are transmitted enterically

Answer 1

A

E

Question 2

Which forms of hepatitis are self-limiting acute infections

Answer 2

A

E

Question 3

Which forms of hepatitis cause chronic disease

Answer 3

B, C and D

Question 4

Transmission, Presentation, Diagnostics of Hep A (HAV)

Answer 4

T- faecal/oral, blood, sexual
P- Asymptomatic Presentation Common
D- IgM antibodies

Question 5

Who is immunised against Hep A

Answer 5

Traverllers
Patients with chronic liver disease (HCV/HBV)
Haemophiliacs
Occupational Lab wokrers
Homosexual Men

Question 6

Purpose of HBV Antibodies purpose
IgM anti-HBc
IgG anti HBc

Answer 6

IgM - indicates acute infection

IgG - indicates chronic infection/exposure.

Question 7

Treatment options for HBV

Answer 7

Pegylated Interfeon

Oral Antivirals

Question 8

Hep C/HCV , presentation & treatment

Answer 8

Rarely Jaundice or acute liver failure, mostly asymptomatic until cirrhotic. treated with antivirals.

Question 9

Hep D/ Delta Virus/ HDV

Answer 9

Small RNA virus, can form super infection with HBV. Very resistant to treatment

Question 10

Hep E/ HEV

Answer 10

Self-limiting, no specific treatment or vaccine available

Question 11

What is NAFLD and name three examples

Answer 11

Non-alcoholic fatty liver disease, associated with metabolic syndromes

• Simple Steatosis
• Non-alcoholic steatohepatitis
• Fibrous and Cirrhosis

Question 12

Examples of Metabolic Syndromes

Answer 12

Diabetes
Obesity
Hypertriglyceridemia
Hypertension

Question 13

What are risk factors for NAFLD

Answer 13

Age
Ethnicity - Hispanics
Genetics

Question 14

What is Steatosis

Answer 14

Abnormal retention of fat in the liver. Impairment of synthesis and elimination off triglycerides. Fatty Liver

Question 15

What is steatohepatitis

Answer 15

Inflammation caused by fat accumulation in the liver.

Question 16

Natural History of NAFLD

Answer 16

1. Normal
2. Steatosis
3. NASH - steatohepatitis
4. Cirrhosis

Question 17

How is NAFLD investigated and diagnosed?

Answer 17

AST/ALT ration
ELF panel (enhanced liver fibrosis)
US
Fibroscan
MR/CT
MR spectrscopy (quantify fat)
Biopsy
Cytokeratin-18 (linked to fibrosis

Question 18

Treatment of NAFLD

Answer 18

Diet and weight reduction
Exercise
Insulin sensitizers (metformin)
GLP-1
Vitamin E
Bariatric Surgery

Question 19

Name 3 autoimmune liver diseases

Answer 19

Autoimmune hepatitis
Primary biliary cholangitis
Primary sclerosing cholangitis

Question 20

Describe autoimmune hepatitis

Answer 20

Female>Males
Elevated IgG
Liver biopsy diagnostic
Responds well to steroids
Given long term azathiprime (immunodepressant)

Question 21

Describe Primary Biliary Cholangitis (PBC)

Answer 21

Female Predominant

Chronic Disease of the smaller bile ducts in the liver, not detected on MRI due to size and is instead detecting by antibody tests (IgM elevation, anti-mitochondiral antibody positive).

Treatment of choice UDCA Ursodeoxycholic acid.

Question 22

Describe Primary sclerosing cholangitis (PSC)

Answer 22

Male predominant

Inflammation and scarring of the bile ducts resulting in sclerosis and narrowing, leading to liver damage as bile cannot be released properly. This affects that med-large bile ducts.

pANCA postive. Stricturing disease. MRCP test of choice.

Given liver transplantation or biliiary stents.

Question 23

Post transplantation treatment

Answer 23

Post OP - ICU
Prophlatic antibiotics and antifungals

Antirejection drigs - steroids, azathioprine Tacrolimus/Cyclosporine
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