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07. Year 2: Alimentary System > Liver Symposium > Flashcards

Liver Symposium Flashcards

1
Q

What are some examples of major liver diseases?

A

Alcohol related liver disease

Viral hepatitis

Non-alcohol fatty liver disease

Autoimmune liver diseases

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2
Q

What are the 5 main groups of viruses that cause viral hepatitis?

A

Hepatitis A

Hepatitis B

Hepatitis C

Hepatitis D

Hepatitis E

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3
Q

Which of the hepatitis viruses are enteric viruses?

A

A and E

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4
Q

What are enteric viruses?

A

Ones transmitted by the faecal-oral route

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5
Q

What hepatitis viruses are parenteral?

A

Hepatitis B, C and D

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6
Q

What does parenteral mean?

A

Administered elsewhere than the mouth and alimentary canal

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7
Q

What hepatitis viruses cause self-limiting infections?

A

A and E

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8
Q

What hepatitis viruses cause chronic infections?

A

B, C and D

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9
Q

What does transmission of hepatitis A occur by?

A

Faecal-oral route

Sexual

Blood

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10
Q

What is the most common age group infected with hepatitis A?

A

5 to 14 years

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11
Q

Is the prevalence of hepatitis A increasing or decreasing worldwide?

A

Decreasing

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12
Q

What is acute disease caused by hepatitis A diagnosed by?

A

IgM antibodies

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13
Q

Who are vacines for hepatitis A given to?

A

Travellers

Patients with chronic liver disease

Haemophiliacs

Occupational exposure (lab workers)

Men who have sex with men

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14
Q

What are examples of hepatitis B antigens?

A

Hepatitis surface antigen (HBsAg)

Hepatitis e antigen (HBeAg)

Hepatitis core antigen (HBcAg)

HBV DNA

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15
Q

What does hepatitis surface antigen (HBsAg) indicated?

A

Presence of hep B virus

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16
Q

What does hepatitis e antigen (HBeAg) indicate?

A

Active replication

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17
Q

What does hepatitis core antigen (HBcAg) indicate?

A

Active replication

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18
Q

What does HBV DNA indicate?

A

Active replication

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19
Q

What are examples of HBV antibodies?

A

Anti-HBs

IgM anti-HBc

IgG anti-HBc

Anti-HBe

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20
Q

What does anti-HBs antibody indicate?

A

Protection

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21
Q

What does IgM anti-HBc indicate?

A

Acute infection

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22
Q

What does IgG anti-HBc indicate?

A

Chronic infection/exposure

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23
Q

What does anti-HBe indicate?

A

Inactive virus

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24
Q

What can hepatitis B infections possible lead to?

A

Resolution (no further progress) or cirrhosis

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25
Q

What are treatment options for hepatitis B infections?

A

Pegylated interferon

Oral antiviral drugs

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26
Q

What oral therapies are available for hepatitis B infections?

A

Lamivudine

Adefovir

Entecavir

Telbivudine

Tenofovir

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27
Q

What can be said about hepatitis C and symptoms?

A

Is usually asymptomatic

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28
Q

What are LFTs like with hep C infection?

A

Can be normal

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29
Q

What is the treatment for hepatitis C infection?

A

IFN-free combination of direct acting antiviral drugs

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30
Q

What kind of virus is hepatits D?

A

Small RNA virus

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31
Q

What are consequences of hepatitis D being a small RNA virus?

A

Does not code for its own protein coat

Enveloped by HBsAg

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32
Q

What can you also be infected with as well as hepatitis D for it to become a superinfection?

A

HBV

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33
Q

What is the transmission of hepatitis D?

A

The same as hepatitis B

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34
Q

What can be said about how easy treatment of hepatitis D is?

A

It is very resistent to treatment

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35
Q

What problems can hepatitis E cause?

A

Self limiting, no long term problems

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36
Q

What treatments/vaccines are available for hepatitis E?

A

No specific treatments

No effective vaccine currently available

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37
Q

Other than hepatitis A to E, what are other viruses that affect the liver?

A

Hepatits F

Hepatitis G

EBV and CMV

Herpes simplex

38
Q

What is hepatitis G related to?

A

Hepatitis C

39
Q

What is hepatitis F a possible variant of?

A

Hepatitis B

40
Q

What does EBV stand for?

A

Epstein-barr virus

41
Q

What does CMV stand for?

A

Cytomegalovirus

42
Q

What does NAFLD stand for?

A

Non-alcoholic fatty liver disease

43
Q

What is non-alcoholic fatty liver disease (NAFLD)?

A

An umbrella term that covers:

simple steatosis

non-alcoholic steatohepatitis

fibrosis and cirrhosis

44
Q

What is metabolic syndrome?

A

Cluster of conditions that occur together

45
Q

What components of metabolic syndrome is non-alcoholic fatty liver disease associated with?

A

Diabetes mellitus

Obesity

Hypertriaglyceridaemia

Hypertension

46
Q

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

A

Age

Ethnicity (such as Hispanics)

Genetic factors (such as PNPLA3 gene)

47
Q

What gene is associated with non-alcoholic fatty liver disease?

A

PNPLA3 gene

48
Q

What do people with non-alcoholic fatty liver disease normally die of?

A

Cardiovascular problems, not liver problems (only 5% do)

49
Q

What does diagnosis of non-alcoholic fatty liver disease involve?

A

Biochemical tests (AST/ALT ratio)

Enhanced liver fibrosis panel (ELF)

Cytokeratin-18

US

Fibroscan

MR/CT

MR spectroscopy

Liver biopsy

50
Q

What does a enhanced liver fibrosis panel (ELF) measure?

A

Hyaluronic acid

TIMP-1

PIINP

51
Q

What is used to classify patients with non-alcoholic fatty liver disease as high or low risk?

A

NAFLD score

52
Q

What NAFLD score indicates high risk?

A

3 or more

53
Q

What does a NAFLD score consider?

A

Age

Diabetes

BMI

AST:ALT

Platelet count

Albumin

54
Q

What is age high risk for NAFLD?

A

>45

55
Q

What state of diabetes is high risk for NAFLD?

A

Present

56
Q

What BMI is high risk for NAFLD?

A

>30

57
Q

What AST:ALT is high risk for NAFLD?

A

>1 (AST>ALT)

58
Q

What platelet count is high risk for NAFLD?

A

Low (<150)

59
Q

What albumin level is high risk for NAFLD?

A

Low (<34)

60
Q

What is the treatment for NAFLD?

A

Diet and weight reduction

Exercise

Insulin sensitizers

Glucagon like peptide-1 (GLP-1) analogues

Farnesoid X nuclar ligand

Vitamin E

Weight reduction surgeries

61
Q

What are examples of autoimmune liver disease?

A

Autoimmune hepatitis

Primary biliary cholangitis (PBC)

Primary sclerosing cholangitis (PSC)

Overlap syndromes

Autoimmune cholangiopathy

IgG 4 disease

62
Q

What does PBC stand for?

A

Primary biliary cholangitis

63
Q

What does PSC stand for?

A

Primary sclerosing cholangitis

64
Q

Does autoimmune hepatitis affect more males or females?

A

Females

65
Q

What antibody is elevated in autoimmune hepatitis?

A

IgG

66
Q

What are the 3 types of antibodies involved in autoimmune hepatitis?

A

Type 1 (ANA, SMA)

Type 2 (LKM1)

Type 3 (SLA)

67
Q

What is used to diagnose autoimmune hepatitis?

A

Liver biopsy

68
Q

What does autoimmune hepatitis respond well to?

A

Steroids

69
Q

What is the treatment for autoimmune hepatitis?

A

Long term azathioprine

Steroids

70
Q

Does primary biliary cholangitis (PBC) affect more males or females?

A

Females

71
Q

What antibody is elevated in PBC?

A

IgM

72
Q

What symptoms are common for PBC?

A

Pruritus and fatigue

73
Q

What is the treatmet for PBC?

A

Ursodeoxycholic acid (UDCA)

74
Q

Does primary sclerosing cholangitis affect more males or females?

A

Males

75
Q

What antibody is active for primary sclerosing cholangitis?

A

pANCA

76
Q

What bile ducts are involved with PBC?

A

Intrahepatic bile duct

77
Q

What bile ducts are involved with PSC?

A

Intra and extrahepatic bile ducts

78
Q

What does PSC lead to?

A

Stricturing

79
Q

What is the test of choice for PSC?

A

MRCP

80
Q

What is the clinical presentation of PSC?

A

Recurrent cholangitis

Jaundice

81
Q

What is the management of PSC?

A

Liver tests

Biliary stents

82
Q

Who gets a liver transplant?

A

Chronic liver disease with poor predicted survival

Chronic liver disease wth associated poor quality of life

Hepatocellular carcinoma

Acute liver failure

Genetic diseases such as primary oxaluria, tyrosemia

83
Q

What are contraindications for a liver transplant?

A

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

Psychosocial factors that would proclude recovery after transplantation

Technical and/or anatomical barriers

Brain death

84
Q

What is used to prioritis cirrhosis for liver transplants?

A

Child’s Pugh scoring A,B and C (same way as people donate blood to the same blood group)

MELD score (bilirubin, creatinine and INR)

UKELD (bilirubin, sodium, creatinine and INR)

85
Q

What does the MELD score consider?

A

Bilirubin

Creatinine

INR

86
Q

What does the UKELD score consider?

A

Bilirubin

Sodium

Creatinine

INR

87
Q

How does survival change as MELD score increases?

A

Survival decreases

88
Q

Liver tranplants are put into the same place where the old liver was, what is this called?

A

Orthotopic

89
Q

What post-operative treatment is required for liver transplants?

A

Post-operative ICU care

Multidisciplinary care

Prophylactic antibiotics and anti-fungal drugs

Anti-rejection drugs (steroids, azathoprine, tacrolimus/cyclosporine)

90
Q

What are some anti-rejection drugs for a liver transplant?

A

Steroids

Azathioprine

Tacrolimus/cyclosporine

07. Year 2: Alimentary System (41 decks)

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