60 Chronic Liver Disease Overview
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Questions and Answers

Which of the following is the leading cause of alcohol-related liver disease in Ireland?

  • Hereditary hemochromatosis
  • Non-alcoholic fatty liver disease
  • Paracetamol overdose
  • Excessive alcohol consumption (correct)

    • Which viral hepatitis strains are predominantly associated with chronic liver disease?

  • Hepatitis D and G
  • Hepatitis A and E
  • Hepatitis B and C (correct)
  • Hepatitis B and A

    • What condition results from genetic deficiencies of alpha-1 antitrypsin?

  • Non-alcoholic fatty liver disease
  • Alcohol-related liver disease
  • Wilson's disease
  • Alpha-1 antitrypsin deficiency (correct)

    • Which autoimmune condition is associated with cholestasis and can cause cirrhosis?

    <p>Primary biliary cholangitis</p> Signup and view all the answers

    Which of the following medications is known to cause acute liver failure?

    <p>Acetaminophen</p> Signup and view all the answers

    Which autoimmune liver disease is primarily characterized by a T-lymphocyte-mediated attack on small intralobular bile ducts?

    <p>Primary Biliary Cholangitis</p> Signup and view all the answers

    Which of the following is NOT commonly associated with Primary Biliary Cholangitis?

    <p>Ulcerative colitis</p> Signup and view all the answers

    What symptom is typically associated with Hepatic encephalopathy?

    <p>Decreased Glasgow Coma Scale</p> Signup and view all the answers

    Which sign is NOT typically associated with chronic liver disease?

    <p>Hyperreflexia</p> Signup and view all the answers

    In autoimmune hepatitis, what demographic is most commonly affected?

    <p>Females, at a ratio of 4:1 compared to males</p> Signup and view all the answers

    Which of the following symptoms is associated with fluid accumulation due to ascites?

    <p>Abdominal distension</p> Signup and view all the answers

    What is the characteristic pathology in Primary Sclerosing Cholangitis?

    <p>Fibrosis and stricturing of bile ducts</p> Signup and view all the answers

    Which of the following symptoms is NOT typically present in chronic liver disease?

    <p>Deep vein thrombosis</p> Signup and view all the answers

    Which of the following conditions can lead to chronic liver disease and cirrhosis?

    <p>Hepatitis C</p> Signup and view all the answers

    What characterizes Non-Alcoholic Fatty Liver Disease (NAFLD)?

    <p>It can progress from steatosis to cirrhosis without significant alcohol intake.</p> Signup and view all the answers

    Which hepatitis type is associated with the highest incubation period?

    <p>Hepatitis B</p> Signup and view all the answers

    What risk factor is specifically associated with Hepatitis C?

    <p>Blood transfusions prior to 1992</p> Signup and view all the answers

    Among the following, which hepatitis type cannot cause chronic hepatitis?

    <p>Hepatitis E</p> Signup and view all the answers

    What is a common cause of fatty liver in individuals without excessive alcohol intake?

    <p>High calorie intake and obesity</p> Signup and view all the answers

    Which of these statements about Hepatitis A transmission is true?

    <p>It can be transmitted through sexual contact.</p> Signup and view all the answers

    What histological change marks the progression from Non-Alcoholic Fatty Liver to cirrhosis?

    <p>Regenerative nodules and fibrosis</p> Signup and view all the answers

    Which hepatitis virus is known to be associated with a vaccine?

    <p>Both A and B</p> Signup and view all the answers

    Which population is at increased risk for Hepatitis B infection?

    <p>Those who have received body piercings</p> Signup and view all the answers

    What is a key characteristic of autoimmune hepatitis?

    <p>Positive SMA and ANA antibodies</p> Signup and view all the answers

    What is the primary risk associated with long-term steroid use in autoimmune hepatitis treatment?

    <p>Bone density reduction</p> Signup and view all the answers

    Which statement about prednisolone treatment is incorrect?

    <p>Sudden cessation of steroids poses no risk</p> Signup and view all the answers

    Which demographic is most commonly affected by autoimmune hepatitis?

    <p>Middle-aged women and teenagers, particularly non-drinkers</p> Signup and view all the answers

    Which screening complication is associated with primary sclerosing cholangitis?

    <p>Cholangiocarcinoma</p> Signup and view all the answers

    How does autoimmune hepatitis typically present on a biopsy?

    <p>Interface hepatitis with lymphoplasmacytic infiltrate</p> Signup and view all the answers

    What is the likelihood of treatment failure with Azathioprine in autoimmune hepatitis?

    <p>20%</p> Signup and view all the answers

    What findings would most likely indicate cholestatic liver disease?

    <p>Jaundice and elevated alkaline phosphatase</p> Signup and view all the answers

    What is indicated by a raised ALT/AST ratio greater than 2:1?

    <p>Alcoholic hepatitis</p> Signup and view all the answers

    Which of the following tests is NOT typically used to investigate Hepatitis C?

    <p>Bilirubin test</p> Signup and view all the answers

    Which liver function test measures synthetic liver function?

    <p>Prothrombin time</p> Signup and view all the answers

    In managing Non-Alcoholic Fatty Liver Disease, which option is essential?

    <p>Weight loss</p> Signup and view all the answers

    What is the priority for Hepatitis C treatment?

    <p>Patients with significant fibrosis or cirrhosis</p> Signup and view all the answers

    What does a raised ALT/AST ratio greater than 2:1 typically indicate?

    <p>Alcoholic hepatitis</p> Signup and view all the answers

    Which of the following liver function tests is primarily a measure of liver synthetic function?

    <p>Albumin</p> Signup and view all the answers

    In the diagnosis of Non-Alcoholic Fatty Liver Disease, which factor must be excluded?

    <p>Significant alcohol consumption</p> Signup and view all the answers

    What is a critical priority in the treatment of Hepatitis C for patients with significant fibrosis or cirrhosis?

    <p>Immediate treatment initiation</p> Signup and view all the answers

    Which investigation method is often used to demonstrate the presence of hepatic steatosis?

    <p>Imaging or biopsy</p> Signup and view all the answers

    Which of the following organs is NOT commonly affected by hereditary haemochromatosis?

    <p>Lungs</p> Signup and view all the answers

    What is a common neurological symptom associated with Wilson's disease?

    <p>Cerebellar ataxia</p> Signup and view all the answers

    Which genetic factor is primarily linked to hereditary haemochromatosis?

    <p>HFE C282Y variant</p> Signup and view all the answers

    What is the most significant risk factor for developing liver cirrhosis in Wilson's disease?

    <p>Impaired biliary copper excretion</p> Signup and view all the answers

    How is hereditary haemochromatosis typically diagnosed?

    <p>Integration of genetic information and tissue iron markers</p> Signup and view all the answers

    Which of the following symptoms is least associated with hereditary haemochromatosis?

    <p>Chronic fatigue syndrome</p> Signup and view all the answers

    What is a potential outcome of untreated Wilson’s disease?

    <p>Acute liver failure</p> Signup and view all the answers

    What is a characteristic feature of Wilson’s disease pathology?

    <p>Impaired intracellular copper transport</p> Signup and view all the answers

    What is the duration of treatment for Glecaprevir and Pibrentasvir?

    <p>8 weeks</p> Signup and view all the answers

    Which serological marker indicates a high infectivity level in Hepatitis B?

    <p>HBeAg</p> Signup and view all the answers

    What is the primary treatment option for Primary Biliary Cholangitis?

    <p>UDCA</p> Signup and view all the answers

    Which of the following is a typical diagnostic feature of Primary Sclerosing Cholangitis?

    <p>Beaded appearance of bile ducts</p> Signup and view all the answers

    What is the target ferritin level during the maintenance phase of hereditary haemochromatosis management?

    <p>50-100 µg/L</p> Signup and view all the answers

    What is a common laboratory finding in patients with Primary Biliary Cholangitis?

    <p>Elevated cholesterol in 85% of cases</p> Signup and view all the answers

    What is the role of family screening in hereditary haemochromatosis?

    <p>It helps in early detection</p> Signup and view all the answers

    Which of the following medications is recommended in the treatment of Hepatitis B?

    <p>Entecavir</p> Signup and view all the answers

    Which condition could lead to liver cirrhosis due to excessive copper deposition?

    <p>Wilson's disease</p> Signup and view all the answers

    In the differential diagnosis for cirrhosis, which of the following is a known toxin that can cause liver damage?

    <p>Paracetamol</p> Signup and view all the answers

    Which autoimmune condition is most directly linked to bile duct damage and can lead to cirrhosis?

    <p>Primary sclerosing cholangitis</p> Signup and view all the answers

    What common medication is associated with liver toxicity and is often mentioned in differential diagnoses for cirrhosis?

    <p>Methotrexate</p> Signup and view all the answers

    Which hereditary condition primarily results from iron overload leading to liver cirrhosis?

    <p>Hemochromatosis</p> Signup and view all the answers

    What is a common feature of Non-Alcoholic Fatty Liver Disease (NAFLD)?

    <p>Characterized by a histological spectrum including steatosis and steatohepatitis</p> Signup and view all the answers

    Which type of hepatitis cannot lead to chronic infection?

    <p>Hepatitis E</p> Signup and view all the answers

    Which of the following factors is associated with the development of Non-Alcoholic Fatty Liver Disease?

    <p>High fructose intake</p> Signup and view all the answers

    What is a risk associated with hepatitis C infection?

    <p>Increased risk of primary hepatocellular carcinoma after developing chronic hepatitis</p> Signup and view all the answers

    What is a common diagnostic criterion for diagnosing Non-Alcoholic Fatty Liver Disease?

    <p>Fatty liver on imaging without significant alcohol use</p> Signup and view all the answers

    Which type of hepatitis B transmission is not classified as percutaneous?

    <p>Perinatal from mother to child</p> Signup and view all the answers

    What is a primary feature of Wilson's disease as it relates to liver pathology?

    <p>It involves abnormal copper accumulation leading to liver damage</p> Signup and view all the answers

    What is the incubation period range for Hepatitis B?

    <p>50 - 180 days</p> Signup and view all the answers

    In the context of chronic hepatitis C, what is the typical progression rate towards cirrhosis?

    <p>1 - 4% per year</p> Signup and view all the answers

    Which of the following statements regarding Hepatitis E is correct?

    <p>It can cause chronic infection in immunosuppressed individuals</p> Signup and view all the answers

    Study Notes

    Hep E

    • Hep E can very rarely have a chronic course in profoundly immunosuppressed individuals

    Hereditary Haemochromatosis

    • Hereditary Haemochromatosis is a cause of chronic liver disease

    Wilsons disease

    • Wilsons disease is a cause of chronic liver disease

    Autoimmune Liver Disease

    • Primary biliary cholangitis, primary sclerosing cholangitis, autoimmune hepatitis are causes of chronic liver disease

    Non Alcoholic Fatty Liver Disease (NAFLD)

    • High calorie intake, high fructose intake, saturated fat intake and sedentary behaviour are associated with NAFLD
    • Western diet and lifestyle is associated with weight gain, obesity, and NAFLD
    • NAFLD is alcohol-like liver disease in individuals who do not consume excessive alcohol
    • NAFLD can progress through a histologic spectrum of liver damage including NAFLD (steatosis), steatohepatitis (NASH), and cirrhosis
    • NAFLD diagnosis is one of exclusion and is made by fatty liver on imaging (ultrasound) in the absence of alcohol excess and features of the metabolic syndrome

    Viral Hepatitis

    • Viral hepatitis is caused by HAV, HBV, HCV, HEV
    • HAV is an RNA virus with an incubation period of 15-50 days
    • HBV is a DNA virus with an incubation period of 50-180 days
    • HCV is an RNA virus with an incubation period of 14-84 days
    • HEV is an RNA virus with an incubation period of 15-60 days
    • All four viruses can cause acute hepatitis
    • HBV and HCV can cause chronic hepatitis
    • HBV and HCV can cause cirrhosis and primary hepatocellular carcinoma
    • Vaccines are available for HAV and HBV

    Hepatitis A

    • Hep A is spread through close personal contact via household or sexual contact and at day-care centres
    • Hep A is spread through fecal-oral contamination of food or water
    • Hep A is spread through blood-borne transmission in injecting drug users (rare)

    Hepatitis C Risk Factors

    • Hepatitis C risk factors include:
      • clotting factor treatment prior to 1987
      • blood transfusion or organ transplant prior to 1992
      • long-term hemodialysis
      • multiple sexual partners
      • injection drug use
      • mass injections and traditional practices
      • birth from an infected mother

    Hepatitis C Disease Course

    • 55-85% of individuals with acute hepatitis C develop chronic infection
    • 70% of those with chronic infection develop chronic hepatitis
    • 1-4% per year of those with chronic hepatitis develop cirrhosis
    • 20% of those with chronic hepatitis develop hepatocellular carcinoma (HCC)
    • 4-5% per year of those with cirrhosis experience decompensation

    Hepatitis B Transmission

    • Hepatitis B transmission routes include percutaneous and perimucosal
    • Percutaneous transmission occurs through injection drug use, transfusion or transplant, occupational exposure, and parenteral practices
    • Perimucosal transmission occurs through perinatal, sexual, and household transmission
    • Investigate recent travel/previous residency in high-risk endemic countries such as Southeast Asia and Africa.

    Autoimmune Liver Disease: Primary Biliary Cholangitis (PBC)

    • PBC features a T-lymphocyte mediated attack on small intralobular bile ducts
    • The continuous assault on bile duct epithelial cells leads to their gradual destruction and eventual disappearance
    • PBC is associated with female gender (95%), Sjogren's syndrome, autoimmune thyroid disease, rheumatoid arthritis, celiac disease, and inflammatory bowel disease
    • Approx 50% of individuals with PBC are asymptomatic at the time of diagnosis
    • Symptoms of liver disease may present

    Autoimmune Liver Disease: Primary Sclerosing Cholangitis (PSC)

    • PSC is a chronic progressive disorder of unknown aetiology
    • PSC is characterized by inflammation, fibrosis, and stricturing of medium and large ducts in the intrahepatic and/or extrahepatic biliary tree
    • PSC is associated with ulcerative colitis

    Autoimmune Liver Disease: Autoimmune Hepatitis (AH)

    • AH is a chronic inflammatory disease of the liver
    • AH is characterized by circulating autoantibodies and elevated serum globulin levels
    • AH is associated with a female to male ratio of 4:1

    History for Chronic Liver Disease and Cirrhosis

    • Important history includes:
      • alcohol use
      • medication use
      • drug use, especially IV drug use
      • recent travel to endemic areas
      • skin pigmentation
      • obesity
      • family history

    Symptoms of Chronic Liver Disease and Cirrhosis

    • Non-specific symptoms include fatigue, anorexia, and weight loss
    • Decreased Glasgow Coma Scale indicates hepatic encephalopathy
    • Jaundice is a symptom
    • Itch (bile salt deposition in the skin) is a symptom
    • Abdominal distension (ascites secondary to portal hypertension) is a symptom
    • Weight gain (fluid accumulation - ascites) is a symptom
    • Malaena or haematemesis (variceal bleeding) is a symptom
    • Infertility (CLD leads to infertility) is a symptom
    • Irregular menstrual bleeding is a symptom

    Signs of Chronic Liver Disease and Cirrhosis

    • General inspection:
      • Decreased GCS indicates hepatic encephalopathy
      • Confabulation indicates Korsakoff's
      • Jaundice indicates increased bilirubin
      • Grey pigmentation/tanned indicates haemochromatosis
    • Arms:
      • Bruising
      • Scratch marks
      • Tattoos
      • Proximal muscle wasting
      • Needle track marks
    • Head and Neck:
      • Scleral icterus
      • Fetor hepaticus
      • Conjunctival pallor
      • Angular stomatitis
      • Raised Jugular Venous Pressure (JVP)
      • Spider naevi
      • Gynaecomastia and reduced body hair
    • Hands:
      • Clubbing
      • Palmer erythema indicates alcohol excess
      • Dupuytrens contracture
      • Asterixis indicates grade 2 hepatic encephalopathy
    • Abdomen:
      • Hepatomegaly
      • Splenomegaly
      • Ascites
      • Caput medusa
    • Other:
      • Lower limb pitting oedema
      • DRE -> Haemorrhoids

    Differential Diagnosis for Cirrhosis

    • Alcohol related liver disease
    • Non-alcoholic fatty liver disease
    • Viral Hepatitis - Hepatitis B, C
    • Autoimmune Hepatitis
    • Primary Sclerosing Cholangitis
    • Primary Biliary Cholangitis
    • Medication related:
      • Methotrexate, Amiodarone
    • Hereditary:
      • Haemochromatosis, Wilson's Disease, Alpha 1 Antitrypsin Deficiency
    • Toxins:
      • Alcohol: leading cause in Ireland
      • Paracetamol causes ACUTE liver failure
      • Other drugs: Methotrexate, Amiodarone
    • Deposition:
      • Fat - NAFLD
      • Iron - Haemochromatosis
      • Wilsons - Copper
    • Viral:
      • Hep A, B, C, E. B and C are predominantly viral
    • Autoimmune:
      • AI hepatitis, PSC, PBC
    • Genetic:
      • Alpha 1 anti-trypsin, haemochromatosis, wilsons

    Liver Blood Tests

    • Liver enzymes (damage to different parts of the liver):
      • ALT
      • AST
      • ALP
      • gGT
    • Liver function (the liver is doing what it should be doing):
      • Bilirubin
      • Albumin
      • Prothrombin time
      • Platelets

    LFT Patterns

    • Hepatocellular/parenchymal damage: raised transaminases: ALT/AST
    • Cholestatic/obstructive: raised ALK PHOS/GGT
    • Bilirubin can be raised in either of these patterns
    • Alcoholic hepatitis: AST>ALT ratio is >2:1
    • Measure of function is critical:
      • Albumin, INR, APTT

    Non Alcoholic Fatty Liver Disease (NAFLD) Management

    • Weight loss
    • Abstain from alcohol
    • Immunization (Hep A, Hep B, Pneumococcal)
    • Exclusion of significant alcohol consumption
    • Exclusion of other causes of hepatic steatosis
    • Absence of coexisting chronic liver disease

    Hepatitis C Investigations

    • Hepatitis C antibody test
    • Hepatitis C antigen test
    • Quantitative HCV RNA tests
    • Genotyping
    • Fibroscan
    • Liver biopsy

    Hepatitis C Treatment

    • All treatment-naïve and treatment-experienced patients with recently acquired or chronic HCV infection must be offered treatment without delay.
    • Hep C Treatment is prioritized in patients with:
      • significant fibrosis or cirrhosis
      • HIV/HBV coinfection
      • pre/post liver transplantation
      • autoantibodies can be supportive

    Primary Sclerosing Cholangitis (PSC) Management

    • Trial UDCA
    • No proven medical therapy
    • Screening for complications:
      • Cholangiocarcinoma (Lifetime risk 7-15%)

    Autoimmune Hepatitis

    • Presents in middle-aged (or teenage) woman, a non-drinker with no viral hepatitis
    • Symptoms include: fatigue, arthralgias/myalgias, oligomenorrhea, jaundice
    • Liver function tests show increased ALT, AST, IgG globulins
    • Positive ANA and SMA antibodies
    • Interface hepatitis with lymphoplasmacytic infiltrate on biopsy
    • Responds to corticosteroids

    Autoimmune Hepatitis Treatment

    • Prednisone is the initial treatment
    • Azathioprine is used for long-term maintenance therapy
    • Monitor bone protection, gastric protection, hypotension, diabetes risk, and risk of stopping steroids suddenly.

    Case Presentation: Section 4

    • This patient presents with symptoms of chronic liver disease and is diagnosed with autoimmune hepatitis
    • Patients with AIH should be counselled about the risks and benefits of long-term steroid use.
    • Long-term prednisolone use can cause complications such as osteoporosis, diabetes, hypertension, and peptic ulcer disease.

    Hepatits E

    • Profoundly immunosuppressed individuals can have a chronic course of Hepatitis E

    Hereditary Haemochromatosis (HH)

    • An inherited disorder where increased intestinal iron absorption leads to iron overload
    • Most commonly caused by the C282Y variant in the HFE gene
    • Not all individuals with the C282Y variant will develop iron overload
    • Diagnosis requires genetic testing and monitoring iron levels in tissues
    • Can affect the liver, heart, pancreas, pituitary and other organs
    • Symptoms include bronze-colored skin, diabetes, joint pain, fatigue, impotence in males, cirrhosis, and abnormal ECG results

    Wilson's Disease

    • An inherited disorder affecting copper metabolism
    • Caused by mutations in the ATP7B gene affecting a copper transporter
    • Leads to copper accumulation in the liver, brain and cornea
    • Can cause liver cirrhosis and neurological symptoms like difficulty speaking, Parkinsonism, ataxia, dystonia and tremor

    Non-Alcoholic Fatty Liver Disease (NAFLD)

    • Refers to liver disease in individuals who do not consume excessive alcohol
    • Can progress from fatty liver (steatosis) to steatohepatitis and cirrhosis
    • Often associated with a Western diet and lifestyle factors, including high calorie intake, high fructose intake, high saturated fat intake, and sedentary behavior
    • Diagnosis involves demonstrating fatty liver on imaging and ruling out other causes like excessive alcohol consumption

    Viral Hepatitis

    • Hepatits A, B, C and E are categorized by the type of virus (RNA or DNA) and their incubation periods
    • All can cause acute hepatitis
    • Hepatitis B and C can lead to chronic hepatitis, cirrhosis and hepatocellular carcinoma
    • Vaccines are available for Hepatitis A and B

    Hepatitis A

    • Transmission occurs through close personal contact, fecally contaminated food and water, and rarely through blood
    • Can be transmitted through household or sexual contact and in day-care centers
    • Food handlers and people handling raw shellfish are at risk of spreading the virus
    • Injecting drug users are also at risk

    Hepatitis C

    • Primarily transmitted through blood
    • Risk factors include blood transfusions or organ transplants before 1992, long-term hemodialysis, multiple sexual partners, injection drug use, mass injections, and birth from an infected mother

    Hepatitis C Disease Course

    • About 70% of people infected with Hepatitis C develop chronic infection
    • Chronic hepatitis can progress to cirrhosis in 20% of cases
    • Cirrhosis carries a high risk of developing hepatocellular carcinoma (HCC)
    • Decompensation of cirrhosis occurs over a 4-5 year period

    Hepatitis B Transmission

    • Transmission can be percutaneous (through the skin), including through injection drug use, transfusions or transplants, occupational exposure, and parenteral practices
    • Perimucosal transmission occurs through perinatal (mother to child), sexual, and household routes.
    • Recent travel to endemic countries like Southeast Asia or Africa may increase the risk of infection

    Hepatitis B Disease Course

    • Most infections result in recovery
    • Acute hepatitis can progress to chronic infection or fulminant (rapidly progressing) hepatitis, leading to death in some cases

    Chronic Hepatitis B Infection

    • Can progress to an inactive carrier state, chronic hepatitis, cirrhosis and HCC

    Hereditary Haemochromatosis - Management

    • Regular phlebotomy (blood removal)
    • Ferritin target levels of 50-100 ug/L
    • Phlebotomy performed every few months for life
    • Screening of family members is essential

    Primary Biliary Cholangitis

    • Characterized by high levels of alkaline phosphatase and gamma-glutamyl transferase
    • AST and ALT levels are usually low
    • Bilirubin levels rise later in the disease course
    • Cholesterol levels are elevated in 85% of cases
    • Treatment involves ursodeoxycholic acid (UDCA), benzafibrate, obeticholic acid, and budesonide

    Primary Sclerosing Cholangitis - Diagnosis

    • Elevated alkaline phosphatase and gamma-glutamyl transferase
    • History of inflammatory bowel disease
    • Imaging: MRCP/ERCP is essential for diagnosis
    • Characteristic findings include multifocal, short, annular strictures, resulting in a "beaded" appearance

    Liver Blood Tests

    • Liver enzymes (ALT, AST, ALP, GGT) indicate liver damage.
    • Liver function tests (bilirubin, albumin, prothrombin time, platelets) assess the liver's ability to perform its functions

    Liver Function Test Patterns

    • Hepatocellular or parenchymal damage: Elevated transaminases (ALT, AST)
    • Cholestatic or obstructive: Elevated alkaline phosphatase and gamma-glutamyl transferase
    • Alcoholic hepatitis: AST > ALT ratio is >2:1
    • Function tests (albumin, INR, APTT) are important for assessing liver function

    Non-Alcoholic Fatty Liver Disease - Management

    • Weight loss
    • Abstinence from alcohol
    • Immunization against Hepatitis A and B, and pneumococcal vaccine
    • Exclusion of other causes of steatosis
    • Management of co-existing chronic liver disease

    Hepatitis C - Investigations

    • Hepatitis C antibody test
    • Hepatitis C antigen test
    • Quantitative HCV RNA tests
    • Genotyping
    • Fibroscan
    • Liver biopsy

    Hepatitis C Treatment

    • All treatment-naïve and treatment-experienced patients with chronic HCV infection should be offered treatment
    • Treatment is prioritized in patients with significant fibrosis or cirrhosis, HIV/HBV coinfection, pre/post liver transplantation, and those with a high risk of transmitting the virus
    • Antiviral therapies include glecaprevir/pibrentasvir and sofosbuvir/velpatasvir

    Hepatitis B Serology

    • HBsAg: Acute/Chronic infection
    • Anti-HBc IgM: Acute infection
    • HBeAg high infectivity
    • Anti-HBe: Low infectivity
    • Anti-HBs: Immunity
    • Anti-HBc IgG and HBsAg: Chronic infection
    • Anti-HBc IgG and anti-HBs: Resolved infection

    Hepatitis B Management

    • Antiviral treatment
    • Prevention through vaccination

    Hepatitis B Treatment

    • Antiviral therapies: Pegylated Interferon, Lamivudine, Adefovir, Entecevir, Tenofovir
    • Prevention: Hepatitis B vaccination is recommended for high-risk groups

    Differential Diagnosis of Cirrhosis

    • Alcohol related liver disease
    • Non-alcoholic fatty liver disease
    • Viral hepatitis (A, B, C, E)
    • Autoimmune hepatitis
    • Primary sclerosing cholangitis
    • Primary biliary cholangitis
    • Medication related (methotrexate, amiodarone)
    • Hereditary (haemochromatosis, Wilson’s disease, Alpha1 antitrypsin deficiency)
    • Toxins
    • Paracetamol (overdose)
    • Other drugs (methotrexate, amiodarone)
    • Deposition
    • Fat (NAFLD)
    • Iron (Haemochromatosis)
    • Copper (Wilson's Disease)
    • Viral (Hepatitis A, B, C, E)
    • Autoimmune
    • AI hepatitis, PSC, PBC
    • Genetic
    • Alpha1 anti-trypsin, haemochromatosis, Wilson's disease.

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    Chronic Liver Disease 1 (PDF)

    Description

    This quiz covers various types of chronic liver diseases including Hep E, hereditary haemochromatosis, Wilson's disease, autoimmune liver disease, and non-alcoholic fatty liver disease (NAFLD). Test your understanding of the causes, progression, and implications of these conditions in this informative quiz.

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