Chemical Pathology 4 - Liver disease CPC Flashcards
What is the inheritance pattern of Gilbert’s?
Autosomal recessive
What test measures bilirubin, and how does it work?
van den Bergh test
Fractionation
A direct reaction shows the conjugated bilirubin
Additional of methanol shows total bilirubin
Therefore you can calculate unconjugated bilirubin
How can normal paediatric jaundice be distinguished from pathological paediatric jaundice?
It’s usually normal - the bilirubin will be unconjugated and it is just due to liver immaturity
If it doesn’t settle - look for rare causes like hypothyroid
How can normal paediatric jaundice be treated?
A spot of liver phototherapy
What would make jaundice worse in Gilbert’s?
Fasting
What is the abnormally-functioning protein that causes Gilbert’s?
UDP glucoronyl transferase - it is reduced to 30% activity
What increases in Gilbert’s - conjugated bilirubin, unconjugated bilirubin or both?
ONLY unconjugated bilirubin
What is the best marker of liver function?
Prothrombin time
How can you tell that a paracetamol OD is bad enough to need transplant?
PT in seconds is > hours since OD
How does acute alcoholic hepatitis present?
Nausea, abdominal pain and jaundice
Pain is due to inflammation
What is the key histological finding that is pathognemonic for alcoholic hepatitis?
Megamitochondria
For how long following exposure to hep A should the virus be discoverable in faeces?
From 2-4 weeks
Which antibody to hep A will be the first to be produced, and for what time period post-exposure to the virus will it be present in serum?
IgM
Initial production at 3 weeks
Peaks at 5 weeks
Gone by 13 weeks
Which immunoglobulin class provides long-term hep A immunity, and how soon after exposure is it produced?
IgG
From 5 weeks
From when, and for how long, does hep A cause jaundice in an infected person?
From 4 weeks, potentially until 8 weeks, post-exposure
