Chemical Pathology 4 - Liver disease CPC Flashcards

1
Q

What is the inheritance pattern of Gilbert’s?

A

Autosomal recessive

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2
Q

What test measures bilirubin, and how does it work?

A

van den Bergh test
Fractionation
A direct reaction shows the conjugated bilirubin
Additional of methanol shows total bilirubin
Therefore you can calculate unconjugated bilirubin

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3
Q

How can normal paediatric jaundice be distinguished from pathological paediatric jaundice?

A

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

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4
Q

How can normal paediatric jaundice be treated?

A

A spot of liver phototherapy

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5
Q

What would make jaundice worse in Gilbert’s?

A

Fasting

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6
Q

What is the abnormally-functioning protein that causes Gilbert’s?

A

UDP glucoronyl transferase - it is reduced to 30% activity

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7
Q

What increases in Gilbert’s - conjugated bilirubin, unconjugated bilirubin or both?

A

ONLY unconjugated bilirubin

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8
Q

What is the best marker of liver function?

A

Prothrombin time

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9
Q

How can you tell that a paracetamol OD is bad enough to need transplant?

A

PT in seconds is > hours since OD

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10
Q

How does acute alcoholic hepatitis present?

A

Nausea, abdominal pain and jaundice

Pain is due to inflammation

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11
Q

What is the key histological finding that is pathognemonic for alcoholic hepatitis?

A

Megamitochondria

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12
Q

For how long following exposure to hep A should the virus be discoverable in faeces?

A

From 2-4 weeks

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13
Q

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?

A

IgM
Initial production at 3 weeks
Peaks at 5 weeks
Gone by 13 weeks

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14
Q

Which immunoglobulin class provides long-term hep A immunity, and how soon after exposure is it produced?

A

IgG

From 5 weeks

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15
Q

From when, and for how long, does hep A cause jaundice in an infected person?

A

From 4 weeks, potentially until 8 weeks, post-exposure

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16
Q

What are the 2 markers of hep B infection that can first be identified in an infected person, and how quickly are these produced?

A

HbS antigen and HbE antigen

Within 2 months of exposure

17
Q

Which hepatitis antigen is most infectious?

A

HbE antigen

18
Q

In a patient who successfully fights off Hep B, for how long are HbS and HbE present in serum?

A
HbS = 4 months
HbE = 2 months
19
Q

In a patient who becomes acutely unwell with hepatitis B, but it does not take a chronic course, what is the typical presentation?

A

Become acutely unwell and jaundiced around 2 months post-infection

20
Q

In a patient who becomes acutely unwell with hepatitis B, but it does not take a chronic course, which antibodies endure in the blood?

A

Main one is anti-HbC (CORE antibody)

also anti-HbS

21
Q

In a patient with chronic Hep B, what antigens and antibodies will be present?

A

surface antigen

e antibody

22
Q

What are the 3 key signs of portal hypertension?

A

Caput medusae
Splenomegaly
Ascites

23
Q

What sign is indicative of liver failure?

A

Flapping tremor

24
Q

If a patient has scratch marks, what does this tell you about their jaundice?

A

It must be post-hepatic, as itching is caused by bile salts and bile acids

25
Q

What is courvoisier’s law?

A

If gallbladder is palpable but painless, it is almost always pancreatic cancer causing the jaundice