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
- A direct reaction shows the conjugated bilirubin
- Additional of methanol shows total bilirubin
- Therefore you can calculate uncojugated bilirubin (indirectly)
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
NB all other liver enzymes stay the same
What is the best marker of liver function?
Prothrombin time
This is the mber of seconds it takes for blood to clot (normally 12-14 seconds)
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
NB IgG will be released eventually
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
What are the 2 markers of hep B infection that can first be identified in an infected person, and how quickly are these produced?
- HbS antigen (surface antigen)
- HbE antigen (indicates if infectious)
Within 2 months of exposure
Which hepatitis antigen is most infectious?
HbE antigen
In a patient who successfully fights off Hep B, for how long are HbS and HbE present in serum?
HbS = 4 months HbE = 2 months
In a patient who becomes acutely unwell with hepatitis B, but it does not take a chronic course, what is the typical presentation?
Become acutely unwell and jaundiced around 2 months post-infection
In a patient who becomes acutely unwell with hepatitis B, but it does not take a chronic course, which antibodies endure in the blood?
Mainly anti-HbC
anti-HbS
little anti-HbE
In a patient with chronic Hep B, what antigens and antibodies will be present?
HbS
Anti HBe
Anti HBc
What are the 3 key signs of portal hypertension?
Caput medusae
Splenomegaly
Ascites
What sign is indicative of liver failure?
Flapping tremor
If a patient has scratch marks, what does this tell you about their jaundice?
It must be post-hepatic, as itching is called by bile salts and bile acids
What is courvoisier’s law?
If gallbladder is palpable but painless, it is almost always pancreatic cancer causing the jaundice
What does it mean if there is no urobilinogen in urine?
Means enterohepatic circulation is NOT intact
enterohepatic circulation (EHC) denotes the movement of bile acid molecules from the liver to the small intestine and back to the liver
Liver Enzymes vs LFTs
Function of liver is measured by:
- Albumin
- Clotting factors (PT, PTTK)
- Bilirubin
NOTE: the other tests are enzymes which are markers for liver DAMAGE
AST and ALT are both raised. AST V high, ALP marginally raised. What does this imply?
- AST and ALT especially tell you that there is hepatic damage
- ALP is marginally high- this excludes obstructive jaundice (obstructive = BIG rise in ALP)
Vaccine for hep A
Havrix
vaccine which helps give some protection (boosts the IgG)
Which antibody is made against HBe antigen?
HBc antibody - precence of this antibody means pt has been infected at some point
2 years after pt presented with alcohol hepatitis. Now is recovered, no jaundiced. Still has spider naevi, Dupytren’s contracture, palmar erythema, gynaecomastia. What is going on here?
Chronic stable liver disease - pt is well
Pt with long Hx of alcohol has distended vein on abdo wall. What else might you find and why?
Splenomegaly
Pt has portal HTN which is producing this distended vein
- The portal vein is made up of the splenic vein and the superior mesenteric vein
- NB The liver will NOT get bigger if you have portal hypertension
Pale liver, lots of nodules. What does this suggest?
alcoholic liver disease
pale since fatty tissue
How do adenocarcinomas tend to spread?
Lymphatics
