George Cutler - (hep B from chronically infected wife)

Question 1

MOA of oedema in Hep b?

Answer 1

hepatocyte death> reduced production of albumin > decrease oncotic pressure > oedema

Question 2

MOA of bruising in hep b?

Answer 2

hepatocyte death > reduced production of coagulation factors > haemorrhagic state > bruising

Question 3

describe the elevation in markers ALT, AST, GGT and ALP

Answer 3

Elevated GGT and ALP
- Is due to the destruction and obstruction of bile canaliculi

o GGT: found in the endoplasmic reticulum of hepatocytes and bile duct epithelium. GGT is elevated with alcohol metabolism and biliary obstruction.
o ALP: found in the canalicular surface of the hepatocyte. Its serum level rises in biliary tract obstruction

Elevated ALT and AST

• Due to hepatocyte death (apoptosis)
  o ALT: ALT is a cytosolic enzyme. It is released into the blood when hepatocytes are damaged, and is
  more specific to liver damage than AST.
  o AST: AST is a 80% mitochondrial, 20% cytosolic enzyme (also found in heart, skeletal muscle, kidney,
  brain and RBC’s)