Jaundice and abnormal liver function

Question 1

Clinical jaundice appears when serum bilirubin is…?

Answer 1

usually around >35

Question 2

Dark urine in the context of jaundice suggests…?

Answer 2

Conjugated hyperbilirubinaemia; suggests post-hepatic jaundice (but may also reflect intra-hepatic cholestasis)

Question 3

Pattern of isolated LFT derangement: AST rise

Answer 3

Tends to be more raised in fatty liver

Question 4

Pattern of isolated LFT derangement: ALT rise

Answer 4

Tends to be raised more in viral/autoimmune hepatitis

Question 5

Pattern of isolated LFT derangement: GGT rise

Answer 5

Associated with alcohol excess

Question 6

If LFTs are found to be raised, what action should be taken initially? (3)

Answer 6

Review medications including OTC/herbal
Stop alcohol
Repeat LFTs in 1/52 if transaminases 3x upper limit of normal , in 4/52 if less than 3x upper limit of normal

Question 7

Actions if LFTs remain elevated when repeated?

Answer 7

Hepatitis screen and US abdomen

Question 8

Pattern of symptoms/bloods which suggest post-hepatic jaundice? (3)

Answer 8

Dark urine and pale stools
Normal Hb
Marked increase in ALP

Question 9

Pattern of LFT derangement in fatty liver? (2)

Answer 9

In AFLD, AST tends be greater than ALT

in NAFLD, ALT tends to be greater than AST

Question 10

Assessment of fibrosis risk in NAFLD? (3)

Answer 10

Enhanced liver fibrosis test
NAFLD fibrosis score
Fibrosis (FIB)-4 score

Question 11

Route of spread of hepatitis A/E?

Answer 11

Faecal-oral

Question 12

Management/prognosis of hepatitis A/E?

Answer 12

Supportive; most recover in <2 months. Do not cause chronic liver disease//carrier state

Question 13

IgM antibodies against Hepatitis A suggest..?

Answer 13

Recent infection

Question 14

Prognosis of hepatitis B? (3)

Answer 14

1% acute liver failure
85% recovery fully
Around 10% carriers/chronic hepatitis

Question 15

How is carrier status in Hep B identified?

Answer 15

Persistence of HBsAg (hepatitis b surface antigen) after 6 months

Question 16

What implies immunity in hep B?

Answer 16

Presence of Anti-HBs (anti hep B surface antibodies)

Question 17

What does the presence of HBeAg imply?

Answer 17

High infectivity

Question 18

How is hep C spread?

Answer 18

Contact with infected blood; mother -> baby; not easily spread through sexual contact

Question 19

How long does it take to generate anti HCV antibodies?

Answer 19

90% patients will have them by 3 months

Question 20

How is Hep B spread? (4)

Answer 20

Infected blood
Sexual intercourse
Mother -> newborn
Human bites

Question 21

How is active hep C infection detected?

Answer 21

HCV RNA test

Question 22

Prognosis of Hep C infection?

Answer 22

around 50-85% develop chronic infection which untreated leads to chronic liver disease, cirrhosis,
and often cancer

Question 23

Management of chronic hep c?

Answer 23

Specialist referral for consideration of Hep C eradication with direct-acting antiviral agents (DAAs)

Question 24

Commonest cause of portal hypertension in UK?

Answer 24

Cirrhosis

Question 25

Occlusion of the hepatic vein resulting in jaundice, epigastric pain and shock

Answer 25

Budd-Chiari syndrome

Question 26

Itching + jaundice in a middle-aged woman?

Answer 26

Think primary biliary cholangitis (previously referred to as primarly biliary cirrhosis)

Question 27

Auto-antibodies associated with PBC?

Answer 27

AMA (M2 subtype)- highly sensitive and specific