L8-9 - Liver Disease

Question 1

What are the two types of liver disease?

Answer 1

Acute and chronic

Question 2

Give 3 causes of acute liver disease

Answer 2

Acute viral hepatitis, drugs/toxins (e.g. paracetamol), inadequate blood supply

Question 3

Give 3 possible consequences of acute liver disease

Answer 3

Decreased Na and Ca, acidosis, renal failure (toxin exposure), hypoglycaemia, increased ammonia, oedema or ascites (fluid retention)

Question 4

What are the causes of chronic liver disease?

Answer 4

Prolonged acute liver disease, chronic viral hepatitis, chronic toxin exposure, cholestatic disease (biliary blockage)

Question 5

What is cirrhosis?

How does this occur?

Answer 5

Terminal stage of chronic liver disease

Prolonged damage leads to liver fibrosis; this destroys hepatocytes, reducing liver function

Question 6

Give 3 things that can cause cirrhosis

Answer 6

Excessive drinking (alcoholic fatty liver can progress to cirrhosis), viral hep B or C, autoimmune (e.g. Primary biliary cirrhosis)

Question 7

What are the main liver function tests?

Answer 7

AST/ALT, ALP, bilirubin, albumin

Question 8

What occurs to AST/ALT levels after liver damage has occurred? Why is this?

Answer 8

Initial damage - both increase at same rate as the cytoplasmic forms are released from hepatocytes

After further damage - AST>ALT as the membrane bound form of AST is released

Question 9

What does a slight AST/ALT elevation usually indicate?

Answer 9

Chronic conditions - viral hep, autoimmune hepatitis, drugs/chemicals, hepatic steatosis (fat deposits)

Question 10

What does a severely elevated AST/ALT level usually indicate?

Answer 10

Acute - viral hep, passing gallstones, drugs/toxins, ischaemic hepatitis (shock liver, decreased blood flow)

Question 11

What does AST>ALT indicate?

Answer 11

Alcohol based condition - alcoholic steatosis, hepatitis or cirrhosis

Question 12

What can a raised ALP indicate?

What test can be carried out to confirm this?

Answer 12

Cholestatic liver disease

Gamma-glutamyl transferase (GGT)

Question 13

What happens to albumin levels in chronic liver disease?

Answer 13

Decrease

Question 14

What can an increased bilirubin level indicate?

Answer 14

Jaundice, cholestatic liver disease

Question 15

What immunological tests can be carried out for liver disease? Why/when would these be used?

Answer 15

Test for viral antigen/antibodies in viral hepatitis

Test for autoantibodies in autoimmune hepatitis and primary biliary cirrhosis

Question 16

What is jaundice?

Answer 16

Hyperbilirubinaemia (high bilirubin)

Question 17

What results in increased bilirubin synthesis? Why is this?

Answer 17

Haemolysis - bilirubin is made using haem groups from broken down RBCs

Question 18

What are the 2 forms of bilirubin? where does the transition between the two take place?

Answer 18

Conjugated and unconjugated

Hepatocytes take in unconjugated and secrete conjugated into biliary tract

Question 19

What are the 3 general types of jaundice? Describe the circumstances that results in these

Answer 19

Pre-hepatic - increased bilirubin synthesis (more than the liver can conjugate)
Hepatic - decrease in uptake by/delivery to hepatocytes
Post-hepatic - blockages causes reabsorption of conjugated bilirubin

Question 20

What are the bilirubin levels/types seen in pre-hepatic jaundice?

Answer 20

Increased unconjugated bilirubin

Question 21

Give 3 causes of pre-hepatic jaundice

Answer 21

Haemolytic anaemia, rhabdomyolysis, haemolytic disease of the newborn

Question 22

What are the 3 types of congenital jaundice?

Answer 22

Gilbert’s disease, Crigler-Najjar syndrome and Dubin Johnson syndrome

Question 23

What is involved in Gilbert’s disease?

What are the levels/type of bilirubin?

Answer 23

Hepatocytes cant take up bilirubin

Increased unconjugated bilirubin

Question 24

What is involved in Crigler-Najjar syndrome?

What are the levels/type of bilirubin?

Answer 24

Hepatocytes cant conjugate bilirubin

Increased unconjugated bilirubin

Question 25

What is involved in Dubin Johnson syndrome?

What are the levels/type of bilirubin?

Answer 25

Hepatocytes cant secrete the conjugated bilirubin

Increased conjugated bilirubin

Question 26

What are the two types of obstructions seen in post-hepatic jaundice? Give an example of each

Answer 26

Intrahepatic - intrahepatic carcinoma, primary biliary cirrhosis, hepatocellular damage

Extrahepatic - gallstones, extrahepatic carcinoma

Question 27

What types of jaundice results in an increased conjugated bilirubin?

Answer 27

Post-hepatic (obstructive jaundice) and Dubin Johnson syndrome