Liver Disease

Question 1

What is the definition of cirrhosis of the liver?

Answer 1

• end stage liver disease
• diffuse process with fibrosis and nodule formation

Question 2

Describe a typical history of someone with liver disease

Answer 2

Symptoms:
- jaundice, dark urine + light stool with itch
- ankle swelling, abdo swelling, RUQ pain
- nausea/ vomiting, fever, GI symptoms

PMH: previous jaundice, cholecystectomy, T2DM, obesity, thyroid disease, other autoimmune disease

DH: new medications, OTC, herbal

SH: drug use, alcohol, sexual partner(s)

FH: jaundice, liver tumours, haemochromatosis

Question 3

What is raised in hepatic causes of liver disease?

Answer 3

• AST
• ALT
• bilirubin
• GGT

Question 4

What is raised in cholestatic causes of liver disease?

Answer 4

• ALP
• bilirubin
• GGT

Question 5

What are the best measures of liver function?

Answer 5

• albumin
• bilirubin
• prothrombin time

Question 6

What are the causes of acute liver injury?

Answer 6

• acute viral hepatitis
• autoimmune liver disease (hepatitis)
• paracetamol toxicity (‘therapeutic’ doses can be toxic if underweight/alcohol misuse/malnutrition)
• drug induced

Question 7

What investigation would you do if you suspected liver disease?

Answer 7

Ultrasound

Question 8

What are the causes of acute cholestasis/cholestatic hepatitis?

Answer 8

• extrahepatic biliary obstruction
• drug injury

Question 9

What are the causes of chronic liver disease?

Answer 9

• chronic viral hepatitis (HBV, HCV)
• autoimmune liver disease (hepatitis, primary biliary cholangitis, primary sclerosing cholangitis)
• metabolic liver disease (haemochromatosis, wilson’s disease, alpha-1 anti-trypsin deficiency)
• fatty liver (alcoholic/non-alcoholic)

Question 10

What are the investigation results for autoimmune hepatitis?

Answer 10

• raised AST and ALT
• positive ANA, SMA, anti-liver kidney microsomal antibodies
• raised IgG levels

Question 11

What is the treatment for autoimmune hepatitis?

Answer 11

• corticosteroids (prednisolone, budesonide)
• azathioprine, mycophenolate

Question 12

What are some associations with primary biliary cholangitis?

Answer 12

• Sjorgren’s syndrome
• systemic sclerosis
• RA
• lupus
• hypothyroidism
• coeliacs disease

Question 13

What are the investigation results and treatment for primary biliary cholangitis?

Answer 13

• elevated GGT and ALP (early disease)
• elevated bilirubin (advanced disease)
• treatment: ursodeoxycholic acid

Question 14

Describe Wilson’s disease

Answer 14

• mutation in ATP7B gene resulting in inability to transport excess copper into bile = bile accumulation
• AR inheritance
• presents with chronic liver disease with neurological/psychiatric symptoms (eg. Parkinsonism, hand tremor, masked facial expression, slurred speech, ataxia, dystonia)

Question 15

What are the investigation results and treatment of Wilson’s disease?

Answer 15

• low caeruloplasmin, high copper levels,
• treatment: copper chelation (panicillamine, trientine) or oral zinc (to reduce copper absorption)

Question 16

Describe hereditary haemochromatosis

Answer 16

• iron accumulation in tissues and organs including liver, adrenal glands, heart, skin, gonads, joints and pancreas
• presents with abnormal LFTs and chronic liver disease, polyarthropathy, adrenal insufficiency, HF, or diabetes (+/- pigmentation)
• due to mutation in HFE gene
• AR inheritance

Question 17

What are the investigation results for hereditary haemochromatosis?

Answer 17

• raised ferritin and transferrin saturation
• liver MRI for iron, liver biopsy
• treatment: venesection
• family screening (1st degree)