Liver Disease Flashcards
What is the definition of jaundice?
The bilirubin production excedes the hepatic capacity to excrete it, and as a result bilirubin deposited in skin, sclera, mucosa, leading to a yellow appearance.
What is the normal range for bilirubin in the body?
3-20umol/L
What are the three causes of jaundice?
Increased rate of bilirubin production (haemolysis, neonatal, congenital)
Normal load of bilirubin cannot be conjugated and/or excreted by damaged liver cells
The biliary flow is obstructed
In what states would the conjugated bilirubin increase?
States where hepatocytes are still working enough to form conjugated bilirubin (excretion problems and post-hepatic problems)
In what states would the unconjugated bilirubin increase?
Pre-hepatic and hepatic jaundice.
What tests would you want to run in someone presenting with jaundice?
FBC, LFTs, coags, amylase
Virology, ultrasound, biopsy if cause isn’t evident
What viruses can cause hepatitis?
Hepatitis (A, B, C, D, E), EBV, CMV, Herpes, yellow fever
How is Hepatitis A transmitted?
Through close personal contact, contaminated food/water. Mainly through fecal material.
Cause of epidemics in 3rd world countries
What is the best way to detect HepA infection?
IgM-anti-HAV antibody
IgG persists beyond convalescence and so exists as the immune defence against re-infection
How does the Hepatitis A Virus damage hepatocytes?
The hepatitis virus is not toxic to hepatocytes, but invades the cells, and the immune response (T cell mediated) damages the infected hepatocytes.
Hepatitis B can produce what disease states?
Acute hepatitis with recovery and clearance of virus
Non-progressive chronic hepatitis
Progressive chronic disease ending in cirrhosis (or carcinoma)
Fulminant hepatitis with massive liver necrosis
Asymptomatic carrier state.
How is hepatitis B transmitted?
Body fluids
What are the different Hepatitis B virus variants?
Wild type
Precore mutation
Core promoter mutation
Treatment induced mutations
What are the complications of cirrhosis?
Portal Hypertension
Hepatocellular carcinoma
Synthesis problems (bleeding, nutrition, encephalopathy)
How do you diagnose Hepatitis B?
Hep B surface antigen, Hep B e antigen, HBV viral load
Markers of human response
Markers of liver disease
