Liver Disease

Question 1

Liver functions

Answer 1

• Synthesis & metabolism of carbohydrates, lipids, proteins & drugs
• Metabolism of bilirubin and bile acids

Question 2

Bilirubin metabolism

Answer 2

Bilirubin is the breakdown product of haem

Bilirubin is hydrophobic and so is conjugated in the liver to make it more soluble

Question 3

Jaundice

Answer 3

Characterised by a yellowing of the sclera and skin due to high serum bilirubin levels

Characteristic of liver disease

Question 4

Haemolytic jaundice

Answer 4

Occurs due to the increased breakdown of erythrocytes

Pre-hepatic

Blood will show a decreased red cell count and increased reticulocyte count

Question 5

Congenital hyperbilirubinaemia

Answer 5

Associated with Gilbert’s syndrome

UDP-glucuronyl transferase deficiency

Question 6

Cholestatic jaundice

Answer 6

Occurs due to abnormal bile excretion or obstruction of the biliary system

Question 7

Hepatitis

Answer 7

Inflammation of the liver

Symptoms = enlarged liver, tender liver, jaundice

Serum transferase will be characteristically elevated

Question 8

Acute hepatitis

Answer 8

Causes = hepatitis B & C, non-viral infections, alcohol, drugs, pregnancy

Mostly self-limiting

Question 9

Chronic hepatitis

Answer 9

Causes = viral infections, chemical stimuli, autoimmune responses

Sustained inflammatory disease may lead to necrosis

Question 10

Hepatitis A

Answer 10

Caused by the HAV virus

Spread via the faecal-oral route

Leads to acute viral hepatitis because the viruses themselves are cytotoxic

Usually self-limiting

Vaccine available

Question 11

Hepatitis B

Answer 11

Causes by the HBV virus

Spread via close personal contact

Liver becomes damaged by an immune-mediated T-cell responses

Has a long incubation period and there is a risk of chronic hepatitis

Anti-virals and a vaccine available

Question 12

Hepatitis C

Answer 12

Caused by the HCV virus

Spread in the blood

Liver becomes damaged by an immune-mediated T-cell response

Has a short incubation period and there is a risk of chronic hepatitis

Anti-virals available

Vaccine difficult to develop

Question 13

Cirrhosis

Answer 13

Cirrhosis is the end result of a variety of diseases

It is due to chronic liver damage and is irreversible

Necrosis of liver cells may lead to fibrosis, causing nodules in the liver

This impairs liver function

Question 14

Causes of cirrhosis

Answer 14

• Viruses
• Alcohol
• Autoimmune diseases
• Wilson’s disease

Question 15

Symptoms of cirrhosis

Answer 15

• Jaundice
• Fever
• Hair loss
• Gynamecomastia

Question 16

Complications of cirrhosis

Answer 16

• Variceal haemorrhage

- Hepatocellular carcinoma

Question 17

Liver tumours

Answer 17

Liver tumours are mostly secondary tumours from metastatic cancers

Prognosis is very poor; less than 6 months

Question 18

Alcoholic fatty liver

Answer 18

Alcohol leads to fat accumulation in hepatocytes

Leads to liver enlargement

Question 19

Alcoholic hepatitis

Answer 19

Alcohol is a hepatotoxin and leads to necrosis

This results in inflammation of the liver

Mallory bodies can be seen and are specific to alcoholic hepatitis