Liver Disease Flashcards
Which enzymes are high in hepatic problems?
ALT and AST
Which enzymes are high in gall bladder and biliary problems?
ALP and GGT
What are the symptoms of NAFLD/ALD?
- Usually asymptomatic unless advanced - incidentally detected on LFTs
- Fatigue/malaise
- RUQ pain
What is the main treatment for NAFLD?
Weight loss
What is NAFLD?
A spectrum of disease
What is the spectrum/progression of NAFLD/ALD?
1) Healthy liver
2) Steatosis
3) Steatohepatitis or non-alcoholic steatohepatitis (NASH)/alcoholic hepatitis
4) Fibrosis
5) Cirrhosis
What is the most common cause of liver cancer in the UK?
Hep C
What causes fibrosis in NAFLD?
Lots of bouts of NASH
What causes alcoholic liver disease?
Fat deposits due to alcohol
What is the equivalent to NASH in alcoholic liver disease?
Alcoholic hepatitis (caused by immune response)
What causes NASH?
Free radicals attacking fat deposits (steatosis)
What is the main treatment of ALD?
Stopping drinking
Which enzyme in LFTs is more raised in NAFLD?
ALT
Which enzyme in LFTs is more raised in ALD?
AST
What are the symptoms of viral hepatitis?
- Fever
- Malaise
- Nausea
- Pruritis (itching)
- Jaundice
- RUQ pain with hepatomegaly
- Dark urine
What defines chronic viral hepatitis?
> 6 months
What are the two key features of Hep A and Hep E?
- Transmitted via faecal oral route
- Only acute (never chronic)
What does serology indicate in Hep A and E?
- IgM = ongoing infection
- IgG = cured
Which has a vaccine - Hep A or E?
Hep A
How are Hep B and C transferred?
- Infected needles
- Unprotected sex
- Childbirth
What % of people with Hep C get chronic infection?
80%
What % of people with Hep C are asymptomatic?
70-80%
What is cirrhosis?
Excessive fibrosis
What can chronic Hep C infection lead to?
- Liver failure
- Cancer
- Cirrhosis
Which enzyme is more raised in Hep C?
ALT
What is the best marker of Hep C?
HCV RNA (through PCR)
Does HCV IgG mean you are cured?
No
What is the treatment for HBV and HCV?
Antivirals
What % of people with Hep B get chronic infection?
20% (If < 6 50%)
What can chronic Hep C infection lead to?
- Cancer
- Cirrhosis
Who can Hep D infect?
Only people with HBV
What are the 3 HBV antigens?
1) HBsAg (surface antigen) - most important
2) HBcAg (core antigen)
3) E antigen
What does increased HBV E antigen indicate?
More likely to infect someone else (marker of replication)
Without what are you not cured from HBV?
IgG-HBsAg
How long does it take to produce antibody to HBsAg?
~ 6 months
The presence of which antibody indicates you are cured from HBV?
IgG-HBsAg (either vaccinated or naturally cleared the infection)
What is the only serology present after a vaccine?
IgG-HBsAg
What does HBcAg/IgG-HBcAg indicate?
Infection with HBV - IgG-HBcAg is not effective but indicates infection
What is the core window?
- When you don’t know what will happen
- Only IgG-HBcAg is present
