Liver Disease

Question 1

Which enzymes are high in hepatic problems?

Answer 1

ALT and AST

Question 2

Which enzymes are high in gall bladder and biliary problems?

Answer 2

ALP and GGT

Question 3

What are the symptoms of NAFLD/ALD?

Answer 3

• Usually asymptomatic unless advanced - incidentally detected on LFTs
• Fatigue/malaise
• RUQ pain

Question 4

What is the main treatment for NAFLD?

Answer 4

Weight loss

Question 5

What is NAFLD?

Answer 5

A spectrum of disease

Question 6

What is the spectrum/progression of NAFLD/ALD?

Answer 6

1) Healthy liver
2) Steatosis
3) Steatohepatitis or non-alcoholic steatohepatitis (NASH)/alcoholic hepatitis
4) Fibrosis
5) Cirrhosis

Question 7

What is the most common cause of liver cancer in the UK?

Answer 7

Hep C

Question 8

What causes fibrosis in NAFLD?

Answer 8

Lots of bouts of NASH

Question 9

What causes alcoholic liver disease?

Answer 9

Fat deposits due to alcohol

Question 10

What is the equivalent to NASH in alcoholic liver disease?

Answer 10

Alcoholic hepatitis (caused by immune response)

Question 11

What causes NASH?

Answer 11

Free radicals attacking fat deposits (steatosis)

Question 12

What is the main treatment of ALD?

Answer 12

Stopping drinking

Question 13

Which enzyme in LFTs is more raised in NAFLD?

Answer 13

ALT

Question 14

Which enzyme in LFTs is more raised in ALD?

Answer 14

AST

Question 15

What are the symptoms of viral hepatitis?

Answer 15

• Fever
• Malaise
• Nausea
• Pruritis (itching)
• Jaundice
• RUQ pain with hepatomegaly
• Dark urine

Question 16

What defines chronic viral hepatitis?

Answer 16

> 6 months

Question 17

What are the two key features of Hep A and Hep E?

Answer 17

• Transmitted via faecal oral route

- Only acute (never chronic)

Question 18

What does serology indicate in Hep A and E?

Answer 18

• IgM = ongoing infection

- IgG = cured

Question 19

Which has a vaccine - Hep A or E?

Answer 19

Hep A

Question 20

How are Hep B and C transferred?

Answer 20

• Infected needles
• Unprotected sex
• Childbirth

Question 21

What % of people with Hep C get chronic infection?

Answer 21

80%

Question 22

What % of people with Hep C are asymptomatic?

Answer 22

70-80%

Question 23

What is cirrhosis?

Answer 23

Excessive fibrosis

Question 24

What can chronic Hep C infection lead to?

Answer 24

• Liver failure
• Cancer
• Cirrhosis

Question 25

Which enzyme is more raised in Hep C?

Answer 25

ALT

Question 26

What is the best marker of Hep C?

Answer 26

HCV RNA (through PCR)

Question 27

Does HCV IgG mean you are cured?

Answer 27

No

Question 28

What is the treatment for HBV and HCV?

Answer 28

Antivirals

Question 29

What % of people with Hep B get chronic infection?

Answer 29

20% (If < 6 50%)

Question 30

What can chronic Hep C infection lead to?

Answer 30

• Cancer

- Cirrhosis

Question 31

Who can Hep D infect?

Answer 31

Only people with HBV

Question 32

What are the 3 HBV antigens?

Answer 32

1) HBsAg (surface antigen) - most important
2) HBcAg (core antigen)
3) E antigen

Question 33

What does increased HBV E antigen indicate?

Answer 33

More likely to infect someone else (marker of replication)

Question 34

Without what are you not cured from HBV?

Answer 34

IgG-HBsAg

Question 35

How long does it take to produce antibody to HBsAg?

Answer 35

~ 6 months

Question 36

The presence of which antibody indicates you are cured from HBV?

Answer 36

IgG-HBsAg (either vaccinated or naturally cleared the infection)

Question 37

What is the only serology present after a vaccine?

Answer 37

IgG-HBsAg

Question 38

What does HBcAg/IgG-HBcAg indicate?

Answer 38

Infection with HBV - IgG-HBcAg is not effective but indicates infection

Question 39

What is the core window?

Answer 39

• When you don’t know what will happen

- Only IgG-HBcAg is present