Liver Disease CPC Flashcards
Aged 20
Referred by Medical school because of abnormal LFTs.
Seen sign on notice board offering £1500 for a weekend measuring gastric acidity.
Need NG tube for 24 hours and take new trial drugs (already used in others)
Never took part.
Screening blood tests showed abnormal LFTs.
Bilirubin 32 micromol/l (5-17)
GGT, ALT, Alk Phos, AST normal.
Never drunk a drop of EtOH
PMH: None
FH: cousin had had 1 episode jaundice.
Investigated at another teaching hospital
Liver biopsy carried out - normal.
Gilberts
What is the van den Bergh reaction
It measures serum bilirubin via fractionation.
A direct reaction measures conjugated bilirubin.
The addition of methanol causes a complete reaction, which measures total bilirubin (conjugated plus unconjugated) - the difference measures unconjugated bilirubin (an indirect reaction)
Is paediatric jaundice normal
It usually is
What is the cause of non-pathological paediatric jaundice
The bilirubin should be unconjugated as the cause is usually liver immaturity coupled with a fall in the haemoglobin early in life.
What are some causes of pathological paediatric jaundice
Hypothyroidism is a cause of neonatal jaundice.
Other tests include looking for haemolysis (Coombes test or DAT) and looking for unconjugated bilirubin levels.
What is the purpose of phototherapy in paediatric jaundice
Phototherapy converts bilirubin into two other compounds - lumirubin and photobilirubin which are isomers that do not need conjugation for excretion.
What are some causes for high bilirubin (3)
- Pre hepatic (unconjugated) - haemolysis (FBC+blood film), Gilbert’s
- Hepatic disease (repeat LFTs) - viral hepatitis, alcoholic hepatitis, cirrhosis.
- Post-hepatic (obstructive jaundice) gallstones, pancreatic cancer.
What is the inheritance of Gilbert’s
Autosomal recessive
What percentage of the population carry the genes for Gilberts
50% of the general population carry the gene.
5-6% of the population have the disease (1 in 20)
What is the pathology of Gilbert’s disease
UDP glucuronyl transferase activity is reduced to 30%
Unconjugated bilirubin is tightly albumin bound and does not enter the urine.
What tests are most accurate at determining liver function (3)
Albumin
Clotting factors (PT, PTTK)
Bilirubin
Aged 35 Chronic alcohol intake Often appeared drunk to A + E Nausea, abdo pain and jaundice. LFTs abnormal: Bilirubin 90 ALP 200 (INR<130) AST 1500 ALT 750
High ALT and AST suggest hepatocyte damage (hepatic)
ALP is marginal - excludes obstructive jaundice
What is the typical serological timeframe for hepatitis A infection (4)
Virus in faeces 2 weeks - 5 weeks after exposure.
Jaundice begins 4 weeks post exposure.
IgM rises 3 weeks post exposure.
IgG increased from 5 weeks post exposure.
How long after infection do you experience symptoms of hepatitis A infection
4 weeks post-exposure
How long after infection do you experience symptoms of hepatitis B infection
3 months post-exposure
