Liver Symposium

Question 1

What can investigations of liver disease help with?

Answer 1

1) Identifying the presence of liver disease
2) Establishing the cause of the liver disease
3) Understanding the severity of the disease

Question 2

What different investigative tests can be performed in order to assess Liver disease?

Answer 2

Liver blood biochemistry (LFT’s):

• Serum Bilirubin
• Aminotransferases
• Alakline phosphatase
• Gamma-glutamyl transferase
• Serum Albumin

Blood Count:

• Normocytic anaemia (GI haemorrhage)
• Leucopenia (lowered WCC)
• Thrombocytopenia (reduced platelet production due to hypersplenism)

Coagulation Tests:

• Increased Prothrombin Time (PT)

Imaging:

• Ultrasound (gallstones, biliary obstruction, splenomegaly)
• CT (smaller focal lesions)
• MRI (focal liver lesions, primary and secondary tumours)

Cholangiography:

MRCP - Magentic Resonance Cholangiopancreatography

ERCP - Endoscopic Retrograde Cholangiopancreatography

• Both MRCP and ERCP are as good as each other at imaging biliary tree, but MRCP has fewer complications as is the test of choice

Histology from Biopsy

Question 3

How do bilirubin and albumin levels change in patients with liver damage

Answer 3

Bilirubin - Generally elevated in liver disease

Albumin - Usually low in patients with liver disease (half-life long so not always reduced in acute liver failure)

Question 4

How do alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels change during liver disease?

Answer 4

• Any large increase in aminotransferases favours liver damage
• Increase in ALT is particullarly specific to hepatocellular damage

Question 5

How do alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) levels vary in Liver disease?

Answer 5

• Levels of ALP will rise with intrahepatic and extrahepatic biliary obstruction
• Elevation of GGT on its own can occur during ingestion alcohol or certain drugs
• Elevation of both PLT and GGT is common in biliary obstruction (cholestatic or obstructive)

Question 6

What is the management of Hepatitis A?

Answer 6

• Immunisation (Immune serum globulin)

Question 7

What is the management of Hepatitis B?

Answer 7

Acute:

• Supportive and monitor for acute liver failure

Chronic:

• HBeAg seroconversion
• Reduction in HBV DNA
• Management of LFT’s
• Nucleoside/nucleotide analogues
• Transplantation

Question 8

What is the management of Hepatitis D?

Answer 8

Effective management of HBV prevents HDV

Question 9

What is the management of Hepatitis C?

Answer 9

Eradicate infection with:

1) Pegylated interferon-alfa
2) Ribavirin

Question 10

How is NAFLD managed?

Answer 10

Non-pharmacological treatment:

1) Weight loss
2) Dietary changes and physical exercise to improve insulin sensitivity

Pharmacological treatment:

1) Treatment for co-existing metabolic disorders (dyslipiaemia and Hypertension)

Question 11

How is autoimmune liver disease managed?

Answer 11

Corticosteroids (prednisolone)