Liver Test 1 Flashcards
What are the 5 components of a liver function test?
Bilirubin.
Alkaline phosphatase (ALP).
Alanine transaminase (ALT).
Gamma-glutamyltransferase (GGT).
Aspartate aminotransferase (AST).
What would diagnostic tests find for a patient with hepatitis (inflammation of the liver)?
Raised transaminases. Raised Aspartate aminotransferase (AST). Raised Alanine transaminase (ALT).
What would diagnostic tests find for a patient with cholestasis (reduction or stoppage of bile flow)?
Raised alkaline phosphatase (ALP). Raised Gamma-glutamyltransferase (GT).
State 3 causes of abnormal liver enzymes.
Alcohol. Medications. Non-alcohol fatty liver disease (NAFLD). Space occupying lesions. Viral hepatitis. Haemochromatosis (overload of iron in body). Rarer causes e.g. autoimmune hepatitis, primary biliary cirrhosis, alpha-1-antitrypsin deficiency, Wilson’s disease (genetic disorder where Cu builds up). Anti-trypsin deficiency (genetic disorder resulting in lung disease).
Name 3 different types of liver disease.
Cirrhosis - scarring (fibrosis) of the liver. Viral hepatitis. Haemochromatosis. Primary Biliary Cholangitis. Autoimmune hepatitis. Primary Sclerosing Cholangitis. Alpha-1-antitrypsin deficiency. Wilson’s disease. alcoholic fatty liver disease (NAFLD).
If a patient has been exposed to hepatitis B before, what anti-body would you expect to be present in the blood?
IgG.
If a patient suffered from acute hepatitis B, what anti-body would you expect to be present in the blood?
IgM.
What is meant by HBeAg?
HBeAg stands for hepatitis B e-antigen. This antigen is a protein from the hepatitis B virus that circulates in infected blood when the virus is actively replicating.
What would lab results find in a hepatitis B blood test?
HBV virions found in blood serum, proves viral replication
↑ ALT, ↑ AST, ↑ CRP, ↑ ESR, ↑ WBC
HBsAg (surface antigen); present in acute infection then cleared in recovery; if present over six months → chronic infection; used to create vaccine
Anti-HBc IgM (core antigen); present in active infection for six months; if present longer individual is carrier; used for screening because present most of the time
Anti-HBc IgG develop after IgM, lifelong secretion indicates individual is immune
Anti-HBe secreted core antigen, appears during viral replication, indicates active infection
Bilirubin normal to increase
What is meant by anti-HBe?
HBeAg and anti-HBe: HBeAg is the hepatitis B envelope antigen, and anti-HBe are the antibodies produced against this antigen. If HBeAg is detectable in a blood sample, this means that the virus is still active in the liver (and can be transmitted to others).
Ledispavir, sofosbuvir, ledipasmir and velpatasvir are all what?
Anti-viral drugs for hepatitis C.
What is meant by haemochromatosis?
Iron overload. Autosomal recessive. Human haemochromatosis (HFE) gene.
State 3 features of haemochromatosis.
Cirrhosis. Skin pigmentation. Diabetes. Cardiomyopathy. Arthritis. Pituitary failure.
How is haemochromatosis diagnosed?
Raised ferritin. HFE gene checked. Hepatic iron index - micromol iron per g dry weight/age.
What is primary biliary cholangitis?
Destruction of bile ducts of the liver - bile builds up in liver (cholestasis).
Ursodeoxycholic acid and obeticholic acid (dissolves gallstones) is used to treat what?
Primary biliary cholangitis.
How is primary biliary cholangitis diagnosed?
Raised IgM. Liver biopsy - bile duct damage, granulomatous cholangitis. Positive anti-mitochondrial antibody.
How is autoimmune hepatitis diagnosed?
Raised IgG. Positive anti-nuclear antibody. Positive smooth muscle antibody. Positive liver-kidney microsomal antibody. Liver biopsy.
Prednisolone (cortisone) and azathioprine (immunosuppressant) is used to treat what?
Primary Sclerosing Cholangitis.
What condition is alpha-1-antitrypsin deficiency associated with?
Chronic obstructive pulmonary disease (COPD).
Wilson’s disease is when copper builds up in the body, state 3 clinical features.
Liver cirrhosis. Acute liver disease. Neuropsychiatric disorder. Kayser-Fleischer rings - dark rings encircle iris of eye (due to copper deposition).
What is Penicillamine used to treat?
Wilson’s disease. It binds to heavy metals e.g. Cu, which are removed in urine.
What condition is non-alcoholic fatty liver disease (NAFLD) associated with?
Obesity.
State a non-invasive marker of cirrhosis.
Tissue elastography e.g. fibroscan - medical imaging to map the elastic properties and stiffness of liver soft tissue.
AST/ALT ratio
FIB-4 - used to measure the amount of scarring in liver.
State a non-invasive marker of liver fibrosis in NAFLD.
AST/ALT ratio > 0.8
FIB-4 - used to measure the amount of scarring in liver.
