Liver Test 1

Question 1

What are the 5 components of a liver function test?

Answer 1

Bilirubin.

Alkaline phosphatase (ALP).

Alanine transaminase (ALT).

Gamma-glutamyltransferase (GGT).

Aspartate aminotransferase (AST).

Question 2

What would diagnostic tests find for a patient with hepatitis (inflammation of the liver)?

Answer 2

Raised transaminases. Raised Aspartate aminotransferase (AST). Raised Alanine transaminase (ALT).

Question 3

What would diagnostic tests find for a patient with cholestasis (reduction or stoppage of bile flow)?

Answer 3

Raised alkaline phosphatase (ALP). Raised Gamma-glutamyltransferase (GT).

Question 4

State 3 causes of abnormal liver enzymes.

Answer 4

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).

Question 5

Name 3 different types of liver disease.

Answer 5

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).

Question 6

If a patient has been exposed to hepatitis B before, what anti-body would you expect to be present in the blood?

Answer 6

IgG.

Question 7

If a patient suffered from acute hepatitis B, what anti-body would you expect to be present in the blood?

Answer 7

IgM.

Question 8

What is meant by HBeAg?

Answer 8

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.

Question 9

What would lab results find in a hepatitis B blood test?

Answer 9

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

Question 10

What is meant by anti-HBe?

Answer 10

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).

Question 11

Ledispavir, sofosbuvir, ledipasmir and velpatasvir are all what?

Answer 11

Anti-viral drugs for hepatitis C.

Question 12

What is meant by haemochromatosis?

Answer 12

Iron overload. Autosomal recessive. Human haemochromatosis (HFE) gene.

Question 13

State 3 features of haemochromatosis.

Answer 13

Cirrhosis. Skin pigmentation. Diabetes. Cardiomyopathy. Arthritis. Pituitary failure.

Question 14

How is haemochromatosis diagnosed?

Answer 14

Raised ferritin. HFE gene checked. Hepatic iron index - micromol iron per g dry weight/age.

Question 15

What is primary biliary cholangitis?

Answer 15

Destruction of bile ducts of the liver - bile builds up in liver (cholestasis).

Question 16

Ursodeoxycholic acid and obeticholic acid (dissolves gallstones) is used to treat what?

Answer 16

Primary biliary cholangitis.

Question 17

How is primary biliary cholangitis diagnosed?

Answer 17

Raised IgM. Liver biopsy - bile duct damage, granulomatous cholangitis. Positive anti-mitochondrial antibody.

Question 18

How is autoimmune hepatitis diagnosed?

Answer 18

Raised IgG. Positive anti-nuclear antibody. Positive smooth muscle antibody. Positive liver-kidney microsomal antibody. Liver biopsy.

Question 19

Prednisolone (cortisone) and azathioprine (immunosuppressant) is used to treat what?

Answer 19

Primary Sclerosing Cholangitis.

Question 20

What condition is alpha-1-antitrypsin deficiency associated with?

Answer 20

Chronic obstructive pulmonary disease (COPD).

Question 21

Wilson’s disease is when copper builds up in the body, state 3 clinical features.

Answer 21

Liver cirrhosis. Acute liver disease. Neuropsychiatric disorder. Kayser-Fleischer rings - dark rings encircle iris of eye (due to copper deposition).

Question 22

What is Penicillamine used to treat?

Answer 22

Wilson’s disease. It binds to heavy metals e.g. Cu, which are removed in urine.

Question 23

What condition is non-alcoholic fatty liver disease (NAFLD) associated with?

Answer 23

Obesity.

Question 24

State a non-invasive marker of cirrhosis.

Answer 24

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.

Question 25

State a non-invasive marker of liver fibrosis in NAFLD.

Answer 25

AST/ALT ratio > 0.8

FIB-4 - used to measure the amount of scarring in liver.