NAFLD Flashcards
What are the 2 types of liver disease?
Why are they named this?
1) hepatocellular = hepatocytes (Liver cells)
2) cholestatic = bile ducts
They are names this due to the location of the primary injury/issue
What is bilirubin?
Where does it come from?
It is a heme breakdown product
It therefore comes from the breakdown of RBC
Describe RBC breakdown.
Explain where it’s components go and what they form.
Macrophages break down RBC’s in spleen or bone marrow (also specialised macrophages called KUPFFER cells found in the liver)
The heme part is broken down further into unconjugated bilirubin and iron
Unconjugated bilirubin is bound to albumin in the serum and transferred to the liver of
What happens to unconjugated bilirubin in the liver?
They are conjugated and made water solvable by glucoronic acids
These can then be excreted in bile and released into the small intestine
What is ALP?
Alkaline phosphatase = enzyme found in biliary duct cells
Therefore a good indication of biliary obstruction or other forms of cholestatic liver disease
What is ALT?
Alanine transaminase = enzyme concentrated in liver hepatocytes
When found in serum it is a marker of liver disease/injury (more hepatocellular over cholestatic)
What is GGT?
Gamma glutamtyl transferase = Does NOT come with routine LFT’s
Marker of biliary obstruction
What do LFT’s differentiate between?
Which indicate which?
1) Hepatitis = Liver inflammation = ALT’s and AST’s (transaminases)
2) cholestasis = Obstructive = ALP’s and GGT
Describe the formation of common bile duct from the liver downwards?
Right and left hepatic duct join
Common hepatic duct
Cystic duct from gallbladder joins common hepatic
Common bile duct formed
What are PSC and PBC?
What is the difference?
Who is more likely to get which?
Primary sclerosing cholangitis = males
Primary biliary cholangitis (previously cirrhosis) = females
PSC is large and or small bile ducts, whereas PBC is small bile ducts in the liver only
What is the treatment for Hep A?
It is self limiting
What is the route of transmission for Hep A?
Faeco-oral
How is Hep A identified in bloods?
Hep A IgM = acute Hep A
Hep A IgG = previous Hep A or VACCINATED!!
What is the first Hep B serological marker to appear in the blood?
How quickly is this normally detectable?
Hep B surface antigen (HBsAg)
4 weeks post infection
What is Hep B surface antibody?
When is it seen/not seen?
Shown in those who have recovered from acute Hep B infection
Not seen in those not able to clear Hep B and suffering from chronic Hep Bg
Infers protection from Hep B
What does positive Hep B core antibody infer?
Does NOT infer protection
Only infers previous or current infection
Once infected once, HBcAg will always be present
What is a normal bilirubin range?
Conjugated = <0.3mg/dL Unconjugated = 0.2-1.2mg/dL
Total = <1.4mg/dL
What may be the case if someone has a high Hep B viral load, nut normal ALT?
What is the treatment for this?
They may be in an immunotolerant phase of the disease where no treatment is indicated
Explain the natural history and progression of Hep C.
Out of 100 acute Hep C patients
- 85% develop chronic Hep C
- 20-50% of those develop liver cirrhosis
- 8-40% of the cirrhotic group develop liver cancer
- 20 of the cirrhotic group develop hepatic failure and require a liver transplant
What is the most common type of liver cancer?
What % of liver cancers are this type?
Hepatocellular carcinoma
75%
What are the most common lung cancers?
Adenomcarcinoma (40%) - linked to non smokers
Squamous cell carcinoma (30%) - linked to male smokers
What is a major environmental risk for hepatocellular carcinoma?
Hep B (and C)
What is the most common type of prostate cancer?
Adenocarcenoma
What is the most common type of breast cancer?
Invasive ductal carcinoma
What is the main drug used to treat Hep C?
What drugs make up this drug?
Epcluse = Sofosbuvir + Velpatasvir
What is haemochromatosis?
Is this condition genetic?
An excess/overload of iron
Yes it can be and often is
What is the inheritance pattern of haemachromatosis?
Which gene and chromosome is responsible?
Autosomal recessive
HFE gene on chromosome 6
How do you diagnose haemochromatosis?
Ferritin levels (serum) raised
What are normal ferritin levels?
Males = 300ng/mL
Females = 200ng/mL
What blood test (other than LFT’s) is good at determining PBC?
Anti-mitochondrial antibody
What blood test results would be negative for autoimmune hepatitis?
Anti-nuclear antibody
Smooth muscle antibody
Liver-kidney microsomes antibody
What other condition does PSC have a strong association with?
How strong?
IBD
75%
What organs are mostly affected with alpha-1-antitrypsin deficiency?
Lungs and liver
What is Wilson’s disease?
Copper build up in the body
Genetic disorder
What is a sign of Wilson’s disease?
Kayser-Fleischer rings
What is the name of the main copper carrying protein found in the blood, which may be low in Wilson’s disease?
Caerulopasmin
What is the difference between NAFLD and NASH?
NASH is a form of NAFLD
10-20% of NAFLD patients have NASH
NAFLD = fatty liver NASH = fatty liver with inflammation
What is another name for the fatty change seen in NAFLD?
Steatosis
How can you differentiate between NASH and NAFLD?
Liver biopsy, there is NO other way
Explain how liver biopsy is open to sampling error.
If you do not sample from a diseased section the result may be misleading.
Name some liver questionnaires?
FIB-4 (cut-off = 1.3)
NAFLD fibrosis score
BARD score (BMI, AST/ALT ratio >0.8, Diabetes) cut-off = 2+
Enhanced Liver Fibrosis (ELF) score
Name a potential scan of the liver.
Fibroscan
