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Inflammation > NAFLD > Flashcards

NAFLD Flashcards

1
Q

What are the 2 types of liver disease?

Why are they named this?

A

1) hepatocellular = hepatocytes (Liver cells)
2) cholestatic = bile ducts

They are names this due to the location of the primary injury/issue

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2
Q

What is bilirubin?

Where does it come from?

A

It is a heme breakdown product

It therefore comes from the breakdown of RBC

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3
Q

Describe RBC breakdown.

Explain where it’s components go and what they form.

A

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

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4
Q

What happens to unconjugated bilirubin in the liver?

A

They are conjugated and made water solvable by glucoronic acids

These can then be excreted in bile and released into the small intestine

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5
Q

What is ALP?

A

Alkaline phosphatase = enzyme found in biliary duct cells

Therefore a good indication of biliary obstruction or other forms of cholestatic liver disease

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6
Q

What is ALT?

A

Alanine transaminase = enzyme concentrated in liver hepatocytes

When found in serum it is a marker of liver disease/injury (more hepatocellular over cholestatic)

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7
Q

What is GGT?

A

Gamma glutamtyl transferase = Does NOT come with routine LFT’s

Marker of biliary obstruction

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8
Q

What do LFT’s differentiate between?

Which indicate which?

A

1) Hepatitis = Liver inflammation = ALT’s and AST’s (transaminases)
2) cholestasis = Obstructive = ALP’s and GGT

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9
Q

Describe the formation of common bile duct from the liver downwards?

A

Right and left hepatic duct join

Common hepatic duct

Cystic duct from gallbladder joins common hepatic

Common bile duct formed

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10
Q

What are PSC and PBC?

What is the difference?

Who is more likely to get which?

A

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

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11
Q

What is the treatment for Hep A?

A

It is self limiting

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12
Q

What is the route of transmission for Hep A?

A

Faeco-oral

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13
Q

How is Hep A identified in bloods?

A

Hep A IgM = acute Hep A

Hep A IgG = previous Hep A or VACCINATED!!

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14
Q

What is the first Hep B serological marker to appear in the blood?

How quickly is this normally detectable?

A

Hep B surface antigen (HBsAg)

4 weeks post infection

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15
Q

What is Hep B surface antibody?

When is it seen/not seen?

A

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

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16
Q

What does positive Hep B core antibody infer?

A

Does NOT infer protection

Only infers previous or current infection

Once infected once, HBcAg will always be present

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17
Q

What is a normal bilirubin range?

A 
Conjugated = <0.3mg/dL
Unconjugated = 0.2-1.2mg/dL

Total = <1.4mg/dL

18
Q

What may be the case if someone has a high Hep B viral load, nut normal ALT?

What is the treatment for this?

A

They may be in an immunotolerant phase of the disease where no treatment is indicated

19
Q

Explain the natural history and progression of Hep C.

A

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
20
Q

What is the most common type of liver cancer?

What % of liver cancers are this type?

A

Hepatocellular carcinoma

75%

21
Q

What are the most common lung cancers?

A

Adenomcarcinoma (40%) - linked to non smokers

Squamous cell carcinoma (30%) - linked to male smokers

22
Q

What is a major environmental risk for hepatocellular carcinoma?

A

Hep B (and C)

23
Q

What is the most common type of prostate cancer?

A

Adenocarcenoma

24
Q

What is the most common type of breast cancer?

A

Invasive ductal carcinoma

25
Q

What is the main drug used to treat Hep C?

What drugs make up this drug?

A

Epcluse = Sofosbuvir + Velpatasvir

26
Q

What is haemochromatosis?

Is this condition genetic?

A

An excess/overload of iron

Yes it can be and often is

27
Q

What is the inheritance pattern of haemachromatosis?

Which gene and chromosome is responsible?

A

Autosomal recessive

HFE gene on chromosome 6

28
Q

How do you diagnose haemochromatosis?

A

Ferritin levels (serum) raised

29
Q

What are normal ferritin levels?

A

Males = 300ng/mL

Females = 200ng/mL

30
Q

What blood test (other than LFT’s) is good at determining PBC?

A

Anti-mitochondrial antibody

31
Q

What blood test results would be negative for autoimmune hepatitis?

A

Anti-nuclear antibody
Smooth muscle antibody
Liver-kidney microsomes antibody

32
Q

What other condition does PSC have a strong association with?

How strong?

A

IBD

75%

33
Q

What organs are mostly affected with alpha-1-antitrypsin deficiency?

A

Lungs and liver

34
Q

What is Wilson’s disease?

A

Copper build up in the body

Genetic disorder

35
Q

What is a sign of Wilson’s disease?

A

Kayser-Fleischer rings

36
Q

What is the name of the main copper carrying protein found in the blood, which may be low in Wilson’s disease?

A

Caerulopasmin

37
Q

What is the difference between NAFLD and NASH?

A

NASH is a form of NAFLD

10-20% of NAFLD patients have NASH

NAFLD = fatty liver
NASH = fatty liver with inflammation
38
Q

What is another name for the fatty change seen in NAFLD?

A

Steatosis

39
Q

How can you differentiate between NASH and NAFLD?

A

Liver biopsy, there is NO other way

40
Q

Explain how liver biopsy is open to sampling error.

A

If you do not sample from a diseased section the result may be misleading.

41
Q

Name some liver questionnaires?

A

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

42
Q

Name a potential scan of the liver.

A

Fibroscan

Inflammation (17 decks)

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