S6 L2 - Jaundice, Hepatitis

Question 1

• *Jaundice (1/3 flashcard)**
• Hepatitis definition
• Occurs when…
• Bilirubin is…
• What should happen to bilirubin

Answer 1

• *Hepatitis is:** the inflammation of the liver
• *Occurs when:** build-up of high bilirubin levels in the blood
• *Bilirubin is:** normal breakdown product of heam (from destruction of RBC)
• *What should happen to bilirubin:**
  1. Haemoglobin in RBC
  2. Converted to bilirubin in the liver
  3. Bilurubin-albumin in the blood stream
  4. Bilirubin conjugated (added glucuronic acid) by UDP glucoronyl transferase (this makes it water soluble)
  5. Excreted via the bile into the GI tract – majority egested in faeces as stercobilin and in urine as urobilinogen

Question 2

• *Types of Jaundice (2/3 flashcard)**
• 3 types and explain, and ‘state’ of the bilirubin

Answer 2

• *Types of jaundice:**
• Pre-hepatic: excessive red cell breakdown, overwhelms the liver ability to conjugate bilirubin, unconjugated bilirubin remains in the blood e.g. haemolytic anaemia, sickle cell anaemia UNCONJUGATED
• Hepatocellular: dysfunction of the hepatic cells, liver loses ability to conjugate bilirubin, liver cirrhosis may compress portions of the biliary tree leading to obstruction, both unconjugated and conjugated bilirubin in the blood e.g. viral hepatitis, alcoholic liver disease, cirrhosis, pregnancy MIX
• Post-hepatic: Obstruction of biliary drainage, bilirubin that is not excreted will be conjugated by the liver CONJUGATED e.g. blocked bile duct
• — have a look at the haemoglobin when deciding which type of jaundice, e.g. low haemoglobin, likely to be pre-hepatic jaundice

Question 3

• *Jaundice (3/3 flashcard)**
• Liver function tests

Answer 3

LIVER FUNCTION TESTS:

• Bilirubin – quantify degree of jaundice
• AST/ALT – marker of hepatocellular injury
• Albumin – marker of liver’s synthesising function
• Phosphorylase kinase (Alkaline phosphatase – ALP) – biliary obstruction
• Tests of coagulation (clotting factors are synthesised in liver, INR, PT)

Question 4

• *Hepatitis B (1/3 flashcard)**
• What is this
• Preventive? Cure? Acute? Chronic?

Answer 4

What is this:
Replication of Hep B in hepatocytes (hepatotropic), leads to destruction of hepatocytes

Preventive? Cure? Acute? Chornic?
Vaccine to prevent it.
But, no cure.
Acute (up to 6 months) -> chonic (6 months +)
Can get better without curative treatment, until it become chronic hep B (then will also have Hep B)

Question 5

• *Hepatitis B (2/3 flashcard)**
• Pathogen
• Patient
• Mechanism of infection
• Symptoms
• Management
• Outcome
• What surface antigen means acute has progressed to chronic infection?

Answer 5

Question 6

• *Hepatitis B (3/3 flashcards)**
• Antigens and antibodies present
• Antigens and antibodies - acute infection, past infection (cleared), chronic infection, immunised

Answer 6

Question 7

• *Hepatitis C**
• Pathogen
• Patient
• Mechanism of infection
• Symptoms
• % that have symptoms
• Management
• Outcome

Answer 7

MORE HEP C BECOME CHRONIC (80%) COMPARED TO HEP B

• No vaccine
• Curative

Question 8

• *Summary of Hep B, Hep C and HIV**
• Acute infection
• Prevention
• Outcome of infection
• Treatment

Answer 8