Liver Problems

Question 1

List possible differentials for the following presentation; Fever, RUQ pain, jaundice

Answer 1

1. Malaria - returning travellers
2. Acute cholecystitis
3. Ascending cholangitis
4. Acute viral hepatitis
5. Liver abscess

Question 2

When someone presents with a liver abscess, what investigations should be performed?

Answer 2

• ECG
• Plain CXR
• Abdominal USS
• Tests for Hep B and C viruses

Question 3

What does the presence of the following mean; Hepatitis A virus IgM?

Answer 3

Current or recurrent hepatitis A infection

Question 4

What does the presence of the following mean; Hepatitis C antibody?

Answer 4

Exposure to Hepatitis C

Question 5

What does the presence of the following mean; Antibody to hepatitis B surface antigen (anti-HBs)?

Answer 5

Immunity to Hepatitis B

Question 6

What does the presence of the following mean; Hepatitis A virus IgG?

Answer 6

Immunity to hepatitis A

Question 7

What does the presence of the following mean; Hepatitis B surface antigen (HBsAg)?

Answer 7

Active hepatitis B infection

Question 8

What does the presence of the following mean; Antibody to hepatitis B core antigen (anti-HBc)?

Answer 8

Exposure to Hepatitis B

Question 9

Who is most at risk of Hepatitis C infection?

Answer 9

IV drug users

Question 10

Where are the high prevalence Hepatitis C areas in the world?

Answer 10

• Central and Eastern Asia
• Middle East
• Northern Africa

Question 11

How is Hep C transmitted?

Answer 11

It is a blood-borne virus

Question 12

What is the hepatitis C incubation period?

Answer 12

2 weeks - 6 months

Question 13

How do 2/3 of people with HepC present in the acute phase?

Answer 13

Asymptomatically

Question 14

What happens to serum transaminases in someone with HepC infection?

Answer 14

They can be 10-20 times the upper limit of normal

Question 15

How do we diagnose chronic HepC?

Answer 15

anti-HCV antibody is the best initial test, followed by HCV RNA detection in the blood by PCR to detect any chronic active infection

Question 16

What treatment is available to someone with a chronic HepC infection?

Answer 16

• Interferon (weekly injection)
• Ribavirin (oral)
• New novel treatments emerging

Question 17

What percentage of patients with Chronic HepC go on to develop liver cirrhosis over 20 years?

Answer 17

15-50%

Question 18

If liver cirrhosis develops, what does this put the patient at further risk for developing?

Answer 18

Hepatocellular carcinoma

Question 19

Which parasite causes amoebic liver abscesses?

Answer 19

Entamoeba histolytica

Question 20

Where is E.histolytica an endemic?

Answer 20

India
Mexico
Africa
Central and South America

Question 21

How is E.histolytica transmitted?

Answer 21

Faecal oral route

Question 22

How do trophozoites reach the portal circulation?

Answer 22

They colonise the small intestine, once ingested, and then invade the colonic mucosa. They can then spread via the portal circulation and reach the liver.

Question 23

What is the common clinical presentation of someone with an amoebic liver abscess?

Answer 23

• Fever
• RUQ pain
• Recent diarrhoea/dysentery history

Question 24

What would be found on LFT and FBC in an amoebic liver abscess?

Answer 24

• Elevated ALP
• Elevated WCC
• NO eosinophilia (which is common in other parasitic infection)

Question 25

What would be seen on a liver USS in someone with an amoebic liver abscess?

Answer 25

A single, hypoechoic lesion

Often in the right lobe

Question 26

If an amoebic liver abscess is aspirated, what would it produce?

Answer 26

Thick, brown fluid

“anchovy paste”

Question 27

What is the treatment of an amoebic liver abscess?

Answer 27

Metronidazole for 7-10 days

Drainage is NOT indicated in most unless there is risk of significant complications