302 Introduction to hepatology, liver function tests, and jaundice

Question 1

What is the sphincter of Oddi?

Answer 1

Where the duct from the pancreas, liver, and gall bladder enters the duodenum

Question 2

hat gives faeces its colour?

Answer 2

Stercobilin

Question 3

What enzyme conjugates bilirubin

Answer 3

UDP-Glucaronyl transferase

Question 4

What are some diseases that interfere with conjugation of bilirubin?

Answer 4

Gilbert’s
Crigler Najjar syndrome
Dubin Johnson syndrome

Question 5

What gives you information about liver function?

Answer 5

Albumin
Bilirubin
INR

Question 6

What do liver enzymes tell you?

Answer 6

The extent and patterns of liver damage

Question 7

What are hepatitic causes of liver damage?

Answer 7

Viral hepatitis (A,B,C,E); drug induced liver injury (DILI); autoimmune hepatitis; Wilson’s disease

Has raised ALT

Question 8

What are some cholestatic causes of liver damage?

Answer 8

Intrahepatic: viral Hepatitis; DILI; autoimmune hepatitis, primary biliary cholangitis; Wilson’s disease, genetic cholestatic syndromes; sepsis

Extrahepatic: stones; benign/malignant stricture, primary sclerosing cholangitis

Shows raised Bilirubin and ALP

Question 9

What are some mixed (cholestatic hepatitis causes of liver damage?

Answer 9

Viral hepatitis, autoimmune hepatitis; DILI

Shows high bilirubin and ALT

Question 10

What is the difference between cirrhosis and fibrosis of the liver?

Answer 10

Fibrosis can be reversed

Question 11

What are some examples of non-invasive Assessment of Hepatic Fibrosis?

Answer 11

AST/ALT ratio
FIB-4 Test
Liver stiffness measurement (fibroscan)
ELF test

Liver biopsy remains gold standard

Question 12

How does hepatic encephalopathy occur?

Answer 12

Because the liver is no longer filtering the toxins out of the blood so it affects the brain

Question 13

What is acute liver failure?

Answer 13

You get jaundiced and then develop encephalopathy within 4 weeks with no pre existing liver disease

Question 14

What are some causes of hyperacute liver injury?

Answer 14

Paracetamol overdose
Hep A and E

Question 15

What is acute on chronic liver failure (ACLF)?

Answer 15

Organ failure in the presence of liver disease

Eg. kidneys, coagulation, circulation, or respiratory failure

Question 16

What is included in a hepatitis serology?

Answer 16

hepatitis A IgM, hepatitis B surface antigen, hepatitis C antibody, hepatitis E IgM

IgG will be present if people have had it in the past. Not indicative of current disease status

Question 17

What is haemochromatosis?

Answer 17

When iron-binding protein accumulates in various tissues, typically leading to liver damage, diabetes mellitus, and bronze discoloration of the skin

Question 18

What is Autoimmune Hepatitis?

Answer 18

Immune mediated chronic liver disease of unknown cause – almost all are women

Excellent response to immunosuppression

Question 19

What is Autoimmune Biliary Disease: Primary Biliary Cholangitis?

Answer 19

90% are women aged 40-50

Asymptomatic/itching, cholestatic liver panel

Small interlobular bile ducts: biopsy shows granulomatous hepatitis

Ursodeoxycholic acid effective, second line treatment is obetacholic acid

Question 20

What is Autoimmune Biliary Disease: Primary Sclerosing Cholangitis?

Answer 20

75% are men and 75% have IBD

PSC triggered by bacteria that enter portal circulation through inflamed intestine

Involve intra or extra hepatic bile ducts

Biopsy shows concentric fibrosis around bile ducts

No effective medical treatment

Increased risk of cholangicarcinoma

Question 21

What are Congenital Cholestatic Syndromes (PFIC/BRIC)?

Answer 21

They’re genetic disorders that present in childhood

They affect bile and bile acid formation and secretion

Question 22

What is cholangitis?

Answer 22

Presentations: Jaundice, rigors and RUQ pain (i.e. painful jaundice)

Liver USG shows dilated CBD
-Commonest cause is gallstones

Treated with antibiotics and ERCP with sphincterotomy and stone removal