Chemical Pathology 4 - Liver disease CPC Flashcards
(33 cards)
What is the inheritance pattern of Gilbert’s?
Autosomal recessive
What test measures bilirubin, and how does it work?
van den Bergh test
Fractionation
A direct reaction shows the conjugated bilirubin
Additional of methanol shows total bilirubin
Therefore you can calculate uncojugated bilirubin
How can normal paediatric jaundice be distinguished from pathological paediatric jaundice?
It’s usually normal - the bilirubin will be unconjugated and it is just due to liver immaturity
If it doesn’t settle - look for rare causes like hypothyroid
How can normal paediatric jaundice be treated?
A spot of liver phototherapy
What would make jaundice worse in Gilbert’s?
Fasting
What is the abnormally-functioning protein that causes Gilbert’s?
UDP glucoronyl transferase - it is reduced to 30% activity
What increases in Gilbert’s - conjugated bilirubin, unconjugated bilirubin or both?
ONLY unconjugated bilirubin
What is the best marker of liver function?
Prothrombin time
NB ALT and AST show DAMAGE rather than function
How can you tell that a paracetamol OD is bad enough to need transplant?
PT in seconds is > hours since OD
How does acute alcoholic hepatitis present?
Nausea, abdominal pain and jaundice
Pain is due to inflammation
What histological findings are pathognemonic for alcoholic hepatitis?
Liver cell damage (ballooning ± Mallory-Denk bodies)
arrows = balloon cells with mallory hyaline
Too much alcohol → fat deposits in liver (reversible if stop drinking)
alcohol abuse → alcoholic hepatitis (neutrophilic infiltration) → balloon cells contain mallory hyaline
This may NOT be reversible
Also fatty liver and megamitochondria
For how long following exposure to hep A should the virus be discoverable in faeces?
From 2-4 weeks
Which antibody to hep A will be the first to be produced, and for what time period post-exposure to the virus will it be present in serum?
IgM
Initial production at 3 weeks
Peaks at 5 weeks
Gone by 13 weeks
Which immunoglobulin class provides long-term hep A immunity, and how soon after exposure is it produced?
IgG
From 5 weeks
From when, and for how long, does hep A cause jaundice in an infected person?
From 4 weeks, potentially until 8 weeks, post-exposure
What are the 2 markers of hep B infection that can first be identified in an infected person, and how quickly are these produced?
HbS antigen and HbE antigen
Within 2 months of exposure
Which hepatitis antigen is most infectious?
HbE antigen
In a patient who successfully fights off Hep B, for how long are HbS and HbE present in serum?
HbS = 4 months HbE = 2 months
In a patient who becomes acutely unwell with hepatitis B, but it does not take a chronic course, what is the typical presentation?
Become acutely unwell and jaundiced around 2 months post-infection
In a patient who becomes acutely unwell with hepatitis B, but it does not take a chronic course, which antibodies endure in the blood?
Main one is anti-HbC (CORE antibody)
also anti-HbS
In a patient with chronic Hep B, what antigens and antibodies will be present?
surface antigen
e antibody
What are the signs of portal hypertension?
Caput medusae
Splenomegaly
Ascites
Portosystemic anastomoses (oesophageal, rectal varices)
What sign is indicative of liver failure?
Failed synthetic function - ↓ clotting factor and albumin
Failed clearance of bilirubin
Failed clearance of ammonia -> encephalopathy -> flapping tremor
If a patient has scratch marks, what does this tell you about their jaundice?
It must be post-hepatic, as itching is called by bile salts and bile acids
