Chemical Pathology 4 - Liver disease CPC Flashcards Preview

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Flashcards in Chemical Pathology 4 - Liver disease CPC Deck (25)
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1

What is the inheritance pattern of Gilbert's?

Autosomal recessive

2

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

3

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

4

How can normal paediatric jaundice be treated?

A spot of liver phototherapy

5

What would make jaundice worse in Gilbert's?

Fasting

6

What is the abnormally-functioning protein that causes Gilbert's?

UDP glucoronyl transferase - it is reduced to 30% activity

7

What increases in Gilbert's - conjugated bilirubin, unconjugated bilirubin or both?

ONLY unconjugated bilirubin

8

What is the best marker of liver function?

Prothrombin time

9

How can you tell that a paracetamol OD is bad enough to need transplant?

PT in seconds is > hours since OD

10

How does acute alcoholic hepatitis present?

Nausea, abdominal pain and jaundice
Pain is due to inflammation

11

What is the key histological finding that is pathognemonic for alcoholic hepatitis?

Megamitochondria

12

For how long following exposure to hep A should the virus be discoverable in faeces?

From 2-4 weeks

13

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

14

Which immunoglobulin class provides long-term hep A immunity, and how soon after exposure is it produced?

IgG
From 5 weeks

15

From when, and for how long, does hep A cause jaundice in an infected person?

From 4 weeks, potentially until 8 weeks, post-exposure

16

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

17

Which hepatitis antigen is most infectious?

HbE antigen

18

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

19

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

20

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

21

In a patient with chronic Hep B, what antigens and antibodies will be present?

surface antigen
e antibody

22

What are the 3 key signs of portal hypertension?

Caput medusae
Splenomegaly
Ascites

23

What sign is indicative of liver failure?

Flapping tremor

24

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

25

What is courvoisier's law?

If gallbladder is palpable but painless, it is almost always pancreatic cancer causing the jaundice

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