Liver disease Flashcards
(45 cards)
What indicates hepatitis?
Raised AST and ALT
What is cholestasis?
Bile not reaching duodenum
Obstructive/metabolic
Signs of obstructive cholestasis:
Raised alkaline phosphatase
Raised GGT
What is blocked in large duct obstruction?
Extrahepatic bile duct
What is blocked in primary sclerosis cholangitis?
Large and/or small bile duct
What is blocked in primary biliary cirrhosis?
Small interlobular bile duct
What is haemochromatosis?
Autosomal recessive (HFE gene) disorder of iron metabolism that results in iron accumulation - causes abnormal liver enzymes, cirrhosis, hepatomegaly, joint pain and bronze skin
Important liver virology:
Hep B surface antigen
Hep C antibody
Features of hepatitis A:
Faeco-oral route
No chronicity
Hep A IgM = acute
Hep A IgG = previous exposure
Features of acute hepatitis B:
Initially Hep B surface antigen and core-IgM are present
Once virus is cleared these two go away and core-IgG develops
Later still Hep B surface antibody develops (implies immunity)
Features of chronic hepatitis B:
Hep B surface antigen and core-IgG stay risen (IgM falls)
Do not develop Hep B surface antibody
What does Hep B core-IgM indicate?
Acute infection
What does Hep B core-IgG indicate?
Hep B exposure
What should you do if you detect Hep B surface antigen?
Refer
What does Hep B surface antibody (>100) indicate?
Immunity
What are the different phases of Hep B infection?
Phase I = Viral load is high and inflammation is low; immune tolerant (0-18 years)
Phase II = Immune active hepatitis; liver problems (18-51 years)
Phase III = Cirrhosis, non-replicative (51-69 years)
When should you treat Hep B?
High viral load + elevated ALT
Hepatitis C curable treatments:
Ledipasvir/Sofosbuvir combined oral pill - 99% clear rate
OMV/PTV/RTV+DSV+RBV - 100% clear rate
Sofosbuvir/Velpatasvir >95% clear rate
Features of haemochromatosis (end organ failure):
Cirrhosis Skin pigmentation Diabetes Cardiomyopathy Arthritis Pituitary failure
How do you diagnose haemochromatosis?
Raised ferritin (women >200, men >300) and HFE genotype homozygote Biopsy and hepatic iron index if ferritin is raised but HFE negative
What does abnormal LFTs and ferritin >1000 indicate in haemochromatosis?
Cirrhosis
Liver should be biopsied
Diagnosis of primary biliary cholangitis:
+ve anti-Mt Ab
Cholestatic LFTs
Raised IgG
Liver biopsy showing BD damage and granulomatous cholangitis
Signs and symptoms of primary biliary cholangitis:
Asymp/fatigue/pruritis Itching and tiredness Cholestatic jaundice Hyperpigmentation esp over pressure points Xanthelasmas, xanthomata Clubbing, hepatosplenomegaly
Complications of primary biliary cholangitis:
Malabsorption causing osteomalacia or coagulopathy
Sicca syndrome
Portal hypertension causing ascites and vatical haemorrhage
Hepatocellular cancer
