Liver Diseases 1

Question 1

Trachea

Answer 1

• Cartilage plates & smooth muscle
• Respiratory epithelium
• Submucosal glands

Question 2

Bronchi

Answer 2

• Cartilage foci & smooth muscle
• Respiratory epithelium
• Submucosal glands

Question 3

Bronchioles

Answer 3

• No cartilage, thinner muscular layer
• Simple ciliated epithelium
• Clara cells

Question 4

the main function of the liver

Answer 4

→ synthesis and metabolism of carbohydrate, lipids, protein and drugs

→ metabolism and excretion of bilirubin and bile acids

Question 5

major primary liver diseases

Answer 5

→ viral hepatitis

→ alcohol liver diseases

→ non-alcoholic fatty liver diseases

→ nonalcoholic fatty liver disease

→ hepatocellular carcinoma

Question 6

major causes of liver disease
(west and east)

Answer 6

→ in the west = alcohol and hepatitis C virus

→ elsewhere = hepatitis B virus, but the incidence is decreasing (vaccination)

Question 7

two facts about the liver

Answer 7

• dual supply of blood vessels
• vulnerability to a wide variety of insults → metabolic, toxic, microbial, circulatory and neoplastic

Question 8

What is another name for jaundice?

Answer 8

icterus

Question 9

What are the symptoms of jaundice?

Answer 9

yellow sclerae and skin

Question 10

Serum bilirubin in jaundice patients

Answer 10

> 10 micromole

Question 11

What is pre-jundice?

Answer 11

haemolytic jaudice

Question 12

What is non-haemolytic jaundice?

Answer 12

congenital hyperbilirubinaemias

Question 13

What are the three types of jaundice?

Answer 13

• haemolytic jaudice - pre-hepatic
• congenital hyperbilirubinaemias - non-haemolytic
• cholestatic jaundice

Question 14

Haemolytic Jaundice (Pre-Hepatic)

Answer 14

increased breakdown of RBC

Question 15

Investigation of Haemolytic Jaundice

Answer 15

• haemolysis
• increase serum unconjugated bilirubin
• normal alkaline phosphatase (ALP) and transferase

Question 16

Congenital Hyperbilirubinaemias

Answer 16

• most common - Gilbert’s syndome
• decreased UDP-glucuronyl transferase activity
• decreased conjugation of bilirubin with glucuronic acid
• unconjugared bilirubin increases and other tests are normal

Question 17

What are the two types of chlostatisis?

Answer 17

intrahepatic cholestatsis

extrahepatic cholestasis

Question 18

intrahepatic cholestatsis

Answer 18

• abnormal bile excretion
• bile channel obstruction

Question 19

extrahepatic cholestasis

Answer 19

bile flow obstruction - distal to the bile canaliculi

Question 20

How do you investigate cholestatic jaundice?

Answer 20

• serum liver biochemistry - jaudice (conjugated bilirubin)

Question 21

Hepatitis Pathology

Answer 21

liver cell necrosis and inflammatory infiltration

Question 22

Hepatitis Presentation

Answer 22

• enlarged and tender liver (+/)
• jaundice (+/-)

Question 23

Hepatitis Investigation

Answer 23

serum transferase increases etc.

Question 24

Hepatitis types

Answer 24

acute and chronic

Question 25

Causes of acute hepatitis

Answer 25

- viruses = hepatitis viruses - non-viral infections - toxoplasma gondii etc. - alcohol - drugs - anti-TB (isoniazid) - others - pregnancy etc

Question 26

Clinical Features of acute hepatitis

Answer 26

- usually (viral) self-limiting, return to normal structure and function - occasionally profession into massive liver necrosis and even death

Question 27

Investigation of acute hepatitis

Answer 27

- increased serum ALT (best indicator of acute hepatic injury) - prothrombin time and bilirubin (reflect disease severity)

Question 28

Chronic Hepatitis

Answer 28

a sustained inflammatory disease

Question 29

Causes of chronic hepatitis

Answer 29

- viral - chemical - autoimmune

Question 30

How long does chronic hepatitis last?

Answer 30

more than 6 months

Question 31

What is Hepatitis A?

Answer 31

acute viral hepatitis

Question 32

How is acute viral hepatitis spread?

Answer 32

faecal-oral

Question 33

how does acute viral hepatitis damage the liver?

Answer 33

cytopathic and immunity-mediated by t cells

Question 34

acute viral hepatitis virus

Answer 34

HAV

Question 35

Clinical Features of Hepatitis A

Answer 35

relatively short incubation period, non-specific symptoms - flu-like

Question 36

Hepatitis A signs

Answer 36

- jaundice +/- - hepatomegaly - moderate - spleen palpable

Question 37

lab testing of Hepatitis A

Answer 37

serum transferase increases

Question 38

Hepatitis A characteristics

Answer 38

Acute, self-limiting; no chronic stage - fulminant hepatitis, rare

Question 39

Hepatitis A management

Answer 39

- no specific treatment - Prophylaxis - immunisation

Question 40

active Hepatitis A vaccine

Answer 40

inactive strain

Question 41

inactive Hepatitis A vaccine

Answer 41

immunoglobulin

Question 42

Hepatitis B Epidemiology

Answer 42

worldwide, prevalent in parts of Africa, middle and far east

Question 43

Hepatitis B virus

Answer 43

HBV, DNA virus

Question 44

HBV Protein

Answer 44

core - protein of core particle pre-core - pre-core/core cleaves to HBeAg surface - envelope protein; HBsAg; basis of current vaccine

Question 45

Spread of Hepatitis B

Answer 45

- parenteral - close personal contact - vertical

Question 46

Hepatitis B - Mechanism of Liver Damage

Answer 46

immunity-mediated by t-cells

Question 47

Clinical Features of Hepatitis B

Answer 47

- long incubation period - chronic carriers - HBsAg >6mo ; HBeAg or viral DNA - highly infectious, risk of chronic hepatitis and cirrhosis - chronic hepatitis - 3-5% acute hep B, serum liver biochemistry abnormal; liver biopsy/histology: mild inflammatory changes to cirrhosis

Question 48

Hepatitis B Treatment

Answer 48

- antiviral agents with indications eg serum HBsAg, HBV DNA - Prophylaxis → avoid high-risk factors, immunisation: active (vaccine) and passive

Question 49

Hepatitis C viruses

Answer 49

HCV; non-A, non-B

Question 50

Hepatitis C spread

Answer 50

blood or blood products, other routes eg. vertical but rare

Question 51

Hepatitis C mechanisms of liver damage

Answer 51

immunity mediate by t-cells

Question 52

Hepatitis C Special Clinical Features

Answer 52

- short incubation - 60-90% becoming carriers - high risk of developing → chronic, active hepatitis cirrhosis, hepatocellular carcinoma

Question 53

Hepatitis C Diagnosis

Answer 53

by exclusion

Question 54

Management of Hepatitis C

Answer 54

- interferon used in acute cases to prevent chronic diseases - needle-stick injuries must be followed and treated early

Question 55

Prophylaxis

Answer 55

HCV is a RNA virus; a rapid change in envelope proteins hence vaccine is difficult