Peer teaching Liver

Question 1

What happens when albumin goes wrong?

Answer 1

Hypoalbuminaemia –> oedema –> ascites

Leuconuchia

Question 2

What happens when regulation of excess oestrogen goes wrong?

Answer 2

Gynaecomastia in men
Spider naevi due to dilation of blood vessels caused by oestrogen
Palmar erythema

Question 3

What happens when production of clotting factors goes wrong?

Answer 3

Easy bruising

Question 4

What happens when regulation of bilirubin goes wrong?

Answer 4

Jaundice, pruritus, change in colour of urine and stool

Question 5

What happens when the urea cycle goes wrong?

Answer 5

Hepatic encephalopathy from build up of ammonia that crosses the blood-brain barrier

Question 6

What happens when the protection against infection via reticuloendothelial system goes wrong?

Answer 6

Prone to infection - spontaneous bacterial peritonitis in ascites

Question 7

When is Gamma-glutamyl transferase raised?

Answer 7

Alcoholic liver disease

Question 8

When is alkaline phosphatase level raised?

Answer 8

Anything to do with biliary tree damage

Also in bone resorption eg. mets

Question 9

When is enzyme aspartate aminotransferase/Alanine aminotransferase raised?

Answer 9

Hepatocyte damage

Question 10

What are causes of chronic liver conditions?

Answer 10

• Infectious (Hep B, Hep C)
• Autoimmune (AIH, PBC, PSC)
• Metabolic (iron – haemochromatosis, copper – -Wilson’s, alpha-1-antitrypsin)
• Alcoholic liver disease
• Non Alcoholic Fatty Liver Disease (NAFLD)

Question 11

Explain the progression of chronic liver disease

Answer 11

Chronic liver condition –> liver damage –> liver symptoms –> liver cirrhosis if prolonged –> liver failure ultimately + higher risk of hepatocellular carcinoma

Question 12

Which hepatitis’ are blood-bourne?

Answer 12

Hep B, C, D

Hep D combines with B

Question 13

Which hepatitis’ are spread by faecal-oral route?

Answer 13

Hep A, normally with travel history - contaninated food/water
Hep E - contaminated food/water. Endemic in UK - found in undercooked pork

Question 14

Which of the hepatitis’ are DNA?

Answer 14

Hep B

Question 15

Which of the hepatitis’ are acute?

Answer 15

All of them - B, C, D can be chronic

Question 16

How do you detect viral hepatitis?

Answer 16

Total Hep B core antibody = anti-HBc
Igm antibody to Hep B core antigen = IgM anti-HBc
Hep B surface antigen HbsAg
Hep B surface antibody = anti-HBs

Question 17

What is the status of
HBsAg -ve,
anti-HBc -ve,
anti-HBs -ve?

Answer 17

Susceptible

Question 18

What is the status of
HBsAg -ve,
anti-HBc +ve,
anti-HBs +ve?

Answer 18

Immune due to natural infection

Question 19

What is the status of
HBsAg -ve,
anti-HBc -ve,
anti-HBs +ve?

Answer 19

Immune due to hep B vaccination

Question 20

What is the status of
HBsAg +ve, 
anti-HBc +ve,
IgM anti-HBc +ve
anti-HBs -ve?

Answer 20

Acutely infected

Question 21

What is the status of
HBsAg +ve, 
anti-HBc +ve,
IgM anti-HBc -ve
anti-HBs -ve?

Answer 21

Chronically infected

Question 22

What is the status of
HBsAg -ve,
anti-HBc +ve,
anti-HBs -ve?

Answer 22

Unclear. Either:

1. Resolved infection (most common)
2. False-positive anti-HBc, thus susceptible
3. “Low level” chronic infection
4. Resolving acute infection

Question 23

Which hepatitis injection is reccomended for travellers?

Answer 23

Hepatitis A

Question 24

What is the treatment for hep A & hep E?

Answer 24

Supportive as they are self limiting

Question 25

What is the treatment for chronic hep B?

Answer 25

Pegylated interferon-alpha 2a = pegasys (stimulates immune response)

Question 26

What is the treatment for chronic hep C?

Answer 26

Velpatasvir/sofosbuvir

Question 27

What is the rhyme for Hep A?

Answer 27

A is Acquired by mouth from Anus, is Always cleared Acutely and only ever Appears once

Question 28

What is the rhyme for Hep B?

Answer 28

B is Blood-Borne and if not Beaten can Be Bad

Question 29

What rhyme is Hep E?

Answer 29

E is Even in England and can be Eaten(sausage from pigs), if not always beaten

Question 30

What rhyme is hep. C?

Answer 30

C is usually Chronic but Can be Cured – at a Cost

Question 31

What is the pathophysiological progression of alcoholic liver diease?

Answer 31

Alcoholic hepatitis --> alcoholic steatosis --> cirrhosis Reduced NAD+ --> less fat oxidation --> accumulation of fat in hepatocytes

Question 32

What is the effect of ROS on the liver?

Answer 32

Damages hepatocytes

Question 33

What is the effect of acetaldehyde on the liver?

Answer 33

Damages liver cell membranes

Question 34

What blood results will you expect in alcoholic liver disease?

Answer 34

GGT very raised AST, ALT mildly raised FBC: macrocytic anaemia

Question 35

What is the treatment of alcoholic liver disease?

Answer 35

Quit alcohol | Treat malnutrition: thiamine