Liver diseases

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What is the main function of the liver?
Synthesis & metabolism of carbohydrate, lipids, protein & drugs. Metabolism & excretion of bilirubin and bile acids
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What is jaundice?
A serum bilirubin level of above 50 micro-moles/L resulting in yellow eyes and skin
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What are the main types of jaundice?
Haemolytic, congential hyperbilirubinaemias, cholestatic
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What is haemolytic jaundice?
An increased amount of bilirubin due to increased break down of red blood cells
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How would you test for haemolytic jaundice?
Check red blood cell count for haemolysis, check for increased serum levels of unconjugated bilirubin,normal levels of ALP and ALT
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What is congenital hyperbilirubinaemias?
When there is a decrease in UDP-glucuronyl transferase activity resulting in a decrease in the conjugation of bilirubin with glucuronic acid unconjugated bilirubin↑
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In what syndrome does congenital hyperbilirubinaemia occur?
Gilberts syndrome
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How would you test or congenital hyperbilirubinaemias?
Check for an increase in unconjugated bilirubin and all other tests remain normal
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What are the two types of cholestatic jaundice?
Intrahepatic cholestasis and extrahepatic cholestasis
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How would you test for cholestatic jaundice?
Check for an increase in conjugated and unconjugated bilirubin. in extrahepatic cholestatic jaundice there will be an increase in ALP.check for decreased levels of vitamin k and so prothrombin time will be reduced.
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What are the main causes of hepatitis?
Viruses, non-viral infection, alcohol, drugs (anti-TB), pregnancy
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How would you investigate hepatitis?
Check for an increased serum ALT, prothrombin time and levels of conjugated and unconjugated bilirubin
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What may cause chronic hepatisis?
It can be viral, chemical or autoimmune
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What causes hepatitis A?
Hepatisis A virus (HAV)
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How is hepatitis A spread?
Faecal-oral route
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How does the hepatitis A virus cause liver damage?
through cytopathic and immunity mediated (T cell) methods
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What are the symptoms of hepatitis A?
Non-specific symptoms such as flu-like symptoms
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What are the clinical signs of hepatitis A?
Jaundice, hepatomegaly, enlarged spleen
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How would you investigate hepatitis A in the lab?
Check serum transferase levels
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What are the outcomes of hepatitis A?
it is acute and self-limiting and does not develop to chronic hepatitis
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How can hepatitis A be prevented?
Through active (inactivated strain) or passive (immunoglobulin) vaccinations
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Where is hepatitis B prevalent?
In parts of africa, middle east and far east
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What causes hepatitis B?
Hepatitis B virus
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How is hepatitis B spread?
Parenteral, close personal contact or verticle
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How does hepatitis B virus cause liver damage?
Immunity mediated mechanisms (T cells)
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What can occur upon infection of hepatitis B virus?
A person may become a chronic carrier or may develop chronic hepatitis
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How is hepatitis B treated?
Anti-viral agents
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How can hepatitis B be prevented?
By avoiding high risk factors or through active or passive vaccinations
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What causes hepatitis C?
Hepatisis C virus
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How is hepatitis C spread?
Through blood or blood products
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How does hepatitis C cause liver damage?
Immunity mediated through T cells
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What may happen upon infection with hepatitis C?
May become a carrier, may develop chronic hepatitis, cirrhosis, hepatocellular carcinoma
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How is hepatitis C diagnosed?
Through excluding hepatitis A or B
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How is hepatitis C managed?
Interferon is used in acute phases to prevent chronic disease
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How can hepatitis C be prevented?
No vaccine is available as the envelope proteins are rapidly changing
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What is cirrhosis?
Necrosis of liver cells followed by fibrosis and nodule formation
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What are the end results of cirrhosis?
Impairment of liver cell function, distortion of liver architecture, portal vein hypertension, liver failure
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What can cause cirrhosis?
Hepatitis virus, alcohol, autoimmune, Wilsons disease, drugs, non-alcoholic fatty liver
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What are the clinical features of cirrhosis?
Jaundice, fever, loss of body hair, spider angioma, yellow eyes, palmar erythema,
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What is decompensated cirrhosis?
Cirrhosis with severely impaired liver function and complications
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What are the complications of cirrhosis?
Portal hypertension, liver failure, hepatocellular carcinoma
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Where may liver tumours originally come from?
GI tract, breast or bronchus
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What increases the risk of hepatocellular carcinoma?
Hepatitis B or C carriers, cirrhosis, aflatoxin, androgenic steroid, contraceptive pill
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What are the clinical features of hepatocellular carcinoma?
Weight loss, fever, anorexia, ascites, abdominal pain,
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How would you investigate hepatocellular carcinoma?
Increase in serum AFP, ultrasound of CT scan of liver, MRI, biopsies avoided
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How is hepatocellular carcinoma treated?
Surgery, liver transplant, not chemotherapy or radiotherapy
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What are the main types of alcoholic liver disease?
Alcoholic fatty liver, alcoholic hepatitis, alcoholic cirrhosis
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What is alcoholic fatty liver?
When alcohol is converted to fat in the liver where it accumulates
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What are the signs/symptoms of alcholic fatty liver?
It is generally asymptomatic but there may be hepatomegally upon examination
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How would you investigate alcoholic fatty liver in the lab?
MCV and gamma-GT levels can be elevated
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What is the outcome of alcoholic fatty liver?
Stop drinking alcohol then fat dissappears, continue drinking alcohol then fibrosis and cirrhosis
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What happens in alcoholic hepatitis?
Liver cell necrosis, leukocyte infiltration, formation of mallory bodies
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What may alcoholic hepatitis lead to?
Cirrhosis
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How would alcoholic hepatitis be investigated?
Leukocytosis with increased levels of bilirubin and transferases. Albumin levels decreased
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How is alcoholic hepatitis treated?
Supportive and additional nutritional intake, coritcosteroids in sever cases
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What is alcoholic cirrhosis?
Destruction and fibrosis of liver cells with micronodular formation
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Card 2

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What is jaundice?

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A serum bilirubin level of above 50 micro-moles/L resulting in yellow eyes and skin

Card 3

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What are the main types of jaundice?

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Card 4

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What is haemolytic jaundice?

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Card 5

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How would you test for haemolytic jaundice?

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