Hepatitis

Question 1

hepatitis is simply

Answer 1

Inflammation of the liver

Question 2

Hepatitis viruses

Answer 2

replicate specifically in hepatocytes (hepatotropic) causing destruction

Question 3

HepA transmission

Answer 3

faeco-oral

Question 4

HepB transmission

Answer 4

Blood/sex/vertical

Question 5

HepC transmission

Answer 5

Blood/sex

Question 6

when does jaundice occur

Answer 6

• Occurs when there is a high level of bilirubin the blood

Question 7

bilirubin is

Answer 7

the normal breakdown product from catabolism of haem  formed from destruction of RBC

Question 8

under normal circumstances bilirubin undergoes

Answer 8

1) conjugation in the in the liver (UDP glucoronyl transferase) making it water soluble
2) Excreted via the bile into the GI tract – majority egested in the faeces as urobilinogen and stercobilin
3) 10% of urobilinogen is reabsorbed into the bloodstream and excreted through the kidney

Question 9

types of jaundice

Answer 9

pre-hepatic
hepatocellular
post-hepatic

Question 10

pre-hepatic

Answer 10

• Excessive red cell breakdown which overwhelms the liver ability to conjugate bilirubin
• Overwhelms the livers ability to conjugate bilirubin  unconjugated bilirubin remains in the blood stream to cause jaundice
• Examples:
  • Haemolytic anaemia
  • Sickle cell

Question 11

Hepatocellular

Answer 11

• Dysfunction of the hepatic cells
• Liver loses the ability to conjugate bilirubin
• Liver cirrhosis may compress intra-hepatic portions of the biliary tree to cause obstruction
• Leads to both unconjugated and conjugated bilirubin in the blood- mixed picture
• Examples:
  • Alcohol liver disease
  • Viral hepatitis
  • Cirrhosis
  • Pregnancy

Question 12

Post-hepatic

Answer 12

• Obstruction of biliary drainage
• Bilirubin that is not excreted will have been conjugated by the liver –> conjugated hyperbilirubinaemia
• Examples
  • Intra-luminal causes such as gall stone

Question 13

jaundice biomarkers

Answer 13

• bilirubin
• albumin
• AST
• ALT
• Alkaline phosphatase

Question 14

bilirubin as a marker

Answer 14

quantify degree of any suspected jaundice

Question 15

Albumin as a marker

Answer 15

marker of the liver’s synthesising function

Question 16

AST and ALT

Answer 16

markers of hepatocellular injury

Question 17

If AST:ALT ratio >2

Answer 17

this is likely alcohol liver disease, whilst if

Question 18

If AST:ALT is around 1

Answer 18

viral hepatitis

Question 19

Alkaline phosphatase as a marker

Answer 19

raised in biliary obstruction