The Liver: The Full Monty!

Dr Alan Bohan, consultant gastro-enterologist UHNS

and black-belt hepatologist (3^rd Dan)

Liver (dys)function Tests:

Albumin/Prothrombin Time

Bilirubin

Alk Phos/GGT for cholestasis

ALT/AST for hepatitis

Other Tests:

Immunoglobulins

Auto antibodies

Hepatitis Serology

Iron Studies

Lipids/Glucose

Ceruloplasmin

α-1 antitrypsin level and genotype

Imaging Studies:

Ultrasound

CT

Cholangiography (MRCP, ERCP, PTHC)

(Magnetic Resonance Cholecysto-Pancreatography, Endoscopic Retrograde Cholecysto-Pancreatography and Percuataous trans Hepatic Cholecystography)

Liver Biopsy

Treatment of Alcoholic Liver Disease:

Corticosteroids

Antioxidants

Nutritional Supplementation

Pentoxyfylline

Anti-TNF antibody treatment

Transplantation

FHF (Fulminant Hepatic Failure):

Relatively uncommon in UK (<100 'orthotopic liver transplantation /yr)

Paracetamol Overdose is commonest cause of FHF (70%)

Idiosyncratic drugs

Viral Hepatitis

Seronegative non A-E Hepatitis

Pregnancy

Wilson

Budd-Chiari

Malignant infiltration

Hepatitis B Virus (HBV) treatment in Practice:

Not recommended for mild liver disease

Recommended in chronic HBV with high ALT and viral load

Patient selection reduces risk of resistance

PEG Interferon monotherapy if no C/I

60% without Sustained Viral Response (SVR) will need analogues

Combination in the future to reduce resistance

Hepatitis C Virus (HCV): Who do you test?

Persons who have injected/inhaled illicit drugs

Persons with conditions associated with HCV

HIV, haemodialysis, abnormal LFTs

Recipients of blood products or organ transplants

Prior to 1992, from donor who later tested positive

Children of HCV infected mothers

Post NSI or exposure to infected blood

Current sexual partners of infected persons

Hep B/HIV positive

Counselling/Prevention of HCV

Avoid sharing personal equipment

Needle exchange programmes

Avoid using illicit drugs

Advised not to donate organs, blood etc.

Risk of sexual transmission is low

(No need for barrier contraception in long term relationships)

Clinical Features of Hereditary Haemochromatosis (HH):

Liver Disease

Diabetes

Cardiac Disease

Arthropathy

Endocrine abnormalities

Pigmentation

Fatigue

Diagnosis of HH:

Liver Disease

Diabetes

Cardiac Disease

Arthropathy

Endocrine abnormalities

Pigmentation

Fatigue

Treatment of HH:

Remains mediaeval

Keep Hb > 10g/dl and Ferritin < 50µg/L

Chelation therapy not recommended

No extra iron and no alcohol