Liver disease

Published on 02/03/2015 by admin

Filed under Internal Medicine

Last modified 02/03/2015

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6 Liver disease

Investigations

Most of the tests designated as liver function tests (LFTs) are not direct measurements of ‘liver function’. The only commonly used tests of synthetic function are the serum albumin and prothrombin time.

Routine serum liver biochemical tests

Box 6.1 shows an interpretation of abnormal liver biochemistry.

The role of imaging

Viral hepatitis

Viral hepatitis (Table 6.1) is caused by hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV) and hepatitis E virus (HEV).

Hepatitis B

HBV is present worldwide, with an estimated 360 million carriers. The UK and the USA have a low carrier rate (0.5–2%), but this rises to 10–20% in parts of Africa, the Middle East and the Far East.

Vertical transmission from mother to child in utero, during parturition or soon after birth, is the usual means of transmission worldwide. This is related to the HBV replicative state of the mother (90% are HbeAg+, 30% HbeAg−ve) and is uncommon in Africa, where horizontal transmission (sibling to sibling) is common. HBV is not transmitted by breast feeding.

Horizontal transmission occurs particularly in children, through minor abrasions or close contact with other children, and HBV can survive on household articles, e.g. toys or toothbrushes, for prolonged periods so transmission may be possible.

HBV spread also occurs by the IV route (e.g. by transfusion of infected blood or blood products, or by contaminated needles used by drug users, tattooists or acupuncturists) or by close personal contact, such as during sexual intercourse, particularly in men having sex with men (25% of cases in the USA). The virus can be found in semen and saliva.

Treatment

HBV infection is mainly asymptomatic and the majority recover completely. Patients should have their HBV markers monitored. If HBcAg is persistent beyond 12 weeks, refer to experts, who may treat patients with nucleoside analogues. Around 1% of patients with acute hepatitis develop fulminant hepatitis (p. 187).

Chronic hepatitis

The aim of treatment is the seroconversion of HbeAg (when present), i.e. the development of anti-HBe and the reduction of HBV DNA to undetectable levels by PCR. In addition, normalization of the serum ALT level and histological improvement in inflammation and fibrosis reflects a good response.

Antiviral agents (Table 6.2)

Choice and duration of treatment

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