Case - Abnormal Liver Function

Elevated caeruloplasmin is a characteristic finding in Wilson's disease, a genetic disorder that causes copper to accumulate in the body. Caeruloplasmin is a copper-binding protein, and its elevated levels indicate impaired copper metabolism in Wilson's disease. On the other hand, elevated ferritin is a marker of iron overload, which is seen in a condition called Haemochromatosis. Therefore, the statement "Elevated caeruloplasmin indicates Wilson's" and "Elevated ferritin indicates Haemochromatosis" are both correct.

A bright liver is the best indication of NAFLD on abdominal ultrasound. NAFLD is characterized by the accumulation of fat in the liver, which can appear as increased echogenicity or brightness on ultrasound. This can be seen as a diffuse increase in liver echogenicity throughout the entire liver parenchyma. Other findings such as abnormal focal lesions suggestive of liver cancer, bile duct dilation, an enlarged spleen, or abnormal flow in the portal vein may be seen in other liver conditions, but a bright liver is specific to NAFLD.

Patients with advanced non-alcoholic fatty liver disease (NAFLD) should be advised to reduce dietary fat intake and increase exercise levels. Reducing dietary fat can help in managing weight and reducing the accumulation of fat in the liver. Increasing exercise levels can improve insulin sensitivity, promote weight loss, and reduce inflammation in the liver. Restricting fluid intake and completely abstaining from alcohol may not be directly related to the treatment of NAFLD. Taking rest is important for overall health but may not specifically address the condition.

Obesity is associated with an increased risk of cardiovascular disease (CVD) and mortality. This is because excess body weight puts strain on the heart and blood vessels, leading to conditions like high blood pressure, high cholesterol, and diabetes, which increase the risk of heart attacks and strokes. Additionally, obesity is also linked to an increased risk of developing gallstones, which are hardened deposits in the gallbladder that can cause pain and other complications. Therefore, the two medical conditions associated with obesity in this question are increased cardiovascular (CVS) mortality and an increased risk of gallstones.

If a typical NAFLD patient were to develop resistant ascites, it means that they have fluid buildup in the abdomen that is not responding to conventional treatment. This can be a sign of advanced liver disease and may indicate the need for a liver transplant. Similarly, if the patient were to develop frequent episodes of encephalopathy, it suggests that their liver function is severely impaired, leading to cognitive and neurological symptoms. In such cases, a liver transplant may be necessary to improve their quality of life and prevent further complications.

Bile duct obstruction is not a feature of NAFLD. NAFLD, or non-alcoholic fatty liver disease, is a condition characterized by the accumulation of fat in the liver. The severity of NAFLD can range from simple steatosis (fat accumulation) to advanced fibrosis and cirrhosis (scarring of the liver). In some cases, NAFLD can progress to liver cancer. However, bile duct obstruction, which refers to a blockage in the bile ducts that carry bile from the liver to the small intestine, is not typically associated with NAFLD.

Metabolic syndrome is a cluster of conditions that occur together, increasing the risk of heart disease, stroke, and type 2 diabetes. Low HDL cholesterol and raised triglycerides are both typical features of metabolic syndrome. HDL cholesterol is considered "good" cholesterol as it helps remove LDL cholesterol (the "bad" cholesterol) from the bloodstream, while triglycerides are a type of fat found in the blood. Having low levels of HDL cholesterol and high levels of triglycerides are common abnormalities seen in metabolic syndrome.

Asking a close contact can provide valuable information about a person's alcohol intake as they may have observed their drinking habits. This can give a more accurate picture of the individual's alcohol consumption. Additionally, measuring the Mean Corpuscular Volume (MCV) can be useful as it reflects the size of red blood cells and can indicate alcohol abuse. Higher MCV levels are often seen in heavy drinkers. Therefore, combining these two approaches can help determine the actual alcohol intake of an individual.

Positive ANCA antibodies are associated with primary sclerosing cholangitis, an autoimmune disease that affects the bile ducts. Raised IgM levels are seen in primary biliary cirrhosis, another autoimmune liver disease. These two pairs of blood tests and diagnoses are correctly matched.

The correct answer includes the following matchings for investigations and diagnoses in suspected Autoimmune hepatitis: AMA and PBC, ASMA and AIH, IgA and Alcohol, IgG and AIH, IgM and PBC, Alpha Feto-protein in HCC, ANCA and PSC. It also states that AIH can be caused by ANA, ASMA, Anti LKM1 antibodies, and Soluble Liver Antigen.

IgG is an immunoglobulin that is produced after the body has been exposed to an infection or has been vaccinated against it. Therefore, the presence of IgG antibodies indicates that the infection has been cleared or that the person is immune to the infection. On the other hand, IgM antibodies are produced during an acute infection, indicating that the infection is currently active. Hepatitis A and E have similar presentations and both infections do not progress to chronic disease. The presence of Anti-Hepatitis B Surface antibody indicates immunity to Hepatitis B, while Anti-Hepatitis B e antibody indicates decreased infectivity. Hepatitis B is a risk factor for hepatocellular carcinoma (HCC) and can be vaccinated against. In Hepatitis B, sexual transmission is the most important route, while in Hepatitis C, IV transmission is the most important route. More than 80% of Hepatitis C patients develop chronic disease.