Gastro/infection Flashcards
Campylobacteria stool culture treatment
Campylobacter self-limiting infection,
When symptoms are severe or have lasted more than a week, treatment with clarithromycin is recommended first-line
What test is a marker of liver function
Albumin - sepsis and malnutrition’s affects
PT/clotting - derange once 70% liver function lost (Also low platelets)
Bilirubin (>40 shows jaundice)
ALT + AST are mor markers of heparocellular damage
What should your action be for a derange ALT
Investigation - best predictor for NAFLD
- alcohol, met syndrome, BMI, viral hep, haemochrom, Wilson’s
E.g non-invasive liver screen, US (?GB disease)
Do ELF test —> NAFLD score or FIB4 score if unavailable
- NAFLD score - low, just address lifestyle
- mod = ELF test/fibro scan
- high = refer
If all normal and no risk factors
Then refer if persists
Difference of ALT/AST
ALT - liver specific
AST - increase alcohol more + autoimmune, but also cardiac and skeletal
What drugs are hepatotoxic
WHat cause Cholestatic pattern
The following drugs tend to cause a hepatocellular picture:
paracetamol
sodium valproate, phenytoin
MAOIs
halothane
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins (rare )
alcohol
amiodarone
methyldopa
nitrofurantoin
The following drugs tend to cause cholestasis (+/- hepatitis):
combined oral contraceptive pill
antibiotics: flucloxacillin, co-amoxiclav, erythromycin (macrolides)
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
fibrates
Liver cirrhosis
methotrexate
methyldopa
amiodarone
What LFT results indicate advanced cirrhosis and warrants referral
A ratio
AST:ALT ratio >1
Low platelets (portal hypertension)
What is ELF score in NAFLD
- number for referral
Enhanced liver fibrosis
- >10 - fibrous can
<10 - reassure, 3 yearly
Majority of NAFLD case involve simple steatosis (good prognosis), minority involve non-alcoholic steatohepatitis (NASH) (high risk of liver fibrosis, cirrhosis, or rarely cancer).
What are some of the non-hepatic causes of deranged LFT
Coeliac, thyroid, muscle disease (e.g. recent sport)
What would a Derange ALT, high Audit C score prompt you to do
ELF or fibroscan
If isolated derange bilirubin - management
Unconjugated in iso?
Repeat split bil
Consider if haemolysis - reticulocyte count, LDH, haptoglobin
Gilbert’s
? Who is At risk of NAFLD
features of the metabolic syndrome (central obesity, hypertension, diabetes/insulin resistance and dyslipidaemia)
What is part of the liver aetiology screen
Viral hepatitis: Hepatitis B surface antigen, hepatitis C antibody (with follow-on polymerase chain reaction (PCR) if positive)
Iron overload: Ferritin and Transferrin saturation
Liver auto-antibodies: anti-mitochondrial antibody (PBC), anti-smooth muscle antibody, antinuclear antibody, serum immunoglobulins. And, in children, check: anti-liver kidney microsomal antibody, coeliac antibodies, alpha-1-antitrypsin level and caeruloplasmin
Others: HbA1c, Coeliac serology
A raised ferritin with normal transferrin saturation (less than 45%) and a raised mean corpuscular volume (MCV) is suggestive of ?
Alcohol related liver disease
What dose raised GGT
In relation to liver disease in general
Elevated GGT occurs with: obesity, NAFLD, drug-induced liver injury, cholestatic liver disorders, liver metastases, and hepatic congestion secondary to heart failure.
A raised GGT is associated with increased liver mortality and all-cause (including cancer) mortality
NAFLD causes
Hypertension
Impaired glucose regulation or type 2 diabetes mellitus
Central obesity (BMI>30, waist circumference>94 cm in men or 80 cm in women)
Hyperlipidaemia
Drugs = steroids, tamoxifen, methotrexate, amiodarone
What does the NAFLD + fib score contain
What are the two drug options in NAFLD
NAFLD Fibrosis Score : 6 variables
6 variables: age, BMI, blood glucose, platelet count, albumin, and aspartate aminotransferase [AST] to alanine aminotransferase [ALT] ratio
The Fibrosis (FIB)-4 Score:
4 variables: age, AST, ALT, and platelet count
Pioglitazone + Vit E
What to do is suspect ALD (LFTs may be normal)
AUDIT>19, then undertake liver bloods tests and abdominal ultrasound and fibroscan
> 16kpa = refer
Some treatment options in alcoholics
Working out units
Acamprosate or Naltrexone with psychological intervention (specialist started)
Disulfraim - makes booze taste bad
Thiamine
Unit = (mls x %) / 100
Shot = 1
Beer =2
Wine = 2-3
What can thiamine deficiency lead to
Wernicks-Korskaff = ocular motor disorders, ataxia, mental state changes
Korskaffs = confabulation, amnesia
Which vaccines are live
Live attenuated
BCG
measles, mumps, rubella (MMR)
influenza (intranasal)
oral rotavirus
oral polio
yellow fever
oral typhoid
What is treatment for Lyme disease
What is Jarisch-Herxheimer reaction
Management of suspected/confirmed Lyme disease
doxycycline if early disease. Amoxicillin is an alternative if doxycycline is contraindicated (e.g. pregnancy)
people with erythema migrans should be commenced on antibiotic without the need for further tests
ceftriaxone if disseminated disease
Jarisch-Herxheimer reaction is sometimes seen after initiating therapy: fever, rash, tachycardia after first dose of antibiotic (more commonly seen in syphilis, another spirochaetal disease)
Treatment course for primary TB
Latent TB
Initial phase - first 2 months (RIPE), then RI for 4 months
Rifampicin - hepatitis, orange secretions, flu-like symptoms
Isoniazid - peripheral neuropathy: prevent with pyridoxine (Vitamin B6), hepatitis, agranulocytosis
Pyrazinamide - gout
Ethambutol - optic neuritis
The treatment for latent tuberculosis is 3 months of isoniazid (with pyridoxine) and rifampicin OR 6 months of isoniazid (with pyridoxine)
Who gets an urgent 2ww for OGD
Dysphasia
>55 with WL + upper abdo pain/reflux/dyspepsia
Others (raised plt with nausea etc = non-urgent
Medications causing dyspepsia
Alpha-blockers, anticholinergics, aspirin, benzodiazepines, beta-blockers, bisphosphonates, calcium-channel blockers, corticosteroids, nitrates, nonsteroidal anti-inflammatory drugs (NSAIDs), theophyllines, and tricyclic antidepressants.
