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
