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.
What is the risk with GORD
10–15% of people with GORD will develop Barrett’s oesophagus, and 1–10% of these will develop oesophageal adenocarcinoma over the next 10–20 years.
Initial management of GORD symptoms
Initial management of GORD symptoms should include:
Advice on lifestyle measures and sleeping with the head of the bed raised.
Reviewing and stopping any drugs that may be exacerbating symptoms, if possible and appropriate.
Offering a full-dose PPI for 4 weeks for proven GORD, to aid healing.
Offering a full-dose PPI for 8 weeks for proven severe oesophagitis, to aid healing.
If there are refractory or recurrent symptoms, management should include:
If there are refractory or recurrent symptoms, management should include:
Considering whether an alternative diagnosis such as cardiac or hepatobiliary disease is contributing to symptoms.
Checking the person’s adherence to initial management.
Reinforcing lifestyle advice.
Prescribing a further 4 weeks of the initial PPI at full-dose or double-dose, or adding in a histamine (H2)-receptor antagonist (H2RA) at bedtime, for people with confirmed oesophagitis.
Switching to an H2RA for people with confirmed endoscopy-negative reflux disease.
Prescribing a high dose of the initial PPI for 8 weeks, or switching to an alternative full-dose or high-dose PPI for 8 weeks, if there is confirmed severe oesophagitis.
Offering a full-dose PPI long-term as maintenance treatment if symptoms of severe oesophagitis are controlled.
How often should stable patients with dyspepsia be reviewed
Annually
Coeliac serological testing
Gluten at least 1 meal a day for 6 weeks
Check the serum immunoglobulin (Ig)A
tissue transglutaminase antibody (tTGA)
total IgA first-line.
what is the commonest cause of pneumonia in the community?
what presents with flu prodromal symptoms
strep pneumonia + h.influexna
legionella
bacteria most common in IE and the subacute IE
staph aureus, then step viridans
commones causes of bacterial mengitits in adults
neonates
Neisseria meningitidis (meningococcus), Streptococcus pneumoniae (pneumococcus), and Haemophilus influenzae type b (Hib
In neonates (younger than 1 month of age), Streptococcus agalactiae, Escherichia coli, S. pneumoniae, and Listeria monocytogenes are the most common causative organisms.
threadworms management
Management
CKS recommend a combination of anthelmintic with hygiene measures for all members of the household
mebendazole is used first-line for children > 6 months old. A single dose is given unless infestation persists
HBsAg negative
anti-HBs positive
anti-HBc (IgG) positive
what does this mean
resolved infection and now natural immunity
just anti-hbs = immunity via vaccine
HBc = previous exposure
