GIT Flashcards
Alcoholic hepatitis
If MD >=32 and steroid used, How to decide to stop or continue?
Lille score?
Prednisolone 40mg for 28 days has been shown to increase survival in patients with severe alcoholic hepatitis.
However, response to steroid treatment should be re-evaluated at 7 days, as not all patients respond and continuing immunosuppressive treatment in patients who are unlikely to benefit may prove deleterious.
As a rule of thumb, an increase in bilirubin over the first 7-days indicates non-response.
The Lille score is a more formal method of assessment that takes into account a range of demographic and laboratory values to give a more nuanced evaluation. A Lille score of > 0.45 signifies the failure of prednisolone and justifies its discontinuation.
The 6-month survival rate for this group of patients is approximately 25%, so supportive treatment should be continued.
*Maddrey’s discriminant function (DF) is often used during acute episodes to determine who would benefit from glucocorticoid therapy
Fecal calprotectin
indications
Fecal calprotectin
Test for intestinal inflammation
- Used as a screening tool for IBD.
- Used to monitor response to treatment in IBD.
- Adults (sensitivity 93%, specificity 96%) for IBD
- Children (specificity 75%)
In addition to IBD, other causes of a raised faecal calprotectin include:
- bowel malignancy
- coeliac disease
- infectious colitis
- use of NSAIDs
