Liver Function Tests

LFTs

Hepatocellular damage (hepatitis)

• Aminotransferases (ALT/AST)
• Gamma-Glutamyl transpeptidase (gamma-GT)

Cholestasis (bile ducts)

• Bilirubin
• Alkaline phosphatase
  

Synthetic function

• Albumin
• Prothrombin time

Antibiotics in meningitis

Unknown

• Cefotaxime

Pneumococcus

• Cefotaxime

TB

• Rifampicin
• Isoniazid
• Pyrazinamide
• Ethambutol

Meningococcus

• Benzylpenicillin
• Cefotaxime

Causes of raised serum amylase

Pancreatic

• Acute/chronic pancreatitis
• Pseudocysts
• Carcinoma

Abdominal

• Perforation, duodenal ulcer
• Ectopic pregnancy
• Ovarian tumours

Hepatic

• Gallstones
• Acute hepatitis

Salivary

• Adenitis
• Tumours
• Mumps

Others

• Diabetic ketoacidosis
• Alcohol
• Anorexia
• Burns

Useful terms to describe skin lesions

Atrophy - Thinning of skin
Bulla - Large fluid-filled blister
Crusted - Dried exudate
Ecchymosis - Large 'bruise'
Erosion - Small denuded area of skin
Excoriation - Scratch mark
Fissure - Deep linear crack
Lichenified - Thickened skin with normal markings
Macule - Flat, circumscribed non-palpable lesion
Nodule - Large papule more than 0.5cm
Papule - Small palpable circumscribed lesion
Petechia - Pinpoint-size macule of blood in the skin
Plaque - Large flat-topped palpable lesion
Purpura - Larger macule of blood in the skin which does not blanch on pressure
Pustule - Pus-filled lesion (white/yellow)
Scaly - Visible flakes/ shedding of skin surface
Telangiectasia - Abnormal visible dilatation of blood vessels
Ulcer - Large denuded area of skin
Vesicle - Small fluid-filled blister
Wheal - Raised erythematous swelling (dermal swelling)

Drug and alcohol abuse and dependence

Current evidence suggests that drinking up to 21 units a week (for men) or 14 units a week for women carries no long-term health risk

Alcohol dependence syndrome

Clinical features

• Compulsive need to drink
• Altered alcohol tolerance
• Stereotyped pattern of drinking
• Drinking takes primacy over other activities
• Repeated withdrawal symptoms
• Relief drinking to avoid withdrawal, e.g. early morning drinking
• Rapid relapse if patient drinks again following a period of abstinence

Management

Psychosocial support and group therapy

• Alcoholics Anonymous

Drugs (effects are enhanced by combining them with counselling)

• Naltrexone reduces the risk of relapse into heavy drinking and the frequency of drinking
• Acamprosate alters neurotransmitters and reduces drinking frequency
• Disulfiram (Antabuse) reacts with alcohol to form acetaldehyde which produces unpleasant symptoms to discourage drinking

Drug abuse

• Solvents 'glue sniffing'
• Euphoria
• Floating sensation
• Amnesia
• Visual hallucinations
• Inhalation of vomit
• Bone marrow/brain/liver/kidney toxicity
• Tolerance
• Amphetamines
• Stimulant
• Euphoria
• Psychological dependence
• Restlessness
• Over-activity
• Paranoid psychosis
• Cocaine
• Stimulant
• Hyperarousal
• Dependence
• Paranoid ideation
• Fits
• Coronary artery spasm/disease
• Perforation of nasal septum if inhaled
• Cannabis
• Exaggeration of pre-existing mood
• No definite withdrawal syndrome or tolerance
• Psychosis
• MDMA 'Ecstasy'
• Psychedelic effects
• Hyperpyrexia
• Acute hepatic/renal failure
• Possible chronic brain damage
• Hypnotics (e.g. benzodiazepines)
• Relaxation
• Sleep induction
• Dependence
• Withdrawal syndrome
• Respiratory depression
• Narcotics (morphine, heroin, codeine, methadone, pethidine)
• Calm
• Slight euphoria
• Analgesia
• Flattening of emotions
• Marked and rapid tolerance
• Withdrawal syndrome
• Respiratory depression
• Complications of injecting
• Infection (e.g. HIV/hepatitis B and C/ endocarditis)
• Vein thrombosis

Management

• Withdrawal programmes, e.g. using methadone
• Psychosocial support to help the addict live without drugs

Acute stress reaction and post-traumatic stress disorder

• Occur in individuals in response to exceptional physical or psychological stress

Acute stress reaction

• Lasts a few hours/days
• Initial state of 'daze'
• Then a phase of either
• Withdrawal/stupor or
• Agitation/over-activity
• Commonly associated with autonomic signs of anxiety

Post-traumatic stress disorder

• Delayed/protracted response to a stressful event
• 'Flashbacks'
• Intense distress in/avoidance of situations resembling the event (including anniversaries)
• Emotional blunting/numbness
• Detachment from others
• Hypervigilance
• Insomnia
• Anxiety and depression
• Occasionally suicide

Management

• Counselling

Potassium-sparing diuretics

Amiloride
Spironolactone

Indications

In addition to postassium-wasting diuretics
Chronic heart failure (spironolactone)

• Ascites due to liver disease

Mechanism of action

• Spironolactone inhibits aldosterone
• Amiloride blocks renal sodium uptake

Side effects

• GI disturbance
• Hyperkalaemia
• Hyponatraemia
• Erectile dysfunction
• Gynaecomastia (spironolactone)
• Rash

Cautions/contraindications

• Severe renal impairment
• Hyperkalaemia
• Hyponatraemia