Giardiasis: Causes, Symptoms, and Diagnosis

Giardiasis is a parasitic infection caused by Giardia lamblia. The incubation period for this infection is typically 1-2 weeks. Symptoms include diarrhea, but it is not bloody like in dysentery. The organism attaches to the small bowel but doesn’t invade it. Metronidazole and tinidazole are commonly used in treatment.

To diagnose giardiasis, stool samples are examined microscopically for cysts, not cultures. It may be necessary to collect several samples to confirm the diagnosis as cysts may not be present in every stool. Infection can be contracted from any contaminated water, whether it is still or running. It is important to practice good hygiene and avoid drinking untreated water to prevent giardiasis.

The patient is presenting with cholestatic jaundice, likely caused by the oral contraceptive pill. This results in intrahepatic jaundice, dark urine, and pale stools. Paracetamol overdose and viral hepatitis would cause hepatocellular jaundice, while Gilbert’s syndrome is an unconjugated hyperbilirubinaemia. Choledocholithiasis could also cause obstructive cholestasis. It is appropriate to stop the pill and consider alternative contraception methods, and additional imaging may be necessary if jaundice doesn’t resolve.

Drug-induced liver disease can be categorized into three types: hepatocellular, cholestatic, or mixed. However, there can be some overlap between these categories, as some drugs can cause a range of liver changes. Certain drugs tend to cause a hepatocellular picture, such as paracetamol, sodium valproate, and statins. On the other hand, drugs like the combined oral contraceptive pill, flucloxacillin, and anabolic steroids tend to cause cholestasis with or without hepatitis. Methotrexate, methyldopa, and amiodarone are known to cause liver cirrhosis. It is important to note that there are rare reported causes of drug-induced liver disease, such as nifedipine.

Understanding Hepatitis B Test Results

Hepatitis B is a viral infection that affects the liver. Understanding the results of hepatitis B tests is important for proper diagnosis and treatment. Here, we will discuss the different test results and what they mean.

Persistent Carrier with High Infectivity:
If a patient is positive for surface antigen, e-antigen, and core antibody, and negative for surface antibodies and e-antibodies, it suggests chronic carrier status. The presence of e-antigen confers high infectivity, indicating active viral replication. Core antibodies are a marker of past infection and will not be found in vaccinated individuals who have never been infected.

Persistent Carrier with Low Infectivity:
If a patient is positive for surface antigen and core antibody, but negative for e-antigen and e-antibodies, it suggests a moderately high viral load and elevated ALT levels. This is caused by a hepatitis B virus that has certain mutations (pre-core mutation) that allow the virus to replicate even when the e-antigen is absent.

Previous Vaccination against Hepatitis B:
If a patient has surface antibodies but not core antibodies, it indicates previous vaccination against hepatitis B.

Spontaneously Cleared Infection:
If a patient has lost surface antigen and developed surface antibodies, it marks seroconversion and indicates immunity. If IgM antibodies to core antigen (anti-HBc IgM) are present, it indicates recent infection.

In conclusion, understanding hepatitis B test results is crucial for proper diagnosis and treatment. Consultation with a healthcare provider is recommended for interpretation of test results and appropriate management.

Ulcerative colitis can be managed through inducing and maintaining remission. The severity of the condition is classified as mild, moderate, or severe based on the number of stools per day, the amount of blood, and the presence of systemic upset. Treatment for mild-to-moderate cases of proctitis involves using topical aminosalicylate, while proctosigmoiditis and left-sided ulcerative colitis may require a combination of oral and topical medications. Severe cases should be treated in a hospital setting with intravenous steroids or ciclosporin.

To maintain remission, patients with proctitis and proctosigmoiditis may use topical aminosalicylate alone or in combination with an oral aminosalicylate. Those with left-sided and extensive ulcerative colitis may require a low maintenance dose of an oral aminosalicylate. Patients who have experienced severe relapses or multiple exacerbations may benefit from oral azathioprine or mercaptopurine. Methotrexate is not recommended for UC management, but probiotics may help prevent relapse in mild to moderate cases.

In summary, the management of ulcerative colitis involves a combination of inducing and maintaining remission. Treatment options vary depending on the severity and location of the condition, with mild-to-moderate cases typically treated with topical aminosalicylate and severe cases requiring hospitalization and intravenous medication. Maintaining remission may involve using a combination of oral and topical medications or a low maintenance dose of an oral aminosalicylate. While methotrexate is not recommended, probiotics may be helpful in preventing relapse in mild to moderate cases.

Crohn’s disease is a type of inflammatory bowel disease that can affect any part of the digestive tract. The National Institute for Health and Care Excellence (NICE) has published guidelines for managing this condition. Patients are advised to quit smoking, as it can worsen Crohn’s disease. While some studies suggest that NSAIDs and the combined oral contraceptive pill may increase the risk of relapse, the evidence is not conclusive.

To induce remission, glucocorticoids are typically used, but budesonide may be an alternative for some patients. Enteral feeding with an elemental diet may also be used, especially in young children or when there are concerns about steroid side effects. Second-line options include 5-ASA drugs, such as mesalazine, and add-on medications like azathioprine or mercaptopurine. Infliximab is useful for refractory disease and fistulating Crohn’s, and metronidazole is often used for isolated peri-anal disease.

Maintaining remission involves stopping smoking and using azathioprine or mercaptopurine as first-line options. Methotrexate is a second-line option. Surgery is eventually required for around 80% of patients with Crohn’s disease, depending on the location and severity of the disease. Complications of Crohn’s disease include small bowel cancer, colorectal cancer, and osteoporosis. Before offering azathioprine or mercaptopurine, it is important to assess thiopurine methyltransferase (TPMT) activity.

To alleviate pain and promote healing, suggest using an ointment (if there are no contraindications) twice a day for 6-8 weeks. Referral to colorectal surgeons is not necessary at this time since there are no indications of a severe underlying condition. If the GTN treatment is ineffective after 6-8 weeks, referral to the surgeons may be considered. Topical diltiazem may be prescribed under specialist guidance, but hydrocortisone ointment is not a recommended treatment for anal fissures.

Understanding Anal Fissures: Causes, Symptoms, and Treatment

Anal fissures are tears in the lining of the anal canal that can cause pain and rectal bleeding. They can be acute or chronic, depending on how long they have been present. Risk factors for developing anal fissures include constipation, inflammatory bowel disease, and sexually transmitted infections such as HIV, syphilis, and herpes.

Symptoms of anal fissures include painful, bright red rectal bleeding, with around 90% of fissures occurring on the posterior midline. If fissures are found in other locations, other underlying causes such as Crohn’s disease should be considered.

Management of acute anal fissures involves softening stool, dietary advice, and the use of bulk-forming laxatives or lubricants before defecation. Topical anaesthetics and analgesia can also be used to manage pain.

For chronic anal fissures, the same techniques should be continued, but topical glyceryl trinitrate (GTN) is the first-line treatment. If GTN is not effective after 8 weeks, surgery (sphincterotomy) or botulinum toxin may be considered and a referral to secondary care may be necessary.

Understanding the causes, symptoms, and treatment options for anal fissures can help individuals manage their condition and seek appropriate medical care when necessary.

Liver Disorders in Pregnancy: Differential Diagnosis

During pregnancy, various liver disorders can occur, leading to abnormal liver function tests. Intrahepatic cholestasis of pregnancy is the most common pregnancy-related liver disorder, affecting 0.1-1.5% of pregnancies. It typically presents in the late second or early third trimester with generalized itching, starting on the palms and soles. An elevated alanine aminotransferase (ALT) is a more sensitive marker than aspartate aminotransferase (AST), and a fasting serum bile acid concentration of greater than 10 mmol/l is the key diagnostic test. Primary biliary cholangitis and acute fatty liver of pregnancy are less likely diagnoses, while cholelithiasis and hyperemesis gravidarum have different clinical presentations. Early diagnosis and management of liver disorders in pregnancy are crucial to prevent adverse outcomes such as prematurity and stillbirth.

Differential Diagnosis for Dysphagia: Achalasia, Benign Oesophageal Stricture, Barrett’s Oesophagus, Carcinoma of the Oesophagus, and Schatzki’s Rings

Dysphagia, or difficulty swallowing, can be caused by various oesophageal disorders. One such disorder is achalasia, which is characterized by dysphagia for both solids and liquids. It occurs in adults aged 25-60 years and is diagnosed by a barium swallow that reveals a dilated oesophagus. Other symptoms include regurgitation of food, chest pain, heartburn, and nocturnal cough. Benign oesophageal stricture is less likely as it only causes dysphagia for solids. Barrett’s oesophagus, a change in cell type of the epithelium in the distal portion of the oesophagus due to prolonged frequent acid exposure, primarily causes heartburn and acid regurgitation. Carcinoma of the oesophagus should be considered, but it usually causes dysphagia of solids and weight loss. Schatzki’s rings, rings of mucosa or muscle in the lower oesophagus, cause intermittent and non-progressive dysphagia for solids, usually after a patient eats a meal in a hurried fashion. Daily dysphagia is not usually a feature.

Possible Crohn’s Disease Diagnosis

This patient’s symptoms suggest a possible diagnosis of Crohn’s disease, which has been previously misdiagnosed as irritable bowel syndrome. The recent discovery of blood in his stools is not consistent with IBS and indicates an alternative cause. Additionally, the presence of ankylosing spondylitis, mouth ulcers, and skin tags are all associated with Crohn’s disease.

To confirm the diagnosis, the patient should undergo faecal calprotectin and blood tests, including FBC, U&Es, albumin, CRP, and ESR. These tests can be performed in primary care. However, the patient should also be referred to a lower GI specialist for further evaluation and confirmation of the diagnosis.

Patients with mild-moderate flares of ulcerative colitis are usually evaluated for treatment response over a period of 4 weeks.

Ulcerative colitis can be managed through inducing and maintaining remission. The severity of the condition is classified as mild, moderate, or severe based on the number of stools per day, the amount of blood, and the presence of systemic upset. Treatment for mild-to-moderate cases of proctitis involves using topical aminosalicylate, while proctosigmoiditis and left-sided ulcerative colitis may require a combination of oral and topical medications. Severe cases should be treated in a hospital setting with intravenous steroids or ciclosporin.

To maintain remission, patients with proctitis and proctosigmoiditis may use topical aminosalicylate alone or in combination with an oral aminosalicylate. Those with left-sided and extensive ulcerative colitis may require a low maintenance dose of an oral aminosalicylate. Patients who have experienced severe relapses or multiple exacerbations may benefit from oral azathioprine or mercaptopurine. Methotrexate is not recommended for UC management, but probiotics may help prevent relapse in mild to moderate cases.

In summary, the management of ulcerative colitis involves a combination of inducing and maintaining remission. Treatment options vary depending on the severity and location of the condition, with mild-to-moderate cases typically treated with topical aminosalicylate and severe cases requiring hospitalization and intravenous medication. Maintaining remission may involve using a combination of oral and topical medications or a low maintenance dose of an oral aminosalicylate. While methotrexate is not recommended, probiotics may be helpful in preventing relapse in mild to moderate cases.