scott@vtx-cpd.com

Replying to Lucy Morley 25/08/2021 - 17:05

Hey.

Great question! The increase in ALP is interesting but not sure how much this can be attributed to liver when there seems to be on-going inflammation in the pancreas. I would definitely be reassured by the ALT not increasing dramatically. The increase in the bilirubin in generally mild. Is it a single bile acids?

I might be inclined to continue to monitor and make sure that phenobarbitone levels are kept in the reference.

sAME?

Scott 🙂

Replying to pippa coupe 16/08/2021 - 16:54

Thank you for your reply Pippa.

Really helpful. I hope you are safe and well.

Sx

Replying to austeja Zykute 26/07/2021 - 16:40

Hey.

Just wanted to keep you updated. I have spoken to a number of colleagues and I am still not sure that people are using the higher doses reported in this webinar. I am still waiting to hear back from the presenter of the webinar and I have bought the webinar to watch myself. I will keep you posted on it all.

Thanks again for the brilliant question.

Scott 🙂

Replying to austeja Zykute 02/08/2021 - 13:19

Hey.

Really interesting. I am pleased there is a glimmer of hope here with this option. Here is the link again:

https://drive.google.com/file/d/13W_y0grU-WFICLGvq356u1Z2QAY-eGPg/view?usp=sharing

Scott 🙂

Hello.

1. I have no experience of using higher doses of UDCA in this way. I have had a look and I am not able to find any references for this. Do you have any references from the lecture. I will have a chat to colleagues and have also dropped Mike an email. I will keep you posted.

2. The main issue with metronidazole and liver disease is the increased possibility of side effects. I would be careful not to use high doses, but it does not mean that metronidazole is totally off the cards. I would try and base antibiotic selection on culture as much as possible. Treatment with a broad‐spectrum antibiotic is indicated for bacterial hepatobiliary disease with coverage for Gram‐positive and Gram‐negative aerobes and anaerobes, as evidenced by the bacteriological culture results. These findings, along with the results of antimicrobial sensitivity testing, underscore the importance of this type of evaluation. While empirical coverage with either a fluoroquinolone and amoxicillin clavulanate or a fluoroquinolone, metronidazole, and a penicillin could be suggested based on the likely organisms involved, resistance remains a potential problem. Significant resistance to both amoxicillin clavulanate and fluoroquinolones among E. coli and Enterococcus spp. isolates, along with examples of changing resistance over time in isolates from individual cases, highlights that an empirical approach to antimicrobial treatment should be used with caution.

3. We will chat more regarding when to remove the gallbladder in that lesson, this decision making can be challenging. Poor resolution with medical management and continued thickening may indeed be an indication.

I hope that helps. Let me know if I can do anything else to help.

Scott 🙂