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home - Liver - Miscellaneous - Rheumatology Written by Dr Sebastian Zeki

Recognises the importance of sepsis as a complication
Aware of the differential diagnosis and management of sepsis and its
possible sequelae

Knows the appropriate use of the appropriate antibiotics and their
complications Aware of prevention of nosocomial infection

Understands the principles and practice of diagnosis and treatment of

Prepared to involve and liaise with specialist sepsis support



Knows the importance of clinical nutrition and its disturbances in
patients with acute and chronic liver disease

Appreciates indications for enteral or parenteral support and
understanding of limitations of these interventions

Shows ability to make careful nutritional assessment
Can liaise with nutritional support team where appropriate


Understands prognostic scoring systems including Child - Pugh
MELD UKELD Maddrey and disease-specific scoring systems where
they exist

Builds the use of accredited quantitative scoring systems into routine
clinical liver practice clinical colleagues and junior staff

Shows consistent application of evidence-based in the
evaluation of liver disease and the determination of prognosis


Rheumatological manifestations of liver disease Viral hepatitisHep B (25% have rheumatological problems)1) Poly-arthritis (in pre-icteric 25% of patients get these) treat with NSAID's2) PAN (fever/arthritis/cardiac/abdominal pain): Diagnose:Angiography-TreatmentPlasma-phoresis and steroids3) Membranous GN-Cryoglobulinaemia (hep B virus severe rash/arthritis/renal and RF/low C4) Hep C1) Non-erosive poly-arthritis (mono or oligo)System PAN like vasculitis3)Membranous GN4) Mixed cryoglobulinaemia5)Antibody production6) Porphyria cutanea tarda7) Sjogren's (5-19%) Auto-immune hepatitisSimilar to SLE (fever/rash/arthritis/young women/ANA positive)But ...(DS DNA negativeNo oral ulcersNephrosisCVS) Primary biliary cirrhosisCF auto-immune associationPBC arthritis (similar to RA)Haemochromatosis60% get arthritis Also ... osteomalacia/HPOA/osteoarthritisSecond and third MCPHipsKneesWristsGet erosive diseaseMay be PC in 40% of haemochromatosisPhlebotomy does not alter prognosis Written by Dr Sebastian Zeki