Essentials of Kumar & Clark’s Clinical Medicine

927 Pages·2017·11.92 MB·English

by  Nicola Zammitt

ESSENTIALS OF
KUMAR & CLARK'S
CLINICAL
MEDICINE
Student ICONSU T I llbooks
Any screen.
Anytime.
Anywhere.
Activate the eBook version
of this title at no additional charge.
Student Consult eBooks give you the power to browse and find
content, view enhanced images, share notes and highlights- both
online and offline.
Unlock your eBook today.
Visit studentconsult.inkling.comfredeem
Scratch offy our code Sc:iu this QR code
to redeem your
Type code into "Enter Code" box ellook U>rough
your mobile device:
Click "Redeem"
Log in or Sign up
G
Go to "My Library"
It's that easy!
Pl.lcePeciO"f
S.lld(l!f kt!1a
For technical assistance:
email studentconsult.h<[email protected]
call 1-800-401-9962 (inside the US)
ELSEVIER call [phone](outside the US)
Usa of the cutrenl edilion of the electronic versm of INs book {eBook) is SUbject i:l the terms. of
lh• nonttaostetab!G. lll"nnted lloanse grant9CJ on s!u<len!oonsut.l.nkJing.oom AIXtJJSS (() tho eaoct;
is llmtf<l to ltlt ~rsl tndM<Suat who ~••m• lhrt PIN, kX::ated on 1M losde OOW!I Of this bOOk. at
S'!Udet"(<X>Ilsuf1 '*bng oom ~nd mt1f nol be troosr~rcd to ooothef pert)' by (es81e ltr'l<:tng, Of dhef meens.
ESSENTIALSOFKUMAR&CLARK’SCLINICALMEDICINE
ESSENTIALS
SERIESEDITORS
PROFESSOR PARVEEN KUMAR
ProfessorofMedicineandEducation,
BartsandtheLondonSchoolofMedicineandDentistry,
QueenMaryUniversityofLondon,and
HonoraryConsultantPhysicianandGastroenterologist,
BartsHealthNHSTrustandHomertonUniversityHospital
NHSFoundationTrust,London,UK
and
DR MICHAEL CLARK
HonorarySeniorLecturer,BartsandtheLondonSchoolof
MedicineandDentistry,QueenMaryUniversityofLondon,
andPrincessGraceHospital,London,UK
ContentStrategist: PaulineGraham
ContentDevelopmentSpecialist: HelenLeng
ProjectManager: AndrewRiley
Designer: ChristianBilbow
IllustrationManager: TeresaMcBryan
ESSENTIALS OF
KUMAR & CLARK’S
CLINICAL MEDICINE
Sixth edition
Editedby
NICOLA ZAMMITT
MBChB,BSc(MedSci),MD,FRCP(Edin)
ConsultantPhysicianandHonoraryClinicalSeniorLecturer,
RoyalInfirmaryofEdinburgh,Edinburgh,UK
ALASTAIR O’BRIEN
MBBS,BSc,PhD,FRCP
ReaderinExperimentalHepatology,UniversityCollege
LondonConsultantHepatologist,UCLH&
TheRoyalFreeHospitalNHSTrusts,London,UK
©2018ElsevierLtd.Allrightsreserved.
Nopartofthispublicationmaybereproducedortransmittedinanyformorbyanymeans,electronic
ormechanical,includingphotocopying,recording,oranyinformationstorageandretrievalsystem,
withoutpermissioninwritingfromthepublisher.Detailsonhowtoseekpermission,furtherinformation
aboutthePublisher’spermissionspoliciesandourarrangementswithorganizationssuchasthe
CopyrightClearanceCenterandtheCopyrightLicensingAgency,canbefoundatourwebsite:www.elsevier.
com/permissions.
ThisbookandtheindividualcontributionscontainedinitareprotectedundercopyrightbythePublisher
(otherthanasmaybenotedherein).
Firstedition1995
Secondedition2000
Thirdedition2003
Fourthedition2007
Fifthedition2012
Sixthedition2018
ISBN9780702066030
Int’lISBN9780702066054
BritishLibraryCataloguinginPublicationData
AcataloguerecordforthisbookisavailablefromtheBritishLibrary
LibraryofCongressCataloginginPublicationData
AcatalogrecordforthisbookisavailablefromtheLibraryofCongress
Notices
Knowledgeandbestpracticeinthisfieldareconstantlychanging.Asnewresearchandexperience
broadenourunderstanding,changesinresearchmethods,professionalpractices,ormedicaltreatment
maybecomenecessary.
Practitionersandresearchersmustalwaysrelyontheirownexperienceandknowledgeinevaluating
andusinganyinformation,methods,compounds,orexperimentsdescribedherein.Inusingsuch
informationormethodstheyshouldbemindfuloftheirownsafetyandthesafetyofothers,including
partiesforwhomtheyhaveaprofessionalresponsibility.
Withrespecttoanydrugorpharmaceuticalproductsidentified,readersareadvisedtocheckthe
mostcurrentinformationprovided(i)onproceduresfeaturedor(ii)bythemanufacturerofeach
producttobeadministered,toverifytherecommendeddoseorformula,themethodandduration
ofadministration,andcontraindications.Itistheresponsibilityofpractitioners,relyingontheirown
experienceandknowledgeoftheirpatients,tomakediagnoses,todeterminedosagesandthebest
treatmentforeachindividualpatient,andtotakeallappropriatesafetyprecautions.
Tothefullestextentofthelaw,neitherthepublishernortheauthors,contributors,oreditors,assume
anyliabilityforanyinjuryand/ordamagetopersonsorpropertyasamatterofproductsliability,
negligenceorotherwise,orfromanyuseoroperationofanymethods,products,instructions,or
ideascontainedinthematerialherein.
PrintedinChina
Lastdigitistheprintnumber: 9 8 7 6 5 4 3 2 1
Contents
Preface vii
Contributors ix
Medicalemergencies xi
Abbreviations xv
Significantwebsites xxix
1 Ethicsandcommunication 1
2 Infectiousdiseases 11
3 Gastroenterologyandnutrition 67
4 Liver,biliarytractandpancreaticdisease 139
5 Haematologicaldisease 197
6 Malignantdisease 253
7 Rheumatology 273
8 Water,electrolytesandacid–basebalance 327
9 Renaldisease 355
10 Cardiovasculardisease 409
11 Respiratorydisease 505
12 Intensivecaremedicine 571
13 Clinicalpharmacologyandtoxicology 589
14 Endocrinedisease 607
15 Diabetesmellitusandotherdisordersof
metabolism 667
16 Thespecialsenses 703
17 Neurology 717
18 Dermatology 807
Normalvalues 823
DictionaryofTerms 827
Index 837
Preface
ThisisthesixtheditionofEssentialsofKumar&Clark’sClinicalMedicineand
wecontinuetostrivetoproduceasmallmedicaltextbookwithanatomy,phys-
iologyandpathophysiologyasakeyparttounderstandingclinicalfeaturesand
treatmentforeachdiseaseprocess.Thebookisbasedonitsparenttextbook,
Kumar & Clark’s Clinical Medicine, from which we have taken these core
principles.Akeyfeatureofthebookisthatitremainssmallandeasytocarry
aroundasaportablereferencesource.
Thesixth editionhas beenextensively revisedandupdated,in linewith
changesinclinicalmedicineandwithitsparenttext.Someupdatesreflect
advancesinmedicalscience,includingtheincreasingrangeofavailablebio-
logicaltherapiesandthedevelopmentofnoveloralanticoagulants.Althoughit
isbeyondthescopeofthisbooktoprovideanexhaustivedruglistthatcovers
prescribinginallpatientgroups,wehaveretainedthesectionattheendofeach
chapterspecificallydedicatedtoadescriptionofcommondrugsrelevanttothat
system.Somechangesrelatetotheethicalapproachestomedicine.Thechap-
teronethicsandcommunicationhasbeenextensivelyrevisedinthelightofthe
GMC’sdutyofcandourandtherecognitionofthepowerandimportanceof
apology and honesty when dealing with patients and families when things
gowrong.Thetextbookhasalsobeenrevisedinthelightofsocialchanges,
suchastheincreasinguseofnovelpsychoactivesubstancesandtheirmedical
consequences.Updatedguidelines,suchasthosecoveringthetreatmentof
malaria, are also included in this text. These represent just some of the
advancesinclinicalmedicinethathavebeenincorporatedintothisedition.
ThesixtheditionofEssentialsofClinicalMedicinehasseenmanychanges
from previous editions, including new editors. However, the current edition
wouldneverhaveevolvedintoitscurrentstatewithouttheverysignificantwork
doneinthepastbyAnneBallinger,whoeditedthefirstfiveeditions.Italsogoes
withoutsayingthattheconstantfeaturethroughouteveryeditionisthesupport
andassistanceofMikeClarkandParveenKumar,theeditorsofClinicalMed-
icineandthisseriesofsmalltextbooks.
NicolaZammitt
Contributors
JenniferC.CraneMRCPDTM&H
ConsultantAcuteMedicineandInfectiousDiseases
WesternGeneralHospital
Edinburgh,UK
2.Infectiousdiseases
EuanA.SandilandsMDFRCP(Edin)PGCert(MedEd)
ConsultantPhysicianinClinicalToxicologyandAcuteMedicine.NationalPoisons
InformationService(Edinburgh),RoyalInfirmaryofEdinburgh,UK
13.Clinicalpharmacologyandtoxicology
KatharineF.StrachanMA,FRCP
ConsultantPhysician,Acute&GeneralMedicine
ClinicalLeadforMedicalEthicsEducation
RoyalInfirmaryofEdinburgh,UK
1.Ethicsandcommunication
Medical emergencies
SYMPTOMBASED
Acutechestpain409
Acutebreathlessness507
Coma741–745
Delirium(toxicconfusionalstate)799–800
Feverinthereturnedtraveller22–24
Headache717–719
Shock578b
SYSTEMBASED
Infectiousdiseasesandtropicalmedicine
Septicaemia14–16
Feverinthereturnedtraveller22–24
Malaria24–29
Gastroenterologyandnutrition
Oesophagealperforation80–81
Acuteuppergastrointestinalbleeding91b
Lowergastrointestinalbleeding93–94
Intestinalischaemia100
Acuteseverecolitis107b
Theacuteabdomen119–121
Liver,biliarytractandpancreaticdisease
Acutehepaticfailure160–164
Bleedingoesophagealvarices168–170
Acutecholecystitis187
Acutecholangitis188
Acutepancreatitis189–193
Diseasesofthebloodandhaematologicalmalignancies
Feverintheneutropenicpatient208b
Sicklecellcrisis217
Warfarinexcess249
Malignantdisease
Superiorvenacavasyndrome257
Acutetumourlysissyndrome257–258
Spinalcordcompression782–785
Feverintheneutropenicpatient208b
Hypercalcaemia653–656