Gastroenterology PDF
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This copy is presented with the compliments of BEECHAM RESEARCH ~lrt ~~ Mox%n -"----".......---.. ~ Maxolon is a trade mark 15888 To Sue and Jenny and our chlIdren MANAGEMENT OF COMMON DISEASES IN FAMILY PRACTICE DDDDDDDDDDDDD Series Editors: J. Fry and M. Lancaster-Smith GASTROENTEROLOGY DDDDDDDDDDDDD M. Lancaster-Smith, BSc, MD, FRCP Consultant Physician, Queen Mary's Hospital, Sidcup, Kent and C.Chapman, BSc, MB, BS, MRCS,LRCP General Practitioner, Maldon, Essex MTP PRESS LIMITED ~~ ~ a member of [he KLUWER ACADEMIC PUBLISHERS GROUP LANCASTER I BOSTON I THE HAGUE I DORDRECHT Published in the UK and Europe by MTP Press Limited Falcon House Lancaster, England British Library Cataloguing in Publication Data Lancaster-Smith, Michael Gastroenterology. - (Management of common diseases in family practice) 1. Gastrointestinal system - Diseases I. Title II. Chapman, C, III. Series 616.3'3 RC801 ISBN-13: 978-94-011-7783-2 e-ISBN-I3: 978-94-011-7781-8 DOl: 10.1007/978-94-011-7781-8 Copyright © 1985 M. Lancaster-Smith and C. Chapman Softcover reprint of the hardcover 18t edition 1985 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission from the publishers. Typeset by UPS Blackburn, 76-80 Northgate, Blackburn, Lancashire. Contents DDDDDDDDDDDDD Series Editors' Foreword vii Introduction ix Acknowledgements x 1. Gastro-oesophageal Reflux 1 2. Dysphagia 9 3. Nausea and Vomiting 19 4. Uncomplicated Peptic Ulcer 25 5. Complicated Peptic Ulcer 39 6. Surgical Management of Peptic Ulcer 45 7. Gastrointestinal Bleeding 57 8. Acute Abdominal Pain 65 9. Chronic Abdominal Pain 75 10. Acute Diarrhoea 83 II. Chronic Diarrhoea 93 12. Malabsorption 101 13. The Irritable Bowel Syndrome 111 14. Ulcerative Proctocolitis and Crohn's Disease 117 15. Diverticular Disease of the Colon 129 16. Constipation and other Problems with Defaecation 133 17. Miscellaneous Gastrointestinal Problems 141 18. Jaundice and Common Liver Diseases 145 Appendix: Patient Information Sheets and Diets 165 Bibliography 183 Index 187 Series Editors' Foreword DDDDDDDDDDDDD Effective management logically follows accurate diagnosis. Such logic often is difficult to apply in practice. Absolute diagnostic accuracy may not be possible, particularly in the field of primary care, when management has to be on analysis of symptoms and on knowledge of the individual patient and family. This series follows that on Problems in Practice which was concerned more with diagnosis in the widest sense and this series deals more definitively with general care and specific treatment of symptoms and diseases. Good management must include knowledge of the nature, course and outcome of the conditions, as well as prominent clinical features and assess ment and investigations, but the emphasis is on what to do best for the patient. Family medical practitioners have particular difficulties and advantages in their work. Because they often work in professional isolation in the com munity and deal with relatively small numbers of near-normal patients their experience with the more serious and more rare conditions is restricted. They find it difficult to remain up-to-date with medical advances and even more difficult to decide on the suitability and application of new and rela tively untried methods compared with those that are 'old' and well proven. Their advantages are that because of long-term continuous care for their patients they have come to know them and their families well and are able to become familiar with the more common and less serious diseases of their communities. vii This series aims to correct these disadvantages by providing practical information and advice on the less common, potentially serious conditions, but at the same time to talk note of the special features of general medical practice. To achieve these objectives, the titles are intentionally those of accepted body systems and population groups. The co-authors are a specialist and a family practitioner so that each can supplement and complement the other. The experience bases are those of the district general hospital and family practice. It is here that the day-to-day problems arise. The advice and presentation are practical and have come from many years of conjoint experience of family and hospital practice. The series is intended for family practitioners - the young and the less than young. All should benefit and profit from comparing the views of the authors with their own. Many will coincide, some will be accepted as new, useful and worthy of application and others may not be acceptable, but nevertheless will stimulate thought and enquiry. Since medical care in the community and in hospitals involves teamwork, this series also should be of relevance to nurses and others involved in personal and family care. JOHN FRY M. LANCASTER-SMITH viii Introduction DDDDDDDDDDDDD Our purpose in this book is to provide a guide for general practitioners who are frequently faced with problems related to the digestive system, rather than a comprehensive text book of gastroenterology. Emphasis has been placed on, and the majority of space devoted to, problems and diseases with which patients commonly present to the surgery. Many can be managed readily in general practice following minimal in vestigation. Others may require hospital referral for diagnosis and treat ment. Nevertheless, even in this category of gastrointestinal disease, many are recurrent or chronic disorders and it is therefore inevitable that the general practitioner will have an important role in the long term manage ment of such conditions. 40% 20% I I I Irritable Ib owel Peptic ulcer Gastro- Inflammatory Biliary and Others syndrome oesophageal bowel liver disease reflux disease Figure New referrals to Gastrointestinal Clinic, Queen Mary's Hospital, Sidcup, Kent, 1983 ix For much of the book we have adopted a problem-orientated approach with chapters covering abdominal pain, diarrhoea, constipation, nausea, vomiting, dysphagia, malabsorption, jaundice and gastrointestinal haemor rhage. By contrast, chapters are devoted to specific common alimentary tract diseases including, gastro-oesophageal reflux, peptic ulcer, inflamma tory bowel disease, the irritable bowel syndrome and diverticular disease. Acknowledgements DDDDDDDDDDDDD We wish to thank Miss Liz Valori and the Dietetic Department of Queen Mary's Hospital, Sidcup for allowing us to publish the diets included in the Appendix. We are also extremely grateful to Mrs Karen Brickenden and Mrs Amanda Lewer for preparing the final manuscript. x
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