Gastroenterology and hepatology

233 Pages·2011·5.232 MB·English

by  Anton Emmanuel, Stephen Inns

Lecture Notes:
Gastroenterology and Hepatology

Lecture Notes:
Gastroenterology
and Hepatology
Anton Emmanuel
BSc MD FRCP
Senior Lecturer in Neurogastroenterology
and Consultant Gastroenterologist
University College Hospital
London, UK
Stephen Inns
MBChB FRACP
Clinical Lecturer in Gastroenterology
Otago School of Medicine, Wellington
and Consultant Gastroenterologist
Hutt Valley Hospital
Wellington, New Zealand
This edition fi rst published 2011, © 2011 by Anton Emmanuel and Stephen Inns
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Library of Congress Cataloging-in-Publication Data
Emmanuel, Anton.
Lecture notes. Gastroenterology and hepatology / Anton Emmanuel, Stephen Inns.
p. ; cm.
Gastroenterology and hepatology
Includes index.
ISBN 978-1-4051-8321-5 (pbk. : alk. paper) 1. Gastroenterology–Outlines, syllabi, etc.
2. Hepatology–Outlines, syllabi, etc. I. Inns, Stephen. II. Title. III. Title:
Gastroenterology and hepatology.
[DNLM: 1. Gastrointestinal Diseases. 2. Liver Diseases. WI 140]
RC802.E46 2011
616.3′3–dc22
2010047191
A catalogue record for this book is available from the British Library.
Set in 8.5/11 pt Utopia by Toppan Best-set Premedia Limited
1 2011
Contents
Preface, vii 18 Pancreatic diseases, 114
19 Biliary diseases, 120
20 Chronic liver disorders, 129
Part I Clinical Basics 21 Hereditary and congenital liver diseases, 139
1 Approach to the patient with abdominal pain, 1 22 Viral hepatitides, 157
2 Approach to the patient with liver disease, 11 23 Drug-induced liver injury, 169
3 Approach to the patient with luminal disease, 17 24 Vascular liver diseases, 173
4 Nutrition, 29 25 Autoimmune hepatitis, 182
5 Gastrointestinal infections, 39 26 Non-alcoholic fatty liver disease, 184
6 Gastrointestinal investigations, 46 27 Alcoholic liver disease, 187
28 Liver tumours and lesions, 191
29 Pregnancy-related liver disease, 197
Part II Gastrointestinal Emergencies 30 Liver transplantation, 200
7 Acute gastrointestinal bleeding, 52
8 Acute upper and lower gastrointestinal
Part IV Study Aids and Revision
emergencies, 55
9 Acute liver failure, 61 Gastrointestinal history check-list, 207
10 Pancreatobiliary emergencies: Abdominal examination routine, 209
acute pancreatitis, 67 Rectal examination routine, 211
Common OSCE cases, 212
Part III Regional Gastroenterology
11 Oral cavity, 73 Part V Self-Assessment
12 Oesophagus, 75
Self-assessment case studies: Questions, 213
13 Stomach and duodenum, 82
Self-assessment case studies: Answers, 215
14 Small intestine, 87
15 Small and large bowel disorders, 94
Index, 217
16 Colon, 103
17 Anorectum, 110

Preface
Science is the father of knowledge, but opinion lates the daily absorption of microgram quantities
breeds ignorance . of vitamins simultaneously with macronutrients
(Hippocrates 460 – 357 BC) in 100 million times that amount.
We have tried to combine a didactic approach
Specialised knowledge will do a man no harm if
to facts alongside recurrently occurring themes to
he also has common sense; but if he lacks this he
aid memory. For example, we have referred to the
can only be more dangerous to his patients.
principles of embryology of the gut to give a
(Oliver Wendell Holmes 1809 – 1894) common sense reminder of how abdominal pain
is referred and how the blood supply can be
T he content of any textbook has, by defi nition,
understood; approached lists of investigations by
got to be factual. There are two potential conse-
breaking them down to tests which establish the
quences of this. The fi rst, and most important, is
condition, the cause or the complications;
that medical fact is based upon science, and
approached aetiological lists by breaking down
we have based this book on the anatomical,
into predisposing, precipitating and perpetuating
physiological and pathological basis of gastroin-
ones. We have eschewed ‘ introductory chapters ’
testinal practice. The second potential conse-
on anatomy, physiology and biochemistry as these
quence of a factual focus is that the text can
are frequently skipped by readers who are often
become rather dry and list like. To limit this we
studying gastroenterology alongside some other
have tried to present the information from a
subject. Rather, we have included preclinical
clinical perspective – as the patients present in
material in the practical context of relevant disease
outpatients or casualty.
areas (fl uid absorption physiology in the section
Gastroenterology is well suited to such an
on diarrhoea, haemoglobin biochemistry in that
approach. It is a fundamentally practical special-
on jaundice, etc.). Ultimately, we hope the reader
ity, with a strong emphasis on history, examina-
uses this book as a source of material to help
tion and endoscopy. The importance of integrating
understand a fascinating speciality, pass exams in
clinical assessment with investigation – both ana-
it, but above all be able to get as much as possible
tomical and physiological – is emphasised by the
out of each patient seen with a gastrointestinal
curiously limited range of symptoms despite the
complaint.
complexity of the gastrointestinal tract. The gut
Anton Emmanuel
contains about three - quarters of the body ’ s
( [email protected] )
immune cells; it produces a wider range of hor-
Stephen Inns
mones than any single endocrine organ; it has
( [email protected] )
almost as many nerves as the spinal cord; it regu-