Oxford Case Histories in Gastroenterology and Hepatology PDF
Preview Oxford Case Histories in Gastroenterology and Hepatology
Oxford Case Histories Oxford Case Histories Series Editors Sarah Pendlebury and Peter Rothwell Published: Neurological Case Histories (Sarah Pendlebury and Peter Rothwell) Forthcoming: Oxford Case Histories in Cardiology (Colin Forfar, Javed Ehtisham, and Rajkumar Rajendram) Oxford Case Histories in Gastroenterology and Hepatology (Alissa Walsh, Otto Buchel, Jane Collier, and Simon Travis) Oxford Case Histories in Nephrology (Chris Pugh, Chris O’Callaghan, Aron Chakera, Richard Cornall, and David Mole) Oxford Case Histories in Respiratory Medicine (John Stradling, Andrew Stanton, Anabell Nickol, Helen Davies, and Najib Rahman) Oxford Case Histories in Rheumatology (Joel David, Anne Miller, Anushka Soni, and Lyn Williamson) Oxford Case Histories in Stroke and TIA (Sarah Pendlebury, Ursula Schulz, Aneil Malhotra, and Peter Rothwell) Oxford Case Histories in Gastroenterology and Hepatology Alissa J. Walsh St.Vincent’s Hospital Staff Specialist Sydney, Australia Otto C. Buchel Consultant Physician and Fellow in Gastroenterology Universitas Hospital Bluemfontein, South Africa Jane Collier Consultant Hepatologist Department of Gastroenterology and Hepatology John Radcliffe Hospital, Oxford, UK Simon P.L. Travis Consultant Gastroenterologist John Radcliffe Hospital Fellow of Linacre College University of Oxford Oxford, UK 1 1 Great Clarendon Street, Oxford ox2 6dp Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide in Oxford New York Athens Auckland Bangkok Bogotá Buenos Aires Cape-Town Chennai Dar es Salaam Delhi Florence Hong Kong Istanbul Karachi Kolkata Kuala Lumpur Madrid Melbourne Mexico City Mumbai Nairobi Paris São Paulo Shanghai Singapore Taipei Tokyo Toronto Warsaw with associated companies in Berlin Ibadan Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Published in the United States by Oxford University Press Inc., New York © Oxford University Press, 2010 The moral rights of the author have been asserted Database right Oxford University Press (maker) First published 2010 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, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this book in any other binding or cover and you must impose this same condition on any acquirer British Library Cataloguing in Publication Data Data available Library of Congress Cataloguing in Publication Data Data available Typeset in Minion by Glyph International, Bangalore, India Printed in Great Britain on acid-free paper by The MPG Books Group, UK ISBN 978–0–19–955789–9 10 9 8 7 6 5 4 3 2 1 Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding. A note from the series editors Case histories have always had an important role in medical education, but most published material has been directed at undergraduates or residents. The Oxford Case Histories series aims to provide more complex case-based learn- ing for clinicians in specialist training and consultants, with a view to aiding preparation for entry and exit-level specialty examinations or revalidation. Each case book follows the same format with approximately 50 cases, each comprising a brief clinical history and investigations, followed by questions on differential diagnosis and management, and detailed answers with discussion. All cases are peer-reviewed by Oxford consultants in the relevant specialty. At the end of each book, cases are listed by mode of presentation, aetiology and diagnosis. We are grateful to our colleagues in the various medical specialties for their enthusiasm and hard work in making the series possible. Sarah Pendlebury and Peter Rothwell Quotes on the first book in the series – “Neurological Case Histories” “I recommend this excellent volume highly ....... this book will enlighten and entertain consultants, and all readers will learn something.” Lancet Neurology 2007; 6: 951 “This short and well-written text is .... designed to enhance the reader’s diagnostic ability and clinical understanding .... A well documented and practical book” European Journal of Neurology 2007; 14: e19 This page intentionally left blank Preface This book contains a series of cases that we have encountered in Oxford Gastroenterology practice. One purpose is to assist re-validation. Another is to provide a resource of real cases in preparation for specialist exams. A further purpose is more general, being educational for physicians in general internal or emergency medicine, or indeed gastroenterologists, since the cases are often advanced and sometimes challenging. All 50 cases include a series of questions, to which we have given detailed, evidence-based answers, although it is the nature of evidence-based practice that clinical judgment is also necessary. We have expressed our views, and hope that you generally agree! We have specifically chosen cases to cover dif- ferent areas within gastroenterology and hepatology. Included in this selection are acute cases where rapid diagnosis and treatment are crucial, as well as chronic disorders that require strategic thinking, and of course, the manage- ment dilemmas of daily practice. We have used the format of case reports with detailed discussions of differ- ential diagnosis and management, for three reasons. First, we believe that one of the best ways to learn advanced clinical medicine is through the analysis of individual cases. In almost all areas of medicine, it is extremely difficult to illustrate the practical process of diagnosis within the format of a traditional textbook. Second, we strongly believe that it is simply more interesting to con- sider real cases than to read a text. This allows a clinician to reflect on their own differential diagnosis and treatment. Finally, there is a lack of case series that stretch the abilities of experienced clinicians and specialists: most are aimed at medical students or young doctors doing early postgraduate exams. It is for this reason that the cases and questions are sometimes challenging, although many are simple, since the aim is to educate. We would like to thank the many colleagues from many disciplines, includ- ing those allied to medicine for contributing cases, providing illustrations, or administrative support, and always for making helpful comments on the man- uscript as it developed: these include (in alphabetical order and without titles!) Adam Bailey, June Beharry, Helen Bungay, Roger Chapman, Rowan Collinson, Godman Greywoode, Hennie Grundling, Tim James, Christiaan Jansen, Satish Keshav, Siraj Misbah, Juan Piris, Andrew Slater, Helen Small, Alina Stoita, Jan van Zyl, Bryan Warren, and David Williams. Cases 16, 26 and 42 were seen and viii PREFACE cared for at the Gastroenterology unit, Universitas Hospital, Bloemfontein, South Africa, which we gratefully acknowledge. We would also like to thank our families for their tolerance, patience, and support for work that occupies evenings, early mornings, and weekends! Alissa Walsh, Otto Buchel, Jane Collier, Simon Travis Oxford, August 2009 Contents Abbreviations xi Normal ranges xiii Cases 1–50 1 List of cases by diagnosis 341 List of cases by principal clinical features at diagnosis 343 List of cases by aetiological mechanisms 345 Index 347
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