Problem-based Approach to Gastroenterology & Hepatology

Taking the problem–based approach, this text helps clinicians improve their diagnostic and therapeutic skills in a focused and practical manner. The cases included demonstrate the diversity of clinical practice in the specialty worldwide, and are divided into five major sections: Upper GI, Pancreato–Biliary, Liver, Small and Large Bowel, and Miscellaneous. About the Authors J.N. Plevris MD, PhD, FRCP(E) Consultant Gastroenterologist & Senior Lecturer, Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh and Hepatology Laboratory, University of Edinburgh Medical School, Edinburgh, UK Subrata Ghosh MD (Edin) FRCP, FRCP (E) Gastrointestinal section, Imperial College School of Medicine, London, UK Colin W. Howden MD, PhD Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, USA Table of Contents UPPER GI: Chapter 1: Clinical approach to Dysphagia and Odynophagia. Illustrated cases will cover several aspects of this alarm –presenting symptom: oesophageal cancer, dysmotility syndromes, benign oesophageal strictures, eosinophilic oesophagitis, foreign bodies, infections such as herpes or CMV oesophagitis. Chapter 2: The problem of heartburn, nausea and vomiting and atypical chest pain Illustrated cases will cover several aspects of these symptoms: from symptomatic heartburn to Barrett’s oesophagus with varying degrees of dysplasia, dysmotility, syndromes, and various causes of nausea / vomiting from common to rare. Chapter 3: The clinical approach to dyspepsia Illustrative cases will systematically approach dyspepsia from the simple functional dyspepsia to all types of gastritis and peptic ulcer disease and to gastric cancer. The importance of other alarm symptoms co–existing with dyspepsia will be highlighted; cases presented as dyspepsia with diagnoses such as pancreatic cancer maybe included in this section. Chapter 4: Acute, recurrent acute and chronic abdominal pain Illustrative cases will help in dissecting surgical from medical causes of abdominal pains; again this very common symptom will be approached systematically from the gastric, pancreato–biliary and metabolic point of view. Chapter 5: Haematemesis, melaena and occult bleeding/ anaemia Illustrative cases will deal with the problem of bleeding from the upper digestive system and small bowel. PANCREATO–BILIARY: Chapter 6: Clinical approach to jaundice Illustrative cases will cover the pancreato–biliary causes of jaundice–gallstone disease, pancreatic cancer, to more rare pancreato–biliary problems such as autoimmune pancreatitis and syndromes (Mirrizzi etc). Chapter 7: The problem of RUQ pain This is a common referral symptom, which may be non–specific or indicate a variety of biliary problems from gallstone disease to sphincter of Oddi dysfunction. Illustrative cases will analyse this common symptom. LIVER: Chapter 8: The acute liver failure patient Illustrated cases from the Liver Unit of presentation and management of Acute liver failure patients including liver transplantation Chapter 9: The chronic liver disease patient: Illustrated cases from the Liver Unit of presentation and management of chronic liver disease patients from the pre–cirrhotic state to liver cirrhosis to listing for liver transplantation. Cases with development of hepatocellular carcinoma as a complication to cirrhosis may be included. Chapter 10: Portal hypertension –a management problem: Illustrative cases will approach the problem of ascites, bleeding and encephalopathy in cirrhosis and management options such as TIPS, endoscopic treatments and pharmacological therapy. Chapter 11: The liver transplant patient: A selected small number of cases from the Transplant unit will serve to familiarise the trainee with aspects of post–transplant problems and care. Chapter 12: Abnormal liver function tests–diagnostic approach One of the commonest referrals to Hepatology. Several cases will illustrate different causes from common to complex or unusual, including liver metabolic disorders. Chapter 13: Infections and the liver: The significant burden of hepatitis B & C worldwide made us to consider a separate chapter, which will be of worldwide interest. Cases of co–infections (e.g. Hep B, C, HIV) or illustrative cases of hepatic abscesses (amoebic, hydatid cysts etc) will be considered. SMALL & LARGE BOWEL: Chapter 14: Chronic diarrhoea and malabsorption Clinical cases will systematically explore the differential diagnosis of chronic diarrhoea; topics to be covered: coeliac disease, Crohn’s disease, bacterial overgrowth and small bowel infections, small bowel tumours etc. Chapter 15: The patient with altered bowel habit: Selected clinical cases will approach the problem of altered bowel habit [constipation or diarrhoea or incontinence]; from IBS to IBD and colon cancer. Chapter 16: Rectal bleeding This common and important alarm symptom merits separate analysis: a number of cases illustrating important pathologies: from UC to colonic polyps / cancer to peri–anal disease such as haemorrhoids. Chapter 17: The problem of persistent lower abdominal discomfort Illustrative cases will explore the common symptom of lower abdominal discomfort, which in many cases is functional, but sometimes be caused by pathology in the nearby organs (e.g. endometriosis, or ovarian pathology). MISCELLANEOUS Chapter 18 Incidental findings in the asymptomatic patient It is not uncommon to extensively investigate patients due to incidental findings particularly following imaging radiology. Illustrative cases will highlight the issues around GI investigations in these asymptomatic patients. Chapter 19: Acute diarrhoea and vomiting Infections of the digestive system are extremely common worldwide and illustrative cases will be presented. This chapter will be of particular international interest if appropriate cases are included. Chapter 20: GI manifestations of Multi–system disorders Uncommon but important GI manifestations of multi–system disorders will be presented. Chapter 21: Unexplained weightloss