Clinical Guide to Gastroenterology E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Clinical Guides
• Sprache: Englisch

Seitenzahl: 714

Veröffentlichungsjahr: 2019

Beschreibung

Clinical Guide to Gastroenterology is an accessible, quick-reference resource that provides practical, evidence-based information on investigations, interventions and management of clinical gastroenterological scenarios.

It is packed full with bullet points, diagrams, tables, and algorithms of the important presentations and conditions within Clinical Gastroenterology.

Divided into sections, the book offers in-depth coverage of presenting complaints in Gastroenterology, common conditions broken down by organ system, important investigations and procedures, and pharmacology. Detail is given to the sequence of clinical examination, investigations and management required to diagnose and treat a wide range of gastroenterological disorders.

• Provides information on symptoms, disorders and issues found in the clinical environment
• Guides readers in decision-making, appropriate investigation, and conducting interventions
• Includes important guidelines and clinical trials within each chapter
• Supplemented by a companion website featuring a wealth of additional material, including more than 70 audio clips, over 50 clinical case studies, and almost 350 self-assessment questions, as well as key clinical trials and guidelines

Clinical Guide to Gastroenterology is a must-have text for junior doctors and medical students as well as doctors, nurses and trainees working within Emergency Departments, Medical, or Surgical Assessment Units.

Leseprobe

Table of Contents

Cover

List of Contributors

Acronyms and Abbreviations

Podcast and Box Icons

About the Companion Website

1.1 Examination Technique

1.1.1 CHAPTER AT A GLANCE

1.1.2 COMMON CONDITIONS

1.1.3 CLINICAL EXAMINATION – PERIPHERIES

1.1.4 CLINICAL EXAMINATION – ABDOMEN

1.1.5 HOW TO PRESENT YOUR FINDINGS

1.1.6 EPONYMOUS SIGNS AND SYMPTOMS

2.1 Dysphagia

2.1.1 CHAPTER AT A GLANCE

2.1.2 DEFINITION

2.1.3 DIAGNOSTIC ALGORITHM

2.1.4 DIFFERENTIALS LIST

2.1.5 KEY HISTORY FEATURES

2.1.6 KEY EXAMINATION FEATURES

2.1.7 KEY INVESTIGATIONS

2.1.8 WHEN TO CALL A SENIOR

2.1.9 KEY CLINICAL TRIALS

2.1.10 GUIDELINES

2.1.11 ADDITIONAL REFERENCES

2.2 Dyspepsia

2.2.1 CHAPTER AT A GLANCE

2.2.2 DEFINITION

2.2.3 DIAGNOSTIC ALGORITHM

2.2.4 DIFFERENTIALS LIST

2.2.5 KEY HISTORY FEATURES

2.2.6 KEY EXAMINATION FEATURES

2.2.7 KEY INVESTIGATIONS (WITH JUSTIFICATION WHERE APPROPRIATE)

2.2.8 WHEN TO CALL A SENIOR

2.2.9 KEY CLINICAL TRIALS

2.2.10 GUIDELINES

2.2.11 ADDITIONAL REFERENCES

2.3 Nausea and Vomiting

2.3.1 CHAPTER AT A GLANCE

2.3.2 DEFINITION

2.3.3 DIAGNOSTIC ALGORITHM

2.3.4 DIFFERENTIALS LIST

2.3.5 KEY HISTORY FEATURES

2.3.6 KEY EXAMINATION FEATURES

2.3.7 KEY INVESTIGATIONS

2.3.8 WHEN TO CALL A SENIOR

2.3.9 KEY CLINICAL TRIALS

2.3.10 GUIDELINES

2.3.11 ADDITIONAL REFERENCES

2.4 Abdominal Pain

2.4.1 CHAPTER AT A GLANCE

2.4.2 DEFINITION

2.4.3 DIAGNOSTIC ALGORITHM

2.4.4 DIFFERENTIALS LIST

2.4.5 KEY HISTORY FEATURES

2.4.6 KEY EXAMINATION FEATURES

2.4.7 KEY INVESTIGATIONS

2.4.8 WHEN TO CALL A SENIOR

2.4.9 KEY CLINICAL TRIALS

2.4.10 GUIDELINES

2.4.11 ADDITIONAL REFERENCES

2.6 GI Bleeding

2.6.1 CHAPTER AT A GLANCE

2.6.2 DEFINITION

2.6.3 DIAGNOSTIC ALGORITHM

2.6.4 DIFFERENTIALS LIST

2.6.5 KEY HISTORY FEATURES

2.6.6 KEY EXAMINATION FEATURES

2.6.7 KEY INVESTIGATIONS

2.6.8 WHEN TO CALL A SENIOR

2.6.9 KEY CLINICAL TRIALS

2.6.10 GUIDELINES

2.6.11 ADDITIONAL REFERENCES

2.7 Change in Bowel Habit

2.7.1 CHAPTER AT A GLANCE

2.7.2 DEFINITION

2.7.3 DIAGNOSTIC ALGORITHM

2.7.4 DIFFERENTIALS LIST

2.7.5 KEY HISTORY FEATURES

2.7.6 KEY EXAMINATION FEATURES

2.7.7 KEY INVESTIGATIONS

2.7.8 WHEN TO CALL A SENIOR

2.7.9 KEY CLINICAL TRIALS

2.7.10 GUIDELINES

2.7.11 ADDITIONAL REFERENCES

2.8 Anaemia

2.8.1 CHAPTER AT A GLANCE

2.8.2 DEFINITION

2.8.3 DIAGNOSTIC ALGORITHM

2.8.4 DIFFERENTIALS LIST

2.8.5 KEY HISTORY FEATURES

2.8.6 KEY EXAMINATION FEATURES

2.8.7 KEY INVESTIGATIONS

2.8.8 WHEN TO CALL A SENIOR

2.8.9 KEY CLINICAL TRIALS

2.8.10 GUIDELINES

2.8.11 ADDITIONAL REFERENCES

2.9 Jaundice

2.9.1 CHAPTER AT A GLANCE

2.9.2 DEFINITION

2.9.3 DIAGNOSTIC ALGORITHM

2.9.4 DIFFERENTIALS LIST

2.9.5 KEY HISTORY FEATURES

2.9.6 KEY EXAMINATION FEATURES

2.9.7 KEY INVESTIGATIONS

2.9.8 WHEN TO CALL A SENIOR

2.9.9 GUIDELINES

2.9.10 ADDITIONAL REFERENCES

3.2 Oesophagus

3.2.1 CHAPTER AT A GLANCE

3.2.2 DEFINITION

3.2.3 UNDERLYING CONCEPTS

3.2.4 ACHALASIA

3.2.5 BARRETT’S OESOPHAGUS

3.2.6 OESOPHAGEAL MALIGNANCY

3.2.7 GASTRO‐OESOPHAGEAL REFLUX DISEASE

3.2.8 EOSINOPHILIC OESOPHAGITIS

3.2.9 OESOPHAGEAL CANDIDIASIS

3.2.10 MALLORY–WEISS SYNDROME

3.2.11 OTHER CONDITIONS

3.2.12 KEY CLINICAL TRIALS

3.2.13 GUIDELINES

3.2.14 ADDITIONAL REFERENCES

3.3 Stomach

3.3.1 CHAPTER AT A GLANCE

3.3.2 DEFINITION

3.3.3 UNDERLYING CONCEPTS

3.3.4 H. PYLORI INFECTION

3.3.5 PEPTIC ULCER DISEASE

3.3.6 GASTRITIS

3.3.7 GASTRIC POLYPS

3.3.8 LYMPHOMA

3.3.9 GASTRIC ADENOCARCINOMA

3.3.10 ZOLLINGER–ELLISON SYNDROME

3.3.11 GASTRIC DYSMOTILITY

3.3.12 KEY CLINICAL TRIALS

3.3.13 GUIDELINES

3.3.14 ADDITIONAL REFERENCES

3.4 Small Intestine

3.4.1 CHAPTER AT A GLANCE

3.4.2 DEFINITION

3.4.3 UNDERLYING CONCEPTS

3.4.4 COELIAC DISEASE

3.4.5 SMALL BOWEL OBSTRUCTION

3.4.6 SMALL BOWEL ISCHAEMIA

3.4.7 MALIGNANCIES OF THE SMALL INTESTINE

3.4.8 OTHER CONDITIONS

3.4.9 KEY CLINICAL TRIALS

3.4.10 GUIDELINES

3.4.11 ADDITIONAL REFERENCES

3.5 Large Intestine

3.5.1 CHAPTER AT A GLANCE

3.5.2 DEFINITION

3.5.3 UNDERLYING CONCEPTS

3.5.4 C. DIFFICILE‐ASSOCIATED DIARRHOEA (CDAD)

3.5.5 INFECTIOUS DIARRHOEA

3.5.6 ISCHAEMIC COLITIS

3.5.7 MICROSCOPIC COLITIS

3.5.8 DIVERTICULAR DISEASE

3.5.9 LARGE BOWEL OBSTRUCTION

3.5.10 PSEUDO‐OBSTRUCTION

3.5.11 IRRITABLE BOWEL SYNDROME (IBS)

3.5.12 COLORECTAL CANCER

3.5.13 KEY CLINICAL TRIALS

3.5.14 GUIDELINES

3.5.15 ADDITIONAL REFERENCES

3.6 Inflammatory Bowel Disease and Irritable Bowel Syndrome

3.6.1 CHAPTER AT A GLANCE

3.6.2 DEFINITION

3.6.3 UNDERLYING CONCEPTS

3.6.4 CROHN’S DISEASE

3.6.5 ULCERATIVE COLITIS

3.6.6 IRRITABLE BOWEL SYNDROME

3.6.7 KEY CLINICAL TRIALS

3.6.8 GUIDELINES

3.6.9 ADDITIONAL REFERENCES

3.7 Liver

3.7.1 CHAPTER AT A GLANCE

3.7.2 DEFINITION

3.7.3 UNDERLYING CONCEPTS

3.7.4 VIRAL HEPATITIS

3.7.5 HEPATITIS B VIRUS

3.7.6 HEPATITIS C VIRUS

3.7.7 HEPATITIS A AND E VIRUSES

3.7.8 AUTOIMMUNE HEPATITIS

3.7.9 ALCOHOLIC LIVER DISEASE AND ALCOHOLIC HEPATITIS

3.7.10 NON‐ALCOHOLIC FATTY LIVER DISEASE

3.7.11 CIRRHOSIS

3.7.12 ASCITES

3.7.13 LIVER FAILURE AND HEPATIC ENCEPHALOPATHY

3.7.14 HEPATOCELLULAR CARCINOMA

3.7.15 OTHER CONDITIONS

3.7.16 KEY CLINICAL TRIALS

3.7.17 GUIDELINES

3.7.18 ADDITIONAL REFERENCES

3.8 Biliary Tract

3.8.1 CHAPTER AT A GLANCE

3.8.2 DEFINITION

3.8.3 UNDERLYING CONCEPTS

3.8.4 GALLSTONES

3.8.5 ASCENDING CHOLANGITIS

3.8.6 PRIMARY SCLEROSING CHOLANGITIS

3.8.7 PRIMARY BILIARY CHOLANGITIS

3.8.8 CHOLANGIOCARCINOMA

3.8.9 GALLBLADDER CARCINOMA

3.8.10 KEY CLINICAL TRIALS

3.8.11 GUIDELINES

3.8.12 ADDITIONAL REFERENCES

3.9 Pancreas

3.9.1 CHAPTER AT A GLANCE

3.9.2 DEFINITION

3.9.3 UNDERLYING CONCEPTS

3.9.4 ACUTE PANCREATITIS

3.9.5 CHRONIC PANCREATITIS

3.9.6 PANCREATIC CANCER

3.9.7 KEY CLINICAL TRIALS

3.9.8 GUIDELINES

3.9.9 ADDITIONAL REFERENCES

4.1 Liver Biochemistry and Faecal Tests

4.1.1 CHAPTER AT A GLANCE

4.1.2 DEFINITION

4.1.3 OUTLINE OF PROCEDURE

4.1.4 INDICATIONS

4.1.5 REQUESTING THE INVESTIGATION

4.1.6 PERI‐INVESTIGATION MANAGEMENT

4.1.7 INTERPRETATION OF RESULTS

4.1.8 COMPLICATIONS

4.1.9 GUIDELINES

4.1.10 ADDITIONAL REFERENCES

4.2 Abdominal Ultrasound (US)

4.2.1 CHAPTER AT A GLANCE

4.2.2 DEFINITION

4.2.3 OUTLINE OF PROCEDURE

4.2.4 INDICATIONS

4.2.5 REQUESTING THE INVESTIGATION

4.2.6 PERI‐INVESTIGATION MANAGEMENT

4.2.7 INTERPRETATION OF RESULTS

4.2.8 COMPLICATIONS

4.2.9 KEY CLINICAL TRIALS

4.2.10 GUIDELINES

4.2.11 ADDITIONAL REFERENCES

4.3 Abdominal X‐ray

4.3.1 CHAPTER AT A GLANCE

4.3.2 DEFINITION

4.3.3 OUTLINE OF PROCEDURE

4.3.4 INDICATIONS

4.3.5 CONTRAINDICATIONS

4.3.6 REQUESTING THE INVESTIGATION

4.3.7 PERI‐INVESTIGATION MANAGEMENT

4.3.8 INTERPRETATION OF RESULTS

4.3.9 COMPLICATIONS

4.3.10 GUIDELINES

4.3.11 ADDITIONAL REFERENCES

4.4 CT Imaging

4.4.1 CHAPTER AT A GLANCE

4.4.2 DEFINITION

4.4.3 OUTLINE OF PROCEDURE

4.4.4 INDICATIONS

4.4.5 REQUESTING THE INVESTIGATION

4.4.6 PERI‐INVESTIGATION MANAGEMENT

4.4.7 INTERPRETATION OF RESULTS

4.4.8 COMPLICATIONS

4.4.9 GUIDELINES

4.4.10 ADDITIONAL REFERENCES

4.5 Oesophagogastroduodenoscopy (OGD)

4.5.1 CHAPTER AT A GLANCE

4.5.2 DEFINITION

4.5.3 OUTLINE OF PROCEDURE

4.5.4 INDICATIONS

4.5.5 CONTRAINDICATIONS

4.5.6 REQUESTING THE INVESTIGATION

4.5.7 PERI‐INVESTIGATION MANAGEMENT

4.5.8 INTERPRETATION OF RESULTS

4.5.9 COMPLICATIONS

4.5.10 GUIDELINES

4.6 Barium Swallow

4.6.1 CHAPTER AT A GLANCE

4.6.2 DEFINITION

4.6.3 OUTLINE OF PROCEDURE

4.6.4 INDICATIONS

4.6.5 REQUESTING THE INVESTIGATION

4.6.6 PERI‐INVESTIGATION MANAGEMENT

4.6.7 INTERPRETATION OF RESULTS

4.6.8 COMPLICATIONS

4.6.9 KEY TRIAL

4.6.10 GUIDELINES

4.6.11 ADDITIONAL REFERENCES

4.8 Magnetic Resonance Cholangiopancreatography

4.8.1 CHAPTER AT A GLANCE

4.8.2 DEFINITION

4.8.3 OUTLINE OF PROCEDURE

4.8.4 INDICATIONS

4.8.5 CONTRAINDICATIONS

4.8.6 REQUESTING THE INVESTIGATION

4.8.7 PERI‐INVESTIGATION MANAGEMENT

4.8.8 INTERPRETATION OF RESULTS

4.8.9 COMPLICATIONS

4.8.10 GUIDELINES

4.8.11 ADDITIONAL REFERENCES

4.9 Endoscopic Retrograde Cholangiopancreatography

4.9.1 CHAPTER AT A GLANCE

4.9.2 DEFINITION

4.9.3 OUTLINE OF PROCEDURE

4.9.4 INDICATIONS

4.9.5 CONTRAINDICATIONS

4.9.6 REQUESTING THE INVESTIGATION

4.9.7 INTERPRETATION OF RESULTS

4.9.8 PERI‐INVESTIGATION MANAGEMENT

4.9.9 COMPLICATIONS

4.9.10 GUIDELINES

4.9.11 ADDITIONAL REFERENCES

4.10 Enteral and Parenteral Feeding

4.10.1 CHAPTER AT A GLANCE

4.10.2 NG TUBE INSERTION

4.10.3 PEG

4.10.4 TOTAL PARENTERAL NUTRITION

4.10.5 GUIDELINES

4.10.6 ADDITIONAL REFERENCE

4.12 Flexible Sigmoidoscopy

4.12.1 CHAPTER AT A GLANCE

4.12.2 DEFINITION

4.12.3 OUTLINE OF PROCEDURE

4.12.4 INDICATIONS

4.12.5 CONTRAINDICATIONS

4.12.6 PERI‐INVESTIGATION MANAGEMENT

4.12.7 INTERPRETATION OF RESULTS

4.12.8 COMPLICATIONS

4.12.9 GUIDELINES

4.12.10 ADDITIONAL REFERENCES

4.13 Colonoscopy

4.13.1 CHAPTER AT A GLANCE

4.13.2 DEFINITION

4.13.3 OUTLINE OF PROCEDURE

4.13.4 INDICATIONS

4.13.5 CONTRAINDICATIONS

4.13.6 PERI‐INVESTIGATION MANAGEMENT

4.13.7 INTERPRETATION OF RESULTS

4.13.8 COMPLICATIONS

4.13.9 GUIDELINES

4.13.10 ADDITIONAL REFERENCE

4.14 Abdominal Paracentesis

4.14.1 CHAPTER AT A GLANCE

4.14.2 DEFINITION

4.14.3 OUTLINE OF PROCEDURE

4.14.4 INDICATIONS

4.14.5 CONTRAINDICATIONS

4.14.6 REQUESTING THE PROCEDURE

4.14.7 PERI‐PROCEDURE MANAGEMENT

4.14.8 INTERPRETATION OF RESULTS

4.14.9 COMPLICATIONS

4.14.10 GUIDELINES

4.14.11 ADDITIONAL REFERENCE

5.1 Pharmacology – Dyspepsia

5.1.1 CHAPTER AT A GLANCE

5.1.2 PROTON PUMP INHIBITORS

5.1.3 HISTAMINE RECEPTOR‐2 ANTAGONISTS

5.1.4 ANTACIDS AND ALGINATES

5.1.5 KEY TRIALS

5.1.6 GUIDELINES

5.1.7 ADDITIONAL REFERENCES

5.2 Pharmacology – IBD

5.2.1 CHAPTER AT A GLANCE

5.2.2 AMINOSALICYLATES

5.2.3 CORTICOSTEROIDS

5.2.4 FIRST‐LINE IMMUNOMODULATORY DRUGS

5.2.5 CALCINEURIN INHIBITORS

5.2.6 TNF ‐α INHIBITORS

5.2.7 KEY TRIALS

5.2.8 GUIDELINES

5.2.9 ADDITIONAL REFERENCES

5.3 Pharmacology – Liver Disease

5.3.1 CHAPTER AT A GLANCE

5.3.2 BENZODIAZEPINES

5.3.3 VITAMIN SUPPLEMENTATION

5.3.4 ANTIVIRAL AGENTS

5.3.5 CHELATORS

5.3.6 KEY TRIAL

5.3.7 GUIDELINES

5.3.8 ADDITIONAL REFERENCES

5.4 Pharmacology

5.4.1 CHAPTER AT A GLANCE

5.4.2 SECONDARY BILE ACIDS

5.4.3 BILE ACID SEQUESTRANTS

5.4.4 PANCREATIC ENZYME PRODUCTS

5.4.5 KEY TRIAL

5.4.6 GUIDELINES

5.4.7 ADDITIONAL REFERENCES

5.5 Pharmacology – Paracetamol Overdose

5.5.1 CHAPTER AT A GLANCE

5.5.2 PARACETAMOL OVERDOSE

5.5.3 PARACETAMOL OVERDOSE ANTIDOTES

5.5.4 KEY TRIAL

5.5.5 GUIDELINES

5.5.6 ADDITIONAL REFERENCES

Index

End User License Agreement

List of Tables

Chapter 1.1

Table 1.1.1 Elements to be undertaken prior to examining the patient

Table 1.1.2 Examination features from the end of the bed

Table 1.1.3 Examination findings in the hands and limbs

Table 1.1.4 General inspection – face and neck

Table 1.1.5 General inspection – chest

Table 1.1.6 Inspection features on the abdomen

Table 1.1.7 Other masses palpable during an abdominal examination

Table 1.1.8 Additional sounds heard on auscultation

Table 1.1.9 Eponymous signs and symptoms

Chapter 2.1

Table 2.1.1 Key history features of different causes of dysphagia

Table 2.1.2 Bedside tests of use in patients presenting with dysphagia

Table 2.1.3 Blood tests of use in patients presenting with dysphagia

Table 2.1.4 Imaging modalities of use in patients presenting with dysphagia

Table 2.1.5 Special tests of use in patients presenting with dysphagia

Chapter 2.2

Table 2.2.1 Different classes of medication which can cause dyspepsia

Table 2.2.2 Bedside tests of use in patients presenting with dyspepsia

Table 2.2.3 Blood tests of use in patients presenting with dyspepsia

Table 2.2.4 Imaging modalities of use in patients presenting with dyspepsia

Table 2.2.5 Special tests of use in patients presenting with dyspepsia

Chapter 2.3

Table 2.3.1 Causes of nausea and vomiting

Table 2.3.2 Common examination findings in different metabolic conditions ass...

Table 2.3.3 Bedside tests to consider in nausea and vomiting

Table 2.3.4 Blood tests to consider in nausea and vomiting

Table 2.3.5 Imaging modalities of use in patients presenting with nausea and ...

Table 2.3.6 Special tests for nausea and vomiting

Chapter 2.4

Table 2.4.1 Bedside tests undertaken when patient presents with abdominal pai...

Table 2.4.2 Blood tests undertaken when patient presents with abdominal pain...

Table 2.4.3 Imaging modalities of use in patients presenting with abdominal p...

Table 2.4.4 Additional tests of use in patients presenting with abdominal pai...

Chapter 2.6

Table 2.6.1 Potential examination findings in an acutely unwell patient with ...

Table 2.6.2 Bedside tests of use in suspected or confirmed UGIB

Table 2.6.3 Blood tests of use in suspected or confirmed UGIB.

Table 2.6.4 Imaging of use in suspected or confirmed UGIB

Table 2.6.5 Special tests of use in suspected or confirmed UGIB

Chapter 2.7

Table 2.7.1 Clinical signs to find in patients with thyroid disease

Table 2.7.2 Bedside tests in patients with a change in bowel habit

Table 2.7.3 Blood tests in patients with a change in bowel habit

Table 2.7.4 Imaging in patients with a change in bowel habit

Table 2.7.5 Special tests in patients with a change in bowel habit

Chapter 2.8

Table 2.8.1 Relevant questions for other chronic diseases which may cause ana...

Table 2.8.2 Underlying causes of dietary deficiency or other malabsorptive state...

Table 2.8.3 Common examination findings of anaemia

Table 2.8.4 Typical examination findings in chronic conditions that cause ana...

Table 2.8.5 Bedside investigations for patients with anaemia

Table 2.8.6 Blood tests for patients with anaemia

Table 2.8.7 Imaging modalities of use in patients with anaemia

Table 2.8.8 Special tests of use in patients with anaemia

Chapter 2.9

Table 2.9.1 Causes of jaundice

Table 2.9.2 Bedside tests undertaken when patient presents with jaundice

Table 2.9.3 Urine dipstick results in causes of jaundice

Table 2.9.4 Blood tests undertaken when patient presents with jaundice

Table 2.9.5 A typical liver screen protocol

Table 2.9.6 Summary of blood test results based on origin of bilirubin causin...

Table 2.9.7 Imaging modalities of use in patients presenting with jaundice

Table 2.9.8 Liver biopsy indications and potential findings

Table 2.9.9 ABCDE approach to a patient presenting with jaundice

Chapter 3.2

Table 3.2.1 Vascular supply and lymphatic drainage of the oesophagus

Table 3.2.2 Layers of the oesophagus

Table 3.2.3 Presenting features of achalasia

Table 3.2.4 Bedside tests of use in patients presenting with suspected achala...

Table 3.2.5 Blood tests of use in patients presenting with suspected achalasi...

Table 3.2.6 Imaging investigations of use in patients presenting with suspect...

Table 3.2.7 Special tests of use in patients presenting with suspected achala...

Table 3.2.8 Presenting features associated with Barrett's oesophagus

Table 3.2.9 Bedside tests of use in patients presenting with suspected Barret...

Table 3.2.10 Blood tests of use in patients presenting with suspected Barrett...

Table 3.2.11 Imaging investigations of use in patients presenting with suspec...

Table 3.2.12 Special tests of use in patients presenting with suspected Barre...

Table 3.2.13 Comparison of major types of oesophageal malignancy

Table 3.2.14 UK oesophageal cancer survival data (all types and stages)

Table 3.2.15 US National Cancer Institute's SEER database 2003–2009 data

Table 3.2.16 Presenting features associated with oesophageal malignancy

Table 3.2.17 Bedside tests of use in patients presenting with suspected oesop...

Table 3.2.18 Blood tests of use in patients presenting with suspected oesopha...

Table 3.2.19 Imaging investigations of use in patients presenting with suspec...

Table 3.2.20 Special tests of use in patients presenting with suspected oesop...

Table 3.2.21 Presenting features associated with GORD

Table 3.2.22 Bedside tests of use in a patient presenting with suspected GORD...

Table 3.2.23 Blood tests of use in a patient presenting with suspected GORD

Table 3.2.24 Imaging investigations of use in a patient presenting with suspe...

Table 3.2.25 Special tests of use in a patient presenting with suspected GORD...

Table 3.2.26 Presenting features associated with eosinophilic oesophagitis

Table 3.2.27 Bedside tests of use in a patient presenting with suspected eosi...

Table 3.2.28 Blood tests of use in eosinophilic oesophagitis

Table 3.2.29 Imaging of use in eosinophilic oesophagitis

Table 3.2.30 Special tests of use in eosinophilic oesophagitis

Table 3.2.31 Presenting features associated with oesophageal candidiasis

Table 3.2.32 Bedside tests of use in oesophageal candidiasis

Table 3.2.33 Blood tests of use in oesophageal candidiasis

Table 3.2.34 Special tests of use in oesophageal candidiasis

Table 3.2.35 Presenting features associated with Mallory–Weiss tears

Table 3.2.36 Bedside tests of use in Mallory–Weiss tear

Table 3.2.37 Blood tests of use in Mallory–Weiss tear

Table 3.2.38 Imaging of use in Mallory–Weiss tear

Table 3.2.39 Special tests of use in Mallory–Weiss tear

Chapter 3.3

Table 3.3.1 Cells of the stomach and their respective secretions

Table 3.3.2 Bedside investigations of use in patients with suspected

H. pylor

...

Table 3.3.3 Bloods tests of use in patients with suspected

H. pylori

infectio...

Table 3.3.4 Special tests of use in patients with suspected

H. pylori

infecti...

Table 3.3.5 Presenting features in patients with suspected or confirmed PUD

Table 3.3.6 Bedside tests of use in patients with suspected PUD

Table 3.3.7 Blood tests of use in patients with suspected PUD

Table 3.3.8 Imaging modalities of use in patients with suspected PUD

Table 3.3.9 Special tests of use in patients with suspected PUD

Table 3.3.10 Presenting features in patients with suspected or confirmed gast...

Table 3.3.11 Presenting features in patients with suspected or confirmed gast...

Table 3.3.12 Blood tests of use in patients with gastric polyps

Table 3.3.13 Special tests of use in patients with gastric polyps

Table 3.3.14 UK cancer survival of MALT lymphomas depending on stage

Table 3.3.15 UK cancer survival of high‐grade B cell lymphomas depending on s...

Table 3.3.16 Presenting features of suspected or confirmed gastric lymphomas...

Table 3.3.17 Blood tests of use in patients with suspected gastric lymphoma

Table 3.3.18 Imaging modalities of use in patients with suspected gastric lym...

Table 3.3.19 Special tests of use in patients with suspected gastric lymphoma...

Table 3.3.20 UK cancer survival of gastric adenocarcinomas

Table 3.3.21 Presenting features of suspected or confirmed gastric adenocarci...

Table 3.3.22 Bedside investigations of use in patients with suspected gastric...

Table 3.3.23 Blood tests of use in patients with suspected gastric malignancy...

Table 3.3.24 Imaging modalities of use in patients with suspected gastric mal...

Table 3.3.25 Different invasive/surgical management options for gastric malig...

Table 3.3.30 Presenting features in patient with suspected or confirmed gastr...

Table 3.3.31 Bedside tests of use in suspected or confirmed gastric dysmotili...

Table 3.3.32 Blood tests of use in suspected or confirmed gastric dysmotility...

Table 3.3.33 Imaging modalities of use in patient with suspected gastric dysm...

Table 3.3.34 Special tests of use in patients with suspected gastric dysmotil...

Chapter 3.4

Table 3.4.1 Layers of small intestine

Table 3.4.2 Presenting features of patients with coeliac disease

Table 3.4.3 Bedside tests of use in suspected or confirmed coeliac disease

Table 3.4.4 Blood tests of use in suspected or confirmed coeliac disease

Table 3.4.5 Special tests of use in suspected or confirmed coeliac disease

Table 3.4.6 Presenting features in a patient with acute small bowel obstructi...

Table 3.4.7 Bedside tests of use in suspected or confirmed acute small bowel ...

Table 3.4.8 Blood tests of use in suspected or confirmed acute small bowel ob...

Table 3.4.9 Imaging of use in suspected or confirmed acute small bowel obstru...

Table 3.4.10 Special tests of use in suspected or confirmed acute small bowel...

Table 3.4.11 Presenting features in a patient with acute small bowel ischaemi...

Table 3.4.12 Bedside tests in a patient with suspected or confirmed acute sma...

Table 3.4.13 Blood tests in a patient with suspected or confirmed acute small...

Table 3.4.14 Imaging in a patient with suspected or confirmed acute small bow...

Table 3.4.15 Special tests in a patient with suspected or confirmed acute sma...

Table 3.4.16 Types of small bowel malignancies

Table 3.4.17 UK small bowel cancer survival data (all types and stages)

Table 3.4.18 Presenting features of small bowel malignancies

Table 3.4.19 Blood tests of use in diagnosis and work‐up of small bowel malig...

Table 3.4.20 Imaging of use in diagnosis and work‐up of small bowel malignanc...

Table 3.4.21 Special tests of use in diagnosis and work‐up of small bowel mal...

Table 3.4.22 Principles of treatment for specific types of small bowel malign...

Chapter 3.5

Table 3.5.1 Presenting features of patients with CDAD

Table 3.5.2 Bedside tests of use in someone with suspected CDAD

Table 3.5.3 Blood tests of use in someone with suspected CDAD

Table 3.5.4 Imaging modalities of use in someone with suspected CDAD

Table 3.5.5 Special tests of use in someone with suspected CDAD

Table 3.5.6 Common GI infections: laboratory‐confirmed cases by PHE 2014

Table 3.5.7 Presenting features of patients with infectious diarrhoea

Table 3.5.8 Bedside tests of use in someone with suspected infectious diarrho...

Table 3.5.9 Blood tests of use in someone with suspected infectious diarrhoea...

Table 3.5.10 Imaging modalities of use in someone with suspected infectious d...

Table 3.5.11 Special tests of use in someone with suspected infectious diarrh...

Table 3.5.12 Presenting features of patients with colonic ischaemia

Table 3.5.13 Bedside investigations of use in patients with suspected ischaem...

Table 3.5.14 Blood tests of use in patients with suspected ischaemic colitis...

Table 3.5.15 Imaging modalities of use in patients with suspected ischaemic c...

Table 3.5.16 Special tests of use in patients with suspected ischaemic coliti...

Table 3.5.17 Presenting features of patients with microscopic colitis

Table 3.5.18 Bedside tests of use in patients with microscopic colitis

Table 3.5.19 Blood tests of use in patients with microscopic colitis

Table 3.5.20 Imaging of use in patients with microscopic colitis

Table 3.5.21 Special tests of use in patients with microscopic colitis

Table 3.5.22 Presenting features of patient with diverticular disease (compli...

Table 3.5.23 Bedside investigations of use in patients with suspected diverti...

Table 3.5.24 Blood tests of use in patients with suspected diverticulitis

Table 3.5.25 Imaging modalities of use in patients with suspected diverticuli...

Table 3.5.26 Special tests of use in patients with suspected diverticulitis

Table 3.5.27 Presenting features in a patient with large bowel obstruction

Table 3.5.28 Bedside investigations of use in patients with suspected large b...

Table 3.5.29 Blood tests of use in patients with suspected large bowel obstru...

Table 3.5.30 Imaging modalities of use in patients with suspected large bowel...

Table 3.5.31 Special tests of use in patients with suspected large bowel obst...

Table 3.5.32 Presenting features in a patient with pseudo‐obstruction

Table 3.5.33 Bedside investigations of use in patients with suspected pseudo‐...

Table 3.5.34 Blood tests of use in patients with suspected pseudo‐obstruction...

Table 3.5.35 Imaging modalities of use in patients with suspected pseudo‐obst...

Table 3.5.36 Special tests of use in patients with suspected pseudo‐obstructi...

Table 3.5.41 UK colorectal cancer survival data (all types and stages)

Table 3.5.42 UK cancer research UK 2014 one‐year survival data categorised by...

Table 3.5.43 Presenting features in a patient with colorectal cancer

Table 3.5.44 Different types of polyps (fleshy outgrowths): benign, pre‐malig...

Table 3.5.45 Bedside investigations of use in patients with suspected colorec...

Table 3.5.46 Blood tests of use in patients with suspected colorectal cancer...

Table 3.5.47 Imaging modalities of use in patients with suspected colorectal ...

Table 3.5.48 Special tests of use in patients with suspected colorectal cance...

Chapter 3.6

Table 3.6.1 Key differences between Crohn's disease and UC

Table 3.6.2 Risk factors for development of Crohn's disease

Table 3.6.3 Presenting features of Crohn's disease

Table 3.6.4 Bedside tests of use in Crohn's disease

Table 3.6.5 Blood tests of use in Crohn's disease

Table 3.6.6 Imaging of use in Crohn's disease

Table 3.6.7 Special tests of use in Crohn's disease

Table 3.6.8 Different steroids use in Crohn's disease

Table 3.6.9 Monoclonal antibodies used in Crohn's disease

Table 3.6.10 Indications for surgery in Crohn's disease and different procedu...

Table 3.6.11 Risk factors for UC

Table 3.6.12 Protective factors for UC

Table 3.6.13 Presenting features of UC

Table 3.6.14 Imaging of use in UC

Table 3.6.15 Special tests of use in UC

Table 3.6.16 Monoclonal antibodies used in UC

Table 3.6.17 Surgical options in UC

Table 3.6.18 Risk factors for IBS

Table 3.6.19 Presenting features of IBS

Table 3.6.20 Blood tests of use in IBS

Table 3.6.21 Special tests of use in IBS

Table 3.6.22 Conservative treatment options in IBS

Table 3.6.23 Medical therapies of use in IBS

Chapter 3.7

Table 3.7.1 Viruses causing hepatitis

Table 3.7.2 Presenting features of HBV

Table 3.7.3 Blood tests of use in HBV

Table 3.7.4 Imaging modalities of use in suspected HBV infection

Table 3.7.5 Special tests of use in HBV

Table 3.7.6 Treatment strategies in HBV

Table 3.7.7 Blood tests of use in HCV

Table 3.7.8 Hepatitis A and E characteristics

Table 3.7.9 Presenting features of hepatitis A and E

Table 3.7.10 Blood tests of use in hepatitis A and E

Table 3.7.11 Imaging of use in hepatitis A and E

Table 3.7.12 Presenting features of autoimmune hepatitis

Table 3.7.13 Blood tests of use in autoimmune hepatitis

Table 3.7.14 Blood tests of use in autoimmune hepatitis

Table 3.7.15 Special tests of use in autoimmune hepatitis

Table 3.7.16 Treatment of AIH

Table 3.7.17 Presenting features of ALD

Table 3.7.18 Bedside tests of use in suspected ALD.

Table 3.7.19 Blood tests of use in suspected ALD

Table 3.7.20 Imaging modalities of use in suspected ALD

Table 3.7.21 Special tests of use in suspected ALD

Table 3.7.22 Presenting features in NAFLD

Table 3.7.23 Bedside tests of use in NAFLD

Table 3.7.24 Blood tests of use in NAFLD

Table 3.7.25 Imaging tests of use in NAFLD

Table 3.7.26 Special tests of use in NAFLD

Table 3.7.27 Child–Pugh prognostic score predicting mortality in patients wit...

Table 3.7.28 Presenting features of patients with cirrhosis

Table 3.7.29 Bedside tests of use in patients with suspected cirrhosis

Table 3.7.30 Blood tests of use in patients with suspected cirrhosis

Table 3.7.31 Imaging modalities of use in patients with suspected cirrhosis

Table 3.7.32 Special tests of use in patients with suspected cirrhosis

Table 3.7.38 Presenting features of liver failure

Table 3.7.39 Bedside tests of use in suspected liver failure and hepatic ence...

Table 3.7.40 Blood tests of use in suspected liver failure and hepatic enceph...

Table 3.7.41 Imaging modalities of use in suspected liver failure and hepatic...

Table 3.7.42 Special tests of use in suspected liver failure and hepatic ence...

Table 3.7.43 Comparison of paracetamol‐ and non‐paracetamol‐induced ALF trans...

Table 3.7.44 Survival after diagnosis of HCC

Table 3.7.45 Median survival based on stage at time of diagnosis based on Bar...

Table 3.7.46 Presenting features of HCC

Table 3.7.47 Blood tests of use in patients with suspected or confirmed HCC

Table 3.7.48 Imaging modalities of use in patients with suspected HCC

Table 3.7.49 Special tests of use in HCC

Table 3.7.50 Diagnostic tests in hereditary haemochromatosis

Chapter 3.8

Table 3.8.1 Presenting features of patients with gallstones

Table 3.8.2 Bedside tests of use in someone with suspected gallstones

Table 3.8.3 Blood tests of use in someone with suspected gallstones

Table 3.8.4 Imaging modalities of use in someone with suspected gallstones

Table 3.8.5 Presenting features of patients with ascending cholangitis

Table 3.8.6 Bedside tests of use in someone with suspected ascending cholangi...

Table 3.8.7 Blood tests of use in someone with suspected ascending cholangiti...

Table 3.8.8 Imaging modalities of use in someone with suspected ascending cho...

Table 3.8.9 Presenting features of patients with PSC

Table 3.8.10 Bedside investigations of use in patients with suspected PSC

Table 3.8.11 Blood tests of use in patients with suspected PSC

Table 3.8.12 Imaging modalities of use in patients with suspected PSC

Table 3.8.13 Presenting features of patients with PBC

Table 3.8.14 Bedside tests of use in patients with suspected PBC

Table 3.8.15 Blood tests of use in patients with suspected PBC

Table 3.8.16 Imaging modalities of use in patients with suspected PBC

Table 3.8.17 Presenting features of patient with cholangiocarcinoma

Table 3.8.18 Bedside investigations of use in patients with suspected cholang...

Table 3.8.19 Blood tests investigations of use in patients with suspected cho...

Table 3.8.20 Imaging modalities of use in patients with suspected cholangioca...

Table 3.8.21 Presenting features in a patient with gallbladder carcinoma

Table 3.8.22 Bedside investigations of use in patients with suspected gallbla...

Table 3.8.23 Blood tests of use in patients with suspected gallbladder carcin...

Table 3.8.24 Imaging modalities of use in patients with suspected gallbladder...

Chapter 3.9

Table 3.9.1 Different causes of acute pancreatitis

Table 3.9.2 Presenting features of acute pancreatitis

Table 3.9.3 Bedside tests for acute pancreatitis

Table 3.9.4 Blood tests for acute pancreatitis

Table 3.9.5 Imaging for acute pancreatitis

Table 3.9.6 Imaging for acute pancreatitis

Table 3.9.7 Aetiology of chronic pancreatitis

Table 3.9.8 Presenting features of chronic pancreatitis

Table 3.9.9 Bedside tests of use in chronic pancreatitis

Table 3.9.10 Blood tests of use in chronic pancreatitis

Table 3.9.11 Imaging of use in chronic pancreatitis

Table 3.9.12 Special tests of use in chronic pancreatitis

Table 3.9.13 Proportion of pancreatic cancer survivors at 1, 5, and 10 years...

Table 3.9.14 Median survival from diagnosis depending on stage of disease

Table 3.9.15 Presenting features of pancreatic cancer

Table 3.9.16 Bedside tests for pancreatic cancer

Table 3.9.17 Blood tests for pancreatic cancer

Table 3.9.18 Imaging tests for pancreatic cancer

Table 3.9.19 Special tests for pancreatic cancer

Chapter 4.1

Table 4.1.1 Different tests and their interpretation

Table 4.1.2 Different tests and their interpretation

Chapter 4.2

Table 4.2.1 Common and important indications for the use of abdominal US

Chapter 4.3

Table 4.3.1 Systematic approach to AXR interpretation.

Chapter 4.4

Table 4.4.1 Types of main abdominal CT imaging modalities

Table 4.4.2 Indications for CT imaging

Chapter 4.6

Table 4.6.1 Reasons to do a barium swallow based on first‐line indications or...

Chapter 5.2

Table 5.2.1 Different starting doses depending on clinical situation.

Chapter 5.3

Table 5.3.1 Different starting doses depending on clinical situation

List of Illustrations

Chapter 1.1

Figure 1.1.1 Nail changes in GI disease.

Figure 1.1.2 Skin changes in GI disease.

Figure 1.1.3 Division of the abdomen.

Figure 1.1.4 Common abdominal surgical scars.

Figure 1.1.5 Common sites of stomas.

Figure 1.1.6 Possible findings in acute abdominal pain.

Figure 1.1.7 Location of palpable abnormalities.

Figure 1.1.8 Palpable anatomy during a female rectal examination.

Figure 1.1.9 Palpable anatomy during a male rectal examination.

Chapter 2.1

Figure 2.1.1 Diagnostic algorithm for dysphagia.

Figure 2.1.2 Endoscopy image of an oesophagus showing a mass consistent with ...

Figure 2.1.3 Endoscopy image of an oesophagus showing proximal dilatation and...

Figure 2.1.4 Endoscopy image of the oesophagus showing a tight impassable pep...

Figure 2.1.5 Area where an outpouching and dilation is likely to occur in the...

Figure 2.1.6 Endoscopy image an oesophagus showing the use of a dilating ball...

Chapter 2.2

Figure 2.2.1 Suggested work‐up for dyspepsia in primary care settings.

Figure 2.2.2 Endoscopy showing retroflexion at the gastric cardia to demonstr...

Figure 2.2.3 Endoscopy demonstrating typical short segment of Barrett's oesop...

Figure 2.2.4 Severe ulceration seen at gastro‐oesophageal junction (GOJ) due ...

Chapter 2.3

Figure 2.3.1 Diagnostic algorithm.

Figure 2.3.2 12‐lead electrocardiogram showing anterior ST‐elevation in keepi...

Figure 2.3.3 CT head demonstrating area of hypodensity in left frontal lobe i...

Figure 2.3.4 Yanker sucker used to remove vomit from mouth.

Chapter 2.4

Figure 2.4.1 Abdomen split into nine quadrants with associated aetiologies al...

Figure 2.4.2 Schematic of triage, where ‘abdominal pain’ is usually managed b...

Figure 2.4.3 Areas (shaded black) of potential bruising seen on the skin surf...

Figure 2.4.4 Image of a urine dipstick. Note the importance of analysing the ...

Figure 2.4.5 Kussmaul breathing compared with normal breathing.

Figure 2.4.6 Typical venous blood gas results in a patient with metabolic aci...

Figure 2.4.7 CT coronal view of acute severe pan‐colitis. Note gas‐filled, th...

Figure 2.4.8 CT axial view demonstrating profound pneumoperitoneum (black are...

Chapter 2.6

Figure 2.6.1 Diagnostic algorithm for UGIB including assessment of severity....

Figure 2.6.2 OGD image of a patient with PUD. There is a large bleeding duode...

Figure 2.6.3 OGD image of a stomach showing portal hypertensive gastropathy....

Figure 2.6.4 OGD view of treated duodenal ulcer. Adrenaline has been injected...

Figure 2.6.5 OGD of oesophageal varices with banding‐induced ulcers (panel 1)...

Figure 2.6.6 OGD image of a dieulafoy lesion (lower portion of image) in prox...

Chapter 2.7

Figure 2.7.1 Diagnostic algorithm for constipation.

Figure 2.7.2 Diagnostic algorithm for diarrhoea.

Figure 2.7.3 Pale conjunctiva in lower eyelid typically seen in patients with...

Figure 2.7.4 Left‐sided fullness located in the supraclavicular fossa in keep...

Figure 2.7.5 Plain AXR demonstrating bowel dilatation pathognomonic of large ...

Figure 2.7.6 CT scan axial view showing an incarcerated left‐sided inguinal h...

Chapter 2.8

Figure 2.8.1 Diagnostic algorithm for the investigation of anaemia.

Figure 2.8.2 Diagnostic algorithm for the investigation of iron‐deficiency an...

Figure 2.8.3 Distribution of colorectal cancer.

Figure 2.8.4 OGD image of varices – these are the swellings in the lumen that...

Figure 2.8.5 Sketch of a typical blood film showing hypochromic and irregular...

Figure 2.8.6 Algorithm to investigate iron‐deficiency anaemia.

Figure 2.8.7 Aetiology of confirmed folate deficiency.

Figure 2.8.8 Aetiology of confirmed vitamin B12 deficiency.

Chapter 2.9

Figure 2.9.1 Diagnostic algorithm.

Figure 2.9.2 Normal bilirubin metabolism. Bilirubin is released from the brea...

Figure 2.9.3 Signs of chronic liver disease.

Figure 2.9.4 Graph of paracetamol level against time. Treatment with N‐acetyl...

Figure 2.9.5 Ultrasound scan showing a gall stone (highlighted in field of vi...

Figure 2.9.6 Magnetic resonance cholangiopancreatography (MRCP) showing CBD o...

Figure 2.9.7 ERCP showing multiple gallstones (light‐coloured spherical objec...

Figure 2.9.8 CT abdomen coronal views showing a tumour of the head of the pan...

Chapter 3.2

Figure 3.2.1 Regions of the oesophagus.

Figure 3.2.2 Cross‐sectional schematic view of histology of oesophagus. Note ...

Figure 3.2.3 OGD showing a normal GOJ. Note the visible z‐line, which demarca...

Figure 3.2.4 OGD showing achalasia. Note that the lumen size of the oesophagu...

Figure 3.2.5 Barium swallow of achalasia. The contrast given is visualised un...

Figure 3.2.6 Example of manometry results. In the top panel there is absence ...

Figure 3.2.7 Endoscopy demonstrating a typical short segment of Barrett's oes...

Figure 3.2.8 CT (axial view) showing advanced oesophageal malignancy causing ...

Figure 3.2.9 Sketch of typical scar (dotted line) seen with an Ivor–Lewis oes...

Figure 3.2.10 OGD showing eosinophilic oesophagitis. Note the longitudinal fu...

Figure 3.2.11 OGD showing oesophageal candidiasis. Note the classic white/yel...

Chapter 3.3

Figure 3.3.1 Anatomy of the stomach.

Figure 3.3.2 Microscopic gastric histology.

Chapter 3.4

Figure 3.4.1 Sections of the small bowel.

Figure 3.4.2 Layers of the small bowel.

Figure 3.4.3 Dermatitis herpetiformis in coeliac patients in an atypical dist...

Figure 3.4.4 Villious atrophy and crypt hyperplasia in coeliac disease on duo...

Figure 3.4.5 Radiological findings on abdominal radiograph of small bowel obs...

Chapter 3.5

Figure 3.5.1 Large bowel anatomy.

Figure 3.5.2 Standard view at colonoscopy of ileo‐caecal valve. Note the pane...

Figure 3.5.3 Large bowel venous drainage.

Figure 3.5.4 Flexible sigmoidoscopy demonstrating yellow exudative pseudomemb...

Figure 3.5.5 Vascular supply of the large bowel. The splenic flexure is the m...

Figure 3.5.6 (a) Normal colon mucosa – the crypts are straight and parallel r...

Figure 3.5.7 Endoscopy demonstrating colonic diverticulosis in the sigmoid co...

Figure 3.5.8 AXR showing sigmoid volvulus and gross bowel dilation – note the...

Figure 3.5.9 Contrast enema showing apple core stricture and pseudo‐achalasia...

Figure 3.5.10 2 cm pedunculated polyp in the sigmoid colon.

Figure 3.5.11 Multiple ring‐enhancing liver metastases are shown on contrast ...

Figure 3.5.12 Computed tomography virtual colonoscopy (CTVC) demonstrating 2 ...

Chapter 3.6

Figure 3.6.1 Key areas where the bowel is affected in IBD.

Figure 3.6.2 Abdominal radiograph of a patient admitted with an acute flare o...

Figure 3.6.3 Flexible sigmoidoscopy of an acute flare of UC. Note the macrosc...

Figure 3.6.4 Histology of Crohn's disease. Note the central granuloma formati...

Figure 3.6.5 Typical appearance of abdominal TB at laparoscopy. Top panel is ...

Figure 3.6.6 CT demonstrating rectal and sigmoid colitis which is typical for...

Figure 3.6.7 Histology taken from patient with known UC – crypt architecture ...

Figure 3.6.8 Picture of stoma (end ileostomy) on the abdominal wall with bag ...

Figure 3.6.9 Schematic of common pouch formations – S and J.

Chapter 3.7

Figure 3.7.1 Schematic of liver.

Figure 3.7.2 Scleral icterus.

Figure 3.7.3 CT of liver (normal).

Figure 3.7.4 Sketch of typical appearance of a liver transplant scar. Note th...

Figure 3.7.5 Sketch of typical site of a liver biopsy. Scars tend to be very ...

Figure 3.7.6 (a) Histology of steatosis and steatohepatitis. In the top half ...

Figure 3.7.7 Simplified CIWA score. Different NHS trusts will have different ...

Figure 3.7.8 US demonstrating small shrunken liver with coarse and heterogene...

Figure 3.7.10 Position to demonstrate asterixis.

Figure 3.7.11 US of mass (annotated) in segment VI of liver consistent hepato...

Figure 3.7.12 CT of liver with large irregularly defined hypodensity near por...

Chapter 3.8

Figure 3.8.1 Biliary tract and circulation.

Figure 3.8.2 US showing a gallstone in the distal CBD casting an acoustic sha...

Figure 3.8.3 CT showing intra‐ and extra‐biliary duct dilation and inflammati...

Figure 3.8.4 MRCP of PSC: 3D maximum intensity projection image showing gener...

Figure 3.8.5 CT axial slice showing hyperdense mass consistent of cholangioca...

Chapter 3.9

Figure 3.9.1 Head of the pancreas is surrounded by the C loop of duodenum, an...

Figure 3.9.2 US image of gallbladder with normal wall thickness and multiple ...

Figure 3.9.3 CT showing chronic pancreatitis. Extensive white specks represen...

Figure 3.9.4 CT showing pancreatic cancer. The blue arrow points at a hypoden...

Chapter 4.1

Figure 4.1.1 Common blood bottles used in clinical practice: LFTs are taken i...

Figure 4.1.2 Visual representation of Bristol stool scale. Adapted from: Lewi...

Chapter 4.2

Figure 4.2.1 Abdominal US probe or transducer. Note the curvilinear shape. Th...

Figure 4.2.2 US image showing thickened gall bladder wall with calculus at th...

Figure 4.2.3 US standard brightness mode (B‐mode or 2D mode) grey‐scale image...

Figure 4.2.4 US B‐mode image of liver and superimposed colour Doppler study o...

Figure 4.2.5 US image of normal liver. Note the uniform echogenicity in grey ...

Figure 4.2.6 US image showing fluid as black colour (ascites) in the abdomina...

Figure 4.2.7 US image showing gross hydronephrosis of right renal tract with ...

Chapter 4.3

Figure 4.3.1 Normal AXR. Note the large body habitus resulting in suboptimal ...

Figure 4.3.2 Normal AXR showing superimposed small and large bowel loops with...

Figure 4.3.3 Normal AXR showing liver shadow in right upper quadrant.

Figure 4.3.4 AXR showing dilated loops of small bowel in keeping with a diagn...

Figure 4.3.5 AXR showing dilated loops of large bowel in keeping with a diagn...

Figure 4.3.6 AXR showing sigmoid volvulus and gross bowel dilation. Note the ...

Figure 4.3.7 AXR showing Rigler’s sign suggestive of bowel perforation. The b...

Figure 4.3.8 AXR showing two different sized opacities in the right upper qua...

Figure 4.3.9 AXR showing ‘lead‐pipe’ colitis, a typical pattern seen in IBD c...

Figure 4.3.10 AXR showing an endovascular repair of an old AAA with tortuosit...

Figure 4.3.11 AXR showing significant faecal loading in keeping with a diagno...

Chapter 4.4

Figure 4.4.1 Image of a typical CT scanner used for a CT abdomen/pelvis or CT...

Figure 4.4.2 CT virtual colonoscopy showing a 2 cm pedunculated sigmoid polyp...

Figure 4.4.3 CT abdomen showing pancreatic malignancy at the head of the panc...

Figure 4.4.4 CT abdomen showing multiple liver metastases (shown as dark grey...

Chapter 4.5

Figure 4.5.1 Different endoscopic instruments: colonoscope (note the addition...

Figure 4.5.2 OGD view of healthy oseophageus at the GOJ.

Figure 4.5.3 OGD showing fibrotic benign oesophageal stricture.

Figure 4.5.4 Therapeutic gastroscopy with balloon dilatation of benign oesoph...

Figure 4.5.5 Therapeutic OGD: successful EMR of high‐grade dysplastic lesion ...

Chapter 4.6

Figure 4.6.1 Barium or gastrografin compounds commonly used.

Figure 4.6.2 Barium swallow showing smooth mid‐oesophageal benign oesophageal...

Figure 4.6.3 Barium swallow showing normal anatomy in different phases – at p...

Figure 4.6.4 Barium swallow showing achalasia.

Chapter 4.8

Figure 4.8.1 Typical MRI scanner used for MRCP.

Figure 4.8.2 MRCP showing normal biliary anatomy: CBD, hepatic, cystic, and p...

Figure 4.8.3 MRCP showing dilated CBD with stone.

Figure 4.8.4 MRCP showing stenosis of the intra‐pancreatic portion of the CBD...

Chapter 4.9

Figure 4.9.1 Diagram showing the opening of the ampulla of Vater into the duo...

Figure 4.9.2 ERCPs showing (a) a guidewire across a stricture in the common b...

Figure 4.9.3 ERCP showing beading and structuring of intrahepatic bile ducts,...

Figure 4.9.4 ERCP showing stone in CBD as spherical opacification.

Chapter 4.10

Figure 4.10.1 (a) NG feeding tube and (b) NG Ryles tube. Note the enteral syr...

Figure 4.10.2 CXR showing correct placement of an NG tube. Note that the tip ...

Figure 4.10.3 CXRs showing incorrect placement of an NG tube. (a) NG tube has...

Figure 4.10.4 Image showing PEG flush against the skin (top left). The umbili...

Figure 4.10.5 Image showing PICC line and a feed bag.

Figure 4.10.6 CXR with a PICC line inserted on the left with tip visible at S...

Chapter 4.12

Figure 4.12.1 Different endoscopic instruments: colonoscope (note the additio...

Figure 4.12.2 Anatomical relationships of proctoscope and sigmoidoscope to th...

Chapter 4.13

Figure 4.13.1 Close‐up of colonoscopy, note the measurements in centimetres a...

Figure 4.13.2 Anatomical relationships of colonoscope to bowel.

Figure 4.13.3 Standard camera view of a colonoscope in the transverse colon....

Chapter 4.14

Figure 4.14.1 Bonano catheter/suprapubic catheter required for an abdominal p...

Figure 4.14.2 Anatomical relationship of paracentesis to underlying structure...

Figure 4.14.3 US view of loculated ascites with fibrin stranding seen within ...

Chapter 5.1

Figure 5.1.1 Chemical structure of omeprazole.

Figure 5.1.2 Gastric parietal cell.

Figure 5.1.3 Chemical structure of ranitidine.

Chapter 5.2

Figure 5.2.1 Chemical structure of aminosalicylate.

Figure 5.2.2 Chemical structure of prednisolone.

Figure 5.2.3 Chemical structure of azathioprine.

Figure 5.2.4 Chemical structure of methotrexate.

Figure 5.2.5 Metabolism of azathioprine.

Figure 5.2.6 Chemical structure of ciclosporin.

Chapter 5.3

Figure 5.3.1 Chemical structure of chlordiazepoxide.

Figure 5.3.2 Chemical structure of ribavirin.

Figure 5.3.3 Chemical structure of sofosbuvir.

Figure 5.3.4 Chemical structure of pencillamine.

Figure 5.3.5 Chemical structure of desferrioxamine.

Chapter 5.4

Figure 5.4.1 Chemical structure of UDCA.

Figure 5.4.2 Chemical structure of colestyramine.

Chapter 5.5

Figure 5.5.1 Paracetamol treatment graph. Note that if the level is measured ...

Figure 5.5.2 Chemical structure of NAC.

Guide

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The Clinical Guides series

Series Editor: Christian Fielder Camm

The Clinical Guides are a brand new resource for junior doctors and medical students. They provide practical and concise information on symptoms, common conditions, and day‐to‐day problems faced in the clinical environment. They are easy to navigate and allow swift access to information as it is needed, with step‐by‐step guidance on investigations, decision‐making and interventions, and how to survive and thrive on clinical rotations and attachments.

Clinical Guide to Gastroenterology

Edited by

Yang Chen MA (Cantab), BM BCh (Oxon), MRCP

Core medical traineeRoyal London Hospital, Barts Health NHS Trust, London, UK

Maxton Pitcher MA, MD (Cantab), BM BCh (Oxon), FRCP

Consultant GastroenterologistSt Mark’s and Northwick Park Hospitals, Harrow, UK

Series editor:

Christian Fielder Camm MA (Cantab), BM BCh (Oxon), MRCP

Cardiology Specialist RegistrarRoyal Berkshire Hospital, Reading, UK

This edition first published 2020© 2020 John Wiley & Sons Ltd

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, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.

The right of Yang Chen and Maxton Pitcher to be identified as the author(s) of the editorial material in this work has been asserted in accordance with law.

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Limit of Liability/Disclaimer of WarrantyThe contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.

Library of Congress Cataloging‐in‐Publication Data

Names: Chen, Yang (Royal London Hospital, Barts Health NHS Trust, London, UK), editor. | Pitcher, Maxton, editor.Title: Clinical guide to gastroenterology / edited by Yang Chen, Maxton Pitcher.Description: Hoboken, NJ : Wiley‐Blackwell, 2019. | Series: Clinical guides | Includes bibliographical references and index. |Identifiers: LCCN 2018054740 (print) | LCCN 2018056615 (ebook) | ISBN 9781119189176 (Adobe PDF) | ISBN 9781119189183 (ePub) | ISBN 9781119189169 (paperback)Subjects: | MESH: Gastrointestinal Diseases–diagnosis | Diagnostic Techniques, Digestive SystemClassification: LCC RC804.D52 (ebook) | LCC RC804.D52 (print) | NLM WI 141 | DDC 616.3/3075–dc23LC record available at https://lccn.loc.gov/2018054740

Cover Design: WileyCover Image: © Science Photo Library ‐ PASIEKA\Getty Images

List of Contributors

Kushala AbeysekeraBristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, London, UK

Saniath AkbarNewham University Hospital, Barts Health NHS Trust, London, UK

Ibrahim Al BakirNorthwick Park and St Mark's Hospital, London North West Healthcare NHS Trust, London, UK

Rosalie AlpineNorthwick Park Hospital, London North West Healthcare NHS Trust, London, UK

Aaron BancilSt. Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

Christian Fielder CammJohn Radcliffe Hospital, Oxford University Hospitals, Oxford, UK

Umar ChaudhryNorthwick Park Hospital, London Northwest Healthcare NHS Trust, London, UK

Yang ChenRoyal London Hospital, Barts Health NHS Trust, London, UK

Dominic CrocombeNewham University Hospital, Barts Health NHS Trust, London, UK

Lucy GlasgowNewham University Hospital, Barts Health NHS Trust, London, UK

Alina HuaSt. Bartholomew's Hospital, Barts Health NHS Trust, London, UK

Misha KabirSt Mark's Hospital, London North West University Hospitals NHS Trust, London, UK

Reza KhorasaneeSandwell Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK

Vincent McCaughanRoyal London Hospital, Barts Health NHS Trust, London, UK

Mairead McErleanRoyal London Hospital, Barts Health NHS Trust, London, UK

Andrew MelvilleUniversity College Hospital, University College London Hospitals NHS Foundation Trust, London, UK

Blair MerrickUniversity College London Hospital, University College London Hospitals NHS Foundation Trust, London, UK

Emma MichaelSt. Bartholomew's Hospital, Barts Health NHS Trust, London, UK

Aruchuna RubanSt Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK

Vinoth NadesalingamNorthwick Park and St Mark's Hospital, London North West Healthcare NHS Trust, London, UK

Rooshi NathwaniNorthwick Park and St Mark's Hospital, London North West Healthcare NHS Trust, London, UK

Nicholas PenneySt Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK

Rohit RaoNewham University Hospital, Barts Health NHS Trust, London, UK

Sachin ShahRoyal London Hospital, Barts Health NHS Trust, London, UK

Edward WarrenQueen Elizabeth Hospital for Children, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

Acronyms and Abbreviations

2WW

Two‐week wait

5‐FU

5‐fluorouracil

5‐HIAA

5‐hydroxyindoleacetic acid

5‐HT

4

5‐hydroxytryptamine‐4 receptor

5‐ASA

5‐aminosalicylic acid

A&E

Accident and emergency

AAA

Abdominal aortic aneurysm

Ab

Antibody

ABG

Arterial blood gas

ACE

Angiotensin converting enzyme

ACS

Acute coronary syndrome

ACTH

Adrenocorticotrophic hormone

ADP

Adenosine diphosphate

ADPKD

Autosomal dominant polycystic kidney disease

AF

Atrial fibrillation

AFB

Acid‐fast bacillus

AFP

α‐fetoprotein

AIDS

Acquired immune deficiency syndrome

AIH

Autoimmune hepatitis

AKI

Acute kidney injury

ALD

Alcoholic liver disease

ALF

Acute liver failure

ALP

Alkaline phosphatase

ALT

Alanine transaminase

AMA

Antimitochondrial antibody

AMTS

Abbreviated Mental Test Score

ANA

Antinuclear antibody

Anti‐AChR

Antibodies to acetylcholine receptors

APTT

Activated partial thromboplastin time

ARB

Angiotensin receptor blocker

ARDS

Acute respiratory distress syndrome

ASMA

Anti‐smooth muscle antibody

AST

Aspartate transaminase

AVM

Arterio‐venous malformation

AXR

Abdominal X‐ray

β‐HCG

β‐human chorionic gonadotrophin

BM

Capillary blood glucose

BMI

Body mass index

BP

Blood pressure

bpm

Beats per minute

BPPV

Benign paroxysmal positional vertigo

C. difficile

Clostridium difficile

Ca125

Cancer antigen 125

CA‐19‐9

Cancer antigen 19‐9

CBD

Common bile duct

CBT

Cognitive behavioural therapy

cCa

Corrected calcium level

CCF

Congestive cardiac failure

CCK

Cholecystokinin

CDAD

C. difficile

‐associated diarrhoea

CD117

Cluster of differentiation 117

CD8+

Cluster of differentiation 8

CDT

Clostridium difficile

toxin

CEA

Carcinoembryonic antigen

CFTR

Cystic fibrosis transmembrane conductance regulator

CgA

Chromogranin A

CIWA

Clinical Institute Withdrawal Assessment for Alcohol

CKD

Chronic kidney disease

CLD

Chronic liver disease

CLO

Campylobacter‐like organism

CMV

Cytomegalovirus

CNS

Central nervous system

COPD

Chronic obstructive pulmonary disease

Cr

Creatine

CRP

C‐reactive protein

CRT

Capillary refill time

CSF

Cerebrospinal fluid

CT

Computed tomography

CTAP

CT abdomen/pelvis

CT CAP

CT chest/abdomen/pelvis

CTPA

Computed tomography pulmonary angiography

CT PET

Computed tomography positron emission tomography

CTVC

Computed tomography virtual colonoscopy

CXR

Chest X‐ray

CYP2E1

Cytochrome P450 2E1

D&V

Diarrhoea and vomiting

DAAs

Directly acting antivirals

DEXA

Dual‐energy x‐ray absorptiometry

DIC

Disseminated intravascular coagulation

DKA

Diabetic ketoacidosis

DNA

Deoxyribonucleic acid

DRE

Digital rectal examination

dsDNA

Double‐stranded deoxyribonucleic acid

DVT

Deep vein thrombosis

DWI

Diffusion weighted imaging

E. coli

Escherichia coli

EATL

Enteropathy‐associated T‐cell lymphoma

EBV

Epstein–Barr virus

ECG

Electrocardiogram

ECHO

Echocardiogram

EEG

Electroencephalograph

eGFR

Estimated glomerular filtration rate

EGFR

Epidermal growth factor receptor

EMA

Anti‐endomyosial antibody

EMR

Endoscopic mucosal resection

ENA

Extrinsic nuclear antigen

ENT

Ear, nose and throat

ERCP

Endoscopic retrograde cholangiopancreatography

ESR

Erythrocyte sedimentation rate

ESWL

Extracorporeal shock‐wave lithotripsy

FAP

Familial adenomatous polyposis

FAST

Focused assessment with sonography for trauma

FBC

Full blood count

FNA

Fine needle aspirate

FOB

Faecal occult blood

FODMAP

Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols

G6PDH

Glucose‐6‐phosphate dehydrogenase

GA

General anaesthetic

GABA

γ‐amino butyric acid

GAVE

Gastric antral vascular ectasia

GBS

Guillian–Barré syndrome

GCS

Glasgow coma score

GDH

Glutamate dehydrogenase

GGT

γ‐glutamyl transferase

GFD

Gluten‐free diet

GFR

Glomerular filtration rate

GI

Gastrointestinal

GIST

Gastrointestinal stromal tumour

GOJ

Gastro‐oesophageal junction

GORD

Gastro‐oesophageal reflux disease

GMC

General Medical Council

GP

General practitioner

H. pylori

Helicobacter pylori

HAS

Human albumin solution

HAV

Hepatitis A virus

Hb

Haemoglobin

HbA1c

Glycated haemoglobin

HBc

Hepatitis B core

HBcAg

Hepatitis B core antigen

HBeAg

Hepatitis B e antigen

HBs

Hepatitis surface

HBsAg

Hepatitis surface antigen

HBV

Hepatitis B virus

HCC

Hepatocellular carcinoma

HCV

Hepatitis C virus

HDU

High‐dependency unit

HDV

Hepatitis C virus

HEV

Hepatitis E virus

HFE

Haemochromatosis gene

HHS

Hyperglycaemic hyperosmolar state

HIV

Human immunodeficiency virus

HLA‐DQ2

Human leucocyte antigen‐DQ2

HNPCC

Hereditary non‐polyposis colorectal cancer

HR