Table Of ContentOxford 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
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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
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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
