Table Of ContentPrimary Care Medicine
for Specialists and
Non-Specialists
A Practitioner's Guide
Primary Care Medicine
for Specialists and
Non-Specialists
A Practitioner's Guide
John R. Hubbard, M.D., Ph.D.
Group Private Practice
Northport, Alabama
Robert P. Albanese, Jr., M.D.
Medical University of South Carolina
and Ralph H. Johnson VA Medical Center
Charleston, South Caro lina
SPRINGER SCIENCE+BUSINESS :MEDIA, LLC
Library of Congress Cataloging-in-Publication Data
ISBN 978-0-306-47289-3 ISBN 978-1-4615-0709-3 (eBook)
DOI 10.1007/978-1-4615-0709-3
Copyright © 2003 by Springer Science+Business Media New York
Origina11y published by Kluwer AcademiclPlenum Publishers, New York in 2003
http://www.wkap.nl
ro 9 8 7 6 5 4 3 2 1
A C.I.P. record for this book is available from the Library of Congress.
AII rights reserved
No part of this work may be reproduced, stored in a retrieval system, or transmitted in any form
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use by the purchaser of the work.
About the Authors
John R. Hubbard, M.D., Ph.D., is a physician, scientist (Ph.D. in biochemistry)
and board certified psychiatrist and addiction psychiatrist who is currently in
group private practice. Previously, he has been a medical school professor at such
distinguished universities as Vanderbilt University School of Medicine, the
University of Virginia School of Medicine, the Medical College of Virginia, and
Harvard Medical School. Dr. Hubbard has published numerous articles in such
diverse areas as addiction medicine, psychiatry, chronic pain, endocrinology, and
arthritis. His other books include Primary Care Medicine for Psychiatrists,
Handbook of Stress Medicine, Substance Abuse in the Mentally and Physically
Disabled, Peptide Hormone Receptors, and Review of Endocrinology and
Reproduction.
Robert Albanese, M.D., is both a board certified internist and psychiatrist who
is currently a professor at the Medical University of South Carolina. He was pre
viously on faculty at the University of Virginia School of Medicine. Dr. Albanese
directs a VA educational program to teach general clinicians-psychiatry and
psychiatrists-general medicine. He has previously been a contributor to the
book "Primary Care Medicine for Psychiatrists".
v
Preface
The basic content and fonnat of this book were inspired by the enthusiastic
response of psychiatrists and psychiatric residents to the previously published
book titled "Primary Care Medicine for Psychiatrists: A Practitioner's Guide"
(John Hubbard and Delmar Short, eds.) which was designed to aid psychiatrists
provide primary care medicine to their patients. "Primary Care Medicine for
Specialists and Non-Specialists" is similarly designed for a wider readership to
be a concise, first-source guide to help specialists and other healthcare providers
(such as family doctors, residents, medical students, physician's assistants, nurse
practitioners, and nurses) provide general medical care. Chapters are brief and to
the-point. This book is not to replace medical consultation or to replace more
comprehensive texts which provide a deep reservoir of subspecialty infonnation.
"Primary Care Medicine for Specialists and Non-specialists" is written in a
simple note-like fonnat (using as few words as possible) in order to rapidly con
vey information. Thus, phrases are used to replace sentences, and lists are used in
place of short phrases whenever possible. For each illness, possible signs/symp
toms, workup suggestions, and common treatment options are discussed. The
depth of each category is not meant to be all-inclusive (as are other texts), but is
designed as a quick reference in areas clinicians do regularly treat. Each chapter
has been reviewed by a specialist or doctor with particular interest in the area to
help assure that the material is accurate and up-to-date.
This book also reviews specific issues in numerous specialty areas (such as
psychiatry, cardiology, OB/GYN, infectious disease, pulmonology, surgery,
endocrinology, gastroenterology, ENT, and others) in the "Highlights in Specialty
Areas" section of each chapter. Particular emphasis has been given to psychiatric
issues as psychiatrists must often care for patients in in-patient settings for
extended periods of time. Thus, this book is practical in nature and designed to be
"used" rather than "read".
John R. Hubbard, M.D., Ph.D.
Robert Albanese, M.D.
vii
Acknowledgments
We wish to thank the many specialists and other doctors who have reviewed and
provided suggestions for specific chapters in this book relevant to their area of
expertise. These doctors include:
Richard Akins, M.D. Laura Lee Kinney, M.D.
Tony Balistreri, M.D. 1. B. Pickett, M.D.
George Dobo, M.D. Julius Sagel, M.D.
Mary Frankis, M.D. Derya Tagge, M.D.
Crystal Gadegbeku, M.D. Lisa Von Moll, M.D.
Floyd Jernigan, M.D. Ira Willner, M.D.
In addition, we wish to give our warmest thanks to our families for their love
and support, including: Suzanne W. Hubbard, DDS, Tara M. Hubbard, and Erin A.
Hubbard as well as Allison Baker Albanese, Dominic P. Albanese and Mathew D.
Albanese.
ix
Contents
Chapter 1 Alcohol and Other Drugs of Abuse
I. Introduction...... ..... .......... ...... ... ......... 1
II. Relapse Prevention . . . . . . . . . . . . . . . . . . . . . . ... . 2. . . . . . . .
III. General Considerations in Treatment ........ .......... .. 3
IV. Alcohol. .... .... .. ........ ..................... .. 4
V. Opiates... ... .... .. .. .. .. .. .... .. ...... ...... ..... 10
VI. Benzodiazepines and other Hypnosedatives ... .... ........ 14
VII. Cocaine, Amphetamine and other Psychostimulant
Disorders ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 . . . . . . . ..
VIII. Marijuana (Cannabinoids) ....... ... ..... ...... ....... 19
IX. Hallucinogens and Volatile Inhalants ... .... .. ....... .... 21
Chapter 2 Cardiac Disease
I. Introduction ......... .... .... ...................... 23
II. Electrocardiograms and Indicated Pathologies ..... .... .... 23
III. Angina Pectoris ............................... ... .. 25
IV. Myocardial Infarction . . . . . . . . . . . . . . . . . . . . . . 2. 5. . . . . . . ..
V. Congestive Heart Failure .... ...... ....... ........ ... . 26
VI. Atrial Fibrillation . . . . . . . . . . . . . ... . . . .. .. . . . . . . . .. 2. 7. .
VII. Pericarditis.................. .... ..... ............. 27
VIII. Highlights in Specialty Areas . . . . . . . . . . . . . . . . . ... . .2 .8 . . .
Chapter 3 Dermatology Problems
I. Introduction. .. ............... .. ...... .. ........... 31
II. Drug Reactions ................. .. .... .... ......... 31
III. Psoriasis... ..... ........................ ....... ... 33
IV. Dermatitis (Eczema) . . . . . . . . . . . . . . . . . . . . . ... . 3.4 . . . . . . .
V. Scabies.... ... .. ..... ..... . . . . . . . . . . . . . . . . . 3.5 . . . . . .
xi
xii Contents
VI. Bacterial Skin Infections ............................. 35
VII. Fungal Skin Infections ..... . . . . . . . . . . . . . . . . . . . . . . . . .. 36
VIII. Herpes Zoster . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 38
IX. Blistering Skin Disorders ........... . . . . . . . . . . . . . . . . .. 39
X. Skin Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 40
XI. Highlights in Specialty Areas . . . . . . . . . . . . . . . . . . . . . . . . .. 41
Chapter 4 Endocrinology
I. Introduction....................................... 45
II. Glucose Disorders .................................. 45
III. Diseases of the Thyroid .............................. 48
IV. Pituitary Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 49
V. Adrenal Diseases ................................... 52
VI. Calcium Metabolism and Metabolic Bone Diseases ......... 54
VII. Highlights in Specialty Areas . . . . . . . . . . . . . . . . . . . . . . . . .. 57
Chapter 5 Gastrointestinal Disorders
I. Introduction....................................... 61
II. Abdominal Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .. 61
III. Diarrhea.......................................... 62
IV. Gastritis.......................................... 63
V. Gastroesophageal Reflux Disease (GERD) ................ 63
VI. Peptic Ulcers ...................................... 64
VII. Gastrointestinal Bleeding . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 64
VIII. Gastroparesis...................................... 65
IX. Gastric Cancer ....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 65
X. Irritable Bowel Syndrome (ffiS) . . . . . . . . . . . . . . . . . . . . . . .. 66
XI. Diverticulitis ...................................... 66
XII. Ulcerative Colitis (UC) .............................. 66
XIII. Crohn's Disease .................................... 67
XIV. Ischemic Colitis ...... . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 67
XV. Colorectal Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 68
XVI. Acute Pancreatitis .................................. 68
XVII. Chronic Pancreatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 69
XVIII. Pancreatic Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 69
XIX. Cholecystitis ...................................... 69
XX. Cholangitis........................................ 70
XXI. Primary Sclerosing Cholangitis ........................ 70
XXII. Cholangiocarcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 71
XXIII. Gilbert's Syndrome ................................. 71
XXIV. Foreign Bodies ... ~. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 71
Contents xiii
XXV. Esophagitis........................................ 72
XXVI. Esophageal Motility Disorders .............. . . . . . . . . . .. 72
XXVII. Esophageal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 72
XXVIII. Highlights in Specialty Areas . . . . . . . . . . . . . . . . . . . . . . . . .. 73
Chapter 6 Hematology and Oncology
I. Introduction....................................... 75
II. Anemia .......................................... 75
III. Abnonnal Bleeding ................................. 77
lV. Polycythemia...................................... 78
V. Neutropenia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 78
VI. Lymphadenopathy .................................. 79
VII. Neoplastic Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 80
VIII. Highlights in Specialty Areas . . . . . . . . . . . . . . . . . . . . . . . . .. 84
Chapter 7 Hepatic Disorders
I. Introduction....................................... 87
II. Drug-Induced Hepatic Disorders ....................... 87
III. Hepatitis A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 87
IV. Hepatitis B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 88
Y. Hepatitis C (Non-A, Non-B Hepatitis) ................... 89
VI. Hepatitis D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . '.' . . .. 89
VII. Other Proposed Types of Acute Hepatitis ................. 90
VIII. Chronic Hepatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 90
IX. Cirrhosis ......................................... 90
X. Ascites .......................................... . 91
XI. Hepatic Encephalopathy ............................. . 91
XII. Hepatic Cancer .................................... . 92
XIII. Highlights in Specialty Areas . . . . . . . . . . . . . . . . . . . ...... . 92
Chapter 8 Infectious Diseases
I. Introduction....................................... 95
II. Fever............................................ 95
III. Nausea, Vomiting, Diarrhea ........................... 96
IV. The Common-Cold Syndrome ......................... 96
V. Pharyngitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 97
VI. Acute Bronchitis ................................... 98
VII. Otitis Extema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . 98
VIII. Otitis Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . 99
IX. Sinusitis ......................................... . 99
xiv Contents
X. Conjunctivitis .................................... 100
XI. Community-Acquired Pneumonia ..................... 101
XII. Urinary Tract Infection ............................. 102
XIII. Prostatitis ....................................... 102
XIV. Sexually Transmitted Diseases ........................ 103
XV. Acute Infectious Arthritis ........................... 104
XVI. Acute Meningitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 105
XVll. Lymphadenopathy and Lymphadenitis . . . . . . . . . . . . . . . . .. 106
XVlll. HIV Disease ..................................... 106
XIX. Highlights in Specialty Areas . . . . . . . . . . . . . . . . . . . . . . . .. 107
Chapter 9 Neurology
I. Introduction...................................... 109
ll. Stroke.......................................... 109
lll. Brain Tumors .................................... 110
IV. Parkinson's Disease ................................ 111
V. Huntington's Disease ............................... 112
VI. Epilepsy ........................................ 113
VIT. Multiple Sclerosis ................................. 114
vm.
Headache........................................ 115
IX. Tremor ......................................... 117
X. Peripheral Neuropathy .............................. 118
XI. Movement Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 119
XII. Highlights in Specialty Areas . . . . . . . . . . . . . . . . . . . . . . . .. 120
Chapter 10 Preventive Health Care
I. Introduction ...................................... 123
II. Recommendations for Health Care Screening ............ 123
1. Cancer ...................................... 123
2. Cardiovascular Disease .......................... 125
3. Osteoporosis .................................. 126
4. Thyroid Disease ............................... 126
III. Recommendations for ImmunizatioQ . . . . . . . . . . . . . . . . . .. 126
1. Children ..................................... 126
2. Adults ....................................... 127
Chapter 11 Psychiatric Disorders
I. Introduction 129
II. Depression 129
m. Generalized Anxiety Disorder 130
