Problem-Based Approach to Gastroenterology and Hepatology

257 Pages·2012·3.86 MB·English

Problem-based Approach to
Gastroenterology and Hepatology
Problem-based Approach
to Gastroenterology and
Hepatology
Edited by
John N. Plevris MD, PhD, FRCPE, FEBGH
Consultant and Reader in Gastroenterology
Centre for Liver and Digestive Disorders
The Royal Infi rmary of Edinburgh
Edinburgh, Scotland
UK
Colin W. Howden MD, FRCP (Glasg.), FACP, AGAF,
FACG
Professor of Medicine
Division of Gastroenterology and Hepatology,
Northwestern University Feinberg School of Medicine
Chicago
Illinois
USA
A John Wiley & Sons, Ltd., Publication
This edition fi rst published 2012 © 2012 by Blackwell Publishing Ltd
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Library of Congress Cataloging-in-Publication Data
Problem-based approach to gastroenterology and hepatology / edited by John N. Plevris,
Colin W. Howden.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-1-4051-8227-0 (pbk. : alk. paper)
ISBN-10: 1-4051-8227-X (pbk. : alk. paper)
1. Gastrointestinal system–Diseases xDiagnosis–Case studies. 2. Liver–Diseases–Diagnosis–Case
studies. I. Plevris, John N. II. Howden, Colin W.
[DNLM: 1. Gastrointestinal Diseases–diagnosis–Case Reports. 2. Gastrointestinal Diseases–
therapy–Case Reports. 3. Liver Diseases–diagnosis–Case Reports. 4. Liver Diseases–therapy–
Case Reports. WI 140]
RC808.P76 2012
616.3'3–dc23
2011015322
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print
may not be available in electronic books.
Set in 9 on 11.5 pt Sabon by Toppan Best-set Premedia Limited
1 2012
Contents
Preface, vii
Contributors, viii
Part One Gastroenterology
1 Dysphagia, 3
Nirmala Gonsalves, Ikuo Hirano, and John N. Plevris
2 The Problem of Heartburn, and Atypical Chest Pain, 17
Ronnie Fass and Tiberiu Hershcovici
3 The Clinical Approach to Dyspepsia, 39
Mary Farid and Brennan Spiegel
4 Acute, Recurrent, and Chronic Abdominal Pain, 44
Brian E. Lacy and Chad C. Spangler
5 Hematemesis, Melena, and Occult Bleeding/Anemia, 64
Grigorios I. Leontiadis and Virender K. Sharma
6 Acute Diarrhea and Vomiting, 72
John P. Flaherty and Michael P. Angarone
7 Chronic Diarrhea and Malabsorption, 84
Paul Beck, Remo Panaccione, and Subrata Ghosh
8 Rectal Bleeding, 96
Matthew Shale, Lotte Dinesen, and Subrata Ghosh
9 Multisystem Disorders and Gastrointestinal Disease, 106
Lynne A. Meekison and John N. Plevris
Part Two Hepatology and Pancreatobiliary
10 Clinical Approach to Pancreatobiliary Disease, 117
Erica J. Revie, Lisa J. Massie, Anne-Marie Lennon, and O. James Garden
11 The Problem of Right Upper Quadrant Pain, 132
Malcolm B. Barnes and Simon Glance
12 Abnormal Liver Function Tests: Diagnostic Approach, 144
Timothy T. Gordon-Walker and John P. Iredale
13 The Acute Liver Failure Patient, 162
Neil C. Henderson and Kenneth J. Simpson
14 The Chronic Liver Disease Patient, 174
Joanna K. Dowman and Phil N. Newsome
v
CONTENTS
15 Portal Hypertension: A Management Problem, 189
Norma C. McAvoy and Peter C. Hayes
16 Infections in the Liver, 202
Veerendra Sandur and George Therapondos
17 The Liver Transplant Recipient, 212
Prakash Ramachandran and Andrew J. Bathgate
18 Incidental Radiological Findings in the Asymptomatic Patient, 226
Tiffany J. Campbell and Dilip Patel
Index, 241
vi
Preface
Problem-based approaches are commonly used in the Atlantic (and beyond). We therefore expect that
Medicine as effective learning tools; the problem this book will be of value to a broad, multinational
drives knowledge, thus promoting critical thinking readership. It has been said that the UK and the USA
and making the whole educational process interesting are “two countries separated by a common lan-
and relevant. We hope that this book, based on the guage”. (The derivation of that is uncertain having
above principles, will be of value to physicians who been variously attributed to Winston Churchill, Oscar
are training in Gastroenterology and Hepatology and Wilde and George Bernard Shaw – any of whom
who may be preparing to take a specialty postgradu- could have prepared a more entertaining preface
ate examination. Given its size, this book is clearly than this). We hope that this is not the perception
not intended to be a major treatise on digestive dis- of this book. Authors based in the USA have used
orders. Furthermore, we do not claim that reading American spelling and units of measurement; those
it will guarantee success in a relevant postgraduate based in the UK have used their own frames of refer-
examination in Gastroenterology/Hepatology. Rather, ence. Hopefully, both are clear and readers will learn
we hope that it will stimulate further reading, will from both.
supplement other preparations for those examina- We would like to take this opportunity to thank all
tions and provide valuable insight into how some of our invited authors for their contributions to this
of the experts – from both sides of the Atlantic – book and their commitment to this project. We are
approach common, important clinical issues in these also grateful to the editorial team at Wiley -Blackwell
specialties. Each chapter contains a number of for all the support and effective co -ordination.
case scenarios that raise questions of diagnosis and
management. Our expert authors then present valu- John N. Plevris
able discussion and important learning points about Colin W. Howden
each case. January 2012
We have been fortunate to be able to draw on the
expertise of friends and colleagues from both sides of
vii
Contributors
Michael P. Angarone DO Joanna K. Dowman MBChB(Hons),MRCP
Clinical Instructor Clinical Research Fellow and Specialist Registrar in
Northwestern University, Division of Infectious Gastroenterology
Disease Queen Elizabeth Hospital Birmingham, and NIHR
Northwestern University Feinberg School of Biomedical Research Unit and Centre for Liver
Medicine Research
Chicago, IL, USA University of Birmingham, UK
Malcolm B. Barnes MBBS(Hons),FRACP Mary Farid MD
Consultant Gastroenterologist Fellow in Gastroentrology
Monash Medical Centre UCLA Affi liated Training Program in Digestive
Victoria, Australia Diseases
University of California
Andrew J. Bathgate MB.CHB, MD, FRCPE Los Angeles, USA
Consultant Hepatologist
Scottish Liver Transplant Unit Ronnie Fass MD
The Royal Infi rmary of Edinburgh Professor of Medicine
Edinburgh, Scotland, UK University of Arizona and Chief of Gastroenterology
Southern Arizona VA Health Care System
Paul Beck PhD, MD, FRCPC Tucson, AZ, USA
Associate Professor of Medicine
Division of Gastroenterology John P. Flaherty MD
University of Calgary Professor of Medicine
Calgary, Alberta, Canada Division of Infectious Diseases
Northwestern University Feinberg School of
Tiffany J. Campbell BSC(Hons),MB C hB, Medicine
MRCP, FRCR Chicago, IL, USA
Consultant Radiologist
Forth Valley Royal Hospital O. James Garden BSc,MBChB,MD,FRCS(Glas),
Larbert, UK FRCS(Ed),FRCP(Ed),FRACS(Hon),FRCSC(Hon)
Regius Professor of Clinical Surgery
Lotte Dinesen MD Clinical Surgery
Specialist Registrar The Royal Infi rmary of Edinburgh
Gastroenterology Section, Division of Medicine Edinburgh, Scotland, UK
Imperial College London
Hammersmith Hospital Subrata Ghosh MBBS, MD (Edin.),FRCP, FRCPE,
London, UK FRCPC
Professor of Medicine
Chairman of Department of Medicine
University of Calgary
Calgary, Alberta, Canada
viii
CONTRIBUTORS
Simon Glance MDBBS(Hons) John P. Iredale DM,FRCP ,FMedSci
Consultant Gastroenterologist Professor of Medicine
The Northern Hospital Tissue Injury and Regeneration Group
Melbourne, Australia MRC Centre for Infl ammation Research
Queen’s Medical Research Institute
Nirmala Gonsalves MD Edinburgh, Scotland, UK
Assistant Professor of Medicine
Division of Gastroenterology Brian E. Lacy MD,PhD
Northwestern University – The Feinberg School of Associate Professor of Medicine
Medicine Dartmouth Medical School
Chicago, IL, USA and
Director
Timothy T. Gordon- Walker MBChB,BSc Gastrointestinal Motility Laboratory
Specialist Registrar in Gastroenterology Dartmouth-Hitchcock Medical Center
The Royal Infi rmary of Edinburgh Lebanon, NH, USA
and
MRC Centre for Infl ammation Research Anne-Marie Lennon MB,PhD,MRCP(UK)
Queen’s Medical Research Institute Assistant Professor of Medicine
Edinburgh, Scotland, UK Department of Gastroenterology and Hepatology
Johns Hopkins Hospital
Peter C. Hayes MD, PhD, FRCPE Baltimore, MA, USA
Professor of Hepatology
Centre for Liver and Digestive Disorders Grigorios I. Leontiadis MD,PhD
The Royal Infi rmary of Edinburgh Assistant Professor
Edinburgh, Scotland UK McMaster University Department of Medicine
Division of Gastroenterology
Neil C. Henderson BMSc(Hons),MBChB(Hons), Health Sciences Centre
MSc,PhD,MD,FRCP(Ed) Hamilton, ON, Canada
Senior Clinical Scientist and Consultant
Hepatologist Norma C. McAvoy MBChB,MRCP(UK)
Centre for Liver and Digestive Disorders Clinical Lecturer
The Royal Infi rmary of Edinburgh Centre for Liver and Digestive Disorders
Edinburgh, Scotland, UK The Royal Infi rmary of Edinburgh
Edinburgh, Scotland, UK
Tiberiu Hershcovici MD
Research Fellow Lisa J. Massie MBChB
Southern Arizona VA Health Care System Specialist Surgical Registrar
Tucson, AZ, USA Clinical Surgery
The Royal Infi rmary of Edinburgh
Ikuo Hirano MD Edinburgh, Scotland, UK
Professor of Medicine
Division of Gastroenterology Lynne A. Meekison MBChB
Northwestern University Feinberg School of Associate Specialist
Medicine Centre for Liver and Digestive Disorders
Chicago, IL, USA The Royal Infi rmary of Edinburgh
Edinburgh, Scotland, UK
ix
CONTRIBUTORS
Phil N. Newsome PhD,FRCP Matthew Shale MRCP
Senior Lecturer in Hepatology and Honorary Academic Clinical Fellow
Consultant Physician Gastroenterology Section
Queen Elizabeth Hospital Birmingham, and NIHR Division of Medicine
Biomedical Research Unit and Centre for Liver Imperial College London, Hammersmith Hospital
Research London, UK
University of Birmingham, UK
Virender K. Sharma FASGE, FACG, AGAF
Remo Panaccione MD, FRCPC Professor of Medicine and Director
Associate Professor of Medicine Arizona Center for Digestive Health
Division of Gastroenterology Gilbert, AZ, USA
University of Calgary
Calgary, Alberta, Canada Kenneth J. Simpson MBChB,MD,PhD,FRCPE
Senior Lecturer in Hepatology
Dilip Patel BMedSci (H ons),MBBS,FRCP(Ed), Centre for Liver and Digestive Disorders
FRCR The Royal Infi rmary of Edinburgh
Consultant Radiologist and Honorary Clinical Edinburgh, Scotland, UK
Senior Lecturer
The Royal Infi rmary of Edinburgh Chad C. Spangler MD
University of Edinburgh Instructor in Medicine
Edinburgh, Scotland, UK Division of Gastroenterology and Hepatology
Dartmouth-Hitchcock Medical Center
Prakash Ramachandran BSc,MBChB,PhD, Lebanon NH, USA
MRCP(UK)
Specialist Registrar in Gastroenterology and Brennan Spiegel MD,MSHS
Hepatology Associate Professor of Medicine
Scottish Liver Transplant Unit VA Greater Los Angeles Healthcare System David
The Royal Infi rmary of Edinburgh Geffen School of Medicine at UCLA
Edinburgh, Scotland UK and
Director
Erica J. Revie BSc,MBChB,MRCS UCLA/VA Center for Outcomes Research and
Specialist Surgical Registrar Education
Clinical Surgery Los Angeles, CA, USA
The Royal Infi rmary of Edinburgh
Edinburgh, Scotland, UK George Therapondos MBChB(Hons),PhD,
MD,FRCP(Ed)
Veerendra Sandur MBBS,MD,DNM, Assistant Professor of Medicine
DM(Gastro) Multiorgan Transplant Program
Liver Transplantation Fellow Toronto General Hospital
Multiorgan Transplant Program University Health Network
Toronto General Hospital Toronto, Ontario, Canada
Toronto, Ontario, Canada
x
PART ONE
Gastroenterology