Intestinal failure
(IF) describes a reduction in gut function, often resulting from previous surgery, leading to malabsorption and malnutrition. Untreated, this can lead to dehydration, weight loss, electrolyte imbalance and death. Early recognition with referral to experienced multidisciplinary IF teams is crucial to achieve good outcomes. IF management includes the control of sepsis, prevention of complications, optimization of nutrition, definition of the underlying anatomy and planning of reconstructive surgery or use of medications to support intestinal function. (Source: Medicine)
Source: Medicine - May 30, 2023 Category: Internal Medicine Authors: Buraq Abdulaema, Martyn Dibb Tags: Nutrition Source Type: research
Malnutrition and undernutrition: causes, consequences, assessment and management
The term ‘malnutrition’ is used to describe a deficiency, excess or imbalance of a wide range of nutrients, resulting in measurable adverse effects on body composition, function and clinical outcome. Malnutrition can refer to individuals who are either over- or undernourished, although it is usually used synonymously with undernutrition. Although it is well known that malnutrition is common in the developing world, it is not widely appreciated that it occurs frequently in UK health settings as a consequence of either psychosocial circumstances or the effects of illness or injury. (Source: Medicine)
Source: Medicine - May 30, 2023 Category: Internal Medicine Authors: Benjamin Allen, John Saunders Tags: Nutrition Source Type: research
The management of micronutrient imbalance: a practical guide
Micronutrients are required in varying quantities to maintain essential functions within the body. Many of these are obtained through dietary sources, but access to a diet balanced in micronutrients varies worldwide; micronutrient deficiencies are the cause of reversible global health problems including iron deficiency anaemia and blindness in children. Lifestyle preferences including alcohol use and vegetarianism can predispose to micronutrient imbalance, with a range of acute and chronic diseases also putting patients at risk. (Source: Medicine)
Source: Medicine - May 30, 2023 Category: Internal Medicine Authors: Suzi Batchelor, Nick Thompson Tags: Nutrition Source Type: research
Intestinal transplantation
The UK has played a pivotal role in developing intestinal transplantation in adult and paediatric recipients. UK adult centres are among the most active worldwide, and improving 5-year survival outcomes are comparable with other solid organ transplant groups. Patients with complications of intestinal failure or other indications for multivisceral transplant are referred and undergo detailed assessment. Transplant centres have developed close working relationships with specialized intestinal failure centres to encourage timely referral. (Source: Medicine)
Source: Medicine - May 30, 2023 Category: Internal Medicine Authors: Charlotte S. Rutter, Lisa Sharkey Tags: Nutrition Source Type: research
Medical management of eating disorders
An increasing number of adults are being admitted to acute medical units for the management of eating disorders such as anorexia nervosa. In most cases nutrition support is the mainstay of treatment and must be introduced at an appropriate rate to avoid both refeeding and underfeeding syndromes. As most hospitalized patients have a high risk of refeeding problems, the optimum approach is to start low but build up rapidly to meet the full requirements for weight gain by days 4 –7. To do this, a generous provision of electrolytes, such as potassium, magnesium and phosphate, and vitamins (especially thiamine) is crucial; ho...
Source: Medicine - May 30, 2023 Category: Internal Medicine Authors: Pete Turner, Aminda De Silva Tags: Nutrition Source Type: research
Self-assessment/CPD answers
Question 1 (Source: Medicine)
Source: Medicine - May 30, 2023 Category: Internal Medicine Tags: Self-assessment/CPD answers Source Type: research
Obesity: surgical management
Obesity is a chronic health condition associated with progressive metabolic co-morbidities and ill-health. Currently available pharmacological, behavioural and dietary strategies provide mild to modest levels of weight reduction that are often not sustained. Bariatric and metabolic surgery remains the most efficacious and cost-effective means of treating individuals with obesity by producing profound and sustained weight loss, as well improvements in metabolic co-morbidities, mobility and quality of life. (Source: Medicine)
Source: Medicine - May 30, 2023 Category: Internal Medicine Authors: Michael A. Glaysher, Shaw S. Somers Tags: Nutrition Source Type: research
Hepatic encephalopathy
(HE) is a neurocognitive disorder associated with both acute and chronic liver injury. It manifests as a wide spectrum of neuropsychological abnormalities ranging from subtle impairments in executive higher functions through to coma. In acute liver failure, the central role of ammonia in the development of brain oedema remains undisputed. However, the gut microbiome and the presence of systemic inflammation or the development of infection have become increasingly recognized as drivers of the development of HE in cirrhosis. (Source: Medicine)
Source: Medicine - May 9, 2023 Category: Internal Medicine Authors: Henry Kibble, Jennifer M. Ryan, Debbie L. Shawcross Tags: Management problems in liver disease Source Type: research
Primary biliary cholangitis
(PBC) is a chronic autoimmune liver disease characterized by lymphocytic destruction of the small, intrahepatic bile ducts, causing chronic cholestasis and progressive fibrosis that eventually leads to biliary cirrhosis. It is a complex disorder resulting from the interaction of genetic and environmental factors and is strongly predominant in female patients (female:male 9:1). Typical symptoms include cholestatic pruritus and the PBC fatigue symptom complex. Features of end-stage liver disease (ESLD) from PBC are the same as those of ESLD from other causes, i.e. (Source: Medicine)
Source: Medicine - May 8, 2023 Category: Internal Medicine Authors: George Mells Tags: Autoimmune liver disease Source Type: research
Wilson disease
is a rare progressive genetic disorder of copper metabolism associated with hepatolenticular degeneration. Left untreated, it results in severe disability and death. The diagnosis is very easily overlooked but, if discovered early, effective treatments are available to prevent or reverse many manifestations of this disorder. The role of copper in disease pathogenesis, coupled with clinical, biochemical and genetic markers, is pivotal to establishing a clear diagnosis. Medical therapy involves chelating agents (e.g. (Source: Medicine)
Source: Medicine - May 8, 2023 Category: Internal Medicine Authors: James Liu Yin, Aftab Ala Tags: Metabolic liver disease Source Type: research
Liver disease in pregnancy
Liver disease in pregnant patients often causes concern. This chapter covers both acute liver pathologies that occur in pregnancy, and pregnancy in mothers with chronic liver disease, focusing on practical diagnostic and management strategies. (Source: Medicine)
Source: Medicine - May 4, 2023 Category: Internal Medicine Authors: Sophie Ragan, Claire J. Grant, Emilie A. Wilkes Tags: Mothers, babies and children Source Type: research
Primary sclerosing cholangitis
(PSC) is a chronic liver disease that leads to chronic cholestasis, biliary strictures and liver fibrosis. It is considered an immune-mediated liver disease, although the exact aetiopathogenesis is not clear and there has been no clinical benefit from immunosuppression. Symptoms in PSC can be variable and include pruritus, abdominal pain, jaundice and fatigue. Diagnosis of PSC requires the exclusion of secondary causes of cholangiopathy and can usually be made on non-invasive imaging without the need for liver biopsy, which is usually reserved for variants. (Source: Medicine)
Source: Medicine - May 2, 2023 Category: Internal Medicine Authors: Jeremy S. Nayagam, Deepak Joshi Tags: Autoimmune liver disease Source Type: research
Liver and biliary disease in childhood
It is estimated that around 1000 children are diagnosed with liver disease in the UK, every year. Their presentation varies from acute to more insidious, often in the context of chronic liver disease. In acute settings, the liver disease can be so severe as to cause acute liver failure, a multisystemic disease requiring urgent referral to a specialized liver centre with access to intensive care support and liver transplantation. The clotting profile is the most sensitive marker of liver disease severity and should always be checked at presentation. (Source: Medicine)
Source: Medicine - April 28, 2023 Category: Internal Medicine Authors: Marianne Samyn Tags: Mothers, babies and children Source Type: research
Autoimmune hepatitis and overlap syndromes
Autoimmune hepatitis (AIH) is an immune-mediated liver disease that can progress rapidly to cirrhosis if left untreated. As the natural history of AIH features both acute and chronic inflammatory liver damage with fluctuating degrees of severity, clinical presentation can vary from asymptomatic to fatigue, jaundice and acute liver failure. The diagnosis is suspected by deranged liver enzymes, supported by hypergammaglobulinaemia and positive autoantibodies; it is confirmed by interface hepatitis and lymphoplasmacytic infiltration on liver biopsy. (Source: Medicine)
Source: Medicine - April 28, 2023 Category: Internal Medicine Authors: Sophia L. Ling, Michael A. Heneghan Tags: Autoimmune liver disease Source Type: research
Contents
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Source: Medicine - April 27, 2023 Category: Internal Medicine Source Type: research
