Acute upper gastrointestinal haemorrhage
Acute upper gastrointestinal bleeding is a common medical emergency associated with a significant mortality and impact upon healthcare resources. The clinical presentation and outcome depend on the co-morbidity and clinical interventions, including upper gastrointestinal endoscopy, endoscopic therapy and appropriate pharmacotherapy. Clinician awareness of potential underlying pathology such as liver cirrhosis is essential. Risk stratification scores can aid the triage of patients and clinical decision-making with regard to the timing of endoscopy. (Source: Medicine)
Source: Medicine - December 30, 2023 Category: Internal Medicine Authors: Eliana Saffouri, A John Morris Tags: Gastrointestinal emergencies Source Type: research
Acute lower gastrointestinal bleeding
often presents a challenging clinical situation. Although bleeding can be severe and associated with significant haemodynamic compromise, cessation is usually spontaneous. The causes are numerous, and the bleeding source can be difficult to identify, even with sophisticated diagnostic methods. Colonoscopy, CT angiography, mesenteric angiography and capsule enteroscopy offer a choice of diagnostic tools. Intervention is occasionally required; the options include therapeutic colonoscopy, super-selective embolization and surgical resection. (Source: Medicine)
Source: Medicine - December 28, 2023 Category: Internal Medicine Authors: Nicola S. Fearnhead Tags: Gastrointestinal emergencies Source Type: research
Symptoms and signs of lower gastrointestinal disease
This chapter discusses the key lower gastrointestinal symptoms of diarrhoea, constipation, abdominal pain, lower gastrointestinal bleeding, perianal symptoms and defecation disorders. These presentations are very commonly seen in both primary and secondary care and can range from acute, life-threatening conditions to chronic functional disorders. This chapter provides practical information and knowledge to guide an approach to each of the symptoms/signs. (Source: Medicine)
Source: Medicine - December 23, 2023 Category: Internal Medicine Authors: Michelle Sherwin, Philip J. Smith Tags: Symptoms and signs Source Type: research
Oesophageal emergencies
Although oesophageal emergencies are relatively rare in comparison to other gastrointestinal emergencies they are associated with marked morbidity and mortality because of diagnostic delays and complications of the perforation itself such as mediastinitis. Prompt recognition, cross-sectional imaging, early intervention and multidisciplinary management in specialist centres are central to improving outcomes. (Source: Medicine)
Source: Medicine - December 23, 2023 Category: Internal Medicine Authors: Adam D. Farmer Tags: Gastrointestinal emergencies Source Type: research
Acute pancreatitis
is an inflammatory condition with a variable clinical course. Its diagnosis involves a combination of clinical assessment, laboratory tests and imaging studies. Disease severity can be determined using clinical scoring systems or radiological evaluations such as the Computed Tomography Severity Index. While most cases of acute pancreatitis have a mild course, a subset of patients experience complications at both local and systemic levels. Conservative management is typically employed, but interventions are warranted in the presence of common bile duct stones or local complications such as walled-off necrosis or pseudocyst...
Source: Medicine - December 23, 2023 Category: Internal Medicine Authors: Alexander Ney, Stephen P Pereira Tags: Gastrointestinal emergencies Source Type: research
Screening and health promotion
There are disadvantages and benefits of screening programmes. Although there is widespread public and political support for medical screening of all kinds, important criteria must be applied before screening is introduced. The differences between population screening and other types of screening are identified here, and the costs, as well as the benefits, associated with screening are outlined. The importance of the difference between the sensitivity and the specificity of a test used in screening is explained. (Source: Medicine)
Source: Medicine - December 23, 2023 Category: Internal Medicine Authors: Michael P Kelly Tags: Spotlight Source Type: research
IBD emergencies
Inflammatory bowel disease (IBD) emergencies are rare, but can be life-threatening, require surgery and result in permanent end-organ damage. The most common complications of ulcerative colitis are fulminant colitis, toxic megacolon and massive haemorrhage. Complications of Crohn's disease include intra-abdominal abscesses and bowel obstruction. Additionally, extraintestinal manifestations can present as an emergency and require urgent intervention. These include thromboembolic events, ocul ar and hepato-pancreatobiliary complications. (Source: Medicine)
Source: Medicine - December 23, 2023 Category: Internal Medicine Authors: Eleanor Liu, Jimmy K. Limdi Tags: Gastrointestinal emergencies Source Type: research
Self-assessment/CPD answers
Question 1 (Source: Medicine)
Source: Medicine - December 23, 2023 Category: Internal Medicine Tags: Self-assessment/CPD answers Source Type: research
Symptoms and signs of upper gastrointestinal disease
This article aims to provide a systematic approach for formulating a differential diagnosis in patients with common symptoms and signs of upper gastrointestinal disease, highlighting ‘red flags’ for serious pathology. (Source: Medicine)
Source: Medicine - December 22, 2023 Category: Internal Medicine Authors: Amin Abdulgader, Maria GO. Saunders, Cathryn M. Edwards Tags: Symptoms and signs Source Type: research
Mesenteric ischaemia
results from a blood flow that is inadequate to meet the metabolic demands of the small bowel. Both acute and chronic mesenteric ischaemia frequently represent a diagnostic challenge as symptoms can be non-specific. The former is typically characterized by acute-onset severe abdominal pain and the latter by reproducible post-prandial abdominal pain. Prompt diagnosis and intervention are central to improving outcomes as these disorders are associated with significant morbidity and mortality. (Source: Medicine)
Source: Medicine - December 22, 2023 Category: Internal Medicine Authors: Adam D Farmer Tags: Gastrointestinal emergencies Source Type: research
Contents
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Source: Medicine - December 9, 2023 Category: Internal Medicine Source Type: research
Editorial Board
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Source: Medicine - December 9, 2023 Category: Internal Medicine Source Type: research
Contents
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Source: Medicine - November 18, 2023 Category: Internal Medicine Source Type: research
Editorial Board
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Source: Medicine - November 18, 2023 Category: Internal Medicine Source Type: research
Pharmacogenetics for the prescriber
Pharmacogenetics is the study of how genetic factors affect the response to drugs (efficacy, adverse effects). Variation in genes can affect either a drug's pharmacokinetics (how the drug is handled in the body) or its pharmacodynamics (how it interacts with proteins in the body to produce its effects). Such variation needs to be evaluated in combination with clinical and environmental factors to personalize either drug choice or drug dose in individual patients. There are some well-characterized examples of pharmacogenetic variation in clinical practice. (Source: Medicine)
Source: Medicine - November 13, 2023 Category: Internal Medicine Authors: Munir Pirmohamed Tags: Clinical pharmacology Source Type: research
