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Practical Gastroenterology
V Balakrishnan
1:
Managing Dysphagia
INTRODUCTION
MECHANISMS
CLASSIFICATION
COMMON CAUSES OF DYSPHAGIA
OROPHARYNGEAL DYSPHAGIA (TRANSFER DYSPHAGIA)
ESOPHAGEAL DYSPHAGIA (TRANSIT DYSPHAGIA)
INVESTIGATIONS
Radiology
Radionuclide Studies
Video Endoscopy
Manometry
Classification of Esophageal Motility Disorders
Disorders of UES and Cervical Esophagus
Treatment
Specific Motor Disorders
Achalasia (failure to relax)
Diagnosis
Differential Diagnosis (pseudo achalasia)
Treatment
Other Hypermotility Disorders
Diagnosis
Esophageal Hypomotility
Obstructive Lesions
Tumors
2:
Treating Gastroesophageal Reflux Disease
INTRODUCTION
DEFINITION
EPIDEMIOLOGY
PATHOPHYSIOLOGY
MECHANISMS OF REFLUX
CLINICAL FEATURES
Typical
Atypical
Non-cardiac Chest Pain
Natural History
Differential Diagnosis
Investigations and Management
Guidelines for the Clinical use of Esophageal pH Recording
Indications
Therapeutic Trial with Proton Pump Inhibitors
Treatment
Nonprescription Therapy
Drug Therapy
Proton Pump Inhibitors
Caveats in Usage of PPI
Modulators of TLESR
Maintenance Therapy
Endoscopic Treatment Modalities
Surgery
Surgical Techniques
Complications of GERD
Surveillance
Conclusion
3:
Nausea and Vomiting: A Common Clinical Problem
INTRODUCTION
Related Terms
Pathophysiology of Vomiting
Act of Vomiting
Approach to a Patient with Vomiting
Clinical Features of Luminal Obstruction
Complications of Vomiting
Investigations
Laboratory Investigations
Imaging Studies
Endoscopic Studies
Special Investigations
Treatment
Non-pharmacological Approach
4:
Managing Recurrent Hiccups
INTRODUCTION
Classification
Selected Causes of Hiccups
Drugs Inducing Hiccups
Hiccups during General Anesthesia or Sedation
Hiccups during Stroke Rehabilitation
Hiccups in Terminally ill Patients
TREATMENT
Non-pharmacological Treatment
Hiccups: Causes and Treatments
Pharmacological Treatments
5:
The Differential Diagnosis of Abdominal Pain
INTRODUCTION
PAIN TYPES
Clinical Pain Syndromes
Acute Abdominal Pain
Important Elements in Patient History
Physical Examination
Palpation
Investigations
Plain X-ray Abdomen
Ultrasound Abdomen
CT Abdomen
Laparoscopy
Guidelines for Management
Treatment of Cause
Chronic Abdominal Pain
Common Causes
Chronic Persistent Pain
Physical Examination
Lab Investigations
Imaging
CT Abdomen
Mesenteric Angiography
Endoscopic Evaluation
Upper GI Scopy and Colonoscopy
Management
Address Physical and Psychologic Symptoms
6:
Peptic Ulcer in the Era of H. pylori
INTRODUCTION
Aims of Management of Peptic Ulcer
Diagnosis of Peptic Ulcer Disease
HOW TO DIAGNOSE H. pylori INFECTION?
Serology Tests
Rapid Urease Test
Histopathology of Gastric Mucosa
Culture for H. pylori
Urea Breath Tests (14C or 13C)
Detection of ELISA Antigen in Stool
Indications for Testing H. pylori Infection
Indications for Eradication of H. pylori
Maastricht 2–2000-Key Management Strategies
Standard Regimes—Triple Therapy or Quadruple Therapy
Triple Drug therapy
Newer Triple Therapy (PPI based) Regimes x two weeks-85–90% eradication rate
Quadruple Drug Therapy for Two Weeks
Indian Scenario
Side Effects of H. pylori Eradication Therapy
Economics of H. pylori Eradication
Management of Duodenal Ulcer
Management of Gastric Ulcer
Management of NSAID Induced Ulcers
Management of Refractory Ulcer
Management of Anastomotic Ulcers
Maintenance Treatment
Gastric Carcinoma and MALToma
7:
The Management of Upper Gastrointestinal Bleed
INTRODUCTION
DEFINITIONS
CAUSES
Causes of Acute Upper Gastrointestinal Bleeding
Resuscitation
Differentiation of Upper from Lower GI Bleeding
Role of Endoscopy
Risk Stratification
MANAGEMENT
Management of Non-variceal Bleeding
Pharmacological Treatment
Endoscopic Therapy
Endosopic therapy for re-bleeding
Secondary Prophylaxis
Management of Variceal Bleeding
Control of Bleeding
Pharmacological Therapy
Endoscopic Therapy
Balloon Tamponade
Transjugular Intrahepatic Portosystemic Shunt (TIPS)
Surgical Treatment
Prevention of Re-bleeding
8:
Chronic Diarrhea
INTRODUCTION
DEFINITION
PATHOPHYSIOLOGY
Clinical Classification of Chronic Diarrhea
Differential Diagnosis of Chronic Diarrhea
Approach to a Patient with Chronic Diarrhea
History
Physical Examination
ROUTINE LABORATORY TESTS
Stool Analysis
Spot Stool Analysis
Quantitative Stool Collection
Radiological Investigations
Role of Endoscopy
Special Testing
Treatment
9:
Pathogenesis and Management of Acute Diarrhea
INTRODUCTION
DEFINITION
ETIOPATHOGENESIS
INFECTIVE DIARRHEAS
E. coli
Cholera
Salmonella
Shigella
Campylobacter
Yersinia
Potozoal Diseases
Non-infective Causes
CLINICAL SUBTYPES
Acute Watery Diarrhea
Acute Bloody Diarrhea
Persistent Diarrhea
Diarrhea with Severe Malnutrition
Food Poisoning
Acute Diarrheal Disease—A Clinical Approach
INVESTIGATIONS
MANAGEMENT
Antibiotics
Symptomatic Treatment
Specific Situations
Community Level Management
Prevention
Fluid Management in Secretory Diarrhea
Assessment of Dehydration
Other Factors to be Considered
Management Objectives
Treatment Plan A — Home Therapy
What Fluids to give in Plan A?
How much Fluid to give?
Feeding
Plan B
Oral Rehydration Solution
How much ORS is Needed?
How to give ORS?
Plan C – Intravenous Fluid Therapy
Other Types of ORS
10:
Inflammatory Bowel Disease—What is New?
INTRODUCTION
EPIDEMIOLOGY
ETIOLOGY AND PATHOGENESIS
Microbiology
Auto-immunity
Clinical Presentation
Endoscopic Differentiation
Histology
Extraintestinal Manifestations
Differential Diagnosis
Imaging Techniques
Medical Treatment
Aminosalicylates
Biological Therapy
Ulcerative Colitis—Medical Treatment
Crohn's Disease—Medical Management
Surgery in Inflammatory Bowel Disease Indications
IBD in Children
IBD and Pregnancy
Nutritional Management in IBD
Cancer Risk in IBD
11:
Intestinal Tuberculosis
INTRODUCTION
EPIDEMIOLOGY
PATHOGENESIS AND PATHOLOGY
CLINICAL FEATURES
DIAGNOSIS
RADIOLOGY
IMMUNODIAGNOSIS
BACTERIOLOGICAL DIAGNOSIS
COLONOSCOPY
DIFFERENTIAL DIAGNOSIS
TREATMENT OF INTESTINAL TUBERCULOSIS
Treatment in Special Situations
Steroids
Surgery
12:
Acute Appendicitis—Do's and Don'ts
INTRODUCTION
PATHOGENESIS
HISTORY AND PHYSICAL EXAMINATION
Common symptoms of appendicitis
Common Signs of Appendicitis
Differential Diagnosis
Laboratory and Radiologic Evaluation
Laboratory Tests
Radiologic Evaluation
Treatment
Special Considerations
13:
Irritable Bowel Syndrome—The Brain Speaks to the Gut
INTRODUCTION
PREVALENCE
SYMPTOMS AND SIGNS
Rome II Diagnostic Criteria for Irritable Bowel Syndrome
Diagnosis
Pathogenesis
Motility Disturbances
Visceral Hypersensitivity
Abnormalities in Brain-gut Regulation
Role of Immune or Inflammatory Mediators
Treatment
General Approach
PROGNOSIS
CONCLUSION
14:
The Gastrointestinal Tract and HIV
INTRODUCTION
Symptoms of Gastrointestinal Involvement
Evaluation of Diarrhea
Protozoal Diarrhea
Viral Diarrhea
Bacterial Diarrhea
Fungal Infections
Drug Induced Diarrhea
Evaluation of Odynophagia and Dysphagia
Evaluation of Abdominal Pain
Anorectal Diseases
Gastrointestinal Bleeding
Liver Involvement in HIV
15:
Anorectal Disorders
INTRODUCTION
SYMPTOMS OF ANORECTAL DISORDERS
Bleeding
Pruritus
Pain
Swelling or Lump
Discharge
HEMORRHOIDS
CLASSIFICATION
DIAGNOSIS
MANAGEMENT
Topical Preparations
TREATMENT DIRECTED AT HEMORRHOIDS
Injection Sclerotherapy
Cryotherapy
Infrared Coagulation
Rubber Band Ligation
Operative Treatment
Stapled Hemorrhoidectomy /Stapled Hemorrhoidopexy
FISSURE IN ANO
Etiology
Pain
Management
Surgical Therapy
Anorectal Abscess
Types of Abscesses
Perianal Abscess
Ischiorectal Abscess
Intersphincteric Abscess
Supralevator Abscess
ANAL FISTULA
Formation of a Fistula
Classification of Fistula
Identification of Fistula Tract
Magnetic Resonance Fistulogram
Surgical Treatment
Rectal Prolapse
Etiology
Clinical Features and Evaluation
Treatment
Complete Prolapse
16:
The Management of Lower Gastrointestinal Bleeding
INTRODUCTION
TERMINOLOGY
The Causes of Lower GI Bleeding in Adults
Common Causes of Acute Lower GI Bleeding in Children and Adolescents
Clinical Evaluation
Associated Findings
Physical Examination
INVESTIGATIONS
Lab Studies
Imaging Studies
Tagged Red Blood Cell Scintigraphy
Angiography
Other Tests
TREATMENT
Endotherapy
Angiographic Therapy
Surgical Therapy
SUMMARY
17:
Constipation
INTRODUCTION
Etiology and Pathophysiology
Constipation Predominant IBS
Slow Transit Constipation
Outlet Dysfunction Constipation
CLINICAL ASSESSMENT
History
Physical Examination
Investigations
Initial Screening Investigations
Additional Tests
MANAGEMENT
General Measures
The Use of Laxatives
Bulk Laxatives
Osmotic Laxatives
Stimulant Laxatives
Saline Laxatives
Other Pharmacological Agents used in Constipation
Behavioral Therapy
Surgery
18:
Functional Gastrointestinal Disorders—All in the Mind?
DEFINITION
CLASSIFICATION
Primary Functional GI Disorders
Functional Dyspepsia
Pathophysiology
DIAGNOSIS
TREATMENT
Functional Constipation
Functional Diarrhea
Functional Vomiting
Functional Abdominal Bloating
Functional Abdominal Pain Syndrome (FAPS)
Aerophagia
Globus
19:
Intestinal Gas Syndromes
INTRODUCTION
PHYSIOLOGY OF INTESTINAL GAS
VOLUME OF GASTROINTESTINAL GAS
COMPOSITION AND SOURCE OF GAS
Clinical Syndromes
CLINICAL ASSESSMENT
Systemic Diseases
INVESTIGATIONS
SPECIAL INVESTIGATIONS
Radiography
Radionuclide Scintigraphy
Real Time Ultrasound Imaging (dynamic study)
Manometry
Myoelectric Techniques
Hydrogen Breath Tests
Anorectal Manometry
Management
CONCLUSION
20:
How to Investigate a Patient with Jaundice?
DEFINITION
BILIRUBIN METABOLISM
HISTORY
PHYSICAL EXAMINATION
CAUSES OF JAUNDICE
INVESTIGATIONS
Urine Examination
Stool Examination
Liver Function Test
Viral Markers
Liver Biopsy
IMAGING STUDIES
Ultrasonography (USG)
CT Abdomen
Magnetic Resonance Cholangiopancreatography
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Percutaneous Transhepatic Cholangiography (PTC)
Differential Diagnosis of Jaundice
SUMMARY OF APPROACH TO A PATIENT WITH JAUNDICE
21:
Hepatitis A
INTRODUCTION
VIRUS STRUCTURE AND ASSEMBLING
STABILITY AND SURVIVAL
EPIDEMIOLOGY
ROUTES OF TRANSMISSION
BIOLOGY AND PATHOGENESIS
CLINICAL MANIFESTATIONS
LAB FEATURES
Determinant of the Severity of Acute Hepatitis A
Management
Prevention
PRE EXPOSURE PROPHYLAXIS
Active Immunization
Dose and Schedule of Hepatitis A vaccine (Havrix)
POSTEXPOSURE PROPHYLAXIS
The changing Epidemiology of Hepatitis A Infection in India and Relevance of Hepatitis A Vaccination
22:
Hepatitis E
INTRODUCTION
VIROLOGY
Epidemiology
CLINICAL FEATURES
HEPATITIS E AND PREGNANCY
Pathology
Diagnosis
Treatment
Prevention
CONCLUSION
23:
Hepatitis B and Hepatitis C: Magnitude of the Problem and Prevention
HEPATITIS B
Transmission
Prevention
Prevention in Special Settings
HEPATITIS B VACCINE
Types of Chronic HBV Infections
Management
Initial Evaluation of a Patient with Chronic Hepatitis B Virus Infection
HEPATITIS C
24:
Management of Cholestasis
INTRODUCTION
EXTRAHEPATIC CHOLESTASIS
INTRAHEPATIC CHOLESTASIS
Physiology of Bile Formation and Flow
Enterohepatic Circulation of Bile Salts
Pathology
Clinical Features of Cholestatic Syndrome
Primary Features
Secondary Complications
Investigations
Disorders of Intrahepatic Bile Ducts
Infiltrative and Metabolic Diseases of the Liver
Drug Induced Cholestasis
Cholestasis of Pregnancy
Cholestasis of Sepsis
Benign Recurrent Intrahepatic Cholestasis (BRIC)
Miscellaneous Conditions
Cholestasis in Infants and Children
Treatment of Pruritus of Cholestasis
Ursodeoxycholic Acid (UDCA)
Treatment of Secondary Consequences
25:
Cirrhosis Liver: Management and Prevention of Complications
INTRODUCTION
ETIOLOGY
PATHOLOGY
CLASSIFICATION
CLINICAL FEATURES
GENERAL EXAMINATION
ABDOMEN
Diagnosis
General Management of Cirrhosis
Complications
Ascites
Paracentesis-Practical Aspects
Ascitic Fluid Analysis
Ascitic Fluid Culture
SAAG (Serum Ascites Albumin Gradient)
SAAG Classification of Ascites
Pitfalls in SAAG estimation
General Dietary Principles
Diuretics
Side Effects of Diuretics
Refractory Ascites
Treatment Options
Complications of Ascites
Ascitic Fluid Infections
Spontaneous Bacterial Peritonitis (SBP)
Portal Hypertension Associated GI Bleed
Hepatic Encephalopathy
Hepatorenal Syndrome
Hepatocellular Carcinoma (HCC)
26:
Alcohol and the Liver
INTRODUCTION
PREVALENCE OF ALCOHOLIC LIVER DISEASE
MECHANISM OF LIVER DAMAGE
Fatty Liver
Alcoholic Hepatitis
Alcoholic Cirrhosis
PATHOLOGY
CLINICAL FEATURES
INVESTIGATIONS
TREATMENT
CONCLUSION
27:
Non-Alcoholic Steatohepatitis
INTRODUCTION
DEFINITION
EPIDEMIOLOGY
Secondary Causes for Fatty Liver
CLINICAL MANIFESTATIONS
LABORATORY ABNORMALITIES
IMAGING STUDIES
HISTOLOGICAL FINDINGS
Staging of Fibrosis
PATHOGENESIS
DIAGNOSIS
ROLE OF LIVER BIOPSY
NATURAL HISTORY AND RISK OF PROGRESSION TO CIRRHOSIS
MANAGEMENT
General Recommendations
Drug Therapy
SUMMARY
28:
Management of Ascites
INTRODUCTION
PATHOGENESIS OF ASCITES
EVALUATION OF ASCITES
PARACENTESIS
ASCITIC FLUID CELL COUNT
ALBUMIN CONCENTRATION AND SAAG
ASCITIC FLUID TOTAL PROTEIN
CULTURE IN BLOOD CULTURE BOTTLES
OPTIONAL TESTS
LAPAROSCOPY
MIXED ASCITES
Treatment of Ascites
Treatment of High SAAG Ascites
Large Volume Paracentesis (LVP)
Refractory Ascites
Ascitic Fluid Infection
Peritoneal Carcinomatosis
29:
Hepatic Encephalopathy—Testing Clinical Talents
INTRODUCTION
CLASSIFICATION
PATHOPHYSIOLOGY
Diagnosis
TREATMENT
General Care
Medical Treatment
Reduction of Production and Absorption of Ammonia
To Effect Changes in Conversion of Ammonia in Tissues
Neurotransmitter Mediated Mechanisms
GABA -Benzodiazepine Receptor Mediated Mechanisms and Manganese
Liver Support Systems
TRANSPLANTATION
30:
Liver Transplantation: What a Physician needs to Know
INTRODUCTION
Indications for Referral of Patients for Liver Transplantation
Acute Liver Failure
King's College Hospital Criteria for Transplantation in Acute Liver Failure
Chronic Liver Failure
DISEASE SPECIFIC RECOMMENDATIONS
Hepatitis B Virus (HBV) Liver Disease
Hepatitis C Liver Disease
Hepatic tumors
Hepatocellular Carcinoma
Metastatic Disease
Alcohol Related Liver Disease (ALD)
Primary Biliary Cirrhosis (PBC) and Primary Sclerosing Cholangitis (PSC)
NON-DISEASE SPECIFIC CRITERIA
SURGICAL CONSIDERATIONS
Operative Complications
MEDICAL CONSIDERATIONS
Rejection
Infection
Non-infectious Complications of Immune-suppression
SUMMARY
31:
Investigation and Management of Gallstone Disease
INTRODUCTION
ACUTE CHOLECYSTITIS
Treatment of Acute Cholecystitis
Immediate Versus Delayed Cholecystectomy
Laparoscopic versus Open Cholecystectomy
Medical Management in Acute Cholecystitis
BILIARY COLIC AND CHRONIC CHOLECYSTITIS
Asymptomatic Gallstones—Should they be Treated?
Medical Therapy for Gallstones
Contact Dissolution
Is Lithotripsy an Option?
Laparoscopic versus Open Cholecystectomy
Complicated Gallstone Disease and Choledocholithiasis
Management of Patients with CBD Stones
Preoperatively Detected Stone
Intraoperatively Detected CBD Stones
Postoperatively Detected CBD Stones
32:
How do we Manage Acute Pancreatitis?
INTRODUCTION
Acute pancreatitis
Severe acute pancreatitis
Mild acute pancreatitis
Acute fluid collections
Pancreatic necrosis and infected necrosis
Acute pseudocyst
Pancreatic abscess
Etiology of acute pancreatitis
DIAGNOSIS
Symptoms
Signs
LABORATORY TESTS
Markers of Pancreatic Injury
Serum Amylase and Lipase
Other Enzymes
Inflammatory Markers
Markers of Biliary Tract Involvement
Severity Assessment
Laboratory Tests
Clinical and Physiologic Assessment Criteria
Computed Tomography
Grade of Acute Pancreatitis
Degree of Necrosis
Management of Mild Pancreatitis
General Management
Antibiotics
Specific Treatment
CT Scanning
MANAGEMENT OF SEVERE PANCREATITIS
General Management
Antibiotics
Nutrition
Pharmacologic Therapy
Role of ERCP in Pancreatitis
Complications
Immediate Complications
Late Complications
Surgery in Acute Pancreatitis
Necrotising Pancreatitis
Pancreatic Abscess
Acute Fluid Collection and Pseudocyst
33:
Experience with Chronic Pancreatitis
INTRODUCTION
Definition
ETIOLOGY
PATHOGENESIS
INVESTIGATIONS
DIAGNOSIS
Complications of Chronic Pancreatitis
Treatment
Relief of Pain
Pancreatic Enzyme Supplements
Diabetes Mellitus
Endotherapy
Surgery
NATURAL HISTORY
34:
Common Gastrointestinal Malignancies
CARCINOMA ESOPHAGUS
Epidemiology
Etiology
Clinical Presentation
Diagnosis
Treatment
Surgery
Radiotherapy
Chemotherapy
Neo-adjuvant Chemotherapy
Concurrent Chemo Radiation
Endoscopic Palliation
CARCINOMA STOMACH
Epidemiology
Etiology
Symptoms
Diagnosis
Treatment
Surgery
Radiotherapy
Chemotherapy
CANCER OF THE PANCREAS
Etiology
Diagnosis
Investigations
Imaging
Pathology
Treatment
Surgery
Radiotherapy
Adjuvant Therapy
Locally Advanced and Metastatic Disease
CANCER OF THE HEPATOBILIARY SYSTEM
Epidemiology
Etiology
Pathology
Diagnosis
Investigations
Treatment
Surgery
Radiotherapy
Chemotherapy
BILE DUCT CANCERS (CHOLANGIOCARCINOMA)
Diagnosis
Investigations
Treatment
GALLBLADDER CARCINOMA
Signs and Symptoms
Investigations
Treatment
Surgery
Radiotherapy
Chemotherapy
CANCER OF THE DUODENUM AND SMALL INTESTINE
Pathology
Diagnosis
Investigations
Contrast GI Studies
Endoscopy
CT Scan
Treatment
Surgery
Radiotherapy
Chemotherapy
COLORECTAL CANCER
Epidemiology
Etiology
Predisposing Factors
Pathology
Symptoms
Investigations
Treatment
Surgery
Radiotherapy
Chemotherapy
CANCER OF THE RECTUM
Epidemiology
Diagnosis
Investigations
Pathology
Treatment
Surgery
Radiotherapy
Chemotherapy
35:
Acute Abdomen: A Challenge to the Surgeon and Physician
INTRODUCTION
WHO SHOULD TREAT AN ACUTE ABDOMEN?
HOW EMERGENT IS THE CONDITION?
WHAT ABOUT THE USE OF NARCOTIC ANALGESICS IN THE INITIAL STAGES OF MANAGEMENT OF AN ACUTE ABDOMEN?
IS THERE A GREATER DEPENDENCE ON IMAGING DATA TODAY AS COMPARED TO YESTER YEARS?
WHAT IS THE BEST CLINICAL APPROACH?
HOW SHOULD THE HISTORY BE TAKEN?
WHAT ARE THE KEY POINTS IN CLINICAL EXAMINATION?
LABORATORY TESTS AND OTHER INVESTIGATIONS
DECISION MAKING
THE TEAM CONCEPT
THE FUTURE
36:
Getting Rid of Intestinal Parasites
INTRODUCTION
PROTOZOAN PARASITES
Giardia Lamblia
Entamoeba Histolytica
Cyclospora Cayetanensis
Diagnosis
Treatment
Prevention
Intestinal Helminth Infections
Intestinal Roundworms (nematodes)
Transmission
Common Roundworm: Ascaris lumbricoides
Hookworm (Old world): Ancylostoma duodenale, (New world): Necator americanus
Strongyloides: Strongyloides stercoralis
Whipworm: Trichuris trichiura
Pinworm: Enterobius vermicularis
Trichinosis: Trichinella
Diagnosis
Treatment
Prevention
Cestodes (tapeworms)
Transmission
Symptoms
Diagnosis
Treatment
Prevention
Trematodes (flukes)
Transmission
Symptoms
Diagnosis
Prevention
37:
Nutrition in Gastrointestinal Diseases
INTRODUCTION
ANATOMY AND PHYSIOLOGY OF DIGESTION AND ABSORPTION
ASSESSMENT OF NUTRITIONAL STATUS
Nutritional Requirements
Balanced Diet
Nutritional Diseases
Food-borne Illness
Nutrition in Gastrointestinal and Liver Diseases
Chronic Liver Disease
Pancreatitis
Inflammatory Bowel Disease (IBD)
Post Gastrectomy State
Celiac Disease
Parenteral and Enteral Nutrition
Elemental Diets and Immunonutrition
CONCLUSION
38:
Genetics in Gastroenterology and Hepatology
INTRODUCTION
CHOLESTATIC LIVER DISEASES
Progressive Familial Intrahepatic Cholestasis (PFIC 1)
Dubin-Johnson Syndrome
Wilson's Disease
Hemochromatosis
Colorectal Cancer
Familial Polyposis of the Colon (FPC)
Peutz-Jeghers Syndrome
Inflammatory Bowel Disease (IBD)
Crohn's Disease
PANCREATITIS
Hereditary Pancreatitis
Chronic Pancreatitis
CONCLUSIONS
39:
Newer Drugs in Gastroenterology and Hepatology
NEWER ANTIVIRAL AGENTS
Adefovir Dipivoxil
Other Newer Antiviral Agents
Combination therapy
Pegylated Interferon
Terlipressin in Hepatorenal Syndrome
Urso-deoxy Cholic Acid (UDCA)
Mechanisms of Action of UDCA
Silymarin in Liver Diseases
BIOLOGICAL THERAPY OF INFLAMMATORY DISEASE
Anti-tumor Necrosis Factor Antibody
Balsalazide
Itopride
Probiotics in Clinical Medicine
Racecadotril
Tegaserod
40:
Conventional Imaging in Gastroenterology
INTRODUCTION
Adverse Effects
Pediatric Imaging
Hepatobiliary System
41:
Imaging in Gastroenterology: Newer Modalities
ULTRASONOGRAPHY
ULTRASONOGRAPHY OF LIVER AND BILIARY SYSTEM
COLOR DOPPLER
COMPUTED TOMOGRAPHY (CT)
SPIRAL CT OF LIVER
CT ARTERIOPORTOGRAPHY (CTAP)
ULTRASONOGRAPHY AND CT OF PANCREAS
SPIRAL CT FOR BOWEL PATHOLOGY
ABDOMEN SCAN-CT OR ULTRASOUND
MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY (MRCP)
COMMON INDICATIONS FOR MRCP
MRCP VERSUS ERCP
MRI OF LIVER
PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY (PTC)
PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE (PTBD)
MOST COMMON INDICATIONS FOR PTBD
ANGIOGRAPHY
ANGIOGRAPHY OF OCCULT GI BLEED
EMOBOLIZATION OF LIVER TUMOR
42:
Gastrointestinal Endoscopy: The Basics
INTRODUCTION
PREPARATION AND SAFETY
SEDATION
CLEANING AND DISINFECTION OF ENDOSCOPES AND ACCESSORIES
UPPER ENDOSCOPY
COMMON INDICATIONS
ENDOTHERAPY OF ESOPHAGEAL VARICES
STRICTURE DILATATION
NON-VARICEAL BLEED
COLONOSCOPY
COMMON INDICATIONS
PREPARATION
COLONOSCOPIC POLYPECTOMY
Complications
ERCP
Preparation
THERAPEUTIC BILIARY PROCEDURES
Sphincterotomy
CBD Stone Removal
Stricture Dilatation
Endoscopic Placement of Prosthesis
Therapeutic Pancreatic Procedures
Complications
43:
Advances in Gastrointestinal Endoscopy
INTRODUCTION
ADVANCES IN ESOPHAGOGASTRODUODENOSCOPY
Sedation-less Endoscopy
Endoscopic Control of Non-variceal Bleeding
Endoscopic Control of Variceal Bleeding
Botulinum Toxin Injection for the Treatment of Achalasia
Endoscopic Mucosal Resection
Improved Imaging of Mucosa
ADVANCES IN TISSUE ABLATION
Argon Plasma Coagulation
Photodynamic Therapy
Barrett's Esophagus (BE)
Screening Recommendations
Selective Ablation of Barrett's Esophagus
Endoscopic Treatment of Gastroesophageal Reflux Disease (GERD)
Palliation of Malignant Obstruction
Endoscopy of the Small Intestine
Colonoscopy and Sigmoidoscopy
Screening Colonoscopy—Time to take a Deeper look
Pancreaticobiliary Endoscopy
Predictors of ERCP-related Complications
Endoscopic Necrosectomy
Endoscopic Ampullectomy
Advances in Endoscopic Ultrasonography (EUS)
The Evolving role of EUS in Esophageal Cancer
Evaluation of Suspected Choledocholithiasis
EUS for the Diagnosis of Suspected Chronic Pancreatitis
EUS-guided Celiac Neurolysis
SUMMARY
44:
Radionuclides in Gastroenterology
INTRODUCTION
Nuclear Gastrointestinal Procedures
Nuclear Hepatobiliary and Liver Reticuloendothelial System Imaging
Esophageal Motility Studies
Gastroesophageal (GE) Reflux Scintigraphy (Milk scan)
Gastric Emptying Studies
Meckel's diverticulum Imaging (for Ectopic Gastric Mucosa)
GI Bleed Scintigraphy
Small and Large Intestinal Motility Studies
Breath Test for Gastric H. pylori Infection
Schilling Test
Liver/Spleen Imaging
Hepatobiliary Scintigraphy
Acute Cholecystitis
Chronic Cholecystitis
Gallbladder Dyskinesia
Neonatal Hyperbilirubinemia
Oncological Applications
45:
The Gastroenterologist and the Internet
INTRODUCTION
Problems with Medical Information on the Internet
Internet Sites for the Gastroenterologist
MEDICAL RESOURCE SITES
ORGANIZATIONS AND SOCIETIES
Other Important Sites
e-journals and e-books
Imaging Sites
Medical Search Engines
Tips for Effective Search
Internet and Telemedicine
CONCLUSION
46:
Normal Values in Gastroenterology
INTRODUCTION
Liver Function Studies
Pancreatic Function Studies
Tumor Markers
Iron Studies
Absorption Studies
Gastric Function Studies
Other Normal Values
INDEX
TOC
Index
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