By Ian Beckingham
Queen's clinical Centre, Nottingham, united kingdom. presents an summary of the illnesses of the liver, pancreas, and gall bladder. For citizens, clinical scholars, and common practitioners. Covers universal and infrequent stipulations and contains algorithms for prognosis and therapy. colour illustrations. Softcover.
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Band ligation eradicates oesophageal varices with fewer treatment sessions and complications than sclerotherapy. Balloon tube tamponade The balloon tube tamponade may be life saving in patients with active variceal bleeding if emergency sclerotherapy or banding is unavailable or not technically possible because visibility is obscured. In patients with active bleeding, an endotracheal tube should be inserted to protect the airway before attempting to place the oesophageal balloon tube. The Minnesota balloon tube has four lumens, one for gastric aspiration, two to inflate the gastric and oesophageal balloons, and one above the oesophageal balloon for suction of secretions to prevent aspiration.
Current surgical therapy. 6th ed. Baltimore, MA: Mosby, 1998:326-30 The picture of the trophozoite was supplied by David Mirecman, University of Utah. 8 Operative specimen of opened hydatid cyst showing multiple daughter cysts Summary points x Most patients with pyogenic abscesses will require percutaneous drainage and antibiotics x A cause can be identified in 85% of cases of liver abscess, most commonly gall stones, diverticulitis, or appendicitis x Amoebic abscesses can be treated by metronidazole alone in 95% of cases x Hydatid disease occurs throughout the world in sheep farming areas x Symptomatic hydatid cysts should be surgically removed 10 Acute pancreatitis I J Beckingham, P C Bornman Acute pancreatitis is relatively common, with an annual incidence of 10-20/million population.
Gall stones should be suspected in patients over 50 years of age (especially women), those who do not drink alcohol, and when the attack begins after a large meal. In patients with an alcohol history and proved gall stones it can be difficult to distinguish between the two causes. A serum alanine transaminase activity greater than three times above normal usually indicates that gall stones are the cause. Patients usually have pain in the epigastrium that typically radiates through to the back. It is often associated with nausea and vomiting.