International Congress for Infectious Diseases, Rio de Janeiro - April 17-21, 1988. F.-A. Waldvogel, President

Fibrin plays a central role in wound healing. It has a hemostatic effect by forming a temporary wound closure and assists in neovascularization and fibroblast prolifera- tion. It therefore makes the repair of injured or severed parts of the human body by simple glueing possible, a notion that men have dreamed of since ancient times. The first modern attempts in this direction, using clotting substances derived from human blood to achieve hemostasis, were reported by Bergel (in 1909), Grey (in 1915), and Harvey (in 1916), who used fibrin powder or fibrin patches to control bleeding from parenchymatous organs. Two decades later Young and Medawar (1940) and Cronkite (1944) used blood plasma or fibrin solutions, adding thrombin to seal nerve anastomoses and to fix skin grafts in humans. Due to the poor adhesive strength of the fibrinogen the results were unsatisfactory. In 1972 a new era in fibrin sealing was initiated by Matras. By using highly concentrated fibrinogen in combination with factor XIII (fibrin-stabilizing factor) and by delaying fibrinolysis with a fibrinolysis inhibitor (aprotinin), a method was developed which after satisfactory results in animals, soon began to be applied in humans.

In OCtober 1986, recognized authorities from a variety of disciplines met in Lisbon, Portugal, to review recent knowledge on eicosanoids - i. e., prostaglandins, throm boxane A , and leukotrienes - and their role in gastrointestinal diseases. 2 Briefly, in the stomach endogenous as well as exogenous prostaglandins may mediate cytoprotective actions in that they stimulate gastric mucus production, bicar bonate secretion and cellular regeneration while providing adequate mucosal blood flow. In contrast, thromboxane A2 by vasoconstriction may act as an ulcerogenic substance. Diarrheal states may be associated with prostaglandins of types E and F as they are capable to enhance intestinal water and electrolyte secretions. In chronic in flammatory bowel disease, mucosal synthesis of leukotrienes was found to be increased more markedly than that of prostaglandins suggesting that leukotrienes may have a major part in the pathogenesis of that disease. In this volume, which is an elaborated collection of the papers given on occasion of the above-mentioned symposium, the facts and problems associated with prostanoid substances are dealt with in four sections on 1. biochemistry, biology and pharmacology of eicosanoids, 2. physiologic and pathophysiologic aspects, 3. established therapeutic implications, and 4. treatment perspectives. We believe that the publication of these contributions by leading workers in the given fields provides a comprehensive and up-to-date appraisal of the role of eicosanoids in gastrointestinal diseases, and it is hoped that this volume will be of value to both basic scientists and practicing clinicians.

This book, the seventh in the series Exercises in Radiological Diagnosis, deals with sonography, an imaging procedure in which the ability of the radiologist plays an exceptionally important role. The author, Catherine Roy, has very extensive experience in the clinical use of sonography. She has selected the images, which are of excellent quality, with great care to illustrate a wide range of conditions and has supplemented them by commentaries and discussions which are easy to comprehend. The systematic use of schematic drawings to interpret the images makes it possible for the reader to follow the author's approach without any difficulty. Schematic drawings are par ticularly important in sonography because the relationship be tween the details in the images and the anatomy may be very weak. Images, schematic drawings, and text (both commentaries and interpretations) are three didactic elements which Cathe rine Roy has skill-fully combined in these exercises into an excellent whole. A. WACKENHEIM v Contents Introduction . . . . . . . . . . . . . . . . . . 1 Iconography, Commentary with Corresponding Schemata. . 2 Subject Index 203 VII Introduction Ultrasound imaging of the abdomen has now become a routine investi gation. It has brought about changes in the procedure of additional investigations and even rendered part of conventional radiology redun dant, particularly that concerning the bile ducts. These exercises are meant for students or physicians who already have basic knowledge of ultrasound diagnosis. It has not been possible to cover the entire spectrum of abdominal pathology, especially trauma, with 114 cases.

Die Endoskopie vermochte bisher Gewebsformationen zu dehnen, zu durchtrennen, abzutragen und zu zerstoren. Gewebedefekte auszufullen, miteinander zu vereinigen und zu heilen, war bislang endoskopisch nicht moglich. Die Einfuhrung von Fibrinklebern eroffnete neue Anwendungsbereiche. Der Kleber kann, in seine Komponenten getrennt, uber doppellumige Sonden uber beliebig weite Strecken an den vorgesehenen Einsatzort unter Sicht des Endoskopes transportiert werden. Die Klebung von Fisteln, Rupturen oder Leckagen an Bronchusstumpfen, im Lungenparenchym oder an gastrointestinalen Anastomosen kann heute komplizierte Heilungsverlaufe und riskante operative Re-Interventionen ersetzen. Die spezielle Technik der endoskopischen Fistelklebung wird in diesem Buch erstmals zusammenfassend und interdisziplinar erortert. Daneben werden neue Moglichkeiten zur Stillung gastrointestinaler Blutungen mit Fibrin durch intramurale Injektion oder oberflachlichem Spray besprochen. Grundlegende Untersuchungen zeigen, dass im Vergleich zu anderen Substanzen, die Fibrinapplikation in das Gewebe zu deutlich geringerer Traumatisation und zu geringeren entzundlichen Reaktionen bei gleichem Hamostaseeffekt fuhrt. Ziel des vorliegenden Buches ist, verstreute Einzelbeobachtung zu sammeln, zu ordnen und zu vergleichen, um dem interessierten Leser die neue Technologie der Verklebung von Defekten und der Hamostase mit biologischen Substanzen zu vermitteln.

Das Spektrum der in den westlichen Industrienationen filhren- den Krankheiten und der darauf basierenden Thdesursachen hat sich in den letzten J ahrzehnten gewandelt. Wahrend frliher die Infektionskrankheiten und speziell die Thberkulose den hochsten Todeszoll forderten, sind in den Jahrzehnten nach dem zweiten Weltkrieg mit steigendem Wohlstand die Herz- und GefaBkrankheiten an die erste Stelle gerlickt. Trotz gewis- ser Erfolge in der Pravention in einigen Uindern wie z. B. in den USA, Kanada, Australien; aber auch in einigen Gebieten West- europas, in denen die Zahl der tOdlichen Hirnschlage und Herzinfarkte inzwischen wieder rlicklaufig ist, wird die Spit- zenposition in der Todesursachenstatistik hier auch weiterhin von diesen Krankheiten eingenommen. In anderen Uindern wie z. B. in Osteuropanehmen die Erkrankungsraten weiter zu. Wenn man sich fragt, was getan werden kann, urn weitere Er- fqlge auf diesem Gebiet zu erzielen, dann ist ein Blick in die Lander des Fernen Ostens hilfreich. In der Volksrepublik Chi- na undin J apanliegt die Sterblichkeit an koronarer Herzkrank- heit bzw. an Herzinfarkten flinf- bis zehnmal niedriger als in der Bundesrepublik Deutschland. Arteriosklerotische Durch- blutungsstorungen der unteren Extremitaten, auch diabeti- sche GefaBerkrankungen kommen dort kaum vor. Vergleicht man die Lebensweise der Bevolkerung in diesen Uindern mit den Verhaltnissen in den westlichen Industriena- tionen, so fallenerhebliche Unterschiedeinder Ernahrungauf. Wahrend in China Fleisch und Molkereiprodukte in deutlich geringeren Mengen als bei uns verzehrt werden, besteht der Hauptanteil der Ernahrung aus einer an pflanzlichem EiweiB und Schlackenstoffen reichen Kost.

Operative ultrasound, which permits direct We have divided the material into three placement of the probe on the organ to be principal sections: hepatic surgery, biliary studied during surgery, has been in existence surgery, and the surgery of portal hyperten for over 20 years. Early experiences with its sion. Our experience with operative ultra use in urologic [15] and biliary surgery [7, 8, sound in pancreatic disease is not adequate 9] were limited by technical difficulties but for discussion in this manual, although many the evolution of B-mode, real-time ultra useful applications have been suggested. sound has made possible the broad applica Each chapter includes an anatomical review tion of ultrasound in the operating room. and a presentation of the basic sonographic The goal of operative ultrasound is to signs to clarify the diagnosis and therapy of provide the surgeon with information about a pathologic conditions. Emphasis has been solid organ which is not obvious from its ex placed on the practical applications of opera ternal morphology. What is the nature of the tive ultrasound. lesion? What is its precise localization within With most of the ultrasound images (all the organ? What vascular and anatomical are presented on a black background) two constraints limit its surgical treatment? Mod schematic diagrams are shown: ern ultrasound technology, which produces The first indicates the position of the probe an image faithful to the true anatomy, per on anterior and lateral projections.

Cell surface receptors are multifunctional proteins with binding sites towards the external environment and effector sites which mediate intracellular events. The purpose of this symposium was to bring together investigators who have a com mon interest in those receptors which are located in the liver, and who have studied endocytic mechanisms for various macromolecules like insulin, lipoproteins, epi dermal growth factor and others. Experiments in this particular field of research date back to the early 60-ies but have only recently led to new and important in sight in the molecular basis of receptor mediated uptake in the liver. The structural features which control these mechanisms are currently under intense investigation in many laboratories. Though this symposium largely emphasizes lipoprotein up take and catabolism by the liver, it was the particular intention of the organizers to discuss methodology and results with investigators who are also interested in he patic uptake of macromolecules. This might then eventually lead to new and com mon concepts for both receptor-ligand interaction and internalization processes in the liver. Biochemists, pathologists and gastroenterologists met for two and a half days and discussed their latest data in this so rapidly developing field of basic rese arch. This conference is part of a series on current topics in gastroenterology and hepatology arranged regularly by the Departments of Medicine and Surgery at the University Hospital Eppendorf. If is our hope, that such exchange of information between the different disciplines in medicine will continue. i. k."

In this age of specialization most patients with diseases of the hind gut and anus are still managed by general physicians or surgeons. The speciality of coloproctology has grown from the art of 'anology', a study of conditions limited to that distance from the anal verge that could be inspected easily by torch- or candlelight or with the aid of a simple speculum. Two centuries ago many proctological ills were often treated by itinerant quacks, partly because the physician considered himself rather too grand to meddle around the anus and the medical profession in general tended to look down on those who studied anal disease. Today, in certain countries, coloproctology has become a speciality every bit as exclusive as urology or orthopaedic surgery, with its own training programme and examinations, usually undertaken after the end of general surgical training. Such super-specialization has undeniable advantages with rapidly advancing technology and therapeutic possibilities. There is no doubt that for the patient suffering from a low rectal carcinoma or severe inflammatory bowel disease there are advantages in being treated by surgeons who are dealing with several cases in a year rather than by a general surgeon who sees such problems relatively rarely. Such specialized colorectal surgery units makes good sense medically and economically in large centres of population with good communications.

The Anglo-Swiss Colo-Proctology Meeting, held at Lausanne in May 1983, enabled numerous specialists to share their experiences of lower gastrointestinal tract pathology. The focus was on ischae mic disease and tumours of the colon, rectum and anus. By featuring ischaemic disease in our programme we hoped to give this too often underestimated process a fair hearing. Ischaemic lesions are far more common than is recognised on clinical grounds alone, particularly in the gastrointestinal tract. Large intestine is chaemia is often confused with other syndromes, especially since the clinical features evoked are, in most cases, atypical. Thus diag nosis is frequently late, with dramatic consequences. The oncology section basically discusses the early diagnosis of gastrointestinal tumours, a prerequisite for improving survival in af fected patients, and also presentation and treatment of certain rare tumours. The third section of this volume covers various diverse subjects including surgical technique, functional disorders of the large intes tine, inflammatory bowel disease, haemorrhoids and investigatory procedures. Several of the articles come from international authorities in their field. Some communications contain unpublished results, and others may lead to new diagnostic and therapeutic methods. We feel that the quality and variety of the texts from the Anglo-Swiss Colo Proctology Meeting merit wide appreciation. We are grateful to Springer-Verlag for accepting these proceed ings for publication."

"Gastrointestinal Disease" is the first monograph in a new series on management and treatment in major clinical subspecialties and patient groups. Further volumes will be published over the next few years. Each book is complete in its own right. The whole series, however, has been prepared to fill a gap, perceived by the publisher, myself and the volume authors, between standard textbooks of medicine and therapeutics and research reviews, symposia and original articles in specialist fields. Each volume aims to provide a concise, up to date account of treatment in its subject area with particular reference to drug therapy. Traditional clinical and therapeutic approaches have been presented in the context of developments in clinical pharmacology. Wherever possible, authorship has been under taken by practising clinicians who themselves have training and experience in clinical pharmacology. The volumes are intended to be guides to treatment, to assist in the choice of drug and other treatment and to provide easy references to drug interactions and adverse reactions. It is expected that these monographs will be particularly useful for the young hospital doctor in training for higher qualifications. However, they should also be valuable to or senior medical students and to those in established hospital general practice who are seeking to update their knowledge and to view recent developments in other fields in a balanced context. The aims of the series should be upheld by this volume on "Gastrointestinal Disease.""

This book of diagnostic exercises cannot be used to good advantage without a good grasp of elementary sonoanatomy and the most common pathologic l images . We have tried to follow a pedagogical progression from the simple to the complicated for each group of clinical situations. We recommend that the sonograms at the beginning of each case study be thoroughly analysed before proceeding to the commentaries which explain the grounds for the final diagnosis. These explanatory remarks are accompanied by the same sonograms, but with arrows and letters added so as to pinpoint the details referred to as the diagnosis progresses. In reading the commentaries it will therefore be a good idea to cover over the figures in which the details are picked out for you, uncovering them one by one as required. 1 Which the reader may obtain from our previous books: Ed., 1982) Ultrasonography of Digestive Diseases (Mosby Publ., 2nd Renal Sonography (Springer Verlag, 1981) 1 Chapter 1 In Which the Reader is Invited to Clean His Glasses 1.1. Mrs. Beech, 75 years, has the complexion of a young girl, but she is losing weight and complains of epigastric pain. She has undergone a whole series of conventional radiological procedures; this may be good news for the film manufacturers, but it has not aided in the diagnosis. Finally, she is referred for an ultrasound examination. Look first at ultrasonic cuts 1.1a, b (transverse), then LId (sagittal).

Howard C. Thomas In normal subjects the regulatory apparatus of the immune system permits responses to foreign antigens but suppresses those directed to "self' components. Autoimmune disease occurs as a failure ofthis system either as a result of a primary defect in the regulatory apparatus (primary autoimmunization) or because of a change in the antigenicity of the tissues (secondary autoimmunization). Autoaggressive reactions are characterised by the presence of autoantibodies. When these are directed to membrane displayed antigens (Fig. 1) they are probably of importance in the lysis of hepatocytes. Those directed to cytoplasmic antigens may be useful diagnostically but are of unknown pathogenic significance. When no extrinsic aetiological factor can be identified, the process is assumed to be the result of a failure ofthe regulatory system, allowing the spontaneous expansion of a clone of autoreactive lymphocytes. The defect may be generalised or specific to certain groups of self-antigens and thus the autoimmune disease may be either multi- or unisystemic. The recent development of techniques to enumerate and measure the functional activity of the suppressor lymphocytes which control the effector limbs of the immune system has enabled investigators to test whether the various purported autoimmune diseases do have as their basis a generalised defect in immunoregu lation. Assessment of antigen-specific immunoregulatory function is, however, not yet readily available. liver Membrane I Antigen (LIM) I Liver I HLA, A, B, C, Sensitisation to Specific -;::!IIIL. .

Dieses Buch ist nach der "Ulcus-Therapie" und den "Postoperativen Syndromen" der dritte Folgeband der Reihe "Interdisziplinare Gastro- enterologie". Die Reflux-Therapie erschien uns als interdisziplinares Thema besonders geeignet. Mehr noch als bei der Ulcus-Therapie ist die Grenzlinie zwischen konservativer und operativer Therapie verwaschen. Wahrend bei der Ulcuskrankheit zumindestens gewisse Vorstellungen uber die Definition des Krankheitsbildes und die Haufigkeit der Er- krankungen bestehen, besteht hieruber - auch heute noch - bei der Refluxkrankheit Unklarheit. Viele Arzte arbeiten nicht mit dem Begriff "Refluxkrankheit" , sondern sehen des Problem einzig im Zusammenhang mit der Hiatushernie. Andere fuhren Refluxbeschwerden automatisch auf eine "Gastritis" zuruck. Dementsprechend herrschen auch uber die therapeutischen Moglichkeiten Unklarheiten. Wahrend die einen auto- matisch beim Vorliegen einer Hiatushernie eine chirurgische Therapie anstreben, beginnen die anderen beim Vorliegen von "Hyperaziditats- beschwerden" nicht einmal mit einer Diagnostik, sondern begnugen sich mit halbherzigen palliativen Massnahmen. Es schien uns deshalb angezeigt, eine Gruppe von Sachkennern dieser Materie zusammenzurufen, eine Bestandsaufnahme vorzunehmen und therapeutische Richtlinien zu erarbeiten. Solche Bemuhungen sind bedeutungsvoll, da die Refluxkrankheit bei ahnlicher Symptomatologie im einen Fall eine harmlose, fast zu vernachlassigende Storung dar- stellt, im anderen Fall aber zu einer bedrohlichen Erkrankung fort- schreiten und im schlimmsten Fall sogar der Schrittmacher eines malignen Tumors sein kann.

The acute abdomen often perplexes the expert as well as the young physician. There are few areas in medicine in which Hippocrates' aphorism-the art is long, life is short, decision difficult, and delay perilous-is more applicable than here. Too often the harried physician fails to listen to the patient who is trying desperately to suggest the diagnosis. The significance of various types and location of pain often are neglected by the doctor. Physical findings are influenced by experience; the presence or absence of tenderness or a mass may be answered in entirely different ways by various observers. Because solid facts frequently are lacking, attempts to resolve diagnostic dilemmas by computer analysis or by algorithms are not likely to be successful. Fortunately, in the great majority of cases, unusual and difficult diagnostic procedures are not necessary for the identification of the acute abdomen and of the major disease. Astute clinical judgment must be based primarily upon careful attention to the pa tient's words and detailed observation."

Gastroenterologic endoscopy has made important progress in the past decade. New techniques and ideas have given it new life. The end of this evolution is not yet in sight. FuIly flexible fiberoptic instruments have eliminated all blank areas from the map of the gastrointestinal tract. Retro- grade visualization of the pancreatic and biliary system has been achieved in conjunction with radiologic methods. Operative endoscopy has de- veloped beyond the removal of foreign bodies, to a stage where laparotomy can be avoided in a number of situations. Hemostasis by laser coagulation and crushing of concrements by ultrasound and electric energy have reached the threshold of clinical applicability. With all these spectacular develop- ments, however, it is important to maintain a firm grasp of the fundamentals of endoscopy. This is the basis of day-to-day success and includes knowl- edge of the proper indications, the ability to manage complications, famil- iarity with the technical properties of the instruments, their skillful handling, and experience in organizing an endoscopy section. Endoscopists, particu- larly members of the Erlangen group, have undertaken the task of charting these fundamentals and of compiling them into a working manual for those already practicing endoscopy or intending to do so. They have been sup- ported in this effort by colleagues from other parts of the Federal Republic of Germany and from Italy.

A practical, portable handbook, newly updated with nearly 100 color images and figures, The Little GI Book: An Easily Digestible Guide to Understanding Gastroenterology, Second Edition is an invaluable resource for anyone new to the world of gastroenterology and hepatology. Featuring new information on the latest advancements in gastroenterology and hepatology and written in a friendly, conversational style, The Little GI Book will help readers learn the core concepts of digestive health and disease and absorb important information without a hiccup. Author Dr. Douglas G. Adler provides a comprehensive, soup-to-nuts guide to gastrointestinal anatomy, physiology, disease states, and treatment. With new color images throughout, The Little GI Book guides the reader through the entire gastrointestinal tract, starting at the top with the esophagus, ending at the bottom with the colon and rectum, and covering everything in between: the stomach, small intestine, liver, pancreas, bile ducts, and gallbladder. The Little GI Book is an indispensable pocket guide for residents, students, nurse practitioners, office staff, industry sales force, and anyone who works in the GI industry but isn't a gastroenterologist.

This fully revised and updated third edition of the Oxford Handbook of Gastroenterology and Hepatology provides up-to-date, pragmatic advice on the management of common conditions and emergencies. An essential resource for all those involved in the care of patients with gastroenterological and hepatological disease, both for specialists and trainees in gastroenterology and hepatology, and also clinicians from other specialties. The handbook includes a problems-based approach, a unique A to Z compendium of conditions, and sections on therapeutic drugs, and emergencies. Thoroughly revised and updated, it now includes such updates as new approaches for the management of eating disorders, and post-liver transplant patients, the latest advances in endoscopy, new therapies, refined advice on how to select between therapeutic options, as well as additional emergency topics on abdominal trauma, bowel obstructions, and major haemorrhage.

At no other time in human existence has there been so many environmental changes. Over 87,000 chemicals are now commercially available in the U.S., almost all of which have not been tested for safety, particularly in young children and the growing fetus.The number and quantity of chemicals has continued to increase since World War II-and so too has the incidence of many chronic health problems, such as Type 2 Diabetes, obesity, thyroid disease, asthma, allergy, autoimmune disease, autism, ADHD, and several cancers. Many studies have revealed that exposure to chemicals and radiation in our everyday environment may increase risk for these conditions. Integrative Environmental Medicine examines the history and changing landscape of our environment in the U.S. and shares up-to-date research and information on ways to reduce exposures and reduce health risks. This text explores the unique properties of many chemicals and their ability to deceive the human body's normal workings, affecting everything from thyroid and autoimmune disease risk, to cancer development, to developmental issues in children, and even the development of diabetes and weight gain through gut bacteria manipulation. We discuss topics of improving regulations and appropriate testing for chemicals, remediation of environmental catastrophes, and designing healthier products for the future. Finally, we discuss best practices for clinicians to ascertain exposure history and teach patients how to avoid harmful exposures and help their body eliminate contaminates through better dietary and lifestyle practices. Throughout this book, we share vetted, practical resources and tools-including websites, phone apps, physician and patient hand-outs-to help healthcare practitioners facilitate healthier choices for themselves and their patients. This text is unique in that it offers tangible, practical information that can easily be integrated into the daily work flow of patient clinical care; websites, phone apps, physician and patient handouts and printable lists.

The Clinical Pocket Guide to Advanced Practice Palliative Nursing is a companion guide to Advanced Practice Palliative Nursing, the first text devoted to advanced practice nursing care of the seriously ill and dying. Each chapter of this pocket guide presents point-of-care guidance on palliative care issues for quick reference in daily practice. Edited by leaders in the field, this handbook provides consistency in the nursing process from assessment to management and evaluation of symptoms and various clinical situations. The Clinical Pocket Guide to Advanced Practice Palliative Nursing contains clinical pearls developed from the textbook and practical tools on pain and symptom assessment, functional status, and communication, making it an ideal resource for practicing APNs.

The new edition of The Best of Five MCQS for the European Specialty Examination in Gastroenterology and Hepatology is a question book designed to assist in preparations for the European Specialty Examination in Gastroenterology and Hepatology (ESEGH). The book has been fully updated to reflect the new examination introduced in 2018 and the most recent guidelines. Containing a foreword by Sir Ian Gilmore, former president of both the British Society for Gastroenterology and the Royal College of Physicians, the book adopts the same Best of Five question format used in the ESEGH and covers the breadth of the curriculum. It has been designed to exactly match the relative proportion of questions on each topic area found in the examination. Each of the 300 questions contained in the book is accompanied by an answer, a set of three succinct bullet points of key 'take-home' messages, and a short summary of the relevant background, evidence-base and up-to-date European guidelines. The book ends with a chapter of 50 questions, which again matches the proportions of topic areas found in the ESEGH, and is designed to act as a mock-examination for use in the final stages of preparation.

Variceal Hemorrhage provides an update of the evidence concerning several aspects of variceal hemorrhage. The book features new information on natural history, diagnosis of esophageal varices, assessment of the risk of bleeding and identification of high risk groups and patients who may benefit or be harmed from different treatments. The volume also presents a critical analysis of the different steps in the management of acute variceal bleeding. Authored by the most prominent world experts in their areas of expertise, Variceal Hemorrhage serves as a very useful reference for gastroenterologists, GI surgeons, residents in internal medicine and physicians dealing with and interested in the different aspects of this severe medical emergency.

Containing a selection of teaching tools for general anatomy and pathology, this work, with flip charts, offers an overview and understanding of the subject matter. It is useful for student or patient education. It is suitable for the home, the school library, or the physicians office and can be written on by a dry marker.

Gastroenterology and Hepatology Lecture Notes is a comprehensive yet easy-to-read overview of luminal gastroenterology and hepatology. Covering the epidemiology, causes, clinical features, investigation, treatment and prognosis of all the main gut and liver conditions, it is ideal for both exam preparation and fact finding. Key features include: A full range of new illustrations, including clinical photographs and scans, that clearly demonstrate signs and symptoms Sections on anatomy, physiology, pharmacology, and epidemiology written to enhance understanding of clinical features Essential information highlighted throughout the text Case-based self-assessment for each chapter helps retention of knowledge and puts it in its clinical context A new section of best answer MCQs New chapters on inflammatory bowel disease and different diagnosis of the upper GI tract Includes a companion website at www.lecturenoteseries.com/gastroenterology featuring 16 in-depth case studies Whether learning the basics of the gastrointestinal system, starting a general medical or gastroenterological placement, or looking for a quick-reference overview to revise key concepts, Gastroenterology and Hepatology Lecture Notes is an ideal resource for medical students, MRCP or FRACP candidates, and junior doctors.

The new edition of this pocket guide has been fully updated to cover the common manifestations of liver disease, how to treat them and when to refer patients on to specialist centers. New chapters on Acute Liver Failure, Nutrition and Congenital Heart Disease have been added to reflect the key issues in management of liver diseases. The book outlines the common clinical liver diseases such as fatty liver disease and viral hepatitis, among others, and their current up to date management. Written by experts in the field and containing figures and tables, as well as case histories and questions, this is an enjoyable and reader-friendly book for the busy physician. With its authoritative, didactic style and short chapters, it covers the common presentations and complications of liver disease, and how to deal with them. Given the increasing prevalence of liver disease in the UK and Worldwide, this is an ideal reference book for primary care physicians, doctors in specialist training, clinical nurse specialists and for gastroenterologists, who see patients with liver disease in their working lives.