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GASTROINTESTINAL & HEPATOBILIARY DISORDERS

Drug induced liver injury

Introduction Drug Induced Liver Injury (DILI) can occur following the use of a variety of either prescription or over-the-counter medications. A high index of suspicion is often necessary in establishing the diagnosis. Early recognition of drug toxicity is important to permit withdrawal of the offending drug, assessment of severity and monitoring for acute liver failure. …

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Hepatocellular carcinoma

Introduction Hepatocellular Carcinoma (HCC) is a primary malignancy of the liver cell and must be differentiated from malignancies elsewhere that metastasize to the liver. Hepatocellular carcinoma occurs more commonly in men than in women and is often diagnosed several years after establishment of the initial causative condition. The disease has a poor prognosis resulting from …

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Amoebic liver abscess

Introduction Amoebic liver abscess is a collection of typically brownish coloured fluid in the liver, occurring often as a single mass in the right lobe and a complication of intestinal infection with Entamoeba histolytica. Lung, heart and brain infections are uncommon sequelae. Occasionally, pyogenic abscesses may have a similar clinical presentation. Treatment of amoebic abscesses …

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Pain Originating from the Oesophagus

Introduction Oesophageal pain is usually burning in quality and tends to be localised behind the sternum. Oesophageal pain may be associated with difficulty in swallowing (dysphagia). Dysphagia to water suggests achalasia, while that to solids and not water suggests mechanical obstruction by tumour or stricture. It may sometimes be confused with other causes of chest …

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Gastro-oesophageal Reflux Disease (GERD)

Introduction Gastro-oesophageal Reflux Disease (GORD or GERD) is caused by backflow of gastric and/or duodenal contents past the lower oesophageal sphincter into the oesophagus without belching or vomiting. The disease is classified into two groups based on endoscopy findings as non-erosive gastro-oesophageal disease (non-erosive GORD) and erosive gastro-oesophageal disease (erosive GORD). Failure to treat may …

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Upper Gastrointestinal Bleeding

Introduction Upper gastrointestinal bleeding is any GI bleeding originating proximal to the ligament of Treitz. Clinical Presentation of upper gastrointestinal bleeding Hematemesis and coffee-ground emesis suggest an upper Gastrointestinal bleeding source. On physical examination, vital signs may reveal obvious hypotension and tachycardia. Cool, clammy skin is an obvious sign of shock. Abdominal examination may disclose …

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Hepatic Encephalopathy

Introduction Hepatic encephalopathy is a complication of either acute or chronic liver disease. It presents with disordered central nervous system function, due to inability of the liver to detoxify ammonia and other chemicals. Causes of hepatic encephalopathy The following are the causes of hepatic encephalopathy: Viral hepatitis Alcoholic hepatitis Cirrhosis of the liver Hepatocellular carcinoma …

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Vomiting

Introduction Vomiting can be induced by a variety of disease processes including gastrointestinal, neurologic, renal, psychiatric, cardiovascular, endocrine, pain and the effects of drugs. The best course of action in identifying the underlying cause is to carry out a detailed clinical evaluation and management plan, looking out for the aetiology, consequences and potential complications of …

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Ascites

Introduction Ascites is the accumulation of excess fluid within the peritoneal cavity. Causes of ascites Ascites is caused by the following disease conditions: Portal hypertension secondary to liver cirrhosis Renal failure Nephrotic syndrome Cardiac failure Abdominal tuberculosis. Intra-abdominal or pelvic malignancies Symptoms of ascites The symptoms of ascites are: Abdominal enlargement Abdominal discomfort or pain …

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Obesity

Introduction to Obesity Obesity is a major component of the metabolic syndrome. Being overweight or obese significantly increases the risk of morbidity and mortality from Type 2 diabetes and its co-morbidities. Successful weight reduction has a positive impact on morbidity and mortality outcomes. Constitutional obesity is a result largely of diet and lifestyle. Measurements for …

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Micronutrient deficiencies

Definition of Micronutrient Deficiencies Deficiencies of minerals (iron, iodine, zinc, calcium, phosphorus, magnesium, copper, potassium, sodium, chloride, fluoride etc); folic acid and vitamins Aetiology of Micronutrient Deficiencies Inadequate dietary intake Increased requirements Increased loss (e.g. worm infestation) Epidemiology Global; high prevalence in under-developed countries, especially sub-Saharan Africa Clinical features of Micronutrient Deficiencies Iron: anaemia Iodine: …

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Kwashiorkor and Marasmus

Introduction to Kwashiorkor and Marasmus Adequate nutrition is the intake and utilization of energy-giving and body building foods and nutrients in the right proportions to maintain well-being, and productivity. Malnutrition manifests as stunting, underweight, wasting (kwashiorkor and marasmus), obesity as well as deficiencies of micronutrients. Epidemiology High prevalence in under-developed countries, especially sub-Saharan Africa Clinical …

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Liver Cirrhosis

Introduction to Liver Cirrhosis Liver Cirrhosis is an advanced stage of chronic liver disease associated with permanent distortion of the liver architecture and replacement of some destroyed hepatocytes with fibrous tissue It is accompanied by some loss of liver function leading to certain recognized symptoms and signs Etiology of Liver Cirrhosis Its etiology is similar …

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