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ABC of liver, pancreas and gall bladder by Ian Beckingham

By Ian Beckingham

Queen's scientific Centre, Nottingham, united kingdom. presents an outline of the ailments 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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In patients in whom a diagnosis of pancreatitis is uncertain, early computed tomography is useful to look for pancreatic and peripancreatic oedema and fluid collections. This avoids inappropriate diagnostic laparotomy. Patients who are thought to have severe pancreatitis or in whom treatment is failing to resolve symptoms should have contrast enhanced computed tomography after 72 hours to look for pancreatic necrosis. 4 Computed tomogram showing extensive mesenteric oedema caused by retroperitoneal fluid due to acute pancreatitis Acute pancreatitis Treatment of acute attacks Mild pancreatitis Treatment of mild pancreatitis is supportive.

Treatment The principal aim of treatment of symptomatic ascites in cirrhotic patients is to improve general comfort and quality of life. Most patients will respond to dietary sodium restriction and diuretic induced excretion of sodium and water, but other treatments are available for those who do not. Treatment does not necessarily improve the prognosis for patients with cirrhosis and may cause complications. Small amounts of ascites that are asymptomatic should not be treated. 3 Classification of ascites by serum:ascites albumin gradient High gradient (>11 g/l) x Cirrhosis x Alcoholic hepatitis x Cardiac ascites x Fulminant hepatic failure x Budd-Chiari syndrome x Portal vein thrombosis x Veno-occlusive disease Low gradient (<11g/l) x Peritoneal carcinomatosis x Tuberculous peritonitis x Pancreatic ascites x Biliary ascites x Nephrotic syndrome x Serositis of collagen, vascular disease Portal hypertension—2.

This is often associated with deep and prolonged coma. The combination of gastrointestinal haemorrhage and hepatic encephalopathy indicates a poor prognosis. A small proportion of cases are precipitated by excess dietary protein, hypokalaemic alkalosis, constipation, and deterioration of liver function secondary to drugs, toxins, viruses, or hepatocellular carcinoma. The treatment of hepatic encephalopathy is empirical and relies largely on establishing the correct diagnosis, identifying and treating precipitating factors, emptying the bowels of blood, protein, and stool, attending to electrolyte and acid-base imbalance, and the selective use of benzodiazepine antagonists.

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