Pub Date : 2008-11-01DOI: 10.1016/j.mpfou.2008.06.018
Myles P.P. Fleming, Neil J.Mc.C. Mortensen
Rectal bleeding is a very common symptom, with the majority of cases being caused by benign conditions. However, a small but significant percentage of those over 40 will have an underlying colorectal cancer. A careful clinical history is important in making a diagnosis and aiding in the choice of further investigations. These investigations range from flexible sigmoidoscopy, barium enema and colonoscopy to the more recent introduction of virtual colonoscopy and CT colonography. Presentations have been altered by NICE referral guidelines and the introduction of the NHS Bowel Cancer Screening Programme. Management depends on the cause and varies from the conservative through clinic-based procedures to formal surgical interventions.
{"title":"The patient with rectal bleeding","authors":"Myles P.P. Fleming, Neil J.Mc.C. Mortensen","doi":"10.1016/j.mpfou.2008.06.018","DOIUrl":"10.1016/j.mpfou.2008.06.018","url":null,"abstract":"<div><p>Rectal bleeding<span><span><span> is a very common symptom, with the majority of cases being caused by benign conditions. However, a small but significant percentage of those over 40 will have an underlying colorectal cancer. A careful clinical history is important in making a diagnosis and aiding in the choice of further investigations. These investigations range from flexible sigmoidoscopy, barium enema and </span>colonoscopy to the more recent introduction of </span>virtual colonoscopy<span> and CT colonography. Presentations have been altered by NICE referral guidelines and the introduction of the NHS Bowel Cancer Screening Programme. Management depends on the cause and varies from the conservative through clinic-based procedures to formal surgical interventions.</span></span></p></div>","PeriodicalId":101230,"journal":{"name":"The Foundation Years","volume":"4 7","pages":"Pages 275-278"},"PeriodicalIF":0.0,"publicationDate":"2008-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.mpfou.2008.06.018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75761970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-11-01DOI: 10.1016/j.mpfou.2008.06.020
Andrew Dixon, Manjula Natarajan
Clostridium difficile (C.difficile) infection has become more common in the healthcare environment over recent years. The number of cases has increased dramatically and has been responsible for severe morbidity and mortality. Assessment and management of patients with confirmed or suspected C.difficile associated diarrhoea is discussed and summarized as a guide for junior doctors in the clinical environment. As with all infective disease, the most important factor remains its prevention. Decline in rates will only come by increasing awareness of the condition, educating healthcare professionals on appropriate antibiotic prescription and improving on good hand hygiene in the healthcare environment.
{"title":"Assessment and management of Clostridium difficile","authors":"Andrew Dixon, Manjula Natarajan","doi":"10.1016/j.mpfou.2008.06.020","DOIUrl":"10.1016/j.mpfou.2008.06.020","url":null,"abstract":"<div><p>Clostridium difficile (<em>C.difficile</em>) infection has become more common in the healthcare environment over recent years. The number of cases has increased dramatically and has been responsible for severe morbidity and mortality. Assessment and management of patients with confirmed or suspected <em>C.difficile</em> associated diarrhoea is discussed and summarized as a guide for junior doctors in the clinical environment. As with all infective disease, the most important factor remains its prevention. Decline in rates will only come by increasing awareness of the condition, educating healthcare professionals on appropriate antibiotic prescription and improving on good hand hygiene in the healthcare environment.</p></div>","PeriodicalId":101230,"journal":{"name":"The Foundation Years","volume":"4 7","pages":"Pages 268-271"},"PeriodicalIF":0.0,"publicationDate":"2008-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.mpfou.2008.06.020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88493768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-11-01DOI: 10.1016/j.mpfou.2008.08.010
Andrew R. Moore, Anthony I. Morris
Acute gastrointestinal (GI) bleeding is both a common reason for hospital attendance and a common occurrence in hospitalized patients. Acute upper gastrointestinal haemorrhage (AUGH) is much more likely to be responsible for profuse or life-threatening bleeding than is lower GI haemorrhage. Despite advances in endoscopic and pharmacological treatments, AUGH still carries an overall mortality of around 10%. Prompt assessment and resuscitation are critical and should be guided by a clinical assessment of the patient’s degree of shock. Careful attention should be paid to risk factors and co-morbidities. Risk stratification is mandatory and helps to guide the timing of definitive intervention. Patients with major AUGH should be nursed in appropriate units (such as high dependency or intensive therapy units), and in higher risk bleeds, specialist assistance should be sought early and appropriate pharmacological measures instituted. Flexible video-endoscopy is the initial investigation of choice as it provides not only diagnostic information but also therapeutic options. Other treatment options include radiological and surgical measures, although these are reserved for refractory bleeding or where endoscopy is inappropriate.
{"title":"Assessment and management of gastrointestinal (GI) haemorrhage","authors":"Andrew R. Moore, Anthony I. Morris","doi":"10.1016/j.mpfou.2008.08.010","DOIUrl":"10.1016/j.mpfou.2008.08.010","url":null,"abstract":"<div><p><span>Acute gastrointestinal (GI) bleeding is both a common reason for hospital attendance and a common occurrence in hospitalized patients. Acute upper gastrointestinal haemorrhage<span> (AUGH) is much more likely to be responsible for profuse or life-threatening bleeding than is lower GI haemorrhage. Despite advances in endoscopic and pharmacological treatments, AUGH still carries an overall mortality of around 10%. Prompt assessment and resuscitation are critical and should be guided by a clinical assessment of the patient’s degree of shock<span>. Careful attention should be paid to risk factors and co-morbidities. Risk stratification is mandatory and helps to guide the timing of definitive intervention. Patients with major AUGH should be nursed in appropriate units (such as high dependency or intensive therapy units), and in higher risk </span></span></span>bleeds<span><span>, specialist assistance should be sought early and appropriate pharmacological measures instituted. Flexible video-endoscopy is the initial investigation of choice as it provides not only diagnostic information but also therapeutic options. Other treatment options include radiological and surgical measures, although these are reserved for refractory bleeding or where </span>endoscopy is inappropriate.</span></p></div>","PeriodicalId":101230,"journal":{"name":"The Foundation Years","volume":"4 7","pages":"Pages 262-267"},"PeriodicalIF":0.0,"publicationDate":"2008-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.mpfou.2008.08.010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83416888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-11-01DOI: 10.1016/j.mpfou.2008.07.005
Sandeep Bajwa, Barrie J. Rathbone
This article covers management of Clostridium difficile associated diarrhoea in a patient with inflammatory bowel disease. It highlights the importance of recognizing severity of the illness and treating both conditions actively. It emphasizes that patients with chronic bowel conditions are more prone to infections, which need early recognition. We advise that every case should be managed individually, with close liaison between the teams.
{"title":"A patient with diarrhoea","authors":"Sandeep Bajwa, Barrie J. Rathbone","doi":"10.1016/j.mpfou.2008.07.005","DOIUrl":"10.1016/j.mpfou.2008.07.005","url":null,"abstract":"<div><p>This article covers management of <em>Clostridium difficile</em> associated diarrhoea in a patient with inflammatory bowel disease. It highlights the importance of recognizing severity of the illness and treating both conditions actively. It emphasizes that patients with chronic bowel conditions are more prone to infections, which need early recognition. We advise that every case should be managed individually, with close liaison between the teams.</p></div>","PeriodicalId":101230,"journal":{"name":"The Foundation Years","volume":"4 7","pages":"Pages 272-274"},"PeriodicalIF":0.0,"publicationDate":"2008-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.mpfou.2008.07.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88289824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-11-01DOI: 10.1016/j.mpfou.2008.07.002
Russell Foster
{"title":"If I could set the medical agenda for the next ten years …","authors":"Russell Foster","doi":"10.1016/j.mpfou.2008.07.002","DOIUrl":"10.1016/j.mpfou.2008.07.002","url":null,"abstract":"","PeriodicalId":101230,"journal":{"name":"The Foundation Years","volume":"4 7","pages":"Pages 293-296"},"PeriodicalIF":0.0,"publicationDate":"2008-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.mpfou.2008.07.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88871354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-11-01DOI: 10.1016/j.mpfou.2008.06.017
Andrew Steel
{"title":"So you want to be a gastroenterologist?","authors":"Andrew Steel","doi":"10.1016/j.mpfou.2008.06.017","DOIUrl":"10.1016/j.mpfou.2008.06.017","url":null,"abstract":"","PeriodicalId":101230,"journal":{"name":"The Foundation Years","volume":"4 7","pages":"Pages 297-298"},"PeriodicalIF":0.0,"publicationDate":"2008-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.mpfou.2008.06.017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75316118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-11-01DOI: 10.1016/j.mpfou.2008.07.006
Stuart M.F. Fraser
{"title":"Dealing with diversity in the consultation","authors":"Stuart M.F. Fraser","doi":"10.1016/j.mpfou.2008.07.006","DOIUrl":"10.1016/j.mpfou.2008.07.006","url":null,"abstract":"","PeriodicalId":101230,"journal":{"name":"The Foundation Years","volume":"4 7","pages":"Pages 284-286"},"PeriodicalIF":0.0,"publicationDate":"2008-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.mpfou.2008.07.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90712146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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