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ABC of liver, pancreas and gall bladder by Ian Beckingham

By Ian Beckingham

Queen's clinical Centre, Nottingham, united kingdom. offers an outline of the illnesses of the liver, pancreas, and gall bladder. For citizens, scientific scholars, and basic practitioners. Covers universal and infrequent stipulations and contains algorithms for prognosis and remedy. colour illustrations. Softcover.

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Antibiotics are of no benefit in the absence of coexisting infections. Investigations are limited to the initial blood tests and ultrasonography when gall stones are suspected. Most patients will recover in 48-72 hours, and fluids can be restarted once abdominal pain and tenderness are resolving. Severe pancreatitis Patients with severe pancreatitis should be admitted to a high dependency or intensive care unit for close monitoring. Adequate resuscitation of hypovolaemic shock (which is often underestimated) remains the cornerstone of management, and patients often require surprisingly large volumes of fluids over the first 24-48 hours.

Another quarter of cases are precipitated by haemorrhage in the gastrointestinal tract. 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.

Scolicidal solutions should not be injected if there is a bile leak because of possible chemical injury to the biliary epithelium. After decompression, the cyst and contents are carefully shelled out by peeling the endocyst off the host ectocyst layer along its cleavage plane. The fibrous host wall of the residual cavity should be carefully examined for any bile leakage from biliary-cyst communications, which are then sutured. The cavity is drained and filled with omentum. Conservative surgery is effective in most cysts, and liver resection is seldom necessary.

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