Clinical Challenges and Images in Gastroenterology: A Diagnostic Guide

Digestive diseases have always been a major threat to global health. Despite the rapid advances in various diagnostic modalities, many a time the final verdict can be elusive and present a diagnostic challenge for the attending doctor. Clinical Challenges & Images in Gastroenterology: A Diagnostic Guide presents 50 real-life cases to illustrate an evidence-based approach for the diagnosis, investigation and management of gastrointestinal diseases commonly encountered in everyday practice, with a special focus on the interpretation of endoscopic and radiological images. This book provides a pragmatic approach for medical students, residents, specialist trainees and specialists alike who have an interest in gastroenterology. Other healthcare providers, such as general practitioners, nurses and dieticians, will also benefit from these case illustrations. The authors of this book are based at the Institute of Digestive Disease, Chinese University of Hong Kong. This institute has contributed to major breakthroughs that have improved the clinical management of digestive diseases including, but not limited to, the advent of endoscopic therapies and minimally invasive surgery, molecular diagnostic tools for cancers and inflammatory bowel disease, and the development of novel treatments for acid-peptic disease and viral hepatitis. Clinical Challenges & Images in GASTROENTEROLOGY: A Diagnostic Guide......Page 1 Title Page......Page 2 Copyright......Page 3 Contents......Page 4 Preface......Page 7 Abbreviations......Page 9 Acknowledgements......Page 14 Dedication......Page 15 History......Page 16 Physical examination......Page 17 What imaging test would you order?......Page 18 How would you proceed?......Page 19 Malignancy......Page 20 Clinical pearls......Page 21 What virus is implicated as a possible cause for NK/T-cell lymphoma?......Page 22 References......Page 23 History......Page 24 What other blood tests would you order?......Page 25 What imaging test would you order?......Page 26 What would you do next?......Page 27 How would you manage this patient?......Page 28 How common is tuberculosis of the intestinal tract?......Page 29 References......Page 30 History......Page 32 Investigations......Page 33 Please describe what you see......Page 34 What is the diagnosis, and how would you proceed?......Page 35 What is the definition of a granuloma?......Page 36 How would you distinguish between Crohn’s disease and ITB (Table 3.1)?......Page 37 References......Page 39 History......Page 40 What other tests would you order?......Page 41 How would you manage his flare?......Page 42 How would you proceed?......Page 43 Clinical pearls......Page 44 References......Page 45 History......Page 46 What are the possible causes of his fever given his history of Crohn’s?......Page 47 Later on, the ZN stain shows acid-fast bacilli. How would this affect your management?......Page 48 What is the performance of interferon-. release assays in the diagnosis of latent TB (Table 5.1)?......Page 49 References......Page 50 History......Page 51 What further investigations would you order?......Page 52 Please describe what you see......Page 54 What other skin manifestations may be seen in Behçet’s disease?......Page 55 What are the treatment options for Behçet’s disease?......Page 56 References......Page 57 History......Page 58 Physical examination......Page 59 How would you manage this patient?......Page 60 What further investigations would you request?......Page 61 What is pancreatic panniculitis?......Page 62 References......Page 63 History......Page 64 Physical examination......Page 65 What is your differential diagnosis?......Page 66 What would you do next?......Page 67 How would you manage this patient?......Page 68 References......Page 69 History......Page 70 What is your differential diagnosis?......Page 71 Does this narrow your differential diagnosis?......Page 72 How would you treat this patient?......Page 73 Clinical pearls......Page 74 Do you know of any new biomarkers under investigation for the use in IgG4-related disease?......Page 75 References......Page 76 History......Page 77 Investigations......Page 78 How would you manage this patient?......Page 79 What is the incidence of Clostridium difficile-associated disease?......Page 80 How would you distinguish between non-severe and severe (fulminant) CDAD (Table 10.1)?......Page 81 How would you manage patients with CDAD (Figures 10.2 and 10.3)?......Page 82 References......Page 83 History......Page 84 What would you do next?......Page 85 What is the working diagnosis?......Page 86 Clinical pearls......Page 87 References......Page 88 History......Page 89 How would you proceed?......Page 90 What would be the next step of management?......Page 92 Do you know of any newer biomarkers?......Page 93 How is HCC staged?......Page 94 References......Page 95 History......Page 97 What would you do next?......Page 98 How would you treat this patient?......Page 99 What is the prognosis of pancreatic adenocarcinoma?......Page 100 References......Page 101 History......Page 102 How would you manage this lady?......Page 103 What imaging test would you order next?......Page 104 What further investigations would you request?......Page 105 What do you know about the genetics of neurofibromatosis Type 1?......Page 106 How would you decide the timing of resumption of anticoagulation?......Page 107 References......Page 108 History......Page 109 What would you do next?......Page 110 Please describe what you see......Page 112 Clinical pearls......Page 113 What are the latest developments in the treatment of MALT lymphoma?......Page 115 References......Page 116 History......Page 117 Please describe what you see......Page 118 What further investigations would you arrange?......Page 119 Please describe what you see......Page 120 Clinical pearls......Page 121 How are neuroendocrine tumours graded?......Page 122 References......Page 124 History......Page 125 What is your differential diagnosis?......Page 126 Please describe what you see......Page 127 Clinical pearls......Page 128 What are the types of AIH (Table 17.2)?......Page 130 How long should immunosuppressants be given in patients with AIH?......Page 131 References......Page 132 History......Page 133 How would you proceed?......Page 134 Clinical pearls......Page 135 What other diseases is this condition associated with?......Page 136 References......Page 137 History......Page 139 What further investigations would you request?......Page 140 How would you proceed?......Page 141 What would be your next step of management?......Page 142 Clinical pearls......Page 143 How would you treat stomach cancer?......Page 144 References......Page 145 History......Page 147 Investigations......Page 148 What further investigations may be helpful?......Page 149 What is the postulated pathogenesis in chronic intestinal pseudo-obstruction?......Page 150 How would you classify the causes of CIPO (Table 20.1)?......Page 151 References......Page 152 History......Page 153 What would you do next?......Page 154 Clinical pearls......Page 156 Classic FAP (>100 adenomas)......Page 157 What are the clinical presentations of classic FAP?......Page 158 What are the latest recommendations for colorectal cancer (CRC) screening for patients with FAP?......Page 159 References......Page 160 History......Page 161 Investigations......Page 162 What further investigations would you request?......Page 163 How would you manage this gentleman?......Page 164 Are there any specific foreign bodies where endoscopic removal should not be attempted, and why?......Page 165 What factors would you take into account when considering timing of endoscopy?......Page 166 References......Page 167 History......Page 168 What is your working diagnosis?......Page 169 What would you do next?......Page 170 Clinical pearls......Page 171 References......Page 172 History......Page 173 What is your differential diagnosis?......Page 174 What would you do next?......Page 175 What is the definition of polycystic liver disease?......Page 176 References......Page 177 History......Page 179 Investigations......Page 180 Please describe what you see......Page 181 What is the final pathological diagnosis?......Page 182 Clinical pearls......Page 183 How would you interpret cyst fluid analysis in pancreatic cysticlesions (Table 25.1)?......Page 184 References......Page 185 History......Page 186 What further investigation would you perform?......Page 187 What would you do next?......Page 188 How would you proceed?......Page 189 How would you manage this patient?......Page 191 Are there any promising therapies on the horizon that you know of?......Page 192 References......Page 193 History......Page 194 What other tests will you order?......Page 195 After stabilisation, what would be the next investigation for her dysphagia?......Page 196 What are the treatment options for achalasia?......Page 197 What is POEM?......Page 199 References......Page 200 History......Page 201 Investigations......Page 202 How would you proceed?......Page 203 How would you proceed endoscopically?......Page 204 Clinical pearls......Page 205 How is electrohydraulic lithotripsy performed?......Page 206 References......Page 207 History......Page 209 What is your differential diagnosis?......Page 210 What are the causes of acute pancreatitis?......Page 211 How would you further investigate the patient to elucidate the aetiology?......Page 212 Calculate the Ranson score of this patient......Page 213 Clinical pearls......Page 215 How would you classify acute pancreatitis?......Page 216 References......Page 217 History......Page 218 What is the differential diagnosis of jaundice?......Page 219 What is Courvoisier’s law?......Page 220 What further imaging would you order?......Page 221 What condition is associated with ampullary adenoma?......Page 222 What are the factors predicting the success of papillectomy?......Page 223 References......Page 224 History......Page 225 Would you arrange an oesophagogastroduodenoscopy (OGD) for this patient?......Page 226 Please describe what you see......Page 227 How would you further manage the patient?......Page 228 Would the presence of oesophagitis affect your management in a patient with Barrett’s oesophagus?......Page 229 How would you manage patients who have biopsy-confirmed Barrett’s oesophagus with high-grade dysplasia?......Page 230 References......Page 231 History......Page 232 What is the differential diagnosis?......Page 233 Please describe what you see......Page 234 What is the predictive value of oral candidiasis for oesophageal candidiasis in immunocompromised patients?......Page 235 References......Page 236 History......Page 237 What is your differential diagnosis?......Page 238 Please describe what you see......Page 239 What further testing would you perform to find out the aetiology?......Page 240 Clinical pearls......Page 241 References......Page 242 History......Page 244 In general, when should colorectal cancer screening commence?......Page 245 In view of the positive family history with one first-degree relative affected at age