By Tadataka Yamada, David H. Alpers, Loren Laine, Neil Kaplowitz, Chung Owyang
Exact, top of the range photographs are specially important for gastrointestinal therapy.The Atlas of Gastroenterology is a gold-standard software that offers experts with a superb array of pictures overlaying all elements of the sector. With endoscopic ultrasonographs, computed tomography scans, magnetic resonance photographs, radionuclide photos, and angiograms demonstrating each medical situation from liver abscess, to endocrine neoplasms of the pancreas, to motility issues of the esophagus, this atlas is just a must-own source for all gastroenterologists.Showing the diversity of the latest imaging applied sciences and incorporating over 1700 full-color pictures, this re-creation is a perfect instructing software, and the fitting better half to the Textbook of Gastroenterology.
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Extra info for Atlas of Gastroenterology, 4th Edition
Palpation begins in the abdominal quadrant farthest from the area of suspected pathological change. Gentle pressure to elicit tenderness and muscular resistance ensues. Progressively deeper palpation is attempted to delineate masses. Intentional efforts to reproduce abdominal pain by means of deep palpation and rapid release of pressure, termed rebound tenderness, are not helpful and should not be attempted. Production of rebound tenderness 21 PART 1 Principles of clinical gastroenterology provides no information that is not available through gentle examination, causes the patient to guard voluntarily, and eliminates the possibility of meaningful serial abdominal examinations.
Patients with mechanical obstruction of the small intestine initially may feel remarkably well between episodes of intense and debilitating colic. The physical examination should be conducted in a systematic and unhurried manner. A complete abdominal examination requires unhindered visualization of the area between the nipples and the midthigh, anteriorly and posteriorly. The examination begins with observation of the patient’s expression and behavior. A patient with serious intraperitoneal abnormalities usually has an anxious, pale face.
17 Findings suggestive of factitious diarrhea Investigation Characteristic findings Cause Sigmoidoscopy Barium enema Stool electrolytes and osmolality (if volume > 500 mL/d and other causes are excluded) Melanosis coli “Cathartic” colon (Na+ + K+) × 2 < osmolality (Na+ + K+) × 2 = osmolality Anthraquinones Diphenolic laxatives and anthraquinones Osmotic laxatives, urine contamination Secretory laxatives (anthraquinone and diphenolic laxatives) Osmolality < 200 mOsm/L From Ewe K, Karbach U. Factitious diarrhea.