Subject(s)
Chemical and Drug Induced Liver Injury/enzymology , Gastroenterology/education , Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Liver Diseases/enzymology , Aged , Autoantibodies/analysis , Bone Demineralization, Pathologic/etiology , Chemical and Drug Induced Liver Injury/epidemiology , Female , Ferritins/analysis , Ferritins/metabolism , Hemochromatosis/diagnosis , Hemochromatosis/metabolism , Hemochromatosis/pathology , Hepatitis B/diagnosis , Hepatitis B/drug therapy , Hepatitis B/immunology , Hepatitis C, Chronic/diagnosis , Hepatitis C, Chronic/genetics , Hodgkin Disease/diagnosis , Hodgkin Disease/drug therapy , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Liver Cirrhosis, Biliary/complications , Liver Diseases/diagnostic imaging , Liver Diseases/immunology , Liver Diseases/pathology , Male , Middle Aged , Non-alcoholic Fatty Liver Disease/diagnosis , Non-alcoholic Fatty Liver Disease/enzymology , Non-alcoholic Fatty Liver Disease/metabolism , Young AdultABSTRACT
Hepatic encephalopathy exists along a continuum from abnormal neuropsychiatric testing in the absence of clinical findings to varying degrees of detectable clinical findings. The International Society for Hepatic Encephalopathy and Nitrogen Metabolism has endorsed the term "covert" to encompass minimal hepatic encephalopathy and grade I overt hepatic encephalopathy. Covert hepatic encephalopathy has been associated with poor quality of life, decreased employment, increased falls, and increased traffic accidents that significantly impact quality of life and health care expenditures. Probiotics, nonabsorbable dissacharides, rifaximin, and l-ornithine-l-aspartate have been evaluated with varying levels of success. Because of the lack of universally accepted diagnostic tools, optimal timing of testing and treatment remains controversial.
Subject(s)
Gastrointestinal Agents/therapeutic use , Hepatic Encephalopathy/drug therapy , Probiotics/therapeutic use , Dipeptides/therapeutic use , Humans , Lactulose/therapeutic use , Patient Selection , Rifamycins/therapeutic use , Rifaximin , Severity of Illness Index , Sickness Impact ProfileABSTRACT
Anorectal conditions are frequently encountered clinical entities but are often misunderstood and misdiagnosed. Although the most common anorectal disorders are not considered life threatening, they can negatively impact patients' activities of daily living and quality of life. Comprehensive anorectal examination, including the use of anoscopy, has become a "lost art," and graduate medical education programs should utilize more formal training in this area. This review discusses the comprehensive anorectal exam and the diagnosis and management of three common anorectal disorders: hemorrhoids, anal fissure, and pruritus ani.
Subject(s)
Fissure in Ano , Hemorrhoids , Physical Examination/methods , Proctoscopy , Pruritus Ani , Fissure in Ano/diagnosis , Fissure in Ano/therapy , Hemorrhoids/diagnosis , Hemorrhoids/therapy , Humans , Pruritus Ani/diagnosis , Pruritus Ani/therapyABSTRACT
Rather than being a diagnosis of exclusion, irritable bowel syndrome (IBS) is a diagnosis that can be identified by symptom-based criteria. The collection of these criteria by a meticulous history can be enhanced by using various tools. Once a positive diagnosis is made, using clinical criteria for diagnosis, one should look for alarm or warning symptoms or signs, and should characterize the type of bowel habit. Determining whether the condition is a diarrhea-predominant or a constipation-predominant IBS will direct further diagnostic evaluation and management.