Essentials 1 The diagnosis of acute liver failure (ALF) is based on the presence of worsening coagulopathy, hepatic encephalopathy and deepening jaundice. 2 In developing countries, viral causes predominate, with hepatitis E infection recognized as a common cause in many…
Essentials 1 The two major forms of inflammatory bowel disease (IBD) are Crohn’s disease and ulcerative colitis. The principal clinical features are diarrhoea and/or abdominal pain. 2 IBD is a chronic and relapsing condition. Patients may present to the emergency…
Essentials 1 Appendicitis is the commonest cause of acute abdominal pain requiring surgical treatment. 2 The diagnosis is primarily clinical, but the absence of a pathognomonic sign or conclusive first-line diagnostic test can cause diagnostic difficulty. 3 Diagnostic delay is…
Introduction The twin challenges of acute pancreatitis are to establish the diagnosis and stratify severity. The difficulty in diagnosing pancreatitis lies in its non-specific symptomatology, which is shared by a number of other gastrointestinal diseases. The 2012 revised Atlanta classification…
Essentials 1 More than 95% of biliary tract disease is attributable to gallstones. 2 Most patients with gallbladder disease present with abdominal pain. 3 Investigations are directed to confirming the diagnosis and detecting the presence of complications. 4 The management…
Essentials 1 Helicobacter pylori is responsible for 70% to 90% of peptic ulcers, with non-steroidal anti-inflammatory drugs (NSAIDs) accounting for most of the remainder. 2 Emergency presentations of peptic ulcer disease vary from mild indigestion to severe life-threatening complications. 3…
Essentials 1 Resuscitation is the priority, with particular attention to restoring perfusion of vital organs by replacing intravascular volume. 2 Upper gastrointestinal (GI) endoscopy is the key investigation and frequently allows definitive therapy. It should be performed at the earliest…
Essentials 1 Gastroenteritis is usually a benign, self-limiting disease that can be diagnosed clinically, warrants no specific investigation and settles spontaneously with symptomatic treatment and oral fluid therapy. 2 The cardinal clinical feature of gastroenteritis is diarrhoea, which may be…
Essentials 1 A diagnosis of symptomatic herniae mandates early surgical repair to avoid life-threatening complications. 2 Herniae may present as a reducible lump or may incarcerate, strangulate and/or present as bowel obstruction. 3 Femoral herniae are often misdiagnosed and, when…
Essentials 1 Small bowel obstruction is most often caused by adhesions, hernias or neoplasms. Large bowel obstruction more commonly results from neoplasms, volvulus or strictures. 2 The common clinical features of bowel obstruction are paroxysms of poorly localized abdominal pain,…