Gastroenterology clinics of North America
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Five major types of viral hepatitis have been described. The recent detection of the delta, C, and E agents has made possible the description of the clinical spectra of the disease. ⋯ Future investigations are needed so that treatment and prevention of the other viral entities, especially in those who are immunocompromised, may be instituted. Liver transplantation offers hope in a subset of patients with end-stage liver disease.
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Gastroenterol. Clin. North Am. · Sep 1994
ReviewThe epidemiology of viral hepatitis in the United States.
Hepatitis types A, B, and C are the most important forms of viral hepatitis in the Unites States. High-risk sexual and drug use behavior have been associated with epidemics of hepatitis A and endemic transmission of both hepatitis B and hepatitis C. Immune globulin preparations and vaccines have been developed that effectively prevent hepatitis A and hepatitis B. In the absence of such preventive measures, the prevention of hepatitis C will depend on a better understanding of the host and environmental factors that facilitate transmission of this disease.
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Gastroenterol. Clin. North Am. · Dec 1993
Review Comparative StudyBleeding peptic ulcer: surgical therapy.
The management of bleeding peptic ulcer disease varies with multiple clinical and endoscopic variables. For the patient with rapid hemorrhage and hemodynamic instability refractory to endoscopic control, operation clearly is indicated. For patients with a low probability of recurrent ulcer hemorrhage because of the absence of endoscopic stigmata or clinical predictors of further ulcer bleeding, nonoperative management with selective use of endoscopic hemostasis is appropriate. ⋯ Surgery also is the wise choice for those patients in whom an initially successful attempt at endoscopic hemostasis fails and who rebleed while hospitalized. Recommendations for the surgical management of bleeding peptic ulcer disease include Immediate operation for (1) patients with rapidly exsanguinating ulcer hemorrhage and (2) patients with active bleeding and failure of endoscopic hemostasis to control the bleeding. Early elective operation after initial endoscopic hemostasis for (1) elderly patients with comorbid disease and/or hemodynamic instability who have active arterial ulcer hemorrhage (Forrest Ia) controlled with endoscopic hemostasis; (2) elderly patients with comorbid disease and/or hemodynamic instability who have a visible vessel in an ulcer crater (Forrest IIa) treated with endoscopic hemostasis: surgery is particularly advised in this circumstance for those with a positive arterial Doppler signal in the ulcer crater or a large posterior duodenal ulcer or a large lesser-curvature gastric ulcer; and (3) elderly patients with comorbid disease and/or hemodynamic instability who develop recurrent ulcer bleeding while hospitalized or with a total blood transfusion requirement exceeding 5 U.
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A variety of infectious enteric pathogens (bacterial, viral, and protozoal) can lead to a systemic diarrheal illness in international travelers traveling from industrialized countries to developing areas of the world. Many of the agents that lead to this syndrome have been identified, and their mode of transmission has been defined. Prophylactic measures are advisable, and effective treatment options are available. This article also discusses issues important in the management of patients who develop a chronic diarrheal illness after travel.
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Gastroenterol. Clin. North Am. · Dec 1992
Review Comparative StudyViral hepatitis, A though E, complicating pregnancy.
Jaundice during pregnancy may be the result either of disease uniquely associated with the pregnant state or disease totally unrelated to the pregnancy. In the United States, the most common cause of jaundice in pregnant women is viral hepatitis. With the exception of hepatitis E virus infection, the clinical course and histologic findings do not differ between pregnant and nonpregnant patients.