Brit J Hosp Med
-
Ulnar tunnel syndrome is compression of the ulnar nerve at the level of the wrist within Guyon's canal. It is most commonly caused by a ganglion cyst but may also be secondary to fractures, inflammatory conditions, neoplasm, vascular anomalies, aberrant musculature or a combination of these. Assessment should include a detailed history focusing on duration, site and progression of symptoms. ⋯ Nerve conduction studies can be used to support the diagnosis and look for proximal compression. Mild symptoms can be managed non-operatively. Surgical exploration and decompression is the gold standard treatment for neuro-compressive causes with largely good outcomes.
-
Malnutrition is the disturbance of normal form or function, arising from the deficiency of one or more nutrients, and is a significant issue in the older adult population. Despite their reduced energy requirements, older patients need the same protein intake and micronutrients as younger patients, but age-related changes may impact the ability to meet these requirements. The cause of malnutrition in individuals is likely to be multifactorial and can therefore be complex to manage. ⋯ Management strategies for optimising nutrition can be divided into systems and supplementation. With an ageing population, most doctors will inevitably become increasingly involved with treating older patients and this article highlights the need to consider a patient's nutritional status. Nutrition should be considered during every ward round and the multidisciplinary team as a whole should maintain an awareness and responsibility for managing malnutrition.
-
Acute-on-chronic liver failure is used to describe an acute decline in liver function in a patient with existing liver disease combined with other organ failure. Acute-on-chronic liver failure is associated with high short-term mortality, and the greater the number and severity of organ failures, the higher the mortality. ⋯ As a result, a trial of critical care treatment may be appropriate for many of these patients. Clinical scoring tools may help clinicians recognise futility, allowing timely withdrawal of organ support and shifting the focus of care toward palliation.
-
This article summarises radiological imaging of the small bowel, with an emphasis on Crohn's disease. Different imaging techniques are discussed, including the advantages and disadvantages of each modality, and radiological findings for common small bowel pathologies are described, supplemented with pictorial examples.
-
Editorial
High-quality end of life care for older people with frailty: helping people to live and die well.
Guidance from the British Geriatrics Society provides practical advice to support healthcare professionals who are involved in caring for frail, older people in the last phase of life.