DISEASES OF THE LIVER: CIRRHOSIS This is a chronic disease with considerable loss of liver cells, fatty infiltration, and fibrosis. It is sometimes the outcome of inadequately treated hepatitis, and more often is associated with chronic alcoholism. Among the changes frequently seen are anemia, prolonged bleeding time, lowered serum albumin, and jaundice. In severe damage [...]

DISEASES OF THE LIVER: HEPATITIS The liver is probably the most complex organ in the body with numerous functions that are listed only briefly here. It synthesizes plasma proteins, hemoglobin, prothrombin, heparin, glycogen, lipoproteins, phospholipids, cholesterol, and numerous other substances. It stores glycogen, iron, copper, and vitamins A and D. It participates in the metabolism [...]

DIET THERAPY FOR MALABSORPTION DISORDERS: GLUTEN-INDUCED ENTEROPATHY Gluten-induced enteropathy is also known as celiac disease in children and non-tropical sprue in adults. Gluten occurs in wheat, oats, rye, and barley. When gluten is ingested changes occur in the epithelial cells of the jejunum, and absorption of sugars, fats, and amino acids is greatly reduced. The [...]

MALABSORPTION DISORDERS: LACTOSE INTOLERANCE Congenital lactase deficiency A small percentage of infants are born with a lack of lactase and therefore are unable to digest the lactose in milk. These infants become severely ill within a few days of birth. They must be given a formula that is free of all sources of lactose, such [...]

MALABSORPTION DISORDERS: DIARRHEA AND ULCERATIVE COLITIS Malabsorption is a general term that describes incomplete absorption of one or more nutrients. Among the causes are increased motility of the gastrointestinal tract; inadequate supply or absence of pancreatic or intestinal enzymes or bile; defect in the structure of the villi so that the area of absorbing surface [...]

DIET THERAPY AND DISEASES OF GASTROINTESTINAL TRACT: DIETARY FIBER The terms “fiber” and “residue” are often misused. Dietary fiber consists of the indigestible parts of plants. It includes cellulose, hemicelluloses, lignin, gums, pectins, and mucilage occurring in the cell structure of plants. Residue refers to the bulk remaining in the lower part of the gastrointestinal [...]

Because of the frequency of concurrent infections and the possibility of silent infections or unusual presentations, some screening tests should be routine for all patients presenting with STD. A similar routine should be offered to patients in high risk groups presenting for check-ups. The following are recommended: Serological tests for syphilis (see p.25) i.e. routine [...]

The physical examination should include oral, genital and anal examination. In female patients, a vaginal speculum should always be used to visualise the cervix and bimanual pelvic examination should be done. In patients with anorectal symptoms and in homosexual men, proctoscopy should be done to exclude anal canal pathology. Patients must be treated with the [...]

Foreign bodies in the colon and rectum are seen particularly among homosexual and bisexual men, having being introduced by the patient or his partner. The patient often presents after attempts to recover the object have failed. Urethral, vaginal or rectal foreign bodies may produce a variety of local symptoms. Specific questions about prescribed and non-prescribed [...]

The following aspects of the patient’s sexual history should be explored: What recent sexual contacts including regular partners, casual partners, prostitutes etc. has the patient had? Has the patient ever had homosexual contacts? If contacts have included homosexual encounters, what form did the encounters take? Did a partner have STD or was a partner in [...]