(BQ) Part 1 book Davidson''s essentials of medicine has contents: Good medical practice, ageing and disease, critical care and emergency medicine, infectious disease, clinical biochemistry and metabolism, kidney and urinary tract disease,... and other contents.
l Study smart wi Student Consult Editedby J.Alastair Innes A V Davidson's Essentials of n :::s Cl) Davidson’s Essentials of Medicine Davidson’s Medicine Essentials of 2nd Edition Edited by J Alastair Innes PhD FRCP(Ed) Consultant Physician and Honorary Reader in Respiratory Medicine, Western General Hospital, Edinburgh, UK With a contribution by Simon Maxwell PhD FRCP FRCP(Ed) FBPharmacolS FHEA Professor of Student Learning (Clinical Pharmacology and Prescribing), University of Edinburgh; Honorary Consultant Physician, Western General Hospital, Edinburgh, UK Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2016 © 2016 Elsevier Ltd All rights reserved No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher Details on how to seek permission, further information about the publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions This book and the individual contributions contained in it are protected under copyright by the publisher (other than as may be noted herein) First edition 2009 Second edition 2016 ISBN-13 978-0-7020-5592-8 International Edition ISBN-13 978-0-7020-5593-5 Ebook ISBN-13 978-0-7020-5595-9 Notices Knowledge and best practice in this field are constantly changing As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions To the fullest extent of the law, neither the publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein Printed in China Content Strategist: Laurence Hunter Content Development Specialist: The Helen Leng publisher’s Project Manager: policy is to use Anne Collett paper manufactured from sustainable forests Designer: Miles Hitchen Illustration Manager: Amy Faith Naylor Illustrator: TNQ Contents Sir Stanley Davidson Preface Acknowledgements Contributors to Davidson’s Principles and Practice of Medicine List of abbreviations Picture credits vi vii viii ix xiv xvi Good medical practice Ageing and disease Critical care and emergency medicine 19 Poisoning 33 Infectious disease 47 Clinical biochemistry and metabolism 139 Kidney and urinary tract disease 159 Cardiovascular disease 201 Respiratory disease 265 10 Endocrine disease 327 11 Diabetes mellitus 381 12 Gastrointestinal and nutritional disorders 413 13 Liver and biliary tract disease 475 14 Blood disease 519 15 Rheumatology and bone disease 561 16 Neurological disease 605 17 Skin disease 687 18 Therapeutics and prescribing 731 19 Interpreting key investigations 795 20 Laboratory reference ranges 809 Index 817 v Sir Stanley Davidson (1894–1981) Davidson’s Principles and Practice of Medicine was the brainchild of one of the great Professors of Medicine of the 20th century Stanley Davidson was born in Sri Lanka and began his medical undergraduate training at Trinity College, Cambridge; this was interrupted by World War I and later resumed in Edinburgh He was seriously wounded in battle, and the carnage and shocking waste of young life that he encountered at that time had a profound effect on his subsequent attitudes and values In 1930 Stanley Davidson was appointed Professor of Medicine at the University of Aberdeen, one of the first full-time Chairs of Medicine anywhere and the first in Scotland In 1938 he took up the Chair of Medicine at Edinburgh and was to remain in this post until retirement in 1959 He was a renowned educator and a particularly gifted teacher at the bedside, where he taught that everything had to be questioned and explained He himself gave most of the systematic lectures in Medicine, which were made available as typewritten notes that emphasised the essentials and far surpassed any textbook available at the time Principles and Practice of Medicine was conceived in the late 1940s with its origins in those lecture notes The first edition, published in 1952, was a masterpiece of clarity and uniformity of style It was of modest size and price, but sufficiently comprehensive and up to date to provide students with the main elements of sound medical practice Although the format and presentation have seen many changes in 21 subsequent editions, Sir Stanley’s original vision and objectives remain More than half a century after its first publication, his book continues to inform and educate students, doctors and health professionals all over the world vi Preface In the 63 years since Davidson’s Principles and Practice of Medicine was first published, the rapid growth in the understanding of pathophysiology, in the variety of available diagnostic tests and in the range of possible treatments has posed an increasing challenge to those seeking to summarise clinical medicine in a single textbook An inevitable consequence has been a parallel growth in the physical size of all the major textbooks, including Davidson Davidson’s Essentials of Medicine seeks to complement the parent volume by helping those who also need portable information to study on the move – whether commuting, travelling between training sites or during remote attachments and electives In this second edition, the entire content of Essentials has been comprehensively revised and updated to reflect the core content from Davidson, while retaining a size which can easily accompany readers on their travels Although the text is concise, every effort has been made to maximise the readability and to avoid dry and unmemorable lists; the intention has been to produce a genuine miniature textbook The text draws directly on the enormous depth and breadth of experience of the parent Davidson writing team and presents the essential elements in a format to suit hand luggage Key Davidson illustrations have been adapted and retained, and ‘added value’ sections include a chapter on ‘Interpreting key investigations’ and a fully updated chapter on ‘Therapeutics and prescribing’ describing the typical clinical use of the major drug groups In an age when on-line information is ever more accessible to doctors in training, most still agree that there is no substitute for the physical page when systematic study is needed With this book, we hope that the proven value of the parent Davidson can be augmented by making the essential elements accessible while on the move J.A.I Edinburgh vii Acknowledgements I am very grateful to the chapter authors of Davidson’s Principles and Practice of Medicine, without whom this project would have been impossible I would also like to acknowledge the invaluable contribution of the team of assistant editors who helped to sift and select the relevant information during preparation of the first edition: Kenneth Baillie, Sunil Adwani, Donald Noble, Sarah Walsh, Nazir Lone, Jehangir Din, Neeraj Dhaun and Alan Japp I remain indebted to Nicki Colledge and Brian Walker for inviting me to help create Essentials and for their support and guidance in the early stages Thanks also to Laurence Hunter, Helen Leng, Ailsa Laing and Wendy Lee at Elsevier for their constant support and meticulous attention to detail Finally, I would like to thank Hester, Ailsa, Mairi and Hamish for their encouragement and support during the gestation of this book, and to dedicate it to the memory of my father, James Innes, who worked with Stanley Davidson on the early editions of Davidson’s Principles and Practice of Medicine J.A.I Edinburgh viii Contributors to Davidson’s Principles and Practice of Medicine, 22nd Edition The core of this book is based on the contents of Davidson’s Principles and Practice of Medicine, with material extracted and re-edited to make a uniform presentation to suit the format of this book Although some chapters and topics have, by necessity, been cut or substantially edited, contributors of all chapters drawn upon have been acknowledged here in recognition of their input into the totality of the parent textbook Albiruni Ryan Abdul Razak Leslie Burnett MBBS PhD FRCPA MRCPI FHGSA Consultant Medical Oncologist, Princess Margaret Cancer Centre, Toronto; Assistant Professor, University of Toronto, Canada Consultant Pathologist, NSW Health, PaLMS Pathology North, Royal North Shore Hospital, Sydney; Clinical Professor in Pathology and Genetic Medicine, Sydney Medical School, University of Sydney, Australia Brian J Angus BSc DTM&H FRCP MD FFTM(Glas) Reader in Infectious Diseases, Nuffield Department of Medicine, University of Oxford; Director, Oxford Centre for Tropical Medicine, UK MFSEM DA(UK) Quentin M Anstee BSc MBBS Jenny I.O Craig MD FRCPE PhD MRCP(UK) Senior Lecturer, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne; Honorary Consultant Hepatologist, Freeman Hospital, Newcastle upon Tyne, UK Andrew W Bradbury BSc MBChB(Hons) MD MBA FEBVS(Hon) FRCSE Sampson Gamgee Professor of Vascular Surgery, Director of Quality Assurance and Enhancement, College of Medical and Dental Sciences, University of Birmingham, UK Mark Byers OBE FRCGP MCEM General Practitioner, Ministry of Defence, UK FRCPath Consultant Haematologist, Addenbrooke’s Hospital, Cambridge, UK Allan D Cumming BSc MD FRCPE Dean of Students, College of Medicine and Veterinary Medicine, University of Edinburgh, UK Graham Dark MBBS FRCP FHEA Senior Lecturer in Cancer Education, Newcastle University; Consultant Medical Oncologist, Freeman Hospital, Newcastle upon Tyne, UK ix Richard J Davenport FRCPE DM Consultant Neurologist, Royal Infirmary of Edinburgh and Western General Hospital, Edinburgh; Honorary Senior Lecturer, University of Edinburgh, UK Robert S Dawe MD FRCPE Consultant Dermatologist, Ninewells Hospital and Medical School, Dundee; Honorary Clinical Reader, University of Dundee, UK David Dockrell MD FRCPI FRCPG FACP Professor of Infectious Diseases, University of Sheffield, UK MD FRCPE Clinical Senior Lecturer in Photobiology, University of Dundee; Honorary Consultant Dermatologist, Ninewells Hospital and Medical School, Dundee, UK J Alastair Innes PhD FRCPE Consultant Physician, Western General Hospital, Edinburgh; Honorary Reader in Respiratory Medicine, University of Edinburgh, UK David E Jones MA BM BCh PhD FRCP Emeritus Professor, Sydney Medical School, University of Sydney, Australia Professor of Liver Immunology, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne; Consultant Hepatologist, Freeman Hospital, Newcastle upon Tyne, UK David R FitzPatrick MD FRCPE Peter Langhorne PhD FRCPG Michael J Field AM MD FRACP Consultant in Clinical Genetics, Royal Hospital for Sick Children, Edinburgh; Professor, University of Edinburgh, UK Jane Goddard PhD FRCPE Consultant Nephrologist, Royal Infirmary of Edinburgh; Part-time Senior Lecturer, University of Edinburgh, UK Neil R Grubb MD FRCP Consultant Cardiologist, Edinburgh Heart Centre; Honorary Senior Lecturer, University of Edinburgh, UK Phil Hanlon BSc MD MPH Professor of Public Health, University of Glasgow, UK Richard P Hobson PhD MCRP(UK), FRCPath Consultant Microbiologist, Leeds Teaching Hospitals NHS Trust; Honorary Senior Lecturer, Leeds University, UK x Sally H Ibbotson BSc(Hons) Professor of Stroke Care, University of Glasgow; Honorary Consultant, Royal Infirmary, Glasgow, UK Stephen M Lawrie MD(Hons) FRCPsych FRCPE(Hon) Head, Division of Psychiatry, School of Clinical Sciences, University of Edinburgh; Honorary Consultant Psychiatrist, Royal Edinburgh Hospital, UK John Paul Leach MD FRCPG FRCPE Consultant Neurologist, Institute of Neuroscience, Southern General Hospital, Glasgow; Honorary Associate Clinical Professor, University of Glasgow, UK Charlie W Lees MBBS FRCPE PhD Consultant Gastroenterologist, Western General Hospital, Edinburgh; Honorary Senior Lecturer, University of Edinburgh, UK D I A B E T E S M E L L I T U S • 11 an IV infusion of saline and/or dextrose plus insulin, 6 U/hr, and potassium as required Peri-operative management The management of patients with diabetes undergoing surgery requiring general anaesthesia is summarised in Figure 11.2 Postoperatively, IV insulin and fluids should be continued (containing appropriate dextrose, sodium and potassium), until the patient’s intake of food is adequate, when the normal regimen can be resumed Major operation/ prolonged fast Minor operation/ only one meal missed No HbA1c ≤ 64 mmol/mol (8%)? Yes Aim for ‘first on list’ Morning of surgery: Omit: • Oral antidiabetic drugs • Short-acting insulin Continue: • Long-acting insulin Start: • IV insulin • IV fluids (dextrose, Na, K) • Daily U & Es - Continue until eating and drinking On recovery: Resume normal treatment with first meal Stop IV treatment hr after meal Withhold metformin if eGFR < 50 Omit: • Oral antidiabetic drugs • Short-acting insulin Continue: • Long-acting insulin Insulin only if: • Glucose > 14 mmol/L • Unable to eat after surgery • Ketonuria or ketonaemia On recovery: Resume normal medication with first meal Reduce insulin dose if intake is reduced Fig 11.2 Management of diabetic patients undergoing surgery and general anaesthesia (Glucose of > 14 mmol/L = 250 mg/dL.) 398 11.9 Complications of diabetes Retinopathy, cataract Nephropathy Peripheral neuropathy Autonomic neuropathy Foot disease Impaired vision Renal failure Sensory loss, motor weakness Postural hypotension, GI problems (gastroparesis; altered bowel habit) Ulceration, arthropathy Macrovascular Coronary circulation Cerebral circulation Peripheral circulation Myocardial ischaemia/infarction Transient ischaemic attack (TIA), stroke Claudication, ischaemia If the infusion is prolonged, urea, electrolytes and urinary ketones should be checked daily Diabetes presenting through complications D I A B E T E S M E L L I T U S • 11 Microvascular/neuropathic Diabetic complications (Box 11.9) may be the presenting finding in a patient not known to have diabetes Around 20% of people with type diabetes have established complications at the time of diag nosis Patients presenting with hypertension or a vascular event should have coexistent diabetes excluded MANAGEMENT OF DIABETES Of new cases of diabetes, approximately 50% can be controlled ade quately by diet alone, 20–30% will need oral antidiabetic medication, and 20–30% will require insulin Regardless of aetiology, the choice of treatment is determined by the adequacy of residual β-cell func tion However, this cannot be determined easily by measurement of plasma insulin concentration because a level that is adequate in one patient may be inadequate in another, depending on sensitivity to insulin Ideal management allows the patient to lead a completely normal life, to remain symptom-free and to escape the long-term complications of diabetes The correct treatment may change with time as β-cell function is lost Diet and lifestyle Lifestyle changes, such as taking regular exercise, observing a healthy diet, reducing alcohol consumption and stopping smoking, are important but difficult for many to sustain Healthy eating Dietary measures are required in the treatment of all people with diabetes People with diabetes should have access to dietitians at diagnosis, at review and at times of treatment change Nutritional 399 D I A B E T E S M E L L I T U S • 11 advice should be tailored to individuals and take account of their age and lifestyle The aims are to improve glycaemic control, manage weight, and avoid both acute and long-term complications Carbohydrate Both the amount and type of carbohydrate determine post-prandial glucose The effect of a particular ingested carbohydrate on blood glucose relative to the effect of a glucose drink is termed the gly caemic index (GI) Starchy foods, such as rice, porridge and noodles, are favoured, as they have a low GI and produce only a gradual rise in blood glucose It is now possible to match the amount of carbo hydrate in a meal with a dose of short-acting insulin using methods such as DAFNE (dose adjustment for normal eating) This enables motivated individuals with type diabetes to achieve and maintain good glycaemic control, while avoiding post-prandial hyper- and hypoglycaemia For people with type diabetes, avoidance of refined carbohydrate and restriction of carbohydrate to 45–60% of total energy intake is recommended Fat The intake of total fat should be restricted to