Kumar & Clark's clinical medicine

1303 Pages·2012·72.26 MB·English

by  Parveen J Kumar

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Clinical
Medicine
Eighth Edition
For Elsevier
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Content Development Specialists: Alison Whitehouse/Ailsa Laing
Project Manager: Lucy Boon
Designer/Design Direction: Stewart Larking
Illustration Manager: Jennifer Rose
Illustrators: Richard Morris, Ethan Danielson
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Clinical
Medicine
Eighth Edition
Edited by
Professor Parveen Kumar

CBE BSc MD DM(HC) FRCP(L&E) FRCPath
Professor of Medicine and Education, Barts and The London School of Medicine and Dentistry,
Queen Mary University of London, and Honorary Consultant Physician and Gastroenterologist,
Barts Health NHS Trust and Homerton University Hospital NHS Foundation Trust, London, UK
Dr Michael Clark
MD FRCP
Honorary Senior Lecturer, Barts and The London School of Medicine and Dentistry,
Queen Mary University of London and Princess Grace Hospital, London, UK
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2012
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the Publisher (other than as may be noted herein).
Eighth Edition 2012
Seventh Edition 2009
Sixth Edition 2005
Fifth Edition 2002
Fourth Edition 1998
Third Edition 1994
Second Edition 1990
First Edition 1987
ISBN 978-0-7020-4499-1
International ISBN 978-0-7020-4500-4
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A catalogue record for this book is available from the British Library
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A catalog record for this book is available from the Library of Congress
Notice
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.
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Contents v
Contents
Online contents vii
Contributors ix
International Advisory Panel xii
Preface to the Eighth Edition xiv
Acknowledgements xv
1. Ethics, law and communication 1
D Bowman and A Cushing
2. Molecular cell biology and human genetics 17
DP Kelsell, C Byrne and KJ Linton
3. The immune system and disease 49
M Peakman
4. Infectious diseases, tropical medicine and
sexually transmitted infections 73
PJ Moss, WL Irving and J Anderson
5. Nutrition 195
M Elia
6. Gastrointestinal disease 229
J Lindsay, L Langmead and SL Preston
7. Liver, biliary tract and pancreatic disease 303
AK Burroughs and D Westaby
8. Haematological disease 371
MF Murphy, JS Wainscoat and KJ Pasi
9. Malignant disease 431
CJ Gallagher, TA Lister and M Smith
10. Palliative medicine and symptom control 485
MJ Johnson, GE Eva and S Booth
11. Rheumatology and bone disease 493
M Shipley, A Rahman, D O’Gradaigh and R Conway
vi Contents
12. Kidney and urinary tract disease 561
MM Yaqoob
13. Water, electrolytes and acid–base balance 637
MM Yaqoob
14. Cardiovascular disease 669
AJ Camm and NH Bunce
15. Respiratory disease 791
AJ Frew and S Doffman
16. Critical care medicine 867
CJ Hinds, D Watson and RM Pearse
17. Drug therapy and poisoning 899
M Rawlins and A Vale
18. Environmental medicine 929
ML Clark and CRA Clarke
19. Endocrine disease 937
MJ Levy and TA Howlett
20. Diabetes mellitus and other disorders
of metabolism 1001
EAM Gale and JV Anderson
21. The special senses 1047
ML Harries, F Vaz, S Verma and RD Hamilton
22. Neurological disease 1067
P Jarman
23. Psychological medicine 1155
J Bourke and PD White
24. Skin disease 1193
DG Paige
Index 1237
Online Contents vii
Online Contents
w w w. s t u d e n t c o n s u l t .c o m
Kumar & Clark’s Clinical Medicine eighth edition can be fully (cid:2) Rabies Professor K N Viswanathan
accessed online via www.studentconsult.com. Follow the
(cid:2) Rheumatic fever Professor K N Viswanathan
instructions on the inside cover to access full text and illus-
trations, as well as additional features (listed below and (cid:2) Rift Valley fever Professor O. Khalafallah,
online under the ‘extras’ tab). These include 30 short chap- Dr A A K Jebriel, Dr M El Sadig, Dr M Mirghani,
ters written by members of our prestigious International Advi- Professor S S Fedail
sory Board. You will also be entitled to one year’s free online
(cid:2) Severe acute respiratory syndrome (SARS) Professor
access to Goldman’s Cecil Medicine 24th edition (2704
K N Lai
pages of major medical reference work).
(cid:2) Snake bite Professor Dr CA Gnanathasan, R Sheriff and
ONLINE CHAPTERS
Professor P Agrawal
Editor: Professor Janaka de Silva
(cid:2) Soil-transmitted helminths Professor NR de Silva
(cid:2) Arsenic poisoning Dr A K Kundu
(cid:2) Thrombotic thrombocytopenic purpura (TTP) associated
(cid:2) Brucellosis Professor S S Fedail with HIV Professor V J Louw
(cid:2) Cholera Professor K N Viswanathan (cid:2) Tropical sprue Professor S A Azer
(cid:2) Dengue fever Professor R Sood (cid:2) Vaccination for adults Professor R Dewan
(cid:2) Diarrhoeas including amoebiasis Professor S A Azer (cid:2) Vitamin B12 and folic acid deficiency Professor
(cid:2) Fluorosis Professor F S Hough V J Louw
(cid:2) Heat stroke and heat stress Professor S A Azer
INTERACTIVE SURFACE ANATOMY
(cid:2) HIV in resource-limited settings Professor M Mendelson
and Professor G Maartens From Drake et al: Gray’s Anatomy for Students
Over 40 interactive animations covering the seven body
(cid:2) HIV nephropathy Dr N Wearne regions, demonstrating major anatomical features, surface
landmarks and other palpable structures. We are grateful to
(cid:2) HIV-associated Immune Reconstitution Inflammatory
the authors of Gray’s Anatomy for Students for the opportu-
Syndrome (IRIS) Professor G Meintjes
nity to provide Kumar & Clark readers with the benefits of
(cid:2) IgA nephropathy Professor K N Lai this unique interactive learning tool.
(cid:2) Infections caused by Rickettsiae, Orientiae and Coxiella
Back
Dr R Premaratna
(cid:2) How to identify specific vertebral spinous processes
(cid:2) Leprosy Professor S A Kamath
(cid:2) Visualizing the inferior ends of the spinal cord and
(cid:2) Leptospirosis Professor K N Viswanathan subarachnoid space
(cid:2) Liver transplantation Dr J T Wells and Professor
Thorax
M R Lucey
(cid:2) How to count ribs
(cid:2) Malaria Professor S A Kamath and Professor (cid:2) Surface anatomy of the breast in women
NR de Silva
(cid:2) Visualizing structures at the T4/5 vertebral level
(cid:2) Neurology of toxins and envenoming Dr U K Ranawaka (cid:2) Visualizing structures in the superior mediastinum
(cid:2) Visualizing the margins of the heart
(cid:2) Non-communicable diseases in sub-Saharan Africa
(cid:2) Where to listen for heart sounds
Dr N Ntusi
(cid:2) How to visualize the pleural cavities and lungs
(cid:2) Pesticide and plant poisoning Professor J de Silva
(cid:2) Where to listen to right lung sounds
(cid:2) Pyogenic meningitis Dr S Shafqat and Dr A Zaidi (cid:2) Where to listen to left lung sounds
viii Online Contents
Pelvis and perineum (cid:2) Where to take peripheral arterial pulses in the head and
(cid:2) Identification of structures in the urogenital triangle of neck
women (cid:2) Testing eye movements – demonstration illustrating the
(cid:2) Identification of structures in the urogenital triangle of muscle involved in each activity.
men
ANIMATIONS OF PRACTICAL PROCEDURES
Abdomen A selection of key practical procedures created especially for
(cid:2) How to find the superficial inguinal ring Kumar & Clark.
(cid:2) How to determine lumbar vertebral levels (cid:2) Arterial cannulation
(cid:2) Visualizing structures at the LI vertebral level (cid:2) Arterial puncture
(cid:2) Visualizing the position of major blood vessels (cid:2) Bladder catheterization: female
(cid:2) Using abdominal quadrants to locate major viscera (cid:2) Bladder catheterization: male
(cid:2) Defining surface regions to which pain from the gut is (cid:2) Central venous catheterization (CVC): jugular vein
referred
(cid:2) Central venous catheterization (CVC): subclavian vein
(cid:2) Where to find the kidneys and spleen
(cid:2) Joint aspiration
(cid:2) Lumbar puncture
Lower limb
(cid:2) Venepuncture
(cid:2) Avoiding the sciatic nerve
(cid:2) Finding the femoral artery in the femoral triangle
HEART AND LUNG SOUNDS
(cid:2) Identifying structures around the knee
Ten pulmonary and 12 cardiac sounds which can be either
(cid:2) Visualizing the contents of the popliteal fossa
heard on their own or accompanied by an instructive narra-
(cid:2) Finding the tarsal tunnel
tive. This workshop has been prepared by Dr Salvatore Man-
(cid:2) Identifying tendons around the ankle and in the foot gione, and we are grateful for the opportunity to make it
(cid:2) Finding the dorsalis pedis artery available to readers of Kumar & Clark.
(cid:2) Identifying major superficial veins
(cid:2) CARDIAC AUSCULTATION:
(cid:2) Where to take peripheral arterial pulses in the lower
Opening snap
limb
Aortic regurgitation and systolic flow murmur
Pericardial friction rub
Upper limb
S3 gallop
(cid:2) Visualizing the axilla, its contents and related structures
Mid-systolic click
(cid:2) Locating the brachial artery in the arm
Patent ductus arteriosus
(cid:2) Locating the triceps brachii tendon and the position of
the radial nerve Early-systolic ejection sound
(cid:2) Identifying the cubital fossa and its contents Aortic stenosis
(cid:2) Identifying tendons and locating major vessels and S4 gallop
nerves in the distal forearm Mitral regurgitation
(cid:2) Identifying the position of the flexor retinaculum and the Aortic regurgitation
recurrent branch of the median nerve Mitral stenosis and opening snap
(cid:2) Visualizing the positions of the superficial and deep
(cid:2) PULMONARY AUSCULTATION:
palmar arches
Bronchial breath sounds
(cid:2) Where to take peripheral arterial pulses in the upper
Crackles
limb
Wheezes
Head and neck Vesicular breath sounds
(cid:2) Visualizing structures at the CIII/CIV and CVI vertebral Pleural friction rub
levels Bronchial breath sounds and late-inspiratory
(cid:2) How to outline the anterior and posterior triangles of the crackles
neck Late-inspiratory squeak
(cid:2) How to locate the cricothyroid ligament (membrane) Amphoric breath sounds
(cid:2) How to find the thyroid gland Whispered pectoriloquy
Contributors ix
Contributors
Jane Anderson BSc PhD MB BS Nicholas Harry Bunce BSc MB Sarah R Doffman MB ChB FRCP
FRCP BS MD Consultant Respiratory Physician,
Consultant Physician and Director, The Consultant Cardiologist, St George’s Brighton and Sussex University Hospitals
Centre for the Study of Sexual Health Healthcare NHS Trust, London, UK NHS Trust, Royal Sussex County
and HIV, Homerton University Hospital Cardiovascular disease Hospital, Brighton, UK
NHS Foundation Trust; Honorary Respiratory disease
Andrew Kenneth Burroughs MB
Professor, The Institute of Cell and
ChB(Hons) FEBG FEBTM Marinos Elia BSc(Hons) MD
Molecular Science, Barts and The
HonDSc(Med) FRCP FMedSci FRCP
London School of Medicine and
Vice President (Hepatology), British Professor of Clinical Nutrition and
Dentistry, Queen Mary University of
Society of Gastroenterology; Consultant Metabolism, Institute of Human Nutrition,
London, London, UK
Physician and Hepatologist and University of Southampton, and
Infectious diseases, tropical medicine and
Professor of Hepatology, University Consultant Physician, University Hospital
sexually transmitted infection
College Medical School, University Southampton NHS Foundation Trust,
John V Anderson MD MA MB BS College London, London, UK Southampton, UK
FRCP Liver, biliary tract and pancreatic disease Nutrition
Consultant Physician, Homerton
Carolyn Byrne PhD Gail Elizabeth Eva BSc MSc PhD
University Hospital NHS Foundation
Professor in Skin Biology, Centre for SROT
Trust and Barts Health NHS Trust;
Cutaneous Research, Blizard Institute, Research Fellow, Department of Brain
Honorary Senior Lecturer at Barts and
Barts and The London School of Repair and Rehabilitation, Institute of
The London School of Medicine and
Medicine and Dentistry, Queen Mary Neurology University College London,
Dentistry, Queen Mary University of
University of London. London, UK London, UK
London, London, UK
Molecular cell biology and human Palliative medicine and symptom control
Diabetes mellitus and other disorders of
genetics Anthony J Frew MA MD FRCP
metabolism
A John Camm MD FRCP Professor of Allergy and Respiratory
Sara Booth MD FRCP
Professor of Clinical Cardiology, Medicine, Brighton and Sussex Medical
Macmillan Consultant in Palliative
St George’s, University of London, School, Brighton and Sussex University
Medicine, Clinical Director of Palliative
London, UK Hospitals NHS Trust, Brighton, UK
Care, Palliative Care Service,
Cardiovascular disease Respiratory disease
Addenbrooke’s Hospital, Cambridge
University Hospitals NHS Foundation Michael L Clark MD FRCP Edwin AM Gale MB BChir FRCP
Trust, Cambridge; Honorary Visiting Honorary Senior Lecturer, Barts and Professor of Diabetic Medicine,
Senior Research Fellow and Hon Senior The London School of Medicine and University of Bristol, Bristol, UK
Lecturer, Department of Palliative Care Dentistry, Queen Mary University of Diabetes mellitus and other disorders of
and Policy, Kings College, London, UK London and Princess Grace Hospital, metabolism
Palliative medicine and symptom control London, UK
Christopher J Gallagher MB ChB
Environmental medicine
Julius Bourke MB BS MRCPsych PhD FRCP
Clinical Lecturer, Centre for Psychiatry, Charles Richard Astley Clarke Consultant Medical Oncologist,
Wolfson Institute of Preventive Medicine, FRCP St Bartholomew’s Hospital, Barts Health
Barts and The London School of Honorary Consultant Neurologist, NHS Trust, London, UK
Medicine and Dentistry, Queen Mary National Hospital for Neurology and Malignant disease
University of London; Consultant Neurosurgery, London, UK
Robin D Hamilton MB BS DM
Psychiatrist, Barts Health NHS Trust and Environmental medicine
FRCOphth
East London NHS Foundation Trust,
Richard Conway MB MRCPI Consultant Ophthalmologist, Moorfields
London, UK
Rheumatology Specialist Registrar, Eye Hospital, London, UK
Psychological medicine
Department of Rheumatology, St. The special senses
Deborah Bowman PhD James’ Hospital, Dublin, Ireland
Meredydd L Harries MB BS
Professor of Bioethics, Clinical Ethics Rheumatology and bone disease
FRCS MSc
and Medical Law, Division of Population
Annie Cushing BDS(Hons) PhD Consultant ENT Surgeon, Royal Sussex
Health Sciences and Education, St.
FDSRCS County Hospital, Brighton, UK
George’s, University of London, UK
Reader in Clinical Communication Skills, The special senses
Ethics, law and communication
Institute of Health Sciences Education,
Barts and The London School of
Medicine and Dentistry, Queen Mary
University of London, London, UK
Ethics, law and communication