May 2011 Vol XXXV Issue 5

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Hepatic Encephalopathy: Are NH4 Levels and Protein Restriction Obsolete?

Peter Caruana, Neeral Shah

Measurement of plasma ammonia and restriction of dietary protein were once standard practice in the management of hepatic encephalopathy. Recent evidence, however, suggests that ammonia levels have little value in the diagnosis of hepatic encephalopathy. Furthermore, protein restriction may have adverse consequences in cirrhotic patients prone to malnutrition. With a review of the current literature, this article addresses these controversial issues and discusses current recommendations for the diagnosis and treatment of hepatic encephalopathy.


A Review of Postoperative Crohn’s Disease

Clyde A. Collins, Rachana Potru, Jesse Green

While surgical resection remains a mainstay of the treatment of Crohnís disease, postoperative recurrence of disease is common. Regardless of risk, all patients should undergo ileocolonoscopic surveillance at 6-12 months after surgery. This review will outline the current evidence for various medical therapies in the prevention of postsurgical recurrence and outline a management algorithm of these patients based on risk stratification.


Introducing Comprehensive Non-Surgical Anorectal Care to the Gastroenterology Fellowship Training Curriculum: The University of South Alabama Experience

Jack A. Di Palma

Anorectal disorders are common and are responsible for frequent complaints from patients presenting to gastroenterologists. Here we introduce a comprehensive fellowship training curriculum at the University of South Alabama.


Abdominal Tuberculosis

Peminda Cabandugama, Noah Pores, Richard C. Feldstein

This case illustrates the subtle and indefinable course of abdominal tuberculosis.

Departments Section

Book Reviews

A Medical Teacherís Manual for Success: Five Simple Steps

The obligation to teach is generally standard for medical school faculty; however, little formal training is provided in how to become a good teacher. A Medical Teacherís Manual for Success: Five Simple Steps has been written as resource to meet that need.

From the Pediatric Gastroenterology Literature

Can Risk of Bleeding from Esophageal Varices be Determined in Patients with Biliary Atresia?

Biliary atresia (BA) is the most common cause of liver transplant in infants, and such infants are at risk of gastrointestinal (GI) bleeding due to progressive portal hypertension and development of esophageal varices. The risk of GI bleeding in this patient population is unknown. The authors of this study attempted to determine the risk of GI bleeding in BA patients using surveillance endoscopy.