Gastrointestinal disorders in AIDS:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1998
|
| Schriftenreihe: | Gastrointestinal endoscopy clinics of North America
8,4 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XVI S., S. 751 - 1011 |
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| 245 | 1 | 0 | |a Gastrointestinal disorders in AIDS |c Lawrence J. Brandt, guest ed. |
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Datensatz im Suchindex
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GASTROINTESTINAL DISORDERS IN AIDS
CONTENTS
Foreword xiii
Charles J. Lightdale
Preface xv
Lawrence J. Brandt
Overview of HIV and AIDS: Biology and Epidemiology
of the Virus 751
Robert S. Klein and Marc N. Gourevitch
HIV 1 infects mononuclear cells using the CD4+ molecule and the
chemical receptors of those cells. After a prolonged clinical latency
period, the ability to replace destroyed cells is outpaced by ongoing
cellular destruction, leading to the characteristic immunodeficiency
of AIDS and its opportunistic infections and neoplasms. In the
United States, the number of new cases of AIDS has diminished
in recent years, although in some groups, such as women, the
number of new cases continues to rise. In the developing world,
AIDS remains a pandemic of huge proportions. In the absence of
an effective vaccine, culturally appropriate efforts at education and
behavior modification offer the best hope of controlling AIDS.
Risk to the Health Care Worker of HIV Infection and
How to Minimize It 769
Raynard J. Cheung and Anthony J. DiMarino, }r
Occupational transmission of HIV fortunately is uncommon. The
risk of acquiring HIV depends on the mode of exposure, the body
fluid involved, and the source patient. Percutaneous injuries carry
GASTROINTESTINAL ENDOSCOPY
CLINICS OF NORTH AMERICA
VOLUME 8 • NUMBER 4 • OCTOBER 1998 vii
the greatest risk (approximately 0.3%), and blood is by far the
most important source of HIV to which the health care worker is
exposed. Universal precautions should be applied to all patients
in order to decrease the risk of occupational transmission of HIV.
Furthermore, a system must be designed to provide adequate as¬
sessment, counselling, and follow up for exposed health care per¬
sonnel. Postexposure prophylaxis must be tailored to the specific
exposure for each health care worker.
Oropharyngeal Lesions in AIDS 783
Richard M. Grimes and Gene C. Stevenson
Any physician who is treating HlV infected patients can expect to
deal with individuals who are or will be experiencing the physical
manifestations of the disease. Fortunately, most of these conditions
can be successfully treated; other cases have palliative treatments
that can improve quality of life and assist in pain reduction and
suffering. All patients with HIV need to be managed jointly
throughout their illnesses so that these patients do not receive
conflicting advice, prescriptions, and so forth. Also, patients benefit
from receiving care from the specialist that is most appropriate for
their condition. The physician or dentist working alone can often
help the patient; when they work together, however, optimum care
is likely the result.
Esophageal Disease in Patients with AIDS: Diagnosis
and Treatment 811
Maurizio Bonacini and Loren A. Laine
Patients with HIV infection often present with symptoms suggest¬
ing esophageal disease: these include odynophagia (pain with
swallowing), dysphagia (difficulty in swallowing), and retrosternal
chest pain. Esophageal symptoms rank second only to diarrhea in
frequency of gastrointestinal complaints among patients with
AIDS. Also, esophageal opportunistic infections have been associ¬
ated with a poor outcome, the mean survival after diagnosis being
less than 6 months in one study. Such short survival may be ex¬
plained by the underlying immunosuppression, as well as a de¬
crease in nutritional intake due to difficulty swallowing.
Gastric Disorders and Nutritional Management 825
Donald P. Kotler
Protein calorie malnutrition is a frequent complication of HIV and
AIDS. Malnutrition has been one of the most common AIDS
defining conditions recognized by the Centers for Disease Control
and Prevention. Proper nutritional management can have a positive
impact on the clinical course of HIV infected patients. Further
information is required in order to assign nutrition its proper prior
Vlii CONTENTS
ity in the clinical management of HIV infected individuals. The
use of gastrostomy feedings in patients with AIDS is similar to the
use of these feedings in other diseases.
Correlation of Intestinal Structure and Function in
HIV Infection 841
Safak Reka and Donald P. Kotler
The gastrointestinal tract has great importance in HIV infection
because of its role as a primary barrier to the external environment
and consequent need for effective immune function. Many factors
promote the development of diarrhea in HIV infected individuals.
Understanding the genesis of the symptom is key to formulating
effective therapy. Ultimate control of the problem depends on
preventing HIV replication and immune depletion, as well as
avoiding the development of opportunistic enteric infections in
patients with severe immune deficiency.
Evaluation of Diarrhea in HIV infected Patients 857
Douglas Simon
Diarrhea is a major problem for patients infected with HIV: initial
studies indicated that 50% of HIV seropositive patients developed
diarrhea, but this may be an underestimate. Diarrhea has an appre¬
ciable adverse affect on the quality of life of these patients; also,
they use more health care facilities and health care dollars than
HIV positive patients without diarrhea. Individuals who have ho¬
mosexuality or bisexuality as their HIV risk factor are more likely
to have diarrhea and to have an enteric pathogen identified as the
cause of diarrhea than are patients who have heterosexuality or
intravenous drug use as their risk factor.
Small Intestine Pathogens in AIDS: Conventional
and Opportunistic 869
Johannes Koch and Robert L. Owen
The small intestine, coming in direct contact with ingested potential
pathogens, depends on active mucosal immunity to withstand in¬
vasion and damage. In patients with AIDS and severe impairment
of immunoregulatory lymphocytes, proliferation of protozoal, vi¬
ral, bacterial, and fungal pathogens produces diarrhea and malab
sorption. When noninvasive tests of stool and blood fail to identify
responsible organisms, endoscopy can reveal mucosal lesions
which are suggestive if not diagnostic. Cryptosporidium, £. intesti
nalis, CMV, MAC, and other infections can be identified by intesti¬
nal biopsy quicker and often at lower overall cost than they can
be by culture.
CONTENTS ix
Diagnosis and Treatment of Colonic Disease in AIDS 889
Klaus E. Monkemiiller and C. Mel Wilcox
The colon is a frequent site of gastrointestinal complications in
patients with HIV infection, and these colonic disorders increase
in frequency as immunodeficiency worsens. The most common
clinical manifestations of colonic disease in AIDS are diarrhea,
lower gastrointestinal bleeding, and abdominal pain. Toxic mega
colon, intussuseption, typhlitis, idiopathic colonic ulcer, and pneu
matosis intestinalis also have been described. In the HlV infected
patient with preserved immunity, the most common cause of colitis
is bacterial, but as the degree of immunodeficiency worsens, oppor¬
tunistic pathogens (CMV, protozoa, mycobacteria, fungi) and neo¬
plasms become more frequent. The frequent use of antibiotics,
chemotherapeutic agents, and frequent hospitalization increase the
susceptibility to Clostridium difficule colitis. Endoscopy plays an
integral role in the management of many colonic disorders in AIDS.
Anorectal Pathology in AIDS 913
Harpreet S. Brar, Lester Gottesman, and
Christina Surawicz
Anorectal complaints are common in persons with AIDS and are
being seen increasingly because advances in therapy for HIV, such
as the new antiretroviral protease inhibitors, have resulted in longer
life expectancy for those with HIV infection. In the past, many
patients with HIV infection were seen at referral centers; now,
however, primary care physicians as well as gastroenterologists
and surgeons in the community are managing and caring for these
patients. For this reason, it is important for clinicians to recognize
the spectrum of anorectal disease in patients with AIDS, as well
as its appropriate evaluation and management.
Gastrointestinal Bleeding in AIDS 933
David A. Greenwald and Lawrence J. Brandt
Gastrointestinal (GI) bleeding is an uncommon manifestation of
AIDS despite the frequent involvement of the GI tract by infections,
malignancies, and a variety of other disorders. GI bleeding may
occur from a variety of causes, some specifically associated with
AIDS and others unrelated to immunocompromise; most patients
with AIDS who have lower GI bleeding have causes attributable
to AIDS specific lesions. Just as in an incompetent patient, an ag¬
gressive approach to diagnosis and treatment of GI bleeding in
AIDS patients is warranted.
HIV Related Hepatic Disease: When and Why to Biopsy 939
Michael A. Poles
Patients infected with HIV are susceptible to a variety of hepatic
processes that are related to immunosuppression or are associated
X CONTENTS
with the risk factors of homosexuality and parenteral drug use.
These processes present in a myriad of ways including fever, right
upper quadrant pain, and hepatomegaly, or simply as asymptom¬
atic elevations of liver tests. Care of these patients demands system¬
atic evaluation and treatment to ensure that morbidity and mortal¬
ity are minimized and quality of life and medical care costs are
optimized.
AIDS Related Biliary Tract Disease 963
John P. Cello
Increasingly, specialists caring for patients with AIDS have re¬
ported relatively small numbers of patients with biliary tract
disease. These conditions fall into three general categories:
(1) non HIV associated conditions of the bile duct, (2) acalculous
cholecystitis, and (3) AIDS cholangiopathy. Whatever the cause, a
sizable percentage of patients with AIDS are found to have abnor¬
mal biliary tract morphology. It is essential for the clinician first
to exclude biliary tract conditions such as gallstone disease and
then to clearly investigate those patients with clinical, biochemical,
or radiographic features suggestive of papillary stenosis. Patients
with AIDS associated papillary stenosis do respond symptomati
cally to ERCP sphincterotomy.
Laparoscopy in AIDS 975
Jill Canin Endres and Barry A. Salky
Surgical problems in the patient with HIV and AIDS are becoming
more commonplace as the incidence of HIV seropositivity increases
and patients with AIDS are living longer. Laparoscopic surgery is
being applied more frequently in the diagnosis and therapy of
these patients' problems as more surgeons become familiar with
the techniques. Although no prospectively randomized trials exist,
the benefits of the laparoscopic approach clearly have had an im¬
pact on the morbidity associated with surgery. The decreased peri
operative immune depression may benefit these patients, and risks
to the operative teams probably are lessened if basic tenets of
laparoscopic surgery are observed.
Cumulative Index 991
Subscription Information Inside back cover
CONTENTS xi |
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| spelling | Gastrointestinal disorders in AIDS Lawrence J. Brandt, guest ed. Philadelphia [u.a.] Saunders 1998 XVI S., S. 751 - 1011 txt rdacontent n rdamedia nc rdacarrier Gastrointestinal endoscopy clinics of North America 8,4 Estomac et intestin, maladies Sida AIDS (Disease) Complications and sequelae Gastrointestinal system Diseases Verdauungskanal (DE-588)4078786-2 gnd rswk-swf HIV-Infektion (DE-588)4203852-2 gnd rswk-swf Krankheit (DE-588)4032844-2 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content HIV-Infektion (DE-588)4203852-2 s Verdauungskanal (DE-588)4078786-2 s Krankheit (DE-588)4032844-2 s DE-604 Brandt, Lawrence J. Sonstige oth Gastrointestinal endoscopy clinics of North America 8,4 (DE-604)BV005455484 8,4 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008301755&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Gastrointestinal disorders in AIDS Gastrointestinal endoscopy clinics of North America Estomac et intestin, maladies Sida AIDS (Disease) Complications and sequelae Gastrointestinal system Diseases Verdauungskanal (DE-588)4078786-2 gnd HIV-Infektion (DE-588)4203852-2 gnd Krankheit (DE-588)4032844-2 gnd |
| subject_GND | (DE-588)4078786-2 (DE-588)4203852-2 (DE-588)4032844-2 (DE-588)4143413-4 |
| title | Gastrointestinal disorders in AIDS |
| title_auth | Gastrointestinal disorders in AIDS |
| title_exact_search | Gastrointestinal disorders in AIDS |
| title_full | Gastrointestinal disorders in AIDS Lawrence J. Brandt, guest ed. |
| title_fullStr | Gastrointestinal disorders in AIDS Lawrence J. Brandt, guest ed. |
| title_full_unstemmed | Gastrointestinal disorders in AIDS Lawrence J. Brandt, guest ed. |
| title_short | Gastrointestinal disorders in AIDS |
| title_sort | gastrointestinal disorders in aids |
| topic | Estomac et intestin, maladies Sida AIDS (Disease) Complications and sequelae Gastrointestinal system Diseases Verdauungskanal (DE-588)4078786-2 gnd HIV-Infektion (DE-588)4203852-2 gnd Krankheit (DE-588)4032844-2 gnd |
| topic_facet | Estomac et intestin, maladies Sida AIDS (Disease) Complications and sequelae Gastrointestinal system Diseases Verdauungskanal HIV-Infektion Krankheit Aufsatzsammlung |
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