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(BQ) Part 1 book Clinical medicine presents the following contents: Ethics, law and communication; molecular cell biology and human genetics; the immune system and disease; infectious diseases, tropical medicine and sexually transmitted infections; nutrition; gastrointestinal disease; liver, biliary tract and pancreatic disease; haematological disease.
Kumar & Clark’s Clinical Medicine Eighth Edition For Elsevier Senior Content Strategist: Pauline Graham 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 Kumar & Clark’s 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 © 2012 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) 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 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data 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 The Publisher Printed in Spain Working together to grow libraries in developing countries www.elsevier.com | www.bookaid.org | www.sabre.org The publisher’s policy is to use paper manufactured from sustainable forests Contents v Contents Online contents Contributors International Advisory Panel Preface to the Eighth Edition Acknowledgements Ethics, law and communication vii ix xii xiv xv D Bowman and A Cushing Molecular cell biology and human genetics 17 DP Kelsell, C Byrne and KJ Linton The immune system and disease 49 M Peakman Infectious diseases, tropical medicine and sexually transmitted infections 73 PJ Moss, WL Irving and J Anderson Nutrition 195 M Elia Gastrointestinal disease 229 J Lindsay, L Langmead and SL Preston Liver, biliary tract and pancreatic disease 303 AK Burroughs and D Westaby Haematological disease 371 MF Murphy, JS Wainscoat and KJ Pasi 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 M Shipley, A Rahman, D O’Gradaigh and R Conway 493 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 tu d e ntco nsult co m Kumar & Clark’s Clinical Medicine eighth edition can be fully accessed online via www.studentconsult.com Follow the instructions on the inside cover to access full text and illustrations, as well as additional features (listed below and online under the ‘extras’ tab) These include 30 short chapters written by members of our prestigious International Advisory Board You will also be entitled to one year’s free online access to Goldman’s Cecil Medicine 24th edition (2704 pages of major medical reference work) ONLINE CHAPTERS Editor: Professor Janaka de Silva Rabies Professor K N Viswanathan Rheumatic fever Professor K N Viswanathan Rift Valley fever Professor O Khalafallah, Dr A A K Jebriel, Dr M El Sadig, Dr M Mirghani, Professor S S Fedail Severe acute respiratory syndrome (SARS) Professor K N Lai Snake bite Professor Dr CA Gnanathasan, R Sheriff and Professor P Agrawal Soil-transmitted helminths Professor NR de Silva Arsenic poisoning Dr A K Kundu Thrombotic thrombocytopenic purpura (TTP) associated with HIV Professor V J Louw Brucellosis Professor S S Fedail Cholera Professor K N Viswanathan Dengue fever Professor R Sood Diarrhoeas including amoebiasis Professor S A Azer Fluorosis Professor F S Hough Tropical sprue Professor S A Azer Vaccination for adults Professor R Dewan Vitamin B12 and folic acid deficiency Professor V J Louw Heat stroke and heat stress Professor S A Azer HIV in resource-limited settings Professor M Mendelson and Professor G Maartens INTERACTIVE SURFACE ANATOMY IgA nephropathy Professor K N Lai From Drake et al: Gray’s Anatomy for Students Over 40 interactive animations covering the seven body regions, demonstrating major anatomical features, surface landmarks and other palpable structures We are grateful to the authors of Gray’s Anatomy for Students for the opportunity to provide Kumar & Clark readers with the benefits of this unique interactive learning tool Infections caused by Rickettsiae, Orientiae and Coxiella Dr R Premaratna Back HIV nephropathy Dr N Wearne HIV-associated Immune Reconstitution Inflammatory Syndrome (IRIS) Professor G Meintjes How to identify specific vertebral spinous processes Visualizing the inferior ends of the spinal cord and subarachnoid space Leprosy Professor S A Kamath Leptospirosis Professor K N Viswanathan Liver transplantation Dr J T Wells and Professor M R Lucey Malaria Professor S A Kamath and Professor NR de Silva Neurology of toxins and envenoming Dr U K Ranawaka Non-communicable diseases in sub-Saharan Africa Dr N Ntusi Pesticide and plant poisoning Professor J de Silva Pyogenic meningitis Dr S Shafqat and Dr A Zaidi Thorax How to count ribs Surface anatomy of the breast in women Visualizing structures at the T4/5 vertebral level Visualizing structures in the superior mediastinum Visualizing the margins of the heart Where to listen for heart sounds How to visualize the pleural cavities and lungs Where to listen to right lung sounds Where to listen to left lung sounds viii Online Contents Pelvis and perineum Identification of structures in the urogenital triangle of women Identification of structures in the urogenital triangle of men Abdomen How to find the superficial inguinal ring How to determine lumbar vertebral levels Visualizing structures at the LI vertebral level Visualizing the position of major blood vessels Using abdominal quadrants to locate major viscera Defining surface regions to which pain from the gut is referred Where to find the kidneys and spleen Lower limb Avoiding the sciatic nerve Finding the femoral artery in the femoral triangle Identifying structures around the knee Visualizing the contents of the popliteal fossa Finding the tarsal tunnel Identifying tendons around the ankle and in the foot Finding the dorsalis pedis artery Identifying major superficial veins Where to take peripheral arterial pulses in the lower limb Upper limb Visualizing the axilla, its contents and related structures Locating the brachial artery in the arm Locating the triceps brachii tendon and the position of the radial nerve Identifying the cubital fossa and its contents Identifying tendons and locating major vessels and nerves in the distal forearm Identifying the position of the flexor retinaculum and the recurrent branch of the median nerve Visualizing the positions of the superficial and deep palmar arches Where to take peripheral arterial pulses in the upper limb Head and neck Visualizing structures at the CIII/CIV and CVI vertebral levels How to outline the anterior and posterior triangles of the neck How to locate the cricothyroid ligament (membrane) How to find the thyroid gland Where to take peripheral arterial pulses in the head and neck Testing eye movements – demonstration illustrating the muscle involved in each activity ANIMATIONS OF PRACTICAL PROCEDURES A selection of key practical procedures created especially for Kumar & Clark Arterial cannulation Arterial puncture Bladder catheterization: female Bladder catheterization: male Central venous catheterization (CVC): jugular vein Central venous catheterization (CVC): subclavian vein Joint aspiration Lumbar puncture Venepuncture HEART AND LUNG SOUNDS Ten pulmonary and 12 cardiac sounds which can be either heard on their own or accompanied by an instructive narrative This workshop has been prepared by Dr Salvatore Mangione, and we are grateful for the opportunity to make it available to readers of Kumar & Clark CARDIAC AUSCULTATION: Opening snap Aortic regurgitation and systolic flow murmur Pericardial friction rub S3 gallop Mid-systolic click Patent ductus arteriosus Early-systolic ejection sound Aortic stenosis S4 gallop Mitral regurgitation Aortic regurgitation Mitral stenosis and opening snap PULMONARY AUSCULTATION: Bronchial breath sounds Crackles Wheezes Vesicular breath sounds Pleural friction rub Bronchial breath sounds and late-inspiratory crackles Late-inspiratory squeak Amphoric breath sounds Whispered pectoriloquy Contributors ix Contributors Jane Anderson BSc PhD MB BS FRCP Nicholas Harry Bunce BSc MB BS MD Consultant Physician and Director, The Centre for the Study of Sexual Health and HIV, Homerton University Hospital NHS Foundation Trust; Honorary Professor, The Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK Infectious diseases, tropical medicine and sexually transmitted infection Consultant Cardiologist, St George’s Healthcare NHS Trust, London, UK Cardiovascular disease John V Anderson MD MA MB BS FRCP Consultant Physician, Homerton University Hospital NHS Foundation Trust and Barts Health NHS Trust; Honorary Senior Lecturer at Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK Diabetes mellitus and other disorders of metabolism Sara Booth MD FRCP Macmillan Consultant in Palliative Medicine, Clinical Director of Palliative Care, Palliative Care Service, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge; Honorary Visiting Senior Research Fellow and Hon Senior Lecturer, Department of Palliative Care and Policy, Kings College, London, UK Palliative medicine and symptom control Julius Bourke MB BS MRCPsych Clinical Lecturer, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London; Consultant Psychiatrist, Barts Health NHS Trust and East London NHS Foundation Trust, London, UK Psychological medicine Deborah Bowman PhD Professor of Bioethics, Clinical Ethics and Medical Law, Division of Population Health Sciences and Education, St George’s, University of London, UK Ethics, law and communication Andrew Kenneth Burroughs MB ChB(Hons) FEBG FEBTM HonDSc(Med) FRCP FMedSci Sarah R Doffman MB ChB FRCP Consultant Respiratory Physician, Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Brighton, UK Respiratory disease Marinos Elia BSc(Hons) MD FRCP Vice President (Hepatology), British Society of Gastroenterology; Consultant Physician and Hepatologist and Professor of Hepatology, University College Medical School, University College London, London, UK Liver, biliary tract and pancreatic disease Professor of Clinical Nutrition and Metabolism, Institute of Human Nutrition, University of Southampton, and Consultant Physician, University Hospital Southampton NHS Foundation Trust, Southampton, UK Nutrition Carolyn Byrne PhD Gail Elizabeth Eva BSc MSc PhD SROT Professor in Skin Biology, Centre for Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London London, UK Molecular cell biology and human genetics Research Fellow, Department of Brain Repair and Rehabilitation, Institute of Neurology University College London, London, UK Palliative medicine and symptom control Anthony J Frew MA MD FRCP Professor of Clinical Cardiology, St George’s, University of London, London, UK Cardiovascular disease Professor of Allergy and Respiratory Medicine, Brighton and Sussex Medical School, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK Respiratory disease Michael L Clark MD FRCP Edwin AM Gale MB BChir FRCP A John Camm 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 Environmental medicine Professor of Diabetic Medicine, University of Bristol, Bristol, UK Diabetes mellitus and other disorders of metabolism Charles Richard Astley Clarke FRCP Consultant Medical Oncologist, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK Malignant disease Honorary Consultant Neurologist, National Hospital for Neurology and Neurosurgery, London, UK Environmental medicine Richard Conway MB MRCPI Rheumatology Specialist Registrar, Department of Rheumatology, St James’ Hospital, Dublin, Ireland Rheumatology and bone disease Annie Cushing BDS(Hons) PhD FDSRCS Reader in Clinical Communication Skills, 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 Christopher J Gallagher MB ChB PhD FRCP Robin D Hamilton MB BS DM FRCOphth Consultant Ophthalmologist, Moorfields Eye Hospital, London, UK The special senses Meredydd L Harries MB BS FRCS MSc Consultant ENT Surgeon, Royal Sussex County Hospital, Brighton, UK The special senses x Contributors Charles J Hinds FRCP FRCA Kenneth J Linton PhD Professor of Intensive Care Medicine, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, and Barts Health NHS Trust, London, UK Critical care medicine Professor of Protein Biochemistry, Centre for Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London London, UK Molecular cell biology and human genetics Trevor A Howlett MD FRCP T Andrew Lister MD FRCP FRCPath FMedSc Consultant Physician and Endocrinologist, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK Endocrine disease William L Irving MA MB BChir PhD MRCP FRCPath Professor of Virology, The University of Nottingham; Honorary Consultant Virologist, Nottingham University Hospitals NHS Trust, Nottingham, UK Infectious diseases, tropical medicine and sexually transmitted infection Paul Jarman MA MB BS(Hons) PhD Consultant Neurologist, The National Hospital for Neurology and Neurosurgery, London, UK Neurological disease Miriam J Johnson MD FRCP MRCGP MB ChB (Hons) Reader in Palliative Medicine, Hull York Medical School, The University of Hull Honorary Consultant to St Catherine’s Hospice and the Acute Scarborough and North East Yorkshire Health Care Trust, North Yorkshire, UK Palliative medicine and symptom control David P Kelsell PhD Professor of Human Molecular Genetics, Centre for Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London London, UK Molecular cell biology and human genetics Louise Langmead MRCP MD Consultant Gastroenterologist, Barts Health NHS Trust, The Royal London Hospital, London, UK Gastrointestinal disease Miles J Levy MD FRCP Consultant Physician and Endocrinologist, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK Endocrine disease James Lindsay PhD FRCP Consultant Gastroenterologist, Barts Health NHS Trust, Department of Gastroenterology, Endoscopy Unit, The Royal London Hospital, London, UK Gastrointestinal disease Emeritus Professor of Medical Oncology, St Bartholomew’s Hospital, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK Malignant disease Peter J Moss MB ChB MD FRCP DTMH Consultant in Infectious Diseases, Department of Infection and Tropical Medicine, and Director of Infection Prevention and Control and Deputy Medical Director, Hull and East Yorkshire Hospitals NHS Trust; Honorary Senior Lecturer, Hull York Medical School, UK Infectious diseases, tropical medicine and sexually transmitted infection Michael F Murphy MD FRCP FRCPath Professor of Blood Transfusion Medicine, University of Oxford; Consultant Haematologist, NHS Blood & Transplant and Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK Haematological disease Donncha O’Gradaigh MB PhD FFSEM FRCPI Consultant Rheumatologist, Department of Rheumatology, Waterford Regional Hospital, Ireland Rheumatology and bone disease David Paige MA MB BS FRCP Consultant Dermatologist, Barts Health NHS Trust; Honorary Senior Lecturer, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK Skin disease K John Pasi PhD MB ChB FRCP FRCPath FRCPCH Professor of Haemostasis and Thrombosis, Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, Queen Mary University of London and Barts Health NHS Trust, London, UK Haematological disease Mark Peakman MB BS BSc MSc PhD FRCPath Professor of Clinical Immunology, King’s College London School of Medicine; Honorary Consultant in Immunology, King’s College Hospital NHS Foundation Trust, London, UK The immune system and disease Rupert M Pearse FRCA FFICM MD Reader and Consultant in Intensive Care Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK Critical care medicine Sean L Preston BSc(Hons) PhD MBBS FRCP Consultant Gastroenterologist, Barts Health NHS Trust, The Royal London Hospital, London, UK Gastrointestinal disease Anisur Rahman MA PhD BM BCh FRCP Professor of Rheumatology, University College London; Honorary Consultant Rheumatologist, University College London Hospital, London, UK Rheumatology and bone disease Sir Michael Rawlins MD FRCP FMedSci Chairman, National Institute for Health and Clinical Excellence; Honorary Professor, London School of Hygiene and Tropical Medicine, London, UK Drug therapy and poisoning Michael Shipley MA MD FRCP Consultant Rheumatologist, University College Hospital, London, UK Rheumatology and bone disease Matthew Smith MA MD MRCP FRCPath Consultant Haemato-Oncologist, St Bartholomew’s Hospital, London, Barts Health NHS Trust, London, UK Malignant disease Allister Vale MD FRCP FRCPE FRCPG FFOM FAACT FBTS HonFRCPSG Director, National Poisons Information Service (Birmingham Unit) and West Midlands Poisons Unit, City Hospital, Birmingham; Honorary Professor, University of Birmingham, Birmingham, UK Drug therapy and poisoning Francis Vaz MB BS BSc(Hons) FRCS(ORL-HNS) Consultant ENT/Head and Neck Surgeon, Department of ENT/Head and Neck Surgery, University College London Hospital, London, UK The special senses ... of metabolism 10 01 EAM Gale and JV Anderson 21 The special senses 10 47 ML Harries, F Vaz, S Verma and RD Hamilton 22 Neurological disease 10 67 P Jarman 23 Psychological medicine 11 55 J Bourke... Al-Moslih Clinical Tutor, Department of Family Medicine, College of Medicine, University of Sharjah, Sharjah Professor J M Muscat-Baron Professor of Medicine, Clinical Dean, Department of Medicine, ... Chaudhry Division of Clinical Haematology, Department of Internal Medicine, University of the Free State, Bloemfontein Professor of Medicine, Department of Medicine, Faculty of Medicine, University