Non-paracetamol causes of ALF often develop clinically over longer periods
of time, compared with paracetamol-induced ALF. Differentiation of ALF from decompensated chronic liver disease in such cases can be difficult (discussed in case 3). Emergency liver transplantation is life saving in selected cases of ALF, but this requires accurate prognostication. Many patients are treated medically www.selleckchem.com/screening/gpcr-library.html with multiorgan support. Both transplantation and multiorgan support are discussed with reference to the cases presented. “
“Dysphagia is common in the general population, and is generally due to either mechanical obstruction or dysmotility. Patient demographics and symptom evaluation are often useful in determining the likely cause, and guide subsequent investigation and management. Oropharyngeal dysphagia is usually caused by neurological conditions where treatment options are limited. Conversely, many of the esophageal causes of dysphagia are amenable to therapy. Gastroscopy is often the first test of choice, given its diagnostic and therapeutic potential, especially when mechanical causes are concerned. Esophageal motor function can be assessed by a Poziotinib molecular weight variety of techniques, ranging from radiology such as barium swallow, to dedicated motility tests such as manometry and impedance monitoring. The choice of test relies on the clinical
indication and the results should be interpreted in conjunction with the patients’ symptoms. High-resolution manometry with topography is now the new benchmark for motility studies. Several new techniques for motility testing have also become available, such as esophageal ultrasound and functional lumen imaging probe, but are currently limited to the research setting. Dysphagia, or difficulty in swallowing, affects up to 22% of patients in this website the primary care setting,1 and represents one of the most common reasons for referral to gastroenterologists. While the history is the most important part of clinical assessment, bedside assessment alone is often inadequate in achieving a diagnosis. Further testing is therefore usually required and may
include barium swallow, upper gastrointestinal endoscopy and, where available, esophageal manometry. More recently, several new tests have become available for esophageal motility assessment, although their utility in the clinical setting remains to be established. Nevertheless, these new techniques offer the opportunity to provide further insights into various motility disorders, thus to improve our understanding of these diseases and, hopefully, lead to identification of new therapeutic targets. This paper aims not only to review the current clinical and laboratory assessments of dysphagia but also the emerging techniques that have been developed recently that allow better understanding of esophageal motor function.