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Comprehensive Care of the Patient with Chronic Illness, An Issue of Medical Clinics of North America, E-Book

Comprehensive Care of the Patient with Chronic Illness, An Issue of Medical Clinics of North America, E-Book

Douglas S. Paauw

(2015)

Abstract

This issue of Medical Clinics of North America, Guest Edited by Douglas S. Paauw, MD is devoted to Comprehensive Care of the Patient with Chronic Illness. Dr. Paauw has assembled a group of expert authors to review the following topics:  Primary Care of the Homeless Patient; Primary Care of the Patient with Chronic Liver Disease; Primary Care of the Transplant Patient; Primary Care of the Patient with CRI; Primary Care of the Patient with Alcoholism; Primary Care of the Childhood Cancer Survivor; Primary Care of the Immigrant Patient; Primary Care of the HIV Patient; Primary Care of the Patient with Chronic Lung Disease; Primary Care of the Patient with Sarcoid; and Primary Care of the Patient with Inflammatory Bowel Disease.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Comprehensive Careof the Patient withChronic Illness i
Copyright\r ii
PROGRAM OBJECTIVE iii
TARGET AUDIENCE iii
LEARNING OBJECTIVES iii
ACCREDITATION iii
DISCLOSURE OF CONFLICTS OF INTEREST iii
UNAPPROVED/OFF-LABEL USE DISCLOSURE iii
TO ENROLL iv
METHOD OF PARTICIPATION iv
CME INQUIRIES/SPECIAL NEEDS iv
MEDICAL CLINICS OF NORTH AMERICA\r v
FORTHCOMING ISSUES v
November 2015 v
January 2016 v
March 2016 v
RECENT ISSUES v
July 2015 v
May 2015 v
March 2015 v
Contributors vii
CONSULTING EDITORS vii
EDITOR vii
AUTHORS vii
Contents xi
Foreword: Comprehensive Care of the Patient with Chronic Illness\r xi
Preface: Walking the Narrow Path—Managing the Patient with Chronic Medical Illnesses\r xi
Comprehensive Care of Patients with Chronic Liver Disease\r xi
Primary Care of the Patient with Chronic Kidney Disease\r xi
Primary Care of the Patient with Asthma\r xi
Primary Care of the Patient with Inflammatory Bowel Disease\r xii
Primary Care Management of Alcohol Misuse\r xii
Care of the Homeless Patient\r xii
Care of Adult Refugees with Chronic Conditions\r xii
Primary Care of the Childhood Cancer Survivor\r xiii
Primary Care of the Solid Organ Transplant Recipient\r xiii
Primary Care of the Human Immunodeficiency Virus Patient\r xiii
The Management of Sarcoidosis: A Primary Care Approach\r xiii
Foreword\r xv
REFERENCES xvi
Preface\r xvii
Comprehensive Care of Patients with Chronic Liver Disease 913
Key points 913
INTRODUCTION 914
CHRONIC LIVER DISEASE AT ANY STAGE: MANAGEMENT GOALS 914
Harm Reduction 914
Transmission 914
Weight, exercise, and nutrition 915
Alcohol and tobacco 916
Screening and immunizations 916
Bone disease 916
Surgical risk 917
Medication management 918
MONITORING 920
Progression to Cirrhosis 920
Hepatocellular Carcinoma 922
Treatment of Associated Conditions 922
SPECIFIC MANAGEMENT OF CIRRHOSIS AND ITS COMPLICATIONS 922
Ascites 922
Evaluation of new ascites 922
Basic management of ascites 923
Management of tense or refractory ascites 923
VARICES 924
Primary Variceal Prophylaxis 925
Secondary Prophylaxis of Variceal Bleeding 926
HEPATIC ENCEPHALOPATHY 927
HEPATOCELLULAR CARCINOMA 929
PROGNOSIS, LIVER TRANSPLANTATION, AND PALLIATIVE CARE 929
Prognosis in Patients with Chronic Liver Disease 929
LIVER TRANSPLANTATION 930
PALLIATIVE AND END-OF-LIFE CARE IN PATIENTS WITH CHRONIC LIVER DISEASE 930
SUMMARY 930
REFERENCES 930
Primary Care of the Patient with Chronic Kidney Disease 935
Key points 935
BACKGROUND 936
EPIDEMIOLOGY 936
NATURAL HISTORY 937
Mortality 937
Progression to End-Stage Renal Disease 938
EVALUATION 938
Screening 939
New Diagnosis 939
ASSESSING RENAL DYSFUNCTION 940
Glomerular Filtration Rate 940
Proteinuria 941
Other Laboratory Studies 941
TREATMENT 942
Renin-Angiotension-Aldosterone System Inhibition 943
Risk Factor Modification 944
COMPLICATIONS 946
Anemia 946
Metabolic Acidosis 947
Chronic Kidney Disease-Mineral and Bone Disorder 947
WHEN TO REFER 947
SUMMARY 948
REFERENCES 948
Primary Care of the Patient with Asthma 953
Key points 953
BACKGROUND 953
RISK FACTORS 954
Occupational Exposure 954
Smoking and Second-Hand Smoke 954
Female Sex 954
Obesity 955
Other Risk Factors, Including Infection 955
DIAGNOSIS OF ADULT-ONSET ASTHMA 955
Patient History and Physical Examination 955
Imaging and Additional Testing 956
MANAGEMENT OF ADULT-ONSET ASTHMA 957
Management Goals 957
Nonpharmacologic Strategies 957
Pharmacologic Strategies 958
Short-acting β2-agonists 958
Inhaled corticosteroids 958
Long-acting β2-agonists 959
Oral corticosteroids 959
Inhaled anticholinergic agents 959
Leukotriene receptor antagonists 959
Theophylline 960
EVALUATION, ADJUSTMENT, AND RECURRENCE 960
Treating Asthma Exacerbations 961
“Difficult-to-Control” Disease and Indications for Referral 961
COMPLICATIONS OF OBSTRUCTIVE LUNG DISEASE 961
Weight Loss and Cachexia 961
Osteoporosis 962
Hypoxemia 962
SUMMARY 963
REFERENCES 963
Primary Care of the Patient with Inflammatory Bowel Disease 969
Key points 969
INTRODUCTION 969
DEMOGRAPHICS 970
Primary Care Management of Alcohol Misuse 989
Key points 989
INTRODUCTION 989
DEFINITIONS, EPIDEMIOLOGY, AND CONSEQUENCES OF ALCOHOL MISUSE 990
Definitions 990
Alcohol misuse 990
Alcohol use disorder 990
Epidemiology 990
Harms of Alcohol Misuse 994
Benefits of Alcohol 994
MANAGEMENT OF SELECTED CONDITIONS IN PATIENTS WITH ALCOHOL MISUSE 995
Insomnia 995
Pain 996
Psychiatric Comorbidity 997
Hypertension 997
Abdominal Pain and Alcoholic Liver Disease 998
Osteoporosis 998
Malnutrition, Wernicke Encephalopathy 999
Anemia 999
SCREENING FOR ALCOHOL MISUSE 999
Routine Screening 999
Alcohol Assessment 1001
MANAGEMENT OF ALCOHOL MISUSE 1001
Brief Intervention: Alcohol Counseling in Primary Care 1002
The evidence 1002
Conducting brief alcohol intervention 1003
Additional Treatments for Alcohol Use Disorder 1003
Mutual-help groups and specialty behavioral treatment 1003
Pharmacotherapy 1003
Medical management of alcohol withdrawal 1005
Follow-up evaluation and managing patients in remission 1006
SUMMARY: ALCOHOL CARE IN PRIMARY CARE 1007
REFERENCES 1008
Care of the Homeless Patient 1017
Key points 1017
INTRODUCTION 1017
CLINIC VISIT 1018
SPECIFIC MANAGEMENT 1021
Diabetes Mellitus 1021
Hypertension 1021
Cardiovascular Disease 1022
Lung Disease 1022
Hepatitis and Chronic Liver Disease 1022
Human Immunodeficiency Virus 1023
Outbreaks and Infestations 1024
Mental Health 1026
Trauma and Injuries 1027
Substance Use Disorders 1028
Chronic Pain 1029
Preventive Services 1030
SPECIFIC POPULATIONS 1032
Women and Children 1032
Teens 1033
Older Adults and Elders 1033
Veterans 1033
Lesbian, Gay, Bisexual, and Transgender 1033
FUTURE DIRECTIONS 1034
Housing 1034
Medical Respite 1034
Palliative Care 1034
Alternative Approaches to Primary Care for Homeless Patients 1034
SUMMARY 1035
REFERENCES 1035
Care of Adult Refugees with Chronic Conditions 1039
Key points 1039
INTRODUCTION 1039
THE IMPORTANCE OF USING A TRAINED INTERPRETER 1041
A BRIEF DESCRIPTION OF THE OVERSEAS EVALUATION 1042
THE DOMESTIC EVALUATION OF ADULTS 1042
Tuberculosis 1043
Chronic Parasitic Worm Infections 1043
Hepatitis B Infection 1044
MENTAL HEALTH 1044
Detection and Treatment 1045
Survivors of Torture 1046
Somatization and Chronic Pain 1048
CHRONIC NONCOMMUNICABLE DISEASES 1048
Hypertension 1049
Diabetes 1049
SUMMARY 1053
ACKNOWLEDGMENTS 1053
SUPPLEMENTARY DATA 1053
REFERENCES 1053
FURTHER READINGS 1057
GENERAL MEDICAL CARE FOR THE REFUGEE PATIENT 1057
CROSS-CULTURE MEDICINE 1057
OVERSEAS AND DOMESTIC EVALUATION FOR US REFUGEES 1057
MANAGEMENT OF LATENT TUBERCULOSIS 1058
FEMALE GENITAL CUTTING 1058
SURVIVORS OF TORTURE 1058
Primary Care of the Childhood Cancer Survivor 1059
Key points 1059
CASE 1059
INTRODUCTION 1059
HISTORY 1060
MANAGEMENT GOALS 1060
RECURRENCE AND SUBSEQUENT MALIGNANCIES 1061
LATE EFFECTS 1063
Physical 1063
Cognitive 1067
Psychosocial 1070
PREVENTIVE CARE 1070
SUMMARY 1071
CASE REVISITED 1071
ACKNOWLEDGMENT 1071
REFERENCES 1072
Primary Care of the Solid Organ Transplant Recipient 1075
Key points 1075
INTRODUCTION 1075
INITIAL ASSESSMENT OF THE SOLID ORGAN TRANSPLANT RECIPIENT 1076
History-Taking Elements 1077
Basic data 1077
Laboratory data 1077
Status of the transplanted organ 1077
Rejection 1077
Infectious complications 1077
Medications 1078
Other Medical History 1080
Systemic illnesses that lead to transplantation 1080
Other complications common to solid organ transplant recipients 1080
Chronic kidney disease 1080
Hypertension 1080
Metabolic complications 1080
Review of Systems 1081
Physical Examination 1081
FOLLOW-UP VISITS 1081
Routine Follow-up 1081
Visits for Medical Conditions or Symptoms 1081
Organ-specific Issues 1082
Kidney transplantation 1082
Pancreas transplantation 1082
Liver transplantation 1082
Heart transplantation 1082
Lung transplantation 1083
When to Consult with Transplant Team/Specialist 1083
PREVENTIVE HEALTH IN SOLID ORGAN TRANSPLANT RECIPIENTS 1083
Immunizations 1083
General considerations 1083
Cancer Screening 1086
Colorectal, breast, prostate, and lung cancer screening 1086
Cervical cancer screening 1086
Skin cancer screening 1087
Bone Density Screening 1087
Substance Use 1087
Exposures 1087
Pregnancy 1088
Mental Health 1088
Screening for Metabolic and Other Conditions 1088
MEDICATIONS: INTERACTIONS AND SIDE EFFECTS 1088
Medication History 1089
Calcineurin inhibitors 1089
Mycophenolate 1089
Prednisone 1092
Azathioprine 1092
Mammalian target of rapamycin inhibitors 1092
Drug interactions 1092
INFECTIOUS COMPLICATIONS IN SOLID ORGAN TRANSPLANT RECIPIENTS 1094
Early: Immediate Posttransplant to 1 Month 1094
Nosocomial infections 1094
Donor-derived infections 1095
Common recipient colonizers 1095
Mid: 1 to 6 Months After Transplantation 1095
Viral infection 1095
Bacterial infections 1095
Fungal infections 1096
Late: More than 6 Months After Transplantation 1096
COMMON INFECTIOUS SYNDROMES (CAP, UTI, DIARRHEA) 1096
Community-acquired Pneumonia 1096
Primary Care of the Human Immunodeficiency Virus Patient 1105
Key points 1105
INTRODUCTION 1105
MANAGEMENT GOALS 1106
Detection and Screening 1106
Goals of Antiretroviral Therapy 1106
Presence of Comorbidities 1107
Approach to the Patient 1110
Baseline Evaluation 1110
PHARMACOLOGIC STRATEGIES 1111
Antiretroviral Therapy 1111
Prevention of Opportunistic Infections 1111
Treatment of Comorbid Chronic Conditions 1111
Cardiovascular disease 1111
NONPHARMACOLOGIC STRATEGIES 1115
Screening and Preventive Care 1115
EVALUATION, ADJUSTMENT, AND RECURRENCE 1116
SUMMARY AND FUTURE CONSIDERATIONS 1119
REFERENCES 1119
The Management of Sarcoidosis 1123
Key points 1123
INTRODUCTION 1123
NATURAL HISTORY OF SARCOIDOSIS 1124
INITIAL EVALUATION 1124
FOLLOW-UP 1128
RESPIRATORY SYSTEM 1129
CARDIAC INVOLVEMENT 1133
NEUROLOGIC INVOLVEMENT 1135
RENAL INVOLVEMENT 1137
EYE INVOLVEMENT 1138
CUTANEOUS INVOLVEMENT 1139
OTHER MANIFESTATIONS 1140
LÖFGREN SYNDROME 1141
SINONASAL SARCOIDOSIS 1142
BONE DISEASE 1143
MISCELLANEOUS PRESENTATIONS 1143
TREATMENT 1144
SUMMARY 1147
REFERENCES 1147
Index 1149