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14.2 Nutrition in pregnancy 2568 ESSENTIALS Nutritional requirements for healthy pregnancy vary according to a woman’s pre-​pregnancy nutritional state and her access to food during pregnancy: there is no unifying nutritional advice that is appro- priate for a...

14.20 Prescribing in pregnancy 2706 ESSENTIALS Many clinicians feel uncertain about prescribing for pregnant women. Despite well-​known examples of drugs that have caused serious adverse effects to the developing fetus, most medications can be used safely and ...

14.21 Contraception for women with medical diseases 2711 ESSENTIALS All women with underlying medical disorders should be given cor- rect advice regarding adequate contraception so that they can make informed choices regarding potential future pregnancies. The...

14.3 Medical management of normal pregnancy 2575 ESSENTIALS The global maternal mortality ratio fell by almost 50% between 1990 and 2015. In resource-​poor nations, provision of basic antenatal facilities with community healthcare workers, improved transport, ...

14.4 Hypertension in pregnancy 2583 ESSENTIALS High blood pressure (BP >140/​90 mm Hg) complicates approximately 10% of pregnancies and may be due to white coat hypertension, chronic hypertension, gestational hypertension, or pre-​eclampsia (de novo or superim...

14.5 Renal disease in pregnancy 2589 ESSENTIALS Pregnancy leads to extensive and complex physiological change in the kidney and renal system. Acute kidney injury—​The causes of acute kidney injury in preg- nancy are as those in the non​pregnant patient, but ad...

14.6 Heart disease in pregnancy 2597 ESSENTIALS Pregnancy is a vasodilator state in which plasma volume and car- diac output increase such that many symptoms and signs of cardiac disease can occur physiologically. Disproportionate symptoms or abnormal signs su...

14.7 Thrombosis in pregnancy 2606 ESSENTIALS Pregnancy and the puerperium are associated with a 10-​fold ­increase in the risk of venous thromboembolism, comprising deep vein throm- bosis and pulmonary embolism, compared to the non​pregnant state. Pulmonary em...

14.8 Chest diseases in pregnancy 2613 ESSENTIALS Respiratory changes in pregnancy include an increase in tidal volume and minute ventilation, leading to a primary respiratory alkalosis. During a normal and uncomplicated pregnancy many women ex- perience the se...

14.9 Liver and gastrointestinal diseases of pregnancy 2619 ESSENTIALS Liver diseases Pregnancy-​specific disorders that cause de novo abnormal serum liver tests in pregnancy include: Hypertension-​related liver diseases and pregnancy—​including pre-​ eclampsia...

15.1 Structure and function of the gastrointestinal tract 2721 15.1 Structure and function of the gastrointestinal tract Michael E.B. FitzPatrick and Satish Keshav† ESSENTIALS The gastrointestinal tract is a hollow tube stretching from the oral cavity through ...

15.10 Malabsorption 2875

15.10.1 Differential diagnosis and investigation of malabsorption 2875 15.10 Malabsorption CONTENTS 15.10.1 Differential diagnosis and investigation of malabsorption  2875 Alastair Forbes and Victoria Mulcahy 15.10.2 Bacterial overgrowth of the small intesti...

15.10.2 Bacterial overgrowth of the small intestine 2879 15.10.2  Bacterial overgrowth of the small intestine 2879 on the diagnosis and its response to treatment. There has until re­ cently been no overarching treatment for intestinal malabsorption itself. The...

15.10.3 Coeliac disease 2884 section 15  Gastroenterological disorders 2884 15.10.3  Coeliac disease Peter D. Mooney and David S. Sanders ESSENTIALS Coeliac disease is a common disorder of the small intestine in which storage proteins in dietary wheat, rye, an...

15.10.4 Gastrointestinal lymphomas 2892 section 15  Gastroenterological disorders 2892 15.10.4  Gastrointestinal lymphomas Kikkeri N. Naresh ESSENTIALS Primary gastrointestinal lymphoma is the most common extranodal lymphoma and is almost exclusively of non-​H...

15.10.5 Disaccharidase deficiency 2902 section 15  Gastroenterological disorders 2902 FURTHER READING Cellier C, et  al. (2000). Refractory sprue, coeliac disease, and enteropathy-​associated T-​cell lymphoma. Lancet, 356, 203–​8. De Leeuw RJ, et al. (2007). W...

15.10.6 Whipple’s disease 2909 15.10.6  Whipple’s disease 2909 Swallow DM (2003). Genetics of lactase persistence and lactose in­ tolerance. Annual Reviews in Genetics, 37, 197–​219. Swallow DM (2006). DNA test for hypolactasia premature. Gut, 55, 131. Tori AJ...