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Gastrointestinal emergencies.
  1. T Wardle, Consultant Physician/Clinical Director and Clinical Sub Dean
  1. Countess of Chester Hospital, Liverpool Road, Chester CH2 1UL

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    By T C K Tham, J S A Collins. (£27.50.) London: BMJ Books, 2000. ISBN 0-727-91485-5.

    Gastoenterology has never really been considered a Cinderella specialty. Any emergencies associated with this specialty usually conjure vivid images of either haemorrhage or faeces, either separately or combined. This book, however, educates the uninitiated that there are many emergencies associated with the gastrointestinal tract and that these may present to either physicians or surgeons. Thus, the multidisciplinary approach to gastroenterology is a plus point for this book and is an important point that future potential authors should note.

    The book has been divided into three, convenient sections. The approach to specific presentations, complications of gastrointestinal procedures and specific conditions. This ensures that there is considerable repetition and cross referencing. Some readers may enjoy this approach while others, like me, find it frustrating. To the authors credit they have succeeded in their aim to write a book that is targeted at junior doctors. I am sure that this will also prove to be a very popular book with medical students and nurse practitioners specialising in gastroenterology. Each of the chapters is clearly broken down into short punchy paragraphs with clearly defined headings. It is however, unfortunate, that the same headings are not used consistently and I found this irritating and not conducive to easy reading. The book comprises of short succinct sections that could have been even shorter by more appropriate use of the English language. Although each chapter is thought provoking and will provide a focus for discussion there are certain omissions and factual inaccuracies Of these my major concern is the failure to mention airway management and oxygen therapy in the patient who is shocked, in particular, from a gastrointestinal haemorrhage. I was also surprised by the failure to see, or reference to the British Society of Gastroenterology guidelines.

    Overall I think that the authors have responded to a difficult challenge, to write a textbook about gastrointestinal emergencies. They have succeeded in part and I am sure that a future edition will be significantly improved. This will make it more attractive to the proposed market of junior doctors, emergency nurse practitioners and medical students as it will be not only a useful clinical aide memoire but also help with revision.

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