Diabetes mellitus affects virtually every organ system in the body and the degree of organ involvement depends on the duration and severity of the disease, and other co-morbidities. Gastrointestinal (GI) involvement can present with esophageal dysmotility, gastro-esophageal reflux disease (GERD), gastroparesis, enteropathy, non alcoholic fatty liver disease (NAFLD) and glycogenic hepatopathy. Severity of GERD is inversely related to glycemic control and management is with prokinetics and proton pump inhibitors. Diabetic gastroparesis manifests as early satiety, bloating, vomiting, abdominal pain and erratic glycemic control. Gastric emptying scintigraphy is considered the gold standard test for diagnosis. Management includes dietary modifications, maintaining euglycemia, prokinetics, endoscopic and surgical treatments. Diabetic enteropathy is also common and management involves glycemic control and symptomatic measures. NAFLD is considered a hepatic manifestation of metabolic syndrome and treatment is mainly lifestyle measures, with diabetes and dyslipidemia management when coexistent. Glycogenic hepatopathy is a manifestation of poorly controlled type 1 diabetes and is managed by prompt insulin treatment. Though GI complications of diabetes are relatively common, awareness about its manifestations and treatment options are low among physicians. Optimal management of GI complications is important for appropriate metabolic control of diabetes and improvement in quality of life of the patient. This review is an update on the GI complications of diabetes, their pathophysiology, diagnostic evaluation and management.

Non-alcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease in developed countries because of the obesity epidemic. The disease increases liver-related morbidity and mortality, and often increases the risk for other comorbidities, such as type 2 diabetes and cardiovascular disease. Insulin resistance related to metabolic syndrome is the main pathogenic trigger that, in association with adverse genetic, humoral, hormonal and lifestyle factors, precipitates development of NAFLD. Biochemical markers and radiological imaging, along with liver biopsy in selected cases, help in diagnosis and prognostication. Intense lifestyle changes aiming at weight loss are the main therapeutic intervention to manage cases. Insulin sensitizers, antioxidants, lipid lowering agents, incretin-based drugs, weight loss medications, bariatric surgery and liver transplantation may be necessary for management in some cases along with lifestyle measures. This review summarizes the latest evidence on the epidemiology, natural history, pathogenesis, diagnosis and management of NAFLD.

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BACKGROUND: Fever is a burning issue in the tropics and the most common cause of morbidity. Quite frequently this fever goes undiagnosed because of many reasons like the lack of diagnostic facilities, insufficient epidemiological data available on causes of fever, and so on. This research study was aimed to find out the etiology and clinical markers of Acute Undifferentiated Febrile Illness [AUFI] among the rural population of Southern India. METHODOLOGY: This prospective, observational study was conducted at Government Villupuram Medical College and Hospital, a rural tertiary care centre in Tamil Nadu, India. Consecutive hospitalised adult patients [>16 years] with AUFI[5-14 days fever] were enrolled into the study from August 2010 to February 2012 [18 months].Upon enrollment, detailed history was recorded, physical examination done and basic blood tests including biochemical examination, smear study for malaria, blood cultures and serology for the commonly encountered infections were done according to study protocol. The patients were followed up until clinical recovery and convalescence. The data were entered in MS excel and analyzed using Epi-info software 2008 version. RESULTS: A total of 403 patients were included in the study . The distribution of AUFI included Malaria 133[33%], Typhoid 83[20.59%], Dengue 42[10.4%], Leptospirosis 25[6.2%], and other causes 36[8.9%] and unknown cause 84[20.84%].Malaria patients were significantly associated with jaundice, altered mentation, travel outside the district, elevated AST/ALT levels, thrombocytopenia and splenomegaly. Typhoid fever was associated with longer fever duration, abdominal pain, coated tongue, relative bradycardia, normal platelet counts and low leucocyte count. Dengue fever could be predicted by rash, pruritis, petechiae ,retro-orbital pain and low platelet counts. Leptospirosis patients showed significant association with conjunctival suffusion, muscle tenderness and subconjunctival hemorrhage. Weil's disease was noticeably rare. Conclusion: Post monsoon upsurge of AUFI should be anticipated and preventive measures at personal and community levels planned. Clinical prediction of AUFI is possible with proper physical examination and judicious use of laboratory.

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Introduction Histopathologists working in a district general hospital usually do not have a subspecialist interest in hepatology. Most district general hospitals have a gastroenterology service and local pathologists usually report liver biopsies. The Royal College of Pathologist (RCP) recommend that ‘as minimal acceptable practise’ a liver biopsy report should include the clinical diagnosis, biopsy size, overall architecture, degree of fibrosis, severity in chronic liver disease (staging/grading), a definitive diagnosis or discussion of the differential diagnosis. Appropriate negative findings (e.g. lack of iron overload or alpha-1-antitrypsin globules) should be documented in the report. Methods A retrospective analysis of all liver biopsies between January 2010 to February 2012 at two district general hospitals (Barnet and Chasefarm NHS trust) in North London was performed. Data was collected from medical records and electronic results. Our aim was to assess whether liver biopsies provided the clinician with adequate information about diagnosis. Results 107 liver biopsies were performed during this period under ultrasound guidance by a radiologist. Mean patient age was 62 years (Range 19 –90). The mean number of core biopsies per patient was 1.5 (range 1 – 6). 10.7% (10/107) of the report did not mention a clinical diagnosis. 30% (32/107) of the biopsy report did not have a definitive or a differential diagnosis about possible aetiology of underlying liver disease. However 98% (47/48) of patients with cancer had a diagnosis on histology. Only 53% (9/17) patients with chronic hepatitis had severity scoring (Ishak staging/grading). Conclusion About one third of liver biopsies did not have diagnosis or discussion about a differential diagnosis. This number goes up to 47.5% (28/59) if we exclude malignancies. 9/28 specimens were sent to a tertiary centre and reported by a liver pathologist who gave a definite or differential diagnosis in all cases. The mortality associated with percutaneous liver biopsy ranges between 0.13 and 0.33%. from an audit from UK district general hospital. With the advent of fibroscan there is less need to perform liver biopsies except in diagnosing malignancies or in hepatitis of unknown/unclear aetiology. From our study we conclude that non-cancer liver biopsies should be reported by pathologists with subspecialist interest in hepatology or the procedure should be performed in a tertiary hospital to give the clinician an accurate diagnosis to aid treatment. Disclosure of Interest None Declared.

were included. Exclusion criteria: outpatient and A&E attendances, telephone consultations. Results Between 2004 and 2011 the mean inpatient readmission rate for medical detoxification was 26.7% (484 readmissions, 1813 total admissions). On average 22.4% of medical and surgical inpatients were readmitted over the 7-year period (293 readmitted/1512 total admissions). Both the yearly readmission rate and percentage of patients requiring readmission increased by 589% and 689% respectively between 2004 and 2011, peaking in 2008e2009 predominantly due to an increase in patients readmitted once (four patients in 2004e2005 compared to 67 patients in 2008e2009). On average patients were readmitted 2.5 times for detoxification. The average period between readmissions was 9.4 months. 10% of patients were re-admitted for detoxification more than 5 times in this period (mode 6 readmissions, range 6e23 readmissions). Conclusion Admission rates for inpatient detoxification are high. However, <25% of patients require readmission and only a minority require more than five detoxifications, thereby reflecting the efficacy of the ASN and Alcohol Care Team in minimising revolving door patients and the economic cost incurred. We recommend that all general hospitals should offer this service to effectively manage alcohol misuse.Abstract PTU-261 Table 1 % Patients readmitted (absolute value/total patients) % Readmissions (absolute value/total admissions)