Gastroenterology

ContentsPrefaceAcknowledgmentsChapter 1. History Taking Ingastrointestinal Disease and Evaluation of Abdominal Pain History Taking Pain Anorexia and Weight Loss Regurgitation and Heartburn(Pyrosis) Dysphagia Nausea and Vomiting Distention of the Abdomen Jaundice Bowel Action, Character of Stools and Gastrointestinal Bleeding Anorectal Symptoms Emotional Background Family History Occupational History Habits Evaluating Abdominal Pain The Lower Right Quadrant The Lower Left Quadrant The Upper Left Quadrant The Upper Right Quadrant ConclusionChapter 22 A Survey of Gastrointestinal Hormonology Presumed Mechanism of Hormonal Action Established Gastrointestinal Hormones Secretin Cholecystokinin Gastrin Candidate Gastrointestinal Hormones Somatostatin Motilin Vasoactive Intestinal Polypeptide Enteroglucagon Pancreatic Polypeptide Gastric Inhibitory Polypeptide Chymodenin Enkephalins and Endorphins Putative Gastrointestinal Hormones Bulbogastrone Entero-oxyntin Historical Digression Selected References Discussion QuestionChapter3 The Esophagus Histology Extrinsic Neural Control Physiology Peristalsis TheLower Esophageal Sphincter The Aging Esophagus Symptoms of Esophageal Disease Dysphagia Odynophagia Heartburn Belching Bleeding Clinical Study of the Esophagus History and Physical Examination XRay Endoscopy Manometry Intraesophageal Monitoring of pH Acid Perfusion of the Esophagus(BernsteinTest) Esophageal Scintigraphy MotorDisorders of the Esophagus Reduced Resting Pressure in the Lower Esophageal Sphincter Increased Resting Pressures in the LES, With Failure to Relax (Achalasia) Aftera Swallow Esophagus(Diffuse Esophageal Spasm) Failure of Relaxation of the UpperEsophageal Sphincter(Cricopharyngealachalasia) Disturbances of Motility in the Hypopharynx and the Body of the Esophagus Miscellaneous Esophageal Disorders Neoplasms Carcinoma Leiomyoma Historical Digression Selected References Clinical Conference Clinical ConferenceChapter 4 Functional Characteristics of the Stomach Functional Histology and Physiology The Oxyntic Gland Area The Antral or Pyloric Gland Area The Regulation of Gastric Secretion The Cephalic Phase The Gastric Phase The Intestinal Phase The Effects of Other Hormones and Prostaglandins The Estimation of Gastric Acidity in Humans Measurement of Serum Gastrin Levels Gastric Motility Measurement of Gastric Emptying Historical Digression Selected References Discussion QuestionsChapter 5 Gastritis and Gastric Mucosal Hypertrophy Superficial and Erosive Gastritis Pathophysiology Pathology Symptoms and Course Treatment Management of Major Upper Gastrointestinal Hemorrhage Chronic Atrophic Gastritis Pathophysiology Pathology Symptoms Diagnosis Treatment Consequences of Chronic Atrophic Gastritis Gastric Mucosal Hypertrophy Pathology and Pathophysiology Symptoms Diagnosis Treatment Historical Digression Selected References Discussion QuestionChapter 6 The Pathophysiology of Pepticulcer Experimental Peptic Ulcers and Erosions Spontaneous Peptic Ulcers in Animals Induced Hypersecretion of Acid and Pepsinogen Induced Stress Induced Damage to the Gastric Mucosal Barrier Pathogenesis of Peptic Ulcer Classification of Peptic Ulcer Patients Pathology of Peptic Ulcer Symptoms Complicationsof BenignPeptic Ulcer Bleeding Perforation Gastric Retention The Special Problem of Gastric Ulcer Differential Diagnosis Risk of Future Cancer Therapeutic Approaches in Peptic Ulcer Previous Attitudes Present Attitudes Antisecretory Drugs Other Therapeutic Modalities Surgery for Peptic Ulcer Gastrojejunostomy Gastric Resection Vagotomy with Drainage Procedure Indications for Surgery in Peptic Ulcer Complications of GastricSurgery Historical Digression Selected References Clinical Conference 3 Clinical Conference 4Chapter 7 The Liver: Structure and Function AnatomicalConsiderations GrossDescription Histology Hepatic Function Plasma Proteins Cholesterol and Bile Acids Production of Phospholipids Transport of Bilirubin The Formation and Secretion of Bile Enzymes Produced at Hepatocytic Canalicular Membranes Enzymes Produced in the Hepatocyte The Aging Liver Historical Digression Selected References Discussion QuestionsChapter 8 Mechanisms and Diagnosis of Hepatic Disease Mechanisms of Acute Liver Disease Hepatocellular Disease Cholestatic Liver Disease Hepatic Disease of Vascular Origin Mechanisms of Chronic Hepatic Disease Slowly Resolving Hepatitis Persistent Chronic Hepatitis Lobular Chronic Hepatitis Active Chronic Hepatitis Cirrhosis of the Liver Hepatocellular Carcinoma Differential Diagnosis of Hyperbilirubinemia Extrahepatic Causes of Unconjugated Hyperbilirubinemia Familial Uptake and Conjugative Disorders of Bilirubin Metabolism Familial Disorders of Bilirubin Excretion Other Neonatal Disorders of Bilirubin Excretion Diagnostic Procedures in Hepatobiliary Disease Plain Abdominal Radiography Percutaneous Liver Biopsy Radionuclide Scanning of the Liver Oral Cholecystography Intravenous Cholangiography GrayScale Ultrasonography of the Liver,Gall Bladder, BileDucts, and Pancreas Computed Tomography of the Upper Abdomen Percutaneous Transhepatic Cholangiography Endoscopic Retrograde Cholangiopancreatography Peritoneoscopy Historical Digression Selected References Discussion QuestionsChapter 9 Complications of Advanced Liver Disease HepaticEncephalopathy Pathophysiology Pathology ClinicalPicture Laboratory Findings Management The Hepatorenal Syndrome Acute Tubular Necrosis Prerenal Azotemia Oliguric,Hyponaturic Azotemia Fulminant Hepatic Failure Pathology ClinicalPicture PrinciplesofTreatment Portal Hypertension and Esophageal Varices The Splenic Vein The Superior Mesenteric Vein The Portal Vein Hyperdynamic Inflow of Arterial Blood Consequences of Portal Hypertension Classification of Portal Hypertension Hemorrhage from Esophageal Varices Management of Variceal Hemorrhage Ascites Mechanism of Ascites Formation Consequences of Ascites Treatment of Ascites Historical Digression Selected References Discussion QuestionChapter 10 Agents Causing Acute Hepatitis Viruses History 1 History 2 The Viruses of Hepatitis Virus A Virus B Virus C(Non-A,Non-B) Ethyl Alcohol The Metabolism of Alcohol Metabolic Effects of Alcohol Pathologic Effects of Alcohol Pathogenesis of Alcoholic Hepatitis and Cirrhosis Diagnosis and Management of Alcoholic Liver Disease OtherChemicalAgents Why So Many Hepatotoxins? Pathways of Hepatic Metabolism of Chemical Agents Types of Hepatic Injury Diagnosis of Hepatotoxicity Management of Acute Toxic Hepatitis Management of Chronic Active Hepatitis Reye-Morgan-Baral(RMB)Syndrome Historical Digression Selected References Discussion QuestionChapter 11 Singular Forms of Cirrhosis of the Liver Wilson Disease Pathophysiology Diagnosis Therapy Hemochromatosis Normal Metabolism of Iron Idiopathic Hemochromatosis Secondary Hemochromatosis Alpha-1-Antitryps in Deficiency(AatD) Pathogenesis Clinical Picture Cystic Fibrosis Primary Biliary Cirrhosis(PBC) Pathogenesis Symptoms and Findings Treatment Course Selected References Discussion Questions Clinical Conference 5 Clinical Conference 6Chapter 12 The Biliary Tract The Bile Acids Lecithin and Cholesterol The Formation of Gallstones Cholesterol Gallstones Pigmentary Gallstones Inflammatory Diseases of the Gall Bladder Acute and Chronic Cholecystitis Diagnosis Treatment The Cholecystoses Primary Sclerosing Cholangitis Carcinoma of the Extrahepatic Biliary Tract Historical Digression Selected References Discussion Question Clinical Conference 7Chapter 13 The Pancreas: Physiology,Inflammations and Neoplasms Anatomy and Development Exocrine Physiology Pancreatic Enzymes The Control of Pancreatic Secretion The Measurement of Pancreatic Exocrine Function Other Methods of Detecting Pancreatic Abnormalities Inflammatory Diseases of the Pancreas Pathogenesis Pathology Symptoms and Signs:Acute Pancreatitis Symptoms and Signs:Chronic Pancreatitis Hereditary Pancreatic Disorders Diagnosis of Pancreatitis Treatment of Pancreatitis Prevention of Further Attacks of Pancreatitis Carcinoma of the Pancreas Symptoms and Signs Diagnosis Treatment Historical Digression Selected References Discussion ProblemChapter 14 The Small Intestine and Colon: Structure and Function Anatomy Embryology Epithelial Renewal MucosalProduction of Antibodies Intestinal Motility Intestinal Microflora Mechanisms of Intestinal Absorption The Transport of Electrolytes and Water Digestion and Absorption of Carbohydrates Digestion and Absorption of Proteins Digestion and Absorption of Fats Absorption of Water-soluble Vitamins Historical Digression Selected References Discussion QuestionChapter 15 Disorders of Intestinal Absorption Causes of Maldigestion Pancreatic Insufficiency Deficiency of Conjugated Bile Acids Due to Cholestasis, BacterialOvergrowth,or Hypomotility Low Intraduodenal pH Primary and Secondary Disaccharidase Deficiencies Causes of Malabsorption Celiac Spruce Refractory Sprues Tropical Sprue Appraisal of Patients with Absorptive Disorders History and Examination Serum Carotenoids Examination of the Stools for Fat Plain Abdominal Films The Xylose Tolerance Test Lactose and Sucrose Tolerance Tests Radioactive Breath Testing Folic Acid Determination Vitamin B12 Absorption Other Plasma Abnormalities in Malabsorption Barium Contrast Radiologic Studies Peroral Biopsy of Jejunal Mucosa Therapy of Malabsorption Syndromes Specific Therapy Exclusion Therapy Ameliorative Therapy Replacement Therapy Historical Digression Selected References Discussion Questions Clinical Conference 8 Clinical Conference 9Chapter 16 Diarrhea and Constipation: Mechanisms, Classification and Illustrations Diarrheal Disorders Classification of Diarrheas Bacterial Diarrheas Cholera Escherichia-coli-Induced Diarrheas Salmonellosis Shigellosis Campylobacterfetus Vibrio parahemolyticus Yersinia enterocolitica Clostridium perfringens(C.welchii) Staphylococcus aureus Clostridium difficile and Pseudomembranous Enterocolitis Viral Diarrheas Protozoan Diarrheas Factitial Diarrheas Radiation Enterocolitis Constipative Disorders Definition Aspects of Colonic Motility The Irritable Bowel Syndrome Hirschsprung Disease Idiopathic Constipation Complications of Chronic Constipation Historical Digression Selected References Discussion QuestionChapter 17 Inflammatory Bowel Disease Incidence and Distribution The Lesions Crohn Disease Ulcerative Colitis Etiological Cogitations Ulcerative Colitis Symptoms and Signs Crohn Disease Ulcerative Colitis Radiological Diagnosis of Inflammatory Bowel Disease Nonintestinal Manifestations of Inflammatory Bowel Disease Fever Cutaneous Complications Arthritis OcularLesions Liver and BiliaryTractInvolvement Anemia Failure of Growth and Development Urinary Tract Disorders The Course of Inflammatory Bowel Disease Crohn Disease Ulcerative Colitis Colonic Cancerin Inflammatory Bowel Disease Ulcerative Colitis Crohn Disease Therapeutic Approaches in Patients with Inflammatory Bowel Disease Glucocorticoids Sulfasalazine Immunosuppressive Agents Supportive Therapy Emotional Support Surgical Management Ileostomy Selected References Clinical Conference 10 Clinical Conference 11Chapter 18 Mesenteric Vascular and Angiodysplastic Disorders The Intestinal Microcirculation Concurrent Exchange in Villi Pathophysiology of Mesenteric and Angiodysplastic Vascular Disorders Pathology Symptoms and Signs of Mesenteric Ischemia and Necrosis Diagnosis Treatment of Mesenteric Vascular Diseases Selected References Discussion QuestionChapter 19 Diverticular Diseases of the Colon and Lower Small Intestine Diverticulosis of the Colon Pathogenesis Symptoms and Signs Diagnosis Treatment Meckel Diverticula Pathogenesis Symptoms Diagnosis Treatment Appendicitis Epidemiology Symptoms and Signs Diagnosis Treatment Historical Digression Selected References Clinical Conference 12Chapter 20 Polyps and Cancer of the Colon Colonic Polyps and Polyposis Syndromes Nonneoplastic Polyps Neoplastic(Adenomatous)Polyps Cancer of the Colon The Role of Diet in the Etiology of Colonic Cancer Pathology Symptoms and Diagnosis Treatment Selected References Clinical Conference 13 ClinicalcConference 14Appendix Clinical Conference DiscussionsIndex