Gastroenterology - 1st Edition - ISBN: 9780409950212, 9781483192673

Gastroenterology

1st Edition

Pathophysiology and Clinical Applications

Authors: Harvey J. Dworken
eBook ISBN: 9781483192673
Imprint: Butterworth-Heinemann
Published Date: 1st December 1981
Page Count: 680
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Description

Gastroenterology is based on its predecessor volume ""The Alimentary Tract"" but the content has been rewritten almost completely. The scope has been expanded to account for major developments in the field of gastroenterology and in order to make the volume more useful to house officers and practicing physicians. The text is designed to be read first, and then summarized if desired with illustrated lectures and demonstrations. This book is organized into 20 chapters. These chapters cover updated gastroenterological topics as of 1982 including symptoms, diagnosis and treatment of diverticular diseases of the colon and lower small intestine; the incidence and distribution of inflammatory bowel diseases; and classification and pathological mechanism of diarrheal disorders. This book will of interest to house officers and practicing physicians.

Table of Contents


Contents

Preface

Acknowledgments

Chapter 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

Conclusion

Chapter 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 Question

Chapter3 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 Conference

Chapter 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 Questions

Chapter 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 Question

Chapter 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 4

Chapter 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 Questions

Chapter 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 Questions

Chapter 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 Question

Chapter 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 Question

Chapter 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 6

Chapter 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 7

Chapter 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 Problem

Chapter 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 Question

Chapter 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 9

Chapter 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 Question

Chapter 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 11

Chapter 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 Question

Chapter 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 12

Chapter 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 14

Appendix

Clinical Conference Discussions

Index

Details

No. of pages:
680
Language:
English
Copyright:
© Butterworth-Heinemann 1982
Published:
Imprint:
Butterworth-Heinemann
eBook ISBN:
9781483192673

About the Author

Harvey J. Dworken

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