Gastroenterology

Gastroenterology

Pathophysiology and Clinical Applications

First published on December 1, 1981

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  • Author: Harvey J. Dworken
  • eBook ISBN: 9781483192673

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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

Product details

  • No. of pages: 680
  • Language: English
  • Copyright: © Butterworth-Heinemann 1981
  • Published: December 1, 1981
  • Imprint: Butterworth-Heinemann
  • eBook ISBN: 9781483192673

About the Author

Harvey J. Dworken

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