CURRENT Diagnosis & Treatment Gastroenterology, Hepatology, & Endoscopy Book

Authors ix

Preface xiii

Section I General Concerns

1 Acute Abdominal Pain: Basic Principles and Current Challenges Frederick L. Makrauer Norton J. Greenberger 1

Acute Abdominal Pain in the Elderly Nonsurgical Disorders Simulating the Acute Abdomen 3

Evaluation of the Acute Abdomen 4

Acute Appendicitis 6

Unique Presentations of Appendicitis 8

2 Inflammatory Bowel Disease: Immunologic Considerations Richard S. Blumberg 11

General Principles of the Gut-Associated Lymphoid Tissues 12

Pathogenesis of Inflammatory Bowel Disease 14

Pathogenesis of Crohn Disease: Underlying Mechanisms of Immune Dysregulation 15

Pathogenesis of Ulcerative Colitis: Immunologic Factors 17

Regulatory Pathways in the Maintenance of Intestinal Tolerance 18

Therapeutic Implications of the Immunobiology of Inflammatory Bowel Disease 19

3 Inflammatory Bowel Disease: Medical Considerations Robert Burakoff Scott Hande 22

General Considerations 22

Clinical Findings 23

Differential Diagnosis 26

Complications 27

Treatment 28

Prognosis 33

4 Inflammatory Bowel Disease: Surgical Considerations Jennifer L. Irani Anthony Ramsanahie Ronald Bleday 34

Ulcerative Colitis 34

Crohn Disease 38

5 Acute Diarrheal Disorders Jerry S. Trier 45

Acute Diarrhea 45

Acute Diarrheal Disease Caused by Specific Infections 50

6 Mesenteric Ischemia Elena M. Stoffel Norton J. Greenberger 64

Mesenteric Ischemia 64

Acute Mesenteric Ischemia 65

Chronic Mesenteric Ischemia 71

7 Gastrointestinal and Biliary Complications of Pregnancy Jaya R. Agrawal Sonia Friedman 75

Gastroesophageal Reflux Disease 75

Nausea and Vomiting 78

Hyperemesis Gravidarum 79

Constipation81

Diarrhea 82

Hemorrhoids 82

Irritable Bowel Syndrome 83

Fecal Incontinence 85

Inflammatory Bowel Disease 85

Abdominal pain 88

Peptic Ulcer Disease 89

Biliary Disease 89

Pancreatitis 90

Appendicitis 91

Intestinal Obstruction, Pseudo-Obstruction, and Gastrointestinal Cancer 92

Endoscopy in Pregnancy 92

8 Hepatic Complications of Pregnancy Chinweike Ukomadu 98

Interpretation of Liver Biochemical Tests During Pregnancy 98

Hepatic Conditions Unique to Pregnancy 99

Conditions not Unique to Pregnancy 101

9 State-of-the Art Imaging of the Gastrointestinal System Koenraad J. Mortele 103

Gastrointestinal Tract Imaging 103

Liver Imaging 116

Biliary Imaging 121

Pancreatic Imaging 126

Summary of Current Recommendations 130

10 Gastrointestinal Manifestations of Immunodeficiency Zhenglun Zhu 131

General Considerations 131

Pathogenesis 131

Clinical Findings 133

Treatment 134

Section II Esophageal Diseases

11 Gastroesophageal Reflux Disease John R. Saltzman John M. Poneros 139

General Considerations 139

Clinical Findings 140

Complications 143

Treatment 143

Course and Prognosis 146

12 Barrett Esophagus John M. Poneros 148

General Considerations 148

Clinical Findings 149

Treatment 151

Course & Prognosis 153

13 Oropharyngeal & Esophageal Motility Disorders Raj K. Goyal Arun Chaudhury Hiroshi Mashimo 155

Oropharyngeal Dysphagia 155

Cricopharyngeal Achalasia & Cricopharyngeal Bar 157

Zenker Diverticulum 159

Globus Pharyngeus 159

Esophageal Motor Dysphagia 160

Gastroesophageal Reflux Disease 161

Esophageal Chest Pain 162

Disorders of Inhibitory Innervation 165

Disorders of Excitatory Nerves and Smooth Muscles 169

14 Eosinophilic Esophagitis Norton J. Greenberger 172

General Considerations 172

Pathogenesis 172

Clinical Findings 173

Differential Diagnosis 173

Treatment 173

Course & Prognosis 174

Unresolved Issues 174

Section III Diseases of the Stomach

15 Peptic Ulcer Disease Edward Lew 175

General Considerations 175

Pathogenesis 176

Clinical Findings 177

Differential Diagnosis 179

Complications 179

Treatment 179

16 Zollinger-Ellison Syndrome (Gastrinoma) Edward Lew 184

General Considerations 184

Pathogenesis 184

Clinical Findings 184

Treatment 187

Prognosis 188

17 Functional (Nonulcer) Dyspepsia Victor S. Wang Robert Burakoff 189

General Considerations 189

Pathogenesis 190

Clinical Findings 192

Differential Diagnosis 195

Treatment 196

Course & Prognosis 199

18 Disorders of Gastric and Small Bowel Motility Victor S. Wang Robert Burakoff 200

Gastroparesis & Chronic Intestinal Pseudo-Obstruction 201

Dumping Syndrome & Accelerated Gastric Emptying 208

Rapid Transit Dysmotility of the Small Bowel 209

19 Treatment of Obesity: The Impact of Bariatric Surgery Malcolm K. Robinson Norton J. Greenberger 210

Treatment of Overweight & Obese Patients 210

Indications for Bariatric Surgery 212

Bariatric Surgical Procedures 213

Postoperative Care & Complications 216

Gastroenterology Evaluation & Treatment 217

Long-Term Outcome of Bariatric Surgery 220

Recommendations & Caveats 221

Section IV Small Bowel Diseases

20 Intestinal Malabsorption Jerry S. Trier 223

Diseases Associated with Intraluminal Maldigestion 231

Diseases Associated with Impaired Mucosal Digestion & Absorption 232

Diseases Caused by Impairment of both Intraluminal Ingestion & Mucosaldigestion/Absorption 240

Diseases Caused by Impairedpostmucosal Transport 242

Section V Colorectal Diseases

21 Diverticular Disease of the Colon Anne C. Travis Richard S. Blumberg 243

Diverticulosis 243

Acute Diverticulitis 247

Diverticular Hemorrhage 252

22 Colorectal Cancer Screening Fay Kastrinos Sapna Syngal 256

Risk Stratification 257

Screening & Surveillance Recommendations 257

Screening Modalities 263

Novel Screening Modalities 266

Summary of Recommendations 268

23 Hereditary Gastrointestinal Cancer Syndromes Elena M. Stoffel Sapna Syngal 269

Hereditary Colorectal Cancer Syndromes 269

Hamartomatous Polyposis Syndromes 276

Other Gastrointestinal Cancer Syndromes 277

24 Irritable Bowel Syndrome Sonia Friedman 279

General Considerations 279

Pathogenesis 280

Clinical Findings 282

Differential Diagnosis 284

Complications 287

Treatment 287

Section VI Pancreatic Diseases

25 Acute Pancreatitis Vikesh Singh Darwin L. Conwell Peter A. Banks 291

General Considerations 291

Pathogenesis 292

Clinical Findings 292

Differential Diagnosis 297

Complications 297

Treatment 297

26 Chronic Pancreatitis Bechien Wu Darwin Conwell Peter Banks 299

General Considerations 299

Pathogenesis 299

Clinical Findings 300

Differential Diagnosis 302

Complications 302

Treatment 302

Course & Prognosis 304

27 Autoimmune Pancreatitis Norton J. Greenberger 305

General Considerations 305

Clinical Findings 305

Differential Diagnosis 308

Treatment 308

Course & Prognosis 309

28 Tumors of the Pancreas Ashish Sharma 310

Pancreatic Cancer 310

Cystic Neoplasms of the Pancreas 316

Pancreatic Lymphoma 319

Section VII Therapeutic Endoscopy & Novel Diagnostic Techniques

29 Polypectomy David L. Carr-Locke 321

Equipment 321

Polypectomy for Sessile Polyps 322

Polypectomy for Pedunculated Polyps 322

Endoscopic Mucosal Resection 323

Endoscopic Submucosal Dissection 323

30 Acute Upper Gastrointestinal Bleeding John R. Saltzman 324

Nonvariceal Bleeding 332

Less Common Causes of Nonvariceal Bleeding 338

Variceal Bleeding 339

31 Acute Lower Gastrointestinal Bleeding Linda S. Lee John R. Saltzman 343

Evaluation of Lower GI Bleeding 343

Specific Causes of Acute Lower GI Bleeding 348

32 Endoscopic Management of Acute Biliary & Pancreatic Conditions Christopher C. Thompson 352

Acute Cholangitis 352

Gallstone Pancreatitis 354

Bile Duct Injuries 355

Pancreatic Duct Injuries 356

Hemorrhagic Biliary & Pancreatic Conditions 358

33 Wireless Capsule Endoscopy & Double-Balloon Enteroscopy Anne C. Travis John R. Saltzman 361

Capsule Endoscopy 361

Double-Balloon Enteroscopy 368

34 Gastrointestinal Foreign Bodies Christopher C. Thompson 371

General Considerations 371

Clinical Findings 371

Treatment 372

35 Endoscopic Retrograde Cholangiopancreatography (ERCP) David L. Carr-Locke 377

Disorders of the Major Duodenal Papilla 377

Biliary System 379

Pancreas 383

36 Endoscopic Ultrasound Linda S. Lee 389

Cancer Staging 391

Nonmalignant Lesions 395

Therapeutic Endoscopic Ultrasound 399

Future Directions 401

Section VIII Liver Diseases

37 Approach to the Patient with Jaundice & Abnormal Liver Tests Norton J. Greenberger 403

General Considerations 403

Pathogenesis 403

Clinical Findings 403

Differential Diagnosis 406

38 Acute Liver Failure Jaya R. Agrawal Amir A. Qamar 410

Specific Causes of Acute Liver Failure 415

39 Viral Hepatitis Anna Rutherford Jules L. Dienstag 420

Hepatitis A 423

Hepatitis B 425

Hepatitis C 434

Hepatitis D 440

Hepatitis E 442

40 Chronic Nonviral Hepatitis Chinweike Ukomadu 444

Autoimmune Hepatitis 444

Wilson Diseas 448

α1-Antitrypsin Deficiency 450

41 Hereditary Hemochromatosis Bechien Wu Benjamin Smith Norman D. Grace 452

General Considerations 452

Pathogenesis 452

Clinical Findings 456

Treatment 459

Prognosis 459

42 Alcoholic Liver Disease Timothy T. Kuo Norman D. Grace 460

General Considerations 460

Pathogenesis 460

Clinical Findings 463

Differential Diagnosis 464

Complications 464

Treatment 464

Prognosis 466

43 Nonalcoholic Fatty Liver Disease David E. Cohen Frank A. Anania 467

General Considerations 467

Pathogenesis 468

Clinical Findings 469

Treatment 470

Course & Prognosis 472

44 Portal Systemic Encephalopathy & Hepatic Encephalopathy Norton J. Greenberger 473

General Considerations 473

Pathogenesis 473

Clinical Findings 474

Treatment 476

45 Ascites & Spontaneous Bacterial Peritonitis Norton J. Greenberger 478

Ascites 478

Spontaneous Bacterial Peritonitis 482

46 Hepatorenal Syndrome Norton J. Greenberger 485

General Considerations 485

Pathogenesis 485

Clinical Findings 486

Differential Diagnosis 486

Treatment 486

47 Portal Hypertension & Esophageal Variceal Hemorrhage Melissa A. Minor Norman D. Grace 489

Gastric Varices 498

Portal Hypertensive Gastropathy 499

Future Treatment Trends 499

48 Drug-Induced Liver Disease Willis C. Maddrey 500

Drugs of Special Interest 503

49 Liver Neoplasms Amir A. Qamar Chinweike Ukomadu 506

Benign Liver Tumors 506

Hepatocellular Carcinoma 510

Cholangiocarcinoma 515

50 Liver Transplantation Amir A. Qamar 517

Indications for Transplantation 517

Pretransplant Evaluation 520

Contraindications 521

Transplantation Procedures 521

Complications 522

Infection & Liver Transplantation 524

Long-Term Medical Care after Liver Transplantation 526

Prognosis 528

51 Primary Biliary Cirrhosis Daniel S. Pratt 529

General Considerations 529

Pathogenesis 529

Clinical Findings 530

Treatment 531

Section IX Biliary Tract Diseases

52 Primary Sclerosing Cholangitis Norton J. Greenberger John R. Saltzman 533

General Considerations 533

Clinical Findings 533

Differential Diagnosis 534

Treatment 535

Course & Prognosis 535

53 Gallstone Disease Gustav Paumgartner Norton J. Greenberger 537

General Considerations 537

Pathogenesis 538

Clinical Findings 541

Differential Diagnosis 542

Complications 542

Treatment 543

Index 547