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HARRISON’S Gastroenterology and Hepatology Derived from Harrison’s Principles of Internal Medicine, 17th Edition Editors ANTHONY S FAUCI, MD Chief, Laboratory of Immunoregulation; Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda DENNIS L KASPER, MD William Ellery Channing Professor of Medicine, Professor of Microbiology and Molecular Genetics, Harvard Medical School; Director, Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Boston DAN L LONGO, MD Scientific Director, National Institute on Aging, National Institutes of Health, Bethesda and Baltimore EUGENE BRAUNWALD, MD Distinguished Hersey Professor of Medicine, Harvard Medical School; Chairman,TIMI Study Group, Brigham and Women’s Hospital, Boston STEPHEN L HAUSER, MD Robert A Fishman Distinguished Professor and Chairman, Department of Neurology, University of California, San Francisco J LARRY JAMESON, MD, PhD Professor of Medicine; Vice President for Medical Affairs and Lewis Landsberg Dean, Northwestern University Feinberg School of Medicine, Chicago JOSEPH LOSCALZO, MD, PhD Hersey Professor of Theory and Practice of Medicine, Harvard Medical School; Chairman, Department of Medicine; Physician-in-Chief, Brigham and Women’s Hospital, Boston HARRISON’S Gastroenterology and Hepatology Editors Dan L Longo, MD Scientific Director, National Institute on Aging, National Institutes of Health, Bethesda and Baltimore Anthony S Fauci, MD Chief, Laboratory of Immunoregulation; Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda Associate Editor Carol A Langford, MD, MHS Associate Professor of Medicine Cleveland Clinic, Cleveland New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2010 by The McGraw-Hill Companies, Inc All rights reserved Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher ISBN: 978-0-07-166334-2 MHID: 0-07-166334-7 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-166333-5, MHID: 0-07-166333-9 All trademarks are trademarks of their respective owners Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark Where such designations appear in this book, they have been printed with initial caps McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs To contact a representative please e-mail us at bulksales@mcgraw-hill.com TERMS OF USE This is a copyrighted work and The McGraw-Hill Companies, 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INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PATICULAR PURPOSE McGraw-Hill and its licensors not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom McGraw-Hill has no responsibility for the content of any information accessed through the work Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise CONTENTS Contributors ix SECTION III DISORDERS OF THE ALIMENTARY TRACT Preface xiii SECTION I 13 Diseases of the Esophagus 112 Raj K Goyal CARDINAL MANIFESTATIONS OF GASTROINTESTINAL DISEASE 14 Peptic Ulcer Disease and Related Disorders 125 John Del Valle Abdominal Pain William Silen 15 Disorders of Absorption 152 Henry J Binder Oral Manifestations of Disease Samuel C Durso 16 Inflammatory Bowel Disease 174 Sonia Friedman, Richard S Blumberg Atlas of Oral Manifestations of Disease 21 Samuel C Durso, Janet A.Yellowitz, Jane C.Atkinson 17 Irritable Bowel Syndrome 196 Chung Owyang Dysphagia 27 Raj K Goyal 18 Diverticular Disease and Common Anorectal Disorders 203 Susan L Gearhart Nausea,Vomiting, and Indigestion 33 William L Hasler 19 Mesenteric Vascular Insufficiency 213 Susan L Gearhart Diarrhea and Constipation 42 Michael Camilleri, Joseph A Murray 20 Acute Intestinal Obstruction 218 Susan L Gearhart,William Silen Weight Loss 58 Carol M Reife 21 Acute Appendicitis and Peritonitis 222 Susan L Gearhart,William Silen Gastrointestinal Bleeding 62 Loren Laine SECTION IV INFECTIONS OF THE ALIMENTARY TRACT Jaundice 68 Daniel S Pratt, Marshall M Kaplan 22 Acute Infectious Diarrheal Diseases and Bacterial Food Poisoning 228 Joan R Butterton, Stephen B Calderwood 10 Abdominal Swelling and Ascites 77 Robert M Glickman, Roshini Rajapaksa 23 Clostridium Difficile–Associated Disease, Including Pseudomembranous Colitis 238 Dale N Gerding, Stuart Johnson SECTION II EVALUATION OF THE PATIENT WITH ALIMENTARY TRACT SYMPTOMS 24 Intraabdominal Infections and Abscesses 244 Miriam J Baron, Dennis L Kasper 11 Approach to the Patient with Gastrointestinal Disease 84 William L Hasler, Chung Owyang 25 Helicobacter Pylori Infections 253 John C.Atherton, Martin J Blaser 12 Gastrointestinal Endoscopy 94 Louis Michel Wong-Kee-Song, Mark Topazian 26 Salmonellosis 260 David A Pegues, Samuel I Miller v 27 Shigellosis 270 Philippe Sansonetti, Jean Bergounioux 28 Infections Due to Campylobacter and Related Species 276 Martin J Blaser 29 Cholera and Other Vibrioses 281 Matthew K.Waldor, Gerald T Keusch 30 Viral Gastroenteritis 289 Umesh D Parashar, Roger I Glass 31 Amebiasis and Infection with Free-Living Amebas 296 Sharon L Reed 32 Protozoal Intestinal Infections and Trichomoniasis 304 Peter F Weller 33 Intestinal Nematodes 312 Peter F Weller,Thomas B Nutman 42 Genetic, Metabolic, and Infiltrative Diseases Affecting the Liver 434 Bruce R Bacon 43 Diseases of the Gallbladder and Bile Ducts 439 Norton J Greenberger, Gustav Paumgartner SECTION VII LIVER TRANSPLANTATION 44 Liver Transplantation 458 Jules L Dienstag, Raymond T Chung SECTION VIII DISORDERS OF THE PANCREAS 45 Approach to the Patient with Pancreatic Disease 472 Phillip P Toskes, Norton J Greenberger 46 Acute and Chronic Pancreatitis 479 Norton J Greenberger, Phillip P Toskes SECTION V SECTION IX EVALUATION OF THE PATIENT WITH LIVER DISEASE NEOPLASTIC DISEASES OF THE GASTROINTESTINAL SYSTEM 34 Approach to the Patient with Liver Disease 322 Marc Ghany, Jay H Hoofnagle 47 Gastrointestinal Tract Cancer 500 Robert J Mayer 35 Evaluation of Liver Function 332 Daniel S Pratt, Marshall M Kaplan SECTION VI DISORDERS OF THE LIVER AND BILIARY TREE 36 The Hyperbilirubinemias 340 Allan W Wolkoff 37 Acute Viral Hepatitis 349 Jules L Dienstag 38 Toxic and Drug-Induced Hepatitis 378 Jules L Dienstag 48 Tumors of the Liver and Biliary Tree 517 Brian I Carr 49 Pancreatic Cancer 528 Yu Jo Chua, David Cunningham 50 Endocrine Tumors of the Gastrointestinal Tract and Pancreas 533 Robert T Jensen SECTION X NUTRITION 51 Nutritional Requirements and Dietary Assessment 554 Johanna Dwyer 39 Chronic Hepatitis 390 Jules L Dienstag 52 Vitamin and Trace Mineral Deficiency and Excess 562 Robert M Russell, Paolo M Suter 40 Alcoholic Liver Disease 415 Mark E Mailliard, Michael F Sorrell 53 Malnutrition and Nutritional Assessment 577 Douglas C Heimburger 41 Cirrhosis and Its Complications 419 Bruce R Bacon 54 Enteral and Parenteral Nutrition Therapy 586 Bruce R Bistrian, David F Driscoll SECTION XI OBESITY AND EATING DISORDERS 55 Biology of Obesity 600 Jeffrey S Flier, Eleftheria Maratos-Flier 56 Evaluation and Management of Obesity 610 Robert F Kushner 57 Eating Disorders 619 B.Timothy Walsh 58 The Metabolic Syndrome 626 Robert H Eckel Appendix Laboratory Values of Clinical Importance 635 Alexander Kratz, Michael A Pesce, Daniel J Fink Review and Self-Assessment 655 Charles Wiener, Gerald Bloomfield, Cynthia D Brown, Joshua Schiffer,Adam Spivak Index 703 This page intentionally left blank CONTRIBUTORS Numbers in brackets refer to the chapter(s) written or co-written by the contributor JOHN C ATHERTON, MD Professor of Gastroenterology; Director,Wolfson Digestive Diseases Centre, University of Nottingham, United Kingdom [25] BRIAN I CARR, MD, PhD Professor of Medicine,Thomas Jefferson University; Director of the Liver Tumor Program, Kimmel Cancer Center, Philadelphia [48] JANE C ATKINSON, DDS Program Director, Clinical Trials Program, Center for Clinical Research, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda [3] YU JO CHUA, MBBS Research Fellow (Medical Oncology), Royal Marsden Hospital, London [49] RAYMOND T CHUNG, MD Associate Professor of Medicine, Harvard Medical School; Director of Hepatology, Massachusetts General Hospital; Medical Director, Liver Transplant Program, Massachusetts General Hospital, Boston [44] BRUCE R BACON, MD James F King Endowed Chair in Gastroenterology; Professor of Internal Medicine, Division of Gastroenterology & Hepatology, St Louis [41, 42] DAVID CUNNINGHAM, MD Professor of Cancer Medicine, Institute of Cancer Research; Consultant Medical Oncologist, Head of Gastrointestinal Unit, Royal Marsden Hospital, London [49] MIRIAM J BARON, MD Instructor in Medicine, Harvard Medical School, Boston [24] JEAN BERGOUNIOUX, MD Medical Doctor of Pediatrics, Unité de Pathogénie Microbienne Moléculaire, Paris [27] JOHN DEL VALLE, MD Professor and Senior Associate Chair of Graduate Medical Education, Department of Internal Medicine, Division of Gastroenterology, University of Michigan Health System,Ann Arbor [14] HENRY J BINDER, MD Professor of Medicine; Professor of Cellular & Molecular Physiology, Yale University, New Haven [15] JULES L DIENSTAG, MD Carl W.Walter Professor of Medicine and Dean for Medical Education, Harvard Medical School; Physician, Gastrointestinal Unit, Massachusetts General Hospital, Boston [37–39, 44] BRUCE R BISTRIAN, MD, PhD Chief, Clinical Nutrition, Beth Israel Deaconess Medical Center; Professor of Medicine, Harvard Medical School, Boston [54] MARTIN J BLASER, MD Frederick H King Professor of Internal Medicine; Chair, Department of Medicine; Professor of Microbiology, New York University School of Medicine, New York [25, 28] DAVID F DRISCOLL, PhD Assistant Professor of Medicine, Harvard Medical School, Boston [54] SAMUEL C DURSO, MD, MBA Associate Professor of Medicine, Clinical Director, Division of Geriatric Medicine and Gerontology,The Johns Hopkins University School of Medicine, Baltimore [2, 3] GERALD BLOOMFIELD, MD, MPH Department of Internal Medicine,The Johns Hopkins University School of Medicine, Baltimore [Review and Self-Assessment] JOHANNA DWYER, DSc, RD Professor of Medicine and Community Health,Tufts University School of Medicine and Friedman School of Nutrition Science and Policy; Senior Scientist Jean Mayer Human Nutrition Research Center on Aging at Tufts; Director of the Frances Stern Nutrition Center,Tufts-New England Medical Center Hospital, Boston [51] RICHARD S BLUMBERG, MD Professor of Medicine, Harvard Medical School; Chief, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston [16] CYNTHIA D BROWN, MD Department of Internal Medicine,The Johns Hopkins University School of Medicine, Baltimore [Review and Self-Assessment] ROBERT H ECKEL, MD Professor of Medicine, Division of Endocrinology, Metabolism and Diabetes, Division of Cardiology; Professor of Physiology and Biophysics; Charles A Boettcher II Chair in Atherosclerosis; Program Director,Adult General Clinical Research Center, University of Colorado at Denver and Health Sciences Center; Director Lipid Clinic, University Hospital,Aurora [58] JOAN R BUTTERTON, MD Assistant Clinical Professor of Medicine, Harvard Medical School; Clinical Associate in Medicine, Massachusetts General Hospital, Boston [22] STEPHEN B CALDERWOOD, MD Morton N Swartz, MD Academy Professor of Medicine (Microbiology and Molecular Genetics), Harvard Medical School; Chief, Division of Infectious Diseases, Massachusetts General Hospital, Boston [22] DANIEL J FINK,† MD, MPH Associate Professor of Clinical Pathology, College of Physicians and Surgeons, Columbia University, New York [Appendix] JEFFREY S FLIER, MD Caroline Shields Walker Professor of Medicine, Harvard Medical School; Dean of the Faculty of Medicine, Harvard School of Medicine, Boston [55] MICHAEL CAMILLERI, MD Atherton and Winifred W Bean Professor; Professor of Medicine and Physiology, Mayo Clinic College of Medicine, Rochester [6] † Deceased ix www.downloadslide.net 724 Ligation, esophageal varices and, 63 Limey bile, 448 Linear gingival erythema, 10 Lipase acute pancreatitis and, 473 macroamylasemia, 497 Lipid(s), 156 digestion-absorption, 157f absorptive phase, 158 preabsorptive phase, 158 steatorrhea and, 157t malabsorption, 173 Lipid storage diseases, 437 Lipodystrophy, metabolic syndrome and, 628 Lipolysis, 156–157, 156t insulin resistance and, 629 Lipolytic enzymes, pancreas and, 480 Lipomas, 514 Lithium obesity and, 610 vasoactive intestinal peptidomas, 548 Lithogenic bile, formation, 441–442 Liver alcohol metabolism in, enzyme systems and, 420 bile acids and, 154, 155f bilirubin and, 68–69 biosynthetic function of, tests measuring, 335–337 cell types, 322 enzymes, 424 NAFLD and, 436 enzymes and, 334–335 injury, 353–355, 378 metastases, primary tumor and, 672, 697–698 structure and function, 322–323 vitamin A in, 570–571 Liver abscesses, 249–250 alkaline phosphatase level and, 665, 690 on CT scan, 250f treatment, 249f, 250 trophozoites and, 298 Liver biopsy chronic active hepatitis and, 670, 695 liver disease and, 328–330 type II autoimmune hepatitis, 411 Liver disease, 68, 324t See also Chronic liver disease approach to patient, 322–331 causes of, patterns in, 323 clinical history and, 323–326 diagnosis of, 323 diagnostic tests in, 327t, 328 familial, 325–326 grading of, 323, 328–330 HCC and, 521 imaging, 328 laboratory testing, 327 liver biopsy and, 328–330 Index patient management, nonspecific issues in, 330–331 physical examination, 326–327 staging, 328–330 Liver fibrosis, vitamin A intoxication and, 572 Liver function, 332 evaluation of, 332–337 tests, 452 Liver tests abnormalities algorithm for, 329f, 333f serum bilirubin elevation and, 72–76 liver function tests, 452 patterns, in hepatobiliary disorders, 336t Liver transplantation, 381, 419, 458 acute rejection and, 466 acute viral hepatitis, 371, 372 in adults, 459–460 alcohol abuse and, 670, 695 in children, 459 contraindications for, 460, 460t αAT deficiency, 436 drug-induced liver injury and, 669–670, 695 end-stage chronic hepatitis B and, 401, 467 HCC and, 523 hepatic complications of, 465t, 466 indications for, 458–460, 459t metastatic disease and, 551 patient outcome, 467–469 postoperative complications, 464–466, 465t postoperative course and management, 463–464 posttransplantation, quality of life, 469 PSC and, 425 sclerosing cholangitis and, 455 technical considerations, 460–463 Liver tumors, 517 Living-donor transplantation, 461–462 surgical technique, 462–463 Local injection therapy, HCC and, 522–523 Localized juvenile periodontitis, Localized perforation, of gallbladder, 448 Long-chain fatty acids (LCFAs), 156 Loperamide acute diarrhea, 48 carcinoid syndrome, 542 vasoactive intestinal peptidomas, 548 watery diarrhea and, 54 Lorazepam, 37, 38 Lovastatin, 632 Low bone mass, 188 Low-birth-weight infants, vitamin A deficiency, 572 Low-carbohydrate/high-protein diets, for weight loss, 615 Lower esophageal muscular ring, 123 Lower esophageal sphincter (LES), 27, 112 GERD and, 117–118 Lower gastrointestinal bleeding (LGIB) in children, 64 diagnostic evaluation, 66, 66f UGIB v., 65 Low-fat diet, hypoproteinemia and, 173 Low-gradient ascites, 80 Lubiprostone, 55 IBS and, 201 Luminal contents, 89 Lung neuroendocrine tumors (NETs), classification of, 539–540 Lung phase, ascariasis, 314 Lycopene, prostate cancer and, 572 Lymph node(s) clearance, gastric carcinoids, 544 colorectal cancer and, 511, 511t metastases, 537 resection, gastric adenocarcinoma and, 504 Lymphatic obstruction, 173 Lymphatics, 158 Lymphocytic colitis, 186 Lymphocytic gastritis, 150 Lymphocytosis, acute viral hepatitis and, 365 Lymphoma(s), 164f, 438, 502 infliximab and, 192 in small bowel, 514 Lymphoproliferative disorders See Myelomonocytic leukemia Lymphoproliferative malignancies, 464 Lynch syndrome II, 528 Lysis of adhesions, 221 Lysolecithin, 446 6-MP, pregnancy and, 194 Macroamylasemia, 496 Macrocytic anemia, cobalamin deficiency and, 169 Macrolides, Campylobacter, 279 Macular degeneration, non-provitamin A carotenoids and, 572 Magnetic resonance cholangiography (MRCP), 74 bile duct and, 103, 104f CCC and, 525–526 chronic pancreatitis and, 477 liver disease, 328 pancreatic cancer and, 529, 530f pancreatic disease and, 492, 493f PSC and, 425 Malabsorption, 144 approach to patient, 160–165 Malabsorption disorders, clinical manifestations of, pathophysiology of, 172t Malabsorption syndromes, 152 classification of, 172t Malabsorptive disease, vitamin A deficiency, 572 Malaria prophylaxis, mefloquine as, 664, 688 Maldigestion, 144 autoimmune pancreatitis and, 491–492 www.downloadslide.net Index Malignancy, 39 Helicobacter pylori infection v., 256 insulinomas and, 545 jaundice and, 73 liver transplantation and, 465 occult, 661, 685 Malignant pyloric obstruction, 102 Mallenkot drain, anorectal abscess, 211 Mallory-Weiss tears, 63, 65, 101, 101f, 123, 678 Malnutrition, 577, 675, 699 in cirrhosis, 432 and nutritional assessment, 577–585 MALT lymphoma, H pylori and, 129 MAMC (Mid-arm muscle circumference), calculation of, 581 management of, 194–195 Manganese, 575 Manometric studies, 28 Manometry, DES and, 117 Marasmic kwashiorkor, 579 nutritional support and, 674, 699 Marasmus, 577 kwashiorkor v., 578t Maternal thiamine deficiency, 564 Maternal-infant transmission HBV and, 362 hepatitis and, 325 Maxillary sinusitis, 17 Mazindol, appetite regulation and, 616 MCFAs See Medium-chain fatty acids MCP-1 See Monocyte chemotactic protein MCTs See Medium-chain triglycerides MDR1 See Multidrug export pump Meal ingestion, colonic motility after, 44 Mebendazole, 664, 688 abdominal angiostrongyliasis, 319 ascariasis, 314 capillariasis, 318 enterobiasis, 318 hookworm, 315 Mechanical inflammation, 446 Mechanical intestinal obstruction, 219 Mechanical ventilation, aspiration and, 597 Meclizine, 36 Mediastinal emphysema, esophageal rupture, 123 Medical history abdominal pain, acute infectious diarrheal diseases, 231 constipation and, 54–55 dysphagia, 30–31 gastrointestinal disease and, 88–89 HCC and, 520–521 indigestion, 39 jaundice and, 72 nausea and vomiting, 35–36 peptic ulcer disease, 133 Medically complex patients, 18 dental care of, 18–19 Medications acid-suppressing, indigestion and, 40 antiemetic, 36 chronic diarrhea and, 48 chronic secretory diarrhea and, 657, 680 diarrhea and, 46–47, 678 EN feeding tubes and, 597 nausea and vomiting, 35 neutralizing, indigestion and, 40 Mediterranean lymphoma, 515 Medium-chain fatty acids (MCFAs), 156 Medium-chain triglycerides (MCTs), 158 enteral feeding formulas with, 592 Medullary carcinoma of thyroid, 49 Mefloquine, malaria prophylaxis and, 664, 688 α-melanocyte-stimulating hormone (α-MSH), 58, 605f Melanosis coli, 55 MELD See Model for End-Stage Liver Disease MELD score See Model for End-Stage Liver Disease Score Melena, 62 Melphalan, 380 MEN See Multiple endocrine neoplasia MEN-1 markers See Multiple endocrine neoplasia-type markers Menaquinone, 573 Ménétrier’s disease, 151, 171 treatment, 151 Meningitis, 267, 665, 689 Mental retardation, obesity and, 606t Meperidine, acute cholecystitis and, 449 6-Mercaptopurine, 190–191 Meropenem, secondary peritonitis, 247 Mesalamine, pregnancy and, 194 Mesalamine enemas, 190 Mesenteric angiography, diverticular bleeding, 204 Mesenteric duplex scan, 214 Mesenteric ischemia, mortality for, 663, 687 Mesenteric vascular insufficiency, 213 Mesenteric vascular occlusion, acute pancreatitis v., 484 Mesenteric venous thrombosis (MVT), 213 diagnostic modalities, 214 management of, 215t Metabolic abdominal crises, Metabolic acidosis, PN therapy and, 595 Metabolic bone disorders, 188 Metabolic disorders, nausea and vomiting, 35 Metabolic disturbances, and their correction, PN, 595t Metabolic liver diseases, 436 Metabolic rate, starvation and semistarvation, 579–580 725 Metabolic syndrome (Syndrome X; Insulin resistance syndrome), 626 clinical features, 630 associated diseases, 630 signs and symptoms, 630 criteria for, 676, 701 diagnosis of, 631 epidemiology of, 626 etiology of, 628–629 HDL cholesterol, 632 NCEP:ATPIII criteria, 626, 627t risk factors, 626–630 treatment of blood pressure, 632–633 diet, 631 HDL cholesterol, 632 impaired fasting glucose, 633 insulin resistance, 633 LDL cholesterol, 632 lifestyle, 631 obesity, 631 physical activity, 631 triglycerides, 632 Metabolism, regulation of, 58 Metabolites, appetite regulation and, 602, 602f Metals, deficiencies and toxicities of, 564t Metastatic endocrine tumors, therapy of, 147 Metastatic gastrointestinal carcinoid tumors, chronic diarrhea and, 48–49 Metastatic malignancy, liver transplantation and, 460 METAVIR, chronic hepatitis, 391, 392t Metformin, 633 insulin sensitivity and, 633 α-Methadopa, carcinoid crises and, 543 Methicillin-resistant S aureus, 247 Methotrexate (MTX), 191 CD, 191 drug hepatotoxicity and, 381 pneumonitis and, 661, 685 pregnancy and, 194 sclerosing cholangitis and, 455 Methyldopa hepatotoxicity, 384 Metoclopramide, 36–37, 678 vasoactive intestinal peptidomas, 548 Metronidazole, 53 acute cholecystitis and, 449 amebic liver abscess, 301, 301t blastocystis hominis infection, 310 C difficile-associated disease, 666, 691 CDAD, 241–242 Dientamoeba fragilis infection and, 310 fulminant CDAD and, 242 Giardiasis, 48, 667, 691 H pylori infection and, 138, 138t, 258, 258t hepatic encephalopathy, 432 intestinal disease and, amebiasis, 300–301 pregnancy and, 194 recurrent CDAD, 242 trichomoniasis and, 310, 688 www.downloadslide.net 726 Metronidazole plus ciprofloxacin, secondary peritonitis, 247 Mezlocillin, acute cholecystitis and, 449 Mianserin, IBS and, 201 Micellar formation, 156 Micelles See Ursodeoxycholic acid Microbes, IBS and, 199 Microlithiasis, 108 Micronodular cirrhosis, HCC and, 518 Micronutrient malnutrition, 580 Microorganisms adherence, 228 diarrhea and, 164–165 host defenses and, acute infectious diarrheal diseases and, 230–232 inoculum size, 228 Microsporidiosis, 308 life cycle of, 309f Microvesicular steatosis, 380 Mid-esophageal diverticulum, 122 Midgut carcinoids, 534, 541 5HTP and, 542 Migrainous neuralgia, 17 Migrating motor complex (MMC), 43–44 Mild esophagitis, 118 Milk-alkali syndrome, 136 Mineral(s), 574 loss, 591 requirements, formulas providing, 592–593 status, short bowel syndrome, 169 Mineral oil, vitamin A absorption and, 571 Minor hematochezia, 108f endoscopy and, 108 Mirizzi’s syndrome, 447 Mirtazapine, 610 Misdirection of food, 27 Mixed function oxidase systems,Vitamin C and, 568 Mixed hyperbilirubinemia, bilirubin disorders and, 345–348 Mixed micelles See Ursodeoxycholic acid MMC See Migrating motor complex Mobile teeth, periodontal disease and, 25f Model for End-Stage Liver Disease (MELD), 461t cadaver donor selection, 461 Model for End-Stage Liver Disease Score (MELD score), 330 survival rate, 467 Monoamine oxidase inhibitors, obesity and, 610 Monocyte chemotactic protein (MCP-1), 482 Monomeric formulas, 592 Monosaccharide malabsorption, 159 Monotherapy, Helicobacter pylori infection, 258 Mood stabilizers, obesity and, 610 Morphine, acute cholecystitis and, 449 Mortality blood pressure and, 632 bulimia nervosa and, 677, 702 Campylobacter enteritis, 280 Index fulminant pancreatitis and, 487 liver abscesses, 249f, 250 mesenteric ischemia and, 663, 687 urgent cholecystectomy and, 449 Mortality rates, perioperative, pancreatic cancer and, 532 Motion sickness, 34 Mouse studies, leptin, 604, 604f Mouth, healthy, 24f Moxifloxacin acute cholecystitis and, 449 C difficile-associated disease, 665, 689 Giardiasis and, 667, 691 MRCP See Magnetic resonance cholangiography MRI, gastrointestinal disease and, 90 MRP2 See Anionic conjugate export pump; Multidrug resistance-associated protein α-MSH See Melanocyte-stimulating hormone MTX See Methotrexate Mucinous ascitic fluid, 80 Mucosa-associated lymphoid tissue (MALT), 505 Mucosal biopsy, GERD and, 118 Mucosal damage, GERD and, 118 Mucosal disease, chronic diarrhea and, 48 Mucosal injury, NSAIDs and, 131f Mucosal malabsorption, chronic diarrhea, 50 Mucositis, 17 Mucous membrane pemphigoid, 17 Multidrug export pump (MDR1), 440 Multidrug resistance-associated protein (MRP2), 341 Multidrug-resistant S.Typhi, 262 resistance to, global distribution, 262f Multiorgan failure, infected pancreatic necrosis and, 487 Multiple endocrine neoplasia (MEN), type 1, gastrinomas and, 145 Multiple endocrine neoplasia-type markers (MEN-1 markers), 537, 538, 539 gastrinomas and, 544 GRFomas, 548 Multisystem disease,Whipple’s disease and, 170–171 Münchhausen syndrome, 51 Muscle cramps, cholera and, 284 Muscle mass, marasmus and, 577 Muscle wasting, 72 MVT See Mesenteric venous thrombosis Myasthenia gravis, dysphagia from, 29 Mycobacterial infection, 184 Mycobacterium avium-intracellulare infection, 50, 184 Mycophenolate, renal transplantation and, 463–464 Myelomonocytic leukemia (AML), 10 Myocardial infarction acute pancreatitis v., 484 dental treatments and, 19 Myofascial pain, 17 Mitomycin C, HCC and, 523 Naegleria infections, 301–302 NAFLD See Nonalcoholic fatty liver disease Nalidixic acid resistance, 266 Nalidixic acid-resistant S.Typhi, 264, 264t Napkin ring lesions, 510f Narcotics, Nasal regurgitation, 31, 31f NASH, 346–347 Nasogastric drainage, 595 Nasogastric suction acute pancreatitis and, 485 pancreatic pleural effusions, 490 National Cholesterol Education Program, Adult Treatment Panel III criteria (NCEP:ATPIII criteria) metabolic syndrome and, 626, 627t, 631 non-HDL cholesterol, 632 Natural killer T cells, 176 Nausea, 33 See also Chronic idiopathic nausea liver disease and, 323 Nausea and vomiting approach to patient, 35–36 causes of, 34t diagnostic testing for, 36 differential diagnosis, 34–36 emetogenic agents for, 35 gastrointestinal disease and, 87 mechanisms of, 33–34 treatment for, 36–38, 37t NCEP:ATPIII criteria See National Cholesterol Education Program,Adult Treatment Panel III criteria Near-total gastrectomy, gastric adenocarcinoma and, 504 NEAT See Nonexercise activity thermogenesis Necroscopy, fulminant pancreatitis and, 487 Necrosis, necrotizing acute pancreatitis and, 487 Necrotizing acute pancreatitis, antibiotic prophylaxis of, 485–486 Neoadjuvant radiotherapy with sensitizing chemotherapy, cholangiocarcinoma and, 526 Neoantigens, drug hepatotoxicity and, 379 Neomycin hepatic encephalopathy, 432 vitamin A absorption and, 571 Neonatal jaundice, unconjugated bilirubin and, 342–343 Neonatally acquired HBV, 359 Neonates HBV infection and, 370 NTS and, 268 Neoplasia chronic UC, 194 ulcerative colitis, 180 www.downloadslide.net Index Neoplastic clone, gastric lymphoma and, 505 Neoplastic diseases, ferritin levels, 435 Nephritic syndrome, 359 Nephrolithiasis, CD and, 686 NERD See Nonerosive reflux disease NETs See Gastrointestinal neuroendocrine tumors Neuritis, 17 Neurodegenerative disease, isoflavones and, 570 Neuroendocrine cell markers, NETs and, 533, 534t Neuroendocrine tumors (NETs) genetic syndromes and, 539t prognostic factors in, 538t Neurologic testing, constipation and, 56 Neuromuscular disorders dysphagia and, laryngeal symptoms and, 31, 31f oropharyngeal motor dysphagia from, 28, 29t Neuropathies, 678 Neuropeptides, weight and, 58 Neuropsychiatric complications, liver transplantation and, 465 Neurotoxins, 229, 230 Neurotransmitters, vomiting and, 34 Neutrophils, pancreatitis and, 482 Nevirapine, Stevens-Johnson syndrome and, 22f NHANES III, metabolic syndrome and, 626 prevalence of, 627t Niacin (Vitamin B3), 567 metabolism and requirements, 567 Niacin deficiency, 567, 672, 697 Niacin toxicity, 568 Nicotinamide, Pellagra syndrome and, 567 Nicotinic acid Pellagra syndrome and, 567 triglycerides and, 632 Niemann-Pick disease, 437 Nifedipine achalasia and, 116 DES and, and hypertensive motor disorders, 117 Nitazoxanide, cryptosporidiosis, 307 Nitrates achalasia and, 116 esophageal cancer, 662, 686 ingestion, 679 gastric adenocarcinoma and, 502–503 Nitric oxide (NO) See also Vasoactive intestinal peptide gastric mucosal integrity and, 127 Nitroglycerin achalasia and, 116 chronic anal fissure and, 659, 683 DES and, and hypertensive motor disorders, 117 Nitroimidazole compounds, intestinal disease and, 300–301 Nizatidine, PUD and, 136 NO See Nitric oxide Nodular tumors, 525 NOMI See Nonocclusive mesenteric ischemia Nonalcoholic fatty liver disease (NAFLD), 436–437 cirrhosis from, 422–423 metabolic syndrome and, 630 treatment for, 437 Noncardiac chest pain, 113 Nondiabetic retinopathy, chronic pancreatitis and, 493–494 Non-dysenteriae Shigella, 274 Nonenteric coated enzymes, steatorrhea and, 495 Nonerosive reflux disease (NERD), 104, 118 Nonexercise activity thermogenesis (NEAT), 607–608 Nonfunctional pancreatic endocrine tumors, 548 Non-Hodgkin’s lymphomas, 514 Noninfectious disease, IBS and, 185–186 Nonmetastatic carcinoid tumors, 542–544 Nonmetastatic primary hepatobiliary tumors, liver transplantation and, 460 Non-O1 V cholerae, gastrointestinal illness and, 287 Nonocclusive mesenteric ischemia (NOMI), 213, 215 Nonpolyposis syndromes, large bowel cancer and, 507–508, 507t Non-provitamin A carotenoids, macular degeneration and, 572 Nonrelaxing puborectalis, 207 Nonsteroidal anti-inflammatory drugs (NSAIDs), 49, 51 acute cholecystitis and, 449 associated duodenal injury, treatment, 139–140 associated gastric injury, treatment, 139–140 associated ulcers, 63 colitis and, 186 colon cancer, 508–509 diarrhea and, 47 endoscopic procedures and, 109 gastritis and, 63–64 gastrointestinal bleeding, 133 guide to, 140t induced disease, epidemiology of, 131 induced ulcer, 143 mucosal injury and, 131f necrotizing acute pancreatitis and, 486 polyposis coli and, 507–508 related mucosal injury, treatment, 139t tissue inflammation and, 127 UGIB and, 62 ulcer disease, 38 ulcers and, 140–141, 255 727 Nonsuppurative acute cholangitis, 451 Nontyphoidal salmonellosis (NTS), 265 clinical manifestations of, 267 diagnosis of, 267–268 epidemiology, 265–267 prevention and control, 269 treatment, 268–269, 268t Non-ulcer dyspepsia, 105 Norepinephrine, appetite regulation, 616 Norfloxacin, and Shigella, 274 Norwalk virus, 289 cloning, 291 diagnosis of, 291–292 epidemiology, 291 human caliciviruses and, 291 pathogenesis, 291 treatment, 292 Norwalk viruses, 291, 664, 688 Novobiocin, bilirubin disposition and, 343 NSAIDs See Nonsteroidal anti-inflammatory drugs NTS See Nontyphoidal salmonellosis Nuclear medicine, gastrointestinal disease and, 90 NUD See Functional dyspepsia Nutrient(s), 554 digestion and absorption, 153–165 EAR of, 555 needs dietary composition, 558–559 disease and, 559 factors altering, 558–559 physiologic factors, 558 route of administration, 559 requirements, essential, 554–555 Nutrient-based terminologies, global considerations of, 561 Nutrition high-risk patient, 581, 581t and Shigella, 274–275 Nutritional assessment, 560–561, 580 history, 580–581 laboratory tests for, 583t–584t requirements, 554–561 Nutritional deficiencies, 657, 680 physical findings of, 582t Nutritional disease, 17 Nutritional manipulation, gastrointestinal disease and, 91 Nutritional monitoring, 560 Nutritional status albumin and, 674, 698–699 body mass index and, 588t laboratory studies and, 581 Nutritional support marasmic kwashiorkor and, 674, 699 SRI and, 588 timing of, 588 Nutritional therapies, 192 www.downloadslide.net 728 Obesity, 610 See also Syndromes of obesity biology of, 600–609 definition and measurement of, 600–601 etiology of, 603–605, 607–608 evaluation of, 610–612 steps in, 610 GERD and, 118 metabolic syndrome and, 626–627 treatment of, 631 NAFLD and, 436 pathogenesis of, 607 pathologic consequences of, 608 prevalence of, 601 therapy for, goals of, 613, 614f treatment, 613–618 selection guide, 615t Obesity genes, 603–605, 604t in humans/mice, 604t Obesity hypoventilation syndrome, 609 Obesity-associated organ systems review, comorbid conditions, 612, 613t Obesity-focused history, 610–612 Obesity-related comorbid conditions, bariatric surgery and, 618 Obstetric injury, fecal incontinence, 209 Obstructive cholelithiasis, 669, 694 Obstructive jaundice, 451–452 pancreatic carcinoma and, 454 Obstructive sleep apnea (OSA), metabolic syndrome and, 630–631 Occlusive ischemia, 213 Occult blood polyposis coli and, 507–508 in stool, 506 Occult colorectal cancers, streptococcus bovis bacteremia and, 508 Occult gallstone disease, 485 Occult GI bleeding (GIB), 62, 67 Occult malignancy, 661, 685 Octreoscan, ZES and, 145, 146 Octreotide, 541, 673–674, 698 acute variceal hemorrhage, 428 anesthesia and, carcinoid crises and, 543 bleeding and, 63 Dumping syndrome, 144 glucagonomas and, 547 GRFomas, 549 insulinomas and, 545 large-duct pancreatitis and, 494 malignant carcinoid syndrome, 53–54 metastatic disease and, 550 necrotizing acute pancreatitis and, 486 pancreatic ascites, 490 pancreatic pleural effusions, 490 somatostatinoma syndrome and, 547 vasoactive intestinal peptidomas, 548 ZES and, 147 Ocular disorders, 187 Ocular melanomas, 526 Index Odors, from systemic disease, 19 Odynophagia, 27, 112 esophageal cancers and, 501 gastrointestinal disease and, 88 Ofloxacin, and Shigella, 274 OKT3, 463 liver transplantation and, 466 OKUDA staging system, HCC and, 520, 520t Oligomenorrhea, BN and, 624 Olsalazine, 189 OLTX See Orthotopic liver transplantation Omega-3 fatty acid preparations, triglycerides and, 632 Omeprazole, 53–54 primary lactose deficiency, 663, 687 PUD and, 136–137 ZES and, 147 Omp C See Outer membrane porin C Oncogenes, PETs and, 538 Ondansetron, 36 Oocytes cryptosporidiosis, 307 Isospora belli parasite, 308 Open-access colonoscopy, 109 Open-access endoscopy, 109 Operative resection, esophageal cancer and, 502 Opiates, 54 gastrointestinal disease and, 91–92 short bowel syndrome, 169 Opisthorchis viverrini, 525 Oral carcinoma, 23f Oral cavity, health status of, 21 Oral cavity muscles, innervation of, 27 Oral contraceptive hepatotoxicity, 386 Oral contraceptives, 667, 692 Oral health, 19 Oral hygiene, aging and, 19 Oral hypoglycemic agents, insulinomas and, 545 Oral intake, criteria for, pancreatitis and, 487 Oral lesions, with HIV infection, 16t Oral mucosa lesions of, 11t–13t pigmented lesions of, 14t ulcers in, 10, 11t–13t Oral mucosa diseases, 10 Oral pain, nondental causes, 17–18 Oral pancreatic enzymes, cobalamin malabsorption, 492 Oral rehydration solution (ORS), cholera and, 285, 285t Oral thrush, candida esophagitis, 121 Organ failure, acute pancreatitis, 483–484 Organic disease, dysphagia, 32 Organic phytochemicals, 554 Orlistat appetite regulation and, 617 NAFLD and, 437 Oropharyngeal dysphagia, 28–29 Oropharyngeal mechanical dysphagia, 29t Oropharyngeal motor dysphagia, 28, 29t neuromuscular disorders causing, 28, 29t ORS See Oral rehydration solution Orthotopic liver transplantation (OLTX) alternatives to, 462 FL-HCC and, 525 HCC and, 522, 523 OSA See Obstructive sleep apnea Osler-Weber-Rendu, 64 Osmotic diarrhea, 50, 153 evaluation of, 53 Whipple’s disease and, 662, 685 Osmotic laxatives, 50 Osteoarthritis, masticatory pain, 17 Osteomyelitis, NTS and, 269 Osteonecrosis, 188 of jaw, 25f bisphosphonate therapy and, 19 Osteopenia, DEXA scan and, 432–433 Osteoporosis in cirrhosis, 432–433 DEXA scan and, 432–433 isoflavones and, 570 Outer membrane porin C (Omp C), CD and, 183 Overflow diarrhea, 44–45 Overlapping sphincteroplasty, fecal incontinence, 209 Over-the-counter agents, gastrointestinal disease and, 91 Overweight, metabolic syndrome and, 626–627 Oxaliplatin colorectal cancer and, 512 tumors and, metastatic to liver, 526 Oxidative stress hypothesis, 629 Oxyntic gastric gland, 125, 126f PaI See cag pathogenicity island Pain from abdomen, mechanisms of, 2–4 abdominal causes, 2–4 history, 6, 6t management, chronic pancreatitis and, 494–495 palliation, 504 pancreatic cancer and, 529 Palate, inflamed, 22f Palliation esophageal cancer and, 502 of pain, external beam irradiation, 504 Palmar erythema, 326 Palpation abdominal swelling and, 78 tenderness at, appendicitis and, 223 pANCAs See Perinuclear antineutrophil cytoplasmic antibodies www.downloadslide.net Index Pancreas autoprotection of, 480 gastrinomas and, 544–545 Pancreas divisum, 496 Pancreatic abscess, 487, 488 infected pancreatic necrosis v., 487 Pancreatic ascites, 488 treatment of, 490 Pancreatic biopsy, with radiologic guidance, 477 Pancreatic calculi, chronic pancreatitis and, 494f Pancreatic cancer, 494, 528, 530f See also Advanced pancreatic cancer clinical features, 529 clinical trial and, 673, 698 diagnostic procedures, 529–532 genetic considerations, 528–529 high-risk individuals, surveillance in, 531 incidence and etiology, 528 operable, treatment for, 531–532 staging of, 530, 531t survival and, 673, 698 by adjuvant therapy, 532f treatment, 531–532 Pancreatic carcinoma, 476, 485 obstructive jaundice and, 454 Pancreatic disease, 39, 472 approach to patient, 472–478 diagnosis of, tests for, 473, 475–478 general considerations, 472–473 Pancreatic ductal system, pseudocysts of pancreas and, 488 Pancreatic endocrine tumors (PETs), 533, 534, 544 chemotherapy for, tumor shrinkage and, 550 malignant behavior, 537 Pancreatic enzyme preparations, 495, 495t, 672, 697 Pancreatic enzymes, in body fluids, 473, 475 Pancreatic exocrine function, 165 Pancreatic exocrine insufficiency, 490–496 chronic pancreatitis and,TIGAR- O classification system, 491t Pancreatic exocrine secretion, biochemistry and physiology of, 479–481 Pancreatic fibrosis, 490 Pancreatic function tests, 475t, 477–478 Pancreatic infection, CT-guided needle aspiration and, 487 Pancreatic inflammation, gallstones and, 481 Pancreatic juice, Pancreatic lesion, surgical resection and, 673, 698 Pancreatic pleural effusions, 488 treatment of, 490 Pancreatic pseudocyst, 475, 476 chronic pancreatitis pain and, 495 MRCP and, 492, 493f Pancreatic secretion, regulation of, 479 Pancreatic secretory trypsin inhibitor (PSTI), 480, 482 gene mutations, 496 Pancreatic sepsis, 485–486 Pancreatic steatorrhea, serum trypsinogen tests and, 492 Pancreatic structure, studies, 475–477 Pancreatic tumors, tests for, 474t–475t Pancreatitis, 108, 452, 685 See also Chronic pancreatitis liver transplantation and, 468 phases of, 481–482 recurrent, 485 Pancreatography, pancreatic ascites, 490 Panitumumab, colorectal cancer and, 513 Pantoprazole GERD and, 119 PUD and, 136 Pantothenic acid (Vitamin B5), 569 Pan-ulcerative colitis, 177f Papillary dysfunction, 449–450 Papillary stenosis, criteria defining, 449–450 Paracentesis, ascites and, 79, 430, 656, 665–666, 679, 690 Paracolic abscesses, surgical therapy and, 206 Paraesophageal hernia, 123 Paraneoplastic hypercalcemia, 549 Paraneoplastic syndromes, in HCC, 519–520 Parasite antigens, giardiasis, 306 Parasympathetic nervous system, 479 Parental feeding, limitations, 593–594 Parental therapy, SNS and, 588 Parenteral catheters, composition of, 593–594 Parenteral electrolytes, requirements, 592, 593t Parenteral emulsions, containing mediumchain triglycerides, 592 Parenteral exposures, jaundice and, 72 Parenteral fat, 592, 593 Parenteral glucose, 592 administration, 594 thiamine deficiency and, 564 Parenteral multivitamins, requirements, 592, 593t Parenteral nutrition (PN), 586, 593 diverticular disease, 205 infusion technique for, 593–594 metabolic disturbances, and their correction, 595t metabolic problems with, 675–676, 700 patient monitoring and, 593–594, 594t technique for, 589 Parenteral protein, 593 Parenteral trace mineral, requirements, 592–593, 593t Parietal cell, 128 Parietal peritoneal inflammation, 2–3 Paromomycin Dientamoeba fragilis infection and, 310 intestinal disease and, amebiasis, 300 729 Paroxetine, obesity and, 610 Partial liver resection, solitary hepatic metastases and, 513 PAS-positive macrophages,Whipple’s disease and, 170–171 Passive immunoprophylaxis, HBV and, 373 Pathogens, 177 Patient counseling, IBS and, 200 evaluation, tools for, 89–91 examination, abdominal pain and, history See Medical history monitoring feeding tube placement and, 596–598 PN and, 593–594, 594t PBP See Primary bacterial peritonitis PCM See Protein-calorie malnutrition PCM and, 589 PCOS See Polycystic ovarian syndrome PCR See Polymerase chain reaction PCT See Porphyria cutanea tarda Pedunculated polyps, 506 Pegylated interferon chronic hepatitis B and, 397, 399t, 401 chronic hepatitis C and, 405, 406t Pegylated interferon plus ribavirin, chronic hepatitis C, 405–406 PEI See Percutaneous ethanol injection Peliosis hepatitis, anabolic steroids and, 381 Pellagra, 567 symptoms, 675, 700 Pelvic floor disorder, 209 Pelvic floor tests, 56, 57 Pelvic inflammatory disease (PID), 224 Pelvic peritonitis, PEM See Protein-energy malnutrition Pemphigus vulgaris, 17 Penetration, PUD and, 133 111 In-pentetreotide, metastatic endocrine tumors, 147 Penicillamine, pyridoxine and, 568 Penicillin diverticular disease, 205 PBP and, 246 secondary peritonitis, 247 Penicillin-based antibiotics, cholestatic hepatitis, 74 Pentamidine, acute pancreatitis and, 485 Pentasa, 189–190 Pentoxifylline, alcoholic cirrhosis, 421 Pepsin, 159–160 Pepsinogen, 159 mucosal injury and, 127 Peptic disorders, Helicobacter pylori and, 129 Peptic stricture, 31, 105f, 118 dysphagia and, 118 Peptic ulcer acute pancreatitis v., 484 ZES and, 145 www.downloadslide.net 730 Peptic ulcer disease (PUD), 125, 128, 544, 662, 685 clinical features of, 133–135 gastric physiology, 125–128 pathogenesis of, factors in, 132–133 pathophysiologic basis of, 128–133 recurrent ulcerations, 143 related complications, 133–135 surgery-related complications, 143 treatment, 136–144 Peptic ulcers, 62, 655, 678 acute gastrointestinal hemorrhage, 99–100, 100f endoscopy and, 105 Peptides, intestinal epithelia and, 153 Pepto-Bismol, PUD and, 137 Percutaneous drainage CCC and, 525–526 intraperitoneal abscesses and, algorithm for, 249f pancreatic abscess and, 487 Percutaneous ethanol injection (PEI), HCC and, 522, 523 Percutaneous liver biopsy, 337 Perforated gallbladder, 685 Perforated retrocecal appendix, Perforated ulcer, duodenal, 662, 685 Perforated viscus, acute pancreatitis v., 484 Perforation acute appendicitis, 225 of gallbladder, 448 PUD and, 133–134 Pergolide, 541 Perianal disease, 181 Perianal pruritus, 317 Perianal skin tags, 187 Periapical cyst, Periapical disease, Periapical granuloma, Perinatal transmission, HCV and, 364 Perinephric abscesses, 251–252 Perinuclear antineutrophil cytoplasmic antibodies (pANCAs), Crohn’s disease and, 182–183 Periodontal disease, 9, 19 elderly and, mobile teeth and, 25f Periodontal infection prevention, Periodontal structures, diseases of, Periodontitis, 9, 22f Peripheral edema, 172, 429 drugs causing, 610 Peripheral nerves, Peripheral neuropathy pyridoxine and, 568 vitamin E and, 675, 699–700 Peripherally acting medications, appetite regulation and, 617 Index Peripherally inserted central catheters (PICCs), 593 Periportal necrosis, 391 Peristaltic bowel sounds, Peritoneal dialysis, 244, 245 Peritoneal inflammation, 678 Peritoneal lavage, fulminant pancreatitis and, 487 Peritoneum, tension of, Peritonitis, 6, 204, 244, 678, 685 Pernicious anemia, 17, 150, 161 gastric adenocarcinoma and, 503 Pesticides, HCC and, 518 PETs See Pancreatic endocrine tumors Peutz-Jeghers syndrome, 528 Peyronie’s disease, 541 PFIC See Progressive familial intrahepatic cholestasis PG See Pyoderma gangrenosum PGE2 See Prostaglandin E2 PGI2 See Prostacyclin Phacomatoses, NETs and, 538 Phagophobia, 27 Phantom pain, 17 Pharmaceutical agents, 656, 679 Pharmacotherapy gastrointestinal disease and, 91–92 weight loss with, 616 Phendimetrazine, appetite regulation and, 616 Phenothiazines, vasoactive intestinal peptidomas, 548 Phenoxybenzamine, 673–674, 698 Phentermine, appetite regulation and, 616 Phenytoin, drug hepatotoxicity and, 378 Phenytoin hepatotoxicity, 385 Pheochromocytoma, weight loss and, 59t, 60 Phlebotomy HH and, 435 porphyrias, 438 PhoP/PhoQ, salmonellosis, 261 Phospholipids, bile acids and, 441 Photodynamic therapy, cholangiocarcinoma and, 526 Photosensitivity, pyridoxine and, 568 Phylloquinone, 573 Physical activity, 554 metabolic syndrome, treatment, 631 obesity and, 615–616 Physical examination abdominal swelling and, 77–78 acute infectious diarrheal diseases, 231 chronic diarrhea and, 52t dysphagia and, 32 gastrointestinal disease and, 88–89 HCC and, 520–521 high-risk patient, nutrition, 581, 581t indigestion and, 39 jaundice and, 72–73 liver disease and, 326–327 nausea and vomiting, 35–36 peptic ulcer disease, 133 Physical fitness, BMI and, 612 PICCs See Peripherally inserted central catheters Picobirnavirus, 294 PID See Pelvic inflammatory disease Piecemeal necrosis, 391, 411 Pigment stones, 443 predisposing factors in, 443t Pigmented lesions, of oral mucosa, 14t Pigmented retinopathy, vitamin E and, 675, 699–700 Pill-induced esophagitis, 122 Pinworm See Enterobiasis Pioglitazone, NAFLD and, 437 Piperacillin acute cholecystitis and, 449 diverticular disease, 205 Plant proteins, 555 Plaque, gingival inflammation and, 25f Plasma carcinoembryonic antigen (CEA), colorectal cancer and, 511, 511t, 512 Plasma insulin levels, insulinomas, 545 Plasma proinsulin levels, insulinomas and, 545 Plasma VIP level,VIPomas, 547 Platelets dysfunction, pyridoxine and, 568 function, chronic liver disease, 432 Pleomorphic adenoma, 18 Pleuropulmonary disorders, amebic liver abscess, 299 Plummer-Vinson syndrome, 123 PN See Parenteral nutrition Pneumonia, acute pancreatitis v., 484 Pneumonitis, methotrexate therapy and, 661, 685 Pneumoperitoneum, 246f Pneumothorax, PN and, 589 PNTML See Pudendal nerve terminal motor latency Polyarteritis nodosa, HBV and, 359–360 Polycystic ovarian syndrome (PCOS) metabolic syndrome and, 630 obesity and, 608, 610 Polymerase chain reaction (PCR), for Norwalk virus, 291–292 Polymerase inhibitors, HCV and, 409 Polymeric diets, 592 Polypectomy, 55 Polyphenol, 570 Polypoid adenomas, 513–514 Polyposis coli, 507 Polyposis syndromes, large bowel cancer and, 507–508, 507t Polyps, colorectal cancer and, 506 POMC See Proopiomelanocortin Population screening studies, iron overload, c282Y homozygotes and, 435t Porcelain gallbladder, 448 Porphyria, www.downloadslide.net Index Porphyria cutanea tarda (PCT), 438 Porphyrias, 437 treatment for, 438 Portal areas, of liver, 322 Portal hypertension, 419, 426 ascites and, 429 bleeding and, 63 classification of, 427, 427t vitamin A intoxication and, 572 Portal inflammation, 391 Portal vein thrombosis, liver transplantation and, 460 Portal venous circulation, colorectal cancer and, 511 Portion control, 615 Postherpetic neuralgia, 17 Post-ligament of Treitz feeding, 597 Postmucosal lymphatic obstruction, 50 Postnecrotic cirrhosis, 411 Postoperative combined modality therapy, colorectal cancer and, 513 Post-vagotomy diarrhea, 144 Post-vagotomy gastroparesis, 37 Potassium, vasoactive intestinal peptidomas, 548 Potassium loss, excessive, 592–593 PPARγ See Proliferator-activated receptor _ PPIs See Proton pump inhibitors Prader-Willi syndrome, obesity and, 605 Pravastatin, triglycerides and, 632 Prealbumin, 674, 698–699 Prednisone eosinophilic esophagitis, 121–122 Ménétrier’s disease, 151 vasoactive intestinal peptidomas, 548 Pregnancy, 37, 194 appendicitis and, 224, 661–662, 685 azathioprine and, 194 cholesterol stone formation and, 443 HBV and, 362 HBV vaccine and, 373, 668, 693 nausea and vomiting, 35 posttransplantation, 469 pyogenic granulomas and, 10 vitamin A deficiency, 571 vitamin A intoxication and, 572 Pregnanediol, bilirubin disposition and, 343 Preplantation renal dysfunction, 463 Prevpac, Helicobacter pylori infection, 139 Primary bacterial peritonitis (PBP), 244 prevention, 246 treatment of, 245–246 Primary biliary cirrhosis, 74, 411, 423, 669, 694 recurrence of, liver transplantation and, 467 treatment, 424 Primary bronchial carcinoids, chronic diarrhea and, 48–49 Primary cancer See Primary tumor Primary disease, recurrence of, liver transplantation and, 467 Primary gastric lymphoma, 505 treatment for, 505 Primary graft failure, liver transplantation and, 466 Primary hepatic disorder, liver transplantation and, 466 Primary hepatocellular carcinoma (HCC), liver transplantation and, 460 Primary hepatocellular malignancies, 459 liver transplantation and, 459 Primary intestinal anastomosis, ischemic bowel and, 216 Primary intestinal lymphoma, malignancies and, 514 Primary intestinal pseudoobstruction, 218 Primary lactose deficiency, 159, 663, 687 differential diagnosis for, 663, 687 Primary liver tumors, 525–527 Primary lymphoma of stomach, treatment for, 505 Primary malnutrition, 577 Primary peristalsis, 27 Primary peritonitis, secondary peritonitis v., 667, 692 Primary radiation therapy, esophageal cancer and, 502 Primary sclerosing cholangitis (PSC), 74, 424, 452, 685, 686 diagnosis and treatment, 425 recurrence of, liver transplantation and, 467 Primary tumor HNPCC and, 508 liver metastases and, 672, 697–698 localization, 549–551 Probenecid, unconjugated hyperbilirubinemia and, 70 Probiotic therapy, 684 Prochlorperazine, 658, 681–682 Procidentia, 684, 685 Proctography, 56 Proctosigmoidoscopy, polyposis coli and, 507–508 Progressive familial intrahepatic cholestasis (PFIC), 346t, 347–348 types 1-3, 75 Proinflammatory cytokines, metabolic syndrome and, 630 Prokinetics, 41 Prolapse gastropathy, 64 Proliferator-activated receptor γ (PPARγ), 603 Promyelocytic leukemia, retinoic acid and, 571 Proopiomelanocortin (POMC), gene mutations in, 605, 605f Propamidine isethionate eyedrops, Acanthamoeba infections, 302 Propranolol, vasoactive intestinal peptidomas, 548 Prostacyclin (PGI2), synthesis of, 127, 127f 731 Prostaglandin analogues, PUD and, 138 Prostaglandin E2 (PGE2) diarrhea and, 541 synthesis of, 127, 127f Prostaglandin inhibitors, 53–54 Prostaglandin-mediated flushing, niacin toxicity, 568 Prostaglandins gastroduodenal mucosal defense, 127 Ménétrier’s disease, 151 Prosthetic vascular grafts, NTS and, 269 Protease inhibitors acute pancreatitis and, 485 HCV and, 409 liver injury and, 380 necrotizing acute pancreatitis and, 486 Proteases, 480 Protein, 555 Protein balance, equation, 585 Protein catabolic rate, 585 Protein catabolism, 580 Protein requirements estimating, 584–585 formulas providing, 592 Protein-calorie malnutrition (PCM), 559, 587 Protein-energy malnutrition (PEM), 577 Protein-losing enteropathy, 171 treatment, 172–173 Proteins, 159 intestinal epithelia and, 153 Proteolytic enzymes acute pancreatitis and, 481 pancreas and, 480 Prothrombin time, vitamin K deficiency and, 574 Proton pump inhibitors (PPIs), 40, 53–54, 655–656, 678 acute gastrointestinal hemorrhage, 100 gastrinomas, 545 GERD and, 113, 119 GI bleeding and, 63 Ménétrier’s disease, 151 PUD and, 136–137 ZES and, 147 Protozoal intestinal infections, 304 Protozoan parasites, 185 Prozac See Fluoxetine Pruritus, acute viral hepatitis, 371 PSC See Primary sclerosing cholangitis Pseudoaneurysms, acute pancreatitis and, 488 Pseudocysts, 475 of pancreas, 488 rupture of, 487 treatment for, 487 Pseudodiarrhea, 44–45, 678 Pseudomembranous colitis, 238 Pseudoobstruction, 101 Pseudopolyps, ulcerative colitis and, 177 Psoas abscesses, 252 www.downloadslide.net 732 PSTI See Pancreatic secretory trypsin inhibitor Psychiatric diagnosis, 660, 683–684 IBS and, 198 Psychiatric treatment,AN, 623 Psychological factors, appetite regulation and, 602 Psychological stress, acid peptic disease and, 132 Psychological therapy, gastrointestinal disease and, 92 Psychotropic agents, obesity and, 610 Psyllium preparations, IBS and, 200 PUD See Peptic ulcer disease Pudendal nerve terminal motor latency (PNTML), fecal incontinence, 209 Pulmonary disease, in obese, 609 Pulmonary disorders, cholecystectomy and, 449 Pulmonary infections, NTS and, 267 Pulpal disease, Pulpitis, Purging behavior BN and, 624 inpatient treatment and, 677, 702 Purtscher’s retinopathy, acute pancreatitis and, 485 Push enteroscopy, 66–67, 96 Pyloric channel ulcers, gastric outlet obstruction and, 142 Pyoderma gangrenosum (PG), 187 Pyoderma vegetans, 187 Pyogenic granulomas, pregnancy and, 10 Pyrantel pamoate ascariasis, 314 enterobiasis, 318 hookworm, 315 Pyridoxine (Vitamin B6), 37, 568 dietary sources, 568 Pyridoxine deficiency, 568 Pyridoxine toxicity, 568 Pyrosis, 112 Pyruvate α-ketoglutarate, 562 Quasispecies, 357 Quinacrine, 68 Quinolones, and Shigella, 274 Quorum sensing, V cholerae and, 283 Rabeprazole, GERD and, 119 Radiation enterocolitis, 51 Radiation esophagitis, 122 Radiation therapy colorectal cancer and, 512 esophageal cancer and, 502 HCC and, 524, 524t Radiofrequency ablation (RFA), HCC and, 522 Radiographic studies, amebic colitis and, 300 Radiography appendicitis and, 223–224 gastrointestinal disease and, 90 Index Radioimmunoassays (RIAs), 545 Radiologic studies esophageal diseases, 113, 114f of small intestine, 162–163, 162f Radiologic tests, pancreatic structure and, 475–476 Radiology, HCC and, 521 Radiopaque marker transit tests, constipation and, 55–56 Radiopharmaceuticals, biliary tree and, 445 Radiotherapy, with radiolabeled somatostatin analogues, metastatic disease and, 551 RAE See Retinol activity equivalent Ranitidine, PUD and, 136 Ranitidine plus antimicrobial agents, Helicobacter pylori infection, 258, 258t Ranson criteria, risk of death, 671, 696 Rapamycin, for immunosuppression, 464 Rash enteric fever and, 263, 263f glucagonomas and, 546 RBP4, obesity and, 603 RDAs See Recommended dietary allowances (RDAs) Recklinghausen’s disease, 538 Recombinant hepatitis B vaccines, 374, 375 Recommended dietary allowances (RDAs), 558 dietary reference intakes and, 555 niacin and, 567 Recovery phase, hepatitis and, 364–365 Rectal carcinoids, 539 abdominoperineal resection and, 544 Rectal examination, 661–662, 684 Rectal prolapse (Procidentia), 207, 210 degree of, 208f presentation and evaluation, 207 treatment, 207, 208 Rectosigmoid, cancers from, 510 Recurrent allograft hepatitis C, liver transplantation and, 466 Recurrent bleeding, prevention of, 428 Recurrent variceal hemorrhage, management of, 429f REE See Resting energy expenditure Refeeding syndrome, 623 Referred pain, 17 in abdominal diseases, 4–5 of thoracic origin, 4–5 Reflux, documentation and quantitation, 119 Reflux esophagitis, 118 Refractory ascites, 430, 430t Regional chemotherapy, HCC and, 523–524 Regional lymph nodes, colorectal cancer and, 511 Regurgitation, 113 Rehydration, 235 acute peritonitis and, 226 human caliciviruses, 292 and Shigella, 274–275 Reiter’s syndrome, 46, 273 Relapsing hepatitis, 369, 667, 692–693 Remissions, gastric adenocarcinoma and, 504–505 Renal abscesses, 251–252 Renal colic, acute pancreatitis v., 484 Renal dysfunction, liver transplantation and, 465 Renal toxicity, liver transplantation and, 465 Renal transplantation, mycophenolate and, 463–464 Renal ultrasonography, renal abscesses, 252 Renin-producing PET, 549 Replicative phase, hepatitis, 392 Reproductive disorders, obesity and, 608 Reproductive system,AN and, 621 Resistin, 603 metabolic syndrome and, 630 Respiratory function, ascites and, 430 Resting energy expenditure (REE), 554, 591, 675, 699 Restrictive weight loss surgeries, 617–618 Restrictive-malabsorptive weight loss surgeries, 617–618 Retinaldehyde (11-cis), vision and, 570 Retinoic acid, 570 13-cis-retinoic acid, 572 Retinoid receptors, cell proliferation and differentiation, 571 Retinoid-mediated gene transcription, 571 Retinoids, 570 Retinol activity equivalent (RAE), vitamin A and, 571 Retinol-binding protein, 570–571, 581 Retroperitoneal burn, 482 Revascularization, intestinal ischemia and, 216 Review and self-assessment answers, 678–702 questions, 655–677 RFA See Radiofrequency ablation Rhabditiform larvae, 316 Rheumatoid arthritis, 17 ferritin levels and, 435 Rheumatologic disorders, 187 RIAs See Radioimmunoassays Ribavirin, 409 side effects, 405, 406 Riboflavin (Vitamin B2), 567 Rifampicin, unconjugated hyperbilirubinemia and, 70 Rifaximin bacterial diarrhea and, 48 diverticular disease, 205 hepatic encephalopathy, 432 recurrent CDAD, 242 Right colonic vascular ectasias, bleeding from, 64 Right hemicolectomy, nonmetastatic carcinoid tumors and, 544 Right-sided heart failure, 668, 693 www.downloadslide.net Index Rimonabant, for weight loss, 617 Ritonavir, liver injury and, 380 RNA viruses, 349 Rokitansky-Aschoff sinuses, 450 Rome criteria, 89 Root canal therapy, Rose spots, enteric fever and, 263, 263f Rosiglitazone, NAFLD and, 437 Rosuvastatin, triglycerides and, 632 Rotavirus, 292, 664, 688 clinical manifestations, 293 diagnosis and treatment, 293–293 diarrhea, 292 epidemiology, 292–293 as etiologic agent, 292 gastroenteritis, 293 diagnosis and treatment, 293–294 prevention, 294 global considerations, 294 group B, 293 pathogenesis, 293 peak activity time, 292f Rotor’s syndrome, 72, 72t, 346t, 347 Roux-en-Y choledochojejunostomy, biliary atresia, 450–451 Roux-en-Y gastric bypass (RYGB), 618 RXR agonists, 571 RYGB See Roux-en-Y gastric bypass S Choleraesuis, 266–267 S dysenteriae type 1, Shiga toxin and, 272, 273 S.Typhi, 262, 262f, 263 SAAG See Serum ascites-albumin gradient Salivary gland,AN and, 621 Salivary gland diseases, 18 Salivary stone, 25f Salmonella, 260 enteric fever and, 264t, 265 osteomyelitis, 267 stool culture, 235 Salmonellosis, 260 etiology, 260–261 pathogenesis, 261 Sapoviruses, 291 SARS-CoV See Severe acute respiratory syndrome-associated coronavirus Saturated fats, 632 SBP See Spontaneous bacterial peritonitis SCFAs See Short-chain fatty acids Schatzki ring, 122 Schilling test, 161 bacterial overgrowth syndrome, 170 cobalamin malabsorption and, 161t Schizophrenia, pyridoxine and, 568 Scleroderma, 684 dysphagia and, 32 Scleroderma esophagus, 117 Sclerosant, sclerotherapy and, 210 Sclerosing cholangitis, 454, 459 ERCP and, 668, 693–694 treatment, 454–455 Sclerotherapy, 122 acute variceal hemorrhage, 428 hemorrhoidal disease, 210 Scurvy, 559 vitamin C and, 569 Secondary active transport, 154 Secondary bacterial peritonitis, conditions leading to, 226t Secondary biliary cirrhosis, 452 Secondary diarrhea, 153 Secondary lactose deficiency, 159 Secondary peristalsis, 27 Secondary peritonitis, 246 primary peritonitis v., 667, 692 treatment for, 247 Secretin, 480 chronic pancreatitis and, 492 gastric acid and, 479 Secretin test, 478, 683 Secretin-cholecystokinin stimulation test, 53 Secretory diarrheas, 685 evaluation of, 53 Sedentary lifestyle, metabolic syndrome and, 627 Selective catheterization, of celiac/superior mesenteric arteries, chronic pancreatitis and, 477 Self esteem,AN and, 623 Sensory nerve injury, causalgic pain and, Sepsis, 584, 588 drotrecogin alfa and, 667, 692 fulminant CDAD and, 242 kwashiorkor and, 578 liver transplantation and, 460, 468 protein catabolism and, 580 Sepsis with hypotension, catheter and, 596 Serine protease inhibitor kasal type (SPINK1), 480, 496 Serine proteases, 480 small-duct pancreatitis and, 494 Serologic assays, HCC and, 521 Serologic markers, Crohn’s disease and, 182 Serotonin (5HT), 541–542 appetite regulation, 616 atypical carcinoid syndromes and, 537f foregut tumors and, 534 typical carcinoid syndromes, 537f Serotonin 5-HT3 antagonists, emesis and, 36 Serotonin receptor agonists, IBS and, 201 Serotonin receptor antagonists, 684 carcinoid syndrome, 542 gastrointestinal disease and, 91–92 IBS and, 201 Serotonin (5HT) receptors, 673, 698 carcinoid syndrome, 542–543 733 5HT See Serotonin Serum albumin, liver function and, 335 Serum albumin level, 584 Serum alkaline phosphatase, 334–335 autoimmune hepatitis, 410–411 Serum aminotransferase levels acute viral hepatitis and, 365 liver disease and, 328 Serum aminotransferase tests, 343 Serum amylase levels acute pancreatitis and, 482–484, 671, 696 ascites fluid and, 489 chronic pancreatitis, 492 pancreatitis and, 473, 474t–475t Serum antibodies, celiac sprue and, 166 Serum ascites-albumin gradient (SAAG), 79–80, 430, 658, 681 Serum aspartate aminotransferase levels, alcoholic cirrhosis and, 667, 692 Serum bilirubin, 68, 332 isolated elevation of, 70–72 measurement of, 69–70 Serum chromogranin A levels, 541, 542 Serum cortisol,AN and, 621 Serum enzyme tests, categories, 334 Serum enzymes, liver and, 334–335 Serum globulins, liver function and, 335 Serum iron studies, HH and, 435 Serum leptin levels,AN and, 621 Serum lipase levels acute pancreatitis and, 671, 696 chronic pancreatitis, 492 pancreatitis and, 473 Serum markers, pancreatic cancer and, 530 Serum proteins, nutritional status using, 581 Serum prothrombin time, 335, 337 Serum transaminase levels,AN and, 621 Serum triglycerides, hypertriglyceridemiaassociated-pancreatitis and, 487 Serum trypsinogen levels, 473, 478 Serum trypsinogen tests, pancreatic steatorrhea and, 492 Serum vasoactive intestinal peptide (VIP), 673, 698 Serum zinc level, 574 Serum-ascites albumin gradient (SAAG), 679 Serum-sickness like syndrome, 369 Sessile polyps, cancers and, 506 sessile polyps and, 506 Sessile tumor of cecum, double-contrast airbarium enema and, 510f Severe acute respiratory syndrome-associated coronavirus (SARS-CoV), 294 Severe cholestasis, 325 Severe constipation, 55 Severe gastrointestinal disorders, enteral nutrition therapy and, 589 Severe SRI, 588 Sex hormone-binding globulin (SHBG), obesity and, 608 www.downloadslide.net 734 Sexual transmission enteric fever and, 261 HBV, 362 HCV and, 364 hepatitis A and, 375 Trichomoniasis and, 310 Sexually transmitted diseases, trichomoniasis and, 310 SHBG See Sex hormone-binding globulin Shiga toxin, 272 Shigella dysenteriae type 1, 230 Shigella infection antibiotics and, 273–274 bloody diarrhea, 657, 680 invasive strategy of, 271f pathogenesis and pathology, 271–272 stool culture, 235 Shigellosis, 270 clinical manifestations, 272–273 complications, treatment of, 274 definition, 270 epidemiology, 270–271 laboratory diagnosis, 273 prevention of, 274 symptom-based therapy, 274 treatment, 273 Shivering thermogenesis, 554 Short bowel syndrome, 168 treatment, 169 Short term memory, thiamine deficiency and, 564 Short-chain fatty acids (SCFAs), 156, 158, 159 Sialolithiasis, 18 Sibutramine appetite regulation and, 616 adverse effects and, 616 contraindications, 616 Sigmoid diverticular disease, 204f Sigmoid volvulus, 102f Sigmoidoscopy, 90 acute diarrhea, 47 large-bowel cancer, for asymptomatic patients, 509 ulcerative colitis, 179 Sildenafil, achalasia and, 116 Silent biliary-enteric fistulas, 448 Simvastatin, triglycerides and, 632 Sinusoids, 323 SIRS See Systemic inflammatory response syndrome Sitz baths, anal fissure and, 212 Skeletal lesions, molybdenum deficiencies and, 575 Skin disorders, liver disease and, 327 Skin lesions porphyrias, 438 riboflavin deficiency and, 567 V vulnificus, 288 Skin nodules, erythematous, acute pancreatitis and, 482 Index Sliding hiatal hernia, 123 Slow-transit constipation, 86 Small bowel V cholerae and, 284 endoscopy, 96 feeding, 597 malignancies, 514–515 Small bowel tumors, 513 angiomas as, 514 benign, 513 leiomyomas as, 514 lipomas as, 514 polypoid adenomas as, 513–514 Small duct pancreatitis, 492, 492t Small intestinal carcinoids, 539 Small intestinal disease, surgical therapy, 193 Small intestinal MMC, 44 Small intestinal motility See Intestinal fluid(s) Small intestine, 85 following resection, 168 neural control of, 43 normal physiology, 42–43 transport mechanisms, 154 Small-bore feeding tubes, 597 Small-duct pancreatitis, enzyme preparations and, 494 Small-intestinal mucosal biopsy, 164f celiac sprue and, 166 disease diagnosed, 163–165, 163t Small-intestinal obstruction, treatment, 220–221 Small-intestine disease, 657, 680 Small-intestine transit time, 159 Smokers, UC and, 659, 682 Smooth-muscle fibers, esophagus/LES, innervation of, 28 SNS See Specialized nutritional support “Soap formation,” acute pancreatitis and, 483 Sodium and potassium acetate salts, PN therapy and, 595 Sodium bicarbonate, for peptic ulcer disease, 136 Sodium restriction, ascites, 430–431, 430f Sodium retention, 429 Sodium valproate hepatotoxicity, 385 Soft tissue infections, NTS and, 267 Solitary hepatic metastases, partial liver resection and, 513 Somatostatin, 127 glucagonomas and, 547 insulinomas and, 545 necrotizing acute pancreatitis and, 486 structure, 543f Somatostatin analogues carcinoid crises and, 543 GRFomas, 549 metastatic disease and, 550 Somatostatin receptor scintigraphy (SRS), primary tumor localization with, 549f Somatostatinoma syndrome, 547 Sonography, pseudocysts of pancreas and, 488 Spasm of Sphincter of Oddi, 449 Specialized nutritional support (SNS), 586 efficacy of, in disease states, 588–589 implementation of, algorithm for, 587f long-term, 590 requirements for, approach to patient, 586–591 risks v benefits, 589 Sphincter of Oddi, gallbladder and, 440–441 Sphincterotomy chronic pancreatitis pain and, 495 indications for, 450 Spider angiomata, 326 Spine, referred pain from, SPINK1 See Serine protease inhibitor kasal type Spironolactone, ascites, 430 Spleen, bilirubin and, 68–69 Splenectomy, splenic abscesses and, 251 Splenic abscesses, 251 Splenomegaly, 326, 428 HCC and, 519 hepatitis and, 364 Split liver grafts, 462 Spontaneous bacterial peritonitis (SBP), 431 Squamous cell cancer, oral, 17 Squamous cell esophageal cancer, 500 SRI See Systemic response to inflammation SSRI, IBS and, 201 Staging system See also CLIP staging system; OKADA staging system;TNM classification system chronic hepatitis, 391, 392t colorectal cancer, 510–512, 511t diverticulitis, 204–205 gastric carcinoma, 504t gastrointestinal cancers endoscopic ultrasound for, 97f HCC, 520–521 hemorrhoidal disease, 209t of liver disease, 323, 328–330 pancreatic cancer and, 530, 531t Staphylococcus aureus, 18, 34, 233, 234t Staphylococcus epidermis, 595 Staphylococcus food poisoning, 233–234, 234t Starvation, 676, 700 marasmus and, 577–578 metabolic rate and, 579–580 protein catabolism and, 580 Statins, 632 drug hepatotoxicity and, 378 triglycerides and, 632 Steatohepatitis, drugs and, 380 Steatorrhea, 152, 155, 155t, 156, 160, 657, 680 causes of, diagnostic studies, 165t lipid digestion defects and, 157t lipids and, 156–158 nonenteric coated enzymes and, 495 Steroid hormones, obesity and, 610 Stevens-Johnson syndrome, nevirapine reaction and, 22f www.downloadslide.net Index Stomach tumors, 502 Stone extraction, chronic pancreatitis pain and, 495 Stool, 54–55 analysis, 47 cholera and, 284 collection, 53 culture acute infectious diarrheal diseases, 234–235 V cholerae and, 285 diet and, 152–153 electrolytes, measurement, 153 examination, Isospora belli parasite, 308 gastrointestinal disease and, 89 occult blood in, 506 anemia and, 106 osmolality, measurement, 153 osmolality gap, 685 shigellosis and, 275 softeners, anal fissure, 212 specimens diarrheal diseases and, 234–235 IBS, 199 non-O1 V cholerae, 287 Stool-bulking agents, IBS and, 200 Strangulating obstruction, 220–221 Strawberry gallbladder, 450 Streptococcus bovis bacteremia, occult colorectal cancers and, 508 Streptococcus mutans, plaque and, Streptozotocin, metastatic disease and, 550 Stress-related gastric mucosal injury, 64, 148 Strictures of extrahepatic bile ducts, 452, 454 Strongyloides diagnosis, 316–317 epidemiology and clinical features, 315–316 ivermectin and, 664, 688 life cycle of, 315, 316f Strongyloidiasis, 315 Sublingual leukoplakia, 23f Substance P, 541 Subtotal gastrectomy, gastric adenocarcinoma and, 504 Sucralfate, 41 PUD and, 137 Sudeck’s point, 213, 214f Sulfamethoxazole, cholestatic hepatitis, 74 Sulfapyridine, 189 Sulfasalazine, 188 pregnancy and, 194 Sulfhydryl compounds, acetaminophen overdose and, 383 Sulfonylureas, obesity and, 610 Sumatriptan, 38 Sunitinib GIST and, 505 metastatic endocrine tumors and, 147 Superior mesenteric arteries, selective catheterization, chronic pancreatitis and, 477 Surgery bacterial overgrowth syndrome and, 170 choledochal cysts and, 451 esophageal rupture, 123 gastrointestinal disease and, 92 insulinomas and, 545 for obesity, 617–618, 617f pancreatic abscess and, 487 pancreatic cancer, 532 PUD and, 141–142 somatostatinoma syndrome and, 547 Surgical debridement, fulminant pancreatitis and, 487 Surgical debulking, glucagonomas and, 546–547 Surgical excision, HCC and, 522 Surgical intervention, acute cholecystitis and, 448–449 Surgical mortality, from bariatric surgery, 618 Surgical resection gastric adenocarcinoma and, 504 HCC and, 522 nonmetastatic carcinoid tumors and, 544 pancreatic lesion and, 673, 698 PETs and, 544 Surgical therapy, 193 acute peritonitis and, 226 anal fissure and, 212 diverticular disease, 205–207 goals of, diverticular disease, 206 indications for, 193t methods of, diverticular disease, 206f outcome of, diverticular disease, 206t Survival by adjuvant therapy, advanced pancreatic cancer and, 532f gastrinomas and, 550 MELD and, 467 pancreatic cancer and, 673, 698 Survival rate advanced pancreatic cancer and, 531 gastric adenocarcinoma and, 504 liver transplantation and, 467–469 Swallow, difficulty initiating, 27 Swallowing oropharyngeal phase of, 28 physiology of, 27–28 Sympathomimetic adrenergic agents, 616–617 Syndrome of postamebic colitis, 298 Syndrome of postinfectious IBS, 46 Syndrome X See Metabolic syndrome Syndromes of obesity, comparison, 606t Systemic chemotherapy HCC and, 523 hepatocellular carcinoma and, 669, 694–695 Systemic disease affecting teeth, 10 liver transplantation and, 460 odors from, 19 Systemic inflammatory response syndrome (SIRS), pancreatitis and, 482 735 Systemic response to inflammation (SRI), 587 lean tissue loss and, 676, 700 Systemic therapy, 5-FU in, colorectal cancer and, 512 T whippelii, serum PCR for, 660, 684 TACE See Transarterial chemoembolization Tachykinins, diarrhea and, 541 Tacrolimus, 191 liver transplantation and, 463, 466 Tangier disease, 437 TCBS See Thiosulfate-citrate-bile saltssucrose agar T-cell activation, 176–177 TCP See Toxin-coregulated pilus 99 Tc-labeled red blood cell scintigraphy, obscure GIB and, 67 Teeth acromegaly and, 10 BN and, 624 developmental disease affecting, 10 diseases of, systemic disease affecting, 10 Tegaserod, 37 Telbivudine, chronic hepatitis B and, 401, 401t Temporomandibular disorder, 17 Tenofovir, chronic hepatitis B and, 401t, 402 Tests of absorptive function, 478 Tetracycline bacterial overgrowth syndrome, 170 cholera and, 285 Dientamoeba fragilis infection and, 310 Helicobacter pylori infection, 138, 138t tooth enamel and, 10 tropical sprue, 168 V vulnificus bacteremia, 288 TGF See Transforming growth factor Thermogenesis, 607 Thiabendazole, abdominal angiostrongyliasis, 319 Thiamine (Vitamin B1), 562, 563 alcohol abuse and, 580 deficiency, 563–566 food sources, 563–564 treatment, 566 food sources of, 563 toxicity, 567 Thiazolidinediones (TZDs), 677, 701 insulin sensitivity and, 633 NAFLD and, 437 obesity and, 610 Thiosulfate-citrate-bile salts-sucrose (TCBS) agar, cholera, 284–285 Third spacing, 584, 659 Third-generation immunoassays, HCV and, 357 Thoracentesis, pancreatic pleural effusions, 490 Thoracic esophagus, motor disorders of, 115–117 Thoracoabdominal surgery, malnourished patients in, SNS and, 588 Thrombocytopenia, in HCC, 519–520 www.downloadslide.net 736 Thromboembolic disorders, 188 Thumbprinting, 214 TIGAR-O classification system, chronic pancreatitis, pancreatic exocrine insufficiency and, 491t Tinidazole, trichomoniasis and, 310, 688 TIPS See Transjugular intrahepatic portosystemic shunt Tissue amebicides, intestinal disease and, 300–301 Tissue cytology, pancreatic cancer and, 529–530 Tissue inflammation, 127 TLI See Trypsin-like immunoreactivity TMP See Trimethoprim TMP/SMX See Trimethoprim/sulfamethoxazole TNF See Tumor necrosis factor TNM classification system, colorectal cancer, 510–511, 511f TNM staging/classification system, HCC and, 520 TNT See Total parenteral nutrition Tobacco use, occult colorectal cancers and, 508 α-tocopherol, vitamin E and, 573 Tocopherols, 572 Tocotrienols, 572 Tolbutamide, 381 Tolerable upper levels (ULs), of nutrient intake, 558 Tongue alterations of, 16t fissured, 26f white-coated, 26f Tonic reflex spasm, of abdominal musculature, 2–3 Tooth decay prevention, Tooth enamel, tetracycline and, 10 Tooth loss, from periodontitis, 10 Topical mesalamine enemas, 189–190 Toroviruses, 294 Total colectomy, polyposis coli and, 507–508 Total energy expenditure, 591 Total gastrectomy gastric adenocarcinoma and, 504 gastric carcinoids, 544 Total mesorectal excision, colorectal cancer and, 512 Total pancreatectomy, chronic pancreatitis and, 495 Total parenteral nutrition (TNT) acute necrotizing pancreatitis, 487 cholestatic syndromes, 75 manganese deficiencies and, 575 molybdenum deficiencies, 575 short bowel syndrome and, 168, 169 Total protein loss, 585 Total surgical resection colorectal cancer, 512 poor outcome following, predicators of, 511t Index Toxic hepatic injury, 379t treatment, 381 Toxic hepatitis, 378 Toxic megacolon, 272 treatment, 279 Toxicity, of tacrolimus, 463 Toxin-coregulated pilus (TCP), 283 Toxins, nausea and vomiting, 35 Trace mineral deficiencies, 562–576 Trace minerals, diseases and, 562 Tracheal suctioning, 597 Tracheobronchial aspiration, 31, 31f Tracheoesophageal fistulas, esophageal cancers and, 501, 502 Trail-making test, for hepatic encephalopathy, 326–327 Transanal proctectomy, rectal prolapse and, 208 Transarterial chemoembolization (TACE), HCC and, 523, 524, 524t Transcription factors, retinoic acid and, 571 Transferrin, 581 Transforming growth factor (TGF) chronic pancreatitis and, 490 gastroduodenal mucosal defense, 127 Transforming growth factor-α (TGF-α), Ménétrier’s disease, 151 Transforming growth factor-β (TGF-β), 176 Transfusion-associated HCV, blood donors and, 363 Transjugular intrahepatic portosystemic shunt (TIPS) acute variceal hemorrhage, 428 ascites, 430 rebleeding and, 63 Transplant rejection, liver transplantation and, 466–467 Transthyretin, 570–571 Trauma, 578, 584 pseudocysts of pancreas and, 488 strictures of extrahepatic bile ducts, 452, 454 Traumatic lesion, inside cheek, 23f Traumatic ulcer, 26f Traveler’s diarrhea, 45, 291 bacterial food poisoning, 233–234 enteric infections, locations for, 232 epidemiology of, 233t patient age, 232–233 travel history and, 232 treatment, 235, 236t Trichomoniasis, 304, 310, 663, 687–688 Trichostrongyliasis species, 318 Trichuriasis, 317 Tricyclic drugs cyclic vomiting syndrome and, 37 gastrointestinal disease and, 91–92 obesity and, 610 PUD and, 138 Trientine,Wilson’s disease and, 436 Trigeminal neuralgia, 17 Triglycerides, 156, 156t, 158, 481 insulin resistance and, 629 metabolic syndrome, treatment of, 632 Trimethoprim (TMP), cholestatic hepatitis, 74 Trimethoprim/sulfamethoxazole (TMP/SMX) acute pancreatitis and, 485 bacterial diarrhea and, 48 blastocystis hominis infection, 310 cholera and, 285 cyclosporiasis, 308 diverticular disease, 205 enteric fever and, 264t, 265 hepatotoxicity, 386 Isospora belli parasite, 308 liver transplantation and, 465 Whipple’s disease and, 171, 684 Triple regimen, H pylori infection, 138–139, 138t Troglitazone, drug hepatotoxicity and, 380 Trophic hormones, short bowel syndrome, 169 Trophozoites, 296, 304, 305f, 306 amebic ulcer and, 298f biopsy specimen and, 299 Dientamoeba fragilis infection and, 310 Entamoeba histolytica, pathogenesis and pathology, 297–298, 297f Tropical sprue, 50, 167 diagnosis and treatment, 168 etiology, 167–168 Trypsin acute pancreatitis and, 481 pancreas and, 480 Trypsin-like immunoreactivity (TLI), acute pancreatitis and, 473 Trypsinogen, 159 assay, 473 pancreatitis and, 482 Tuberculous peritonitis, 79, 80 Tuberin, 538 Tubular polyps, 506 Tubulovillous polyps, 506 Tumor(s) of ascending colon, presenting symptoms, 510 benign small bowel, 513 biology, of NETs, 533–534, 537–539 distribution, ZES and, 145 metastatic to liver, 526 serum amylase levels, 473 surgical resection of, esophageal cancer, 501–502 Tumor brushings, cytologic examination of, esophageal cancer and, 501 Tumor markers, 537 Tumor necrosis factor (TNF), 176 Tumor necrosis factor-α (TNF-α), 603 metabolic syndrome and, 630 Tunneled catheters, 593–594 Turcot’s syndrome, 507 Turner’s sign, acute pancreatitis and, 482 www.downloadslide.net Index Type diabetes See Diabetes mellitus type Typhoid fever See Enteric fever Typical carcinoid syndromes, serotonin and, 537f Tyrosine kinase inhibitor, advanced pancreatic cancer and, 531 TZDs See Thiazolidinediones UBT See Urea breath test UC See Ulcerative colitis UDCA See Ursodeoxycholic acid UDPGT gene, 70–71 UES See Upper esophageal sphincter UGIB See Upper gastrointestinal bleeding UGT1A1, 343 Ulcer See also Specific ulcer; Ulcer disease diagnostic evaluation, 134 therapy, approach to, 140–141 Ulcer disease, 38 Ulceration of stomach, differential diagnosis, 134 Ulcerative colitis (UC), 177, 655, 678 acute -phase reactants, 179–180 cancers and, 508 colonic mucosa in, 178f complications, 180 differential diagnosis, 183, 184t infectious disease v., 184–185 laboratory, endoscopic, radiographic features, 179–180 macroscopic features, 177 microscopic features, 177–178 signs and symptoms, 179, 179t surgical therapy, 193 treatment, 172 ulcerative colitis and, 508 ULs See Tolerable upper levels Ultrasonography appendicitis and, 223–224 choledochal cysts and, 451 chronic pancreatitis, 475–476 gallbladder and, emptying function of, 445 liver tests and, 337 pancreatic disease and, 492, 493f Ultrathin endoscope, 113 Ultratrace elements, 575 Unconjugated bilirubin, 332 Unconjugated hyperbilirubinemia, 70–72, 71f bilirubin metabolism disorders and, 342–345 United Network of Organ Sharing (UNOS), 461 HCC and, 522, 523 liver transplantation waiting list, criteria for, 461t living-donor transplantation and, 462 survival rate, liver transplantation and, 467 University of Wisconsin solution, cadaver donor selection, 461 UNOS See United Network of Organ Sharing Unsedated esophagoscopy, 113 Unstirred water layer, 157 Upper endoscopy anisakiasis and, 665, 690 nausea and vomiting, 36 Upper esophageal sphincter (UES), 27–28, 112 Upper gastrointestinal bleeding (UGIB), 62, 655, 677 diagnostic evaluation, 65–67, 65f LGIB v., 65 sources of, hospitalized patients, 62t Upper gastrointestinal symptoms, altered, IBS and, 197 Upper gastrointestinal tract diseases, Helicobacter pylori infection v., colonization of, 255f Urea breath test (UBT), 140 H pylori and, 664, 689 Helicobacter pylori infection and, 257 Urea nitrogen, protein catabolism and, 584 Uremia, Ureteral injury, 658–659, 682 Urgent cholecystectomy, 449 Urgent endoscopy, 99 acute gastrointestinal hemorrhage and, 99–101 Urinalysis, Urinary 5HIAA excretion, carcinoid syndrome and, 541, 542 Urinary amylase measurements, 473 Urinary bladder obstruction, Urinary D-xylose test, 162 Urinary metabolites, 605 Urinary thiamine loss, thiamine deficiency and, 564 Urinary tract infections, NTS and, 267 Urine bilirubin, 333 measurement of, 70 Urine loss, excessive, 592–593 Urologic disorders, 188 Ursodeoxycholic acid (UDCA), 425, 440 gallstone disease and, 446 Ursodiol, 187–188 Uveitis, 659, 682 UC and, 686 V alginolyticus, 288 V cholerae, 281 quorum sensing and, 283 V cholerae O139 Bengal, quorum sensing and, 283 V parahaemolyticus, gastrointestinal illness and, 286–287 V vulnificus, gastrointestinal illness and, 287–288 V vulnificus bacteremia, 287–288 cutaneous manifestations with, 288 Vaccination hepatic viruses and, HCC and, 521 hepatitis A schedules, 373t schedules, HBV, 374t Vaccine, rotavirus infection, 294 Vagal inputs, appetite regulation and, 602, 602f Vaginitis,Trichomoniasis and, 310 Vagotomy, 142 737 VA-HIT trial (Veterans Affairs HDL Intervention Trial), triglycerides and, 632 Valproate drug hepatotoxicity and, 378 obesity and, 610 Van den Bergh reaction assay, 657, 680 bilirubin and, 69 Vancomycin CDAD, 241 continuous ambulatory peritoneal dialysis peritonitis, 247 fulminant CDAD and, 242 Vanishing bile duct syndrome, 75 VAQTA, hepatitis A vaccination and, 373, 373t Variceal hemorrhage, 331 treatment, categories of, 427–428 Varicella-zoster virus (VZV), esophagitis and, 120 Varioliform gastritis, 150 Vascular disturbances, Vascular ectasias, 64, 101, 102f Vascular endothelial growth factor (VEGF), gastroduodenal mucosal defense, 127 Vascular lesions, 64 Vasoactive intestinal peptide (VIP), 479 Vasoactive intestinal peptidomas, treatment, 548 Vasoconstrictors, anesthetic dose and, 19 Vasospastic mesenteric ischemia, 215 VBG See Vertical banded gastroplasty VC See Virtual colonoscopy VEGF See Vascular endothelial growth factor Vena cava obstruction, collateral venous flow and, from umbilicus, 658, 681 Venous stasis, obesity and, 609 Ventilatory status, SNS and, 589 Verapamil, insulinomas and, 545 Vertical banded gastroplasty (VBG), 618 Very low calorie diets (VLCDs), 615 Very low density lipoproteins (VLDLs), dyslipidemia, 629 Vesicular lesions, of oral mucosa, 11t–13t Veterans Affairs HDL Intervention Trial See VA-HIT trial VFSS See Videofluoroscopic swallowing study VHL See Hippel-Lindau disease Vibrio genus, 281 species, 286 gastrointestinal illness and, 286–288 Vibrioses, noncholera, features of, 286t Videoendoscopy, dysphagia and, 32 Videofluoroscopic swallowing study (VFSS), 28 Villous polyps, 506 Vincent’s infection, VIP See Vasoactive intestinal peptide VIPomas, 538, 547 differential diagnosis, 673, 698 Viral esophagitis, 120–121 Viral gastroenteritis, 289, 679 www.downloadslide.net 738 Viral hepatitis assessment, 325 clinical and epidemiologic features, 361t differential diagnosis, 370–371 pathology of, 360 rare complications, 370 Viral infections, liver transplantation and, 465 Viral kinetics studies, 405 Viral particles, HBV and, 351, 352t, 353 Viral proteins, HBV and, 351, 352t, 353 Viral replication, HBeAg and, 668, 693 Virtual colonoscopy (VC), 106–107, 108f large-bowel cancer, for asymptomatic patients, 509 Virus detection, EIAs and, 292 Visceral abscesses, 249 Visceral afferent hypersensitivity, 38 Visceral hypersensitivity, mechanisms for, 198, 198t Vision, retinaldehyde and, 570 Vital signs,AN and, 621 Vitamin(s), 562 deficiency, and excess, 562–576 diseases and, 562 DRIs for, 556t malnutrition, clinical findings about, 563t requirements, formulas providing, 592–593 status assessment of, 584 short bowel syndrome, 169 structures and functions of, associated with human disorders, 565t–566t Vitamin A, 570 acute toxicity of, 572 body stores of, 562 deficiency, 571 children and, 676, 700 dietary sources of, 571 intoxication, 572 metabolism, 570–571 Vitamin B, malabsorption, Schilling test and, 161t Vitamin B1 See Thiamine Vitamin B2 See Riboflavin Vitamin B3 See Niacin Vitamin B5 See Pantothenic acid Vitamin B6 See Pyridoxine Vitamin B12, 152 body stores of, 562 GERD and, 119 Vitamin C, 568, 580, 674–675, 699 absorption and dietary sources, 569 deficiency, 569 toxicity, 569 Vitamin D, 144 malabsorption, 161 sclerosing cholangitis and, 454–455 Vitamin D-deficiency rickets, 559 Vitamin E, 675, 699–700 absorption and metabolism, 572–573 Index deficiency, treatment, 573 requirement, 573 toxicity, treatment, 573 Vitamin K, 573, 674–675, 699 chronic cholestatic syndromes and, 432 deficiency, 573 HCC and, 524, 524t Vitamin X, EAR of, 676, 700 VLDLs See Very low density lipoproteins Vomiting, 33–35 See also Cyclic vomiting syndrome; Emesis; Nausea and vomiting BN and, 624 disordered gut sensorimotor function and, 35 Von Hippel-Lindau syndrome, 528 Waist circumference BMI and, 611–612 ethnic-specific issues, 612t metabolic syndrome, 628–629, 676, 701 rimonabant and, 617 Warfarin, vitamin E toxicity and, 573 Water, 555 giardiasis and, 306 Water secretion, pancreatic secretion and, 480 Waterborne infection cryptosporidiosis, 307 giardiasis, 304 Water-soluble contrast enema, 102 Watery diarrhea, 48–49, 657, 680 See also Chronic watery diarrhea cholera and, 283 loperamide for, 54 Shigella infection, 271 Weight gain, critically ill and, 591 Weight loss, 58, 58–59, 631 adrenal insufficiency and, 59t, 60 approach to patient, 60 through behavioral therapy, 616 causes, 59–60, 59t diet, 631 elderly and, 59t, 60, 658, 682 energy balance and pathophysiology of, 59f esophageal cancers, 501, 662, 686 gallstones and, 443 gastric adenocarcinoma and, 503 HCC and, 519 hypertriglyceridemia-associated-pancreatitis and, 487 involuntary, screening tests for, 60t low-carbohydrate/high-protein diets, 615 NAFLD and, 437 obesity and, 610 Orlistat for, 617 partial gastric resection, 144 PCM and, 587, 588 physical activity therapy, 615–616 rimonabant for, 617 severe, 31 significance of, 59 surgeries, categories, 617–618 unintentional, elderly and, 658, 682 Weight regulation, physiology of, 58–59 Weight status, disease risk with, classification of, 612t Wermer’s syndrome, 683 Wernicke-Korsakoff syndrome, 566 Wernicke’s encephalopathy, alcoholic patients and, thiamine deficiency and, 566 Wet beriberi, thiamine deficiency and, 565 Whipple procedure, pancreatic cancer and, 532 Whipple’s disease, 50, 163, 164f, 170, 660, 684 osmotic diarrhea and, 662, 685 treatment, 171 WHO (World Health Organization) cholera, 282 GI NET classification, 537 ORS, for cholera, 285t Widal test, enteric fever and, 263, 263f Wild-type chronic hepatitis B, laboratory features of, 345f Wilson’s disease, 73–74, 325–326, 426, 435–436 copper deficiency and, 575 treatment for, 436 Wireless capsule endoscopy (WCE), Crohn’s disease and, 181, 182f Xenotransplantation, with genetically modified organs of nonhuman origin, 462 Xerophthalmia, vitamin A deficiency, 571 Xerostomia, 19 X-ray examination acute intestinal obstruction, 219–220 pseudocysts of pancreas and, 488, 489f upper gastrointestinal, chronic pancreatitis, 475 Yersiniosis, 46 90 Yttrium resin beads, tumors and, metastatic to liver, 526 Zenker’s diverticulum, 122, 656, 679 ZES See Zollinger-Ellison syndrome Zidovudine, liver injury and, 380 Zieve’s syndrome, 421 Zinc, 580 deficiency, 574 gluconate lozenges, 574 hepatic encephalopathy, 432 toxicity, 574 Wilson’s disease and, 436 Zollinger-Ellison syndrome (ZES), 38, 85, 89, 135, 145, 145–147, 538, 544–545, 683 diagnosis of, 146 imaging studies, 146t treatment, 147 tumor distribution, 145 tumor localization, 146 Zoochemicals, 554 Zymogen activation, 480 pancreatitis, 481–482 ... utero and continues until after the tooth erupts Normally all 20 deciduous teeth have erupted by age and have been shed by age 13 Permanent teeth, eventually totaling 32, begin to erupt by age and. .. England Medical Center Hospital, Boston [51] RICHARD S BLUMBERG, MD Professor of Medicine, Harvard Medical School; Chief, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s... the correct answers is provided to facilitate learning and assist the reader in preparing for standardized examinations Gastroenterology and hepatology, like many other areas of medicine, are changing