Oxford American Handbook of Gastroenterology and Hepatology

Oxford American Handbook of Gastroenterology and Hepatology About the Oxford American Handbooks in Medicine The Oxford American Handbooks are pocket clinical books, providing practi- cal guidance in quick reference, note form. Titles cover major medical special- ties or cross-specialty topics and are aimed at students, residents, internists, family physicians, and practicing physicians within specifi c disciplines. Their reputation is built on including the best clinical information, complemented by hints, tips, and advice from the authors. Each one is carefully reviewed by senior subject experts, residents, and students to ensure that content refl ects the reality of day-to-day medical practice. Key series features • Written in short chunks, each topic is covered in a two-page spread to enable readers to fi nd information quickly. They are also perfect for test preparation and gaining a quick overview of a subject without scanning through unnecessary pages. • Content is evidence based and complemented by the expertise and judgment of experienced authors. • The Handbooks provide a humanistic approach to medicine – it’s more than just treatment by numbers. • A “friend in your pocket,” the Handbooks offer honest, reliable guidance about the diffi culties of practicing medicine and provide coverage of both the practice and art of medicine. • For quick reference, useful “everyday” information is included on the inside covers. Published and Forthcoming Oxford American Handbooks Oxford American Handbook of Clinical Medicine Oxford American Handbook of Anesthesiology Oxford American Handbook of Cardiology Oxford American Handbook of Clinical Dentistry Oxford American Handbook of Clinical Diagnosis Oxford American Handbook of Clinical Pharmacy Oxford American Handbook of Critical Care Oxford American Handbook of Emergency Medicine Oxford American Handbook of Gastroenterology and Hepatology Oxford American Handbook of Geriatric Medicine Oxford American Handbook of Nephrology and Hypertension Oxford American Handbook of Neurology Oxford American Handbook of Obstetrics and Gynecology Oxford American Handbook of Oncology Oxford American Handbook of Ophthalmology Oxford American Handbook of Otolaryngology Oxford American Handbook of Pediatrics Oxford American Handbook of Physical Medicine and Rehabilitation Oxford American Handbook of Psychiatry Oxford American Handbook of Pulmonary Medicine Oxford American Handbook of Rheumatology Oxford American Handbook of Sports Medicine Oxford American Handbook of Surgery Oxford American Handbook of Urology Oxford American Handbook of Gastroenterology and Hepatology Edited by A dam S . C heifetz, MD Assistant Professor of Medicine, Harvard Medical School Director, Center for Infl ammatory Bowel Disease Beth Israel Deaconess Medical Center Boston, Massachusetts A lphonso B rown, MD Assistant Professor of Medicine, Harvard Medical School Co-Director, Pancreas Center Beth Israel Deaconess Medical Center Boston, Massachusetts M ichael C urry, MD Assistant Professor of Medicine, Harvard Medical School Director for Liver Transplantation, Liver Center Beth Israel Deaconess Medical Center Boston, Massachusetts A lan C . M oss, MD Assistant Professor of Medicine, Harvard Medical School Director of Translational Research Center for Infl ammatory Bowel Disease Beth Israel Deaconess Medical Center Boston, Massachusetts with S tuart B loom G eorge W ebster 3 3 Oxford University Press, Inc. publishes works that further Oxford University’s objective of excellence in research, scholarship and education. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offi ces in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Copyright © 2011 by Oxford University Press, Inc. Published by Oxford University Press Inc. 198 Madison Avenue, New York, New York 10016 www.oup.com Oxford is a registered trademark of Oxford University Press First published 2011 UK version: 2006 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Oxford University Press, Library of Congress Cataloging in Publication Data Oxford American handbook of gastroenterology and hepatology / edited by Adam S Cheifetz … [et al.] ; with Stuart Bloom, George Webster. p. ; cm. Other title: Handbook of gastroenterology and hepatology Includes index. ISBN 978-0-19-538318-8 1. Gastroenterology–Handbooks, manuals, etc. 2. Hepatology–Handbooks, manuals, etc. I. Cheifetz, Adam S. II. Title: Handbook of gastroenterology and hepatology. [DNLM: 1. Gastrointestinal Diseases–Handbooks. WI 39] RC802.O94 2011 616.3′3–dc22 2010028005 10 9 8 7 6 5 4 3 2 1 Printed in China on acid-free paper This material is not intended to be, and should not be considered, a sub- stitute for medical or other professional advice. Treatment for the con- ditions described in this material is highly dependent on the individual circumstances. And, while this material is designed to offer accurate information with respect to the subject matter covered and to be current as of the time it was written, research and knowledge about medical and health issues is constantly evolving and dose schedules for medications are being revised continually, with new side effects recognized and accounted for regularly. Readers must, therefore, always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulation. Oxford University Press and the authors make no representations or warranties to readers, express or implied, about the accuracy or! completeness of this material, including, without limitation, that they make no representation or warranties about the accuracy or effi cacy of the drug dosages mentioned in the material. The authors and the publishers do not accept, and expressly disclaim, any responsibility for any liability, loss, or risk that may be claimed or incurred as a consequence of the use and/or application of any of the contents of this material. This page intentionally left blank vii Preface The Oxford American Handbook of Gastroenterology and Hepatology is intended for medical students, residents, and gastroenterology fellows. It is by no means a complete referendum on gastroenterology but a place to start your learning. Nor is it meant to replace full literature searches or the experience of direct patient care. It will, however, provide you with an accessible and convenient reference and help build a fund of knowledge about gastroenterology at a time when you are most likely to retain it—on the wards or in the clinic, working directly with patients. The handbook is designed to fi t in your pocket and organized to make your life easier. We hope you fi nd it helpful. The rest of the advice we will leave to Sir William Osler: “He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.” Adam S. Cheifetz Alan C. Moss Alphonso Brown Michael Curry viii Acknowledgments We would like to thank our friends and family and those physicians, patients, and nurses that have helped to train us and make us the physicians we are today. Special thanks go to Martin Smith, MD and Robert Najarian, MD for providing the majority of the radiology and pathology images shown within this handbook. We also thank the authors of the original British edition, Stuart Bloom and George Webster. ix Contents Detailed contents xi Abbreviations xxiii 1 Top 10 clinical problems 1 2 Emergencies 61 3 Upper gastrointestinal tract 3.1 Esophagus 95 3.2 Stomach 113 3.3 Small intestine 137 4 Liver 157 5 Pancreas and biliary tree 5.1 Pancreas 217 5.2 Biliary tree 237 6 Colon and rectum 6.1 Colon 249 6.2 Rectum 297 7 Intestinal infections 309 8 Intestinal manifestations of systemic disease 333 9 Procedures and nutrition 9.1 Procedures 375 9.2 Nutrition 417 Appendix 429 Index 433 This page intentionally left blank xi Detailed contents 1 Top 10 clinical problems 1 Anemia and occult GI bleeding 2 Anemia 2 Increased red cell destruction: hemolysis 3 Anemia in liver disease 4 Iron defi ciency anemia presumed due to occult GI blood loss 5 Ascites 7 Assessment of ascites 7 Ascites: Management 9 Chronic or recurrent abdominal pain 11 Cirrhosis and Chronic liver disease 15 Background 15 Compensated cirrhosis 16 Decompensated cirrhosis 17 Constipation 19 Evaluation 19 Diagnostic approach and investigations 21 Treatment considerations 23 Acute diarrhea (less than 14 days) 26 Classifying acute diarrhea 27 Investigations 29 Treatment 30 Diarrhea in travelers 32 Chronic diarrhea 34 Defi nition 34 Pathophysiology and causes 34 History and examination 37 Diagnostic tests 39 Antidiarrheal therapy 41 Dyspepsia and gastro-esophageal refl ux 42 Defi nitions and common causes 42 Epidemiology 42 When and how to investigate 42 Starting treatment 43 Managing gastro-esophageal refl ux disease (GERD) 44 Managing peptic ulcer disease 44 Managing nonulcer dyspepsia 46 The role of Helicobacter testing and eradication in managing dyspepsia 47 Mouth and swallowing problems 48 Problems with the mouth 48 Problems with swallowing 49 xii DETAILED

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