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Home , Achlorhydria, Blind loop syndrome, Drooling, Ductal cells, Dumping syndrome, Duodenal atresia

EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 825

Index

The bold letter t or f following a page reference indicates that the information appears on that page only in a table or figure, respectively.

: examination of, 41–8; regions, 43f , 145, 190t abdominal aortic reconstruction, 275t acetyl-CoA, 53 : about, 37–40; with colon N-acetylcysteine, 582 , 365t; and , 386; with achalasia, 118f; about, 121–2; Crohn’s disease, 314, 342t; with cystic cricopharyngeal, 117t, 118; esophageal, fibrosis, 456; GI tract, 307, 373, 375, 379; 6–8, 14, 96, 118f, 120f; and gas, 14; and with hepatocellular , 647; in Hirschsprung’s disease, 388; vigorous, , 434, 445; with ulcerative , 121–2 342t , 57t, 217, 245t, 451 abetalipoproteinemia, 194, 201t perfusion test, 98, 106t abscesses: amebic, 392; anorectal, 397, 399, acid suppressants, 145 406–7; appendiceal, 320t; colonic, 391; : children, 687t, 689, 698, 715, 727t, crypt, 285, 331, 332f; diverticuler, 253; 729; , 571, 591; , 253, and , 373; eosinophilic, 114; 266; transplantation, 641; , horseshoe, 406; liver, 474; , 113; 433t; , 335 pancreatic, 434; pararectal, 316t; perianal, (chemicals), 115 344t acinar cells, 56, 418–19, 422 absorption: of , 194–9, 227–8; acquired immunodeficiency syndrome. see in colon, 360, 362–4; of electrolytes, AIDS 185–92, 333; of fat, 192–4; of glucose, acrodermatitis enteropathica, 205t 194f; principles of, 178; of protein, , 149 199–202; of vitamins and minerals, abdomen, 24–7 178–83; of water, 183–5, 360 acute mesenteric ischemia, 252–4 acanthosis, glycogen, esophageal, 126t acyclovir, 294t, 301, 653 acanthosis nigricans, 126 acyclovir treatment, 114 ACE inhibitors. see angiotensin converting acyl-CoA-carnitine acyltransferase, 54 (ACE) inhibitors adalimumab, 328 acetaminophen, 523t, 524, 525t, 570, 581–2, Addison’s disease, 21t, 150, 520 631 adefovir, 558 acetate, 350, 362 adenine, in gene sequences, 741 acetic acid, 199, 245 : duct, 486; chronic EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 826

826 INDEX

, 21t; colon, 366; with Crohn’s 146, 151; and GI , 36, 165; and disease, 318; , 105, 112, 125, HIV, 304; and malassimilation, 207; 126t, 127; , 479–80; gastric, causing malnutrition, 23; causing 152t, 168; , 255; with pancreatitis, 430t, 431, 437, 445; causing ulcerative colitis, 343 , 128 , 126t withdrawal, 11, 572 : , 486; colon, 20, 367f; alcohol–drug interactions, acetaminophen, causing diarrhea, 20, 21t, 229; drug- 570 induced, 579, 580t; hepatic, 584–5; alcoholic : , 55t; clinical hepatocellular, 644; liver, 583t; small features, 569–71; diagnosis, 566t, 567; intestine, 255; , 369 management, 572–3; causing portal adenomyosis, 479 hypertension, 602t, 603 adenosquamous carcinoma, 126t alcoholic lipemia, 507 S-adenosylmethionine, 655 alcoholic : about, 517, 567–9; adenovirus, 530, 634t, 642 cirrhosis, 571–2; clinical features, 501, adenylate cyclase, 214–15, 230, 712 504; fatty liver, 569; hepatitis, 569–71; adhesions, colonic, 376t, 377 management, 572–4 adrenal , 140 aldosterone, 32, 187, 190, 361 adrenal insufficiency, 235t, 457 alendronate sodium, 116 adrenocorticosteroids, 190 ALG, 639 , 341t alginates, 109, 195 , 13–15 alkaline phosphatase tests, 506 afferent loop stasis, 201t alkalis, 115 aflatoxins, 55t, 647 alkalosis, 617, 627 age factors: cholelithiasis, 464t; colitis, 224; allograft rejection, 641–2 colon cancer, 364, 366, 368; colorectal almitrine bismesylate, 612 cancer, 335, 398, 404; , 372; aloe, 232 , 464t; gastric cancer, 9, 170; H. alopecia, 205t pylori, 147; hepatitis B, 559t; , 382t Hirschsprung’s disease, 700t; liver disease, alpha1-antitrypsin deficiency: about, 520; and 552, 556t, 562t, 635t; , cirrhosis, 597, 598t; clinical features, 731; 426, 431t, 437, 444; serious GI events, and inherited liver disease, 585 160t; ulcerative colitis, 334, 353; upper GI alpha-adrenergic agonists, 231 bleeding, 37; , 686, 687t alpha-fetoprotein test, 508 AIDS: about, 289; and acalculous aluminum hydroxide, 243 , 477–8; and anorectal amanita, 430t , 407; and , 590; amebiasis, 22, 221–2, 320t, 321, 341t diagnosis, 290–1, 296, 298–9, 305; and ameboma, 391 diarrhea, 21t, 22, 222; and herpes, 408; amenorrhea, 203t, 502t, 566 and mycobacterial avium-intracellulare amikacin, 293t (MAI), 292; and Salmonella, 389–90 amiloride, 187, 617 AIDS cholangiopathy, 304 amino acids: absorption, 185–6, 199–200, air embolism, 75 202; aromatic, 625; branched-chain, 628; Alagille’s syndrome, 482, 731–2 catabolism, 494; dietary , 63; alanine aminotransferase, 505, 513 enteral formulas, 71–2; malnutrition, 55–6; albendazole, 294t, 299, 394 supplements, 573; total parenteral nutrition albumin, 32–3, 66–7, 248–9, 321, 506, 601t, (TPN), 73 618, 632 aminoglycosides, 217, 622 Alcock’s canal, 396 aminosalicylic acid, 246 alcohol: causing acute hepatitis, 530t; 5-aminosalicylic acid . see causing , 48; Boerhaave’s syndrome, mesalamine 134; and celiac disease, 61–2; and aminotransferases, 471, 474, 505–6, 513–21, diarrhea, 21t, 22; effects on liver, 55t; 548, 555, 571–2, 591, 600. see also deficiency, 179; causing , transaminases EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 827

INDEX 827

amiodarone, 576, 584 aneurysm: abdominal, 26; aortic, 24–5 ammonia, 245, 494, 625 , 35, 254 , 216, 582, 621 , 34, 35t, 165, 410, 412, 413t , 113, 293t, 296–7 , 547 , 216, 389, 392, 476 angiography, 253, 268, 276 , 56, 195, 199, 305, 427–8, 442, 446, angioma, 255 471 angiomatosis, 302 amyloidosis, 117t, 201t, 275t, 278f, 316t, angioplasty, 253 321, 344t, 645 angiosarcoma, 55t, 585, 634t amylopectin, 195 angiotensin converting enzyme (ACE) amylose, 195 inhibitors, 287 amyotrophic lateral sclerosis, 117t angular fissure, 23 anabolic hormone, 50 animoaciduras, 200 anabolism, 75 anisakiasis, 320t anaerobes, 198f, 476 , 388 anaerobic streptococci, 244 ankylosing spondylitis, 316t, 319, 335, 344t, : , 395–6; carcinoma, 303; 347 examination of, 399–402; -abscess , 18 disease, 406; , 303, 344t, 399; anorectal spaces, 396 , 402; presenting complaints, : about, 12–13; and , 396–9; veneral , 407 25; and , 570; and anal sphincter: anatomy, 381, 395–6; ascites, 33; and celiac disease, 235; defecation, 383f, 386; and fecal cholecystitis, 471; with Crohn’s disease, incontinence, 381–4; spasm, 403 315t; and diarrhea, 219; drug-induced, , 389; to treat cholecystitis, 472; to 350; and , 647; treat cholelithiasis, 465; to treat with HIV, 305; inflammatory bowel hemorrhoids, 403; to treat herpes, 408; to disease, 64t; and , 31; in liver treat ischemia, 286; to treat pancreatitis, disease, 501, 502t; marasmus, 56; 436, 441; to treat , 389 nutritional intervention, 70; and protein anaphylaxis, 275t deficiency, 206; with ulcerative colitis, anastomosis: Billroth, 146f, 151; in 334; vitamin deficiency, 57t , 170–1; ileoanal, 353; Roux- , 401–2 en-Y, 482; small intestine, 482 : causing diarrhea, 20, 213t, 225, . see also ; with 226t; to treat , 114; to treat abdominal , 29; and alcoholic GERD, 109; -containing, 225, cirrhosis, 572; aplastic, 547; with cancer, 227t; to treat pancreatitis, 442 255; and celiac disease, 235t, 237; antiarrhythmics, 225 children, 684, 689, 693, 694t, 706t; and : to treat bacterial overgrowth, cholelithiasis, 464t; and cirrhosis, 600; 208t, 248, 252; to treat bile duct disease, with Crohn’s disease, 314; and diagnosis, 480; to treat , 731; to treat C. 4; causing diarrhea, 20; and GI bleeding, difficile, 390; to treat cancer, 255; to treat 34; hemolytic, 217, 317t, 344t, 347; and cholangitis, 483–4, 594; to treat hiatus , 103; hypchromic microcytic, cholecystitis, 472; to treat 206; in inflammatory bowel disease, choledocholithiasis, 476; and cirrhosis, 316t–17t, 318, 321, 333–5 passim, 340, 600; to treat colitis, 224; to treat Crohn’s 344t–5t, 347; iron deficiency, 317t, 365t, disease, 323, 329; to treat , 366, 380; in ischemia, 285; and 454; causing diarrhea, 213t; to treat malassimilation, 204t, 208–9; and diarrhea, 218; causing diarrhea, 223–4, malnutrition, 23; megaloblastic, 317t; 233t; to treat diarrhea, 715, 718; to treat normochromic, normocytic-type, 321; diverticulitis, 373; to treat , pernicious, 57t, 144t, 150, 182t; with toxic 215; to treat H. pylori infection, 149; to , 340, 345t; with ulcerative treat , 628; causing colitis, 333, 335, 344t; hepatitis, 518, 551t; to treat HIV-related deficiency, 205t , 292; causing EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 828

828 INDEX

hyperbilirubinemia, 727t; to treat arginine, 745 inflammatory bowel disease, 340; to treat arsenicals, 584 ischemia, 269, 286; and liver arterial desaturation, 502t, 504 transplantation, 639; to treat pancreatitis, arterial reconstruction, 271 436; to treat , 622–3; to treat arteriography, 37 PUD, 164; to treat Salmonella, 389; to , 95, 251, 588 treat Shigella, 213t, 389; to treat arthritis: and Crohn’s disease, 319; and spontaneous bacterial peritonitis, 623; to gastric secretions, 161; with hepatitis, 547, treat strongyloides stercoralis, 394; to treat 566; and inflammatory bowel disease, ulcerative colitis, 352–3; to treat Whipple’s 316t, 319, 335, 344t, 347; in liver disease, disease, 208t, 251 547, 566, 584, 588, 591–2; with ulcerative : causing constipation, 17, colitis, 335, 344t, 347 698; causing esophagitis, 115; to treat artificial sweeteners, 19, 225 gastropathies, 152; to treat GERD, 109; to ASA, 148t, 150, 160, 165, 525t, 600, 612 treat H. pylori infection, 173; to treat 5-ASA. see mesalamine , 382t; and Asacol®, 349–50 ulcerative colitis, 348 , 429t, 591 , 36 ascites: about, 32–3, 612–13; and alcoholic antidepressants, 124, 382t, 525t liver disease, 570–1; causes, 47; chylous, antifungal agents, 296 33; and cirrhosis, 592, 599–600, 601t; , 11 cirrhotic, 612–13; complications, 620–3; antihypertensives, 17 with congestive failure, 615; anti-inflammatory agents, 116, 275t, 279, diagnosis, 613–15; dietary therapy, 63; 341t examination for, 47–8; with hepatic antilymphocyte products, 639 encephalopathy, 624; infected, 33, 620; in antimetabolites, 225 liver disease, 32–3, 457, 501, 502t, 551, antimicrobials, 215, 246, 329–30 570, 592, 599–600, 601t, 604, 606; antimitochondrial tests, 507, 521 management, 574, 616–20, 616–20; antimotility agents, 382t, 389, 394 pancreatic, 438; pathogenesis, 612–20; and antinuclear factor test, 507 , 604, 606; in antiproteases, 420 , 653; refractory, 618; in veno- antiretroviral drugs, 291, 300, 304, 306 occlusive disease, 660 antismooth muscle antibody test, 507 ascitic fluid, 33 antithrombin C disease, 275t ascorbic acid. see antithymocyte globulin, 641 aspartate aminotransferase, 197, 505, 513 antituberculous drugs, 295, 518 aspiration: children, 112; deglutition, 117; antral G-cell hyperfunction, 144t diagnostic, 33; and diverticula, 131; antrum, retained, 144t , 97; enteral nutrition, 71–2; anxiety, 30 gastric, 172; with GERD, 107, 112, 693; aortic aneurysm, 24 and GI hemorrhage, 165; , 6; in aorto-SMA graft, 254 neonates, 101; and squamous cell aortovisceral bypass, 276 carcinoma, 128; vomited , 34 apathy, 624 . see ASA aperistalsis, 121 assimilation. see absorption; apnea, 694 asterixis, 599, 624 apolipoproteins, 53, 193 asthma, 114 apoprotein, 55, 494 , 23, 204t, 207 apoptosis, 313t, 314, 328, 748, 752 ATG, 639 , 27, 29, 216, 320t atherosclerosis, 148t, 258, 264, 276, 279 : appendicitis, 27, 29, 216, 320t; atonic colon, 386 tumors, 250 atresia: biliary, 64, 593, 730–1; duodenal, appetite, 12, 203t 689; esophageal, 101 , 74, 161 Auerbach’s plexus, 90, 141, 176 areflexia, 58t auscultation, 38, 42 EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 829

INDEX 829

azathioprine, 314, 325t, 326, 352, 429t, 526, bifidobacteria, 244 567 biguanides, 579 azithromycin, 295 bile: decreased output, 71; formation, azotemia, 572, 627, 631 494–500; forming , 461; in azotorrhea, 424, 438, 442 gastritis, 146; in jaundice, 30; limy, 473; in AZT, 291 urine, 31 bile acids: bacterial overgrowth, 246–7; , 302 depletion, 60; causing diarrhea, 225, 226t, Bacillus cereus, 213–14, 712 230, 243, 479, 712; in digestion, 192–3; backwash , 337, 338f disolve gallstones, 468; inflammatory baclofen, 108 bowel disease, 64t; , 64t, bacterascites, monomicrobial nonneutrocytic, 323, 456, 479, 712; micelles, 60 621 bile duct: carcinoma, 316, 316t; congenital bacteremia, 75, 472 anomalies, 477; congenital diseases, : colonic, 195, 199, 362–4; causing 480–2; damage, 474; dilation, 31, 305; diarrhea, 19, 202, 212–18, 213t, 233t; inflammatory diseases, 483–5; , HIV-associated, 292, 293t 479–80; obstruction. see cholestasis; bacterial infections, 292 roundworms in, 392; strictures, 465, 466t, bacterial overgrowth syndrome, 57t, 193, 468t, 473, 479, 481, 483–5 passim; 208, 226, 245t, 246–8, 321, 323 transport systems, 489–500 bacteriocins, 245 bile gastritis, 151 bacteroides, 244 bile leaks, 485, 641 Bacteroides species, 621 bile salts: and bacteria, 245, 364; and balantidiasis, 341t cholelithiasis, 461–2; and Crohn’s disease, Balantidium coli, 320t, 392 315t, 324; deconjugation, 193; and balloon angioplasty, 276 diarrhea, 226; in digestion, 245, 421, 494; Bantu siderosis, 55t dissolution, 468–9; enterohepatic barf. see vomiting circulation, 495f; gallstones, 462; barium x-ray, 7, 18, 97–8, 106t inflammatory bowel disease, 64t; jaundice, barley malt extract, 702t 31; malabsorption, 193, 323–4, 364; and Barrett’s , 95 malassimilation, 201t; maldigestion, 23; Barrett’s , 105, 112, 127 replacement, 211t; , 494; Barrett’s esophagus, 98, 110, 112 wastage, 231 Barrett’s , 105, 108, 127 biliary atresia, 64, 482, 595, 730–1 basiliximab, 640 biliary cirrhosis, 64 basolateral membrane transport, 496f, 498–9 biliary , 25, 28, 467t, 470–1, 473–4 beaver . see Giardia lamblia biliary , 481, 483 Behçet’s syndrome, 114, 275t, 341t biliary diversion, 735 belching. see gas , 478 bentiromide test, 425–6 , 463, 478, 653 benzathine penicillin, 408 . see bile duct; gallbladder benzodiazepines, 523, 572, 625, 628 bilirubin: and bacteria, 245; children, 725; beriberi, 57t and choledocholithiasis, 474; and Bernstein test, 98, 106t, 108 cholelithiasis, 465; and cirrhosis, 572, 591, beta adrenergic agent, 145 599, 601t; digestion, 245; in jaundice, beta blockers, 525t, 600, 609 30–1, 726; and liver function, 505; and beta-adrenergic agonists, 609 pancreatic carcinoma, 446; squamous cell beta-glucuronidase, 465, 473 carcinoma, esophageal, 129; tests, 505; beta-hydroxybutyrate dehydrogenase, 54 total parenteral nutrition (TPN), 75 betaine, 579 bilirubin diglucuronide, 30, 501 , 350 Billroth anastamoses, 146f, 151 Betnesol®, 350 binding agents, 382t bezoars, 148t, 151, 173 biofeedback training, 384 secretion, 157, 422, 712 biofilm, 473 EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 830

830 INDEX

biologics, 80 deformity, 206; disease, 208, 482, 643; in , 98, 106t, 510–11 malassimilation, 204t, 206–8 passim; pain, deficiency, 57t 205t, 207; softening, 204t–5t; tenderness, bisacodyl, 19, 702t 204t; vitamin deficiencies, 205t bisexuality, 297, 302–3 borborygmi. see gas classification, 486 , 122 bismuth compounds, 218 bougienage, 131, 133 bisphosphonates, 148t, 151, 593 bowel cleansing, 37 Bitot’s spots, 203t, 205t bowel habits, 18 black liver, 529 , 14, 25, 59, 70, 255, 323 Blastocystis hominis, 392 bowel rest, 73, 77, 324, 373 bleeding. see also blood loss; hemorrhage; bowel sounds, 44, 204, 279, 285, 335, 340 and alcoholic liver disease, 570; bradycardia, 375 choledocholithiasis, 475; and diarrhea, 20, , 190t 211, 216–17, 224; with diverticulitis, 373; brain tumor, 11, 117t esophogeal, 97, 113; GI tract, 33–5, 103, carcinoma, 126t, 648 408–13, 410t–11t, 413t, 606, 627; with , 703, 705, 729 ischemia, 253; in liver disease, 504, 570–1, breath hydrogen test, 60, 234, 238, 247, 321 600, 604–9 passim, 623, 626t; obscure, 34; bring up. see vomiting occult, 34; PUD, 157; rectal, 314, 315t, bromocryptine, 628 318, 332–4, 342t, 365t, 380, 397–8, 403; bronchoscopy, 129 with tumors, 255; ulcer, 146f; vitamin K bronchospasm, 107, 694t deficiency, 205t, 206 Brooke , 353 , 201t, 226t, 244 brown bowel syndrome, 60t , 13–16, 60, 110, 218, 254, 297, 373, bruising, 203t, 205t, 504 377, 379, 382t, 438, 445. see also brush cytology, 98, 113, 129 distension Budd-Chiari syndrome, 583t, 598t, 602t, blood loss. see also bleeding; hemorrhage; 615, 653, 659–60 GI tract, 103, 318; and hookworms, 393; , 326, 329, 350 inflammatory bowel disease, 64t; and bulbar poliomyelitis, 117t squamous cell carcinoma, 128 burbulence. see gas blood replacement, 607 Burkitt’s , 303 : about, 35–6; and ascites, 33; , 115, 160, 477 children, 683, 713, 715; with colon cancer, . see gas 366; and constipation, 18, 386; with butyrate, 59 diarrhea, 20, 211, 216–17, 231, 285, 390; butyric acid, 199, 245 inflammatory bowel disease, 333; with ulcerative colitis, 336 caffeine, 525t blood supply: anal canal, 395; esophagus, 89; cagA gene, 162 liver, 492; pancreas, 417, 418f; small calcification: gallbladder, 472–3; pancreas, intestine, 175; stomach, 140–1 27, 423–4, 435, 437 blood nitrogen, 34, 37 calcitonin, 226t blood in vomit, 33, 36, 134, 165, 694t calcium: and Crohn’s disease, 321; blurred vision, 203t, 319, 348 deficiency, 204t, 235t; with fat body mass index, 66, 70 malassimilation, 206; inflammatory bowel body piercing, 551, 551t disease, 64t; malabsorption, 207; Boerhaave’s syndrome, 134 supplements, 61–2, 210t, 592 bombesin. see releasing polypeptide calcium antagonists, 382t (GRP) , 201t age, children, 704, 706t calcium channel blockers, 17t, 109, 121–2, bone deformities, 206 124, 133, 231, 525t depression, 327 calcium homeostasis, 207 bone metastases, 27 calcium oxalate, 319 : aches, 204t; in celiac disease, 236; camera pill, 208 EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 831

INDEX 831

Cameron’s , 103 carotene deficiency, 238, 455 cAMP. see cyclic AMP carotenemia, 31 Campath-1H, 640 casein, 71, 200 , 20, 320t, 336 Castell’s sign, 46 , 213t, 216, 292, 293t, catecholamines, 49, 53, 63, 250, 263, 275t 712 catheter embolization, 75 canalicular membrane transport, 498f, catheterization, 75 499–500 caudal fibers, 88 cancer. see carcinoma; neoplasms CCK. see (CCK) Candida, 113, 150, 399 , 391 Candida albicans, 6, 293t, 295–6 cefotaxime, 621 , 133, 341t ceftriaxone, 293t, 389 caput medusae, 606–7 celiac disease: about, 61–2, 520; in adults, carbamazepine, 582 236; blood tests, 209; children, 235–6, carbohydrates: absorption, 194–9, 227–8; 706t; complications and prognosis, 241; anaerobic bacterial fermentation, 198f; and constipation, 236; diagnosis, 4; diet, 61–2, bacteria, 245; causing diarrhea, 227; 241; and gastritis, 151; laboratory findings, digestion, 50, 51f, 227, 232, 385, 419; 236–40; prognosis, 241; symptoms, 235t; malabsorption, 226t, 228; malassimilation, treatment, 241 202–6, 235t; maldigestion, 244; celiac plexus, 141 malnutrition, 55–6; metabolism, 51f, 493; cell cycle: C0 phase, 749; G1 phase, 749, supplements, 71; tolerance test, 238; total 751; G2 phase, 749; G2/M phase, 751; M parenteral nutrition (TPN), 74 phase, 749, 752; process, 748–50; , 195 regulatory mechanism, 752, 753f; S phase, , 245, 627 749, 751 carbon tetrachloride, 524, 581 Cellcept®, 639, 643 carbonated beverages, 134 central , 117t, 206, 303, 586, carboxypeptidases, 199, 420 682 carcinoembryonic , 366, 447 centroacinar cells, 418, 422 carcinoid, small intestine, 255 centromeres, 746 carcinoid syndrome, 21t, 231, 250, 649 cephalosporins, 389–90, 621 carcinoma: adenoid cystic, 126t; cerebrotendinous xanthomatosis, 65t adenosquamous, 126t; anal, 303; bile duct, cerebrovascular accident, 117t 316t; cecum, 320t; cervical, 303; colonic, ceroidosis, 60t 343–5, 344t; colorectal, 303, 364–9, cestodes, 219 398–9, 404, 648; causing diarrhea, 211; Chagas’ disease, 122, 387 ductal, 481; esophageal, 115, 126t; Charcot’s triad, 474, 483 gallbladder, 479–80; gastric, 11, 169f; cheilosis, 23, 56, 203t, 205t, 207 , 444; hepatocellular, 557, 561, chemical-induced esophagitis, 115–16 572, 578, 583t, 585, 600, 627, 646–8; chemical-induced gastritis, 145–6 causing ischemia, 276t; medullary, 231; chemoreceptor trigger zone, 10, 11f mucosal, 112; pancreatic, 439, 443–50; . see specific drugs squamous cell, 125–8, chenodeoxycholic acid, 245, 457, 468 carcinomatosis, 253 diarrhea, 227t carcinosarcoma, esophageal, 7, 126t childbirth, 172, 382 cardiac arrythmia, 253, 388 Child-Pugh classification, 600–1, 605 cardiac-caused cirrhosis, 598t children. see also infants; , cardiogenic , 253, 275t 28–30, 236, 681–5; acalculous , cirrhotic, 610–11 cholecystitis, 477; anemia, 684, 689, 693, cardiopulmonary bypass, 275t 694t, 706t; aspiration, 112; biliary atresia, cardiopulmonary , 172 730; bilirubin, 725; blood in stool, 683, Caroli’s disease, 480, 594 713, 715; bone age, 704, 706t; bone Caroli’s syndrome, 481 deformities, 206; calcium malabsorption, carotene, 208, 321, 579 207; celiac disease, 235–6, 706t; EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 832

832 INDEX

cholangitis, 465; cholestasis, 590; chronic 335–6, 344t, 346, 483–5, 593f, 594, 597, abdomen, 28–30; cirrhosis, 593; 598t constipation, 695–701, 702t; Crohn’s : acalculous cholecystitis, disease, 324, 331; and cystic fibrosis, 453; 478; and bile gastritis, 151; cholecystitis, cystic fibrosis, 453, 456–7, 718–25; 470; choledocholithiasis, 476–7; diarrhea. see diarrhea, in children; , cholelithiasis, 460, 466, 469; for 721; , 688t, 711–12, 718; gallbladder carcinoma, 480; and gastric esophagitis, 114; failure to thrive, 720; , 172; and HIV infection, 305 fever, 690, 732; GERD, 112, 691–5; cholecystitis: acalculous, 477–8; acute growth failure, 703–10; hepatitis, 531, 536; abdomen, 471–3; AIDS cholangiopathy, hepatobiliary disease, 722–5; 305; and , 467t; Hirschsprung’s disease, 387, 387–8; choledocholithiasis, 471–7; cholelithiasis, hypoalbuminemia, 721; , 465, 467; chronic acalculous, 478; chronic 727; inflammatory bowel disease, 687t, calculous, 470 706t, 712; intestinal obstruction, 721; cholecystokinin (CCK), 56, 144–5, 192, 419, intussusception, 686; jaundice, 725–35; 421f, 478 liver cancer, 648; liver disease, 689, 722; cholecystoses, 478–9 , 730; lung disease, , 481, 594 719; malnutrition, 701–10; Meckel’s choledochojejunostomy, 482, 485 diverticulum, 249; meconium , 719; choledocholithiasis, 466, 471–3 megarectum, 387; pancreatic insufficiency, cholelithiasis: about, 460; classification of, 718, 723–4; pancreatitis, 722; parasites, 460, 461t; clinical features, 465–7; 393; portal , 661; and complications, 466f; with Crohn’s disease, protein deficiency, 206; pruritus, 732, 735; 319; with cystic fibrosis, 456; diagnosis, , 721; rehydration therapy, 466; frequency of, 460, 461t; history, 465; 710–11, 714t; renal disease, 689; renal inflammatory bowel disease, 316t; failure, 715; Salmonella, 389; management, 467–9; causing pancreatitis, Strongyloides stercoralis, 393; vitamin 430; in pregnancy, 653; risk factors, 464t; deficiency syndromes, 58t; and , 243 malabsorption, 207; volvulus, 689; , pancreatic, 231 vomiting, 684–5; Wilson’s disease, 518, choleretic , 19 585–6 cholestasis: causes, 590t; and Child-Turcotte-Pugh score, 636 choledocholithiasis, 474; and Chlamydia, 292, 341t, 408 cholelithiasis, 465; drug-induced, 584; chlordiazepoxide, 523t enteral nutrition, 71; extrahepatic, 590–1; chloride: exchange, 187, 189; secretion, fat malabsorption, 193; causing 189–90, 712 hyperbilirubinemia, 32f; in infants, 481; chloridorrhea, 226t inflammatory, 582–3; inherited, 732; chloroform, 519t intrahepatic, 589–90; jaundice, 28; chlorpromazine, 523t, 582 malassimilation, 201t; management, chlorpropramide, 582 594–6; neonatal, 729–32; of pregnancy, choking, 95 654–5; pure, 583 , 465, 480, 485–7 cholestatic hepatobiliary disease, 23, 64 , percutaneous transhepatic cholestatic liver disease, 58t (PTC), 510 cholesterol: absorption, 53, 191f, 192–3; cholangiopancreatography, endoscopic cholecystoses, 478; dietary therapy, 385; in retrograde (ERCP), 40, 424, 435, 448–9, digestion, 192; causing ischemia, 275t, 474, 509–10 277f; malabsorption, 246; malassimilation, cholangiopathy, 304–5 209; role of liver, 494 cholangitis: about, 483; and cholecystitis, cholesterol embolus, 275t, 277f 472; and choledocholithiasis, 473–5; and cholesterol esters, 53–4, 192 cholelithiasis, 465–6; and cholestasis, cholesterol stones, 319, 460–1, 464t, 468, 589–90; chronic, 465, 482; and ischemia, 473 253; nonsuperative, 591; sclerosing, 64, cholesterolosis, 478 EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 833

INDEX 833

cholestyramine: to treat cholestasis, 655; and investigators, 84; methodology, 82–3; cirrhosis, 592; to treat Crohn’s disease, monitoring, 85; phases, 81–2; planning, 323; to treat diarrhea, 224, 231, 243; to 83–4; reporting, 86 treat , 384; to treat clofazimine, 293t irritable bowel syndrome, 382t; and clofibrate, 464t malabsorption, 63, 64t; and Clostridium difficile, 213t, 216, 224, 284, malassimilation, 201t; causing 336, 340, 341t, 390 malnutrition, 23; replacement, 211t Clostridium perfringens, 213–14, 712 cholic acid, 245, 247, 457, 463 Clostridium species, 244 cholinergics, 213t Clostridium welchii, 149 chromatin, 745, 764–5 clotrimazole, 293t, 296 chromatosomes, 745 clubbing, 502t, 504 chromium, 56 CMV. see chromosomes: replication, 754, 758–9; disturbances, 504 structure, 745–7 , 37, 502t, 601, 653 chronic abdomen, 28–30 cobalamin. see vitamin B12 chronic fatigue syndrome, 592 cobalt, 56 chronic mesenteric ischemia, 254 cocaine, 148t, 151, 275t, 279, 519t, 584 Churg-Strauss syndrome, 151 Coccidia, 222 Chvostek’s sign, 207 coccidioidosis, 296 chylomicrons, 53, 192–3 , 323, 340, 525t chylous ascites, 33 coil embolotherapy, 612 chymotrypsin, 56, 199, 420, 430 colchicine, 21t, 213t, 225, 233t, 573 , 436, 442 : for colon cancer, 368; GI ciprofloxacin, 218t, 293t, 329, 353, 621, 623 bleeding, 412; for ulcerative colitis, 334, circulation. see blood supply 345, 347, 352 circulatory collapse, 639 colestipol, 211t, 243 cirrhosis: about, 596–8; alcoholic, 567, colic: and acute abdomen, 24–5; biliary, 25, 571–2; and ascites, 47, 612–13; biliary, 64, 28; children, 688t; and cholelithiasis, 465; 454, 457, 481, 521, 591–3, 597, 602t; renal, 29; ureteral, 25 causes, 598t; and cholelithiasis, 464t; and colipase, 192, 421 cholestasis, 589; clinical features, colitis. see also ulcerative colitis; acute, 392; 598–600; complications, 504; cryptogenic, collagenous, 394; Crohn’s, 282, 308, 319; 578; dietary therapy, 63; drug-induced, causing diarrhea, 20, 216; dietary therapy, 327, 584; and hepatitis, 557, 559t, 566–7; 62; diversion, 59, 362; eosinophilic, 394; hepatocellular carcinoma, 561, 646; and gastritis, 151; in graft-versus-host , 631; with disease, 341t; and HIV, 292; ischemic, 35, inflammatory bowel disease, 316t; 279–87, 280–7, 307, 321; lymphocytic, inherited, 585; and ischemia, 274; 394; microscopic, 394; postdysenteric, micronodular, 571, 597–8; , 597; 222; pseudomembranous, 223–4, 320t and portal hypertension, 602t; and PUD, collagen, 200 160; treatment, 600–1; with ulcerative collagen disease, 275t, 276, 645 colitis, 344t, 346 , 151 cirrhotic habitus, 501, 502t collagenous sprue, 201t, 241, 242f cis-acting elements, 765–7, 769 collateral circulation, 264 cisapride, 12, 108 collateral vessels, portosystemic, 604 cisplatin, 171 colon. see also colitis; abdominal mass, 39; , 621t about, 357; absorption and secretion, 360, , 293t, 525t–6t 362–4; anatomy and function, 357–60; clavulinic acid, 621 bleeding, 408–12; constipation, 384–8; , 390 digestion, 362–4; diverticulosis, 372–4; clinical trials: design, 83–4; ethical concerns, fecal incontinence, 381–4; infections, 80, 85–6; informed consent, 85; 388–92; irritable bowel syndrome, 377–81; institutional review committee, 86; , 361; neoplasms, 35t, 364–9, EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 834

834 INDEX

364–72; supply, 359f; obstruction, Cortifoam®, 350–1 374–7; perforation, 25 Cortiment®, 350 colonic ileus, 375 costiveness. see constipation colonic mucosa, 59 Cotazym®, 211t, 442 , 276t, 284, 336t co-trimoxazole, 218t , 59, 362 coughing, 97, 107 coma, 63, 73, 172, 570, 624 Cowdry’s Type A, 113 Compleat B®, 212t Coxsackie, 530 (CBC), 26 . see pain, abdominal Condylomata acuminata, 303, 398–9, 407 creatinine, 27, 36, 616 confusion, 253, 345t, 474 creatinine kinase, 265 congenital abnormalities, 101–3, 480–2 creatinine-height index (CHI), 66 congestive , 12, 35, 77, 205t, CREST syndrome, 591 253, 275t, 276, 279, 588, 615, 658–9 cricopharyngeus, 88 conjunctival , 203t Crigler-Najjar syndrome, 527–9, 528t, 727 conjunctivitis, 316t Crohn’s disease, 73; abdominal pain, 28; connective disease, 97, 394 about, 307; adenocarcinoma, 255; conococcal , 407 anatomic distribution, 308, 311t; bacterial constipation: about, 16–19, 695–6; with anal overgrowth syndrome, 245t; children, 324, fissure, 405; causes, 385–6, 698t–9t; celiac 331; chronic diarrhea, 21t; clinical disease, 236; children, 695–701, 702t; features, 314–17; and colon cancer, 369; chronic, 17t; with colon cancer, 366; with complications, 317–19; and constipation, cystic fibrosis, 455t, 456; defined, 384; 18; diagnosis, 320–2; and diarrhea, 226t; diagnosis, 697–9; and diverticulitis, 373; dietary therapy, 62–3; epidemiology, with hepatic encephalopathy, 627–8; and 309–11; and esophagitis, 114; etiology, Hirschsprung’s disease, 700t; with irritable 312–14; with fat malassimilation, 206; and bowel syndrome, 377, 385; management, fissures, 405; gastric, 148t, 151, 152t; 699–701; in megarectum, 387; with incidence of, 312t; and , neoplasms, 366, 450; with obstruction, 279, 284–5; manifestations of, 316t; 374, 385; pathophysiology, 696–7; in nutrition, 76–7; pathology, 307–8; and pelvic floor dyssynergia, 388; and small bowel, 243; and , 60; proctitis, 212; with RAP, 684; treatment, therapy, 208t, 323–31 382t, 702t; and ulcerative colitis, 333 Cruveilhier-Baumgarten sign, 607 constitutional growth delay, 704 crying. see children; colic contraceptives: cholelithiasis, 464t; hepatic cryoglobulinemia, 559 vein thrombosis, 659; hyperbilirubinemia, cryotherapy, 648 529; ischemia, 275t, 280; liver disease, crypt abscess, 285, 331, 332f 579, 583; liver neoplasms, 580t, 583t, crypt hypoplasia, 59, 60t 584–5, 644 cryptococcosis, 20, 22, 296 convulsions, 57t cryptosporidiosis, 221f copper, 56, 65t, 484, 586, 596, 600 Cryptosporidium: about, 222; causing corneal changes, 58t, 203t, 205t diarrhea, 213t, 222, 298, 711; causing Correa hypothesis, 149, 169 gastritis, 150; HIV-associated, 294t, 298, Cortenema®, 350 305, 478 : to treat alcoholic liver Cullen’s sign, 432 disease, 572–3; to treat Chagas’ disease, Curling’s ulcer, 160 77; to treat Crohn’s disease, 325t, 326–7, Cushing’s disease, 520–1 330; cytochromes, 525t; to treat gastritis, cutaneous changes, 502t, 504 152; to treat hepatitis, 567; and liver . see vitamin B12 transplantation, 639; and nonalcoholic liver cyclamate, 246 disease, 576; to treat pancreatitis, 436; role cyclic AMP, 19, 145, 187–90, 214, 230, 453 in digestion, 49; to treat sclerosing cyclic GMP, 190, 215, 230 cholangitis, 484; to treat ulcerative colitis, cyclohexylamine, 246 347–50, cyclo-oxygenases, 144, 150, 160–1 EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 835

INDEX 835

cycloserine, 57t deoxyribonucleic acid (DNA): and cyclosporine: to treat Crohn’s disease, 325t, chromatin, 764–5; cis-acting elements, 327, 348; in liver transplantation, 638–9; to 765–7; gene sequences, 743, 745; treat ulcerative colitis, 352 methylation and transcription control, 781; cyproheptadine, 250 , 759–64; repair mechanisms, , 444 761–4; replication, 753–9; structure, , 486 741–2, 754t; transcription, 743, 764–81 cystic fibrosis: about, 718; adult, 453–8; depapillation of the , 23 children, 453, 456–7, 718–25; and depression, 12, 30, 379 cholelithiasis, 464t; and cirrhosis, 590, dermatitis, 57t, 203t, 205t, 235t, 399, 450 594; causing cirrhosis, 598t; dermatitis herpetiformis, 201t, 236 complications, 454–7; , 455; dermatomyositis, 117t diagnosis, 457; dietary therapy, 65t; gene dermatosis, scrotal, 203t therapy, 806–9; and growth failure, 706t; dextran, 618 and malassimilation, 201t; management, dextrins, 195, 420 723–4; pancreatic insufficiency, 718–22; diabetes: and acute abdomen, 26; Candida treatment, 458 esophagitis, 6; celiac disease, 235; and cystinuria, 200, 201t cholelithiasis, 464t; and constipation, 386; cysts: biliary, 481; congenital, 126t; with cystic fibrosis, 455; and diarrhea, 21t, 22, Entamoeba histolytica, 391; hepatic, 646; 192, 226t; and distension, 172; and ovarian, 320t dysmotility, 119; and electrolyte cytochromes, 524–6 absorption, 192; and inherited liver cytomegalovirus: causing acute hepatitis, disease, 588; ischemia, 275t, 276, 287; 543; causing cholecystitis, 478; with liver, 55t, 517, 551t, 559, 574–6 passim; Crohn’s disease, 320t; causing gastritis, and malassimilation, 201t; mellitus, 16, 147; causing hepatitis, 530, 543; HIV- 113, 455; pancreas, 424, 426–7, 437, 444t, associated, 294t, 295, 300; postoperative, 445–6, 450–1; stomach, 172 639; ulcerative colitis, 341t diamine oxidase, 265 cytoprotective agents, 606 diaphoresis. see perspiration cytosine, in gene sequences, 741 diarrhea, acute: about, 209–12; bacterial, cytotonic enterotoxins, 213 212–18; causes, 209–11, 213t; children, cytotoxic enterotoxins, 213 710–18; defined, 212; and diagnosis, 3; cytotoxin associated gene (cagA), 162 diagnosis, 22; invasive, 213; toxigenic, 213 diarrhea, in children: about, 710; assessment, Daclizumab, 640 712–15; Cryptosporidium, 222; cystic danthron, 229t fibrosis, 719; dietary therapy, 717; dantrolene, 566 , 217; management, DDT, 444t, 445 716–18; pathophysiology, 710–12; protein debridement, 437 deficiency, 206; , Declaration of Helsinki, 79, 86 216 defecation, 17–18, 29, 40, 377–9, 383f diarrhea, choleraic, 323, 364 deglutition, 90, 116–19 diarrhea, chronic: abnormal intestinal transit, : assesesment and management, 226, 228–30; anatomic approach to, 21t; 714t; and constipation, 386; and diarrhea, bacterial, 212–18; causes, 225–6, 233t; 715; and enteral nutrition, 73; with hepatic and cystic fibrosis, 719; diagnosis, 22; encephalopathy, 627; with ischemia, 265; exudative, 20, 231; with HIV, 302; in pregnancy, 654; with , investigating, 232; mechanisms, 226t; 340, 345t; and vomiting, 10–11 osmotic, 19, 226–8; secretory, 19–20, delirium, 624 229t, 230–1; self-induced, 231–2 Delta agent. see diarrhea, in general: about, 19–22; and dementia, 57t, 204t, 624 bacterial overgrowth syndrome, 247; and demyelination of central nervous system, 206 bile acid, 193, 243; bloody, 20, 211, Dent sleeve, 124f 216–17, 285, 390, 393; and C. difficile, deoxycholic acid, 65t, 245 390; malassimilation, 202, EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 836

836 INDEX

204t; and carcinoid syndrome, 250; and low-fat, 324; malabsorption, 62, 64; celiac disease, 235t, 236; chewing gum malassimilation, 208t; pancreatitis, 441 diarrhea, 227t; with colitis, 394; with Dieulafoy lesions, 34, 165 colon cancer, 366; with colonic digestion: about, 178; carbohydrates, 50, 51f, obstruction, 374–5; and constipation, 18, 227, 232, 385, 419; colon, 362–4; fats, 50, 366; with Crohn’s disease, 314, 315t, 323, 51f, 191f, 192–4; gallbladder, 192; protein, 339, 342t; dietary therapy, 59–60; drug- 50, 51f, 192, 199–202; stomach, 180; related, 222–5, 350; and electrolyte triglycerides, 53 absorption, 192; with eosinophilic colitis, digitalis, 21t, 213t, 253, 275t, 287 394; with fat malassimilation, 206; and diglucuronide, 30 growth failure, 706t; with HIV, 291–2, dilation: to treat achalasia, 8, 122; to treat 297, 302; and hookworms, 393; colitis, 287; colon, 221, 339–40, 345t; to inflammatory bowel disease, 64t; with treat , 7; to treat ischemia, 254, 279, 285; and esophagitis, 115; intrahepatic biliary, 31, malassimilation, 209; and malnutrition, 59; 480; lymphatic, 307; peroral, 110–11, 127, , 393; with pancreatic diseases, 438, 130, 133; to treat portal hypertension, 609; 445; with Shigella, 388; short bowel stomach, 172, 339 syndrome, 243; with small bowel diloxanide, 392 obstruction, 318; with Strongyloides diltiazem, 525t stercoralis, 299; therapy for, 382t; with dioctyl sodium sulfosuccinate, 226t ulcerative colitis, 331, 333–4, 339, 342t; Dipentum®, 327, 349–50 vitamin deficiency, 57t, 205t; in Whipple’s dipeptidylaminopeptidase IV, 200 disease, 251 diphenlylhydantoin, 523t diarrhea, osmotic, 198f , 218t, 323, 348, 382t, 389 diarrhea, traveler’s, 20, 218 diphyllobothrium latum, 57t , 523t, 525t direct tube tests, 424–5 dicarboxylic acids, 60 disaccharidase deficiencies, 201t, 226t, 227, dichlorodiphenyltrichloroethane (DDT), 445 232–4, 315t , 161, 582 disaccharidases, 59, 195, 197–9, 201 dicyclomine, 382t disaccharides, 50, 196f, 197 dideoxyinosine, 305 discharge, anorectal, 399 diencephalic syndrome, 706t disopyramide, 225 diet. see also alcohol; nutrition; alcoholic disopyrobezoars, 173 liver disease, 572, 574; anorexia, 12; disorientation, 204t carbohydrates, 194; cholelithiasis, 464t; distal intestinal obstruction syndrome, 721–2 constipation, 18; defined formula, 71; distension. see also bloating; and acute diarrhea, 59–60, 717; elemental, 71; abdomen, 25; after , 172; and enteral formulas, 71–2; “fad,” 64t; failure ascites, 33; with carbohydrate to thrive, 235, 703; fat intake, 192, 209; malassimilation, 204t; and celiac disease, fiber, 382t, 384–5, 404–5; low-salt, 616; 235–6; with colonic obstruction, 375; and , 444t, 445; protein constipation, 18, 386; and diarrhea, 230, content, 199; restrictive, 64t; semi- 234; and diverticulitis, 373; and enteral elemental, 71; vitamin deficiency nutrition, 72–3; by intraesophageal syndromes, 57t; vitamins and minerals, balloon, 99; with irritable bowel syndrome, 178–83 377; with ischemia, 253, 285; with liver dietary therapy: anal fissures, 405; ascites, disease, 33, 503, 571, 613; with toxic 63; celiac disease, 61–2; constipation, 701; megacolon, 340; tracheoesophageal fistula, diarrhea, 59–60, 717; diverticulosis, 372; 101 fecal incontinence, 384; fiber, 382t; diuretics, 33, 253, 275t, 660; to treat general principles, 59–63; GERD, 109; alcoholic liver disease, 574; to treat ascites, growth failure, 710; hereditary liver 617; causing diarrhea, 232; causing disease, 65t; inflammatory bowel disease, pancreatitis, 429t 62, 62–3, 324–5; ischemic disease, 286; divalent ions, 227 lactose-free, 65, 323; liver disease, 63–5; diversion colitis, 59, 362 EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 837

INDEX 837

diverticula. see also specific types; causing dyspepsia, 8–9, 16, 28, 145, 160, 350, 378. bacterial overgrowth, 245t; see also gas cricopharyngeal, 7; duodenal, 430t; dysphagia: about, 6–7, 94–5; and achalasia, esophageal, 131–3; gastric, 173; Meckel’s, 94, 96, 122; classification of, 117t; 249; pulsion, 133; small bowel, 201t, 245t; colorectal, 343; diagnosis, 7; and traction, 133 diverticula, 131, 133; esophageal, 94–5, diverticulitis, 26–7, 249–50, 286, 320t, 321, 105, 113, 116, 123; GERD, 107, 110, 373t, 376 694t; and HIV, 291, 295, 300–1; and iron diverticulopexy, 131 deficiency, 207; malnutrition, 23; diverticulosis, 35t, 133, 372–4 management, 7; oropharyngeal, 94–5, DNA. see deoxyribonucleic acid (DNA) 116–19; and mechanisms, 94; doctor–patient relationship, 30, 290 and squamous cell carcinoma, 128, 130; on domperidone, 12, 382t treating portal hypertension, 608; and dopamine, 190 tumors, 125 doxorubicin, 450 dysplasia, 112, 127, 169, 343, 345, 368 , 115, 218t dyspnea, 35, 207, 588 drooling, 115 dysproteinemia, 647 drowsiness, 544 dyssynergia, pelvic floor, 388 drug abuse. see drugs drugs. see also clinical trials; and eating, fear of, 274 cholelithiasis, 464t; causing cholestasis, E. coli. see Escherichia coli 582–3; and constipation, 17; causing ecchymosis, 205t diarrhea, 213t, 222–5, 232; and GI eclampsia, 652t, 654, 656–7 hemorrhage, 165; causing hepatitis, ecstasy, 519t 517–18, 539; causing hyperamylasemia, ectasia, vascular, 151 427t; illicit, 532, 599; causing liver eczema, 203t disease, 579–85; and malabsorption, 64t; edema: bile duct, 439; with carbohydrate and malassimilation, 201t; metabolized by malassimilation, 204t; and celiac disease, the liver, 522–6; and nutrient absorption, 235t; cerebral, 624, 627; with cirrhotic 63; overdose, 624, 627; pyridoxine- ascites, 614, 618; with Crohn’s disease, antagonists, 57t; causing vomiting, 11 307, 317; with hepatic encephalopathy, Dual Energy X-ray Absorptiometry (DEXA), 624; and iron deficiency, 207; in liver 208 disease, 33; in malassimilation, 206; Dubin-Johnson syndrome, 527, 528t, 529 malnutrition, 56, 77; and nutritional ductal cell adenocarcinoma, 444 assessment, 69t; with pancreatic diseases, ductal cells, 418–19 438, 445; periportal, 346; with Dukes’ classification, 365 Strongyloides stercoralis, 299 , 21t, 233t efavirenz, 291 , 689 effusion, 33, 433t, 614, 637 duodenal ulcer disease: children, 160; cystic egg white: in enteral formulas, 71; excess fibrosis, 454, 456; and gastric secretion, ingestion, 57t 155; and H. pylori, 155, 157, 162; elastase, 199 pathophysiologic defects, 153t; treatment, elderly patients: achalasia, 58t, 122; acute 164; upper GI bleeding, 34t, 409 abdomen, 26; chronic abdomen, 28; with , 157 cirrhotic ascites, 620; constipation, 386; : anatomy, 138–41; iron dysphagia, 6; GI bleeding, 36; hepatitis, absorption, 182–3; physiology, 142–5; 532; ischemia, 253–4, 258, 272–3, 280, PUD, 155, 156f, 158f, 159–60 284, 286; megarectum, 387; Salmonella, Dupuytren’s , 502t, 571 389; ulcerative colitis, 339; vitamin D-xylose, 59, 238 deficiency syndromes, 122; volvulus, 172 , 218, 388 electrocoagulation, 402, 407 , 502t, 504 electrolytes: abnormalities, 335; absorption, dysgammaglobulinemia syndromes, 241 185–92, 333; and acute abdomen, 27; dysmotility, 119 disturbances, 73, 345t, 502t; enteral EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 838

838 INDEX

nutrition, 71; and gastritis, 148t; enteroenteric fistula, 245t inflammatory bowel disease, 64t; with enterogastrone, 144 ischemic colitis, 285; secretion, 189–92; enterohepatic circulation, 193 total parenteral nutrition (TPN), 75 enterokinases, 199, 420, 421f ELISA test, 391, 394, 539 enteropathy: choleretic, 19; in Crohn’s embolectomy, 271–2 disease, 315t; gluten-sensitive. see celiac embolism, 243, 347 disease; HIV-associated, 301–2; and embolus, 271 malnutrition, 23; nutritional intervention, emepronium bromide, 115 71; protein-losing, 23, 55, 64t, 68, 248–9, emphysema, 585 302, 315t empyema, 472 enterotoxins, 188, 213–16, 226t, 230 encephalopathy: and alcoholic liver disease, Entocort®, 350 571–2; and cirrhosis, 592, 601t; with , 65t; liver, 722–3; pancreatic, 60, cirrhotic ascites, 614; dietary therapy, 63, 419–21, 442; to treat pancreatic 63–5; hepatic, 245, 457, 502t, 623–9 insuffiency, 724; replacement, 457–8; role encopresis, 387 in metabolism, 524–6; secretion of, endarterectomy, 276 419–21; supplements, 208t endarteritis obliterans, 412 eosinophilic colitis, 394 endocrine changes, 502t, 504 , 114 endocrine secretion, 77, 141 eosinophilic gastritis, 152 endometriosis, 29 eosinophilic gastroenteritis, 341t endopeptidases, 199, 420 eosinophilic pneumonitis, 392 endoplasmic reticulum: protein processing, epidermoid carcinoma, 126t, 444 795; protein targeting, 790–5; transport of epidermolysis bullosa, 114 proteins, 795–9 epiphrenic diverticula, 133 : abdominal mass, 40; epirubicin, 171 adenocarcinoma, 127; biliary tree episcleritis, 316t, 319, 345t, 348 obstruction, 208t; caustic chemical Epsom salts, 227t ingestion, 115; colitis, 413f; of colon, Epstein-Barr virus, 429t, 530, 543, 642 362f; for colon cancer, 368; for Crohn’s ERCP. see cholangiopancreatography, disease, 321–2, 342t; dyspepsia, 9; endoscopic retrograde (ERCP) dysphagia, 7; , 98, 99f, ergocalciferol. see vitamin D2 113–14, 119, 123, 125, 129, 133, 301; and eructio nervosa, 15 food-bolus obstruction, 134; foreign erythema nodosum, 316t, 319, 335, 345t, bodies, 134; gastric, 145, 147, 151–3, 170; 347–8 GERD, 106t, 108, 110, 112; GI bleeding, erythro, 526t 36–7, 165; hemostatic, 166; Mallory-Weiss erythrocyte sedimentation, 321, 333, 335 tear, 134; for pancreatic carcinoma, 448; erythrocytosis, 647 for ulcerative colitis, 336t, 337–9, 342t , 216, 293t, 525t, 582 endoymsium, 237 Escherichia coli: about, 214–15; causing energy requirements, 69–70 cholecystitis, 476; causing diarrhea, 19–20, enkephalins, 190, 192 213t, 217–18, 226t, 230, 712; causing Ensure®, 212t peritonitis, 621, 621t; in small intestine, Entamoeba histolytica, 213t, 221, 294t, 297, 244; types, 215t; and ulcerative colitis, 336, 391–2, 712 336, 341t enteral nutrition, 70–3, 76, 212t, 324, 349 , 6–8, 118f, 119, 121 enteritis: causing , 430t; esophageal sphincter, lower: anatomy, 88–90; children, 688t, 711–12, 718; and function, 94; GERD, 103; motor disorders, disaccharidase deficiencies, 233; and GI 6–7, 108; vomiting, 90 bleeding, 35t; and HIV, 292; and esophageal sphincter, upper: anatomy, 88–90; malassimilation, 201t; parasitic, 219–22 function, 91 Enterobacter, 621t esophageal transaction, 608 , 19, 60t esophageal ulceration, 72 Enterocytozoon bieneusi, 298 esophagitis: allergic, 114; chemical-induced, EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 839

INDEX 839

114; eosinophilic, 114; and food-bolus Fabry’s disease, 320t obstruction, 134; GERD, 105, 108, 693; factor II, 494, 504 causing hemorrhage, 165; immune- factor IX, 494, 504 mediated, 114–15; infectious, 34, 113–14; factor V, 347, 494, 504 nonreflux-induced, 113–16; , 34; factor VII, 494, 504 pill, 34; and vomiting, 11 factor VIII, 347 esophagus: about, 88; anatomic variants, factor X, 494, 504 101–5; anatomy, 88–90; angina-like pain, failure to thrive. see also growth failure; 123–5; blood supply, 89; diagnostic about, 703; assessment, 705–9; cystic investigations, 97–100; diseases, 94–7; fibrosis, 720; GERD, 693, 694t , 89–90; hypertensive peristalsis, famciclovir, 294t, 301 118f; innervation, 89; irritable, 125; Familial Adenomatous Polyposis (FAP) lymphatic drainage, 89; motor disorders, Syndrome, 173, 368 6–7; nutcracker, 118f, 119, 121; familial polyposis syndrome, 173, 364, 368 physiology, 90–4; primary disorders, 119; familial short stature, 704 rings, 130–1; secondary disorders, 119; , 442 ulcers, 155; webs, 130–1 farting. see gas estrogens, 275t, 287, 429t, 464t, 525t, 651 fasting, 20, 46, 55t, 63, 225, 318, 437, 450, etanercept, 347 527, 528t, 529 ethambutol, 293t fat. see also triglycerides; absorption, 192–4; ethanol: causing diarrhea, 226t, 227; liver dietary intake, 209; in digestion, 50, 51f, disease, 504, 512, 569, 647 192–4; malabsorption, 193, 198, 243, 246, ethanolamine, 608 315t, 319, 724; malassimilation, 206, 235t; ethics, 232, 574 metabolism, 50, 51t, 493–4; in stool. see ethnicity: and celiac disease, 236; steatorrhea; total parenteral nutrition choledochal cysts, 481; and cholelithiasis, (TPN), 74 464t; and cholestasis of pregnancy, 654; fatigue: and alcoholic liver disease, 570; and and Crohn’s disease, 311; and cystic celiac disease, 236; and gastritis, 147; and fibrosis, 453; and enzymatic metabolism, GI bleeding, 35; and hepatitis, 566; and 525; and lactase deficiency, 199, 227, inherited liver disease, 588; and iron 233–4, 684; and , 379; deficiency, 207; in liver disease, 501; with and lymphoma, 255; and osmotic diarrhea, pancreatic diseases, 445; with ulcerative 227. see also geographic factors; colitis, 334 sclerosing cholangitis, 483; and squamous fatty acids. see also ; cell carcinoma, 128 deficiency, 455; and diarrhea, 19, 225, , 161 226t, 227, 230, 324; in digestion, 49–50, eukaryotic cells: cell cycle, 748–50; cellular 143, 192–3; enteral formulas, 71; compartmentalization, 789–806; classes of hydroxylated, 188; , 74; RNA, 739, 741; expression of genetic lipolysis of, 50; long-chain, 206, 324, 364; information, 771; flow of genetic luminal, 59; malassimilation, 206; information, 747–8; post-transcription malnutrition, 59; oxidation, 54; processing, 772–80; post-translational reabsorption, 199; short-chain, 195, 197, processing, 787–806; transcription, 764–72 228, 245, 324 eukaryotic genomes: molecular anatomy, fatty liver: about, 517; alcoholic liver disease, 743–4; organization, 744–7; regulation, 569; causing cirrhosis, 598t; causing 772–80 hepatitis, 551t; and malnutrition, 23, 56; Everolimus®, 640 nonalcoholic liver disease, 574–9; in excess egg white ingestion, 57t pregnancy, 655–6; with ulcerative colitis, , 5–6, 520, 610 346 exocrine cells, 56 fear of eating, 274 exons: defined, 743; splicing, 776, 777f, 781f , 276t exopeptidases, 199 fecal incontinence, 398 eye problems, 203t, 205t, 316t, 319, 345t, 348 fecal occult , 34 fedotozine, 382t EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 840

840 INDEX

feeding center, 12 fistulotomy, 406 ferritin, 208, 577 FK-506, 639 Festal®, 211t Flagyl®, 390 fetor hepaticus, 624 . see gas fever: and alcoholic liver disease, 570; and flatus. see gas biliary colic, 467t; Boerhaave’s syndrome, flatworms, 219 134; children, 690, 732; cholecystitis, 305, Fleete®, 401 471–2; with cirrhotic ascites, 614; with flora: colon, 349; fecal, 227; and gas, 14; Crohn’s disease, 314, 342t; diagnosis, 4; small intestine, 244–6 and diarrhea, 215–19, 224; with , 584 diverticulitis, 375; and gastritis, 147; and fluconazole, 113, 293t, 296, 526t HIV, 292, 296, 303; inflammatory bowel fluid thrill, 33 disease, 64t; with irritable bowel flukes, 219, 465 syndrome, 380; with ischemic colitis, 285; flumazenil, 628 in liver disease, 501, 502t; with liver fluoroquinolones, 389, 526t transplantation, 641; and pancreatitis, 432; fluoroscopy, 116 with Shigella, 388; with Strongyloides 5-fluorouracil, 171 stercoralis, 299; with toxic megacolon, fluoxetine, 526t 340, 345t; and ulcerative colitis, 333–4, , 250 342t, 346; in Whipple’s disease, 251 fluticasone, 114 fiber, 18, 59, 73, 195, 382t, 384–5, 404–5 fluvoxamine, 526t , 347, 494 flux. see diarrhea fibrinolytic agents, 287 focal nodular hyperplasia, 644–5 , small intestine, 255 focal segmental ischemia, 279 fibrosis. see also cystic fibrosis; and folacins, 178 cirrhosis, 596; congenital hepatic, 602t; , 23, 62, 179, 203–5t, 206, drug-induced, 584; esophageal, 107; 208, 235t, 236–7, 246 idiopathic portal, 602t; liver, 346, 481, folic acid: absorption, 178–9; deficiency, 57t, 548t, 571; pancreas, 437, 439; 59, 60t, 64t, 207, 321; digestion, 245; retroperitoneal, 194; submucosal, 151; of replacement, 210t varix lumen, 608 follicular hyperkeratosis, 203t, 206, 235t Filaria species, 394 food. see diet; nutrition fissures, anal: about, 404; and bleeding, 413t; Food and Drug Administration, 81 carcinoma, 303; with Crohn’s disease, 318; food poisoning, 213–14 diagnosis, 405; and HIV, 292; with foreign bodies: esophagus, 134; stomach, inflammatory bowel disease, 316t; causing 148t, 151 pain, 396–7; pathogenesis, 405; with formic acid, 199 perianal mass, 398; and , Formula 2®, 212t 40; treatment, 405–6; with ulcerative foscarnet, 294t, 300–1 colitis, 344t fractures, 207 fissures, mouth, 203t, 207 fructose, 65t, 197, 227t fistula-abscess disease, 406 fructose intolerance, 706t fistulas: anal, 128, 130, 303, 344t, 399; aorto- fundoplication, 109, 695 enteric, 34; aortoenteric, 410t; with fungal infection, 295–7 cholecystitis, 472; colocutaneous, 373t; fungemia, 75 colonic, 391; colovaginal, 373t; furosemide, 429t, 617–18 colovesical, 373t; with Crohn’s disease, 342t; causing diarrhea, 226t; enteroenteric, GABAB receptors, 108 245t, 318; esophagorespiratory, 128, 130; galactosemia, 65t, 597, 598t, 706t gastrocolic, 245t; perianal, 318; perirectal, gallbladder: abdominal mass, 39; and cystic 318; rectovaginal, 316t, 344t; rectovesical, fibrosis, 456; in digestion, 192; and HIV, 316t; small bowel, 201t, 308, 310f; 304; inflamed. see cholecystitis; and splenic, 602t; tracheoesophageal, 101–3; jaundice, 31; neoplasms, 479–80; with with ulcerative colitis, 342t pancreatic diseases, 445; ulcers, 155 EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 841

INDEX 841

: acalculous cholecystitis, gastroesophageal reflux disease (GERD). see 477–8; cholecystoses, 478–9; congenital, GERD 477; neoplasms, 479–80; Gastrografin®, 134, 456 postcholecystectomy, 479 , 12 gallstones. see cholelithiasis gastropathy: chemical, 146, 148t, 150; gamma-glutamyl transpeptidase, 506, 517 hypertrophic, 152; portal hypertensive, ganciclovir, 294t, 300 606–7 Gardner’s syndrome, 368 , percutaneous endoscopic, 71 gas. see also dyspepsia; about, 13–16; with “gay bowel syndrome,” 22 celiac disease, 235t, 236; in cholelithiasis, G-cell hyperplasia, 160, 450 454; with GERD, 110; irritable bowel gemcitabine, 171, 449 syndrome, 378; with malabsorption, 227; gender. see sex with malassimilation, 202–4; with gene sequences. see also transcription; DNA, ulcerative colitis, 335 743, 745; mRNA, 743; size, 744 gaseous distension. see gas gene therapy, cystic fibrosis, 806–9 gastrectomy, 151, 171 genes: expression. see transcription; secretion: in disease, 155, 163, translation; families, 524; , 525 168, 389, 451; mechanism, 143–4 gentamycin, 476 gastric atrophy, 57t geographical factors. see also ethnicity; gastric cystica profunda, 152t cholestasis of pregnancy, 654; diarrhea, 20; gastric erosions, 34t gallstone disease, 460; hepatitis B, 553; , 142, 149, 152 lactase deficiency, 199, 227; parasites, 299, , 171 591; squamous cell carcinoma, 128 gastric phycomycosis, 150 GERD (gastroesophageal reflux disease): gastric rupture, 172 about, 105, 691; , 124; children, gastric secretion: gastric acid, 143–4; 691–5; clinical features, 8, 107; , 141, 143, 150; , 141; complications, 110–12, 693–4; pepsinogen, 141, 144 cricopharyngeal myotomy, 118, 131–2; gastric ulcer disease, 154f and cystic fibrosis, 455t; diagnosis, 106t, , 152t 107–8, 692–5; and esophageal disorders, , 172 97; and esophageal motor disorders, 119, gastrin: causing diarrhea, 226; and protein 123; and growth failure, 706t; heartburn, absorption, 199; role in digestion, 199; 95; and , 122; and hiatus secretion, 144, 163, 423; in Zollinger- hernia, 101f, 103, 105; management, 695; Ellison syndrome, 231 pathophysiology, 105–7, 691–2; and gastrin releasing polypeptide (GRP), 190t pneumatic balloon dilation, 122; schematic , 144t, 450–1 representation, 104f; treatment, 108–10; gastritides, 147–53, 148t and vomiting, 11 gastritis: about, 145–6; atrophic, 153; giant cell carcinoma, 444 autoimmune, 150; bacterial, 147–50; bile- giant hypertrophic gastritis. see Ménétrier’s reflux, 151; chemical-induced, 145–6; disease classification of, 148t; collagenous colitis, Giardia lamblia: about, 219–20; causing 151; and dysplasia, 169; eosinophilic, 152; diarrhea, 21t, 213t, 718; and HIV, 297; fungal, 150; and gastric cancer, 169, treatment, 294t 169–70; gastritides, 147–53; giardiasis, 22, 219–20, 321 granulomatous, 151; parasitic, 150; and Gilbert’s syndrome, 32f, 503, 505, 527, 528t, portal hypertension, 606t; viral, 147 727 gastritis cystica profunda, 148t, 153 gliadin, 234, 237 gastrocolic fistula, 14, 245t globulins, 507, 533, 538 gastroduodenitis, erosive, 160, 165 globus, 4–5 gastroenteritis: bacterial, 214–17; causing glomerular filtration rate (GFR), 68 diarrhea, 214–17, 219; eosinophilic, 320t; glomerulonephritis, 554, 559, 591 and malabsorption, 198; viral, 219 , 57t; with carbohydrate , 244 malassimilation, 203t; and celiac disease, EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 842

842 INDEX

235t; in malnutrition, 23, 56; vitamin B12 gestational age, 704 deficiency, 207; vitamin B6 deficiency, growth hormone, 53 205t GRP. see gastrin releasing polypeptide (GRP) glucagon: to treat alcoholic liver disease, guanethidine, 213t 573; with carbohydrate malassimilation, guanine, in gene sequences, 741 204; depletion, 63; and food-bolus guanylate cyclase, 215, 230 obstruction, 134; in , 231; guarding of abdominal muscles, 25–6 and pancreas, 423; role in digestion, 49, 53 Guillain-Barré syndrome, 547 , 450 gum disease, 58t, 203t, 205t glucoamylase, 195 (), 195 , 160, 190, 394 gut hypersensitivity, 15 gluconeogenesis, 53–4, 63–4, 494 gut transit study, 18 glucose: absorption, 185–6, 194f, 197; gynecomastia, 502t digestion, 49–50; malnutrition, 55–6, 59, 77; total parenteral nutrition (TPN), 74 H+/K+-ATPase, 36, 143, 150 glucose galactose, 227t H+/K+-ATPase pump. see proton pump glucose oliogasaccharides, 71 H. pylori. see pylori glucose-saline replacement therapy, 231 H2 antagonists. see H2-receptor antagonists glucuronide, 30 H2 blockers. see H2-receptor antagonists glutamine, 53 H2-receptor antagonists: to treat cystic gluten, 200, 208t fibrosis, 458; to treat dyspepsia, 9; to treat gluten-sensitive enteropathy, 61, 234–42. see gastritis, 152; to treat Meckel’s also celiac disease diverticulum, 250; to treat pancreatitis, 442 glycerin, 702t HAART, 291, 302, 304, 306 glycine, 245, 457 hair problems, 203t, 205t glycogen, 50, 54, 63, 194 halothane, 582 glycogen acanthosis, 126t hamartoma, small intestine, 255 glycogen storage disease, 65t, 706t Harris-Benedict equation, 69–70, 76 glycogenolysis, 50, 53 Hartnup’s disease, 200, 201t glycolysis, 50t, 189 Hashimoto’s thyroiditis, 150 glycoproteins, 180, 197, 420 head circumference, children, 705–7 goiter, 203t , 216, 250, 319 gold, 341t heart disease, 96, 108, 250, 253, 284, 732 Golgi apparatus, 197, 201, 420, 801–3 heart failure, 47, 57t, 205t GoLYTELY™, 722 heartburn: about, 5–6; achalasia, 122; and gonococcus, 22 esophageal disorders, 95; and esophageal , 292, 341t, 407 motor disorders, 119; GERD, 95; with Good Clinical Practice (GCP), 79 irritable bowel syndrome, 378; in graft dysfunction, 641 esophagus, 122–3 graft-versus-host disease, 131, 146, 148t, height, children, 705–7 150, 341t, 602t : appearance of, 139f; and granular cell tumor, esophageal, 126t, 127 dyspepsia, 8; and gastric cancer, 168–71; , 307 and gastric folds, 152t; and gastritis, 146f, granulomatosis, allergic, 275t 148t, 149, 151, 169; isolation of, 138; and granulomatous gastritis, 148t, 151 NSAIDs, 161; and pseudolymphoma, 173; granulomatous inflammation, liver, 583 and PUD, 155–9, 162–4 Grey Turner’s sign, 432 helix-loop-helix, 769 group D streptococci, 621t Heller myotomy, 122 growth failure. see also failure to thrive; HELLP syndrome, 657 about, 703; assessment, 705–9; hemaccel, 618 constitutional growth delay, 704; hemagglutination test, 221, 391 diagnosis, 706t; dietary therapy, 710; hemangioma: cavernous, 645–6; esophagus, enteral nutrition, 77; familial short stature, 126t 704; management, 710; small for . see blood in vomit EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 843

INDEX 843

, 398. see also blood in stool hepatitis E, 541–2 , perianal, 403 hepatitis G, 543 hematuria, 474 hepatitis GB, 543 hemobilia, 34, 410t hepatitis, ischemic, 506, 658 hemochromatosis: and cirrhosis, 571, 597; hepatitis, neonatal, 536 dietary therapy, 65t; genetic, 518; in hepatitis serology, 507 inherited liver disease, 586–9 hepatitis, viral, 32, 429t, 530–65, 547t, 566t, , 31, 32f, 204t, 505 597, 598t. see also specific types hemophilia, 290 hepatobiliary disease, children, 722–5 hemorrhage. see also bleeding; blood loss; hepatobiliary function, 493–500 with amebiasis, 221; colonic, 344t, 347; hepatoblastoma, 648 and diagnosis, 3; with GERD, 112; with , 644 inflammatory bowel disease, 316t; and hepatocellular carcinoma, 557, 561, 572, 578, ischemia, 275t, 276; and ischemic colitis, 583t, 585, 600, 627, 646–8 285; and malnutrition, 58t; mucosal, 151; hepatocellular disease: clinical features, 346; and NSAIDs, 160; postpartum, 653; and and jaundice, 31; malassimilation, 201t; PUD, 165; treatment, 166–7; upper GI, reduces coagulation factors, 494 161, 164–8 hepatocellular dysfunction, 32f hemorrhoidectomy, 404 hepatocellular injury, 581–2 hemorrhoids, 35t, 40, 344t, 396–9, 402–4, hepatocytes, 30, 492, 596 412, 413t : and alcoholic liver disease, hemosiderin, 285 570–1; with carbohydrate malassimilation, , 134, 166 204t; Caroli’s disease, 480; and esophageal hemosuccus pancreaticus, 34 disorders, 97; in esophageal disorders, 128; heparin, 272, 660 and HIV infections, 303; and jaundice, 31; , 480–1 in liver disease, 503–4; and malnutrition, hepatitis A, 292, 517, 531–5 23; in pregnancy, 653 hepatitis, acute: about, 530–1, 582; causes, hepatopulmonary syndrome, 611–12 530t; complications, 544–7; figures, 543f, hepatorenal syndrome, 571, 629–32 545–6f; pathology, 544; types, 531–43 , 292, 567, 595, 723 hepatitis, alcoholic, 566t, 567, 602t, 603 hepatosteatonecrosis. see fatty liver hepatitis, autoimmune, 518, 566–7, 590, 597, herbal remedies, 519t, 584 598t heredity: gastric cancer, 171; colon cancer, hepatitis B: about, 517, 536–8; acute, 536–8; 369; cystic fibrosis, 453; disaccharidase causes, 551t; chronic, 517, 552–9; and deficiencies, 232, 234; fructose cirrhosis, 571, 598t; diagnosis, 552t; drug- intolerance, 65t; liver disease, 56t, 65t, induced, 327; and hepatocellular 585–9; pancreatitis, 437, 444; PUD, carcinoma, 646; and HIV, 292, 304; in 159–60 pregnancy, 653; prevention and treatment, hernia, 376 534t; risk, 535t herpes: causing acute hepatitis, 530; causing : about, 515, 539–40; and esophagitis, 6, 113–14; causing gastritis, alcoholic liver disease, 568, 571; causes, 147; causing hepatitis, 652; HIV 551t; chronic, 515, 559–65; and cirrhosis, infections, 294t, 295, 301; inflammatory 598t; and HIV, 304; in pregnancy, 653; bowel disease, 341t; sexually transmitted prevention and treatment, 534t; risk, 535t disease (STD), 408 hepatitis, chronic, 602t; about, 548–51; and herpetic mouth, 113 cirrhosis, 597; diagnosis, 544; drug- heterogenous nuclear RNA, role, 743 induced, 584; with inflammatory bowel heterosexuality, 290, 535t disease, 316t; risk factors, 551t; types, heterotopia, esophageal, 126t 552–65; with ulcerative colitis, 346; viral, hiatus hernia, 101f–2f, 103–5, 172 550–65 High-Nitrogen Vivonex®, 212t hepatitis D: about, 540–1, 565; and cirrhosis, hilum, 140 598t Hippel-Lindau disease, 450 hepatitis, drug-induced, 517–18, 519t, 551t, 566 Hirschsprung’s disease, 358, 387, 698, 700t EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 844

844 INDEX

, 109, 145, 167, 190t, 250 hypercholesterolemia, 576 histones, 745 hypercoagulability, 274 Histoplasma, 150 hyperdynamic circulation, 502t, 504 histoplasmosis, 293t, 296, 320t, 341t , 76, 654 history-taking, 3–4 hypergammaglobulinemia, 540, 567 HIV: about, 289; causing acute pancreatitis, hypergastrinemia, 144, 450 429t; basic principles, 289–91; and hyperglycemia, 73, 75 cholestasis, 590; GI involvement, 291–303; hyperimmune bovine colostrum, 222 hepatitis, 535t; treatment, 291, 293t–4t hyperkalemia, 73 HIV enteropathy, 302 hyperkeratosis, 58t, 205t HIV wasting syndrome, 305–6 hyperlipidemia, 74, 431, 516t hnRNA. see heterogenous nuclear RNA hyperlipoproteinemia, 429t, 431 hoarseness, 97, 107, 128 hyperosmolar nonketotic coma, 73 Hodgkin’s disease, 303 hyperoxaluria, 243, 319 homosexuality: and cytomegalovirus, 300; , 144t, 431 and diarrhea, 22; Giardia lamblia, 297; hyperpepsinogenemi, 160 hepatitis, 535t; and HIV, 290; Kaposi’s hyperperistalsis, 35, 386 sarcoma, 302; and sexually transmitted hyperphosphatemia, 73 diseases, 407; squamous cell carcinoma, hyperplasia: benign lymphoid, 320t; bowel, 303 237, 307; in Crohn’s disease, 307; focal hookworms, 393 nodular, 644–5; foveolar, 150, 152–3; hormones. see also specific types; affecting gallbladder, 479; G-cell, 144t, 451; electrolyte absorption, 188; causing nodular regenerative, 645; causing portal diarrhea, 19, 228, 712; gastrointestinal, hypertension, 602t; stomach, 173 144; and intestinal secretion, 190, 230–1; hyperreflexia, 624 causing liver neoplasms, 647; role in , 9 digestion, 50–3, 188 hypersecretion, 144t, 148t, 152, 450 Human Genome Project, 738 hypersensitivity pneumonitis, 327 human genomes. see eukaryotic genomes hypersomnia, 624 human immunodeficiency virus. see HIV hypersplenism, 457, 504 human virus, 303 hypertension, 33–4, 151, 576 hunger, 12, 682 hyperthyroidism, 20, 21t, 144t, 226, 226t, hydrocephalus, 11 706t : and gas, 13; secretion of, hypertriglyceridemia, 75, 576 141, 143 hypertrophic pyloric , 172 hydrocortisone acetate, 350 hyperuricosuria, 458 hydrogen, 201–2, 245 hypoalbuminemia, 23, 56, 333–5, 340, 345t, hydrogen sulfide, 245 721 hydrops, gallbladder, 473 hypocalcemia, 16, 58t, 207, 335 hydroureter, 27 hypochlorhydria, 152, 169, 451 3-hydroxybutyrate dehydrogenase, 54 hypochondriasis, 30 hydroxylases, 524 hypochromia, 37 , 382t hypogammaglobulinemia, 201t, 222, 249 hyperaldosteronism, 617 hypogeusia, 203t, 205t hyperalimentation, 437 hypoglycemia, 494, 570, 573, 627, 647 hyperammonemia, 64 hypokalemia, 73, 75, 335, 343, 365t, 366, hyperamylasemia, 265, 427–8, 434 451, 617, 627 hyperbilirubinemia: alcoholic liver disease, hypomagnesemia, 73, 207, 335 571; causes, 32f; cholecystitis, 471; hyponatremia, 73, 627 congenital, 527–30; conjugated, 529–30, hypoparathyroidism, 21t 729–32; jaundice, 31, 501–3; management, hypoperfusion, 260, 275–6 729; measuring, 505; neonatal hepatitis, hypophosphatemia, 73, 75 722; unconjugated, 527–9, 726–9 hypoproteinemia, 235t, 249, 694t hypercalcemia, 16, 385–6, 429t, 431, 647 hypoprothrombinemia, 235t, 502t EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 845

INDEX 845

hyporeflexia, 204t defecation, 696; dehydration, 713; hypospermia, 350 diarrhea, 22, 217, 711, 713, 718–19; , 26, 36, 224, 253, 276, 279, dietary therapy, 710, 717; enzyme 345t, 430, 474, 570, 614 deficiency, 656; failure to thrive, 720; hypothalamus, 12 feeding, 705; fibrocystic disorders, 480–1; hypothyroidism, 16, 385 GERD, 692–5; growth, 703–10; hepatitis, , 235 536; hypertrophic , 172; , 36, 134, 275t, 430 jaundice, 722, 725–35; malnutrition, hypoxemia, 611–12 701–3; meconium ileus, 719; obstruction, hypoxia, 506, 627 358; pancreatic insufficiency, 724; hysterectomy, 384 premature, 704; rehydration therapy, 716; rotavirus, 219; Sandifer’s syndrome, 694; , 161 vitamin deficiency, 58t; vomiting, 686 ileal disease, 23, 57t, 62, 193, 201t, 464t infection: anorectal, 407; biliary. see ileal plasmacytoma, 320t cholangitis; colonic, 388–92; fungal ileal pouch, 353, 368 infection, 295–7; H. pylori, 149, 173; ileal resection, 201t, 243, 315t herpes, 294t, 295, 301; HIV-related, ileitis, 216, 310f 292–303, 293t–4t, 303, 305; ileocecal sphincter, 229, 245t, 363f mycobacterial, 292–5; parasitic, 220, 222, ileostomy, 368 297–9; post-surgical, 641–2; respiratory, , 34, 180, 208 627; urinary, 627; viral, 300–2, 429t ileus: colonic, 375, 390; and cystic fibrosis, inflammatory bowel disease, 38. see also 454; distension, 231; gallstone, 472; and Crohn’s disease; ulcerative colitis; islet cell tumors, 450; meconium, 455t, children, 687t, 706t, 712; causing diarrhea, 456; nutritional intervention, 70; 20, 21t, 211; dietary therapy, 62–3; and GI pancreatitis, 77; paralytic, 471 bleeding, 34, 35t, 410t, 413t; and ischemic illness behavior, 30 colitis, 284–5; malnutrition, 64t; immunoproliferative small intestinal disease, manifestations of, 316t; therapy for, 325t 255 infliximab, 314, 325t, 328, 347, 573 immunosuppression, 217, 218t, 255. see also informed consent, 80, 84–6 HIV Infufer®, 346 immunosuppressive agents: to treat Crohn’s innervation, 89. see nerve supply disease, 323, 325t, 326–8, 330; to treat insecticides, 430t ischemia, 287; and liver transplantation, institutional review committee, 86 638–41; to treat sclerosing cholangitis, , 50, 55–6, 77, 204, 208t, 573, 575, 484; to treat small bowel tumors, 255; to 579 treat ulcerative colitis, 352 , 450 Imodium®, 323, 340, 348 interferon, 250, 304, 540, 556t, 558, 562t–3t, impotence, 502t, 588 564–5, 565t, 643, 649 incapacity, 4 interleukins, 168–70 incontinence, 18–19, 381–4 International Conference on Harmonisation . see dyspepsia of Technical Requirements for Registration indinavir, 291 of Pharmaceuticals for Human Use, 79 indirect pancreatic function tests, 424t, 425–6 International Normalized Ratio (INR), 36, indocyanine green, 527 507, 599. see (PT) test indole compounds, 245 intestinal bypass, 201t indomethacin, 161, 523t, 612 , 24 infants. see also children; absorption, 198; , 169–70 Alagille’s syndrome, 732; amylase intestinal resection, 201t, 226t deficiency, 198; apnea, 694; biliary atresia, intestine, small. see small intestine 482; celiac disease, 239; cholestasis, 481, intra-abdominal , 47 728t, 729–34; cirrhosis, 731; constipation, intracellular transport, 499 358, 698–9; Crigler-Najjar syndrome, 529; Intralipid®, 212t cystic fibrosis, 454, 457, 719–22; intramural diverticulosis, 133 EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 846

846 INDEX

intravenous drug use, 290, 292, 300, 304 , 506, 658 intrinsic factor, 141, 143, 150, 180 islet cell tumors, 19, 21t, 450–1 introns, defined, 743 islets of Langerhans, 418 intussusception: children, 686; with cystic Isocal®, 212t fibrosis, 454, 456; causing obstruction, isomaltose, 197, 232 222, 255, 376 , 57t, 293t, 523t, 566, 582, 584 iodine, 56, 203t Isospora belli, 294t, 299 iodoquinol, 222, 294t, 392 isphagula, 385 ions. see electrolytes Ito cells, liver, 493, 603 irinotecan, 171 itraconazole, 293t iritis, 316t, 319, 345t, 348 ivermectin, 394 iron: absorption, 182–3, 184f; and celiac disease, 62; excess, 55t, 65t, 588, 596; jaundice: about, 30–2, 501–3, 725; acute malabsorption, 208; replacement, 210t; abdomen, 26; and alcoholic liver disease, sources, 182–3; storage disorder, 586 570; in , 505; children, iron deficiency: blood loss, 34; and celiac 725–35; cholecystitis, 471; disease, 235t, 236–7; with colon cancer, choledocholithiasis, 473; and cholestasis, 365t, 366; with Crohn’s disease, 315t, 321; 595; and cholestasis of pregnancy, 655; and esophageal webs, 7, 131; and GI cholestatic, 513f; cholestatic hepatobiliary bleeding, 37; and hiatus hernia, 103; and disease, 31; and cirrhosis, 592, 599, 601; hookworms, 393; with inflammatory bowel with cirrhotic ascites, 614; evaluation, disease, 317t; with irritable bowel 732–4; and hepatitis, 566; syndrome, 380; and malassimilation, hyperbilirubinemia, 501–3; management, 203–4t; and malnutrition, 23, 56; 734–5; neonatal, 722, 725–35; pancreatic manifestations of, 206; neoplasms, 128t; diseases, 432, 445; pathological, 726–32; with ulcerative colitis, 335, 344t, 346; and physiological, 726; ulcerative colitis, 346 whipworm, 393 jejunitis, 201t irritability, 206, 235, 624 , 201t irritable bowel syndrome: and bloating, jejunoileitis, 241 15–16; causes, 377; chronic diarrhea, 21t; , 71, 182, 189, 255 chronoic abdomen, 28–9; constipation, 16–17, 385; diagnosis, 377–8; causing Kaposi’s sarcoma, 152t, 302 diarrhea, 20, 209, 226t; mucus stool, 399; Kasai procedure, 482, 731 therapy, 380–1, 382t Kayser-Fleischer ring, 518, 530t, 586 irritable esophagus, 125 keratoconjunctivitis sicca, 559 ischemia: about, 258; and acute abdomen, 27; keratomalacia, 203t, 205t acute arterial, 265–73, 273–4; causing , 529 acute hepatitis, 530t; acute mesenteric, ketoacidosis, 427t 252–4; caused by thrombosis, 243; causes, ketoconazole, 113, 293t, 526t 275t; chronic mesenteric, 254, 274–6; ketones, 54 classification of, 258–60, 259f; clinical , 161 presentation, 265–6; and Crohn’s disease, ketosis, 654 28, 320t; and diarrhea, 211; focal : enlarged, 39; hepatorenal syndrome, segmental, 279; and gastritis, 151; GI 571, 629–32; transplantation, 640 bleeding, 35t, 410t, 413t; investigation, . see renal failure 266–9; and liver transplantation, 641; kinase, 250 nongangrenous, 276–87; pathophysiology Klebsiella, 621t of, 263–5; with peritonitis, 264–5, 269, koilonychia, 207 270f; prognosis, 273; and protein-losing Krukenburg tumor, 170 enteropathy, 249; and short bowel KuZyme HP®, 211t syndrome, 76; treatment, 269–73 kwashiorkor, 55, 60t, 206 ischemic colitis. see ischemia; nongangrenous ischemic colitis labetol, 523t ischemic heart disease, 108 Lactaid®, 234 EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 847

INDEX 847

lactase, 19, 64t, 198–9, 227, 234, 244, 323 leukemia, acute, 275t lactate dehydrogenase, 207, 265 , 265, 285, 321, 340; biliary lactic acid, 122, 227 colic, 467t; cholecystitis, 471–2; lactitol, 628 choledocholithiasis, 474; Crohn’s disease, Lactobacillus, 364, 621t 323; ischemia, 253; toxic megacolon, 345t; lactose: absorption, 194–5; and celiac ulcerative colitis, 334–5, 346 disease, 236; causing diarrhea, 19, 213t, , 327, 572 225; dietary therapy, 60–3; and levodopa, 628 disaccharidase deficiencies, 232; enteral libido, 203t nutrition, 73; intolerance of, 60, 62–3, 71, , 559 236, 321, 379; and malnutrition, 59 lidocaine, 523t lactulose, 19, 213t, 227, 573, 628, 701, 702t lifestyle modification, 109, 123; 168, 123 lamivudine, 304, 556t, 558, 565, 616. see ligament of Treitz, 34 also 3TC ligation, 608 Langerhans cell histiocytosis, 151 lignins, 195 , 27 limy bile, 473 , 253 , 152t laryngitis, 97 linoleic acid, 74, 203t, 455 laryngoscopy, 116 Linton-Nachlas tube, 607 laryngospasm, 694t lipases, 27, 56, 192, 305, 421, 442, 471 , 90–1, 97, 112, 117, 126, 392–3 lipid solutions, 23, 74 laser therapy, 127, 130 lipids, 53, 507 lavage: colonic, 628; peritoneal, 436 lipolysis, 50, 54–6, 192 lax bowels. see diarrhea , small intestine, 255 laxatives: abuse, 232; children, 701; to treat lipoprotein: chlyomicrons, 193; metabolism, constipation, 18–19, 385–6, 628, 701, 52f; role of liver, 493 701t; causing diarrhea, 20, 21t, 213t, 225, lipoprotein lipase, 53 226t, 227, 232; osmotic, 19, 382t; and lipoxygenase products, 190t ulcerative colitis, 341t lithium, 231 LCAT. see lecithin-cholesterol acyltransferase lithocholic acid, 245–6 (LCAT) , 475–6 LDL, 53–4 liver. see also fatty liver; abdominal mass, 39; lecithin, 461–2, 579 abnormal chemistry, 303; anatomy and lecithin-cholesterol acyltransferase (LCAT), function, 493–500; bile acid production, 53 193; diagnostic tests, 505–11; and E. legs, weak, 23 histolytica, 391; enlarged. see leiomyoma: esophageal, 125, 126t; small hepatomegaly; evaluation, 513–14; intestine, 255 examination of, 45–6; gluconeogenesis, leiomyosarcoma: esophageal, 126t; small 53; hyperbilirubinemia, 527–30; intestine, 255 indications, 600; inherited, 585–9; LDL LES. see esophageal sphincter, lower catabolism, 54; , 491–3; lesions: angiodysplastic, 410; annular, 255; neoplasms, 643–51; nutritional disorders, anorectal, 396; apple-core, 376; with celiac 55–6; portal hypertension, 601–12; results disease, 239–40; Dieulafoy, 34, 165; eye, and future, 642–3; structure and function, 316t; hepatic, 346, 457, 644–5, 649–51; 491–500; transplantation. see liver with Kaposi’s sarcoma, 302; mass, 276t; transplantation; vascular disorders, 658–61 oral, 113; polypoid distal, 255; prolapsing, liver disease. see also specific types; abcess, 398; pseudolymphoma, 173; 222; biliary, 316t; cholestatic, 64; chronic, pseudomembrane, 224; PUD, 153; 32–3, 552, 584–5, 606; clinical features, pulmonary, 295; skin, 347; skip, 308; 501–5; with Crohn’s disease, 319; with small intestine, 234; , 217t; cystic fibrosis, 457; diagnosis, 4, 511–21; structural, 116; submucosal, 127; tumor- dietary therapy, 63–5; drug-induced, like, 126t 579–85; and fat malabsorption, 193; and leucine zipper, 769 GI bleeding, 36; and HIV, 303–5; and EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 848

848 INDEX

jaundice, 31; and malassimilation, 201t; macronodular cirrhosis, 571–2, 598, 599f nutritional intervention, 71; in pregnancy, macronutrients, 50 651–7; and protein deficiency, 206; total magnesium: and Crohn’s disease, 324; parenteral nutrition (TPN), 75 deficiency, 204t, 235t; causing diarrhea, , 63, 532, 541, 548, 566, 624, 19–20, 225; malabsorption, 207; 627, 653 malnutrition, 77; replacement, 210t liver transplantation: about, 632; magnesium hydroxide, 19, 701, 702t complications, 640–2; contraindications, magnesium sulfate, 227t 635t; indications, 481, 485, 531, 541, 548, magnetic resonance 574, 579, 610, 612, 620, 623, 629, 632–4; cholangiopancreatography (MRCP), 475f, living donors, 636–7; model for end-stage 476 liver disease, 635–6; postoperative magnetic resonance imaging, 510 management, 637–40; and pregnancy, 654; malabsorption. see also malassimilation; procedure, 637; workup, 634 malnutrition; about, 202; and bacterial lobules, 419f, 596 overgrowth syndrome, 247; calcium, 207; Lomotil®, 323, 340, 348 of carbohydrates, 198–9, 226t; clinical , 218t, 294t, 323, 348, 382t, 384, , 202; with Crohn’s 389 disease, 314, 315t; causing diarrhea, lorazepam, 523t 19–20, 211, 226t; dietary therapy, 62, 64; Lucey-Driscoll syndrome, 727 drug-induced, 64t; of fat, 193, 198, 315t, lumbar lordosis, 15 319, 724; of glucose, 197; with HIV, 306; lump in . see globus inflammatory bowel disease, 64t; in liver Lundh test, 425 disease, 502t; and lymphoma, 255; lung consolidation, 97, 107 magnesium, 207; and malnutrition, 23, 59; lung disease, 250, 453, 585, 719 and parasitic enteritis, 219; erythematosus, 117t, 389 postgastrectomy, 244; vitamin D, 207; lye, 115, 131 vitamin deficiency syndromes, 57t; and lymph nodes, enlarged, 128 Whipple’s disease, 251 , 26, 292, 408 malaise, 216, 218, 501, 502t, 531–2, 537, lymphangiectasia, 194, 201t 542, 559, 576, 641 lymphangioma, esophageal, 126t malassimilation. see also malabsorption; lymphatic drainage: anal canal, 395–6; maldigestion; carbohydrate, 202–6, 235t; esophagus, 89; small intestine, 175; and celiac disease, 235t; classification of, stomach and duodenum, 141 201t; diagnostic approach, 207–9; causing , 151, 394 diarrhea, 211; of fat, 206, 235t; of iron, lymphocytic gastritis, 152t 206–7; therapy for, 208t, 210t , 22, 303 maldigestion. see also malassimilation; lymphoma, 152t; bacterial overgrowth about, 23, 202; clinical signs and syndrome, 245t; B-cell, 303; and celiac symptoms, 202–3; causing diarrhea, 226t; disease, 235t, 239, 241–2; causing postgastrectomy, 244; of starch, 198 cholestasis, 595; with Crohn’s disease, malignant melanoma, esophageal, 126t 151; causing diarrhea, 21t, 229t, 233t; Mallory-Weiss tear, 34, 97, 134, 165 drug-induced, 328; and fat malabsorption, malnutrition. see also malassimilation; 194; gastric, 149, 171; and gastritis, 151; nutrition; about, 22–3; albumin, 67; and causing GI bleeding, 34t; hepatitis C, 559; alcoholic liver disease, 570–1; assessment, HIV-associated, 303; intestinal, 237, 320t; 65–8; causes, 54t, 55–6; and celiac and malassimilation, 201t; malnutrition, disease, 236; children, 701–10; with 54t; small intestine, 255; and sprue, 241 Crohn’s disease, 314, 315t; causing lysine, 745 diarrhea, 20, 211; effects on GI tract and lysolecithin, 430, 471 pancreas, 56–9; effects on the intestine, lysosomes, 420 60t; and HIV, 304; with inflammatory bowel disease, 62, 64t, 316t; kwashiorkor, macroamylasemia, 427t 55; marasmus, 55–6; nutrition support, macrocytosis, 236 76–7 EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 849

INDEX 849

MALT (mucosa-associated lymphoid tissue) 253–4, 260; thrombosis, 252, 254, 274 syndrome, 149, 152t, 171 mesenteric venous occlusion, 273–4 maltase, 195 messenger RNA: and DNA mutations, maltose, 420 759–64; gene sequences, 743; post- maltotrioses, 232, 420 transcription processing, 772–80; manganese, 56 transcription, 739, 769–71; translation, Manning criteria, 378–9 782–7 mannitol, 19, 225, 227t, 627 metabolic disturbances, 17t, 434, 638 manometry, esophageal, 99, 108, 110, 118f, metabolic , 117t 123, 124f metabolism: carbohydrates, 51f; fat, 51f; marasmus, 55–6, 206 lipoprotein, 52f; protein, 51f; role of liver, marsupialization, 407 524–6 mass, abdominal. see abdominal mass metaplasia, myeloid, 659 , 201t METAVIR system, 548–9, Meckel’s diverticulitis, 320t metformin, 579 Meckel’s diverticulum, 155, 249–50 Methanobrevibacter smithii, 13 meconium ileus, 455t, 456, 719 methionine, 245 mediastinal tumor, 7 methotrexate: causing diarrhea, 225; to treat mediastinoscopy, 129 inflammatory bowel disease, 314, 325t, Medical Research Council of Canada (MRC), 326–58 passim; causing liver disease, 579, 80 584 megacolon: aganglionic. see Hirschsprung’s methylcellulose, 385 disease; and constipation, 18; toxic, 217, methyldopa, 341t, 566, 582, 584 221, 285–7, 316t, 323, 334–6, 340, 342–3, methyltestosterone, 583 344t–5t, 348 methysergide, 250 megaloblastosis, 207–8 : as anti-emetic, 12; to megarectum, 387 improve gastric emptying, 173 Meissner’s plexus, 90, 141, 176 metoprolol, 523t melanosis coli, 18, 232 : to treat amebiasis, 222, 392; , 33, 134, 165, 279, 365t, 366, 397, to treat bacterial overgrowth, 248; to treat 409. see also blood in stool choledocholithiasis, 476; to treat colon memory loss, 571 infections, 390, 392; to treat Crohn’s menadione. see vitamin K3 disease, 323, 325t, 329–30; to treat hepatic Ménétrier’s disease, 148t, 152 encephalopathy, 628; to treat HIV-related meningismus, 216 infections, 294t; to treat inflammatory menstruation, 15, 29, 379 bowel disease, 353; to treat mental apathy, 206 Microsporidium, 299; to treat parasitic mental retardation, 527 infections, 220, 222, 297; to treat meperidine, 436 pseudomembranous colitis, 224 6-mercaptopurine, 325t, 327 micelles, 60, 192, 462 mercaptopurine, 429t, 526 microcytosis, 37 Meritene Powder®, 212t micronodular cirrhosis, 571, 597–8 mesalamine, 325t, 327, 329–30, 349, 352 , 394 Mesasal™, 327, 349–50 Microsporidium, 294t, 298, 305 mesenteric adenitis, 216 midesophageal diverticula, 133 mesenteric arterial occlusion: clinical midodrine, 632 presentation, 265–6; investigation, 266–9; , 177 treatment, 269–73 milk of magnesia, 382t mesenteric : anatomy, 260–1; blood milk protein enteropathy, 706t flow, 261–3; occlusion, 265–73 Milkman’s fractures, 207 mesenteric insufficiency, 151 Milwaukee classification, 479 mesenteric ischemia. see ischemia mineral oil, 701, 702t mesenteric vasculature, 260–5 minerals: absorption, 178–83; deficiency, mesenteric : anatomy, 260–1; occlusion, 205t; replacement, 210–11t EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 850

850 INDEX

Mirizzi’s syndrome, 466 293t , 382t Mycobacterium tuberculosis, 149, 293t, 295 mittelschmerz, 29 mycophenolate mofetil, 639 MMF, 639 myeloproliferative disorders, 602t, 659 model for end-stage liver disease (MELD), , 90, 141, 176, 387–8 635–6 myocardial , 253, 276 molecular medicine, 738 myoclonus, 624 molybdenum, 56 myopathy: metabolic, 117t; proximal, 205t monoglycerides, 192–3 myotomy: cricopharyngeal, 118, 131–2; and monomeric formulas, 71, 77 diverticula, 133; esophageal, 8, 121; monosaccharides, 50, 196f, 201t Heller, 122; pyloric, 173 montelukast sodium, 114 myotonic dystrophy, 17 Morgagni’s columns, 395 , 479, 523t Na+/K+-ATPase pump. see sodium pump motility: colon, 361; esophagus, 7, 120–3, nails, 204t, 207 134; gallbladder, 478; parenteral nutrition, , 161 76; small intestine, 177–8, 228; stomach, narcotics, 600, 627 142–3 nasal erosions, 72 motor disorders, esophagus, 6–7, 119–23 nasal regurgitation, 95 mouth-to-anus capsule, 208 nasoenteric feeding, 72–3 MRC. see Medical Research Council of nasogastric suction, 323, 343, 436, 456 Canada (MRC) nausea: about, 9–12; and acute abdomen, 25; mRNA. see messenger RNA and alcoholic liver disease, 570; and mucin, 463 ascites, 33; and cholecystitis, 305; and mucocele, appendiceal, 320t diarrhea, 214–15, 218–19; and , esophageal, diverticulitis, 373; drug-induced, 350; and 126t gastritis, 146–7; with HIV, 297; and mucosa-associated lymphoid tissue (MALT) hookworms, 393; inflammatory bowel syndrome, 149, 152t, 171 disease, 64t; with ischemia, 253; and mucosal carcinoma, 112 jaundice, 31; and nasoenteric feeding, 73; mucosal defence mechanisms, 155 and NSAIDs, 160; with pancreatic mucosal inflammation, 313f diseases, 445; and pancreatitis, 432; in mucus: and cholelithiasis, 463; in gastric pregnancy, 654, 656; with small bowel juice, 143; inflammation, 221; secretion of, obstruction, 318; with Strongyloides 141; in stool, 211, 377–9, 386, 399 stercoralis, 299 multiple sclerosis, 17, 117t neck surgery, 117t mumps, 429t necrosis: acute tubular, 631; caustic chemical Münchausen syndrome, 30 ingestion, 115; cholecystitis, 472; and Murphy’s sign, 471–2 enteral nutrition, 72; and gastritis, 150, muscle atrophy, 206 152; and ischemic colitis, 285, 287; liver, muscle catabolism, 64 596; of the pancreas, 434; toxic, 581–2 muscle tenderness, 204t neoadjuvant therapy, 127 muscle wasting: with carbohydrate , 201t, 628 malassimilation, 203t–4t; with cirrhotic neonatal hepatitis, 585 ascites, 614; with hepatic encephalopathy, neonates. see infants 624; and malnutrition, 23, 56; and neoplasms. see also specific types; anal, 303, nutritional assessment, 69t; and 397; anorectal, 397; appendiceal, 250; pancreatitis, 438; and protein benign, 125–7; biliary, 486–7; brain, 11; malassimilation, 206 brainstem, 117t; carcinoid, 320t; in celiac muscular dystrophy, 117t disease, 235t; classification of, 126t; muscularis mucosa hypertrophy, 316t colonic, 399, 403; with Crohn’s disease, , 219 318, 320t; diagnosis, 4, 170; and diarrhea, myasthenia gravis, 117t 222; drug-induced, 584–5; esophageal, Mycobacterium avium-intracellulare, 291–2, 95–7, 112, 122, 125–30; gallbladder, EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 851

INDEX 851

479–80; gastric, 144t, 149, 154f, 168–71; NSAIDs: avoided in cirrhosis, 600; and and GI bleeding, 34, 410t, 413t; head and bleeding, 36, 165; to treat cholecystitis, neck, 117t; and hemorrhaging, 165; 472; cytochromes, 525t; and gastric hepatic, 515t, 521, 643–51; HIV- duodenal disease, 160–2; and gastritis, associated, 291, 302–3; hypopharyngeal, 145, 148t, 150; and H. pylori, 157–9; 131; intestinal, 28, 243, 250, 253, 255, mechanism, 161; and PUD, 28, 155; risk 320t; with ischemic bowel disease, 28; factors, 160t; selection of, 162t islet cell, 19, 21t, 226, 444, 450–1; liver, nucleosomes, 745 643–51; mediastinal tumor, 7; neurogenic, 59-nucleotidase, 506, 591, 651 171; oropharyngeal, 117t; pancreatic, 427t, nutrient deficiency. see malnutrition 444; prevention, 171; rectal, 303, 398–9, nutrient-dependent transport, 185–6, 187f 403; screening for, 368–9; skin, 764; small nutrient-independent transport, 187–9 bowel, 243, 255, 320t; treatment, 170–1 nutrition. see also diet; malnutrition; Neoral®, 638–9 assessment, 65–8; body composition, 66; neostigmine, 375 body weight, 66; creatinine-height index nephrolithiasis, 243, 317t, 319 (CHI), 66; and Crohn’s disease, 324; nephropathy, 571 energy requirements, 69–70; enteral, 70–3; , 68 essential concepts, 49–54; and HIV, 305–6; nerve supply: to anal canal, 396; to colon, immune competence, 68; intervention, 358–60, 386; to esophagus, 89, 94; to 65–77; liver, 55t; malnourished patient, pancreas, 417; to small intestine, 176; to 76–7; methods of assessment, 67t; stomach and duodenum, 141 nitrogen requirements, 68–9; oral neurogenic tumors, 255 refeeding, 70; plasma proteins, 66; neuroleptic agents, 275t subjective global assessment (SGA), 66, neuromuscular disease, 7 69t; total parenteral nutrition (TPN), 70, neurotensin, 190t 73; tube feeding, 70; , 66 neurotransmitters, 93–4, 188, 190, 230, 358, nutritional , 23 625 , 113 , 304 nevirapine, 291 obesity: and alcoholic liver disease, 568; and , 57t, 203t–5t cholecystitis, 463; and cholelithiasis, 464t; nicotine, 525t and cholesterol, 463; GERD, 109–10; liver night blindness, 58t, 203t, 205t disease, 55t, 517, 551t, 561, 568, 574, night sweats, 292, 296, 303 576; nutrition, 70; causing pancreatic , 109, 695 cancer, 444t nitrates, 109, 121–2, 124, 133 obstipation. see constipation nitrites, 287 obstruction. see also pseudo-obstruction; nitrofurantoin, 566 arterial, 271; biliary, 28, 193, 465, 470–4, nitrogen, 68–9, 71 597, 688t, 723, 730, 734; bowel, 28, 255; nitroglycerin, 134 causes, 376–7, 690; cholecystitis, 470–1; nitrosamines, 444 clinical features, 24–5, 31, 39, 44; colonic, nodular regenerative hyperplasia, 645 14, 25, 59, 63, 70, 374–7; and nongangrenous ischemic bowel disease: constipation, 16, 374, 385; and cystic causes, 276–9; colitis, 279–87; etiology, fibrosis, 455t, 456, 721–2; and diarrhea, 276–9; focal segmental ischemia, 279 374–5; and distension, 231; esophageal, nongangrenous ischemic colitis: clinical 95, 114, 131, 134; gallstone ileus, 472; presentation, 279–86; figures, 281f–5f; gastric, 688t; hepatic, 660; intestinal, 392, pathogenesis, 279; treatment, 286–7, 684, 686, 689, 700t, 719, 721, 728t, 729; 286–7 causing ischemia, 276t; and jaundice, 31, nongranulomatous ulcerative jejunoileitis, 32f; lymphatic, 47; pancreatic, 418, 420, 320t 429–30, 432; post-ampullary, 688t; norepinephrine, 190, 192 sinusoid, 660; small bowel, 317–18; small nortriptyline, 382t, 523t intestine, 375 Norwalk virus, 213t, 218–19 occlusion, mesenteric. see ischemia EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 852

852 INDEX

occult bleeding, 34 478; cholecystoses, 479; cholelithiasis, , 152, 250, 252, 294t, 298–9, 442, 428, 463, 465, 474; chronic abdomen, 607, 632, 649 28–30; cirrhotic ascites, 614; colitis, 280; : about, 6, 95; with esophageal colon cancer, 25, 365t; constipation, 17, neoplasms, 128; in esophagitis, 113, 116; 385, 700t; Crohn’s disease, 314, 315t, 317, in GERD, 107; HIV-associated, 295, 339, 342t; cystic fibrosis, 454, 456; and 300–1 diagnosis, 3; and diarrhea, 214–19 passim, ofloxacin, 621 221, 224, 234; diverticular disease, 28, Ogilvie’s syndrome, 375–6 373; fatty liver, 569, 576; gallbladder OKT3, 639, 641 cancer, 480; gastric volvulus, 172; GI oligomeric formulas, 71 bleeding, 410; graft-versus-host disease, oligopeptides, 199–200 150; hepatitis, 531; HIV-associated, 291, oligosaccharides, 71, 195, 198–9 297; hookworms, 393; inflammatory bowel , 629 disease, 38, 40, 64t; irritable bowel , 350 syndrome, 29, 377–80 passim, 382t; : to treat dysphagia, 7; to treat GI ischemia, 28, 253–4, 264–5, 274, 279; bleeding, 167 lactase deficiency, 60–1; liver disease, 503, opaque calculus, 27 652, 655; liver neoplasms, 504, 644, 646; , 17 malassimilation, 207; menstruation, 29; at , 592 night, 28; nonspecific, 258; and NSAIDs, optic neuritis, 392 160; obstruction, 318, 374–6 passim, 721; oral contraception, 253, 275t, 279 pancreatic, 417–18, 432, 434, 437–8, 445, oral refeeding, 70, 717 452, 722; parasites, 393; peritonitis, 621; donation, 636 postprandial, 64t, 266, 437, 441; , 640–1 postsurgical, 485; PUD, 28; renal, 29; ornithin aspartate, 628 Shigella, 388; Strongyloides stercoralis, oropharyngeal incoordination, 117t 299, 393; therapy for, 382t; toxic oropharyngeal inflammation, 117t megacolon, 340; tumors, 255; ulcerative oropharynx, 244, 295, 302 colitis, 331, 334, 339, 342t, 346; vomiting, Osmolite®, 212t 688t, 690; in Whipple’s disease, 250 osteomalacia, 58t, 207–8, 235t, 236 pain, anorectal: anal carcinoma, 303; causes, osteopenia, 206 396–7; Chlamydia, 408; and diarrhea, 212, osteoporosis, 592–3 216; fissures, 400; hemorrhoids, 403; otitis media, 72 herpes, 408; in homosexual men, 303; ovarian cysts, 320t proctalgia fugax, 40–1 ovarian disease, 25 pain, back: and acute abdomen, 25; and overhydration, 73 dysphagia, 95; , 95; owl-eye, 147 pancreatic, 28, 445, 722 oxalate, 206, 243, 319 pain, biliary, 25, 28, 465, 478–9 oxaluria, 206 pain, bone, 204t–5t, 207, 236 oxazepam, 523t pain, chest: achalasia, 122; Boerhaave’s oxidation, 54, 60 syndrome, 134; Candida esophagitis, 113; oxidative , 575, 579 and diverticula, 133; and dysphagia, 95; oxygen bridge, 194–5 esophageal disorders, 5, 96, 113, 115–16, oxygen therapy, 612 119, 121, 123–5; food-bolus obstruction, oxyntic cells, 141 134; with GERD, 107–8; nausea and oxyphenisatin, 566 vomiting, 11; neoplasms, 125, 128; , 121; portal paclitaxel, 171 hypertension, 608; testing, 98–9; trauma, pain, abdominal: abdominal mass, 38; acute 134; and vomiting, 11 abdomen, 24–5; arterial occlusion, 266; pain, epigastric, 8, 10, 28, 146–7, 445 ascites, 614; biliary, 463, 465–6, 467t, 481; pain, , 204t celiac disease, 235t, 236, 241; cholangitis, pain, kidney stones, 11 483–4; cholecystitis, 305, 470–2 passim, pain, muscle, 204t EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 853

INDEX 853

pain, on . see odynophagia ischemia, 275t; and malassimilation, 207; pain proneness, 30 and , 418; pathogenesis, pain, somatic, 24 428–33; and portal vein thrombosis, 433t, pain, visceral, 24, 466 661; treatment, 436–7, 441–3 palliation: gastric cancer, 170; esophageal pancreatoduodenal resection, 449 neoplasms, 7, 127, 130; , pancreatojejunostomy, 442 480; for pancreatic carcinoma, 449 pancreolauryl test, 426 pallor: celiac disease, 235; children, 714t; pancreozymin, 421f cholelithiasis, 466; GI bleeding, 35; iron pancytopenia, 57t deficiency, 207; malassimilation, 203t pantothenic acid, 57t palmar erythema, 31, 502t, 566, 570–1, 651 papaverine, 271–2, 287 palpation: abdomen, 25–6, 44; abdominal para-aminobenzoic acid, 426 mass, 38, 375; for ascites, 47; liver, 45; , 33, 615t, 618 pelvic organs, 40; rectal, 400; , 46 paralyzed intestines, 16 pancreas: abdominal mass, 39; anatomy, paraparesis, spastic, 624 417–18; carcinoma, 443–50; diabetes, 424, parasites: causing achalasia, 122; in biliary 426–7, 437, 444t, 445–6, 450–1; fetal tract, 465, 591; in children, 706t; causing development, 452f; function tests, 423–8; cholangitis, 483; and cholelithiasis, 465; islet cell tumors, 450–1; and jaundice, 31; and cholestasis, 591; in colon, 331, 391–4; malnutrition, 56–9; neoplasms, 427t, causing diarrhea, 21t, 22, 213t, 233t; 450–1; physiology, 419–23; role in enteritis, 219–22; gastritis, 150; GI tract, digestion, 180; secretion, 423; therapy for, 148t, 150–1, 292; HIV-associated, 292, 208t 294t, 297–9, 297–300; malassimilation, pancreas divisum, 452 208; causing neoplasms, 486; causing Pancrease®, 211t, 442 pancreatitis, 429 pancreatic resection, 201t parasthesia, 205t , 449 parenteral nutrition, 59. see total parenteral pancreatic atrophy, 423 nutrition (TPN) pancreatic calcification, 27, 423 , 23, 204t, 207, 329 pancreatic carcinoma, 201t Parkinson’s disease, 17, 117t pancreatic cholera, 19, 451 , 294t, 298 pancreatic insufficiency: and celiac disease, parotid enlargement: in cirrhosis, 571; in 241; children, 718, 723–4; cystic fibrosis, liver disease, 502t; in malassimilation, 455–7, 718–22; diagnosis, 423; causing 203t diarrhea, 226t; dietary therapy, 71, 211t; partial thromboplastin time, 36 malabsorption, 193, 198, 244; parvovirus, 213t malassimilation, 201t, 207–8; Paterson-Kelly (Plummer-Vinson) syndrome, management, 723–4; tests, 423–8; vitamin 7, 131, 207 deficiency syndromes, 57t pathophysiologic defects, 153t , 423 patient autonomy, 85 pancreatic replacement therapy, 442, 443t, patient rights, 79 455t, 457–8 patient–doctor relationship, 30, 290 pancreatitis: acute, 431t, 432–7; and acute pectin, 195 abdomen, 26; alcohol-induced, 420; , 583t causes, 420, 429t; and choledocholithiasis, , 57t, 250 473–4; chronic, 437–43; and chronic pelvic floor dyssynergia, 388 abdomen, 28, 201t; clinical features, 28, pelvic inflammatory disease, 25, 29, 320t 432, 437–738; complications, 433–4, , 114 438–9; cystic fibrosis, 456, 722; diagnosis, , 114 434–5, 440–1; causing diarrhea, 21t; penicillamine, 57t, 341t, 484, 586 dietary therapy, 73, 77; drug-induced, 327; penicillin, 390 and enzyme secretion, 420; evaluation of, pentamidine, 305, 429t 434–5, 440; gallstone, 466, 477; HIV- Pentasa®, 327, 349–50 associated, 305; interstitial, 430; causing pentaspan, 618 EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 854

854 INDEX

pentazocine, 523t peritoneal metastases, 47 pentoxifylline, 573 peritonitis: abdominal pain, 24–6; bile, 481; : and celiac disease, 234; in digestion, cholecystitis, 472; in Crohn’s disease, 318; 145; in gastric juice, 109, 143; and GERD, with ischemia, 264–5, 269, 270f, 279, 285; 109; hydrolysis, 199; and PUD, 155; role spontaneous bacterial, 620–3, 627 in PUD, 155; secretion of, 141, 143, 199 peroral dilation, 110, 127, 130, 133 pepsinogen, 141, 144–5, 199 personality changes, 624 pepsinogenemia, 160 perspiration, 9, 35 peptic stricture, 110–11 petechiae, 203t (PUD): bleeding, 34t, 36, pets, 22 157, 165; causes, 155; children, 681, 684; Peyer’s patches, 307–8 and chronic abdomen, 28; and cirrhosis, pH monitoring, 99, 100f, 108, 110, 123–4 160; classification of, 166; diagnosis, 4; pharmaceutical industry. see also clinical and GI bleeding, 36–7, 409; and H. pylori, trials 149, 155–9, 162–4; heredity, 159–60; pharyngeal constrictor muscles, inferior, 88 causing irritable bowel syndrome, 378; pharyngeal irritation, 72 lesions, 153; NSAIDs, 28, 155; pain, 28; phencyclidine (PCP), 519t pathophysiologic defects in, 153t; , 529, 655 pathophysiology of, 153–60; proton pump phenolphthalein, 226t, 232 inhibitors, 164; role of pepsin, 155; phenothiazines, 12, 231, 582, 584 treatment, 164; and vomiting, 11 phenylalanine, 65t peptidases, 200, 792, 798 phenylephrine, 252 peptide elongation, 784–5 phenylketonuria, 706t peptide YY, 423 phenytoin, 525, 525t, 582 peptides, 71, 144, 200, 230, 234, 419, 450. phlebotomy, 65t see also specific types phlegmon, 434 Pepto-Bismol®, 218t phosphate, inorganic, 265 percussion: abdomen, 26, 44; for ascites, 47; phospholipases, 192, 430, 471 liver, 45–6; spleen, 46 phospholipids, 53, 192 perforation: colon, 221, 344t, 391; phosphorus, 77, 204t, 208, 321 esophagus, 134; free, 316t, 318; photodynamic therapy, 127, 130 gallbladder, 471–2, 475; and lymphoma, photophobia, 203t, 319, 348 255; and NSAIDs, 160; of , 402; phototherapy, 729 small intestine, 216, 241, 249; stomach, physiotherapy, 454 165; walled-off, 316t phytates, 65t perianal disease, 41, 292, 303, 315, 316t, phytobezoars, 173 339–40, 410t, 413t phytonadione. see vitamin K1 perianal mass, 398–9 pica, 207 perianal warts, 407 pigment stones: composition, 460, 464–5; , 547, 602t formation, 55t pericholangitis, 316t, 344t, 346, 484 pigmentation: and cholestasis, 595; in celiac perifollicular hemorrhages, 205t disease, 235t; and jaundice, 30; in liver perifollicular papules, 205t disease, 588; in malassimilation, 203t; and perifollicular petechiae, 203t malnutrition, 23 Peripheral Arterial Hypothesis, pill-induced esophagitis, 95 613 pilonidal disease, 406–7 peripheral edema, 23 pinaverium bromide, 382t peripheral neuritis, 235t pinworm, 393, 399 peripheral neuropathies, 23, 57t, 329 , 161 peristalsis: contractions, 93f; control plaques: colonic, 390; esophageal, 113–14, mechanisms, 91–4; and GERD, 106; 295–6; gastric, 147; intestinal, 205t, 224, hypertensive, 118f; postsurgical, 102; 272 primary, 90, 92f; secondary, 91 Plummer-Vinson syndrome. see Paterson- peritoneal irritation, 253 Kelly (Plummer-Vinson) syndrome EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 855

INDEX 855

pneumatic balloon dilation, 122 and hyperamylasemia, 428, 434; and liver Pneumocystis carinii, 291, 299 disease, 583, 651–7; termination, 657t; , 26, 72, 97 vitamin deficiency syndromes, 57t; and polidocanol, 608 vomiting, 11 polyarteritis, 430t, 554 presyncope, 35, 165 polyarteritis nodosa, 554 , 382t, 575, 628 , 253, 274, 275t, 276, 287, procainamide, 225 659 procidentia, 398, 400 polyethylene glycol solution, 19, 722 procollagenase, 430 polyglutamates, 178–9 proctalgia fugax, 40–1, 397 polymeric formulas, 71, 77 proctitis: and bleeding, 337, 413t; clinical polymyositis, 117t, 520 features, 407–8; and constipation, 17t, 18, polypectomy, 35t 212, 386; in homosexual men, 292; polyps: adenomatous, 366–8, 367f; colonic, radiation, 412; tenesmus, 397; treatment, 366–8; and constipation, 18; fibrovascular, 349, 351, 408 126; gallbladder, 4789; gastric, 173; proctocolectomy, 353, 368, 484 hyperplastic gastric, 152 , 399 , 473, 480 proctosigmoiditis, 335, 351 cutanea tarda, 559 proctosigmoidoscopy, 342t, 386–7, 401 Portagen®, 212t proelastase, 430 portal hypertension: about, 601; in alcoholic proenzymes, 199, 430 liver disease, 570–2 passim; and ascites, Prograf®, 639 33; bile duct disease, 481–2; and cirrhosis, prokaryote cells, 789 592; cirrhotic cardiomyopathy, 610–11; prokinetic agents, 108, 382t complications, 604–6; diagnosis, 606–7; prolamins, 61 etiology and pathophysiology, 602–6; and prolapse: rectal, 316t, 344t, 384, 398, 403, gastritis, 151, 606t; and GI bleeding, 34; 455t, 721; uterine, 384 and hepatitis, 566; causing ischemia, 274, proliferative glomerulonephritis, 559 275t; in liver disease, 502t, 504; proline, 200, 789 management, 607–10 propionate, 362 portal venous stasis, 274 propionic acid, 199, 245 portopulmonary hypertension, 612 propranolol, 523t postcholecystectomy syndrome, 479, 485 proprioception, 207 posterior column degeneration, 58t propylthiouracil, 573 postvagotomy, 144t propythiouracil, 582 potassium. see also H+/K+-ATPase; prostaglandins: and carcinoid syndrome, 250; absorption, 360; depletion, 237, 348, 366, and cholecystitis, 471; causing diarrhea, 451; causing diarrhea, 213t; causing 226t, 230; gastric role, 74; GI protection, esophagitis, 116; causing gastropathy, 151; 161; inhibitors, 231; and intestinal inflammatory bowel disease, 64t; secretion, 190t, 231; to treat pancreatitis, replacement, 77, 213t; secretion, 360 436; production, 144 potassium chloride, 116, 151 protease inhibitors, 525t, 585 , 353 proteases, 199, 442 pre-albumin, 67 protein: absorption, 199–202; amylase, 195; preaortic plexus, 396 and cystic fibrosis, 718, 721; deficiency, Precision Isotonic Diet®, 212t 203t–4t; in digestion, 50, 51f, 192, 230; in Precision LR Diet®, 212t DNA replication, 756t; glycosylation, preclinical studies, 80–1 799–801, 802f; heat-labile, 230; , 327, 343, 351, 593 malabsorption, 721; malassimilation, pre-eclampsia, 654, 656–7 203–4t, 206; plasma, 66; post-translational pregnancy. see also childbirth; biliary processing, 787–9, 787–9; processing in complications, 463, 464t, 477; and E. endoplasmic reticulum, 795; replacement, histolytica, 391; ectopic, 25, 320t; false, 212t; restriction, 63; sorting and transport 16; and GERD, 107; and hepatitis, 542; from Golgi apparatus, 801–6; synthesis, EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 856

856 INDEX

740, 782–7; targeting, 790–5; transport Pustow operation, 442 from endoplasmic reticulum, 795–9; pyelography, 27, 40 vesicular transport, 803–6 pyelonephritis, 25 protein-energy malnutrition, 54t, 55–9, pyloric sphincter, 144t 203t–4t, 437, 701–3 pyloric stenosis, 172 protein-losing enteropathy, 23, 55, 64t, 68, , 173 248–9, 302, 315t pyloroplasty, 144t proteinuria, 249 , 71, 244 proteolysis, 52f, 56 pyoderma gangrenosum, 316t, 319, 335, Proteus, 621t 345t, 347–8 prothrombin, 494 pyrazinamide, 293t prothrombin time (PT) test, 64, 208, 507, pyridoxine. see vitamin B6 572, 599, 601t pyridoxine-antagonist drugs, 57t proton pump antagonists. see proton pump pyrimethamine, 294t inhibitors pyrosis. see heartburn proton pump inhibitors, 7, 37, 109, 167, 695 proton pump mechanism, 150 Questran®, 224 protozoa, 219 quinacrine, 31, 220, 297 pruritus: anorectal, 399; in bile duct disease, quinacrine hydrocloride, 294t 484; children, 732, 735; and cirrhosis, 592; , 213t, 225, 523t in gallbladder cancer, 480; and hookworms, 393; and jaundice, 31; in liver RAD, 640 disease, 501, 502t, 529, 583, 592; and radiation colitis, 413t neoplasms, 486; and pancreatic diseases, radiation injury, 275t, 277f 445; and pinworm, 393; in pregnancy, , 100, 106t, 510, 734 655–6; with Strongyloides stercoralis, 299 radiotherapy: anal carcinoma, 303; pseudocyesis, 16 complications, 95, 116; esophageal pseudocyst, pancreatic, 434, 438, 439f–40f neoplasms, 7, 127, 130; for gastric cancer, pseudodiverticulum, 372 171; and GI bleeding, 35t, 412; liver pseudolymphoma, 173 neoplasms, 648; pancreatic cancer, 449 pseudolymphoma, gastric, 173 Ramstedt’s procedure, 173 pseudomembranous colitis, 20, 223–4, 284, , 443, 724 320t, 390 Ranson’s criteria, 431t, 432 Pseudomonas species, 718 RAP (recurrent abdominal pain). see pain, pseudo-obstruction, 201t, 245t, 252 abdominal, children pseudopolyps, 344t Rapamune®, 640 psoriasis, 399 rapamycin, 640, 643 psychological trauma, 10. see also stress rash: and carcinoid syndrome, 250; with psychosis, in celiac disease, 235t hepatitis, 547; in parasitic infection, 299, psychosocial factors: childhood RAP, 26; and 393; vesicular, 652 diagnosis, 3–4; growth failure, 706t, 707; Raynaud’s phenomenon, 95, 122, 592 and HIV-infected patients, 306; liver recombinant DNA technology, role, 738–41 transplantation, 635t recombinant factor VII, 167 psyllium, 211t, 385, 404 , 165 pteroylglutamates, 178 rectal prolapse, 384 pteroylglutamic acid. see folic acid rectum: anatomy, 358; bleeding, 314, 315t, puborectalis muscles, 17, 40, 381, 395, 697 318, 332–4, 342t, 365t, 380, 397–8, 403; PUD. see peptic ulcer disease (PUD) neoplasms, 303, 398–9, 403; perforation, pulmonary infections, 101 402; prolapse, 316t, 344t, 384, 398, 403, purgatives, 389 455t, 721; trauma, 382 : and celiac disease, 235t; in reflexes, 204t gastroenteritis, 217; causing pancreatitis, reflux, gastroesophageal. see GERD 430t; skin, 205t; vitamin deficiency, 58t reflux ileitis, 337, 338f pus in stool, 18, 20, 211, 231 refractory sprue, 241 EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 857

INDEX 857

regurgitation. see also GERD; vomiting; ribosomal RNA: role, 742; transcription, about, 5–6; achalasia, 122; in esophageal 739–40; translation, 740 disorders, 95–6; nasal, 95; in Zenker’s ribosomes, 483f, 742 diverticulum, 131 rickets, 205t, 206–7 rehydration therapy: cholecystitis, 472; rifabutin, 293t, 295 diarrhea, 225, 714t, 716; gastroenteritis, rifampicine, 523t 214; nausea, 11; oral, 716 rifampin, 293t, 592, 655 renal calculi, 348 rigidity, 624 renal colic, 29 rings, esophageal, 130–1 renal disease, 206, 317t ritonavir, 291 renal failure: after liver transplantation, 638, RNA. see ribonucleic acid (RNA) 640–1; children, 715; chronic, 12, 144t, Rome II criteria, 377 160; and hepatorenal syndrome, 629, 631; rotavirus, 213t, 218–19, 711 with ischemia, 253; in liver disease, 502t, Rotor’s syndrome, 528t, 530 540, 544, 552, 586, 600, 617, 627, 635; roundworms, 219, 392 nutritional intervention, 73; and Roux-en-Y anastomosis, 482 pancreatitis, 429t, 434 rRNA. see ribosomal RNA renal function disturbances, 327 rubber-band ligation, 404 renal insufficiency, 427t rumination, 96 renal stones, 25, 206 rupture, gastric, 172 renin-angiotensin system, 263 reovirus, 213t sacroiliitis: Crohn’s disease, 319; reperfusion injury, 264 inflammatory bowel disease, 316t, 347 research: clinical trials, 81–2; Declaration of s-adenosylmethionine, 655 Helsinki, 79, 86; ethical concerns, 79, 85; Salazopyrin®, 349 methodology, 82–3; monitoring, 85; salicylates, 429t preclinical studies, 80–1; regulations, Salmonella, 320t; causes, 389; causing 79–80 diarrhea, 213, 216–18, 712; HIV- resection: bowel, 271, 273–4; colon, 374; associated, 292, 293t; treatment, 389–90; gastric, 149, 152; hepatic, 491, 574, 644, with ulcerative colitis, 336, 341t 647–8; ileal, 201t, 243; , 217 pancreatoduodenal, 449; small intestine, Salofalk®, 349–50 144t, 242–3, 254, 317 Sandifer’s syndrome, 694t respiratory failure, 434 saquinavir, 291 resuscitation, of ischemic patient, 269, 270f sarcoidosis, 148t, 151, 602t , 5, 97, 134 satiety center, 12 reticulin, 237 scalene node biopsy, 130 reverse transcriptase inhibitors, 291 Schatzki’s ring, 7, 131, 134 rheumatoid arthritis, 275t, 347, 591–2, 645 Schilling test, 245, 248, 321, 426 , allergic, 114 schistosomiasis, 341t, 602t ribavirin, 304, 540, 562t–3t, 564, 565t , 451, 466, 468, 470, 472, 474 riboflavin. see vitamin B2 scleral icterus, 31, 527 ribonucleases, 420 scleral injection, 319 ribonucleic acid (RNA): classification, 741; scleroderma: causing bacterial overgrowth degradation, 777–8, 779f; and DNA syndrome, 245t; causing diarrhea, 226; mutations, 759–64; in DNA replication, esophageal, 95, 97, 119, 122–3; and 740, 755–9; editing, 776, 778f; post- GERD, 108; and malassimilation, 201t; transcription processing, 764–80; parenteral nutrition, 76 processing, 772–4; promoter selection, sclerosing cholangitis, 64, 335–6, 344t, 346, 778–80; and protein synthesis, 740, 782–7; 483–5, 593f, 594, 597, 598t splicing mechanisms, 774–6; structure, sclerosis, 484, 572, 602t 741; as template for DNA, 740; sclerotherapy, 608 transcription, 739–40, 743; translation, scorpion , 430t 740, 747, 760t, 774, 782–7 scratch test, 45 EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 858

858 INDEX

scurvy, 58t pseudomembranous colitis, 224 seborrhea, 203t, 205t shock liver, 506 secondary , 586 short bowel syndrome, 71, 76–7, 194, 198, secretagogues, 226t, 231 242–3, 706t , 144–5, 419 short-chain fatty acids, 195, 197, 228, 245, secretion: basal, 423; in colon, 360; of 324, 625 enzymes, 419–21; gastric, 143–5; in Shwachman syndrome, 706t pancreas, 418–19, ; postprandial, 423; sicca syndrome, 591–2 regulation of, 423; rotavirus-induced, 712; sickle cell disease, 275t, 276, 389–90 in small intestine, 230–1 , 18, 22, 224, 297, 300, 321, seizures, 207, 216, 624 337, 380, 386, 404 , 56, 579 simethicone, 382t senecio alkaloids, 55t Simulect®, 640 Sengstaken-Blakemore tube, 607 sinus tract formation, 113 senna, 19, 232 sinusitis, 72 , 75, 77, 274, 275t, 276, 474, 477, 641 sinusoidal lining, liver, 493 Septata intestinalis, 298 sitophobia, 64t , 190t, 231, 292t, 358 skin: atopy, 114; with carbohydrate serotonin antagonists, 250, 525t malassimilation, 203t; carcinoid syndrome, serum biochemical tests, 27 250; and dysphagia, 95; with inflammatory serum immunologic tests, 507–11 bowel disease, 316t; telangiectasia, 165; sex factors: Caroli’s disease, 480; with ulcerative colitis, 347; vitamin cholelithiasis, 464t; , 369; deficiencies, 205t; xanthoma, 482 Condylomata acuminata, 407; constipation, skin tags, 398, 402, 405 385; Crohn’s disease, 311t; esophageal sleep disturbances, 107, 225, 380, 624, 683 cancer, 127–8; fecal incontinence, 374, small bowel disease, 20, 317–18 383; Gilbert’s syndrome, 527; small for gestational age, 704 hemochromatosis, 588; hepatitis B, 558; small intestine: absorption of carbohydrates, hepatosplenomegaly, 723; 194–9; absorption of electrolytes, 185–92; hyperbilirubinemia, 527; inflammatory absorption of fat, 192–4; absorption of bowel disease, 311t; irritable bowel protein, 199–202; absorption of vitamins syndrome, 379; liver disease, 531, 556, and minerals, 178–83; absorption of water, 559t, 562, 566–7, 571, 588, 655; liver 183–5; absorption principles, 178; neoplasms, 644, 646; nutrition, 69; anatomy, 175–7; bacterial overgrowth, pancreatic cancer, 443; pancreatitis, 437; 246–8; , 238–40; disaccharidase pelvic floor dyssynergia, 388; pilonidal deficiencies, 232–4; flora, 244–6; disease, 407; proctalgia fugax, 40; PUD, idiopathic pseudo-obstruction, 252; 163; pyloric stenosis, 172; rectal prolapse, malassimilation, 202–9; Meckel’s 398; sclerosing cholangitis, 483; ulcerative diverticulum, 249–50; motility, 177–8, colitis, 311t, 334 228; neoplasms, 250, 255; protein-losing, sexual activity, 290, 535t, 551t, 558, 565, 248–9; Whipple’s disease, 250 599 small nuclear RNA, 743 sexual orientation, 290. see also small vessel disease, 275t; 277f heterosexuality small-cell carcinoma, esophageal, 126t sexually transmitted disease (STD), 399, smoking: gastric cancer, 168; NSAIDs, 160t; 407–8. see also HIV pancreatic cancer, 444; PUD, 155, 163 , 33 snRNA. see small nuclear RNA : causes, 388; causing socioeconomic status, 128 diarrhea, 213t, 215, 218, 712; sodium: absorption, 186, 187f–8f, 197; and gastroenteritis, 215; and HIV, 292, 293t; protein absorption, 201–2; reabsorption, treatment, 388–9; with ulcerative colitis, 617; restriction, 63 336, 341t sodium bicarbonate, 172 shock: in GI bleeding, 409; with ischemia, sodium citrate, 227t 265; and pancreatitis, 432, 434; sodium phosphate, 227t EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 859

INDEX 859

sodium pump, 185, 187, 197, 360 bacterial overgrowth, 246, 248; biliary sodium sulfate, 227t atresia, 482; and celiac disease, 236–7; soiling, 352, 386–7, 696–7, 700 clinical features, 424; with Crohn’s : to treat diarrhea, 231; in disease, 315t, 323; cystic fibrosis, 454, digestion, 145; electrolyte secretion 456; and diarrhea, 226, 228, 231, 321; effects, 190, 192; to treat islet cell tumors, dietary therapy, 59–60; and 451; and pancreatic diseases, 423; to treat malassimilation, 209; and malnutrition, pancreatitis, 442; to treat portal 22–3; and pancreatitis, 424–5, 437, 441–2; hypertension, 607 and parasitic enteritis, 219; and short , 451 bowel syndrome, 243 sorbitol, 19, 21t, 225, 227t, 701, 702t steatosis, 55t, 457, 509, 569, 571, 575–8 speech pathologists, 118 passim, 654, 656 dysfunction, 479 stenosis: and enteral nutrition, 72; sphincteroplasty, 151, 452 esophageal, 103; papillary, 304; pyloric, sphincterotomy: AIDS cholangiopathy, 304; 172 for anal fissures, 406; for stents, 127, 130, 133, 442, 475, 486, 573 choledocholithiasis, 475–6; and fecal sterculia, 385 incontinence, 384; for pancreas divisum, steroids, 64t, 114, 391, 394–5, 429t, 573, 655 452; for pancreatitis, 435; for stomach: abdominal mass, 39; anatomy, postcholecystectomy syndrome, 479 138–41; function, 143–5; gastritis, 145–53, spider angiomata, 651 145–53; hemorrhage, 164–8; motility, spider nevi: in alcoholic liver disease, 570–1; 142–3; neoplasms, 168–71; physiology, in hepatitis, 566; in jaundice, 31; in liver 142–5; postgastrectomy problems, 244; disease, 502t PUD, 153–60, 162–4; role in digestion, spider telangiectasia, 624 180 spinal cord degeneration, 207, 235t : angular, 58t, 203t, 207; with spinal cord lesion, 217t carbohydrate malassimilation, 203t; and spiramycin, 222, 298 islet cell tumors, 450; with ulcerative spironolactone, 33, 188, 617 colitis, 335 splanchnic circulation, 260–5, 630 stool: blood in, 18, 20, 33, 35–6, 165, 211, spleen: and ascites, 33; enlarged. see 216–17, 231, 285, 333, 336, 366, 386, 390, hepatosplenomegaly; ; 683, 713, 715; changes in, 377; color, examination of, 46–7 35–6, 503, 732; consistency, 16, 19, 211, splenomegaly: and alcoholic liver disease, 377, 697, 713; fatty acids. see steatorrhea; 571; in cirrhosis, 600; investigating, 38; in frequency, 16, 19–20, 35, 209, 212, 218, liver disease, 543; and portal hypertension, 224, 333, 342, 378–9, 384–5, 696; with 602t, 606; and portal vein thrombosis, 661 malassimilation, 204; mucus in, 377–9, spondylitis, 319, 335, 347 399; pus in, 18, 20, 211, 231; straining at, spontaneous bacterial peritonitis, 615t, 16, 378, 397, 402–4 passim, 696; volume 620–3, 627 of, 19–20, 185, 209, 211–12, 216, 228, sprue: celiac. see celiac disease; collagenous, 231, 333, 717 201t, 241, 242f; refractory, 241; tropical, straining at stool, 16, 378, 397, 402–4 198, 201t, 239, 241 passim, 696 squamous cell carcinoma, esophageal, 115, strawberry gallbladder, 478 125–8, Streptococcus species, 244 squamous cell papilloma, esophageal, 125 streptokinase, 271–2, 287 Standard Vivonex®, 212t , 293t Staphylococcus aureus, 213–14 streptozocine, 450 staphylococcus aureus, 341t stress. see also psychological trauma; and starch, 50, 194–5, 198 gastritis, 151; globus, 4; heartburn, 6; RAP, starvation, 54, 57t 682, 685; vomiting, 690 STD. see sexually transmitted disease (STD) stress erosions, 34 . see fatty liver stress hormones, 53 steatorrhea. see also fat; malabsorption; and strictures: and bacterial overgrowth EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 860

860 INDEX

syndrome, 245t; biliary, 346, 439, 485; tumors, 450; liver neoplasms, 648; liver colonic, 344t, 346; with Crohn’s disease, transplant. see liver transplantation; 322, 342t, 373, 376; causing diarrhea, Mallory-Weiss tear, 134; meconium ileus, 226t; esophageal, 105, 113–14, 116; 456; pancreatic, 208t, 442, 449, 452; fibrous, 316t; with ischemic colitis, 287; peritonitis, 269; pilonidal disease, 407; postischemic, 376; postsurgical, 376; small polyps, 368; for portal hypertension, 608; intestine, 201t, 222, 279f; with ulcerative post-radical neck, 117t; small bowel colitis, 342t obstruction, 317; ulcerative colitis, 343, stricturoplasty, 287 345, 352–3 stridor, 115 swallowing: difficulty. see dysphagia; pain. string sign, 310f see odynophagia , 26 sweat clorides, 457 Strongyloides stercoralis, 213t, 299, 393–4 sympathectomy, 192 subacute bowel obstruction, 28 sympathetic afferents, 11f subacute combined degeneration, 57t syncope, 35 subjective global assessment (SGA), 68, 69t synechiae, 348 substance P, 145, 190t , 347 substrates, 49, 53, 525 syphilis, 149–50, 292, 303, 341t, 405, 407–8 , 246 systemic mastocytosis, 160 succussion splash, 72 systemis sclerosis, 17 sucrase-isomaltase, 196 sucrose: absorption, 194; deficiencies, 232; tabes dorsalis, 117t dietary therapy, 65t : and acute abdomen, 26; and sugars, 189, 195, 197, 238, 246, 357, 362–3, alcoholic liver disease, 570; cholecystitis, 711, 717, 801 472; with cirrhotic ascites, 614; and GI : digestion, 246; to treat bleeding, 36; and pancreatitis, 432; with inflammatory bowel disease, 349 toxic megacolon, 340, 345t; and ulcerative , 64t, 245, 325t, 347, 349 colitis, 333; with vomiting, 9 , 246 tachypnea, 26 sulfonamides, 305, 329, 429t, 582 tacrolimus, 525t, 639, 641 supraclavicular lymphadenopathy, 97, 128 tamoxifen, 576 suprahyoid muscles, 91 tannins, 65t surgery: abdominal aneurysm, 26; acute tapeworms, 219 abdomen, 24, 26; AIDS cholangiopathy, tattoos, 551t, 599 304; anal fissures, 406; antireflux, 14, taurine, 245, 457 109–12, 122; Barrett’s esophagus, 112; tegaserod, 19, 382t bile duct disease, 480, 482–3, 486; biliary telangiectasia, 624 atresia, 731; gastric cancer, 170–1; telomeres, 747, 758–9 cholecystectomy, 469; cholecystitis, 472; tenesmus: and diarrhea, 211, 232, 388; with choledochal cysts, 481; cholelithiasis, 389, lesions, 397; with prolapse, 398; with 473; chronic abdomen, 30; colon cancer, ulcerative colitis, 351 364, 366; colonic obstruction, 375, 377; terlipressin, 607 Crohn’s disease, 330–1; cystic fibrosis, testicular atrophy, 502t 456–7, 719; diverticula, 131, 133; testosterone, 573 dysphagia, 123; esophageal fistulas, 102; tetany: and celiac disease, 235t, 236; and esophageal neoplasms, 7, 125, 127, 130; malabsorption, 207; and malassimilation, esophageal trauma, 134; fecal 204t incontinence, 384; gallbladder neoplasms, : to treat bacterial overgrowth, 480; gastric, 151, 153, 167, 173; GERD, 248; to treat Crohn’s disease, 329; to treat 108–9, 111–12, 695; GI bleeding, 167; HIV-related infections, 293t; to treat hemorrhoids, 403; hiatus hernia, 103; infection, 392; causing pancreatitis, 429t; Hirschsprung’s disease, 387; intestinal to treat STDs, 408 bypass, 551t; ischemia, 253–4, 266, 271–3 thalassemia, 589 passim; ischemic colitis, 286–7; islet cell the flux. see diarrhea EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 861

INDEX 861

thenar mass reduction, 206 factors, 767–9 , 525t transection, esophageal, 91 Therapeutic Product Division, Health transfer RNA: role of, 742, 782; Canada, 81 transcription, 739, 772; translation, 740 thiabendazole, 299, 394 transjugular intrahepatic portosystemic . see vitamin B1 (TIPS) shunt, 573–4, 608, 620, 629, 632, thiazolidinediones, 579 660–1 thoracic rosary, 203t translation: defined, 747; process, 782–7; 3TC, 291, 304. see also lamivudine regulation, 787 , 304, 502t, 504, 547, 572 transplantation: bone marrow, 115; ethics, thrombocytosis, 317t, 321, 344t, 347, 659 574; indications, 601; kidney, 640; liver. thromboembolic disease, 344t see liver transplantation thrombolytic therapy, 271–2, 660 Traube’s space, 46 , 653 trauma: acalculous cholecystitis, 477; anal, thrombophlebitis, 445 303; anorectal, 382; esophageal, 133–4; thrombosis: with catheter embolization, 75; gastric, 148t; neurological, 160; rectal, of hemorrhoids, 403; hepatic, 626t, 638, 292; small bowel, 243; surgical, 384 641, 659; inferior vena cava, 659; and Travasol®, 212t ischemia, 274; mesenteric, 243, 252, 274, Travasorb STD®, 212t 347, 433; and pancreatitis, 433t, 434; travel: diarrhea risk, 20, 218, 713, 715; perianal, 397, 403; portal, 464, 602t, 604, hepatitis risk, 533, 535, 542; Shigella risk, 626t, 661; postsurgical, 640–1; splenic, 388 602t; superior vena cava, 619; treatment, travel history, 399 254; of varix lumen, 608; venous, 254 traveler’s diarrhea, 20, 218 thrush, oral, 113 trehalose, 232 thymine, in gene sequences, 741 trematodes, 219 thymoglobulin, 639 Treponema pallidum, 408 thyrocalcitonin, 190t trichloroethylene, 519t disease, 231 trichobezoars, 173 thyroiditis, 559, 591 trichuris, 213t TNM staging system, 170, 365 Tri-Council Policy Statement: Ethical Conduct tobacco use. see smoking for Research Involving Humans, 86 Todani classification, 481 tricyclic antidepressants, 125 tolbutamide, 523t, 525t, 527 triglycerides. see also fat; 71, 143, 193; toluene, 519t lipolysis of, 192; malassimilation, 208t; tomography, computed, 509 maldigestion, 23; malnutrition, 55, 60; and tongue, 203t, 207 protein-losing enteropathy, 249; total parenteral nutrition (TPN), 70, 73, 212t, replacement, 212t; role in digestion, 53; 252, 286, 324, 349, 455, 464t, 478, 576 role of liver, 494 toxoplasmosis, 291 trimebutine, 382t TPN. see total parenteral nutrition (TPN) trimethoprim-sulfamethoxazole: to treat tracheoesophageal fistula, 72, 101–3 colonic infection, 389; to treat HIV-related , 167 infections, 293t–4t, 299; to treat peritonitis, trans-acting factors, 767–9 623; to treat Whipple’s disease, 251 transaminases, 129, 505–6. see also tRNA. see transfer RNA aminotransferases trophozoites, 221, 391 transcobalamin II, 182t Trousseau’s sign, 207 transcription: alternative polyadenylation Trypanosoma cruzi, 122 sites, 780; and chromatin structure, 764–5; trypsin, 56, 199, 234, 420, 430 cis-acting elements, 764–7, 769; defined, trypsinogen, 199, 420, 426 747; initiation, 769–71; promoter selection, tryptophan, 245 778–81; regulation, 771; RNA degradation, tube feeding. see enteral nutrition 777–8, 779f; RNA editing, 776, 778f; tuberculosis, 320t, 321 splicing mechanisms, 774–6; trans-acting tubulovesicles, 366, 368 EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 862

862 INDEX

tumors. see neoplasms valacyclovir, 294t, 301 Turcot’s syndrome, 368 valproic acid, 429t tylosis, 126, 128t Valsalva’s maneuver, 252 tympany, 16, 340 vanadium, 56 tyrosine, 65t , 224, 390 tyrosinemia, 65t, 597, 598t vanishing duct syndrome, 584 variceal bleeding, 34, 37, 457, 599–600, UDP-glucuronyl transferase, 527, 529 604–6, 653 UES. see esophageal sphincter, upper variceal dilation, esophagus, 89 ulceration: aphthous, 308, 309f, 316t, 321; of varicella, 429t colon, 391; with Crohn’s disease, 308; , 275t, 276, 287, 320t, 430t, 547, with cytomegalovirus, 300; deep, 105, 112; 591, 645 duodenal, 34, 155, 156f, 158f, 159–60, vasoactive intestinal peptide-secreting 162–4; with Entamoeba histolytica, 221; tumors, 451 esophageal, 114, 116, 295, 301; flask- vasoactive intestinal polypeptide (VIP): shaped, 297; gastric, 34, 152, 155, 162–3; causing diarrhea, 19; and pancreatic with ischemic colitis, 285; mucosal, 134; secretion, 423 and NSAIDs, 160; rectal, 320t, 410t, 413t; vasoconstrictors, 253, 263, 276, 607 in ulcerative colitis, 331 vasopressin, 190t, 263, 607 ulcerative colitis: about, 331; children, 712; vasospasm, 264, 269, 271–2 chronic diarrhea, 21t, 226t; clinical venereal disease. see sexually transmitted features, 332–5; and colon cancer, 369; disease (STD) complications, 340–8, 344–5t; diagnosis, venereal warts, 398 335–9; dietary therapy, 62; manifestations veno-occlusive disease, 602t, 660 of, 316t; pathophysiology, 331–2; rectal verapamil, 275t, 280, 523t bleeding, 380; resembling Crohn’s disease, vibration sense, 23, 204–5, 207 320t, 321; treatment, 348–53 , 19, 213t, 214, 226t, 230, ultrasonography, 508–10 712 ultraviolet light, 592 , 213t, 215, 341t undifferentiated carcinoma, esophageal, 126t videocapsule imaging, 208 United States, drug research, 80 villous atrophy, 60t upchuck. see vomiting vinyl chloride, 585 uracil, in gene sequences, 742, 762–3 Viokase®, 211t urea, 36, 245 VIP. see vasoactive intestinal polypeptide , 11 (VIP) urination, frequent, 379 , 451 urine, color, 474 , 32, 429t, 530–65, 547t, 566t, urobilinogen, 245, 503 597, 598t. see also specific types urokinase, 271–2, 287, 660 virologic response, 562, 564f ursodeoxycholic acid, 457, 469, 484, 579, viruses: causing diarrhea, 213t, 219; causing 593, 655, 723, 735 esophagitis, 113; HIV-associated, 294t, urticaria, 393 300–2; RNA, 747 uterine prolapse, 384 visceral nociception, abnormal, 125 uveitis, 316t, 319, 335, 345t viscus, perforated, 27 vitamin A: to treat cystic fibrosis, 455; vacA gene, 162 deficiency, 58t, 60t, 64, 203t, 205t, 206, vacuolating cytotoxin gene (vacA), 162 235t, 455; causing liver disease, 584; vadodilators, 263, 287 replacement, 210t vagal afferents, 11f vitamin B1 deficiency, 23, 57t, 77, 204t–5t, vagal cholinergic reflex, 5 235t : and cholelithiasis, 464t; vitamin B2 deficiency, 57t, 203t complications, 172; malabsorption, 193 vitamin B6, 235t vagovagal reflex, 97, 106 vitamin B6 deficiency, 23, 57t, 203t, 205t vagus , 89, 143, 359, 417, 423 vitamin B12: absorption, 143, 180–3; and EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 863

INDEX 863

bacteria, 245; and Crohn’s disease, 324; , 58t, 523t, 525, 525t deficiency, 57t, 59, 60t, 182, 204t–5t, warts, anal. see Condylomata acuminata 206–8, 235t, 237, 321; dietary therapy, 62; wasting syndrome, 305–6 malabsorption, 246, 315t; malnutrition, 23, water: absorption, 183–5; contaminated, 22; 56; and pancreatitis, 443; and R factor, in gastric juice, 143; loss in feces, 199, 426; replacement, 210t 211; secretion, 712 vitamin B deficiency, 23, 56 waterbrash: about, 5; in esophageal disorders, vitamin C deficiency, 58t, 203t–5t 96; with GERD, 107; with vomiting, 9 vitamin D: deficiency, 58t, 64, 203t–5t, 235t, weakness: and celiac disease, 235t; and 455; dietary therapy, 62; inflammatory cirrhosis, 599; and GI bleeding, 35; and bowel disease, 64t; malabsorption, 206–7; iron deficiency, 207; with malassimilation, supplements, 592 204, 204t; with pancreatic diseases, 445; vitamin D2, 210t and protein deficiency, 206 vitamin E: deficiency, 58t, 64, 206, 235t; to webs, esophageal, 130–1, 207 treat nonalcoholic liver disease, 579; weight, children, 705–7 replacement, 210t weight loss: and alcoholic liver disease, 570; vitamin K: bacteria, 245; bacterial with carbohydrate malassimilation, 203t, overgrowth syndrome, 247; , 204; and celiac disease, 235t, 236; and 494; deficiency, 58t, 64, 203t, 205t, 206, cholelithiasis, 464t; and cirrhosis, 599; and 235t, 237, 721; dietary therapy, 60; constipation, 18; with Crohn’s disease, inflammatory bowel disease, 64t; in liver 314, 315t, 339; diagnosis, 3; causing disease, 504; supplements, 655 diarrhea, 20, 211; dysphagia, 95; gastritis, vitamin K1, 210t 147; with GERD, 107; with HIV, 291–2, vitamin K3, 210t 296, 303, 305–6; inflammatory bowel vitamine E, 60t disease, 38; with irritable bowel syndrome, vitamins: absorption, 178–83; deficiencies, 380; and ischemia, 274; and liver cancer, 23, 56, 57t, 60t, 570, 720; dietary therapy, 647–8; in liver disease, 501, 502t; and 60, 62 lymphoma, 255; and malassimilation, 207, vitiligo, 591 209; and malnutrition, 23, 66; and VLDL, 53, 55 nonalcoholic liver disease, 576, 578; and volvulus, 28, 172, 243, 376t, 377 pancreatic diseases, 445; and pancreatitis, vomit, blood in, 33, 36 438; and squamous cell carcinoma, 128; vomiting. see also regurgitation; about, 9–12; with Strongyloides stercoralis, 299; with and acute abdomen, 25; , ulcerative colitis, 334, 339; in Whipple’s 570; and biliary colic, 467t; Boerhaave’s disease, 251 syndrome, 134; causes, 687t; children, Werner-Morrison syndrome, 451 684–5, ; cholecystitis, 167t, 471; cyclic, Wernicke’s encephalopathy, 205t 690; and diarrhea, 214–16, 219; and Wernicke-Korsakoff syndrome, 57t, 205t diverticulitis, 373; fatty liver, 656; gastric wheezing, 97, 107, 250 volvulus, 172; and gastritis, 146–7; GERD, Whipple’s disease: about, 250–1; chronic 110, 691; and hepatitis, 531, 542; and diarrhea, 21t; and Crohn’s disease, 151; hookworms, 393; inflammatory bowel and fat malabsorption, 193; and islet cell disease, 64t; investigation, 689–90; with tumors, 450; and MAI, 292; ischemia, 253; and malnutrition, 23; malassimilation, 201t; therapy, 208t management, 691; and nasoenteric feeding, whipworm, 393 73; nausea, 393; and pancreatitis, 77, 432; Wilson’s disease: about, 518, 585–6; causing in pregnancy, 654, 656; and protein cirrhosis, 597; and cirrhosis, 598t; dietary deficiency, 206; with small bowel therapy, 65t; causing dysphagia, 117t; obstruction, 318; symptoms and signs, causing hepatitis, 530t, 551t 688t wind. see gas vomiting center, 10, 11f World Medical Assembly, 79 von Hippel-Lindau disease, 450 Von Meyenberg’s complexes, 482 xanthelasma, 501, 502t, 592, 595 VSL#3, 353, 382t xanthogranulomatous gastritis, 151 EN_GAST_IND.QXD 08/31/2005 11:31 AM Page 864

864 INDEX

xanthoma, 482, 501, 502t xenotransplantation, 643 xeroderma, 58t xeroderma pigmentosum, 764 xerophthalmia, 58t xerosis, 203t, 205t x-ray. see barium x-ray Xylocaine®, 114

Yersinia enterocolitica, 213t, 216, 341t, 712 Yersinia species, 320t

Zenapax®, 640 Zenker’s diverticulum, 7, 117t, 118, 131–2 zidovudine. see AZT : absorption, 63; deficiency, 203t, 205t, 628; and diarrhea, 23; inflammatory bowel disease, 64t; and malnutrition, 56; replacement, 210t; Wilson’s disease, 65t Zollinger-Ellison syndrome: associated conditions, 180; and celiac disease, 239; chronic diarrhea, 21t; and Crohn’s disease, 320t; and gastric folds, 152; causing gastritis, 148t; and intestinal secretion, 231; islet cell tumors, 450; and liver cancer, 649; malabsorption, 193 zygomycosis, 150 zymogen granules, 56, 420