Gastrointestinal system PDF
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Gastrointestinal System First and second edition authors: Elizabeth Cheshire Melanie Sarah Long Third edition author: Rusheng Chew 4 th Edition CRASH COURSE SERIES EDITOR: Dan Horton-Szar BSc(Hons) MBBS(Hons) MRCGP NorthgateMedicalPractice Canterbury Kent, UK FACULTY ADVISOR: Martin Lombard MD MSc FRCPIFRCP(Lond) Consultant Gastroenterologist and Hepatologist RoyalLiverpool University Hospital Liverpool, UK Gastrointestinal System Megan Griffiths MBChB(Hons) Foundation Doctor Wirral University Teaching Hospital Merseyside, UK Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2012 CommissioningEditor:JeremyBowes DevelopmentEditor:SheilaBlack ProjectManager:AndrewRiley Designer:StewartLarking IconIllustrations:GeoParkin Illustrator:Cactus ©2012ElsevierLtd.Allrightsreserved. Nopartofthispublicationmaybereproducedortransmittedinanyformorbyanymeans,electronicor mechanical,includingphotocopying,recording,oranyinformationstorageandretrievalsystem,without permissioninwritingfromthepublisher.Detailsonhowtoseekpermission,furtherinformationaboutthe Publisher’spermissionspoliciesandourarrangementswithorganizationssuchastheCopyrightClearanceCenter andtheCopyrightLicensingAgency,canbefoundatourwebsite:www.elsevier.com/permissions. ThisbookandtheindividualcontributionscontainedinitareprotectedundercopyrightbythePublisher(otherthan asmaybenotedherein). Firstedition1998 Secondedition2002 Reprinted2003(twice),2005 Thirdedition2008 Fourthedition2012 ISBN:978-0-7234-3620-1 BritishLibraryCataloguinginPublicationData AcataloguerecordforthisbookisavailablefromtheBritishLibrary LibraryofCongressCataloginginPublicationData AcatalogrecordforthisbookisavailablefromtheLibraryofCongress Notices Knowledgeandbestpracticeinthisfieldareconstantlychanging.Asnewresearchandexperiencebroadenour understanding,changesinresearchmethods,professionalpractices,ormedicaltreatmentmaybecomenecessary. Practitionersandresearchersmustalwaysrelyontheirownexperienceandknowledgeinevaluatingandusing anyinformation,methods,compounds,orexperimentsdescribedherein.Inusingsuchinformationormethods theyshouldbemindfuloftheirownsafetyandthesafetyofothers,includingpartiesforwhomtheyhavea professionalresponsibility. Withrespecttoanydrugorpharmaceuticalproductsidentified,readersareadvisedtocheckthemostcurrent informationprovided(i)onproceduresfeaturedor(ii)bythemanufacturerofeachproducttobeadministered,to verifytherecommendeddoseorformula,themethodanddurationofadministration,andcontraindications.Itis theresponsibilityofpractitioners,relyingontheirownexperienceandknowledgeoftheirpatients,tomake diagnoses,todeterminedosagesandthebesttreatmentforeachindividualpatient,andtotakeallappropriate safetyprecautions. Tothefullestextentofthelaw,neitherthePublishernortheauthors,contributors,oreditors,assumeanyliability foranyinjuryand/ordamagetopersonsorpropertyasamatterofproductsliability,negligenceorotherwise,or fromanyuseoroperationofanymethods,products,instructions,orideascontainedinthematerialherein. The Publisher's policy is to use paper manufactured from sustainable forests PrintedinChina Series editor foreword TheCrashCourseseriesfirstpublishedin1997andnow,15yearson,wearestill goingstrong.Medicineneverstandsstill,andtheworkofkeepingthisseries relevantfortoday’sstudentsisanongoingprocess.Thesefourtheditionsbuildon thesuccessoftheprevioustitlesandincorporatenewandrevisedmaterial,tokeep theseriesuptodatewithcurrentguidelinesforbestpractice,andrecent developmentsinmedicalresearchandpharmacology. Wealwayslistentofeedbackfromourreaders,throughfocusgroupsandstudent reviewsoftheCrashCoursetitles.Forthefourtheditionswehavecompletely re-writtenourself-assessmentmaterialtokeepupwithtoday’s‘single-bestanswer’ and‘extendedmatchingquestion’formats.Theartworkandlayoutofthetitles hasalsobeenlargelyre-workedtomakeiteasierontheeyeduringlongsessionsof revision. Despitefullyrevisingthebookswitheachedition,weholdfasttotheprincipleson whichwefirstdevelopedtheseries.CrashCoursewillalwaysbringyouallthe informationyouneedtoreviseincompact,manageablevolumesthatintegrate basicmedicalscienceandclinicalpractice.Thebooksstillmaintainthebalance betweenclarityandconciseness,andprovidesufficientdepthforthoseaimingat distinction.Theauthorsaremedicalstudentsandjuniordoctorswhohaverecent experienceoftheexamsyouarenowfacing,andtheaccuracyofthematerialis checkedbyateamoffacultyadvisorsfromacrosstheUK. Iwishyouallthebestforyourfuturecareers! Dr Dan Horton-Szar SeriesEditor v Intentionally left as blank Prefaces Author Medicalexamscanbeadauntingexperience.Thistextbookaimstohelpprepare studentsbyprovidingacomprehensiveoverviewofthegastrointestinalsystem, presentedinaclearandconcisemanner.Ittakesreadersthroughalogicalthought processstartingwithbasicanatomyandphysiologyandculminatingwithclinical disorders.Thisprovidesastrongfoundationwhichallowsstudentstounderstand thebasicsciences,andthenapplythistoaclinicalscenario. Aswellasaidingrevision,hopefullythisbookwillalsoproveausefulresourcewhen makingthetransitionfromstudenttohouseofficer.Itprovidesadetailedoverview ofthecommongastrointestinalproblemsthatyouwillcertainlyfaceonthewards. Ihopethatyouenjoyreadingthisbookandfinditausefulresource. Megan Griffiths Liverpool 2012 Faculty advisor Despitetheirbestintentionsandnoticeoftimetables,allstudentsfindthat examscometoosoon.CrashCourseiswrittenbypeoplewho’vebeentherefor peoplewhoaregettingthere!Theseriesislargelywrittenbystudentsintheir finalyearorjustafterqualifyingasdoctorswhohaverecentlypassedtheirexams andwhoknowwhatyouneedtoknowtopassandexcelinyourexam.This bookontheGastrointestinalSystemtellsyouthat,butIhopeiscomprehensive enoughtogiveyouevenmore–agoodgroundinginclinicalgastroenterology andhepatology.ItisanexcitingsubjectareaandCrashCourseisdesignedtobring italivewithinformation.Theillustrationsinthisbookpackinathousandmore wordsthanwecouldinthetextandIhopeyouwillenjoylearningfromthem. Martin Lombard Liverpool 2012 vii Acknowledgements Therearetwopeoplewhodeserveaspecialmentionfortheirroleintheproduction ofthe4theditionofthisbook.ThefirstisMartinLombard,facultyadvisor,whose knowledgeofthegastrointestinalsystemandgeneralmedicinehasensuredthat thisbookhaskeptuptodatewithalltherecentchangesinclinicalmedicine. ThesecondisSheilaBlack,contentdevelopmentspecialist,forallherguidanceand patienceinensuringthatthisbookwouldbecompletedontime. ToRushengChewandtheauthorsofpreviouseditions,thankyoufor providingsuchagreatformatandstartingbase,uponwhichIhavebeenable tobuild. Iwouldalsoliketotakethisopportunitytothankmyfamilyandfriendsforall theirloveandsupport. viii Contents Serieseditorforeword . . . . . . . . . . . . . . . v Embryologyanddevelopment . . . . . . 78 Prefaces . . . . . . . . . . . . . . . . . . . . . . vii Histology . . . . . . . . . . . . . . . . 78 Acknowledgements. . . . . . . . . . . . . . . . viii Thefloraofthelargeintestine . . . . . . 79 Functionsandphysiology. . . . . . . . . 79 1. Introductiontothegastrointestinal Pharmacologyofintestinalmotility . . . . 81 system . . . . . . . . . . . . . . . . . . 1 Disordersofthelargeintestine . . . . . . 83 Anatomicaloverview. . . . . . . . . . . . 1 Functionsofthegastrointestinaltract . . . . 1 6. Theliver . . . . . . . . . . . . . . . . 99 Foodgroups. . . . . . . . . . . . . . . . 2 Overview . . . . . . . . . . . . . . . . 99 Development . . . . . . . . . . . . . . . 6 Anatomy . . . . . . . . . . . . . . . . 99 Embryologyanddevelopment . . . . . .102 2. Theuppergastrointestinaltract. . . . . . . 9 Histology . . . . . . . . . . . . . . . .102 Overview . . . . . . . . . . . . . . . . . 9 Functionsandphysiology. . . . . . . . .105 Functionsandphysiology. . . . . . . . . . 9 Pathologicalmanifestationsofliver Themouth,oralcavityandoropharynx . . 15 damage . . . . . . . . . . . . . . . .113 Disordersofthemouthand Systemicandorganicmanifestationsof oropharynx. . . . . . . . . . . . . . . 21 liverdamage . . . . . . . . . . . . . .115 Theoesophagus . . . . . . . . . . . . . 23 Disordersoftheliver. . . . . . . . . . .122 Disordersoftheoesophagus . . . . . . . 25 7. Thepancreasandbiliarytract . . . . . .135 3. Thestomach. . . . . . . . . . . . . . . 31 Thepancreas . . . . . . . . . . . . . .135 Overview . . . . . . . . . . . . . . . . 31 Disordersoftheexocrinepancreas . . . .142 Anatomy . . . . . . . . . . . . . . . . 31 Thebiliarysystem . . . . . . . . . . . .146 Embryologyanddevelopment . . . . . . 34 Disordersofthegallbladderandbiliary Histology . . . . . . . . . . . . . . . . 35 tract . . . . . . . . . . . . . . . . . .149 Functionsandphysiology. . . . . . . . . 37 Disordersofthestomach. . . . . . . . . 45 8. Clinicalassessmentofgastrointestinal disease . . . . . . . . . . . . . . . . .151 4. Thesmallintestine. . . . . . . . . . . . 51 Commonpresentationsofgastrointestinal Overview . . . . . . . . . . . . . . . . 51 disease. . . . . . . . . . . . . . . . .151 Anatomy . . . . . . . . . . . . . . . . 51 Dysphagia. . . . . . . . . . . . . . . .151 Embryologyanddevelopment . . . . . . 54 Dyspepsia . . . . . . . . . . . . . . . .151 Histology . . . . . . . . . . . . . . . . 54 Nauseaandvomiting. . . . . . . . . . .152 Physiology. . . . . . . . . . . . . . . . 58 Abdominaldistension. . . . . . . . . . .152 Digestionandabsorption. . . . . . . . . 62 Abdominalpain . . . . . . . . . . . . .153 Thefloraofthesmallintestine . . . . . . 68 Weightloss . . . . . . . . . . . . . . .156 Disordersofthesmallintestine . . . . . . 68 Gastrointestinal(GI)bleeding. . . . . . .156 5. Thelargeintestine. . . . . . . . . . . . 73 Anaemia . . . . . . . . . . . . . . . .156 Overview . . . . . . . . . . . . . . . . 73 Jaundice. . . . . . . . . . . . . . . . .157 Anatomy . . . . . . . . . . . . . . . . 73 Diarrhoeaandconstipation . . . . . . . .158 ix
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