Handbook of Digestive Diseases

449 Pages·2004·1.94 MB·English

by  Anil Minocha MD FACP FACG

Anil Minocha, MD, FACP, FACG
Professor of Medicine
Director of DigestiveDiseases
University of MississippiMedicalCenter
Jackson, Mississippi
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Minocha, Anil.
The handbook of digestive diseases / Anil Minocha.
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1. Digestive organs--Diseases--Handbooks, manuals, etc.
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DEDICATION
With pride and love, I dedicate this book to my daughter Geeta, the
light of my life; to my loving parents, Kamla and Ram S. Minocha, for
their constant encouragement and dedication that shaped my life; and
to my entire Minocha family for their patience, love, and understand-
ing without which the book could not have been written.

CONTENTS
Dedication....................................................................................................iii
Acknowledgments........................................................................................ix
About the Author.........................................................................................xi
Preface........................................................................................................xiii
SectionOne: Common GastrointestinalComplaints
Chapter 1: Dysphagia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Chapter 2: Noncardiac Chest Pain. . . . . . . . . . . . . . . . . . . . . . . 8
Chapter 3: Nausea and Vomiting . . . . . . . . . . . . . . . . . . . . . . 11
Chapter 4: Belching. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Chapter 5: Hiccups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Chapter 6: Dyspepsia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Chapter 7: Acute Abdominal Pain. . . . . . . . . . . . . . . . . . . . . . 22
Chapter 8: Upper Gastrointestinal Bleeding. . . . . . . . . . . . . . 29
Chapter 9: Lower Gastrointestinal Bleeding. . . . . . . . . . . . . . 35
Chapter 10: Occult and Obscure Gastrointestinal Bleeding. . . 38
Chapter 11: Acute Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Chapter 12: Traveler’s Diarrhea. . . . . . . . . . . . . . . . . . . . . . . . . 47
Chapter 13: Chronic Diarrhea. . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Chapter 14: Constipation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Chapter 15: Pruritus Ani. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Chapter 16: Chronic Rectal Pain Syndromes. . . . . . . . . . . . . . . 62
Chapter 17: Fecal Incontinence. . . . . . . . . . . . . . . . . . . . . . . . . . 63
Section Two: Nutrition
Chapter 18: Malnutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Chapter 19: Enteral Nutrition. . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Chapter 20: Parenteral Nutrition. . . . . . . . . . . . . . . . . . . . . . . . 77
Section Three: Esophagus
Chapter 21: Gastroesophageal Reflux Disease . . . . . . . . . . . . . 85
Chapter 22: Barrett’s Esophagus . . . . . . . . . . . . . . . . . . . . . . . . 94
Chapter 23: Esophageal Cancer. . . . . . . . . . . . . . . . . . . . . . . . . 97
Chapter 24: Gas-Bloat Syndrome. . . . . . . . . . . . . . . . . . . . . . . 101
Chapter 25: Schatzki’s Ring . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Chapter 26: Infectious Esophagitis. . . . . . . . . . . . . . . . . . . . . . 103
Chapter 27: Pill Esophagitis . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Chapter 28: Caustic Ingestion. . . . . . . . . . . . . . . . . . . . . . . . . . 108
Section Four:Stomach and Duodenum
Chapter 29: Gastritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Chapter 30: Peptic Ulcer Disease. . . . . . . . . . . . . . . . . . . . . . . 116
Chapter 31: Functional Dyspepsia. . . . . . . . . . . . . . . . . . . . . . 121
Chapter 32: Helicobacter Pylori. . . . . . . . . . . . . . . . . . . . . . . . 123
vi Contents
Chapter 33: Gastroparesis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Chapter 34: Gastric Polyps. . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
Chapter 35: Gastric Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
SectionFive: Liver
Chapter 36: Hepatitis A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Chapter 37: Hepatitis B. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Chapter 38: Hepatitis C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Chapter 39: Hepatitis D and E. . . . . . . . . . . . . . . . . . . . . . . . . 155
Chapter 40: Primary Biliary Cirrhosis. . . . . . . . . . . . . . . . . . . 156
Chapter 41: Primary Sclerosing Cholangitis. . . . . . . . . . . . . . 159
Chapter 42: Alcoholic Liver Disease . . . . . . . . . . . . . . . . . . . . 163
Chapter 43: Nonalcoholic Fatty Liver Disease . . . . . . . . . . . . 167
Chapter 44: Drug-Induced Liver Disease . . . . . . . . . . . . . . . . 170
Chapter 45: Autoimmune Hepatitis. . . . . . . . . . . . . . . . . . . . . 177
Chapter 46: Hemochromatosis. . . . . . . . . . . . . . . . . . . . . . . . . 184
Chapter 47: Wilson’s Disease. . . . . . . . . . . . . . . . . . . . . . . . . . 188
Chapter 48: Alpha Antitrypsin Deficiency. . . . . . . . . . . . . . . 191
1
Chapter 49: Liver Cirrhosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Chapter 50: Medical Care of the Cirrhotic Patient. . . . . . . . . 197
Chapter 51: Ascites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
Chapter 52: Spontaneous Bacterial Peritonitis . . . . . . . . . . . . 206
Chapter 53: Hepatic Encephalopathy . . . . . . . . . . . . . . . . . . . 210
Chapter 54: Hepatorenal Syndrome. . . . . . . . . . . . . . . . . . . . . 214
Chapter 55: Hepatocellular Carcinoma. . . . . . . . . . . . . . . . . . 216
Chapter 56: Hepatobiliary Disease During Pregnancy. . . . . . 218
Chapter 57: Fulminant Hepatic Failure. . . . . . . . . . . . . . . . . . 224
Chapter 58: Liver Transplantation. . . . . . . . . . . . . . . . . . . . . . 227
SectionSix: Gallbladder and Pancreas
Chapter 59: Gallstones. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Chapter 60: Acute Pancreatitis. . . . . . . . . . . . . . . . . . . . . . . . . 236
Chapter 61: Chronic Pancreatitis . . . . . . . . . . . . . . . . . . . . . . . 241
Chapter 62: Pancreatic Cancer . . . . . . . . . . . . . . . . . . . . . . . . . 246
Chapter 63: Zollinger-Ellison Syndrome. . . . . . . . . . . . . . . . . 250
SectionSeven: Small Intestine
Chapter 64: Chronic Intestinal Pseudo-Obstruction. . . . . . . . 255
Chapter 65: Small Bowel Obstruction . . . . . . . . . . . . . . . . . . . 259
Chapter 66: Small Bowel Bacterial Overgrowth. . . . . . . . . . . 263
Chapter 67: Lactose Intolerance. . . . . . . . . . . . . . . . . . . . . . . . 267
Chapter 68: Celiac Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
Chapter 69: Tropical Sprue. . . . . . . . . . . . . . . . . . . . . . . . . . . . 274
Chapter 70: Intestinal Lymphangiectasia . . . . . . . . . . . . . . . . 275
Chapter 71: Whipple’s Disease . . . . . . . . . . . . . . . . . . . . . . . . 276
Contents vii
Section Eight: Large Intestine
Chapter 72: Acute Appendicitis . . . . . . . . . . . . . . . . . . . . . . . 279
Chapter 73: Clostridium Difficile Diarrhea. . . . . . . . . . . . . . . 281
Chapter 74: Irritable Bowel Syndrome. . . . . . . . . . . . . . . . . . . 286
Chapter 75: Inflammatory Bowel Disease. . . . . . . . . . . . . . . . 293
Chapter 76: Microscopic Colitis. . . . . . . . . . . . . . . . . . . . . . . . 306
Chapter 77: Acute Colonic Pseudo-Obstruction. . . . . . . . . . . 309
(Ogilvie’s Syndrome)
Chapter 78: Diverticular Disease of the Colon . . . . . . . . . . . . 312
Chapter 79: Colorectal Polyps . . . . . . . . . . . . . . . . . . . . . . . . . 318
Chapter 80: Colorectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . 320
Chapter 81: Familial Polyposis/Cancer Syndromes. . . . . . . . 326
Chapter 82: Colorectal Cancer Screening. . . . . . . . . . . . . . . . . 333
Chapter 83: Anorectal Disorders . . . . . . . . . . . . . . . . . . . . . . . 337
Chapter 84: Miscellaneous Colorectal Disorders . . . . . . . . . . 343
Section Nine: Diagnostic and TherapeuticModalities
Chapter 85: Antibiotic Prophylaxis . . . . . . . . . . . . . . . . . . . . . 347
Chapter 86: Esophagogastroduodenoscopy . . . . . . . . . . . . . . 349
Chapter 87: Colonoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351
Chapter 88: Complications of Colonoscopy . . . . . . . . . . . . . . 354
Chapter 89: Endoscopic Retrograde . . . . . . . . . . . . . . . . . . . . 355
Cholangiopancreatography
Chapter 90: Endoscopic Ultrasound . . . . . . . . . . . . . . . . . . . . 358
Chapter 91: Percutaneous Endoscopic Gastrostomy . . . . . . . 360
and Jejunostomy
Chapter 92: Gastrointestinal Radiology. . . . . . . . . . . . . . . . . . 364
SectionTen: MiscellaneousTopics
Chapter 93: AIDS Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
Chapter 94: Food Allergies. . . . . . . . . . . . . . . . . . . . . . . . . . . . 378
Chapter 95: Gastrointestinal Cancer Screening. . . . . . . . . . . . 382
and Surveillance
Chapter 96: Gastrointestinal Problems.. . . . . . . . . . . . . . . . . . 384
in Systemic Disorders
Chapter 97: Systemic Manifestations of Gastrointestinal. . . . 391
Diseases
Chapter 98: Gastrointestinal Infections. . . . . . . . . . . . . . . . . . 394
Chapter 99: Acute Intestinal Ischemia. . . . . . . . . . . . . . . . . . . 403
Chapter 100: Chronic Mesenteric Ischemia. . . . . . . . . . . . . . . . 410
Chapter 101: Ischemic Colitis. . . . . . . . . . . . . . . . . . . . . . . . . . . 412
Chapter 102: Obesity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421

ACKNOWLEDGMENTS
This book has been an enormous "solo" project that would not have
been possible without the teachings, assistance, and cooperation of
many friends, senior colleagues, teachers, and thought-leaders with
whom I have interacted throughout my career and who have selfless-
ly shared their knowledge and wisdom that carries me through this
day.
I am deeply indebted to the numerous expert friends and col-
leagues who have reviewed the contents of the book and provided me
with important feedback and helpful suggestions. In particular, I
would like to express my deep sense of gratitude to Thomas Abell,
MD; Bhupinder Anand, MD; Farshid Araghizadeh, MD; Maher
Azzouz, MD; Adil Bharucha, MD; Roger Blake, MD; Alan Buchman,
MD; Randall Burt, MD; Lawrence Brandt, MD; Michael Camilleri,
MD; Jennifer Christie, MD; Poonputt Chotiprasidhi, MD; Ray Clouse,
MD; Sheila Crowe, MD; Richard deShazo, MD; Douglas Drossman,
MD; Chris Friedrich, MD, PhD; Susan Galandiuk, MD; Robert
Halpert, MD; Harold Henderson, MD; Jorge Herrera, MD; Peter
Kahrilas, MD; Bret Lashner, MD; Kalyana Lavu, MD; Scott
Malinowski, PharmD; Stephen McClave, MD; Roy Orlando, MD; C. S.
Pitchumoni, MD; Satish Rao, MD; Douglas Rex, MD; Arvey Rogers,
MD; Sitesh Roy, MD; Lawrence Schiller, MD; Reza Shaker, MD;
Gagan Sood, MD; and last but not the least, Christina Surawicz, MD.
The high quality of the text is primarily due to their help and guid-
ance; the errors are all mine.
I am greatly indebted to my publisher, John Bond, and the acquisi-
tions editor, Carrie Kotlar, for providing me with this unique oppor-
tunity to contribute to my passion of medical education and high
quality patient care. Finally, it was the project editor, Robert Smentek,
and his team who successfully converted a bland manuscript into a
book that readers can easily read and assimilate. I am grateful to him
for doing his best to make me—and my book—look good.