Sleisenger and Fordtran's GASTROINTESTINAL AND LIVER DISEASE Any screen. Any time. Anywhere. Activate the eBook version of this title at no additional charge. Expert Consult eBooks give you the power to browse and find content, view enhanced images, share notes and highlights—both online and offline. Unlock your eBook today. 1 Visit expertconsult.inkling.com/redeem 2 Scratch off your code Scan this QR code to redeem your eBook through your mobile device: 3 Type code into “Enter Code” box 4 Click “Redeem” 5 Log in or Sign up 6 Go to “My Library” It’s that easy! For technical assistance: email [email protected] call 1-800-401-9962 (inside the US) call +1-314-447-8200 (outside the US) Use of the current edition of the electronic version of this book (eBook) is subject to the terms of the nontransferable, limited license granted on expertconsult.inkling.com. Access to the eBook is limited to the first individual who redeems the PIN, located on the inside cover of this book, at expertconsult.inkling.com and may not be transferred to another party by resale, lending, or other means. Sleisenger and Fordtran’s GASTROINTESTINAL AND LIVER DISEASE REVIEW AND ASSESSMENT 10 TH EDITION Sleisenger and Fordtran’s GASTROINTESTINAL AND LIVER DISEASE REVIEW AND ASSESSMENT Emad Qayed, MD Assistant Professor of Medicine Division of Digestive Diseases Emory University School of Medicine Interim Chief of Gastroenterology Grady Memorial Hospital Atlanta, Georgia Shanthi Srinivasan, MD Nikrad Shahnavaz, MD Associate Professor of Medicine Assistant Professor of Medicine Division of Digestive Diseases Division of Digestive Diseases Emory University School of Medicine Emory University School of Medicine Chief, Gastroenterology Unit Atlanta, Georgia Atlanta VA Medical Center Atlanta, Georgia iii 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 SLEISENGER AND FORDTRAN’S GASTROINTESTINAL AND LIVER DISEASE: REVIEW AND ASSESSMENT, TENTH EDITION ISBN: 978-0-323-37639-6 Copyright © 2017 by Elsevier, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Previous editions copyrighted 2010, 2007, 1999, and 1996. Library of Congress Cataloging-in-Publication Data Names: Qayed, Emad, editor. | Srinivasan, Shanthi, editor. | Shahnavaz, Nikrad, editor. Title: Sleisenger and Fordtran’s gastrointestinal and liver disease. Review and assessment / [edited by] Emad Qayed, Shanthi Srinivasan, Nikrad Shahnavaz. Other titles: Gastrointestinal and liver disease. Review and assessment | Review and assessment Description: Tenth edition. | Philadelphia, PA : Elsevier, [2017] | Includes bibliographical references. Identifiers: LCCN 2015045935 | ISBN 9780323376396 (hardcover : alk. paper) Subjects: | MESH: Gastrointestinal Diseases | Liver Diseases | Examination Questions Classification: LCC RC801 | NLM WI 18.2 | DDC 616.3/30076--dc23 LC record available at http://lccn.loc.gov/2015045935 Senior Content Strategist: Suzanne Toppy Senior Content Development Specialist: Anne Snyder Publishing Services Manager: Patricia Tannian Project Manager: Amanda Mincher Book Designer: Brian Salisbury Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 DEDICATION To my dear wife, Yara; my children, Bassem and Zaina; and my mother, Nawal. Emad Qayed To my parents; my husband, Srini; and my children, Karthik, Arjun, and Anand. Shanthi Srinivasan To my wife, Suzanne; my parents, Roya and Shahpoor; and my grandmother, Rafat. Nikrad Shahnavaz And to all of our colleagues, contributors, and trainees. ACKNOWLEDGMENTS The authors would like to thank Suzanne Toppy, Anne Snyder, and Amanda Mincher for their valuable contributions in publishing this book. CONTRIBUTORS Khaled Abdeljawad, MD Sunil Dacha, MD Gastroenterology Fellow Associate in Medicine Division of Digestive Diseases Division of Digestive Diseases Emory University School of Medicine Department of Internal Medicine Atlanta, Georgia Emory University School of Medicine Atlanta, Georgia Muhammad Fuad Azrak, MD, MPH Kanak Das, MBBS Clinical Assistant Professor Internal Medicine Assistant Professor Wayne State University Division of Gastroenterology and Hepatology Detroit, Michigan Department of Medicine Attending Physcian University of Tennessee Health Science Center Internal Medicine Memphis, Tennessee Oakwood Hospital and Medical Center Dearborn, Michigan Nader Dbouk, MD Assistant Professor of Surgery Matthew Barnes, MD Methodist University Hospital Transplant Institute Resident, Internal Medicine Residency Program University of Tennessee Health Science Center University of Tennessee Health Science Center Memphis, Tennessee Memphis, Tennessee Tanvi Dhere, MD Stephen Hans Berger, MD Assistant Professor Gastroenterology Fellow Director of Inflammatory Bowel Diseases Division of Digestive Diseases Digestive Diseases Emory University School of Medicine Emory University School of Medicine Atlanta, Georgia Atlanta, Georgia Jason M. Brown, MD Anthony Gamboa, MD Gastroenterology Fellow Gastroenterology Fellow Division of Digestive Diseases Division of Digestive Diseases Emory University School of Medicine Emory University School of Medicine Atlanta, Georgia Atlanta, Georgia Saurabh Chawla, MD Stephan U. Goebel, MD Director of Endoscopy Assistant Professor of Medicine Grady Memorial Hospital Division of Digestive Diseases Assistant Professor of Medicine Emory University School of Medicine Division of Digestive Diseases Atlanta VA Medical Center Emory University School of Medicine Atlanta, Georgia Atlanta, Georgia William Joseph Goldkamp, MD Jennifer Christie, MD, FASGE Chief Resident Associate Professor of Medicine Department of Medicine Emory University School of Medicine University of Tennessee Health Science Center Division of Digestive Diseases Memphis, Tennessee Director of Gastrointestinal Motility and Clinical Research Emory Healthcare Hazem Hammad, MD Atlanta, Georgia Assistant Professor of Clinical Medicine Division of Gastroenterology University of Missouri Hospital Columbia, Missouri vii viii Contributors Melanie Harrison, MD Jeffrey Nadelson, MD Assistant Professor of Medicine Gastroenterology Fellow Division of Digestive Diseases Medicine-GI Emory University School of Medicine University of Tennessee Health Sciences Center Atlanta, Georgia Memphis, Tennessee Heba Iskandar, MD, MSCI Behtash Ghazi Nezami, MD Assistant Professor of Medicine Postdoctoral Research Fellow Division of Digestive Diseases Division of Digestive Diseases Emory University School of Medicine Emory University School of Medicine Atlanta, Georgia Atlanta, Georgia Elnaz Jafarimehr, MD John Paul Norvell, MD Gastroenterology Fellow Assistant Professor of Medicine Emory University School of Medicine Division of Digestive Diseases Atlanta, Georgia Emory Transplant Center Emory University School of Medicine Steven Keilin, MD, FASGE Atlanta, Georgia Assistant Professor of Medicine Joshua Novak, MD Director of Pancreaticobiliary Service Associate Director, Advanced Endoscopy Fellowship Assistant Professor of Medicine Division of Gastroenterology Division of Gastroenterology and Hepatology Emory University Hospital Emory University School of Medicine The Emory Clinic Atlanta, Georgia Atlanta, Georgia Samir Parekh, MD Jan-Michael A. Klapproth, MD Director of Hepatology Associate Professor of Medicine Department of Medicine Division of Gastroenterology Emory University School of Medicine University of Pennsylvania Atlanta, Georgia Phildalphia, Pennsylvania Mehul Parikh, MD Rahul Maheshwari, MD Gastroenterologist Gastroenterology Fellow Gastroenterology Specialists of Gwinnett Division of Digestive Diseases Lawrenceville, Georgia Emory University School of Medicine Atlanta, Georgia George M. Philips, MD Advanced Endoscopy Fellow Julia Massaad, MD Emory University School of Medicine Assistant Professor of Medicine Atlanta, Georgia Director, GI Fellowship Program Director of Education Anjana Pillai, MD Division of Digestive Diseases Assistant Professor of Medicine Emory University School of Medicine Division of Digestive Diseases Atlanta, Georgia Emory Transplant Center Emory University School of Medicine Parit Mekaroonkamol, MD Atlanta, Georgia Division of Digestive Diseases Emory University School of Medicine Emad Qayed, MD Atlanta, Georgia Assistant Professor of Medicine Division of Digestive Diseases Brett Mendel, MD Emory University School of Medicine Gastroenterology Fellow Interim Chief of Gastroenterology Division of Digestive Diseases Grady Memorial Hospital Emory University School of Medicine Atlanta, Georgia Atlanta, Georgia José Rivera-Acosta, MD, MSc Fazia Mir, MD Assistant Professor Fellow Department of Internal Medicine, GI Division Division of Gastroenterology University of Puerto Rico, School of Medicine University of Missouri–Columbia Liver Transplant Hepatology Faculty Columbia, Missouri Transplant Center Hospital Auxilio Mutuo San Juan, Puerto Rico Contributors ix Sonali Sakaria, MD Shanthi Srinivasan, MD Assistant Professor of Internal Medicine Associate Professor of Medicine Associate Program Director Division of Digestive Diseases Division of Digestive Diseases Emory University School of Medicine The Emory Clinic Chief, Gastroenterology Unit Emory University School of Medicine Atlanta VA Medical Center Grady Memorial Hospital Atlanta, Georgia Atlanta, Georgia Sahar Taba Taba Vakili, MD, MPH Kavya M. Sebastian, MD Lead Research Specialist Assistant Professor Division of Digestive Diseases Division of Digestive Diseases Emory University School of Medicine Emory University School of Medicine Atlanta, Georgia Atlanta, Georgia Ravi Vora, MD Nikrad Shahnavaz, MD Gastroenterology Fellow Assistant Professor of Medicine Division of Digestive Diseases Division of Digestive Diseases Emory University School of Medicine Emory University School of Medicine Atlanta, Georgia Atlanta, Georgia Joel P. Wedd, MD, MPH Lauren M. Shea, MD Assistant Professor of Medicine Gastroenterology Division of Digestive Diseases Emory University School of Medicine Emory University School of Medicine Atlanta, Georgia Atlanta, Georgia Sagar Shroff, MD Field F. Willingham, MD, MPH Fellow Director of Endoscopy Division of Digestive Diseases Associate Professor of Medicine Emory University School of Medicine President of the Georgia Gastroenterologic and Endoscopic Atlanta, Georgia Society Division of Digestive Diseases Emory University School of Medicine Atlanta, Georgia PREFACE In writing this tenth edition of Sleisenger and Fordtran’s Gas- thereby making this book a stand-alone review tool. However, trointestinal and Liver Disease Review and Assessment, we have the reader is encouraged to review the main textbook for fur- been fortunate to work with an extremely talented group of ther information and to sharpen his or her clinical knowledge. faculty and fellows from our own division of digestive dis- Another exciting aspect of the new edition is the availabil- eases at Emory University, and also from prominent institu- ity of an online testing mode. An online test component can tions nationwide. be taken in an untimed study mode or in a timed assessment In this edition, we compiled all new questions that are mode. We compiled three exams (200 questions each, with board-style, case-based patient vignettes, with a strong focus four sections of 50 questions) that can be accessed in a timed on clinically relevant information. These questions test medi- mode to simulate exam settings. If you are thinking of com- cal knowledge, clinical reasoning and interpretation, and pleting these exams, we recommend that you do that first, as problem solving skills. The new edition mimics the contents they contain questions taken from throughout this book. of the gastroenterology board examinations in content, style, We hope you enjoy testing your gastroenterology knowl- and number of questions for each section, and each question edge using this book as much as we enjoyed writing and edit- has a single best answer. We avoided questions that have more ing these questions. than one correct answer choice, as well as “all of the above,” “none of the above,” and “all except” types of questions. In Emad Qayed writing and editing the answers, we made sure every answer Shanthi Srinivasan clearly explained the correct and incorrect answer choices, Nikrad Shahnavaz xi