The Netter Collection OF MEDICAL ILLUSTRATIONS Digestive System Part II—Lower Digestive Tract 2nd Edition A compilation of paintings prepared by FRANK H. NETTER, MD Editor Associate Editors James C. Reynolds, MD Suzanne Rose, MD, MSEd June F. Klinghoffer Distinguished Professor of Medicine Professor and Chair Senior Associate Dean for Education Department of Medicine University of Connecticut School of Medicine Drexel University College of Medicine Farmington, Connecticut Philadelphia, Pennsylvania Missale Solomon, MD Senior Associate Editor Assistant Professor of Medicine Director, Nutrition and Small Bowel Disorders Peter J. Ward, PhD Drexel University College of Medicine Associate Professor of Anatomy Philadelphia, Pennsylvania Department of Biomedical Sciences West Virginia School of Osteopathic Medicine Lewisburg, West Virginia Additional Illustrations by Carlos A.G. Machado, MD CONTRIBUTING ILLUSTRATORS John A. Craig, MD Tiffany S. DaVanzo, MA, CMI Kristen Wienandt Marzejon, MS, MFA James A. Perkins, MS, MFA 1600 John F. Kennedy Blvd. Ste. 1800 Philadelphia, PA 19103-2899 THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS ISBN: 978-1-4557-7391-6 DIGESTIVE SYSTEM: PART II—LOWER DIGESTIVE TRACT, VOLUME 9, SECOND EDITION 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). Permission for Netter Art figures may be sought directly from Elsevier’s Health Science Licensing Department in Philadelphia, PA: phone 1-800-523-1649, ext. 3276, or (215) 239-3276; or email [email protected] 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. International Standard Book Number 978-1-4557-7391-6 Executive Content Strategist: Elyse O’Grady Senior Content Development Specialist: Marybeth Thiel Publishing Services Manager: Patricia Tannian Senior Project Manager: John Casey Senior Design Manager: Julia Dummitt Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 ABOUT THE SERIES Dr. Frank H. Netter exemplified the CUSHING’S SYNDROME IN A PATIENT WITH THE CARNEY COMPLEX distinct vocations of physician, artist, and teacher. Even more important— he unified them. Netter’s illustrations always began with meticulous research into the detailed human clinical anatomy and pathology, a philosophy that steered his broad and deep medical Carney complex is characterized understanding. He often said: “Clarifi by spotty skin pigmentation. Pigmented lentigines and blue cation is the goal. No matter how beau ninecvliu cdainng b teh ese eeyne loidns t,h vee rfamciell–ion tifully painted, a medical illustration bcoonrdjuenrsc otifv athee, tlhipes ,s cthleera–and the labia and scrotum. has little value if it does not make clear a medical point.” His greatest challenge Additional features of the Carney complex can include: and greatest success was charting a Myxomas: cardiac atrium, middle course between artistic clarity cutaneous (e.g., eyelid), and mammary and instructional complexity. That suc Testicular large-cell cess is captured in this series, beginning calcifying Sertoli cell tumors Growth-hormone in 1948, when the first comprehensive secereting pituitary adenomas Dr. Frank Netter at work. collection of Netter’s work, a single Psammomatous melanotic schwannomas volume, was published by CIBA Pharmaceuticals. It met with such success that over the following 40 years the collection was expanded into an 8volume series— each devoted to a single body system. In this second edition of the legendary series, we are delighted to offer Netter’s timeless work, now arranged and informed by modern text and radiologic imaging contributed by highly respected neurologic authorities from worldrenowned medical institutions, and supple PPNAD adrenal glands are usually of normal size and most are studded with black, brown, or red nodules. Most of the pigmented mented with new illustrations created by artists working nodules are less than 4 mm in diameter and interspersed in the adjacent atrophic cortex. in the Netter tradition. Inside the classic green covers, A brand new illustrated plate painted by Carlos Machado, students and practitioners will find hundreds of original MD, for The Endocrine System, Volume 2, 2nd ed. works of art—the human body in pictures—paired with the latest in expert medical knowledge and innovation and anchored in the sublime style of Frank Netter. The single-volume “blue book” that paved the way for the multivolume Netter Collection of Medical Illustrations Noted artistphysician, Carlos Machado, MD, the series aff ectionately known as the “green books.” primary successor responsible for continuing the Netter tradition, has particular appreciation for the Green Book series. “The Reproductive System is of special significance for those who, like me, deeply admire Dr. Netter’s work. In this volume, he masters the representation of textures of different surfaces, which I like to call ‘the rhythm of the brush,’ since it is the dimension, the direction of the strokes, and the interval separating them that create the illusion of given textures: organs have their external surfaces, the surfaces of their cavities, and texture of their parenchymas realistically represented. It set the style for the subsequent volumes of Netter’s Collection—each an amazing combination of painting masterpieces and precise scientific information.” Though the science and teaching of medicine endures changes in terminology, practice, and discovery, some things remain the same. A patient is a patient. A teacher is a teacher. And the pictures of Dr. Netter—he called them pictures, never paintings—remain the same blend of beautiful and instructional resources that have guided physicians’ hands and nurtured their imaginations for more than half a century. The original series could not exist without the dedica tion of all those who edited, authored, or in other ways contributed, nor, of course, without the excellence of Dr. Netter. For this exciting second edition, we also owe our Dr. Carlos Machado at work. gratitude to the Authors, Editors, Advisors, and Artists whose relentless efforts were instrumental in adapting these timeless works into reliable references for today’s clinicians in training and in practice. From all of us with the Netter Publishing Team at Elsevier, we thank you. THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS v ABOUT THE EDITORS James C. Reynolds, MD, Editor, is professor of Physicians) and served in this role from 1999 to 2007. Peter J. Ward, PhD, Senior Associate Editor, was medicine and the June F. Klinghoffer Distinguished From 2006 to 2008 he served as president of the medical born in Denver but grew up primarily in Casper, Chair of the department of medicine at Drexel Univer- staff at Hahnemann University Hospital and was a Wyoming, graduating from Kelly Walsh High School sity College of Medicine in Philadelphia. member of the board of directors of the hospital. He in 1992. He attended Carnegie Mellon University in Dr. Reynolds, a native of Florida, graduated from became interim chair of medicine in 2002. In 2005 he Pittsburgh and graduated with a bachelor of science Florida State University and received his medical was named the June F. Klinghoffer Distinguished Chair degree in biology (genetics, biochemistry, molecular degree from the University of Florida, where he was of the department of medicine. As Chair he has led the biology) with a minor in chemistry in 1996. He first president of his class and received several honors, department to a fivefold increase in clinical billing while encountered gross anatomy, histology, embryology, and including admission to Alpha Omega Alpha as a junior, doubling faculty size and extramural research income. neuroanatomy at the College of Veterinary Medicine in the John B. Gorrie Award as the student with the best The department continues to receive accolades for its 1998. Having found a course of study that engrossed promise for outstanding future performance, as well as support of exceptional quality and transplantation him, he matriculated through these courses at Purdue research awards. He completed his residency at Cornell outcomes and for the national recognition of several College of Veterinary Medicine, as well as at the branch University at New York Hospital and Memorial Sloan divisions. campus of the Indiana University School of Medicine. Kettering Cancer Center. He then completed a 3-year Dr. Reynolds is a member of the editorial board of Dr. Ward completed a master’s degree in Dr. Kevin fellowship at the Hospital of the University of Digestive Diseases and Sciences and is a reviewer for many Hannon’s muscle research laboratory and then began a Pennsylvania. He joined the faculty at the University of other journals. He has published over 100 manuscripts doctorate program in anatomy education under Dr. Pennsylvania, where he became program director and in peer-reviewed journals and has coedited five books. James Walker. He completed his thesis work in 2005— associate chief of the division. He remained funded by He has received numerous honors including Phi Beta strategies to improve student achievement and recall of the National Institutes of Health (NIH) and other Kappa, AOA, and “Physician of the Year” in 1995 by medical anatomy—a qualitative and quantitative study. national organizations for his research into the effect of the Greater Pittsburgh Chapter of the Crohn’s and In July 2005 Dr. Ward joined the faculty of the West neuropeptides on gastrointestinal motility. In 1990 he Colitis Foundation of America, and has been recog- Virginia School of Osteopathic Medicine (WVSOM) in became chief of the division of gastroenterology, hepa- nized as the most outstanding gastroenterologist in Lewisburg, West Virginia. He has taught gross anatomy, tology, and nutrition at the University of Pittsburgh, Pittsburgh on two separate occasions by Pittsburgh embryology, neuroscience, histology, radiography, and where he was a tenured associate professor of medicine Magazine. He has also been named among Philadel- the history of medicine. During this time he has also and cell biology. He was co-director of the Centers for phia’s “Top Docs” 10 times by Philadelphia Magazine. been director of the WVSOM plastination facility, Digestive Health and an associate professor of medicine He has received teaching awards in both basic and clini- coordinator of the graduate teaching fellows, chair of and cell biology. In 1996 he became professor of cal sciences from the University of Pennsylvania and the curriculum committee, creator and director of a medicine with tenure and chief of the division of gas- Drexel. clinical anatomy intensive elective course, host of many troenterology and hepatology at MCP Hahnemann Dr. Reynolds is board certified in internal medicine anatomy-centered events between WVSOM and the University, now the Drexel University College of Med- and gastroenterology and hepatology by the American Japan College of Osteopathy and the Atlas College of icine. He held this position and that of program direc- Boards of Internal Medicine. His primary clinical inter- Osteopathy. Dr. Ward has also served on the council of tor from 1996 to 2008. In those 12 years he held ests are in the early detection and prevention of cancer, the American Association of Clinical Anatomists numerous leadership roles in the hospital and college complications of gastroesophageal reflux, and gastroin- and several of the special interest groups of the same of medicine. He was elected vice-president of the uni- testinal motility disorders. organization. He is also a member of the American versity physicians practice plan (Drexel University Association of Anatomists, American Association for the History of Medicine, and the American Association of Veterinary Anatomists. His research continues to explore how medical students learn effectively, with particular emphasis on anatomy. In conjunction with Bone Clones, Inc., Dr. Ward has been producing a series of tactile models that mimic the feel of anatomical structures when intact and when ruptured during the physical examination. He enjoys exploring the use of video and other media as a supplementary resource in medical education. These videos are available to view at Clinical Anatomy Explained! on YouTube. vi THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS About the Editors committee, and web-based education subcommittee, and she has chaired the CME subcommittee. She was selected as the co-director of the annual postgraduate course for the AGA at Digestive Disease Week in 2000 and as the director for this course for 2017. She also has served on both the women’s committee and educa- tion committee of the American College of Gastroen- terology (ACG). She has prepared many educational products, including slide sets and problem-based learn- ing cases, and has edited a textbook in GI entitled Gas- trointestinal and Hepatobiliary Pathophysiology. She edited her second book on Constipation: A Practical Approach to Diagnosis and Treatment, which was pub- lished in 2014. In her role in medical education, Dr. Rose completed a 2-year term as co-chair of the Northeast Group on Educational Affairs (NEGEA) of the Association of American Medical Colleges (AAMC) and served as the chair of the group on educational affairs of the Associa- tion of American Medical Colleges. She has extensive Suzanne Rose, MD, MSEd, Associate Editor, was experience in curriculum development and was a leader Missale Solomon, MD, Associate Editor, is cur- appointed the senior associate dean for education at of the development of the clinical curriculum at Mount rently an assistant professor of medicine at Drexel the University of Connecticut School of Medicine in Sinai and now in leading curriculum reform at University College of Medicine. She is the director of 2011. Within 1 year of her arrival at UConn she was UCONN. Dr. Rose has been chosen as LEAD faculty nutrition and small bowel disorders in the division of able to successfully lead the institutional limited site for a leadership in academic medicine program of the gastroenterology and attending gastroenterologist in survey with the LCME, rectifying numerous issues, and AAMC. Dr. Rose was selected to receive the NEGEA the Drexel Adult Cystic Fibrosis Center. She received transforming the educational setting into a team-based distinguished service and leadership award in April her medical education at Jimma University in Ethiopia collaborative environment working together to move 2015 as the inaugural recipient. and later attended Drexel University College of Medi- forward an innovative curriculum reform project. Dr. Rose has presented at meetings of the AAMC, cine for her internal medicine residency and gastroen- Before her arrival at UConn, she served for 13 years at AGA, ACG, and American College of Physicians. terology fellowship. In 2014 she received the Nestle Mount Sinai School of Medicine in various leadership Topics of presentations have been diverse and include: nutrition clinical fellowship. She is also the recipient of capacities including associate dean for academic and leadership, mentoring, academic advancement, curricu- the Developing Innovative Gastroenterology Specialty student affairs, associate dean for continuing medical lum development, student professionalism, gastroen- Training (DIGEST) grant offered by the Cystic Fibro- education, and vice-chair for faculty affairs. She previ- terology education, as well as gastroenterology topics sis Foundation. Dr. Solomon’s clinical practice focuses ously held positions at Cornell University Medical related to health and disease in women and motility. on nutritional disorders related to gastrointestinal dys- College in New York City (1996-1997) as the director She is the author of many publications and scholarly function and gastrointestinal complications related to of motility and the second-year pathophysiology course. works in medical education and in GI disorders, and for cystic fibrosis. Her academic interests include of devel- She also was on faculty at the University of Pittsburgh these scholarly achievements she attained the rank of opment of nutrition-based curriculum, adopt protocols from 1990 to 1996, where she ran the second-year GI professor of medicine (and professor of medical educa- and standardize practices to aide in the training of course. She played leadership roles in the gastroenter- tion) with academic tenure while at Mount Sinai, future residents and fellows. Dr. Solomon and her ology (GI) fellowship programs at both Pittsburgh and and upon review again, was awarded this status at the husband Samson live in Marlton, New Jersey with their Cornell. University of Connecticut. two children. Dr. Rose’s clinical interests are in pelvic floor dys- Dr. Rose received her bachelor’s degree in Russian function and GI disorders in women. She has served language and literature from the University of Pennsyl- many leadership roles in GI organizations. She has been vania, followed by a master’s degree in education from an active participant in the American Gastroenterologi- Penn. She spent the summer of 1976 at Leningrad State cal Association (AGA) and was elected by her peers to University. She taught high school for 2 years and was a serve on the governing board of the AGA as education park ranger at the Grand Canyon before completing councilor. She will be a recipient of the AGA Distin- postbaccalaureate studies at Columbia University to guished Educator Award, 2016. This resulted in a pro- pursue a career in medicine. She graduated from Case posal for a new model of continuous professional Western University School of Medicine in Cleveland as development with flexible and adaptive learning tai- a member of Alpha Omega Alpha, and also did her lored to the individual needs of practitioners. She also internship and residency at Case. Her GI fellowship, convened all of the GI societies to create entrustable including her final year as the chief fellow, was done at professional Activities (EPAs) for GI fellowship train- The Cleveland Clinic. Dr. Rose credits her success to ing, which was published with Dr. Rose as the lead her wonderful family. She is managing her hectic, but author in the summer of 2014 in multiple journals. In always exciting, LAT (living apart together) life includ- addition to partnering to create the AGA academy of ing her mutual-commuting marriage to Rabbi Kenneth educators, the first subspecialty academy to foster A. Stern. She and her husband have two amazing grown teaching and educational scholarship, she is currently children, Zachary, an attorney, and Isadora, a profes- working on a future leaders program for the AGA. Prior sional in higher education administration. Personal roles in this organization include chair of the education interests include traveling, snorkeling, reading, and col- and training committee, member of future trends com- lecting turtles. mittee, GI teaching project committee, nominating THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS vii PREFACE The opportunity to continue to promote the extraor- complexity and integrated beauty of this fascinating from Temple University. Dr. Parkman brings a special dinary educational value of the exquisite art of Dr. organ system. The classic images Dr. Netter drew were new focus on the neurophysiology and electrical physi- Frank Netter in a state-of- the-art update of this classic preserved whenever possible and altered only as neces- ology of normal gastric function and disease. series has been an honor for me and my esteemed asso- sary. Dozens of modern radiographic and endoscopic I review common anatomic, physiologic, and clinical ciate editors. Netter’s images have brought insightful images have been added to all sections in all volumes. aspects of intestinal disorders in Section 1 of Part II. In value to students for over 6 decades and have now been The first section in both Parts I and II summarizes Section 2, Dr. Missale Solomon offers a beautifully updated and enhanced to benefit future generations of shared aspects of the digestive system. Each subsequent written treatment of normal and abnormal disorders of students. This updated edition of Digestive System has section is dedicated to a specific organ and reviews the primary digestive organ, the small intestine. In been rewritten and renewed to include cutting-edge normal anatomy and physiology, pathology, pathophys- Section 3, one of modern gastroenterology’s eminent science and state-of-the-art endoscopic, pathologic, and iology, and disease presentation and treatment. educators and Dean at the University of Connecticut, radiographic images, along with Netter’s ageless draw- Each section has been written by authors who were Suzi Rose, MD, discusses the colon. ings and images that provide insights that foster stu- chosen for their dedication to teaching the fascinating Part III reviews the normal physiology and patho- dents’ and practitioners’ understanding of the anatomy, aspects of the digestive system. I had the honor of physiology of the liver, biliary tract, and pancreas. physiology, and pathophysiology of all eight regions choosing incredibly distinguished associate editors with Grace Su, MD, a distinguished clinician and scientist that make up the fascinating and complex digestive whom I have had the pleasure of working throughout from the University of Michigan, has exquisitely system. my career. In each case they have published expertise updated the section on the liver in a way that will bring Frank Netter, MD, described by the Saturday Evening in their respective organ system and have demonstrated great insights into this, the largest solid organ in the Post as the “Michelangelo of Medicine,” continues to be their commitment to and skill in medical education. body. John Martin, MD, another premier physician an icon in medical education. The insightful imagery Their knowledge and insights bring updated scientific from the Mayo Clinic, provides wonderful modern of his medical illustrations provides value for students understanding of disease mechanisms and current treat- images of the biliary tract in Section 2, as well as at all levels of experience who seek insights into the ments that will convey understanding of the largest and descriptions of its many associated disorders. Section 3, structure and function of digestion in ways that few most complex organ system that is unparalleled by on pancreatic function and disease, is written by one of other texts have in the history of medical education. His other texts. In each section, Dr. Peter Ward updated the world’s premiere scientists and clinicians on pancre- vision for these texts—integrating factual information each of the subsections on normal anatomy and physiol- atology, Dr. David Whitcomb, chief of gastroenterol- with visual aids—provides unparalleled insights. While ogy. He has worked hard to preserve the original pic- ogy and hepatology at the University of Pittsburgh. born at the onset of the twentieth century, his back- tures of Dr. Netter while ensuring the accuracy of the I would like to express my gratitude for the talented ground mimics many modern medical students— text based on current terminology and science. and dedicated contributors to this wonderful update. beginning his education in the arts before becoming a In Part I of this three-part set I sought to provide First and foremost, thanks must be given to Dr. Netter scientist. By following his mother’s wishes to move insights and an overview of the upper digestive tract. posthumously for providing the initial version of this beyond art and into medicine, Frank Netter used his Michele Young, MD, associate chief of gastroenterology text and its wonderful illustrations. I especially want to passion and brush to communicate the science and the at the University of Arizona’s Veterans Administrative thank the associate editors and other contributing art of medicine in unparalleled ways. In distinction to Hospital in Phoenix, has written the first organ-focused authors. I also want to thank the amazing artists anatomy texts that offer images of structure only, chapter on the complex anatomy, physiology, and patho- who work with the publishers, Jim Perkins, Tiffany Netter’s paintings also brought incredible insights into physiology of pharyngeal and upper esophageal func- DaVanzo, Kristen Wienandt Marzejon, and especially the pathophysiology of disease. Just as important, in tions. New insights into imaging and physiologic Dr. Machado, for their talents and commitment to ways unsurpassed by any other text, he and his dedi- understanding of the complexities of swallowing are preserving the magnificent style and imagery of Dr. cated disciples have illustrated how patients are affected provided. David A. Katzka, MD, distinguished profes- Netter’s drawing. I want to thank my editors at Elsevier, by the suffering caused by disease. In all three of these sor of medicine at the Mayo Clinic, revised the section Marybeth Thiel and Elyse O’Grady, for their expertise, revised parts of Digestive System, new artists, committed on the esophagus, and is clearly one of the world’s patience, and support. Finally, I want to thank my to the style and value of Dr. Netter’s illustrations and authorities on the topic. New insights into diseases that loving wife for more than 4 decades of unwavering led by Carlos Machado, MD, have modernized both the are common today but were not known at the time of support of my efforts to make contributions to the field science and the art of his illustrations in all aspects of the first edition, including Barrett’s esophagus and of gastroenterology, which never ceases to fascinate and the digestive system. eosinophilic esophagus, are beautifully illustrated and challenge me. This update of the digestive system’s anatomy and discussed. Part I closes with a section by Henry Parkman, disease has taken a new approach to communicate the MD, a renowned gastric physiologist and physician James C. Reynolds, MD viii THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS Introduction to the First Edition ADVISORY BOARD Julio C. Bai, MD Juan Andrés de Paula, MD David Rubin, MD Chair of Gastroenterology Chief of the Intestinal Diseases Section Joseph B. Kirsner Professor of Medicine University of El Salvador Gastrointestinal Division Section Chief, Gastroenterology, Hepatology, Hospital de Gastroenterología Dr. Carlos Bonorino Hospital Italiano de Buenos Aires and Nutrition Udaondo Associate Professor of Medicine and Physiology Co-Director, Digestive Diseases Center Buenos Aires, Argentina University Institute Hospital Italiano de Buenos Aires University of Chicago Medicine and Duchossois Buenos Aires, Argentina Center for Advanced Medicine Brian P. Bosworth, MD Chicago, Illinois Associate Professor of Medicine Janusz A. Jankowski, MD, PhD Director, Gastroenterology Fellowship Program Consultant Physician Peter D. Siersema, MD, PhD Weill Cornell Medical College University Hospitals of Coventry and Warwickshire Professor of Gastroenterology New York Presbyterian Hospital Honorary Professor Head, Department of Gastroenterology New York, New York Warwick Medical School, University of Warwick and Hepatology Coventry, United Kingdom University Medical Center Utrecht Marcia Cruz-Correa, MD, PhD Utrecht, The Netherlands Associate Professor of Medicine and Biochemistry University of Puerto Rico Director, Gastrointestinal Oncology Program University of Puerto Rico Cancer Center San Juan, Puerto Rico x THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS CONTRIBUTORS EDITOR Reena V. Chokshi, MD Ajish Pillai, MD Assistant Professor of Medicine Gastroenterology Fellow James C. Reynolds, MD Division of Gastroenterology, Hepatology, and Drexel University College of Medicine June F. Klinghoffer Distinguished Professor Nutrition Philadelphia, Pennsylvania and Chair The University of Texas Health Science Center at Plates 2-44, 2-46 Department of Medicine Houston Drexel University College of Medicine Houston, Texas Christopher Steele, MD, MPH, MS Philadelphia, Pennsylvania Plate 3-76 (imaging) Resident, Osler Medical Training Program Plates 1-11–1-22, 1-24–1-26 The Johns Hopkins University School of Medicine Kevin D. Dieckhaus, MD, FIDSA Baltimore, Maryland SENIOR ASSOCIATE EDITOR Associate Professor of Medicine Plates 3-20, 3-21, 3-23, 3-61, 3-73–3-85 Chief, Division of Infectious Diseases Peter J. Ward, PhD Director of Global Heath and International Studies Christina E. Stevenson, MD, FACS Associate Professor of Anatomy University of Connecticut School of Medicine Assistant Professor of Surgery Department of Biomedical Sciences Farmington, Connecticut University of Connecticut School of Medicine West Virginia School of Osteopathic Medicine Plates 3-45–3-59 Farmington, Connecticut Lewisburg, West Virginia Plates 3-30–3-34, 3-36–3-44, 3-69–3-72, 3-86, Plates 1-1–1-10, 2-1–2-7, 3-1–3-19 Faripour Forouhar, MD 3-89–3-93 Professor and Emeritus Chief ASSOCIATE EDITORS Anatomic Pathology Department Savanna Thor, MD University of Connecticut School of Medicine Gastroenterology Fellow Suzanne Rose, MD, MSEd Farmington, Connecticut Drexel University College of Medicine Professor of Medicine Plates 3-62, 3-66, 3-88 (pathology) Philadelphia, Pennsylvania Senior Associate Dean for Education Plate 2-44 University of Connecticut School of Medicine John R. Harrison, PhD Farmington, Connecticut Associate Professor Haleh Vaziri, MD Plates 3-20–3-95 Director, Human and Virtual Anatomy Laboratories Assistant Professor of Medicine Department of Craniofacial Sciences Director of Inflammatory Bowel Disease Center Missale Solomon, MD University of Connecticut School of Medicine and Division of Gastroenterology Assistant Professor of Medicine School of Dental Medicine University of Connecticut School of Medicine Director, Nutrition and Small Bowel Disorders Farmington, Connecticut Farmington, Connecticut Drexel University College of Medicine Plates 3-24–3-29 Plates 3-22, 3-35, 3-60, 3-62–3-68, 3-87, 3-88, 3-94, Philadelphia, Pennsylvania 3-95 Plates 2-8–2-33, 2-48–2-76, 2-78–2-83 Marco Molina, MD Assistant Professor of Radiology Tobias Zuchelli, MD CONTRIBUTORS Section Head of Abdominal Imaging and Ultrasound Gastroenterology Fellow Department of Radiology Drexel University College of Medicine Eva Alsheik, MD University of Connecticut School of Medicine Philadelphia, Pennsylvania Assistant Professor of Medicine Farmington, Connecticut Plates 2-78–2-82 Division of Gastroenterology Plates 3-87 (imaging) Drexel University College of Medicine Hahnemann University Hospital Neilanjan Nandi, MD Philadelphia, Pennsylvania Assistant Professor of Medicine Plates 2-8, 2-9, 2-78–2-82 Associate Program Director Division of Gastroenterology Rosemarie Arena, MD Drexel University College of Medicine Gastroenterology Fellow Hahnemann University Hospital Drexel University College of Medicine Philadelphia, Pennsylvania Philadelphia, Pennsylvania Plates 2-34–2-47, 2-77 Plate 1-23 THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS xi SECTION 1 OVERVIEW OF LOWER DIGESTIVE TRACT