Principles of Clinical Gastroenterology E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 2471

Veröffentlichungsjahr: 2011

Beschreibung

A Concise, Symptom-Based Textbook for Diagnosis and Decision Making in Clinical Practice Over the past twenty years, thousands of physicians have come to depend on Yamada's Textbook of Gastroenterology. Its encyclopaedic discussion of the basic science underlying gastrointestinal and liver diseases as well as the many diagnostic and therapeutic modalities available to the patients who suffer from them was--and still is--beyond compare. This new textbook, Principles of Clinical Gastroenterology, is designed to inform practitioners on the features of the major clinical disorders in gastroenterology and hepatology from the point of view of the clinician observing signs and symptoms of a patient under care and management. It is a practical guide to diagnosis and decision making in clinical practice and provides a rich source of information on diseases of the gastrointestinal tract and liver. Covering the full range of examinations in gastroenterology and hepatology, with extremely timely chapters on patients with dyspepsia, eating disorders, jaundice, hepatitis, cirrhosis, and on screening, Principles of Clinical Gastroenterology gives you easy access to approaches that a clinician might take to common symptoms and signs presented by patients with such disorders. The chapters include the epidemiology, history, signs and symptoms, diagnosis, treatment, and prognosis of the most commonly encountered disorders in gastroenterology and hepatology. This textbook will be an invaluable resource whether you are a gastroenterologist, internist, surgeon, or other clinician who sees patients with gastrointestinal and liver disorders. It should be kept close at hand for frequent consultation.

Leseprobe

Contributors

Preface

1 Clinical decision making

What is evidence-based medicine?

Critical appraisal of an article about a diagnostic test

Critical appraisal of an article about a therapy

Conclusions

2 Economic analysis in the diagnosis and treatment of gastrointestinal diseases

Forms of economic analysis

Costs

Evidence-based approach to economic studies

Are the results valid?

What are the results?

Will the results help in caring for my patients?

Conclusions

3 Psychosocial factors in the care of patients with functional gastrointestinal disorders

A neurobiological model of functional gastrointestinal disorders and how it relates to symptoms, in particular the psychological and psychiatric aspects of the disorders

Centrally targeted pharmacotherapeutic approaches

Summary of empirically validated psychological treatments

Future development of integrated pharmacological and cognitive-behavioral approaches

Practical advice on how to recognize psychological and psychiatric aspects of patients, with a focus on somatization, anxiety, and depression

Proposed algorithm for management of functional gastrointestinal disorders

4 Approach to the patient with dyspepsia and related functional gastrointestinal complaints

Clinical presentation of dyspepsia

Dyspepsia in the general population and clinical practice

Causes of dyspepsia

Pathogenesis of functional dyspepsia

Diagnostic approach to the patient with uninvestigated dyspepsia

Management strategies

Prognosis

5 Approach to the patient with dysphagia, odynophagia, or noncardiac chest pain

Symptom definitions

Approach to the patient with dysphagia

The medical history and physical examination of the patient with dysphagia

Approach to the patient with oropharyngeal dysphagia

Approach to the patient with esophageal dysphagia

Symptomatic treatment of dysphagia

Approach to the patient with odynophagia

Approach to the patient with noncardiac chest pain

6 Approach to the patient with gastroesophageal reflux disease

Clinical manifestations

Diagnostic evaluation

Differential diagnosis

Clinical course

Medical and surgical therapy

7 Approach to the patient with dyspepsia and peptic ulcer disease

Cliinical presentation and diagnosis of peptic ulcer

Natural history of peptic ulcer

Antiulcer pharmacology

Medical treatment of active peptic ulcer disease

8 Approach to the patient with gross gastrointestinal bleeding

Clinical presentation

Acute upper gastrointestinal bleeding

Acute lower gastrointestinal bleeding

Obscure gastrointestinal bleeding

9 Approach to the patient with occult gastrointestinal bleeding

Quantifying blood loss

Gastrointestinal hemoglobin metabolism

Iron metabolism and deficiency

Etiology of blood loss

Clinical manifestations of blood loss

Assessment and diagnostic strategies

Fecal blood screening for colorectal neoplasia

Therapeutic considerations

10 Approach to screening for colorectal cancer

Goals of screening

The contexts of screening

The nature of screening

The nature of screening tests

Evidence of effectiveness

Recent developments in screening tests

Other considerations in screening practice

Conclusions

11 Approach to the patient with unintentional weight loss

Etiology

Diagnosis

Treatment and prognosis

12 Approach to the patient with obesity

Regulation of energy storage, intake, and expenditure

History and physical examination

Gastrointestinal complications of obesity

Systemic complications of obesity

Treatment of obesity

Complications of weight loss

Conclusions

13 Approach to the patient with nausea and vomiting

Definitions

Socioeconomic impacts of nausea and vomiting

Pathophysiology of nausea and vomiting

Causes of nausea and vomiting

History and physical examination

Laboratory studies and diagnostic testing

Principles of management

14 Approach to the patient with abdominal pain

Background and importance

The neurobiology of pain

Clinical assessment of the patient with abdominal pain

Approach to the treatment of abdominal pain

Conclusions

15 Approach to the patient with gas and bloating

Normal physiology

Clinical syndromes

Pathogenesis of gas and bloating

Evaluation of the patient with gas and bloating

Principles of management

16 Approach to the patient with acute abdomen

Neuroanatomy of abdominal pain

Associated gastrointestinal symptoms

History

Physical examination

Confounding factors

Deciding whether to operate

Causes of acute abdomen in adults

17 Approach to the patient with ileus and obstruction

Epidemiology

Pathophysiology

Changes in motility

Changes in lumenal content

Epithelial changes

Changes in blood flow

Metabolic and systemic consequences

Clinical manifestation

History

Physical findings

Differential diagnosis

Laboratory tests

Radiology

Endoscopy

Motility studies

Therapeutic considerations

Intestinal decompression

Surgical approach

Endoscopic therapy

Pharmacotherapy

18 Approach to the patient with diarrhea

General epidemiology

General definition

Pathophysiology of diarrhea

Acute diarrheas: definition

Acute infectious diarrheas

Prolonged infectious diarrheas

Nosocomial diarrheas

Runner’s diarrhea

Chronic diarrheas: definition, classification, and epidemiology

Steatorrhea (malabsorptive diseases)

Watery diarrheas

True secretory diarrheas

Inflammatory diarrheas

Clinical evaluation of chronic diarrhea

Antidiarrheal therapy

19 Approach to the patient with suspected acute infectious diarrhea

Definitions

Epidemiology

Etiology and microbiology

Clinical features (Tables 19.2 and 19.3)

Diagnostic evaluation

Treatment

20 Approach to the patient with constipation

Epidemiology

Psychological distress, abuse, and impact on quality of life

Definition

Etiology, subtypes, and pathophysiology of chronic constipation

Clinical evaluation of chronic constipation

Treatment of chronic constipation

Complications of constipation

21 Approach to the patient with abnormal liver chemistries

Clinical evaluation

Hepatic function tests

Serum markers of hepatobiliary dysfunction

Disease-specific markers

A general approach to suspected liver disease

22 Approach to the patient with jaundice

Bilirubin

Hyperbilirubinemia

Approach to the patient with jaundice

Diagnostic approach

Complications of cholestasis

23 Approach to the patient with ascites and its complications

The patient with suspected ascites

The patient with new-onset ascites

The patient with cirrhosis and ascites

The patient with cirrhosis and hepatic hydrothorax

The patient with spontaneous bacterial peritonitis

The patient with cirrhosis and acute renal failure

The patient with hepatorenal syndrome

24 Approach to the patient with central nervous system and pulmonary complications of end-stage liver disease

Hepatic encephalopathy

Hepatopulmonary syndrome

Portopulmonary hypertension

25 Approach to the patient with acute liver failure

Definitions

Incidence and demographics

Etiology

Clinical presentation and complications

Prognosis in acute liver failure

Management of acute liver failure

Liver transplantation

Investigational surgical approaches

Artificial and bioartificial liver devices

26 Approach to the patient with chronic viral hepatitis B or C

Hepatitis B

Hepatitis C

27 Approach to the patient with a liver mass

Basic approach to the liver mass

Hepatic hemangioma

Focal nodular hyperplasia

Hepatic adenoma

Nodular regenerative hyperplasia

Biliary cystadenoma

Focal fatty change

Regenerative and dysplastic nodules

Summary

28 Approach to gastrointestinal and liver diseases in pregnancy

Common gastrointestinal complaints in pregnancy

Chronic gastrointestinal diseases in pregnancy

Gastrointestinal endoscopy during pregnancy

Hepatobiliary diseases during pregnancy

Infectious hepatitis and pregnancy

29 General nutritional principles

Basic nutritional principles

Altered nutritional states

30 Approach to the patient requiring nutritional supplementation

Nutritional assessment

Choosing the route for nutritional support

Enteral nutrition

Parenteral nutrition

Nutritional support in the hospitalized patient with gastrointestinal disease

Micronutrient deficiency and treatment

31 Genetic counseling for gastrointestinal patients

Principles of genetics

Genetic testing and counseling

Genetic tools and technologies

Summary and conclusions

Index

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Library of Congress Cataloguing-in-Publication Data

Principles of clinical gastroenterology / edited by Tadataka Yamada; associate editors, David H. Alpers . .. [et al.]. p.; cm.

Includes bibliographical references and index.

ISBN 978-1-4051-6910-3

1. Gastrointestinal system—Diseases. 2. Liver—Diseases. 3. Gastroenterology. I. Yamada, Tadataka. II. Alpers, David H.

[DNLM: 1. Gastrointestinal Diseases. 2. Liver Diseases. WI140 P957 2008] RC801.P753 2008 616.3’3—dc22

2008000954

ISBN: 978-1-4051-6910-3

Contributors

David A. Ahlquist, MD

Professor of Medicine

Mayo Clinic College of Medicine;

Consultant, Division of Gastroenterology

and Hepatology

Mayo Clinic

Rochester, Minnesota, USA

James E. Allison, MD, FACP, AGAF

Clinical Professor of Medicine Emeritus

University of California, San Francisco;

Division of Gastroenterology

San Francisco General Hospital;

Adjunct Investigator, Kaiser Division of Research

San Francisco, California, USA

Anthony J. Bauer, PhD

Associate Professor of Medicine

Division of Gastroenterology

University of Pittsburgh

Pittsburgh, Pennsylvania, USA

Klaus Bielefeldt, MD, PhD

Associate Professor of Medicine

Division of Gastroenterology

University of Pittsburgh

Pittsburgh, Pennsylvania, USA

Andres T. Blei, MD

Professor of Medicine

Division of Hepatology

Feinberg School of Medicine

Northwestern University

Chicago, Illinois, USA

Randall W. Burt, MD

Professor of Medicine

Division of Gastroenterology

University of Utah School of Medicine;

Senior Director for Prevention and Outreach

Huntsman Cancer Institute

University of Utah

Salt Lake City, Utah, USA

Roger F. Butterworth, PhD, DSC

Director, Neuroscience Research Unit

Hôpital Saint-Luc

University of Montreal

Montreal, Quebec, Canada

Louis A. Chaptini, MD

Assistant Professor of Medicine

Division of Gastroenterology and Liver Diseases

Cooper University Hospital

Robert Wood Johnson Medical School

University of Medicine and Dentistry of New Jersey

Camden, New Jersey, USA

Ray E. Clouse, MD

Professor of Medicine and Psychiatry

Late of Division of Gastroenterology

Washington University School of Medicine;

Physician, late of Department of Medicine

Barnes-Jewish Hospital

St Louis, Missouri, USA

John A. Donovan, MD

Assistant Professor of Clinical Medicine

Division of Gastrointestinal and Liver Diseases

Keck School of Medicine

University of Southern California

Los Angeles, California, USA

Andrew W. DuPont, MD, MSPH

Assistant Professor, Internal Medicine

Division of Gastroenterology and Hepatology

The University of Texas Medical Branch

Galveston, Texas, USA

Grace H. Elta, MD

Professor

Department of Internal Medicine

Division of Gastroenterology

University of Michigan Health System

Ann Arbor, Michigan, USA

Robert J. Fontana, MD

Associate Professor

Department of Internal Medicine

Division of Gastroenterology

University of Michigan Health System

Ann Arbor, Michigan, USA

Guadalupe Garcia-Tsao, MD

Professor of Medicine

Section of Digestive Diseases

Yale School of Medicine

New Haven, Connecticut;

Veterans Affairs Connecticut Healthcare System

West Haven, Connecticut, USA

Ralph A. Giannella, MD

Mark Brown Professor of Medicine

Division of Digestive Diseases

University of Cincinnati College of Medicine

Cincinnati, Ohio, USA

David Y. Graham, MD

Professor of Medicine and Molecular Virology

and Microbiology

Michael E. DeBakey Veterans Affairs Medical

Center

Baylor College of Medicine

Houston, Texas, USA

Edward G. Grant, MD

Professor and Chair

Department of Radiology

Keck School of Medicine

University of Southern California

Los Angeles, California, USA

Chandra Prakash Gyawali, MD, MRCP

Associate Professor of Medicine

Associate Program Director

Division of Gastroenterology

Washington University School of Medicine

St Louis, Missouri, USA

William L. Hasler, MD

Professor

Department of Internal Medicine

Division of Gastroenterology

University of Michigan Health System

Ann Arbor, Michigan, USA

Gerald Holtmann, MD, PhD

Professor of Medicine

University of Adelaide;

Director, Department of Gastroenterology

and Hepatology

Royal Adelaide Hospital

Adelaide, South Australia, Australia

Willemijntje A. Hoogerwerf, MD

Assistant Professor

Department of Internal Medicine

Division of Gastroenterology

University of Michigan Health System

Ann Arbor, Michigan, USA

John M. Inadomi, MD

Dean M. Craig Endowed Chair in

Gastrointestinal Medicine

Director, GI Health Outcomes, Policy and

Economics (HOPE) Research Program

University of California, San Francisco;

Chief, Clinical Gastroenterology

San Francisco General Hospital

San Francisco, California, USA

Samuel Klein, MD

William H. Danforth Professor of Medicine and

Nutritional Science

Center for Human Nutrition

Washington University School of Medicine

St Louis, Missouri, USA

Jeffrey M. Lackner, PsyD

Assistant Professor

University at Buffalo

The State University of New York

Buffalo, New York, USA

John D. Long, MD

Associate Professor of Medicine

Section on Gastroenterology

Wake Forest University School of Medicine

Winston-Salem, North Carolina, USA

Emeran A. Mayer, MD

UCLA Center for Neurovisceral Sciences and

Women’s Health

David Geffen School of Medicine

University of California, Los Angeles

Los Angeles, California, USA

Raphael B. Merriman, MD, MRCPI

Assistant Professor of Medicine

Division of Gastroenterology

University of California, San Francisco

San Francisco, California, USA

Rebecca M. Minter, MD

Assistant Professor

Department of Surgery

University of Michigan Health System

Ann Arbor, Michigan, USA

Richard H. Moseley, MD

Professor

Department of Internal Medicine

Division of Gastroenterology

University of Michigan Health System;

Chief, Medical Service

Veterans Affairs Ann Arbor

Healthcare System

Ann Arbor, Michigan, USA

Michael W. Mulholland, MD, PhD

Professor and Chair

Department of Surgery

University of Michigan Health System

Ann Arbor, Michigan, USA

Bruce D. Naliboff, PhD

UCLA Center for Neurovisceral Sciences and

Women’s Health

David Geffen School of Medicine

University of California, Los Angeles

Los Angeles, California, USA

Deborah W. Neklason, PhD

Research Assistant Professor

Department of Oncological Sciences

Huntsman Cancer Institute

University of Utah

Salt Lake City, Utah, USA

Pankaj Jay Pasricha, MD

Professor of Medicine

Chief, Division of Gastroenterology

and Hepatology

Stanford University School of Medicine

Stanford, California, USA

Steven R. Peikin, MD

Professor of Medicine

Division of Gastroenterology and Liver Diseases

Cooper University Hospital

Robert Wood Johnson Medical School

University of Medicine and Dentistry of New Jersey

Camden, New Jersey, USA

Marion G. Peters, MD

John V. Carbone, MD, Endowed Chair in Medicine

Division of Gastroenterology

University of California, San Francisco

San Francisco, California, USA

Satish S.C. Rao, MD, PhD, FRCP

Professor of Medicine

Director, Neurogastroenterology and

Gastrointestinal Motility

University of Iowa Carver College of Medicine

Iowa City, Iowa, USA

Joel E. Richter, MD

Richard L. Evans Chair and Professor

Department of Medicine

Temple University School of Medicine

Philadelphia, Pennsylvania, USA

Hugo Rosen, MD, FACP

Waterman Professor of Medicine and Immunology

Endowed Chair in Liver Research

Division Head, Gastroenterology and Hepatology

University of Colorado Health Sciences Center

Aurora, Colorado, USA

Sammy Saab, MD, MPH

Head, Outcomes Research in Hepatology

Associate Professor of Medicine and Surgery

David Geffen School of Medicine

University of California, Los Angeles

Los Angeles, California, USA

Philip S. Schoenfeld, MD, MSEd,

MSc(Epi)

Associate Professor

Department of Internal Medicine

Division of Gastroenterology;

Director, Training Program in Gastrointestinal

Epidemiology

University of Michigan Health System

Ann Arbor, Michigan, USA

Angela Schwab, MS, CGC

Cardiovascular Research Manager

Intermountain Healthcare

Salt Lake City, Utah, USA

Andrew H. Soll, MD

Professor, David Geffen School of Medicine

University of California, Los Angeles;

Attending Physician, Veterans Affairs Greater

Los Angeles Healthcare System

Los Angeles, California, USA

Cindy Solomon, MS, CGC

MELARIS Product Manager

Myriad Genetic Laboratories

Salt Lake City, Utah, USA

Mimi Takami, MD

Assistant Professor

Department of Internal Medicine

Division of Gastroenterology

University of Michigan Health System

Ann Arbor, Michigan, USA

Nicholas J. Talley, MD, PhD

Chair, Department of Internal Medicine

Mayo Clinic Jacksonville

Jacksonville, Florida;

Professor of Medicine and Epidemiology

Consultant, Division of Gastroenterology

and Hepatology

Mayo Clinic College of Medicine

Rochester, Minnesota, USA

Beth Taylor, MS, RD, CNSD

Nutrition Support Specialist

Barnes-Jewish Hospital

St Louis, Missouri, USA

Ryan M. Taylor, MD, MSC

Fellow

Department of Internal Medicine

Division of Gastroenterology

University of Michigan Health System

Ann Arbor, Michigan, USA

Javier Vaquero, MD

Postdoctoral Research Fellow

Neuroscience Research Unit

Hôpital Saint-Luc

University of Montreal

Montreal, Quebec, Canada

Graeme P. Young, MD, FRACP

Professor of Gastroenterology

Department of Medicine

Flinders University of South Australia;

Director, Department of Gastroenterology

Flinders Medical Centre

Adelaide, South Australia, Australia

Preface

The Textbook of Gastroenterology was launched over 20 years ago, and from the beginning it was designed to be an encyclo pedic discussion of all of the disease states encountered in clinical practice by gastroenterologists, internists, surgeons, and other clinicians who see patients with gastrointestinal and liver disorders. A major component of the Textbook was a section that described the approaches a clinician might take to common symptoms and signs presented by patients with such disorders. This section has proved to be an invaluable resource for students, house officers, and practitioners who are not primarily gastroenterologists. To meet the needs of these readers more effectively we have expanded on the con cept embodied in the chapters comprising that section of the Textbook and formatted them into a separate textbook in its own right, which we have titled Principles of Clinical Gastroenterology. It is designed to inform the reader on the fea tures of the major clinical disorders in gastroenterology and hepatology, from the point of view of the clinician observing signs and symptoms of a patient under care and manage ment. We hope that the Principles will be a practical guide to diagnosis and decision making in clinical practice and pro vide a rich source of information on diseases of the gastroin testinal tract and the liver. Of course, we refer the reader of the Principles to the Textbook for in-depth discussion of the basic science underlying these diseases, as well as the many diagnostic and therapeutic modalities available to the patients who suffer from them.

We are delighted to have a new publisher, Wiley-Blackwell, for this edition. Their keen insight into the publishing indus try and the way in which textbooks are utilized today has been the basis for creating the Principles. We are also grateful for their knowledge of the international world of medicine, which will help us to distribute the contents of the Principles to a global audience. The editors would like especially to thank Elisabeth Dodds at Wiley-Blackwell, whose commit ment to excellence has contributed materially to the quality of the book. In addition, without the assistance of Alison Brown the Principles would not have been published.

Our efforts were especially facilitated by the expert assis tance of Lori Ennis and Barbara Boughen, who collaborated as a team complementing editorial talents with interpersonal skills, to maintain the high quality of the text and deliver the manuscripts in a timely fashion. The editors are indebted to their administrative and secretarial assistants, Patricia Lai, Terri Astin, Jennifer Mayes, Sue Sparrow, Patty Poole, Gracie Bernal-Muñoz, and Maria L. Vidrio.

Tadataka Yamada, MD