Atlas of Gastroenterology Atlas of Gastroenterology, 4th Edition, Edited by Tadataka Yamada © 2009 Blackwell Publishing Ltd. ISBN: 978-1-405-16909-7 Atlas of Gastroenterology EDITED BY Fourth Edition Tadataka Yamada, MD President, Global Health Program Bill & Melinda Gates Foundation Seattle, Washington; Adjunct Professor Department of Internal Medicine Division of Gastroenterology University of Michigan Health System Ann Arbor, Michigan, USA ASSOCIATE EDITORS David H. Alpers, MD William B. Kountz Professor of Medicine Department of Internal Medicine Division of Gastroenterology Washington University School of Medicine St Louis, Missouri, USA Anthony N. Kalloo, MD Professor of Medicine Johns Hopkins University School of Medicine; Director, Division of Gastroenterology and Hepatology Johns Hopkins Hospital Baltimore, Maryland, USA Neil Kaplowitz, MD Thomas H. Brem Chair, Professor of Medicine, Chief Division of Gastrointestinal and Liver Diseases Director, Liver Disease Research Center Keck School of Medicine University of Southern California Los Angeles, California, USA Chung Owyang, MD Professor of Internal Medicine H. Marvin Pollard Collegiate Professor and Chief Division of Gastroenterology University of Michigan Health System Ann Arbor, Michigan, USA Don W. Powell, MD The Bassel and Frances Blanton Distinguished Professor of Internal Medicine Professor, Neuroscience and Cell Biology Program Director, General Clinical Research Center Director, Division of Gastroenterology and Hepatology The University of Texas Medical Branch Galveston, Texas, USA A John Wiley & Sons, Ltd., Publication This edition fi rst published 2009, © 2009 by Blackwell Publishing Ltd Blackwell Publishing was acquired by John Wiley & Sons in February 2007. 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No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom. Library of Congress Cataloging-in-Publication Data Atlas of gastroenterology / edited by Tadataka Yamada ; associate editors, David H. Alpers . . . [et al.]. – 4th ed. p. ; cm. Includes bibliographical references and index. ISBN 978-1-4051-6909-7 (alk. paper) 1. Gastroenterology–Atlases. 2. Gastrointestinal system–Diseases–Atlases. I. Yamada, Tadataka. II. Alpers, David H. [DNLM: 1. Gastrointestinal Diseases–Atlases. WI 17 A87916 2009] RC801.T48 2009 Suppl. 616.3′300222–dc22 2008040926 A catalogue record for this book is available from the British Library. Set in 9/12 pt Meridien by SNP Best-set Typesetter Ltd., Hong Kong Printed in Singapore by Fabulous Printers Pte Ltd 1 2009 v Contents Contributors, ix Preface, xvii PART 1 Principles of clinical gastroenterology 1 Approach to the patient with gross gastrointestinal bleeding, 1 Grace H. Elta, Mimi Takami 2 Approach to the patient with occult gastrointestinal bleeding, 10 David A. Ahlquist 3 Approach to the patient with acute abdomen, 21 Rebecca M. Minter, Michael W. Mulholland 4 Approach to the patient with ileus and obstruction, 27 Klaus Bielefeldt 5 Approach to the patient with diarrhea, 34 Don W. Powell 6 Approach to the patient with suspected acute infectious diarrhea, 56 John D. Long, Ralph A. Giannella 7 Approach to the patient with constipation, 71 Satish S.C. Rao 8 Approach to the patient with abnormal liver chemistries, 84 Richard H. Moseley 9 Approach to the patient with jaundice, 92 Janak N. Shah, Raphael B. Merriman, Marion G. Peters 10 Approach to the patient with ascites and its complications, 103 Guadalupe Garcia-Tsao 11 Approach to the patient with acute liver failure, 114 Ryan M. Taylor, Christopher P. Golembeski, Robert J. Fontana 12 Approach to the patient with chronic viral hepatitis B or C, 136 Sammy Saab, Hugo Rosen 13 Approach to the patient with a liver mass, 144 John A. Donovan, Edward G. Grant, Gary C. Kanel PART 2 Gastrointestinal diseases A Esophagus 14 Esophagus: anatomy and developmental and structural anomalies, 152 Ikuo Hirano 15 Motility disorders of the esophagus, 160 Ikuo Hirano, Peter J. Kahrilas 16 Gastroesophageal refl ux disease, 178 Joel E. Richter 17 Esophageal infections and disorders associated with acquired immunodefi ciency syndrome, 188 C. Mel Wilcox 18 Esophageal neoplasms, 196 Anil K. Rustgi, Weijing Sun 19 Miscellaneous diseases of the esophagus: foreign bodies, physical injury, systemic and dermatological diseases, 205 Evan S. Dellon, Nicholas J. Shaheen B Stomach 20 Stomach and duodenum: anatomy and structural anomalies, 220 Jean-Pierre Raufman, Eric Goldberg 21 Disorders of gastric emptying, 228 Henry P. Parkman, Frank K. Friedenberg, Robert S. Fisher 22 Peptic ulcer disease, 237 David Y. Graham, Akira Horiuchi, Mototsugu Kato Contents vi 23 Gastritis and gastropathy, 251 David Y. Graham, Robert M. Genta 24 Tumors of the stomach, 261 Wai K. Leung, Enders K.W. Ng, Joseph J.Y. Sung 25 Surgery for peptic ulcer disease and postgastrectomy syndromes, 276 Robert E. Glasgow, Sean J. Mulvihill 26 Miscellaneous diseases of the stomach, 283 John C. Rabine, Timothy T. Nostrant C Small intestine 27 Small intestine: anatomy and structural anomalies, 289 Deborah C. Rubin, Jacob C. Langer 28 Dysmotility of the small intestine and colon, 295 Michael Camilleri, Silvia Delgado-Aros 29 Bacterial, viral, and toxic causes of diarrhea, gastroenteritis, and anorectal infections, 311 Gail A. Hecht, Jerrold R. Turner, Phillip I. Tarr 30 Chronic infections of the small intestine, 318 George T. Fantry, Lori E. Fantry, Stephen P. James, David H. Alpers 31 Celiac disease, 327 Peter H.R. Green, Anne R. Lee 32 Disorders of epithelial transport in the small intestine, 335 Richard J. Grand, Mark L. Lloyd, Ward A. Olsen 33 Short bowel syndrome, 340 Richard N. Fedorak, Leah M. Gramlich, Lana Bistritz 34 Tumors of the small intestine, 358 Robert S. Bresalier 35 Miscellaneous diseases of the small intestine, 374 C. Prakash Gyawali, Marc S. Levin D Colon (for colonic infections see Chapter 29) 36 Colon: anatomy and structural anomalies, 384 Steven M. Cohn, Elisa H. Birnbaum 37 Infl ammatory bowel disease, 389 William F. Stenson, William J. Tremaine, Russell D. Cohen 38 Miscellaneous infl ammatory and structural disorders of the colon, 409 David H. Alpers, David H.B. Cort 39 Diverticular disease of the colon, 415 Tonia M. Young-Fadok, Michael G. Sarr 40 Neoplastic and nonneoplastic polyps of the colon and rectum, 423 Graeme P. Young, Finlay A. Macrae, Anthony C. Thomas 41 Polyposis syndromes, 449 Randall W. Burt, Russell F. Jacoby 42 Malignant tumors of the colon, 465 David H. Alpers, Francis M. Giardiello 43 Anorectal diseases, 491 Adil E. Bharucha, Arnold Wald E Pancreas 44 Pancreas: anatomy and structural anomalies, 508 David G. Heidt, Michael W. Mulholland, Diane M. Simeone 45 Acute pancreatitis, 514 Anil B. Nagar, Stephen J. Pandol 46 Chronic pancreatitis, 534 Chung Owyang, Cyrus Piraka 47 Nonendocrine tumors of the pancreas, 544 James J. Farrell, Howard A. Reber 48 Endocrine neoplasms of the pancreas, 554 Robert T. Jensen, Jeffrey A. Norton 49 Hereditary diseases of the pancreas, 566 Carlos G. Micames, Jonathan A. Cohn F Gallbladder and biliary tract 50 Gallbladder and biliary tract: anatomy and structural anomalies, 573 Theodore H. Welling, Diane M. Simeone 51 Gallstones, 582 Cynthia W. Ko, Sum P. Lee 52 Primary sclerosing cholangitis and other cholangiopathies, 592 Russell H. Wiesner, Kymberly D.S. Watt 53 Cystic diseases of the liver and biliary tract, 599 Albert J. Chang, Jung W. Suh, Shelly C. Lu 54 Tumors of the biliary tract, 606 Joseph J.Y. Sung, Yuk Tong Lee G Liver 55 Liver: anatomy, microscopic structure, and cell types, 615 Gary C. Kanel 56 Acute viral hepatitis, 623 Marc G. Ghany, T. Jake Liang 57 Chronic hepatitis B viral infection, 636 Robert G. Gish Contents vii 58 Hepatitis C virus infection, 642 Aijaz Ahmed, Emmet B. Keeffe 59 Drug-induced liver disease, 648 Frank V. Schiødt, William M. Lee 60 Autoimmune hepatitis, 656 E. Jenny Heathcote 61 Primary biliary cirrhosis, 660 Marlyn J. Mayo, Dwain L. Thiele 62 Hemochromatosis, 668 Jacob Alexander, Kris V. Kowdley 63 Metabolic diseases of the liver, 676 Ronald J. Sokol, Mark A. Lovell 64 Alcoholic liver diseases, 680 Suthat Liangpunsakul, David W. Crabb 65 Nonalcoholic fatty liver disease, 687 Arun J. Sanyal, Onpan Cheung 66 Central nervous system and pulmonary complications of end-stage liver disease, 698 Javier Vaquero, Andres T. Blei, Roger F. Butterworth 67 Liver transplantation, 711 Francis Y.K. Yao, Nathan M. Bass 68 Hepatocellular carcinoma, 720 Lewis R. Roberts 69 Liver abscess, 728 David S. Raiford 70 Vascular diseases of the liver, 731 Laurie D. DeLeve, Gary C. Kanel 71 Liver biopsy and histopathological diagnosis, 736 Sugantha Govindarajan H Abdominal cavity 72 Abdominal cavity: anatomy, structural anomalies, and hernias, 755 Sareh Parangi, Richard A. Hodin 73 Intraabdominal abscesses and fi stulas, 764 Paul Knechtges, Ellen M. Zimmermann 74 Diseases of the peritoneum, retroperitoneum, mesentery, and omentum, 772 Shawn D. Larson, B. Mark Evers I Miscellaneous 75 Complications of AIDS and other immunodefi ciency states, 779 Phillip D. Smith, Nirag C. Jhala, C. Mel Wilcox, Edward N. Janoff 76 Gastrointestinal manifestations of immunological disorders, 787 Fergus Shanahan, Stephen R. Targan 77 Parasitic diseases: protozoa, 793 Ellen Li, Samuel L. Stanley Jr 78 Parasitic diseases: helminths, 803 Alejandro Busalleu, Martin Montes, A. Clinton White Jr 79 Gastrointestinal manifestations of systemic diseases, 813 Joel S. Levine 80 Skin lesions associated with gastrointestinal and liver diseases, 821 Matilde Iorizzo, Joseph L. Jorizzo 81 Oral manifestations of gastrointestinal diseases, 839 John C. Rabine, Timothy T. Nostrant 82 Gastrointestinal vascular malformations or neoplasms: aterial, venous, arteriovenous, and capillary, 846 Mitchell S. Cappell 83 Intestinal ischemia, 858 Julián Panés, Josep M. Piqué 84 Radiation injury in the gastrointestinal tract, 878 Steven M. Cohn, Stephen J. Bickston PART 3 Diagnostic and therapeutic modalities in gastroenterology A Endoscopic 85 Upper gastrointestinal endoscopy, 884 Field F. Willingham, William R. Brugge 86 Colonoscopy and fl exible sigmoidoscopy, 900 Jerome D. Waye, Christopher B. Williams 87 Endoscopic retrograde cholangiopancreatography, endoscopic sphincterotomy and stone removal, and endoscopic biliary and pancreatic drainage, 907 Tony E. Yusuf, David L. Carr-Locke 88 Gastrointestinal dilation and stent placement, 913 James D. Lord, Drew B. Schembre, Richard A. Kozarek 89 Management of upper gastrointestinal hemorrhage related to portal hypertension, 934 Paul J. Thuluvath 90 Endoscopic diagnosis and treatment of nonvariceal upper gastrointestinal hemorrhage, 943 David J. Bjorkman 91 Endoscopic therapy for polyps and tumors, 948 Sergey V. Kantsevoy Contents viii 92 Laparoscopy and laparotomy, 963 Wenliang Chen, David W. Rattner B Imaging 93 Plain and contrast radiology, 965 Marc S. Levine, Stephen E. Rubesin, Hans Herlinger, Igor Laufer 94 Diagnostic sonography, 977 Philip W. Ralls, R. Brooke Jeffrey Jr, Robert A. Kane, Michelle L. Robbin 95 Endoscopic ultrasonography, 993 Marcia I. Canto, Sanjay B. Jagannath 96 Applications of computed tomography to the gastrointestinal tract, 1004 Karen M. Horton, Pamela T. Johnson, Elliot K. Fishman, Alec J. Megibow 97 Magnetic resonance imaging, 1015 Diane Bergin 98 Applications of radionuclide imaging in gastroenterology, 1029 Harvey A. Ziessman 99 Angiography, 1042 Kyung J. Cho 100 Interventional radiology, 1064 Kyung J. Cho C Pathology 101 Endoscopic mucosal biopsy: histopathological interpretation, 1085 Elizabeth Montgomery, Anthony N. Kalloo D Gastrointestinal function studies 102 Evaluation of gastrointestinal motility: emerging technologies, 1143 John W. Wiley, Chung Owyang Figure credits, 1158 Index, 1167 ix Contributors David A. Ahlquist, MD Professor of Medicine Consultant Division of Gastroenterology and Hepatology Mayo Clinic College of Medicine Rochester, Minnesota, USA Aijaz Ahmed, MD Associate Professor of Medicine Division of Gastroenterology and Hepatology Stanford University Medical Center Stanford, California, USA Jacob Alexander, MD, DM Senior Research Fellow Division of Gastroenterology University of Washington Seattle, Washington, USA Nathan M. Bass, MD, PhD Professor of Medicine Medical Director, Liver Transplantation Program Division of Gastroenterology University of California, San Francisco; San Francisco, California, USA Diane Bergin, MD Assistant Professor of Radiology Department of Radiology University College Hospital Galway, Ireland Stephen J. Bickston, MD Associate Professor Department of Internal Medicine Division of Gastroenterology and Hepatology; Medical Director, Inpatient Digestive Health Center of Excellence University of Virginia Health System Charlottesville, Virginia, USA Klaus Bielefeldt, MD, PhD Associate Professor of Medicine Division of Gastroenterology University of Pittsburgh Pittsburgh, Pennsylvania, USA Professor of Medicine Harvard Medical School Boston, Massachusetts, 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 Alejandro Busalleu, MD Vice Rector for Academic Affairs Principal Professor Department of Pathology Instituto de Medicine Tropical Alexander von Humboldt Universidad Peruana Cayetano Heredia Lima, Peru Roger F. Butterworth, PhD, DSc Director, Neuroscience Research Unit Hôpital Saint-Luc University of Montreal Montreal, Quebec, Canada Michael Camilleri, MD Atherton and Winifred W. Bean Professor of Medicine and Physiology College of Medicine Mayo Clinic Rochester, Minnesota, USA Marcia Irene Canto, MD, MHS Associate Professor Director of Clinical Research Departments of Medicine (Gastroenterology) and Oncology Johns Hopkins University School of Medicine Baltimore, Maryland, USA Mitchell S. Cappell, MD, PhD Chief, Division of Gastroenterology William Beaumont Hospital Royal Oak, Michigan, USA Adil E. Bharucha, MD Professor of Medicine Division of Gastroenterology and Hepatology Clinical Enteric Neuroscience Translational and Epidemiological Research Program Mayo Clinic College of Medicine Rochester, Minnesota, USA Elisa H. Birnbaum, MD Associate Professor Department of Surgery Section of Colon and Rectal Surgery Washington University School of Medicine at Barnes-Jewish Hospital St. Louis, Missouri, USA Lana Bistritz, MD, FRCPC Gastroenterology Fellow Division of Gastroenterology University of Alberta Edmonton, Alberta, Canada David J. Bjorkman, MD, MSPH, SM (Epid) Professor of Medicine and Dean University of Utah School of Medicine Salt Lake City, Utah, USA Andres T. Blei, MD Professor of Medicine Division of Hepatology Feinberg School of Medicine Northwestern University Chicago, Illinois, USA Robert S. Bresalier Chairman and Professor Department of Gastrointestinal Medicine and Nutrition University of Texas, M.D. Anderson Cancer Center Houston, Texas, USA William R. Brugge, MD Director, Gastrointestinal Endoscopy Massachusetts General Hospital; Contributors x David L. Carr-Locke, MB, BChir, FRCP, FASGE Director, The Endoscopy Institute Brigham and Women’s Hospital Boston, Massachusetts, USA Albert J. Chang, MD Division of Gastroenterology and Liver Diseases Keck School of Medicine University of Southern California Los Angeles, California, USA Wenliang Chen, MD Advanced Laparoscopic Surgery Fellow 2006 Massachusetts General Hospital Boston, Massachusetts, USA Onpan Cheung Gastroenterology and Hepatology Fellow Medical College of Virginia Virginia Commonwealth University Richmond, Virginia, USA Kyung J. Cho, MD Professor Division of Interventional Radiology Department of Radiology University of Michigan Health System Ann Arbor, Michigan, USA Russell D. Cohen, MD, FACG, AGAF Associate Professor of Medicine Co-director, Clinical Infl ammatory Bowel Disease The University of Chicago Medical Center Chicago, Illinois, USA Jonathan A. Cohn, MD Professor of Medicine and Associate Professor of Cell Biology Duke University Medical Center Durham, North Carolina, USA Steven M. Cohn, MD, PhD Paul Janssen Professor of Medicine and Immunology Division of Gastroenterology and Hepatology Department of Medicine University of Virginia Health System Charlottesville, Virginia, USA David H.B. Cort, MD Digestive Disease Medical Consultant St Louis, Missouri, USA David W. Crabb, PhD John B. Hickam Professor and Chair Department of Medicine Division of Gastroenterology and Hepatology Indiana University School of Medicine Indianapolis, Indiana, USA Laurie D. DeLeve, MD, PhD Professor of Medicine Liver Disease Research Center Division of Gastrointestinal and Liver Diseases Keck School of Medicine University of Southern California Los Angeles, California, USA Silvia Delgado-Aros, MD, MSc Metge Adjunt Servei Digestiu Hospital del Mar (IMAS) Barcelona, Spain Evan S. Dellon, MD, MPH Assistant Professor Center for Esophageal Diseases and Swallowing, and Center for Gastrointestinal Biology and Disease University of North Carolina, School of Medicine Chapel Hill, North Carolina, USA John A. Donovan, MD Assitant Professor of Clinical Medicine Division of Gastrointestinal and Liver Diseases Keck School of Medicine University of Southern California Los Angeles, California, USA Grace H. Elta, MD Professor Department of Internal Medicine Division of Gastroenterology University of Michigan Health System Ann Arbor, Michigan, USA B. Mark Evers, MD Professor, Departments of Surgery and Biochemistry & Molecular Biology Robertson-Poth Distinguished Chair in General Surgery Director, Sealy Center for Cancer Cell Biology Director, UTMB Comprehensive Cancer Center The University of Texas Medical Branch Galveston, Texas, USA George T. Fantry, MD Associate Professor Director, Heartburn and Dyspepsia Program Department of Medicine University of Maryland School of Medicine Baltimore, Maryland, USA Lori E. Fantry, MD, MPH Associate Professor Department of Medicine University of Maryland School of Medicine Baltimore, Maryland, USA James J. Farrell, MD Director of Pancreaticobiliary Endoscopy Assistant Professor of Medicine Division of Digestive Diseases David Geffen School of Medicine University of California, Los Angeles Los Angeles, California, USA Richard N. Fedorak Professor of Medicine Division of Gastroenterology University of Alberta Edmonton, Alberta, Canada Robert S. Fisher, MD Gastroenterology Section Department of Medicine Temple University Hospital Philadelphia, Pennsylvania, USA Elliot K. Fishman, MD, FACR Professor of Radiology and Oncology Department of Radiology Johns Hopkins Medical Institutions Baltimore, Maryland, USA Robert J. Fontana, MD Associate Professor Department of Internal Medicine Division of Gastroenterology University of Michigan Health System Ann Arbor, Michigan, USA Frank K. Friedenberg, MD, MS (Epi) Gastroenterology Section Department of Medicine Temple University Hospital Philadelphia, Pennsylvania, 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 Robert M. Genta, MD Clinical Professor of Pathology and Medicine (Gastroenterology) University of Texas Southwestern Medical Center; Director of Academic Affairs Caris Diagnostics Irving, Texas, USA