a LANGE medical book CURRENT Diag n o sis & Tre at m e n t Gast ro e n t e ro lo g y, He p at o lo g y, & En d o sco p y Third Edition Editor Norton J. Greenberger, MD Clinical Professor of Medicine, Harvard Medical School Senior Physician, Division of Gastroenterology, Hepatology and Endoscopy Brigham and Women’s Hospital Boston, Massachusetts Associate Editors Richard S. Blumberg, MD Professor of Medicine, Harvard Medical School Chief, Division of Gastroenterology, Hepatology and Endoscopy Brigham and Women’s Hospital Boston, Massachusetts Robert Burakoff, MD, MPH Associate Professor of Medicine, Harvard Medical School Clinical Chief of Gastroenterology, Division of Gastroenterology, Hepatology and Endoscopy Brigham and Women’s Hospital Boston, Massachusetts New York Chicago San Francisco Athens London Madrid Mexico City Milan New Delhi Singapore Sydney Toronto Greenberger_FM_p00i-xiv.indd 1 8/14/15 4:09 PM Copyright © 2016 by McGraw-Hill Education. All rights reserved. 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Under no circumstances shall McGraw-Hill Education and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise. www.ketabpezeshki.com 66485457-66963820 www.ketabpezeshki.com 66485457-66963820 Co nte nts Authors ix 5. Acute Diarrheal Disorders 51 Preface xiii Jerry S. Trier, MD Acute Diarrhea 51 Section I. General Concerns Acute Diarrheal Disease Caused 1. Acute Abdominal Pain: by Specific Infections 56 Basic Principles & Current Challenges 1 6. Mesenteric Vascular Disease 73 Frederick L. Makrauer, MD Elena M. Stoffel, MD, MPH Norton J. Greenberger, MD Kunal Jajoo, MD Acute Abdominal Pain in the Elderly 4 Norton J. Greenberger, MD Nonsurgical Disorders Simulating Mesenteric Ischemia 73 the Acute Abdomen 4 Acute Mesenteric Ischemia 74 Evaluation of the Acute Abdomen 5 Chronic Mesenteric Ischemia 80 Acute Appendicitis 9 Colonic Ischemia 81 Unique Presentations of Appendicitis 12 7. Gastrointestinal & Biliary 2. Inflammatory Bowel Disease: Complications of Pregnancy 84 Immunologic Considerations & Therapeutic Implications 14 Sonia Friedman, MD Jaya R. Agrawal, MD, MPH Richard S. Blumberg, MD Gastroesophageal Reflux Disease 84 Scott B. Snapper, MD, PhD Nausea & Vomiting 87 General Principles of the Hyperemesis Gravidarum 90 Gut-Associated Lymphoid Tissues 16 Constipation 91 Pathogenesis of Inflammatory Bowel Disease 18 Diarrhea 91 Pathogenesis of Crohn Disease: Underlying Hemorrhoids 92 Mechanisms of Immune Dysregulation 21 Irritable Bowel Syndrome 93 Pathogenesis of Ulcerative Colitis: Fecal Incontinence 95 Immunologic Factors 21 Inflammatory Bowel Disease 95 Regulatory Pathways in the Maintenance Abdominal Pain 102 of Intestinal Tolerance 22 Peptic Ulcer Disease 103 Therapeutic Implications of the Immunobiology Biliary Disease 103 of Inflammatory Bowel Disease 24 Pancreatitis 104 Appendicitis 105 3. Inflammatory Bowel Disease: Intestinal Obstruction, Pseudo-Obstruction, Medical Considerations 26 & Gastrointestinal Cancer 106 Jonathan S. Levine, MD Endoscopy in Pregnancy 106 Robert Burakoff, MD, MPH 8. Hepatic Complications of Pregnancy 112 General Considerations 26 Clinical Findings 27 Nikroo Hashemi, MD, MPH Differential Diagnosis 30 Chinweike Ukomado, MD, PhD Complications 32 Interpretation of Liver Biochemical Vaccinations 33 Tests During Pregnancy 112 Treatment 34 Hepatic Conditions Unique to Pregnancy 113 Prognosis 39 Conditions not Unique to Pregnancy 116 4. Inflammatory Bowel Disease: 9. State-of-the-Art Imaging of the Surgical Considerations 40 Gastrointestinal System 119 Jennifer L. Irani, MD Francesco Alessandrino, MD Ronald Bleday, MD Koenraad J. Mortele, MD Ulcerative Colitis 40 Gastrointestinal Tract Imaging 119 Crohn Disease 44 Liver Imaging 134 iii www.ketabpezeshki.com 66485457-66963820 www.ketabpezeshki.com 66485457-66963820 Greenberger_FM_p00i-xiv.indd 3 8/14/15 4:09 PM iv Co nt ent s Biliary Imaging 139 Treatment 195 Pancreatic Imaging 144 Course & Prognosis 196 Summary of Current Recommendations 149 Unresolved Issues 196 10. Gastrointestinal Manifestations of Section III. Diseases of the Stomach Immunodeficiency 150 15. Peptic Ulcer Disease 197 Zhenglun Zhu, MD, PhD General Considerations 150 Edward Lew, MD, MPH Pathogenesis 150 General Considerations 197 Clinical Findings 152 Pathogenesis 198 Treatment 153 Clinical Findings 199 Differential Diagnosis 202 Section II. Esophageal Diseases Complications 202 Treatment 202 11. Gastroesophageal Reflux Disease 157 16. Zollinger-Ellison Walter W. Chan, MD, MPH Syndrome (Gastrinoma) 209 John R. Saltzman, MD, FACP, FACG, FASGE, AGAF Edward Lew, MD, MPH General Considerations 157 Clinical Findings 158 General Considerations 209 Complications 162 Pathogenesis 209 Treatment 162 Classification 209 Course & Prognosis 166 Clinical Findings 210 Treatment 213 12. Barrett Esophagus 167 Prognosis 214 Kunal Jajoo, MD 17. Functional (Nonulcer) Dyspepsia 215 John R. Saltzman, MD, FACP, FACG, FASGE, AGAF Walter W. Chan, MD, MPH General Considerations 167 Robert Burakoff, MD, MPH Clinical Findings 168 Treatment 171 General Considerations 215 Course & Prognosis 173 Pathogenesis 216 Clinical Findings 219 13. Oropharyngeal & Esophageal Differential Diagnosis 221 Motility Disorders 174 Treatment 222 Course & Prognosis 226 Hiroshi Mashimo, MD, PhD 18. Disorders of Gastric Oropharyngeal Dysphagia 174 Impaired Ues Relaxation, Cricopharyngeal & Small Bowel Motility 227 Spasms, & Cricopharyngeal Bar 178 Walter W. Chan, MD, MPH Zenker Diverticulum 179 Robert Burakoff, MD, MPH Globus Pharyngeus 179 Esophageal Motility Disorders 179 Gastroparesis & Chronic Intestinal Esophageal Motor Dysphagia 180 Pseudo-Obstruction 228 Gastroesophageal Reflux Disease 182 Dumping Syndrome & Accelerated Esophageal Chest Pain 183 Gastric Emptying 237 Disorders of Inhibitory Innervation 186 Rapid Transit Dysmotility of the Small Bowel 237 Disorders of Excitatory Nerves 19. Treatment of Obesity: The Impact And Smooth Muscles 190 of Bariatric Surgery 238 14. Eosinophilic Esophagitis 193 Malcolm K. Robinson, MD Norton J. Greenberger, MD Norton J. Greenberger, MD General Considerations 193 Treatment of Overweight & Obese Patients 239 Epidemiology 193 Indications for Bariatric Surgery 240 Pathogenesis 193 Bariatric Surgical Procedures 241 Clinical Findings 194 Postoperative Care & Complications 244 Differential Diagnosis 194 Gastroenterology Evaluation & Treatment 246 www.ketabpezeshki.com 66485457-66963820 www.ketabpezeshki.com 66485457-66963820 Greenberger_FM_p00i-xiv.indd 4 8/14/15 4:09 PM Cont ent s vv Long-Term Outcome of Bariatric Surgery 248 25. Mast Cell Disorders 328 Recommendations & Caveats 250 Matthew J. Hamilton Mariana Castells, Section IV. Small Bowel Diseases Norton J. Greenberger 20. Intestinal Malabsorption 251 General Considerations 328 Classifications of Mast Cell Disorders 329 Jerry S. Trier, MD Pathogenesis of Mast Cell Disorders 330 Diseases Associated With Clinical Findings 330 Intraluminal Maldigestion 257 Differential Diagnosis 332 Diseases Associated with Impaired Treatment 332 Mucosal Digestion & Absorption 260 Clinical Course and Prognosis 334 Diseases Caused by Impairment Unresolved Issues 334 of Both Intraluminal Digestion & Mucosal Digestion/Absorption 270 Section VI. Pancreatic Diseases Diseases Caused by Impaired Postmucosal Transport 272 26. Acute Pancreatitis 335 Section V. Colorectal Diseases Darwin L. Conwell, MD, MS Peter A. Banks, MD 21. Diverticular Disease of the Colon 274 General Considerations 335 Anne C. Travis, MD, MSc, FACG, AGAF Pathogenesis 336 Clinical Findings 337 Diverticulosis 274 Differential Diagnosis 340 Acute Diverticulitis 279 Complications 340 Diverticular Hemorrhage 284 Treatment 341 22. Colorectal Cancer Screening 288 27. Chronic Pancreatitis 343 Ramona Lim, MD Darwin L. Conwell, MD, MS Sapna Syngal, MD, MPH Peter A. Banks, MD Fay Kastrinos, MD, MPH General Considerations 343 Risk Stratification 289 Pathogenesis 343 Screening & Surveillance Recommendations 290 Clinical Findings 345 Screening Modalities 296 Differential Diagnosis 349 Additional Screening Modalities 300 Complications 349 Summary of Recommendations 303 Treatment 349 23. Hereditary Gastrointestinal Course & Prognosis 351 Cancer Syndromes 304 28. Autoimmune Pancreatitis 352 Ramona Lim, MD Norton J. Greenberger, MD Sapna Syngal, MD, MPH Elena M. Stoffel, MD, MPH General Considerations 352 Clinical Findings 352 Hereditary Colorectal Cancer Syndromes 304 Distinct Clinical and Hamartomatous Polyposis Syndromes 311 Histologic Profile 355 Serrated Polyposis Syndrome 312 Diagnosis and Differential Diagnosis 356 Colorectal Polyposis Not Otherwise Specified 313 Treatment 356 Other Gastrointestinal Cancer Syndromes 313 Course & Prognosis 358 24. Irritable Bowel Syndrome 316 29. Tumors of the Pancreas 359 Sonia Friedman, MD Julia McNabb-Baltar, MD, FRCPC General Considerations 316 Richard Swanson, MD Pathogenesis 317 Pancreatic Cancer 359 Clinical Findings 319 Cystic Neoplasms of the Pancreas 366 Differential Diagnosis 321 Pancreatic Lymphoma 370 Complications 325 Treatment 325 www.ketabpezeshki.com 66485457-66963820 www.ketabpezeshki.com 66485457-66963820 Greenberger_FM_p00i-xiv.indd 5 8/14/15 4:09 PM vi Co nt ent s Section VII. Therapeutic Endoscopy & 36. Endoscopic Retrograde Diagnostic Techniques Cholangiopancreatography 434 David L. Carr-Locke, MA, MD, DRCOG, FRCP, FACG, 30. Polypectomy 371 FASGE, NYSGEF, AFAF Kunal Jajoo, MD Linda S. Lee, MD Equipment 371 Disorders of the Major Duodenal Papilla 434 Polypectomy for Sessile Polyps 372 Biliary System 436 Polypectomy for Pedunculated Polyps 372 Pancreas 441 Endoscopic Mucosal Resection 373 Endoscopic Submucosal Dissection 373 37. Endoscopic Ultrasound 446 31. Acute Upper Gastrointestinal Bleeding 375 Linda S. Lee, MD Cancer Staging 448 John R. Saltzman, MD, FACP, FACG, FASGE, AGAF Nonmalignant Lesions 452 Nonvariceal Bleeding 385 Therapeutic Endoscopic Ultrasound 456 Less Common Causes of Future Directions 458 Nonvariceal Bleeding 390 Variceal Bleeding 392 Section VIII. Liver Diseases 32. Acute Lower Gastrointestinal Bleeding 397 38. Approach to the Patient with John R. Saltzman, MD, FACP, FACG, FASGE, AGAF Jaundice & Abnormal Liver Tests 460 Linda S. Lee, MD Norton J. Greenberger, MD Evaluation of Lower GI Bleeding 397 Specific Causes of Acute General Considerations 460 Lower GI Bleeding 402 Pathogenesis 460 Clinical Findings 460 33. Endoscopic Management of Acute Differential Diagnosis 463 Biliary & Pancreatic Conditions 406 Diagnostic Considerations in Patients with Elevated Serum Aminotransferases 465 Andrew C. Storm, MD Christopher C. Thompson, MD, MSc, FACG, FASGE 39. Acute Liver Failure 467 Acute Cholangitis 406 Sonal Kumar, MD, MPH Gallstone Pancreatitis 408 Amir A. Qamar, MD Bile Duct Injuries 410 Pancreatic Duct Injuries 411 Specific Causes of Acute Liver Failure 474 Hemorrhagic Biliary & Pancreatic Conditions 413 40. Viral Hepatitis 480 34. Wireless Capsule Endoscopy & Anna Rutherford, MD, MPH Jules L. Dienstag, MD Deep Small Bowel Enteroscopy 416 Hepatitis A 483 Anne C. Travis, MD, MSc, FACG, AGAF Hepatitis B 485 John R. Saltzman, MD, FACP, FACG, FASGE, AGAF Hepatitis C 495 Capsule Endoscopy 416 Hepatitis D 504 Deep Small Bowel Enteroscopy 424 Hepatitis E 506 35. Gastrointestinal Foreign Bodies 427 41. Chronic Nonviral Hepatitis 508 Andrew C. Storm, MD Michael P Curry, MD Christopher C. Thompson, MD, MSc, FACG, FASGE Sanjiv Chopra, MD, MACP General Considerations 427 Autoimmune Hepatitis 508 Clinical Findings 427 Wilson Disease 513 Treatment 429 α -Antitrypsin Deficiency 516 1 www.ketabpezeshki.com 66485457-66963820 www.ketabpezeshki.com 66485457-66963820 Greenberger_FM_p00i-xiv.indd 6 8/14/15 4:09 PM Cont ent s vviiii 42. Hereditary Hemochromatosis 518 Differential Diagnosis 559 Treatment 559 Matthew S. Chang, MD Benjamin Smith, MD 48. Portal Hypertension & Esophageal Norman D. Grace, MD Variceal Hemorrhage 562 General Considerations 518 Norman D. Grace, MD Pathogenesis 519 Melissa A. Minor, MD, MPH Clinical Findings 524 Treatment 526 Gastric Varices 572 Prognosis 527 Portal Hypertensive Gastropathy 573 Idiopathic Portal Hypertension 573 43. Alcoholic Liver Disease 528 Future Treatment Trends 573 Gyorgy Baffy, MD, PhD 49. Drug-Induced Liver Disease 574 Tibor Krisko, MD Willis C. Maddrey, MD, MACP, FRCP General Considerations 528 Pathogenesis 529 Drugs of Special Interest 578 Clinical Findings 531 50. Liver Neoplasms 581 Differential Diagnosis 532 Treatment 532 Amir A. Qamar, MD Alcoholic Hepatitis 533 Chinweike Ukomadu, MD, PhD 44. Nonalcoholic Fatty Liver Disease 536 Benign Liver Tumors 581 Hepatocellular Carcinoma 586 David E. Cohen, MD, PhD Cholangiocarcinoma 591 Frank A. Anania, MD Metastatic Liver Disease 592 General Considerations 536 51. Liver Transplantation 593 Pathogenesis 537 Clinical Findings 538 Amir A. Qamar, MD Treatment 539 Indications for Transplantation 593 Course & Prognosis 541 Pretransplant Evaluation 596 Contraindications 597 45. Portal Systemic Encephalopathy & Transplantation Procedures 597 Hepatic Encephalopathy 543 Complications 598 Norton J. Greenberger, MD Infection & Liver Transplantation 600 Long-Term Medical Care After General Considerations 543 Liver Transplantation 602 Pathogenesis 543 Prognosis 603 Clinical Findings 544 Treatment 546 52. Primary Biliary Cirrhosis 605 46. Ascites & Spontaneous Daniel S. Pratt, MD Bacterial Peritonitis 549 General Considerations 605 Pathogenesis 605 Norton J. Greenberger, MD Clinical Findings 606 Ascites 549 Treatment 607 Spontaneous Bacterial Peritonitis 554 Section IX. Biliary Tract Diseases 47. Hepatorenal Syndrome 557 Norton J. Greenberger, MD 53. Primary Sclerosing Cholangitis 610 General Considerations 557 Norton J. Greenberger, MD Pathogenesis 557 John R. Saltzman, MD, FACP, FACG, FASGE, AGAF Clinical Findings 558 General Considerations 610 Acute Kidney Injury in Patients Clinical Findings 610 with Cirrhosis and Infection 558 www.ketabpezeshki.com 66485457-66963820 www.ketabpezeshki.com 66485457-66963820 Greenberger_FM_p00i-xiv.indd 7 8/14/15 4:09 PM viii Co nt ent s Differential Diagnosis 612 Clinical Findings 619 Treatment 612 Differential Diagnosis 620 Course & Prognosis 613 Complications 620 Treatment 622 54. Gallstone Disease 615 Index 626 Gustav Paumgartner, MD Norton J. Greenberger, MD Color insert appears between pages 386 and 387. General Considerations 615 Pathogenesis 616 www.ketabpezeshki.com 66485457-66963820 www.ketabpezeshki.com 66485457-66963820 Greenberger_FM_p00i-xiv.indd 8 8/14/15 4:09 PM