The Digestive System: From Basic Sciences to Clinical Practice

428 Pages·2022·34.037 MB·English

by  Pierre Poitras, Marc Bilodeau, Mickael Bouin, Jean-Eric Ghia

Pierre Poitras   Editor
The Digestive System:
From Basic Sciences
to Clinical Practice
123
The Digestive System: From Basic Sciences to Clinical Practice
Pierre Poitras
Editor
Marc Bilodeau • Mickael Bouin • Jean-Eric Ghia
Co-Editors
The Digestive
System: From Basic
Sciences to Clinical
Practice
Editor Co-Editors
Pierre Poitras Marc Bilodeau
Université de Montréal Professor of Medicine
Montréal, QC, Canada Université de Montréal
Montreal, QC, Canada
Mickael Bouin
Clinical Professor of Medicine
Université de Montréal
Montreal, QC, Canada
Jean-Eric Ghia
Professor of Immunology
University of Manitoba
Winnipeg, MB, Canada
ISBN 978-3-030-98380-2 ISBN 978-3-030-98381-9 (eBook)
https://doi.org/10.1007/978-3-030-98381-9
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland
AG 2022
0th edition: © Les Presses de l’Universite de Montreal 2020
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V
Preface
This book aims to facilitate your learning experience during your undergraduate stud-
ies, as well as to guide you later in your clinical practice as a general practitioner or as
a physician nonspecialist in digestive diseases.
We deliberately chose a direct style, unencumbered by references, hoping to stimu-
late in you the desire to further explore the scientific literature.
As editor, I wanted to offer a personalized version of digestive medicine, as I discov-
ered it with outstanding mentors such as Robert Modigliani, Jean- Claude Rambaud,
John H. Walsh, Charles Code, Morton Grossman, and Serge Bonfils during my years
of training in gastroenterology, and as I evolved within it during 40 years of profes-
sional life with my colleague gastroenterologists, GI surgeons, radiologists, and pathol-
ogists at Hôpital Saint- Luc in Montreal, all passionate like me about the digestive
system.
Our approach is to introduce the disease as a dysregulation of the healthy state.
Anatomy, histology, and physiology illustrate the normal functioning of the organs,
and pathophysiology teaches us the dysregulation process involved. Semiology allows
us to build a differential diagnosis from the patient symptoms. Finally, we confirm the
diagnosis by various measures of investigation, and we use pharmacology to apply the
proper treatment.
The amount of bioscientific knowledge is huge and is growing every day. It is impos-
sible to assimilate and control, quantitatively or qualitatively, all available data from
genetics, molecular biology, etc. Some of these basic discoveries will have an immediate
impact on our medical practice, while others will have to wait. This book seeks to link
basic sciences and clinical practice. The authors made special efforts to highlight the
fundamental notions that impact on current patient care, but, needless to say, this
requires continual reassessment.
We thank you in advance for sending us your comments and suggestions to improve
this work. You can reach us at the following address:
[email protected]
Pierre Poitras
Montreal, QC, Canada
VII
Acknowledgments
This book was made possible thanks to the contribution of many people, who I would
like to thank here:
Thank you to my teachers and mentors, who taught me to give the best for the care
of my patients.
Thank you to my colleagues at Hôpital Saint-Luc de Montréal, gastroenterologists,
hepatologists, surgeons, radiologists, pathologists, biochemists, and experts in digestive
diseases who have been able to create, during all these years, a hospital environment
conducive to happy and efficient work.
Thank you to the University of Montreal, which has allowed me to have a career
that has been as exciting as it has been fruitful.
Thank you to all the students that I have met throughout my career and who were a
constant stimulus for this profession as a clinician and a teacher.
Thank you to all the colleagues who participated in the writing of this book.
Thank you to all our readers of previous French editions. Your appreciation and
comments have been an inspiration to us.
Thank you to all our past and present sponsors who support us in the dissemination
of knowledge.
Thank you to our publishers, Springer Nature for this English version and Les
Presses de l’Université de Montréal for the French editions, for their editorial expertise
and support.
Finally, special thanks to Monique, an exceptional life companion, psychotherapist,
and constant collaborator, who has taught me so much about life and medical human-
ism, and who has allowed me to become who I am, personally, socially, and profession-
ally. It is to her that I dedicate this book.
Pierre Poitras
Montreal, QC, Canada
IX
Introduction
This book is organized into two parts. In the first part, the eight main organs of the
digestive system are studied, and in the second part, the major clinical symptoms that
afflict the digestive system are revised.
In the first part, each organ is presented in the same way: the first five sections of a
chapter deal with "basic" knowledge of macroscopic and microscopic anatomy, embry-
ology, absorption-secretion, and motor-sensory functions; the clinical disorders are
then listed in three general sections: inflammation, tumor, and function disorders.
In the second part, digestive symptoms are presented in order to facilitate rapid and
effective clinical management.
To guide your readings, colored boxes are used to highlight important issues: blue
for diagnostic key points, orange for therapeutic considerations, green for pediatric
aspects, yellow for tropical specificities, and pink for interactions between basic and
clinical sciences.
Our goal is to make you appreciate the digestive system and thus stimulate your
interest and curiosity. Do not hesitate to increase your knowledge by consulting spe-
cialized books to answer any questions that may arise in you while reading this book.
XI
Contents
I The Digestive Organs
1 T he Esophagus ..................................................................................................................................... 3
P. Poitras, M. Bouin, C. Faure, J. P. Galmiche, R. Ratelle, and W. G. Paterson
2 T he Stomach .......................................................................................................................................... 31
P. Poitras, M. Bradette, V. Groleau, R. Ratelle, X. Marchand, and D. Armstrong
3 The Small Intestine ........................................................................................................................... 67
P. Poitras, J. Carrier, V. Marchand, A. Serme, G. Soucy, and J. P. Allard
4 T he Colon ................................................................................................................................................. 125
P. Poitras, J. E. Ghia, A. Sawadogo, C. Deslandres, R. Wassef, M. Dapoigny,
and C. Bernstein
5 T he Pancreas ......................................................................................................................................... 173
R. G. Lahaie, S. Bouchard, P. Poitras, F. Vandenbroucke-Menu, U. Halac,
P. Hammel, and P. D. James
6 T he Biliary Tree .................................................................................................................................... 205
M. Dagenais, R. G. Lahaie, F. Alvarez, P. Poitras, and A. Barkun
7 T he Anorectum .................................................................................................................................... 225
M. Bouin, R. Wassef, P. Jantchou, D. Bernard, P. Poitras, and C. N. Andrews
8 T he Liver ................................................................................................................................................... 249
M. Bilodeau, J. Bissonnette, H. Castel, D. Corsilli, D. Fenyves, C. Fournier,
J. M. Giard, G. Huard, P. M. Huet, D. Marleau, G. Pomier- Layrargues,
J. P. Villeneuve, C. Vincent, B. Willems, F. Alvarez, and Mark G. Swain
II Digestive Symptoms, Signs and Other
9 Esophageal Symptoms: Heartburn, Dysphagia, and Chest Pain........................ 307
P. Poitras and M. Bouin
10 N ausea and Vomiting ...................................................................................................................... 311
P. Poitras, L. Tremblay, and K. Orlicka
11 Upper Gastrointestinal Bleeding (UGIB) ............................................................................ 315
P. Poitras, J. Bissonnette, and Alan Barkun
12 D yspepsia ................................................................................................................................................ 321
P. Poitras
13 D iarrhea.................................................................................................................................................... 325
P. Poitras
X II Contents
14 Abdominal Distension and Bloating ..................................................................................... 331
P. Poitras
15 C onstipation .......................................................................................................................................... 337
P. Poitras, M. Bouin, C. Faure, and M. Dapoigny
16 A bdominal Pain ................................................................................................................................... 345
P. Poitras, A. Archambault, and V. Marchand
17 A bdominal Hernias ........................................................................................................................... 353
R. Ratelle
18 F ecal Incontinence............................................................................................................................. 359
M. Bouin, R. Wassef, C. Faure, and P. Poitras
19 A norectal Pain ...................................................................................................................................... 363
M. Bouin, P. Poitras, and R. Wassef
20 R ectal Bleeding.................................................................................................................................... 367
R. Wassef and P. Poitras
21 Lower GI Bleeding .............................................................................................................................. 371
R. Wassef and P. Poitras
22 F ood Allergies ...................................................................................................................................... 377
E. Drouin
23 Undernutrition and Nutritional Support ........................................................................... 381
L. D’Aoust, M. Lemoyne, and Johane P. Allard
24 O besity ...................................................................................................................................................... 389
L. D’Aoust, V. Groleau, and F. S. Hould
25 Genes and Digestive Cancers ..................................................................................................... 397
B. Panzini
26 J aundice ................................................................................................................................................... 403
P. Poitras and S. Paquin
27 A bnormal Liver Tests ....................................................................................................................... 407
J. P. Villeneuve
28 A scites........................................................................................................................................................ 413
J. Bissonnette
29 Diets and Digestive Diseases ..................................................................................................... 417
L. D’Aoust and P. Poitras
Supplementary Information
Index ............................................................................................................................................................. 427
XIII
Contributors
Johane P. Allard, MD Division of Gastroenterology and Hepatology, Toronto General
Hospital, University Health Network, Toronto, ON, Canada
Professor of Medicine, University of Toronto, Toronto, ON, Canada
Fernando Alvarez, MD Department of Gastroenterology, Hepatology and Nutrition, CHU
Sainte-Justine, Montreal, QC, Canada
Professor of Pediatrics, Université de Montréal, Montreal, QC, Canada
Christopher N. Andrews, MD Division of Gastroenterology & Hepatology, Foothills Medical
Centre, Calgary, AB, Canada
Clinical Professor of Medicine, University of Calgary, Calgary, AB, Canada
André Archambault, MD Department of Anesthesiology, Centre Hospitalier de l’Université de
Montréal (CHUM), Montreal, QC, Canada
Assistant Clinical Professor of Anesthesiology, Université de Montréal, Montreal, QC, Canada
David  Armstrong, MA, MB, BChir Division of Gastroenterology & Farncombe Family
Digestive Health Research Institute, McMaster University Medical Centre, Hamilton, ON,
Canada
Professor of Medicine, McMaster University, Hamilton, ON, Canada
Alan Barkun, MD Division of Gastroenterology, McGill University Health Center, Montreal,
QC, Canada
Professor of Medicine, McGill University, Montreal, QC, Canada
Denis Bernard, MD Digestive and Colorectal Surgery, CHUM, Montreal, QC, Canada
Professor of Surgery, Université de Montréal, Montreal, QC, Canada
Charles N. Bernstein, MD Director, University of Manitoba IBD Clinical and Research Cen-
tre, Winnipeg, MB, Canada
Distinguished Professor of Medicine, Bingham Chair in Gastroenterology, University of Mani-
toba, Winnipeg, MB, Canada
Marc Bilodeau, MD Liver Unit, CHUM, Montreal, QC, Canada
Professor of Medicine, Université de Montréal, Montreal, QC, Canada
Julien Bissonnette, MD Liver Unit, CHUM, Montreal, QC, Canada
Assistant Clinical Professor of Medicine, Université de Montréal, Montreal, QC, Canada
Simon Bouchard, MD GI Unit, CHUM, Montreal, QC, Canada
Assistant Clinical Professor of Medicine, Université de Montréal, Montreal, QC, Canada
Mickael Bouin, MD, PhD GI Unit, CHUM, Montreal, QC, Canada
Clinical Professor of Medicine, Université de Montréal, Montreal, QC, Canada
Marc Bradette, MD Division of Gastroenterology, CHU Québec, Quebec, QC, Canada
Clinical Professor of Medicine, Université Laval, Quebec, QC, Canada