Gastroenterology, Hepatology, & Endoscopy

682 Pages·2015·142.891 MB·English

by  Norton Greenberger, Richard Blumberg, Robert Burakoff

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. Except as permitted under the United States Copyright Act of 1976, no part of
this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written
permission of the publisher, with the exception that the program listings may be entered, stored, and executed in a computer system, but they may not
be reproduced for publication.
ISBN: 978-0-07-183773-6
MHID: 0-07-183773-6
The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-183772-9,
MHID: 0-07-183772-8.
eBook conversion by codeMantra
Version 1.0
All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we
use names in an editorial fashion only, and to the bene t of the trademark owner, with no intention of infringement of the trademark. Where such
designations appear in this book, they have been printed with initial caps.
McGraw-Hill Education eBooks are available at special quantity discounts to use as premiums and sales promotions or for use in corporate training
programs. To contact a representative, please visit the Contact Us page at www.mhprofessional.com.
Notice
Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are
required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is
complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes
in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work
warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions
or for the results obtained from use of the information contained in this work. Readers are encouraged to con rm the information contained herein with
other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan
to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in
the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.
TERMS OF USE
This is a copyrighted work and McGraw-Hill Education and its licensors reserve all rights in and to the work. Use of this work is subject to these terms.
Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble,
reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any
part of it without McGraw-Hill Education’s prior consent. You may use the work for your own noncommercial and personal use; any other use of the
work is strictly prohibited. Your right to use the work may be terminated if you fail to comply with these terms.
THE WORK IS PROVIDED “AS IS.” McGRAW-HILL EDUCATION AND ITS LICENSORS MAKE NO GUARANTEES OR
WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK,
INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND
EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF
MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill Education and its licensors do not warrant or guarantee that
the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free. Neither McGraw-Hill Education
nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting
therefrom. McGraw-Hill Education has no responsibility for the content of any information accessed through the work. 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