Gastrointestinal system

215 Pages·2013·9.981 MB·English

by  Megan Griffiths, Rusheng Chew

Gastrointestinal System
First and second edition authors:
Elizabeth Cheshire
Melanie Sarah Long
Third edition author:
Rusheng Chew
4
th Edition
CRASH COURSE
SERIES EDITOR:
Dan Horton-Szar
BSc(Hons) MBBS(Hons) MRCGP
NorthgateMedicalPractice
Canterbury
Kent, UK
FACULTY ADVISOR:
Martin Lombard
MD MSc FRCPIFRCP(Lond)
Consultant Gastroenterologist and Hepatologist
RoyalLiverpool University Hospital
Liverpool, UK
Gastrointestinal
System
Megan Griffiths
MBChB(Hons) Foundation Doctor
Wirral University Teaching Hospital
Merseyside, UK
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2012
CommissioningEditor:JeremyBowes
DevelopmentEditor:SheilaBlack
ProjectManager:AndrewRiley
Designer:StewartLarking
IconIllustrations:GeoParkin
Illustrator:Cactus
©2012ElsevierLtd.Allrightsreserved.
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ThisbookandtheindividualcontributionscontainedinitareprotectedundercopyrightbythePublisher(otherthan
asmaybenotedherein).
Firstedition1998
Secondedition2002
Reprinted2003(twice),2005
Thirdedition2008
Fourthedition2012
ISBN:978-0-7234-3620-1
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AcataloguerecordforthisbookisavailablefromtheBritishLibrary
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Notices
Knowledgeandbestpracticeinthisfieldareconstantlychanging.Asnewresearchandexperiencebroadenour
understanding,changesinresearchmethods,professionalpractices,ormedicaltreatmentmaybecomenecessary.
Practitionersandresearchersmustalwaysrelyontheirownexperienceandknowledgeinevaluatingandusing
anyinformation,methods,compounds,orexperimentsdescribedherein.Inusingsuchinformationormethods
theyshouldbemindfuloftheirownsafetyandthesafetyofothers,includingpartiesforwhomtheyhavea
professionalresponsibility.
Withrespecttoanydrugorpharmaceuticalproductsidentified,readersareadvisedtocheckthemostcurrent
informationprovided(i)onproceduresfeaturedor(ii)bythemanufacturerofeachproducttobeadministered,to
verifytherecommendeddoseorformula,themethodanddurationofadministration,andcontraindications.Itis
theresponsibilityofpractitioners,relyingontheirownexperienceandknowledgeoftheirpatients,tomake
diagnoses,todeterminedosagesandthebesttreatmentforeachindividualpatient,andtotakeallappropriate
safetyprecautions.
Tothefullestextentofthelaw,neitherthePublishernortheauthors,contributors,oreditors,assumeanyliability
foranyinjuryand/ordamagetopersonsorpropertyasamatterofproductsliability,negligenceorotherwise,or
fromanyuseoroperationofanymethods,products,instructions,orideascontainedinthematerialherein.
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PrintedinChina
Series editor foreword
TheCrashCourseseriesfirstpublishedin1997andnow,15yearson,wearestill
goingstrong.Medicineneverstandsstill,andtheworkofkeepingthisseries
relevantfortoday’sstudentsisanongoingprocess.Thesefourtheditionsbuildon
thesuccessoftheprevioustitlesandincorporatenewandrevisedmaterial,tokeep
theseriesuptodatewithcurrentguidelinesforbestpractice,andrecent
developmentsinmedicalresearchandpharmacology.
Wealwayslistentofeedbackfromourreaders,throughfocusgroupsandstudent
reviewsoftheCrashCoursetitles.Forthefourtheditionswehavecompletely
re-writtenourself-assessmentmaterialtokeepupwithtoday’s‘single-bestanswer’
and‘extendedmatchingquestion’formats.Theartworkandlayoutofthetitles
hasalsobeenlargelyre-workedtomakeiteasierontheeyeduringlongsessionsof
revision.
Despitefullyrevisingthebookswitheachedition,weholdfasttotheprincipleson
whichwefirstdevelopedtheseries.CrashCoursewillalwaysbringyouallthe
informationyouneedtoreviseincompact,manageablevolumesthatintegrate
basicmedicalscienceandclinicalpractice.Thebooksstillmaintainthebalance
betweenclarityandconciseness,andprovidesufficientdepthforthoseaimingat
distinction.Theauthorsaremedicalstudentsandjuniordoctorswhohaverecent
experienceoftheexamsyouarenowfacing,andtheaccuracyofthematerialis
checkedbyateamoffacultyadvisorsfromacrosstheUK.
Iwishyouallthebestforyourfuturecareers!
Dr Dan Horton-Szar
SeriesEditor
v
Intentionally left as blank
Prefaces
Author
Medicalexamscanbeadauntingexperience.Thistextbookaimstohelpprepare
studentsbyprovidingacomprehensiveoverviewofthegastrointestinalsystem,
presentedinaclearandconcisemanner.Ittakesreadersthroughalogicalthought
processstartingwithbasicanatomyandphysiologyandculminatingwithclinical
disorders.Thisprovidesastrongfoundationwhichallowsstudentstounderstand
thebasicsciences,andthenapplythistoaclinicalscenario.
Aswellasaidingrevision,hopefullythisbookwillalsoproveausefulresourcewhen
makingthetransitionfromstudenttohouseofficer.Itprovidesadetailedoverview
ofthecommongastrointestinalproblemsthatyouwillcertainlyfaceonthewards.
Ihopethatyouenjoyreadingthisbookandfinditausefulresource.
Megan Griffiths
Liverpool
2012
Faculty advisor
Despitetheirbestintentionsandnoticeoftimetables,allstudentsfindthat
examscometoosoon.CrashCourseiswrittenbypeoplewho’vebeentherefor
peoplewhoaregettingthere!Theseriesislargelywrittenbystudentsintheir
finalyearorjustafterqualifyingasdoctorswhohaverecentlypassedtheirexams
andwhoknowwhatyouneedtoknowtopassandexcelinyourexam.This
bookontheGastrointestinalSystemtellsyouthat,butIhopeiscomprehensive
enoughtogiveyouevenmore–agoodgroundinginclinicalgastroenterology
andhepatology.ItisanexcitingsubjectareaandCrashCourseisdesignedtobring
italivewithinformation.Theillustrationsinthisbookpackinathousandmore
wordsthanwecouldinthetextandIhopeyouwillenjoylearningfromthem.
Martin Lombard
Liverpool
2012
vii
Acknowledgements
Therearetwopeoplewhodeserveaspecialmentionfortheirroleintheproduction
ofthe4theditionofthisbook.ThefirstisMartinLombard,facultyadvisor,whose
knowledgeofthegastrointestinalsystemandgeneralmedicinehasensuredthat
thisbookhaskeptuptodatewithalltherecentchangesinclinicalmedicine.
ThesecondisSheilaBlack,contentdevelopmentspecialist,forallherguidanceand
patienceinensuringthatthisbookwouldbecompletedontime.
ToRushengChewandtheauthorsofpreviouseditions,thankyoufor
providingsuchagreatformatandstartingbase,uponwhichIhavebeenable
tobuild.
Iwouldalsoliketotakethisopportunitytothankmyfamilyandfriendsforall
theirloveandsupport.
viii
Contents
Serieseditorforeword . . . . . . . . . . . . . . . v Embryologyanddevelopment . . . . . . 78
Prefaces . . . . . . . . . . . . . . . . . . . . . . vii Histology . . . . . . . . . . . . . . . . 78
Acknowledgements. . . . . . . . . . . . . . . . viii Thefloraofthelargeintestine . . . . . . 79
Functionsandphysiology. . . . . . . . . 79
1. Introductiontothegastrointestinal
Pharmacologyofintestinalmotility . . . . 81
system . . . . . . . . . . . . . . . . . . 1
Disordersofthelargeintestine . . . . . . 83
Anatomicaloverview. . . . . . . . . . . . 1
Functionsofthegastrointestinaltract . . . . 1 6. Theliver . . . . . . . . . . . . . . . . 99
Foodgroups. . . . . . . . . . . . . . . . 2 Overview . . . . . . . . . . . . . . . . 99
Development . . . . . . . . . . . . . . . 6 Anatomy . . . . . . . . . . . . . . . . 99
Embryologyanddevelopment . . . . . .102
2. Theuppergastrointestinaltract. . . . . . . 9
Histology . . . . . . . . . . . . . . . .102
Overview . . . . . . . . . . . . . . . . . 9
Functionsandphysiology. . . . . . . . .105
Functionsandphysiology. . . . . . . . . . 9
Pathologicalmanifestationsofliver
Themouth,oralcavityandoropharynx . . 15
damage . . . . . . . . . . . . . . . .113
Disordersofthemouthand
Systemicandorganicmanifestationsof
oropharynx. . . . . . . . . . . . . . . 21
liverdamage . . . . . . . . . . . . . .115
Theoesophagus . . . . . . . . . . . . . 23
Disordersoftheliver. . . . . . . . . . .122
Disordersoftheoesophagus . . . . . . . 25
7. Thepancreasandbiliarytract . . . . . .135
3. Thestomach. . . . . . . . . . . . . . . 31
Thepancreas . . . . . . . . . . . . . .135
Overview . . . . . . . . . . . . . . . . 31
Disordersoftheexocrinepancreas . . . .142
Anatomy . . . . . . . . . . . . . . . . 31
Thebiliarysystem . . . . . . . . . . . .146
Embryologyanddevelopment . . . . . . 34
Disordersofthegallbladderandbiliary
Histology . . . . . . . . . . . . . . . . 35
tract . . . . . . . . . . . . . . . . . .149
Functionsandphysiology. . . . . . . . . 37
Disordersofthestomach. . . . . . . . . 45 8. Clinicalassessmentofgastrointestinal
disease . . . . . . . . . . . . . . . . .151
4. Thesmallintestine. . . . . . . . . . . . 51
Commonpresentationsofgastrointestinal
Overview . . . . . . . . . . . . . . . . 51
disease. . . . . . . . . . . . . . . . .151
Anatomy . . . . . . . . . . . . . . . . 51
Dysphagia. . . . . . . . . . . . . . . .151
Embryologyanddevelopment . . . . . . 54
Dyspepsia . . . . . . . . . . . . . . . .151
Histology . . . . . . . . . . . . . . . . 54
Nauseaandvomiting. . . . . . . . . . .152
Physiology. . . . . . . . . . . . . . . . 58
Abdominaldistension. . . . . . . . . . .152
Digestionandabsorption. . . . . . . . . 62
Abdominalpain . . . . . . . . . . . . .153
Thefloraofthesmallintestine . . . . . . 68
Weightloss . . . . . . . . . . . . . . .156
Disordersofthesmallintestine . . . . . . 68
Gastrointestinal(GI)bleeding. . . . . . .156
5. Thelargeintestine. . . . . . . . . . . . 73 Anaemia . . . . . . . . . . . . . . . .156
Overview . . . . . . . . . . . . . . . . 73 Jaundice. . . . . . . . . . . . . . . . .157
Anatomy . . . . . . . . . . . . . . . . 73 Diarrhoeaandconstipation . . . . . . . .158
ix