Practical Gastroenterology and Hepatology Board Review Toolkit (eBook)

Kenneth R. DeVault, Michael B. Wallace, Bashar A. Aqel, Keith D. Lindor (Herausgeber)

eBook Download: PDF

2016 | 2. Auflage
John Wiley & Sons (Verlag)
978-1-118-82907-3 (ISBN)

Infos

Packed with Board-focused hints, case studies and an online Board-standard MCQ test offering CME credits, this fantastic book covers every gastroenterology disease and symptom you're likely to encounter and is the perfect tool to prepare for Board exams and certification.

Editor-in-Chief: Nicholas J. Talley, MD, PhD, is a nationally and internationally recognized clinical gastroenterologist and researcher with a special interest in neurogastroenterology and gastrointestinal epidemiology. He is Pro Vice-Chancellor (and Professor) and Dean (Health) at the University of Newcastle, Australia, but also holds appointments as Adjunct Professor and Consultant Gastroenterologist at the Mayo Clinic, Rochester, US, and Adjunct Professor at University of North Carolina. He was previously Chair of the Department of Medicine at Mayo Clinic Florida. Dr Talley is a previous Editor-in-Chief of the American Journal of Gastroenterology.

Inhalt

Practical gastroenterology and hepatology board review toolkit 3
Contents 7
List of contributors 11
Foreword 17
Preface 19
About the companion website 19
Section I How to Ace the Boards in Gastroenterology and Hepatology 21
1 Introduction and Overview of the Gastroenterology Boards 23
What to Expect at the Test Center 23
The Examination 23
Maintenance of Certification Changes 24
Specific Tips and Recommendations for the Gastroenterology Board Examination 24
Consider Attending a Formal Board Review Course 24
Review Prominent Societal Guidelines Regarding Common Disease States 24
Recurring Themes 25
Practice Questions 25
Reference 25
Section II Esophagus and Stomach 27
Part 1 Pathobiology of the Esophagus and Stomach 29
2 Anatomy, Embryology, and Congenital Malformations of the Esophagus and Stomach 31
Anatomy 31
Upper Esophageal Sphincter 31
Esophageal Body 31
Lower Esophageal Sphincter 31
Mucosa 31
Embryology 32
Congenital Malformations of the Esophagus and Stomach 32
Esophageal Atresia and Tracheoesophageal Fistula 32
Congenital Stenosis 33
Esophageal Duplications 33
Vascular Anomalies 33
Esophageal Rings 33
Esophageal Webs 33
Heterotopic Gastric Mucosa 33
Congenital Malformations of the Stomach 33
References 34
3 Esophageal and Gastric Motor Function 35
Esophageal Motor Function 35
Innervation of Esophageal Muscle 35
Oral, Pharyngeal, and Upper Esophageal Sphincter Function 35
Motor Function of the Esophageal Body 36
Lower Esophageal Sphincter 36
Gastric Motor Function 36
Electrophysiology of Gastric Motility 36
Proximal Stomach 37
Distal Stomach 37
Gastric Emptying: A Coordinated Activity? 38
References 38
Part 2 Other Diagnostic Modalities 41
4 Radiologic Approach to Diagnosis 43
Esophagus 43
Techniques 43
Dysphagia 43
Imaging after Antireflux Surgery 43
Stomach 46
Techniques 46
Major Indications 46
References 47
5 Esophageal Motility Disorders 48
Introduction 48
Esophageal Diagnostics 48
Achalasia 48
Clinical Presentation 49
Chagas Disease 50
Therapy 50
Prognosis 51
EGJ 51
Outflow Obstruction 51
Non-Achalasia Esophageal Motility Disorders 51
Distal Esophageal Spasm 51
Hypercontractile Esophagus 52
Disorders with Absent, Weak, or Frequent Failed Peristalsis 52
References 54
6 Gastric Motility Testing 56
Introduction 56
Gastric Motility Testing 56
Gastric Emptying Testing 56
Electrogastrography 57
Gastrointestinal Manometry 58
Gastric Accommodation Testing 58
References 59
Part 3 Problem-Based Approach to Diagnosis and Differential Diagnosis 61
7 General Approach to History-Taking and Physical Examination of the Upper Gastrointestinal Tract 63
Setting the Stage 63
Heartburn 63
Dysphagia 64
Nausea/Vomiting 64
Abdominal Pain 64
Diarrhea 64
Finishing the Visit 65
References 65
8 Heartburn, Regurgitation, and Chest Pain 66
Heartburn and Regurgitation 66
Heartburn Symptoms as Predictors of GERD 66
Mechanisms of Heartburn 67
Chest Pain 68
Gastroesophageal reflux related chest pain 68
Motility Disorders 69
Differentiating Esophageal from Non-esophageal Causes of NCCP 69
Functional Chest Pain 69
Psychological Evaluation 70
References 70
9 Dysphagia 72
Pathophysiology 72
Infections 72
Mucosal Abnormalities 72
Anatomic Abnormalities 72
Functional Abnormalities 72
Clinical Features 72
Oropharyngeal Dysphagia 72
Esophageal Dysphagia 73
Diagnosis 73
Therapeutics 73
Oropharyngeal dysphagia 74
Esophageal Dysphagia 74
Prognosis 75
References 75
10 Miscellaneous Upper Gastrointestinal Symptoms 76
Belching (Eructation) and Aerophagia 76
Definition and Epidemiology 76
Pathophysiology 76
Clinical Features 77
Diagnostic Testing 77
Therapeutic Approach 78
Halitosis 78
Definition and Epidemiology 79
Etiology and Pathophysiology 79
Diagnosis 79
Therapeutics 80
Hiccups 81
Definition and Epidemiology 81
Pathophysiology/Clinical Features 81
Evaluation 82
Therapeutics 83
Conclusion 84
Rumination 84
Epidemiology 85
Clinical Features 85
Pathophysiology and Diagnosis 85
Differential Diagnosis 86
Treatment 86
References 88
11 Dyspepsia 90
Introduction 90
Dyspepsia 90
Definitions 90
Differential Diagnosis 90
Management of Dyspepsia 91
Functional Dyspepsia 91
Classification 91
Pathophysiology 92
Management Approach to FD 92
Other Gastroduodenal Disorders 92
References 92
12 Nausea and Vomiting 94
Definition and Epidemiology 94
Pathophysiology 94
Clinical Features 95
Diagnosis 95
Laboratory Testing 95
Radiologic and Endoscopic Imaging 95
Gastrointestinal Motility Testing 96
Psychological Assessment 96
Differential Diagnosis 96
Therapeutics 96
Dietary Modification 96
Pharmacological Options 97
Surgical Options 98
Psychological, Behavioral, and Integrative Options 98
References 98
13 Hematemesis 99
Initial Approach to the Patient 99
History 99
Physical Examination 99
Laboratory Studies 99
Nasogastric Aspiration 100
Triage 100
Medical Therapy 100
Acknowledgements 101
References 101
Part 4 Diseases of the Esophagus 103
14 Gastroesophageal Reflux Disease 105
Definition and Epidemiology 105
Key Terms 105
Pathophysiology 105
Clinical Features 106
Laryngopharyngeal Reflux 107
Asthma 107
Chronic Cough 107
Non-cardiac Chest Pain 107
Diagnosis of GERD and Extraesophageal Reflux 107
Endoscopy 107
pH Monitoring 107
Laryngoscopy 108
Therapeutic Approach 108
GERD 108
Extraesophageal Reflux 109
References 110
15 Barretts Esophagus 111
Definition 111
Epidemiology, Genetics, Environmental Influence, and Natural History 111
Predictors of Progression 112
Screening 113
Endoscopic Surveillance 113
Evaluation 113
Management 113
Managing Underlying GERD 114
Cancer Prevention 114
Endotherapy 114
Non-dysplastic Barretts Esophagus 114
Barretts Low-Grade Dysplasia 114
Barretts High-Grade Dysplasia and Intramucosal Adenocarcinoma 114
References 116
16 Eosinophilic Esophagitis 118
Definition and Epidemiology 118
Pathophysiology 118
Clinical Features 119
Diagnosis 119
Differential Diagnosis 120
Therapeutics 120
Treatment of Active Disease 120
Maintenance Therapy 121
Therapeutic End Point 121
Prognosis 122
References 123
17 Strictures, Rings, and Webs 125
Definition and Epidemiology 125
Pathophysiology 126
Clinical Features 126
Diagnosis 127
Esophagogastroduodenoscopy 127
Barium Swallow 127
Motility Testing 127
Differential Diagnosis 127
Treatment 127
Dilation Therapy 128
Combined Antegrade and Retrograde Dilation 128
Dilation and Intralesional Steroid Injection Therapy 128
Incisional Therapy 128
Stents 129
Management of Refractory Benign Esophageal Strictures 130
References 131
Part 5 Diseases of the Stomach 133
18 Peptic Ulcer Disease 135
Background and Epidemiology 135
Etiologies 135
Helicobacter pylori 135
Aspirin and Non-steroidal Anti-inflammatory Drugs 135
Non-NSAID, Non-H. pylori Idiopathic Ulcers 136
Clinical Features 136
Diagnosis 136
Therapeutics 136
H. pylori Ulcers 136
NSAID Ulcers 137
Non-NSAID, Non-H. pylori Idiopathic Ulcers 137
Peptic Ulcer Bleeding 137
Endoscopic Hemostasis 138
Acid-Suppressive Therapy 138
Rebleeding 138
References 139
19 Helicobacter pylori 141
Bacteriology 141
Epidemiology and Transmission 141
Pathogenesis and Disease Associations 142
Duodenal and Gastric Ulcers 142
Gastric MALT Lymphoma 142
Other Conditions Associated with H. pylori 142
Diagnosis 142
Treatment 143
Controversies in Management 143
Who to Diagnose and Who to Treat 143
Pregnancy 144
Cancer Prevention 144
References 145
20 Gastritis 146
Definitions 146
Assessment 146
Basic Morphology 147
Inflammatory Infiltrate: Mononuclear Cells 147
Inflammatory Infiltrate: Polymorphs (Neutrophils and Eosinophils) 147
Fibrosis of the Lamina Propria and Smooth-Muscle Hyperplasia 147
Hyperplasia of Glandular Elements 147
Glandular Atrophy 148
Metaplasia Phenotypes 148
Endocrine Cells Hyperplasia 148
Intraepithelial Neoplasia (Synonym: Non-invasive Neoplasia Formerly Defined as Dysplasia)
Classification 148
Main Forms of Gastritis 148
Helicobacter pylori Gastritis 148
Chemical Gastritis/Gastropathies 149
Autoimmune Gastritis 150
References 150
21 Gastroparesis 152
Etiology 152
Diabetic Gastroparesis 152
Postsurgical Gastroparesis 153
Idiopathic Gastroparesis 153
Clinical Presentation 153
Evaluation of Patients with Suspected Gastroparesis 153
Scintigraphy 153
Wireless Motility Capsule 154
Breath-Testing 154
Treatment 154
Dietary Treatment 155
Metabolic Control 155
Prokinetic Agents 155
Antiemetic Agents 156
Psychotropic Medications as Symptom Modulators 156
Pyloric Botulinum Toxin Injection 156
Gastric Electric Stimulation 156
References 157
22 Non-variceal Upper Gastrointestinal Bleeding 158
Etiology 158
Initial Assessment and Management 158
Endoscopy 159
Thermal Contact Probes 159
Injection Therapy 159
Endoscopic Clips 159
Band Ligation 159
Peptic Ulcer Bleeding 160
Active Bleeding and Non-bleeding Visible Vessels 160
Adherent Clots 161
Clean-based Ulcers 161
PPIs and Peptic Ulcer Bleeding 161
H. pylori Testing 161
Rebleeding after Peptic Ulcer Hemostasis 161
Variceal Bleeding 161
Esophagitis 162
Stress Ulcers 162
Dieulafoy Lesion 162
Mallory–Weiss Tear 162
Cameron Erosions 163
Upper GI Malignancy 163
Gastric Antral Vascular Ectasia 163
Portal Hypertensive Gastropathy 163
Hemobilia 163
Hemosuccus Pancreaticus 163
Post-ERCP Sphincterotomy Bleeding 163
Aortoenteric Fistula 163
Angiomas 164
References 164
23 Other Gastric Tumors (Benign and Malignant) 165
Mucosal Tumors 165
Gastric Polyps 165
Gastric Lymphoma and MALT lymphoma 167
Ménétriers Disease 167
Zollinger–Ellison Syndrome 167
Submucosal Tumors 168
Leiomyoma 168
Gastrointestinal Stromal Tumor 168
Lipoma 169
Gastric Carcinoids 169
Granular Cell Tumor 169
Pancreatic Rest 169
Biopsy of Submucosal Tumors 169
References 171
24 Eosinophilic Gastroenteritis 172
Definition and Epidemiology 172
Pathophysiology 172
Clinical Features 173
Diagnosis 173
Therapeutics 174
References 175
25 Esophageal and Gastric Involvement in Systemic and Cutaneous Diseases 176
Connective-Tissue Diseases 176
Systemic Sclerosis 176
Inflammatory Myopathies 176
Mixed Connective-Tissue Disease 176
Sjögrens Syndrome 177
Systemic Lupus Erythematosus 177
Endocrine and Metabolic Diseases 177
Diabetes Mellitus 177
Hypothyroidism 178
Hyperthyroidism 179
Inflammatory Diseases 179
Crohns Disease 179
Behçets Disease 180
Sarcoidosis 181
Neuromuscular Diseases 181
American Trypanosomiasis (Chagas Disease) 181
Amyloidosis 182
Paraneoplastic Syndromes 182
Cutaneous Syndromes 183
Pemphigus 183
Pemphigoid 183
Acquired and Inherited Epidermolysis Bullosa 183
Lichen Planus 183
Cutaneous Hyperkeratosis Syndromes 184
References 185
Part 6 Functional Disease of the Esophagus and Stomach 187
26 Functional Esophageal Disorders 189
Definitions 189
Epidemiology 189
Pathophysiology 189
Clinical Features and Diagnosis 190
Functional Heartburn 190
Functional Chest Pain 190
Functional Dysphagia 190
Globus 190
Differential Diagnosis 190
Therapeutics 190
Functional Heartburn 190
Functional Chest Pain 191
Functional Dysphagia 191
Globus 191
References 191
Section III Intestine and Pancreas 193
Part 1 Pathobiology of the Intestine and Pancreas 195
27 Clinical Anatomy, Embryology, and Congenital Anomalies 197
Small and Large Intestine 197
Anatomy and Embryogenesis 197
Abdominal Wall Congenital Anomalies 197
Enteric Nervous System Anomalies 198
Pancreas 198
Anatomy and Embryogenesis 198
Pancreas Divisum (PD) 199
Ectopic Pancreas 199
Pancreatic Agenesis 199
Congenital Cysts 199
Anomalous Pancreaticobiliary Ductal Union (APBDU) 200
References 200
28 Small-Intestinal Hormones and Neurotransmitters 201
Introduction 201
Specific Peptides 201
Gastrin 201
Cholecystokinin 203
Secretin 203
Peptide YY 204
Somatostatin 204
Vasoactive Intestinal Polypeptide 205
Motilin 205
Gastropancreatic Neuroendocrine Tumors 205
Classification 205
Incidence 205
Functioning Gastropancreatic NETs 205
Non-functioning Gastropancreatic NETs 205
Biomarker Tests 206
Tumor Localization 206
Treatment 206
References 206
29 Mucosal Immunology of the Intestine 207
Mucosal and Epithelial Barrier 207
Innate Immune System 207
Antigen Uptake and Induction of a Mucosal Immune Response 207
Adaptive Immune System 208
Humoral Response and Secretory IgA 209
Tolerance and Regulatory T Cells 209
Commensal Flora 209
References 209
30 Motor and Sensory Function 211
Neuromuscular Apparatus 211
Anatomy and Morphology 211
Smooth-Muscle Cells 211
Interstitial Cajal Cells 211
Platelet-Derived Growth Factor Alpha Cells 212
Enteric Nervous System 212
Glial Cells 212
Autonomic Nervous System 212
Gut Sensation: Neurobiology 213
Gut Motility 213
Small Intestine 213
Large Intestine 214
Motor Activity of the Anorectum 215
Intestinal Microbiota in Motility and Sensation 215
References 217
31 Neoplasia 218
Definition and Epidemiology 218
Clinical Features 218
Pathophysiology 218
Diagnosis 220
Treatment 220
Acknowledgements 220
References 220
Part 2 Problem-Based Approach to Diagnosis and Differential Diagnosis 221
32 General Approach to Relevant History-Taking and Physical Examination 223
Introduction to History Taking 223
Patient Concerns 223
Abdominal Pain 223
Bowel Complaints 224
Nausea and Vomiting 226
GI Bleeding 226
Jaundice 227
Other Symptoms 227
Physical Examination 228
Abdominal Examination 228
Digital Rectal Examination 228
Ultrasonography and the Physical Examination 229
Medical Simulation in Gastroenterology 229
Current Preventive Guidelines in Gastroenterology 231
Conclusion 231
Acknowledgments 231
References 231
33 Acute Diarrhea 233
Definition and Epidemiology 233
Pathophysiology 233
Clinical Features 233
Diagnosis 234
Differential Diagnosis 234
Watery Diarrhea 234
Inflammatory Diarrhea 235
Shigella 235
Non-typhoid Salmonella 236
Campylobacter 236
Shiga Toxin-Producing E. coli 236
Yersinia 236
Drug-Induced Diarrhea 236
Treatment 236
References 237
34 Chronic Diarrhea 238
Definition and Epidemiology 238
Pathophysiology 238
Clinical Features 238
Diagnosis and Differential Diagnosis 239
Therapeutics 240
Prognosis 242
References 242
35 Loss of Appetite and Loss of Weight 243
Introduction 243
History and Physical Exam 243
Causes of Unintentional Weight Loss 244
Reduced Caloric Intake 244
Decreased Caloric Utilization 244
Increased Energy Expenditure 245
Increased Losses 245
Evaluation of Unintentional Weight Loss 245
Step 1: Detailed History and Physical Examination 245
Step 2: Laboratory and Radiographic Testing 245
Step 3: GI Testing 245
Nutrition Management of Unintentional Weight Loss 246
References 246
36 Gastrointestinal Food Allergy and Intolerance 247
Overview of Food Allergies and Food Intolerances 247
Are There Predisposing Factors in Food Allergies? 247
Immune-Mediated GI Adverse Reactions to Food 248
IgE-Mediated 248
Mixed IgE- and Non-IgE-Mediated 248
Non-IgE-Mediated 248
Non-Immune-Mediated GI Adverse Reactions to Food 248
Food Poisoning 248
Lactose Intolerance 248
FODMAPs 249
Toxic Reactions to Foods 249
Food Aversion 249
Diagnosis 249
Management of Adverse Reactions to Foods 250
References 250
37 Obesity: Presentations and Management Options 251
Definitions and Epidemiology 251
GI Comorbidities 251
Management Options 252
Lifestyle Modification 252
Pharmacotherapy 252
Bariatric (Metabolic) Surgery 253
Endoscopic Treatments 254
Endoscopic Gastroplasty Techniques 255
Aspiration Therapy 255
Conclusion 255
References 255
38 Hematochezia 257
Definition and Epidemiology 257
Clinical Features 257
Diagnosis 258
Differential Diagnosis 258
Therapeutics 259
Prognosis 259
References 260
39 Obscure Gastrointestinal Bleeding 261
Definition and Epidemiology 261
Clinical Features 261
Diagnosis 261
Differential Diagnosis 263
Management 263
Prognosis 264
References 264
40 Constipation 266
Definition and Epidemiology 266
Pathophysiology 266
Slow-Transit Constipation (“Colonic Inertia”) 266
Defecation Disorders 266
Clinical Features 267
Diagnosis 268
Diagnosis of Colonic Inertia 268
Diagnosis of Disordered Defecation 268
Differential Diagnosis 268
Irritable Bowel Syndrome 268
Megarectum and Megacolon 268
Hirschsprung Disease (Aganglionic Megacolon) 268
Therapy 268
Slow-Transit Constipation 269
Disordered Defecation 269
Prognosis 269
References 270
41 Perianal Disease 271
Definition and Epidemiology 271
Pathophysiology 271
Clinical Features 271
Diagnosis 271
Therapeutics 272
Management 274
References 274
42 Fecal Incontinence 276
Definition and Epidemiology 276
Etiology 276
Mechanisms of Normal Fecal Continence 276
Pathophysiology 277
Anal Sphincter Weakness 277
Rectal Sensorimotor Dysfunctions 277
Impaired Rectal Evacuation 277
Clinical Features 277
Diagnostic Testing 278
Anal Manometry 278
Rectal Sensation and Compliance 278
Endoscopy 278
Endoanal Ultrasound 278
Dynamic Proctography (Defecography) 278
Pelvic MRI 278
Needle EMG of the External Sphincter 278
Management 278
Dietary and Pharmacological Approaches 278
Pelvic Floor Exercises and Biofeedback Therapy 278
Incontinence Products 278
Surgical Approaches 278
Conclusion 279
References 280
43 Colorectal Cancer Screening 281
Introduction 281
Review of Screening Methods 281
Stool-Based Tests 281
Endoscopic Screening Tests 282
Imaging Tests 282
Discussion of the Guidelines 283
Conclusion 283
References 284
44 Endoscopic Palliation of Malignant Obstruction 286
Equipment and Review of Technology 286
How to Place SEMS 286
Malignant Dysphagia 286
Malignant Gastric Outlet Obstruction 287
Colonic Obstruction 288
Enteral Tubes 288
References 289
Part 3 Diseases of the Small Intestine 291
45 Crohns Disease 293
Definition and Epidemiology 293
Pathophysiology 293
Clinical Features 293
Disease Severity 293
Diagnosis 294
Laboratory Findings 294
Endoscopy 294
Radiographic Findings 295
Histology 295
Differential Diagnosis 295
Therapeutics 295
Medical Therapy 295
Surgery 297
Prognosis 298
References 298
46 Small-Bowel Tumors 299
Introduction 299
Benign Tumors of the Small Intestine 299
Malignant Small Bowel Tumors 300
Adenocarcinoma of the Small Bowel 300
Neuroendocrine Tumors 300
Gastrointestinal Stromal Tumors 300
Primary Lymphomas 300
Celiac-Associated T-cell High-Grade Lymphoma 300
Burkitt-Type Lymphoma of the Small Intestine 300
Mucosa-Associated Lymphoid Tissue Lymphoma – Maltoma 301
Immunoproliferative Small Intestinal Disease (Mediterranean Lymphoma) 301
Clinical Features 301
Diagnosis 301
Imaging Modalities 301
Therapy 302
Benign Tumors 302
Adenocarcinoma 302
Neuroendocrine Tumors 302
Lymphoma 303
Gastrointestinal Stromal Tumors 303
References 303
47 Small-Intestinal Bacterial Overgrowth 305
Definition and Epidemiology 305
Pathophysiology 305
Clinical Manifestations 306
Diagnosis 306
Treatment 307
References 309
48 Celiac Disease and Tropical Sprue 311
Celiac Disease 311
Definition and Epidemiology 311
Clinical Features 311
Diagnosis 311
Treatment 313
Tropical Sprue 314
Definition and Epidemiology 314
Pathophysiology 314
Clinical Features 314
Diagnosis 314
Treatment 314
References 315
49 Whipples Disease 316
Definition and Epidemiology 316
Pathophysiology 316
Immune Response 316
Histopathology 316
Clinical Features 316
GI Symptoms 316
Extraintestinal Symptoms 317
Neurological Symptoms 317
Physical Findings 317
Radiologic and Endoscopic Findings 317
Laboratory Findings 317
Diagnosis 317
Differential Diagnosis 317
Malabsorptive and Infiltrative Diseases of the Small Bowel 317
Small-Bowel Infections 317
Therapeutics 317
Prognosis 318
References 318
50 Short-Bowel Syndrome 319
Definition and Epidemiology 319
Pathophysiology 319
Clinical Features 320
Differential Diagnosis 320
Therapeutics 320
Medical Management 320
Surgical Management 322
Prognosis 322
References 323
51 Protein-Losing Gastroenteropathy 324
Pathophysiology 324
Etiology 324
Primary Intestinal Lymphangiectasia 324
Secondary Intestinal Lymphangiectasia 324
Mucosal Disorders with Erosions, Ulcers, or Denuded Areas 325
Mucosal Disorders without Erosions 325
Clinical Features 325
Diagnosis 325
Tests for Intestinal Protein Loss 325
Tests to Determine Underlying Etiology 326
Therapy 326
Medical Therapies 326
Surgical Therapies 327
Nutrition Support 327
Monitoring 327
References 327
52 Acute Mesenteric Ischemia and Chronic Mesenteric Insufficiency 328
Acute/Chronic Mesenteric Ischemia 328
Vascular Anatomy/Function Mesenteric Circulation 328
Mesenteric Vascular Physiology 328
Acute Mesenteric Ischemia 329
Non-occlusive Mesenteric Ischemia 329
Clinical Manifestations 329
Diagnosis 329
Treatment Algorithms 330
Chronic Mesenteric Insufficiency 332
References 332
53 Intestinal Obstruction and Pseudo-obstruction 333
Intestinal Obstruction 333
Diagnosis 333
Management 333
Further Diagnostic Imaging 334
Complications and Recurrence 334
Large Bowel Obstruction 334
Intestinal Pseudo-obstruction 335
Chronic Intestinal Pseudo-obstruction 335
Enteric Dysmotility Syndromes without VisceralDilation 338
Postoperative Ileus and Acute Colonic Pseudo-obstruction (Ogilvie Syndrome) 339
References 339
Part 4 Diseases of the Colon and Rectum 341
54 Ulcerative Colitis 343
Definition 343
Epidemiology 343
Risk Factors 343
Pathophysiology 343
Clinical Features 343
Ulcerative Colitis 343
Indeterminate Colitis 344
Extraintestinal Manifestations of IBD 344
Complications of IBD 344
Diagnosis 344
Historical Factors 344
Physical Examination 345
Laboratory Evaluation 345
Imaging 345
Endoscopy 345
Pathology 345
Differential Diagnosis 345
Therapeutics 345
5-Aminosalicylates 346
Antibiotics 346
Corticosteroids 346
Thiopurine Immunosuppressants 346
Cyclosporine 346
TNF-a Inhibitors 346
Surgical Therapy for UC 347
References 347
55 Clostridium difficile Infection and Pseudomembranous Colitis 348
Definition and Epidemiology 348
Pathophysiology 348
Clinical Features of C. difficile Infection 349
Diagnosis 349
Differential Diagnosis 350
Treatment 350
Initial CDI 350
Recurrent CDI 350
Prognosis 351
References 351
56 Colonic Ischemia 353
Epidemiology 353
Pathophysiology 353
Pharmacologic-Induced Colon Injury 354
Clinical Manifestations 355
Therapy 356
References 357
57 Acute Diverticulitis 358
Definition and Epidemiology 358
Pathophysiology 358
Clinical Features 358
Diagnosis 360
Medical Management 360
Management of Complicated Diverticulitis 361
Surgery 361
References 362
58 Acute Colonic Pseudo-obstruction 363
Definition and Epidemiology 363
Pathophysiology 363
Clinical Features 363
Diagnosis 364
Therapeutics 364
Supportive Therapy 364
Medical Therapy 365
Endoscopic Decompression 366
Percutaneous Cecostomy 367
Surgical Therapy 367
Prognosis 368
References 368
59 Colonic Polyps and Colorectal Cancer 369
Definition and Epidemiology 369
Pathophysiology 369
Host Factors 370
Past Medical History 370
Family History 370
Young-Onset CRC 371
Environmental Exposures 372
Prevention 372
Clinical Features 372
Diagnosis 372
Differential Diagnosis 372
Therapeutics 373
Prognosis 374
References 374
60 Pregnancy and Luminal Gastrointestinal Disease 377
Esophagus and Stomach 377
Gastroesophageal Reflux Disease 377
Peptic Ulcer Disease 377
Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum 377
Small Intestine and Colon 379
Irritable Bowel Syndrome 379
Constipation 379
Diarrhea 379
Abdominal Pain 379
Inflammatory Bowel Disease 379
Celiac Disease 380
Acute Abdominal Pain 380
References 381
61 Consequences of Human Immunodeficiency Virus Infection 383
Definition and Epidemiology 383
Pathogenesis 383
Clinical Features 384
Enterocolitis 384
Proctitis 385
Diagnosis 385
Differential Diagnosis 385
Therapeutics 385
Prognosis 386
References 387
Part 5 Diseases of the Pancreas 389
62 Acute Pancreatitis and (Peri)pancreatic Fluid Collections 391
Introduction 391
Definitions 391
Interstitial Pancreatitis 391
Pancreatic Necrosis 391
Extrapancreatic Fluid Collections 391
Pancreatic Pseudocyst 392
Walled-Off Peripancreatic Necrosis 393
Walled-Off Pancreatic Necrosis 393
Walled-Off Pancreatic and Peripancreatic Necrosis 393
Epidemiology 393
Pathophysiology 393
Clinical Features 394
Acute Peripancreatic Fluid Collections 394
Pancreatic Pseudocysts 394
Acute Necrotic Collection 394
Walled-Off Necrosis 394
Diagnosis 394
Differential Diagnosis 395
Therapeutics 395
Interstitial Pancreatitis 395
Necrotizing Pancreatitis 395
Prognosis 396
References 397
63 Chronic Pancreatitis and Pancreatic Pseudocysts 398
Chronic Pancreatitis 398
Clinical Manifestations 398
Diagnosis 398
Treatment 399
Pseudocysts 399
Natural History 399
Diagnosis 399
Symptoms 400
Drainage of Pseudocysts 400
Medical Therapy 400
Surgical Drainage 400
Radiologic (Percutaneous) Drainage 401
Endoscopic Drainage 401
Pseudocyst Recurrence 401
References 402
64 Pancreatic Cancer and Cystic Pancreatic Neoplasms 403
Pancreatic Cancer 403
Definition and Epidemiology 403
Pathophysiology 403
Clinical Features 403
Diagnosis 403
Differential Diagnosis 404
Therapeutics 404
Prognosis 404
Cystic Pancreatic Neoplasms 405
Definition and Epidemiology 405
Pathophysiology 405
Clinical Features 406
Diagnosis 406
Differential Diagnosis 407
Therapeutics 407
Prognosis 407
References 407
Part 6 Functional Diseases of the Small and Large Intestine 409
65 Irritable Bowel Syndrome 411
Definition and Epidemiology 411
Pathophysiology 411
Clinical Features 412
GI Symptoms 412
Extraintestinal Symptoms and Comorbid Disorders 412
Severity 412
Diagnosis 412
Symptom-Based Criteria 412
Alarm Features 413
Diagnostic Testing 413
Therapeutics 413
Patient-Centered Care 413
Diet 413
Physical Activity 413
Therapies for IBS with Constipation 414
Therapies for IBS with Diarrhea 415
Therapies for Multiple Subtypes of IBS 415
Non-pharmacologic Therapies 416
Prognosis 417
References 417
66 Chronic Functional Constipation and Dyssynergic Defecation 420
Definition and Epidemiology 420
Pathophysiology 420
Clinical Features 421
Diagnosis and Differential Diagnosis 422
Management 423
Fluid, Dietary Fiber, and Exercise 424
Laxatives 424
New Therapies for Functional Constipation 425
Biofeedback Therapy for Dyssynergic Defecation 425
Refractory Cases: The Role of Surgery and Neuromodulation 425
References 425
67 Chronic Functional Abdominal Pain 427
Definition and Epidemiology 427
Pathophysiology 427
Clinical Features 428
Diagnosis 428
Differential Diagnosis 429
Therapeutics 429
Prognosis 431
References 431
68 Abdominal Bloating and Visible Distension 432
Epidemiology 432
Patient Evaluation 432
Pathophysiology of Bloating and Distension 433
Treatment 433
Elimination Diets 434
Self-Help Therapies 434
Antibiotics 434
Prokinetics 434
Secretagogues 434
References 435
Part 7 Transplantation 437
69 Gastrointestinal Complications of Solid Organ and Hematopoietic Cell Transplantation 439
Introduction 439
Infections in the GI System Following SOT or HCT 439
Viral Infections 440
Fungal Infections 441
Parasitic Infections 441
Bacterial Infections 441
GI Malignancies after SOT and HCT 441
Post-transplant Lymphoproliferative Disorder 441
GI Adverse Drug Events 442
General GI Complications 442
Special Topics 443
Graft-versus-host Disease (GVHD) 443
Sinusoidal Obstruction Syndrome (SOS) 443
References 444
Section IV Liver and Biliary Tract 445
Part 1 Diagnostic Approaches in Liver Disease 447
70 Approach to History-Taking and Physical Examination in Liver and Biliary Disease 449
Introduction 449
History-Taking 449
Jaundice 449
Viral Hepatitis 449
Drug-Induced Liver Disease 450
Non-Alcoholic Fatty Liver Disease 450
Alcoholic Liver Disease 450
Right Upper Quadrant Pain 451
Physical Examination 451
Examination of the Abdomen 452
Inspection 452
Auscultation 452
Percussion 452
Palpation 452
Abnormal Liver Function Tests 453
Acknowledgements 454
References 454
71 Acute Liver Failure 455
Introduction 455
Definition 455
Etiology 455
Pathophysiology 456
Diagnostic Evaluation 456
Management 457
Etiology-Specific Therapies 457
General Supportive Care 457
Monitoring of Blood Tests 457
Nutrition 457
Management of Infection Risk 457
Coagulation Abnormalities and Bleeding 458
Management of Encephalopathy Grades I and II 459
Management of Encephalopathy Grades III and IV 459
Renal Support 459
Monitoring for Raised ICP 459
Treatment of Intracranial Hypertension 459
Mannitol 459
Hypertonic Saline 459
Hyperventilation 459
Barbiturates 459
Hypothermia 459
Seizure Management in ALF 459
Liver Support Devices 460
Prognostic Scoring Systems 460
Liver Transplantation 460
References 460
72 Imaging of the Liver and Bile Ducts: Radiographic and Clinical Assessment of Findings 462
Introduction 462
Liver Cysts 462
Hemangioma 462
Focal Nodular Hyperplasia 463
Hepatic Adenoma 464
Nodular Regenerative Hyperplasia 465
Miscellaneous Benign Lesions 466
Hepatocellular Carcinoma 466
Other Malignant Liver and Biliary Tumors 466
Cholelithiasis/Choledocholithiasis 467
Primary Sclerosing Cholangitis 468
References 468
73 Assessment of Liver Fibrosis: Liver Biopsy and Other Techniques 470
Liver Biopsy 470
Technique and Safety 470
Complications and Risks of Liver Biopsy 470
Preprocedure Assessment and Equipment 471
Technique 471
Postbiopsy Monitoring 471
Interpretation 472
Alternatives to Assessment of Liver Fibrosis 472
Serum Biomarkers 472
Ultrasound-Based Elastography 473
Magnetic Resonance Elastography 474
Evaluation of Portal Hypertension 474
References 474
74 Endoscopic Techniques Used in the Management of Liver and Biliary Tree Disease: ERCP and EUS 475
Equipment and Review of Technology 475
ERCP 475
EUS 475
How to Perform ERCP and EUS 476
Role of EUS and ERCP in the Diagnosis and Management of Hepatobiliary Disease 476
Suspected Choledocholithiasis 476
Biliary Obstructions and Strictures 477
Role of EUS 478
Role of ERCP 478
Proximal or Hilar Obstructions 478
Indeterminate Biliary Strictures 479
Bile Leaks 479
Primary Sclerosing Cholangitis 479
Ampullary Tumors 479
Occult Cholelithiasis and Microlithiasis 479
Sphincter of Oddi Dysfunction 479
Miscellaneous Uses of EUS 479
Complications of EUS and ERCP 479
References 480
Part 2 Diseases of the Liver 483
75 Acute Viral Hepatitis: Hepatitis A, Hepatitis E, and Other Viruses 485
Hepatitis A 485
Definition and Epidemiology 485
Pathophysiology 485
Clinical Features 486
Diagnosis 487
Differential Diagnosis 487
Therapeutics 487
Prevention 488
Prognosis 489
Hepatitis E 489
Definition and Epidemiology 489
Pathophysiology 489
Clinical Features 489
Diagnosis 489
Differential Diagnosis 490
Therapeutics 490
Prevention 490
Prognosis 490
Other Viruses 490
Herpesvirus Family 490
References 491
76 Chronic Hepatitis B and D 493
Hepatitis B Virus 493
Natural History of Chronic HBV Infection 494
Conclusion 498
Hepatitis Delta Virus 498
References 499
77 Hepatitis C 500
Diagnosis and Evaluation 500
When and Who to Treat 501
Treatment 501
Genotype 1 501
Genotype 1a or Undifferentiated Genotype 1 503
Genotype 1b 504
Nuances for Ledipasvir/Sofosbuvir and Velpatasvir 504
Nuances for Paritaprevir/Ritonavir/Ombitasvir plus Dasabuvir 504
Nuances for Simeprevir and for Grazoprevir 504
Genotype 2 505
Genotype 3 505
Genotype 4 505
Genotypes 5 and 6 505
Nuances for Liver Transplantation 505
Conclusion 506
References 506
78 Bacterial and Other Non-viral Infections of the Liver 507
Pyogenic Liver Abscess 507
Microbiology 507
Epidemiology 507
Pathogenesis 507
Clinical Features 507
Diagnosis 507
Treatment 507
Pylephlebitis 508
Amebic Liver Abscess 508
Microbiology 508
Epidemiology 508
Pathogenesis 508
Clinical Features 508
Diagnosis 508
Treatment 509
Acute Cholangitis 509
Microbiology 509
Pathogenesis 509
Clinical Features 509
Diagnosis 509
Treatment 509
Granulomatous Hepatitis 510
Microbiology 510
Diagnosis 510
Bacterial Infections of the Liver 511
Protozoa 511
Malaria 511
Leishmaniasis 514
Toxoplasmosis 514
Fungi 514
Helminths 515
Echinococcosis (Hydatid Disease) 515
Trematodes (Flukes) 515
Nematodes (Roundworms) 516
References 516
79 Alcoholic Liver Disease 518
Introduction 518
Definition and Epidemiology 518
Pathophysiology 518
Metabolic Mechanisms 518
Acetaldehyde 519
Oxidative Stress and MEOS 519
Genetic and Hereditary Factors 519
Clinical Features 519
Diagnosis 519
Differential Diagnosis 520
Prognosis 520
Management 520
Lifestyle Modification 520
Drug Therapy 521
Other Treatment Options 521
Liver Transplantation 521
References 522
80 Drug-Induced Liver Injury 523
Definition and Epidemiology 523
Clinical Presentation and Clinical Evaluation 524
Idiosyncratic DILI 524
Acetaminophen 524
Diagnosis and Causality Assessment 524
Idiosyncratic DILI 524
Acetaminophen 525
Causative Drugs 525
Risk Factors 525
Prognosis 526
Idiosyncratic DILI 526
Acetaminophen 526
Management 526
References 527
81 Autoimmune Liver Diseases 528
Autoimmune Hepatitis 528
Definition and Epidemiology 528
Pathophysiology 528
Clinical Features 528
Diagnosis 528
Differential Diagnosis 529
Therapeutics 529
Treatment End Points 529
Primary Biliary Cholangitis 530
Definition and Epidemiology 530
Pathophysiology 530
Clinical Features 530
Diagnosis 530
Overlap Syndrome with AIH 531
Therapeutics: Disease-Related Complications 531
Therapeutics: Primary Underlying Disease 531
Monitoring 531
Celiac Disease 532
Definition and Epidemiology 532
Clinical Features 532
Diagnosis 532
Therapeutics 532
References 532
82 Vascular Diseases of the Liver 533
Budd–Chiari Syndrome 533
Definition and Epidemiology 533
Pathophysiology 533
Etiology 533
Clinical Manifestations 534
Diagnosis 535
Therapy 535
Medical Therapy and Management of Complications 535
Prognosis and Survival 536
Hematopoietic Stem Cell Transplantation 536
Definition and Epidemiology 536
Sinusoidal Obstruction Syndrome 536
Pathophysiology 536
Clinical Features 538
Diagnosis 538
Therapy 539
Prognosis 540
References 540
83 Metabolic Syndrome and Non-alcoholic Fatty Liver Disease 542
Definition and Epidemiology 542
Pathophysiology 543
Clinical Features 543
Symptoms and Signs 543
Laboratory Abnormalities 544
Imaging Features 544
Histologic Features 545
Assessment of Disease Severity 546
Diagnosis 546
Differential Diagnosis 546
Prognosis 547
Treatment 547
Treatment of Associated Conditions 547
Pharmacologic Treatment 548
General Recommendations 548
References 548
84 Hemochromatosis, Wilsons Disease, and Alpha-1-Antitrypsin Deficiency 550
Hereditary Hemochromatosis 550
Epidemiology and Pathophysiology 550
Clinical Features 550
Diagnosis 552
Differential Diagnosis 552
Treatment 553
Experimental Treatments 553
Rationale 553
Wilsons Disease 553
Pathogenesis 553
Clinical Features 553
Diagnosis 554
Differential Diagnosis 554
Treatment 554
Trientine 555
D-penicillamine 555
Zinc 555
Monitoring 555
Experimental Treatment 555
Liver Transplantation 555
Alpha-1-Antitrypsin Deficiency 556
Pathogenesis 556
Clinical Features 556
Diagnosis 556
Treatment 556
Experimental Treatments 556
References 556
85 Hepatic Manifestations of Systemic Diseases 558
Cardiovascular Disorders 558
Pulmonary Disorders 559
Renal Disorders 559
Endocrine Disorders 559
Rheumatologic Disorders 560
Gastroenterologic Disorders 560
Hematologic Disorders 561
Infiltrative Systemic Disorders 561
Miscellaneous Disorders 562
References 562
86 Diseases of the Biliary Tract and Gallbladder 563
Gallstone Disease and Cholecystitis 563
Definition 563
Presentation and Diagnosis 563
Treatment of Acute Cholecystitis 564
Choledocholithiasis and Cholangitis 565
Choledocholithiasis 565
Cholangitis 565
Gallbladder Polyps 566
Definition 566
Presentation and Diagnosis 566
Treatment 567
Biliary Flukes 567
Definition 567
Presentation 567
Diagnosis 567
Cholangiocarcinoma 567
Cancer of the Gallbladder and Biliary Tree 567
Definition 567
Presentation 567
Diagnosis 567
Staging 568
Surgical Therapy 568
Cholangiocarcinoma 568
Definition 568
Risk Factors 568
Presentation 568
Diagnosis 568
Staging 569
Chemotherapy 569
Resection and Outcomes 569
Transplantation 569
Primary Sclerosing Cholangitis 570
Definition 570
Epidemiology 570
Pathophysiology 570
Clinical Features 570
Diagnosis 570
Histologic Features 570
Therapeutics 571
References 572
87 Portal Hypertension 574
Introduction 574
Diagnosis of Portal Hypertension 574
Ultrasonography 574
Computed Tomography 574
Magnetic Resonance Imaging 574
Varices 574
Pathophysiology 575
Clinical Features 575
Detection of Varices: Esophagogastroduodenoscopy 575
Treatment 575
Varices at Other Sites 576
Ascites 577
Pathophysiology 577
Clinical Features 577
Diagnosis 577
Treatment 578
Prognosis 579
Spontaneous Bacterial Peritonitis 579
Pathophysiology 579
Organisms 579
Clinical Features 579
Diagnosis 579
Treatment 579
Prognosis 579
Hepatorenal Syndrome 580
Pathophysiology 580
Clinical Features 580
Diagnosis 580
Treatment 580
Hepatic Encephalopathy 580
Pathophysiology 580
Clinical Features 581
Diagnosis 581
Treatment 581
Prognosis 582
Hepatopulmonary Syndrome and Portopulmonary Hypertension 582
Hepatopulmonary Syndrome 583
Portopulmonary Hypertension 583
Prognosis 584
References 585
88 TIPS 587
Equipment and Review of Technology 587
Application 587
Diagnostic Methods 587
Evidence-Based Therapeutics 589
Complications 590
References 592
89 Primary Carcinoma of the Liver 594
Hepatocellular Carcinoma 594
Epidemiology 594
Risk Factors 594
Pathogenesis 595
Clinical Features 595
Diagnosis 596
Treatment 596
Cholangiocarcinoma 598
Epidemiology and Risk Factors 598
Clinical Features and Diagnosis 599
Treatment 599
References 600
90 Pregnancy and Liver Disease 602
Definition and Epidemiology 602
Pathophysiology 602
Hyperemesis Gravidarum 602
Intrahepatic Cholestasis of Pregnancy 602
HELLP Syndrome 603
Acute Fatty Liver of Pregnancy 603
Clinical Features 603
Hyperemesis Gravidarum 603
Intrahepatic Cholestasis of Pregnancy 603
Pre-eclampsia 603
HELLP Syndrome 603
Acute Fatty Liver of Pregnancy 603
Diagnosis 604
Hyperemesis Gravidarum 604
Intrahepatic Cholestasis of Pregnancy 604
HELLP Syndrome 604
Acute Fatty Liver of Pregnancy 604
Therapeutics 604
Hyperemesis Gravidarum 604
Intrahepatic Cholestasis of Pregnancy 604
Pre-eclampsia 604
HELLP Syndrome 604
Acute Fatty Liver of Pregnancy 605
Prognosis and Recurrence of Disease in Future Pregnancies 605
Hyperemesis Gravidarum 605
Intrahepatic Cholestasis of Pregnancy 605
HELLP Syndrome and Acute Fatty Liver of Pregnancy 605
References 606
91 Pediatric Liver Disease 607
Biliary Atresia 607
Pathophysiology and Types 607
Diagnosis and Management 608
Survival with Native Liver 608
Clinical Features 608
Adolescents and Adults without Chronic Liver Disease 608
Quality of Life 609
Transplantation 609
Cystic Fibrosis 609
Pathophysiology/Definition 609
Epidemiology 609
Diagnosis 609
Differential Diagnosis 610
Alpha-1-Antitrypsin Deficiency 610
Pathophysiology 610
Clinical Features and Diagnosis 610
Progressive Familial Intrahepatic Cholestasis 611
Benign Recurrent Intrahepatic Cholestasis 611
Alagille Syndrome 611
Dubin–Johnson Syndrome 612
Crigler–Najjar Syndrome 612
Urea Cycle Defects 612
Glycogen Storage Diseases 612
Inborn Errors of Mitochondrial Fatty Acid Oxidation 612
Liver Transplantation in Children 613
Indications and Contraindications 613
Position on Waitlist 614
Technical Aspects of Liver Transplantation in Children 614
Living Donor Transplantation in Children 614
Complications of Liver Transplantation 614
Quality of Life 614
Adherence 615
Transition to Adult Service 615
References 615
Part 3 Liver Transplantation 619
92 Indications and Selection of Patients for Liver Transplantation 621
Prognosis and Allocation 621
Indication and Timing of Liver Transplantation Evaluation 622
General Assessment of the Potential Liver Transplant Candidate 622
Deceased versus Living Donor Liver Transplantation 623
Listing for Simultaneous Liver–Kidney Transplantation 623
Disease-Specific Considerations 623
Acute Liver Failure 623
Alcoholic Liver Disease 623
Non-Alcoholic Steatohepatitis 624
Hepatitis C 624
Hepatitis B 625
Autoimmune Hepatitis 625
Cholestatic Liver Diseases 625
Metabolic Diseases 625
Hepatocellular Carcinoma 626
Cholangiocarcinoma 626
Hepatopulmonary and Portopulmonary Syndromes 626
Conclusion 627
References 627
93 What Every Hepatologist Should Know about Liver Transplantation 628
Introduction 628
Liver Allocation 628
Future Trends in Organ Allocation 628
Donor Selection 629
Surgical Anatomy of the Liver 629
Techniques of Liver Transplantation 630
Phases of Liver Transplantation 631
Total Hepatectomy 631
Anhepatic Phase 631
Reperfusion 632
Biliary Anastomosis 632
Surgical Complications of Liver Transplantation 633
Hemorrhage 633
Hepatic Arterial Complications 633
Portal Vein Complications 634
Hepatic Vein and IVC Complications 634
Biliary Complications 634
Donor-Related Complications 634
Living Donor Liver Transplantation 635
Conclusion 635
References 635
94 Immunosuppression Used in Liver Transplantation 637
Immunosuppressive Drugs 637
General Principles 637
Calcineurin Inhibitors (Cyclosporine, Tacrolimus) 638
Antiproliferative/Antimetabolite Agents (Azathioprine, Mycophenolate Mofetil/Mycophenolate Sodium) 641
Corticosteroids (Methylprednisolone, Prednisone, Prednisolone) 642
Mammalian Target of Rapamycin Inhibitors (Sirolimus, Everolimus) 642
Induction Antibodies 643
Lymphocyte-Depleting Antibodies (Antithymocyte Globulin, Alemtuzumab) 643
Non-Lymphocyte-Depleting Antibodies (Basiliximab) 643
Rescue Treatment for Episodes of Acute Rejection 644
Immunosuppressive Strategies to Minimize Long-Term Adverse Effects 644
References 644
95 Medical Management of the Liver Transplant Patient 646
Immunosuppression 646
Medical Complications 646
Biliary Complications 646
Rejection 646
Infectious Complications 647
Vaccinations 647
Renal Complications 648
Cardiovascular Complications 648
Metabolic Complications 648
Neurological Complications 649
Malignancy Complications 649
Primary Disease Recurrence 649
References 650
96 Organ Allocation Policy: Practical Issues and Challenges to the Gastroenterologist 652
Introduction 652
Allocation 652
Distribution 652
Modifications in Distribution Scheme 653
MELD Exceptions 653
Hepatocellular Carcinoma 653
Hepatopulmonary Syndrome 653
Cholangiocarcinoma 653
Cystic Fibrosis 654
Familial Amyloid Polyneuropathy 654
Primary Hyperoxaluria 654
Portal Pulmonary Syndrome 654
Other Exceptions 654
Practical Challenges 654
Allocation and Renal Dysfunction 654
Allocation and Hyponatremia 654
Infections 655
Portal Vein Thrombosis 655
Conclusion 655
Acknowledgement 655
References 655
97 Endoscopic Ultrasound 657
Introduction 657
Pancreatic EUS 657
Pancreatic Cancer 657
Pancreatic Cysts 657
Chronic Pancreatitis 658
Autoimmune Pancreatitis 658
Pancreatic Endocrine Tumors 658
Small-Bowel EUS 658
Ampullary Adenomas and Cancers 658
Duodenal Polyps and Cancers 658
Colorectal EUS 658
Colon Cancer 658
Rectal Cancer 658
Anal Cancer 659
Fecal Incontinence 659
Anal Fistulas 659
Complications of EUS 659
References 659
Index 661
EULA 679

Produkt-Details

• Erscheint lt. Verlag: 14.7.2016
• Mitarbeit: Chef-Herausgeber: Nicholas J. Talley
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Allgemeines / Lexika
• Themenwelt: Medizinische Fachgebiete ► Innere Medizin ► Gastroenterologie
• Themenwelt: Medizinische Fachgebiete ► Innere Medizin ► Hepatologie
• Themenwelt: Medizin / Pharmazie ► Studium
• Schlagworte: AASLD • Allgemeine u. Innere Medizin • ASG • ASGE • Board • CME credit • EASL • Gastroenterologie • Gastroenterologie u. Hepatologie • gastroenterology • Gastroenterology & Hepatology • Gastrointestinal surgery • General & Internal Medicine • GI • hepatology • Magen-Darm-Chirurgie • MCQs • Medical Science • Medizin • Trainee
• ISBN-10: 1-118-82907-7 / 1118829077
• ISBN-13: 978-1-118-82907-3 / 9781118829073