Gastroenterology Volume I Second EditionPDF电子书下载

SECTION Ⅰ THE EXAMINATION OF THE PATIENT 1

Chapter 1 HISTORY TAKING＆J．L．A．ROTH 3

INTRODUCTION 3

RECORDING THE HISTORY 4

HISTORY OF PRESENT ILLNESS 4

PAST MEDICAL HISTORY 6

PERSONAL HISTORY 8

FAMILY HISTORY 13

Chapter 2 SYMPTOMATOLOGY 14

ABDOMINAL PAIN AND DISCOMFORT 14

Philosophic Concepts—Beneficent vs．Deleterious Effect of Pain 15

Appraisal of Pain Intensity 16

Mechanism of Abdominal Pain 18

Pitfalls in the Interpretation of Abdominal Pain 26

Clinical Appraisal of Pain 28

Chapter 3 SYMPTOMATOLOGY(Continued)＆J．L．A．ROTH 37

DISAGREEABLE TASTE 38

COATED TONGUE 38

SORE TONGUE 39

BAD BREATH 39

HUNGER AND APPETITE 40

THIRST 44

NAUSEA 44

VOMITING 45

REGURGITATION 50

RUMINATION 51

HICCUP 51

PYROSIS 52

DYSPHAGIA 54

AEROPHAGIA 59

HEADACHE AND THE GASTROINTESTINAL TRACT 69

VERTIGO 69

OTHER SYMPTOMS 70

Chapter 4 PHYSICAL EXAMINATION 72

GENERAL INSPECTION 73

LYMPH NODES 75

NERVOUS SYSTEM 76

HEAD AND NECK 76

CHEST AND CARDIOVASCULAR SYSTEM 78

EXAMINATION OF ABDOMEN 78

Inspection 78

Palpation and Percussion 80

Auscultation 89

EXAMINATION OF SPINE 89

RECTAL EXAMINATION 90

EXAMINATION OF THE PELVIS AND GENITALS 91

Chapter 5 ORAL MANIFESTATIONS OF INTERNAL DISEASE＆LESTER W．B？RKET 93

GINGIVITIS 94

GINGIVAL ENLARGEMENT 94

ULCERONECROTIC GINGIVOSTOMATITIS(TRENCH MOUTH) 95

THE METALLIC STOMATITIDES 96

HERPETIC STOMATITIS 96

ERYTHEMA MULTIFORME 97

HYPERKERATOTIC LESIONS OF THE ORAL MUCOSA 98

MONILIASIS 100

ORAL ASPECTS OF NUTRITIONAL DEFICIENCIES 101

DISEASES OF THE TONGUE 103

Chapter 6 THE MANNER OF UTILIZING THE LABORATORY AND OTHER METHODS IN DIAGNOSIS 107

CHOICE OF DIAGNOSTIC AIDS 107

GENERAL PRINCIPLES IN THE DIAGNOSTIC SURVEY 108

SECTION Ⅱ THE ESOPHAGUS AND DIAPHRAGM 311

Chapter 7 APPLIED ANATOMY AND PHYSIOLOGY OF THE ESOPHAGUS＆FRANK BROOKS 113

ANATOMY 113

PHYSIOLOGY 119

Chapter 8 ANOMALIES AND THE ESOPHAGUS，ESOPHAGEAL STENOSIS AND STRICTURE 124

ANOMALIES 124

ESOPHAGEAL STENOSIS OR STRICTURE(NOT CONGENITAL)＆Joseph P．Atkins 127

Caustic Burns and Stricture 128

Roentgenolic Diagnosis＆L．S．Finkelstein 129

Treatment＆Joseph P．Atkins 130

Chapter 9 TESTS EMPLOYED IN THE STUDY OF ESOPHAGEAL FUNCTION AND DISEASE 132

INTRODUCTION 132

ESOPHAGOSCOPY IN THE STUDY OF ESOPHAGEAL AFFECTIONS＆Joseph P．Atkins 133

MEDICAL ESOPHAGOSCOPY＆B．H．Sullivan，Jr 138

EXFOLIATIVE CYTOLOGY OF THE ESOPHAGUS＆F．Vilardell 141

Chapter 10 ACHALASIA(CARDIOSPASM)＆J．L．A．ROTH 145

DEFINITION 145

ETIOLOGY—PATHOGENESIS 146

DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS 154

Esophagoscopy in Diagnosis＆Joseph P．Atkins 157

Roentgenologic Diagnosis＆George N．Stein 158

COMPLICATIONS AND ASSOCIATED DISEASES 161

THERAPY 163

Endo-esophageal Treatment—Dilatation＆Joseph P．Atkins 164

Surgical Treatment＆Herbert R．Hawthorne and Paul Nemir，Jr 165

PROGNOSIS 166

Chapter 11 TUMORS OF THE ESOPHAGUS＆JAMES F．YOUNG 169

CARCINOMA OF THE ESOPHAGUS 169

Pathology 170

Diagnosis 171

X-ray Examination＆L．S．Finkelstein 172

Exfoliative Cytology＆F．Vilardell 177

Complications 178

Therapy 178

Radiation Therapy＆E．A．Tulsky 179

OTHER MALIGNANT TUMORS 182

BENIGN TUMORS OF THE ESOPHAGUS 182

X-ray Diagnosis＆L．S．Finkelstein 183

Chapter 12 ESOPHAGEAL DIVERTICULUM＆JOHN H．WILLARD 186

PHARYNGEAL(PHARYNGO-ESOPHAGEAL)DIVERTICULUM 186

X-ray Diagnosis＆L．S．Finkelstein 189

TRACTION DIVERTICULUM 191

TRACTION-PULSION DIVERTICULUM 193

Chapter 13 Part Ⅰ—ESOPHAGITIS AND PEPTIC ULCER OF THE ESOPHAGUS＆J．L．A．ROTH 195

ESOPHAGITIS AND PEPTIC ULCER OF THE ESOPHAGUS 195

Etiology 196

Pathogenesis of Reflux Esophagitis 197

Pathogenesis and Classification of Peptic Ulcer of the Esophagus 198

Pathology 200

Clinical Features 201

Esophagitis 201

Diagnosis and Differential Diagnosis 201

X-ray Diagnosis＆L．S．Finkelstein 202

Peptic Ulcer of Esophagus 206

Diagnosis 207

Therapy 208

Part Ⅱ—TUBERCULOSIS，SYPHILIS，FUNGUS INFECTION AND SCLERODERMA OF THE ESOPHAGUS 210

TUBERCULOSIS 210

SYPHILIS 211

FUNGUS INVOLVEMENT 213

SCLERODERMA 213

Chapter 14 DYSPHAGIA WITH IRON DEFICIENCY，ESOPHAGEAL WEBS AND ESOPHAGEAL RINGS＆FRANZ GOLDSTEIN 216

DYSPHAGIA WITH IRON DEFICIENCY(PLUMMER-VINSON SYNDROME，PATERSON-KELLY SYNDROME) 216

Diagnosis 217

X-ray＆L．S．Finkelstein and F．Goldstein 217

LOWER ESOPHAGEAL WEBS 219

LOWER ESOPHAGEAL RINGS(SCHATZKI＇S RINGS) 219

Chapter 15 VARICES，FOREIGN BODIES，FISTULA AND PERFORATION OF ESOPHAGUS＆JOSEPH P．ATKINS 223

ESOPHAGEAL VARICES 223

Diagnosis 223

X-ray＆L．S．Finkelstein 224

FOREIGN BODIES IN THE ESOPHAGUS 225

Diagnosis 226

X-ray＆L．S．Finkelstein 227

Treatment 228

ESOPHAGEAL FISTULA 228

Roentgenologic Diagnosis＆L．S．Finkelstein 229

PERFORATION AND RUPTURE OF THE ESOPHAGUS 229

Chapter 16 DIAPHRAGMATIC HERNIA，ESOPHAGEAL HIATUS HERNIA AND EVENTRATION OF THE DIAPHRAGM 232

DIAPHRAGMATIC HERNIA 233

ESOPHAGEAL DIAPHRAGMATIC HIATUS HERNIA 235

When to Suspect Hiatus Hernia—Significant Clinical Features 239

Gastric Analysis 241

Einhorn String Test 241

X-ray Examination＆G．N．Stein and A．Finkelstein 242

Esophagoscopy 246

Concomitants of Hiatus Hernia and the Differential Diagnosis 247

Complications 251

Therapy 254

Surgical Management of Hiatus Hernia＆Herbert R．Hawthorne 256

Prognosis 257

EVENTRATION OF THE DIAPHRAGM 257

SECTION Ⅲ AFFECTIONS OF THE STOMACH 263

Chapter 17 APPLIED ANATOMY AND PHYSIOLOGY OF THE STOMACH＆ALVIN J．CUMMINS 265

APPLIED ANATOMY OF THE STOMACH 266

FUNCTIONS OF THE STOMACH 275

Secretory Function 276

Motor Functions of the Stomach 283

Chapter 18 TESTS EMPLOYED IN THE STUDY OF GASTRIC FUNCTION AND DISEASE：ANALYSIS OF THE STOMACH CONTENTS＆DAVID C．H．SUN 289

EXAMINATION OF GASTRIC CONTENTS 290

Gastric Residuum 290

Chemical Examination of Gastric Content 296

Cultures of Stomach Content 298

Fractional Gastric Analysis(Rehfuss) 299

CAFFEINE GASTRIC ANALYSIS 304

TEST FOR BASAL GASTRIC SECRETION(INTERDIGESTIVE) 305

HISTAMINE TEXT FOR GASTRIC SECRETORY FUNCTION 307

INSULIN HYPOGLYCEMIA GASTRIC ANALYSIS FOR EVALUATING VAGAL CONTINUITY 310

PEPSINOGEN IN THE BLOOD 311

PEPSINOGEN IN THE URINE(UROPEPSIN ) 312

GASTRIC ANALYSIS WITH ALCOHOL TEST MEAL 312

TUBELESS GASTRIC ANALYSIS 313

NEUTRAL RED TEST FOR GASTRIC SECRETORY FUNCTION 314

Chapter 19 OTHER AIDS IN THE STUDY OF GASTRIC FUNCTION AND DISEASE 317

FLUOROSCOPY AND ROENTGENOGRAPHY 317

GASTROSCOPY＆J．F．Monaghan and P．R．Nast 318

EXFOLIATIVE CYTOLOGY＆F．Vilardell 329

EINHORN STRING OR THREAD IMPREGNATION TEST 337

Fluorescein String Test in Hemorrhage 339

Chapter 20 DISORDERS OF GASTRIC SECRETION＆DAVID C．H．SUN 340

ACHLORHYDRIA，ANACIDITY AND ACHYLIA 340

GASTRIC HYPERACIDITY 347

GASTRIC HYPERSECRETION 348

Chapter 21 ACUTE GASTRITIS＆ARTHUR M．SCHOEN 351

ACUTE EXOGENOUS GASTRITIS 351

ACUTE ENDOGENOUS GASTRITIS 360

Chapter 22 CHRONIC GASTRITIS＆F．VILARDELL 368

HISTORICAL ASPECTS 369

PATHOLOGY AND CLASSIFICATION 370

ETIOLOGY 373

DIAGNOSTIC PROCEDURES 377

Gastric Suction Biopsy 381

Gastroscopy＆J．F．Monaghan and P．R．Nast 385

Biopsy-Gastroscopy Correlations 390

Gastric Secretions and Chronic Gastritis 392

Radiology of Gastritis 396

DIAGNOSIS OF GASTRITIS 399

THERAPY 400

Chapter 23 CHRONIC GASTRITIS(Continued)Special Types．Its Relation to Other Diseases＆F．VILARDELL 405

POSTANASTOMOTIC GASTRITIS 405

GIANT HYPERTROPHY OF THE GASTRIC MUCOSA(MENETRIER＇S DISEASE) 406

FOCAL LYMPHODD HYPERPLASIA OF THE GASTRIC MUCOSA 412

GASTRITIS AND PEPTIC ULCER 413

CHRONIC GASTRITIS AND CANCER 414

GASTRITIS AND ANEMIA 415

Chapter 24 ETIOLOGY AND PATHOLOGY OF GASTRIC AND DUODENAL ULCER＆HARRY SHAY and DAVID C．H．SUN 420

ETIOLOGY OF PEPTIC ULCER 421

Definition—Introduction 421

Mucosal Defensive Factors 422

Aggressive Factors 425

Acid-Pepsin 425

Adrenal Gland and Peptic Ulcer 427

Stress and Gastric Secretion．Hypothalamico-Pituitary-Adrenal Concept 430

The Brain and Autonomic Nervous System in Peptic Ulcer 433

Stressful Stimuli Other Than Purely Emotional Stress 435

Psychosomatic Relationships 436

Pituitary Gland 438

Sex Hormones 439

Thyroid and Parathyroid Glands 439

Pancreas 440

Allergy 442

Infection and Peptic Ulcer 443

Relation of Reserpine，Phenylbutazone，Aspirin，Nicotine and Caffeine to Peptic Ulcer 444

Heredity and Constitution in Peptic Ulcer 446

Gastric and Duodenal Ulcers Fundamentally Different？ 449

PATHOLOGIC ANATOMY OF PEPTIC ULCER 451

Chapter 25 DIAGNOSIS OF UNCOMPLICATED CHRONIC PEPTIC ULCER 466

FREQUENCY AND ECONOMIC IMPORTANCE 467

SUBJECTIVE COMPLAINTS 469

Mechanism of Ulcer Pain 469

Peptic Ulcer Syndrome 472

PHYSICAL EXAMINATION 479

X-RAY DIAGNOSIS OF GASTRIC ULCER＆G．Stein 482

X-RAY DIAGNOSIS OF DUODENAL ULCER 491

GASTROSCOPY IN DIAGNOSIS OF GASTRIC ULCER＆J．F．Monaghan and P．R．Nast 497

GASTRIC ANALYSIS AND CYTOLOGIC EXAMINATION 499

BLOOD IN THE STOOLS 503

BLOOD COUNT 503

BLOOD GROUPS AND PEPTIC ULCER 505

STRING TEST OF EINHORN 505

ENDOCRINE TUMORS AND PEPTIC ULCER 505

DIAGNOSTIC SUMMARY AND DIFFERENTIAL DIAGNOSIS 506

ULCER-CANCER RELATIONSHIP 507

Malignant Change in Gastric Ulcer 507

Differential Diagnosis Between Benign and Malignant Gastric Ulcer 509

Roentgenologic Classification of Ulcerating Gastric Lesions＆G．Stein and A．Finkelstein 517

Gastric Analysis and Cytologic Examination 519

Other Laboratory Findings 519

In vivo Radioautography 519

Trial of Therapy 519

Independent Occurrence of Ulcer and Cancer in the Same Stomach 520

PYLORODUODENAL IRRITABILITY(PSEUDO-ULCER SYNDROME)(IRRITABLE DUODENUM)(EFFECT OF TOBACCO)(HYPERINSULINISM) 521

Chapter 26 MANAGEMENT OF UNCOMPLICATED PEPTIC ULCER 527

IMPORTANCE OF COMPLETE DIAGNOSIS IN ORGANIZATION OF THERAPEUTIC REGIMEN 528

Adequate History 528

Complete Diagnosis 529

HEALING THE PRESENT ULCER，TREATMENT DIRECTED TOWARD ACTIVE ULCER AND ITS IMMEDIATE ENVIRONMENT 534

Principles of Physiologic Stomach Rest 534

Diet 535

Antacids 538

Antisecretory and Motor Inhibitor(Anticholinergic)Drugs 547

Sedatives 549

Avoidance of Gastric Irritants and Stimulants 550

Control of Night Distress 550

Drugs to Increase Mucosal Resistance and Miscellany 551

Hospitalization Versus Ambulatory Treatment 552

Duration of Active Ulcer Regimen 552

Special Therapeutic Measures in Ulcer Therapy 553

Ritual for Gastric Ulcer 556

Prevention and Management of Iatrogenic Peptic Ulcer 556

Ulcer Cure or Prevention of Recurrence 557

DIET AND THERAPY OUTLINES FOR PATIENTS WITH PEPTIC ULCER 559

Chapter 27 COMPLICATIONS OF PEPTIC ULCER DISEASE＆WILLIAM S．HAUBRICH 565

VARIETIES AND VAGARIES OF PERFORATION 566

ACUTE FREE PERFORATION 568

ACUTE PERFORATION WITH SPONTANEOUS CLOSURE 582

PENETRATION AND CONFINED PERFORATION 582

OBSTRUCTION AT OR NEAR THE PYLORUS 592

BILOCULAR STOMACH 602

SUBPHRENIC ABSCESS 605

CARCINOMA AT SITE OF DUODENAL ULCER 609

Chapter 28 HEMATEMESIS AND MELENA＆A．BOGOCH 614

INTRODUCTION AND CLASSIFICATION OF CAUSES 616

CAUSES OF HEMATEMESIS AND MELENA 617

Sources of Bleeding 618

Diseases of the Esophagus 618

Diseases of the Stomach and Duodenum 621

Diseases of the Small Intestine 629

Diseases of Proximal Colon 630

Diseases of Neighboring Organs 630

Diseases of Blood 632

Diseases of Blood Vessels 636

Systemic Diseases 638

CLINICAL AND PHYSIOLOGIC EFFECTS OF MASSIVE GASTRODUODENAL BLEEDING 640

EARLY DIAGNOSTIC INVESTIGATIONS 648

MEDICAL MANAGEMENT 653

MORTALITY IN BLEEDING PEPTIC ULCER；SELECTION OF PATIENTS FOR EMERGENCY SURGERY 659

FOLLOW-UP DIAGNOSTIC STUDIES AND MANAGEMENT 663

ELECTIVE SURGERY FOR PREVENTION OF RECURRENT BLEEDING 663

Chapter 29 INDICATIONS FOR OPERATION AND SELECTION OF OPERATIVE PROCEDURE IN THE MANAGEMENT OF PEPTIC ULCER DISEASE＆J．L．A．ROTH 668

INDICATIONS FOR OPERATION 668

Operation for Complications 669

Operation for Intractability 671

Operation for Gastric Ulcer 672

INDIVIDUALIZED SELECTION OF ULCER OPERATION 674

Chapter 30 CARE OF THE SURGICAL PATIENT＆DONALD R．COOPER 682

EXPECTED RESPONSE OF A NORMAL PATIENT TO SURGICAL TRAUMA 683

PREOPERATIVE PREPARATION 685

POSTOPERATIVE PERIOD 696

Chapter 31 SEQUELAE OF GASTRIC SURGERY FOR PEPTIC ULCER＆WILLIAM S．HAUBRICH 702

EARLY POSTGASTRECTOMY PROBLEMS 703

INTERMEDIATE POSTGASTRECTOMY PROBLEMS 705

LATER POSTGASTRECTOMY PROBLEMS 707

Recurrent Peptic Ulceration 707

Postprandial Problems 714

Nutritional Impairment 720

OTHER POSTGASTRECTOMY PROBLEMS 725

Return to Gainful Endeavor 727

PREVENTION OF POSTGASTRECTOMY PROBLEMS 727

Chapter 32 FACTORS INFLUENCING PROGNOSIS IN PEPTIC ULCER 734

Age 734

PAST MEDICAL HISTORY 735

CHARACTER OF ULCER 736

ULCER ENVIRONMENT OR LOCAL MILIEU(EXCLUDING COMPLICATIONS) 737

INFLUENCE OF ASSOCIATED DISEASE 738

IMMEDIATE INFLUENCE OF COMPLICATIONS 739

INTRACTABILITY 741

Chapter 33 CARCINOMA OF THE STOMACH 743

FREQUENCY 745

PATHOGENESIS 746

PATHOLOGY 749

DIAGNOSIS 755

Symptomatology 755

Physical Examination 759

X-ray Examination 760

Gastroscopy＆J．F．Monaghan and P．R．Nast 767

Gastric Cytology＆F．Vilardell 771

Gastric Analysis 775

Examination of Stools 777

Blood Picture 777

Blood Chemistry，Serology and Sedimentation 777

Gastrocamera 777

Radioactive Phosphorus 778

Electrogastrogram 779

Final Remarks on Diagnosis 779

DIFFERENTIAL DIAGNOSIS 780

COMPLICATIONS 784

TREATMENT 785

Prophylaxis 785

Surgical Treatment＆L．Kraer Ferguson 786

Radiation Therapy 795

Other Therapeutic Agents 795

Medical Care 795

PROGNOSIS 796

Chapter 34 MALIGNANT TUMOBS OF THE STOMACH OTHER THAN CARCINOMA＆J．F．YOUNG 802

MALIGNANT LYMPHOMAS 802

Classification and Pathology 802

Incidence 803

Clinical Features 804

X-ray Study 805

Gastroscopy＆J．F．Monaghan and P．R．Nast 806

Cytologic Aspects＆F．Vilardell 807

Other Diagnostic Aids 809

Therapy 809

Surgical Management 809

Radiation and Chemotherapy＆E．G．Tulsky 809

Prognosis 810

LEUKEMIA 810

SMOOTH MUSCLE TUMORS 811

Leiomyosarcoma 811

OTHER SARCOMAS 813

CARCINOIDS(ARGENTAFFINOMAS) 813

METASTATIC DISEASE INVOLVING THE STOMACH 814

Chapter 35 BENIGN TUMORS OF THE STOMACH＆V．TACHDJIAN 817

INCIDENCE 817

ETIOLOGY AND PATHOLOGY 818

TYPES OF TUMOR AND HISTOLOGIC FEATURES 818

CLINICAL FEATURES 828

X-RAY EXAMINATION 829

ENDOSCOPY＆J．F．Monaghan and P．R．Nast 831

DIAGNOSIS 832

TREATMENT AND PROGNOSIS 832

Chapter 36 CHRONIC INFECTIONS OF THE STOMACH，GRANULOMAS OF THE STOMACH AND DUODENUM，FOREIGN BODIES 835

SYPHILIS AND THE STOMACH 836

Syphilis of the Stomach 836

Gastric Manifestations of Extragastric Syphilis 850

Gastric Crises of Cerebrospinal Syphilis 851

Treatment＆A．Tornay 854

OTHER CHRONIC INFECTIONS＆Geraldo Siffert 857

Tuberculosis of the Stomach 857

Treatment，＆D．D．Harrell 861

Mycotic Infections of the Stomach 861

Anthrax of the Stomach 862

GRANULOMAS OF THE STOMACH AND DUODENUM 864

Eosinophilic Granuloma 864

Granuloma Related to Regional Enteritis 865

FOREIGN BODIES IN THE STOMACH 869

Chapter 37 PYLORIC MUSCLE HYPERTROPHY IN ADULTS．PROLAPSE OF GASTRIC MUCOSA THROUGH THE PYLORUS＆J．EDWARD BERK 875

PYLORIC MUSCLE HYPERTROPHY IN ADULTS 875

PROLAPSE OF GASTRIC MUCOSA THROUGH THE PYLORUS 886

Chapter 38 DIVERTICULA OF THE STOMACH＆JOHN H．WILLARD 893

CLINICAL FEATURES 895

TREATMENT 897

Chapter 39 ANOMALIES OF THE STOMACH＆ORVILLE F．NIELSEN 899

CONGENITAL HYPERTROPHIC PYLORIC STENOSIS 901

CASCADE STOMACH 905

PREPYLORIC SEPTUM 909

CONGENITAL DEFECT OF GASTRIC MUSCULATURE 910

VOLVULUS OF THE STOMACH 911

DUPLICATION OF THE ALIMENTARY TRACT 914

Chapter 40 ACUTE DILATATION OF THE STOMACH AND INJURIES AND RUPTURE OF THE STOMACH＆ORVILLE F．NIELSEN 920

ACUTE DILATATION OF THE STOMACH 920

INJURIES AND RUPTURE OF THE STOMACH 925

INDEX 929