Sleisenger & Fordtran's
`
`Gastrointestinal
`and Liver Disease
`
`Pathophysiology / Diagnosis / Management
`
`6th Edition
`Volume 2
`
`Marvin H. Sleisenger, M.D.
`Professor of Medicine
`University of California, San Francisco
`Distinguished Physician
`Department of Veterans Affairs
`Medical Center
`San Francisco VA Medical Center
`San Francisco, California
`
`Nutrition Section Editor:
`Samuel Klein, M.D.
`Professor of Medicine
`Director, Center for Human Nutrition
`Washington University School of Medicine
`St. Louis, Missouri
`
`Mark Feldman, M.D.
`Southland Professor and Vice Chairman
`Department of Internal Medicine
`University of Texas Southwestern
`Medical Center at Dallas
`Chief, Medical Service
`Department of Veterans Affairs Medical
`Center
`Dallas, Texas
`
`Bruce F. Scharschmidt, M.D.
`Professor of Medicine
`Division of Gastroenterology
`University of California, San Francisco
`San Francisco, California
`Vice President, Clinical Affairs
`Chiron Corporation
`Emeryville, California
`
`W.B. SAUNDERS COMPANY
`A Division of Harcourt Brace & Company
`Philadelphia London Toronto Montreal Sydney Tokyo
`
`This material wascopied
`at the KM and may be
`Subject US Copyright Laws
`
`Ex. 1027 - Page 1
`
`

`

`Sleisenger & Fordtran's
`
`t stL al
`std' (cid:9)
`and Liver I isease
`
`6th Edition
`Volume 2
`
`Marvin H. Sleisenger, M.D.
`Professor of Medicine
`University of California, San Francisco
`Distinguished Physician
`Department of Veterans Affairs
`Medical Center
`San Francisco VA Medical Center
`San Francisco, California
`
`Nutrition Section Editor:
`Samuel Klein, M.D.
`Professor of Medicine
`Director, Center for Human Nutrition
`Washington University School of Medicine
`St. Louis, Missouri
`
`Mark Feldman, M.D.
`Southland Professor and Vice Chairman
`Department of Internal Medicine
`University of Texas Southwestern
`Medical Center at Dallas
`Chief, Medical Service
`Department of Veterans Affairs Medical
`Center
`Dallas, Texas
`
`Bruce F. Scharschmidt, M.D.
`Professor of Medicine
`Division of Gastroenterology
`University of California, San Francisco
`San Francisco, California
`Vice President, Clinical Affairs
`Chiron Corporation
`Emeryville, California
`
`W.B. SAUNDERS COMPANY
`
`A Division of Harcourt 13race Company
`Philadelphia London Thronto Montreal Sydney Tokyo
`
`This
`
`L.p y .:%.0 Laws
`
`Ex. 1027 - Page 2
`
`

`

`W.B. SAUNDERS COMPANY
`A Division of Harcourt Brace & Company
`
`The Curtis Center
`Independence Square West
`Philadelphia, Pennsylvania 19106
`
`Library of Congress Cataloging-in-Publication Data
`
`Sleisenger and Fordtran's gastrointestinal and liver disease: Pathophysiology/
`diagnosis/management / [edited by] Mark Feldman, Bruce F. Scharschmidt, Marvin
`H. Sleisenger-6th ed.
`
`p. (cid:9)
`
`cm.
`
`Rev. ed. of: Gastrointestinal disease. 5th ed. c1993.
`
`Includes bibliographical references and index.
`
`ISBN 0-7216-6291-9 (set)
`
`1. Gastrointestinal system—Diseases. (cid:9)
`John S. (cid:9)
`Ili. Feldman, Mark. (cid:9)
`V. Gastrointestinal diseases.
`[DNLM: 1. Gastrointestinal Diseases. (cid:9)
`
`I. Sleisenger, Marvin H. (cid:9)
`IV. Scharschmidt, Bruce F.
`
`WI 100 S6322 1998]
`
`RC801.G384 1997 (cid:9)
`
`616.3'3—dc20
`
`DNLM/DLC (cid:9)
`
`II. Fordtran,
`
`96-21131
`
`SLEISENGER AND FORDTRAN'S GASTROINTESTINAL (cid:9)
`AND LIVER DISEASE: Pathophysiology/ (cid:9)
`Diagnosis/Management (cid:9)
`
`VOlume 1 ISBN 0-7216-6292-7
`Volume 2 ISBN 0-7216-6293-5
`Set ISBN 0-7216-6291-9
`
`Copyright © 1998, 1993, 1989, 1983, 1978, 1973 by W.B. Saunders Company.
`
`All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means,
`electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without
`permission in writing from the publisher:
`
`Printed in the United States of America.
`
`Last digit is the print number: (cid:9)
`
`9 (cid:9)
`
`8 (cid:9)
`
`7 (cid:9)
`
`6 (cid:9)
`
`5 (cid:9)
`
`4 (cid:9)
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`3 (cid:9)
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`2 (cid:9)
`
`I
`
`This matEri I
`at th€
`
`Ex. 1027 - Page 3
`
`

`

`Contents
`
`VOLUME 1
`Section 1
`Biology of the Gastrointestinal Tract
`
`Chapter 1
`Gastrointestinal Hormones and
`Neurotransmitters
`Nigel W Bunnett
`John H. Walsh
`The Chemical Messengers
`The Receptors
`Mechanisms of Signal Transduction
`Integrative Control of Gastrointestinal Function
`Conclusions
`
`Chapter 2
`Immunology and Inflammation of the
`Gastrointestinal Tract
`Martin E Kagnoff
`General Characteristics of the Immune System
`
`The Intestine as a Lymphoid Organ
`Immunologic Diseases and Disorders
`
`Chapter 3
`Principles of Gastrointestinal Neoplasia
`Anil K Rustgi
`Daniel K. Podolsky
`Mechanisms of Normal Cell Proliferation
`Regulation of Normal Cell Proliferation:
`Signaling Pathways of Cell Growth Responses
`Characteristics of Malignant Cells
`Mechanisms of Oncogcnesis
`Neoplasia-Associated Genes
`Biology of Tumor Metastasis
`Diagnostic Strategies: Current and Future
`Approaches
`Principles of Therapy: Current and Future
`
`3
`
`3
`9
`13
`15
`17
`
`19 (cid:9)
`
`19 (cid:9)
`
`Section II
`Approach to Patients with Symptoms and Signs
`
`Chapter 4
`Psychosocial Factors in Gastrointestinal
`Disorders
`Douglas A. Drossman
`A Conceptualization
`Environmental Stress and Gastrointestinal Function
`Brain-Gut Interactions
`Psychoneuroimmunology
`Clinical Relationships Between Psychosocial Factors
`and Gastrointestinal Illness
`Clinical Applications
`
`Chapter 5
`Abdominal Pain, Including the Acute
`Abdomen
`Robert E. Glasgow
`Sean J. Mulvihill
`Anatomic Basis of Pain
`Stimulants of Pain
`Types of Pain
`An Approach to the Patient with Acute Abdominal
`Pain
`An Approach to the Patient with Chronic
`Abdominal Pain
`
`Chapter 6
`Chronic Functional Abdominal Pain
`Douglas A. Drossman
`The Physician's Experience with Chronic Functional
`Abdominal Pain
`Definition, Epidemiology, and Health Care
`Impact
`Neurophysiology
`Clinical Features
`Clinical Assessment
`Treatment Approach
`
`69 (cid:9)
`
`69 (cid:9)
`70 (cid:9)
`70 (cid:9)
`71 (cid:9)
`
`72 (cid:9)
`75 (cid:9)
`
`80 (cid:9)
`
`Chapter 7
`Dysphagia, Odynophagia, Heartburn, and
`Other Esophageal Symptoms
`Joel E. Richter
`80 Dysphagia
`80 Odynophagia
`Heartburn (Pyrosis)
`81 (cid:9)
`Globus Sensation
`Chest Pain
`Respiratory; Ear, Nose, and Throat; and Cardiac
`Symptoms
`
`82 (cid:9)
`
`88 (cid:9)
`
`This
`
`.pytiz,:. LBWS
`
`25
`32
`
`49
`
`49
`
`51
`52
`52
`54
`60
`
`61
`63
`
`90
`
`90
`
`90
`91
`93
`94
`95
`
`97
`
`97
`99
`100
`101
`102
`
`103
`
`XXi
`
`Ex. 1027 - Page 4
`
`(cid:9)
`

`

`xxii (cid:9)
`
`Contents
`
`Chapter 8
`Dyspepsia
`K. McQuaid
`Definition
`Epidemiology
`Causes of Organic Dyspepsia
`Functional (Nonulcer) Dyspepsia
`Evaluation
`Empirical Treatment Versus Early Endoscopy
`Treatment of Functional Dyspepsia
`
`Chapter 9
`Nausea and Vomiting
`Makau Lee
`Mark Feldman
`The Act of Vomiting
`Neural Pathways and Pathophysiology of Vomiting
`Clinical Approach to Patients with Nausea and
`Vomiting
`Specific Syndromes Associated with Vomiting
`Consequences of Vomiting
`Therapy of Vomiting
`
`Chapter 10
`Diarrhea
`Kenneth D. Fine
`Definition of Diarrhea
`Four Mechanisms of Diarrhea
`Diagnostic Approach to Patients
`Some Important Diarrheal Syndromes
`
`Chapter 11
`Intestinal Gas
`Alessandra Strocchi
`Michael D. Levitt
`Volume and Composition of Bowel Gas
`Sources of Bowel Gas
`Clinical Gas Problems
`
`Treatment
`105 Management of Specific Situations
`
`117
`
`105
`Chapter 13
`106 Constipation
`John E. Lennard-Jones
`106
`Presenting Symptoms
`108
`Epidemiology
`111
`Clinical Classification
`112
`Pathophysiology
`114
`Constipation as a Manifestation of Systemic
`Disorders
`Constipation as a Manifestation of Central Nervous
`Disease of the Extrinsic Nerve Supply to the Gut
`Constipation Secondary to Structural Disorders of
`the Colon, Rectum, Anus, and Pelvic Floor
`Drug Treatment May Cause or Aggravate
`Constipation
`Psychological Disorders as Causes or Aggravating
`Factors in Constipation
`Clinical Assessment
`Investigation
`Medical Treatment
`Particular Clinical Problems
`
`117
`118
`
`119
`120
`124
`125
`
`128
`
`Chapter 14
`128 Acute and Chronic Gastrointestinal Bleeding
`Loren Lame
`128
`Epidemiology
`130
`137 Manner of Presentation
`Initial Assessment of the Patient
`Resuscitation
`Differentiating Upper from Lower Gastrointestinal
`Bleeding
`Diagnostic Evaluation of Patients with
`Gastrointestinal Bleeding
`Specific Bleeding Lesions and Their Treatment
`
`153
`
`153
`153
`157
`
`Chapter 12
`Fecal Incontinence
`Lawrence R. Schiller
`Prevalence
`Mechanisms of Fecal Incontinence
`Differential Diagnosis of Fecal Incontinence
`Evaluation of Patients with Fecal Incontinence
`
`Chapter 15
`Jaundice
`Steven Lidofsky
`Bruce F Scharschmidt
`Determinants of Serum Bilirubin Concentration
`Differential Diagnosis of Jaundice
`Diagnostic Approach to the Patient with Jaundice
`Therapeutic Options
`
`160
`
`160
`161
`162
`163
`
`Section III
`Nutrition in Gastroenterology
`
`Chapter 16
`The Malnourished Patient: Nutritional
`Assessment and Management
`Samuel Klein
`Khursheed N. Jeejeehhoy
`
`Basic Nutritional Concepts
`Assessment of Nutritional Status
`Refeeding the Malnourished Patient
`Patients with Severe Malabsorption
`
`235 (cid:9)
`
`This snateri= I
`at the
`
`167
`170
`
`174
`
`174
`175
`176
`176
`
`180
`
`180
`
`181
`
`183
`
`184
`184
`185
`186
`193
`
`198
`
`198
`198
`198
`199
`
`200
`
`200
`204
`
`220
`
`220
`221
`226
`230
`
`235
`241
`246
`247
`
`Ex. 1027 - Page 5
`
`

`

`Contents (cid:9)
`
`xxiii
`
`Chapter 17
`Enteral and Parenteral Nutrition
`Samuel Klein
`C. Richard Fleming
`Enteral Nutrition
`Parenteral Nutrition
`Clinical Applications of Nutrition Support
`
`254 (cid:9)
`
`Chapter 18
`Obesity, Anorexia Nervosa, and Bulimia (cid:9)
`Stephen D. Phinney
`Charles H. Halsted
`254 Obesity (cid:9)
`Anorexia and Bulmia (cid:9)
`263 (cid:9)
`268
`
`Section IV
`Topics Inv olving Multiple Organs
`
`Chapter 19
`Complications of Gastrointestinal Endoscopy
`Harvey S. Young
`Emmet B. Keeffe
`General Complications
`Complications of Upper Endoscopy
`Complications of Sigmoidoscopy and Colonoscopy
`
`Chapter 20
`Diverticula of the Esophagus, Stomach, and
`Small Bowel
`William V Harford
`Zenker's Diverticula
`Diverticula of the Esophageal Body
`Esophageal Intramural Pseudodiverticula
`Gastric Diverticula
`Duodenal Diverticula
`Jejunal Diverticula
`
`Chapter 2/
`Hernias and Volvulus of the Gastrointestinal
`Tract
`Katherine E. McArthur
`Diaphragmatic Hernias
`External Hernias of the Abdominal Wall
`Groin Hernias (Including Inguinal Hernias)
`Internal Hernias
`Gastric Volvulus
`Midgut Volvulus
`Volvulus of the Large Bowel
`
`Chapter 22
`Foreign Bodies and Bezoars
`K. Hamilton
`D. Po/ter
`Foreign Bodies
`Bezoars
`Conclusions
`
`Chapter 23
`Caustic Injury to the Upper Gastrointestinal
`Tract
`Peter M. Loeb
`Abram M. Eisenstein
`
`301 (cid:9)
`
`301 (cid:9)
`305 (cid:9)
`306 (cid:9)
`
`309 (cid:9)
`
`309
`311
`312
`313
`313
`315
`
`317
`
`317
`320
`322
`323
`324
`326
`326
`
`331 (cid:9)
`
`331
`334
`334
`
`335 (cid:9)
`
`Caustic Agents
`Pathogenesis and Pathology
`Clinical Features
`Diagnostic Studies
`Treatment
`Recommended Approach
`Late Complications
`Button Battery Ingestion
`
`Chapter 24
`Nonsteroidal Anti-Inflammatory Drugs and
`Gastrointestinal Disease
`Byron Cryer
`Introduction
`Epidemiology
`Mechanisms of Toxicity of NSAIDs
`Clinical Manifestations of NSAID Injury
`Throughout the Gastrointestinal Tract
`Therapeutic Effects of NSAIDs in the Large
`Intestine
`
`Chapter 25
`Abdominal Abscesses and Gastrointestinal
`Fistulas
`J. P. Minei
`J. Champine
`Abdominal Abscesses
`Gastrointestinal Fistulas
`
`Chapter 26
`Protein-Losing Gastroenteropathy
`Thomas A. Brasitus
`Bruce M. Bissonnette
`Definition and History
`Etiology
`Diagnosis
`Treatment
`
`Chapter 27
`Gastrointestinal Complications of Solid
`Organ and Bone Marrow Transplantation
`Sally A. S. Weisdorf
`William D. Payne
`
`This •-•- ata.1=1..
`at -.- ',V.' a-
`
`Laws
`
`278
`
`278
`288
`
`335
`336
`336
`337
`337
`339
`339
`340
`
`343
`
`343
`343
`343
`
`346
`
`353
`
`357
`
`357
`363
`
`369
`
`369
`369
`373
`374
`
`376
`
`Ex. 1027 - Page 6
`
`(cid:9)
`(cid:9)
`(cid:9)
`

`

`xxiv (cid:9)
`
`Contents
`
`Side Effects of Immunosuppressive Agents
`Infectious Complications
`Nutritional Complications
`Malignant Complications
`Solid Organ Transplantation
`Bone Marrow Transplantation
`Graft-Versus-Host Disease
`
`Chapter 28
`Gastrointestinal Manifestations of the
`Acquired Immunodeficiency Syndrome
`C. Mel Wilcox
`Scott L. Friedman
`Evaluation and Management of Gastrointestinal and
`Hepatobiliary Symptoms in AIDS
`Diarrhea
`Weight Loss
`Odynophagia and Dysphagia
`Abdominal Pain
`Anorectal Disease
`Jaundice and Hepatomegaly
`Gastrointestinal Bleeding
`
`Chapter 29
`Effects on the Gut of Systemic Disease and
`Other Extraintestinal Conditions
`John R. Weber
`James C. Ryan
`Endocrine Disease
`Pregnancy
`
`376
`377
`378
`378
`378
`381
`383
`
`Neoplastic Diseases
`Hematologic Diseases
`Rheumatologic and Collagen Diseases
`Renal Disease
`Neurologic Disease
`Pulmonary Disease
`Cardiac Disease
`Infiltrative Diseases
`Disorders of Lipid Metabolism
`
`387
`
`Chapter 30
`Oral and Cutaneous Manifestations of
`Gastrointestinal Disease
`Ginat W Mirowski
`387
`Timothy G. Berger
`388 Mouth and Tongue
`394 Mucocutaneous Candidiasis
`396 Mucocutaneous Features of HIV Infection
`398 Mucocutaneous Ulcerative Diseases
`399
`Vesiculobullous Diseases
`400
`Cutaneous Manifestations of Intestinal Disease,
`404
`Including Inflammatory Bowel Disease
`Vascular and Connective Tissue Disorders
`Cutaneous Markers Associated with Gastrointestinal
`Malignancies
`411 Malabsorption/Deficiency Syndromes
`Vitamin Deficiencies
`Pancreatic Disease and the Skin
`Cutaneous Manifestations of Liver Disease
`Parasitic Diseases of the Gut and Skin
`
`411
`416
`
`Section V
`Esophagus
`
`Chapter 31
`Anatomy and Developmental and Acquired
`Anomalies of the Esophagus
`John D. Long
`Roy C. Orlando
`Anatomy
`Embryology
`Developmental Anomalies
`Acquired Anomalies
`
`Diagnosing Motor Disorders
`Disorders of the UES and Cervical Esophageal
`Region
`A chal aS i a
`Other Hypermotility Disorders of the Distal
`Esophagus
`Disorders Restricted to the LES
`Systemic Diseases Associated with Esophageal
`Hypomotility
`
`457
`
`457
`459
`460
`465
`
`Chapter 32
`Motor Physiology and Motor Disorders of
`the Esophagus
`Ray E. Clouse
`N. E. Diamant
`Overview of Normal Function
`Innervation
`Coordinated Esophageal Motor Activity
`Mechanisms Producing Disordered Motility
`
`467
`
`Chapter 33
`Gastroesophageal Reflux Disease and Its
`Complications
`Peter J. Kahrilas
`Definitions and Epidemiology
`467
`Histopathology of Esophagitis
`Pathogenesis
`468
`470
`Clinical Presentation and Natural History
`473 Management
`
`This materi= I
`
`at the"
`511131,-_t
`
`417
`418
`422
`426
`427
`429
`430
`430
`431
`
`439
`
`439
`440
`440
`441
`442
`
`443
`444
`
`445
`447
`447
`448
`448
`449
`
`474
`
`476
`479
`
`486
`490
`
`490
`
`498
`
`498
`498
`500
`505
`508
`
`Ex. 1027 - Page 7
`
`

`

`Chapter 34
`Esophageal Disorders Caused by Infection,
`Systemic Illness, Medications, Radiation,
`and Trauma
`Paul H. Baehr
`George B. McDonald
`Infections
`Systemic Illness
`Medications
`Radiation
`Trauma
`
`519
`
`519
`526
`529
`530
`531
`
`Contents
`
`xxv
`
`Chapter 35
`Esophageal Tumors
`Andrew M. Axelrad
`David E. Fleischer
`Malignant Tumors
`Other Primary and Metastatic Malignant Tumors
`Benign Tumors
`
`540
`
`540
`550
`551
`
`Section VI
`Stomach and Duodenum
`
`Chapter 36 (cid:9)
`Anatomy and Anomalies of the Stomach and (cid:9)
`Duodenum
`Carol A. Redel
`R. Jeff Zwiener
`Anatomy of the Stomach
`Anatomy of the Duodenum
`Congenital Anomalies of the Stomach and
`Duodenum
`
`Chapter 37
`Gastric Motor Physiology and Motor
`Disorders
`Michael Camilleri
`Charlene M. Prather
`Gastric Neuromuscular Anatomy
`Control Mechanisms of Gastric Motility
`Motor Functions of the Stomach Regions
`Regional Motor Dysfunctions in Disease
`Gastric Stress
`Gastric Dumping
`Acute Gastric Dilatation
`Conclusion and a Look to the Future
`
`Chapter 38
`Gastric Secretion: Normal and Abnormal
`Mark Feldman
`Cellular Biology of Gastric Secretion
`Regulation of Gastric Acid Secretion
`Parietal Cell Physiology
`Gastric Acid Secretion in Humans
`Gastric Acid Secretion During Development and
`Aging
`Gastric Acid Secretion in Disease
`Pepsinogen and Gastric Lipase Secretion
`Gastric Bicarbonate Secretion
`1(1- , and Cl - Secretion
`Gastric Na (cid:9)
`Gastric Mucin Secretion
`Intrinsic Factor Secretion
`
`Chapter 39
`Helicobacter pylori
`Walter L. Peterson
`David Y Graham
`Epidemiology
`Acute Infection
`Virulence Factors
`Chronic Infection
`Natural History of Chronic Infection
`Gastric Secretion
`Phenotypic Expression of Gastritis and Acid
`Secretion
`Diagnosis
`Treatment
`Immunization
`
`Chapter 40
`Peptic Ulcer and Its Complications
`Andrew H. Soli
`Etiology and Pathophysiology of Peptic Ulcer
`Abnormalities of Mucosal Defense and Healing in
`Peptic Ulcer
`Other (Non-Helicobacter pylori) Forms of Peptic
`Ulcer
`Childhood Peptic Ulcer
`Peptic Ulcer in Elderly Patients
`Potential Risk Factors and Associations
`Psychologic Factors in Peptic Disease
`The Genetics of Peptic Ulcer Diseases
`Epidemiology of Peptic Ulcer
`Diseases Associated with Peptic Ulcer
`Disorders Associated with a Decreased Incidence of
`Peptic Ulcer
`Clinical Presentation
`Diagnosis of Peptic Ulcer Disease
`Differential Diagnosis
`Recommendations for Evaluation and Follow-Up
`Atypical Ulcers
`Natural History of Peptic Ulcer
`Antiulcer Pharmacology
`
`557
`
`557
`561
`
`564
`
`572
`
`572
`573
`574
`574
`577
`582
`583
`584
`
`587
`
`587
`588
`592
`593
`
`596
`596
`597
`598
`599
`599
`599
`
`604
`
`604
`606
`606
`608
`608
`610
`
`611
`611
`613
`615
`
`620
`
`621
`
`627
`
`629
`631
`631
`631
`631
`632
`633
`634
`
`635
`635
`638
`640
`641
`643
`644
`645
`
`This
`
`- Laws
`
`Ex. 1027 - Page 8
`
`

`

`xxvi (cid:9)
`
`Contents
`
`Medical Treatment of Active Peptic Ulcer Disease
`Refractory Gastric and Duodenal Ulcers
`Ulcer Recurrence
`Treatment of NSAID Ulcers
`Prevention of NSAID Ulcers
`Complications of Peptic Ulcer
`
`Chapter 41
`Zollinger-Ellison Syndrome and Other
`Hypersecretory States
`James E. McGuigan
`Zollinger-Ellison Syndrome
`Other Hypersecretory States
`
`Chapter 42
`Operations for Peptic Ulcer and Their
`Complications
`Neal E. Seymour
`Elective Operative Treatment of Peptic Ulcer
`Disease
`Surgical Treatment of Peptic Ulcer Complications
`Complications of Surgery for Peptic Ulcer Disease
`
`653 (cid:9)
`659 (cid:9)
`660 (cid:9)
`662 (cid:9)
`663 (cid:9)
`665 (cid:9)
`
`679 (cid:9)
`
`Chapter 43
`Other Types of Gastritis and Gastropathies,
`Including Menetrier's Disease
`Wilfred M. Weinstein
`Classification of Gastritis
`Glossary of Terms and the Distribution of Gastritis
`Erosive and Hemorrhagic Gastritis and Gastropathy
`Associations with Erosive/Hemorrhagic Gastritis
`Non-Helicobacter pylori Types of Nonerosive
`Gastritis and Gastropathy
`
`679
`691
`
`Chapter 44
`Tumors of the Stomach
`Gordon D. Luk
`Adenocarcinoma
`696 Lymphoma
`Stromal Tumor
`Gastric Carcinoid
`Metastases to the Stomach
`Miscellaneous Tumors
`Gastric Polyps
`
`696 (cid:9)
`703 (cid:9)
`706 (cid:9)
`
`Chapter 45
`Anatomy, Histology, Embryology, and
`Developmental Anomalies of the Pancreas
`James H. Grendell
`Thomas H. Ermak
`Normal Anatomy
`Normal Histologic and Ultrastructural Appearance
`Embryonic Development
`Relation to Other Organs
`Congenital Anomalies
`
`Chapter 46
`Pancreatic Physiology and Secretory Testing
`Stephen J. Pandol
`Overview
`Functional Anatomy
`Composition of Exocrine Pancreatic Secretions
`Functions of the Major Digestive Enzyme
`Digestive Enzyme Synthesis and Transport
`Cellular Regulation of Enzyme Secretion
`Organ Physiology
`Pancreatic Secretory Function Tests
`
`Chapter 47
`Hereditary and Childhood Disorders of the
`Pancreas
`M. James Lopez
`Richard J. Grand
`Hereditary Diseases
`Acquired Pancreatic Disease
`
`Section VII
`Pancreas
`
`Chapter 48
`Acute and Chronic Pancreatitis
`Peter A. Banks
`
`Acute Pancreatitis
`Definition
`Pathology
`Pathogenesis
`Pathophysiology
`Predisposing Conditions
`Clinical Presentation
`Laboratory Diagnosis
`Radiologic Features
`Differential Diagnosis
`Therapy and Prevention of Recurrences
`Complications
`Prognosis
`Chronic Pancreatitis
`Definition
`Pathology
`Etiology
`Pathophysiology
`Clinical Presentation
`Diagnosis
`Radiologic Features
`Differential Diagnosis
`Treatment
`Complications
`Prognosis
`
`761 (cid:9)
`
`761
`762
`766
`767
`768
`
`771 (cid:9)
`
`771
`771
`772
`772
`775
`775
`776
`778
`
`782 (cid:9)
`
`782 (cid:9)
`802 (cid:9)
`
`This ^"a`= (cid:9)
`
`z
`
`jE:::
`
`711
`
`711
`712
`713
`713
`
`718
`
`733
`
`733
`749
`751
`753
`753
`753
`754
`
`809
`
`809
`809
`816
`816
`817
`818
`822
`823
`826
`828
`828
`835
`838
`838
`838
`839
`839
`840
`841
`842
`844
`847
`848
`854
`857
`
`Ex. 1027 - Page 9
`
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`

`

`Contents (cid:9)
`
`xxvii
`
`Chapter 49
`Pancreatic Cancer
`John P Cello
`Incidence and Epidemiology
`Pathophysiology and Clinical Manifestations
`Diagnosis
`Therapy
`Conclusion
`
`Chapter 50
`Endocrine Tumors of the Pancreas
`Robert T Jensen
`Jeffrey A. Norton
`Instil inomas
`Glucagonomas
`VI Pornas
`
`Somatostatinomas
`GRFomas
`PPomas and Nonfunctioning Pancreatic Endocrine
`Tumors
`Other Pancreatic Endocrine Tumors
`Tumor Localization
`Management of Metastatic Pancreatic Endocrine
`Tumors
`
`Chapter 51
`Other Tumors and Diseases of the Pancreas (cid:9)
`Markus Goldschmiedt
`Kumar Gutta
`Cystic Diseases of the Pancreas
`Pancreatic Tumors Other than Adenocarcinoma
`Pancreatic Involvement in Systemic Diseases
`Pancreatic Involvement in Infectious Diseases
`
`863
`
`863 (cid:9)
`863 (cid:9)
`864 (cid:9)
`867 (cid:9)
`869 (cid:9)
`
`871 (cid:9)
`
`873 (cid:9)
`876 (cid:9)
`878 (cid:9)
`
`Section VIII
`Biliary Tract
`
`Chapter 52
`Anatomy, Anomalies, and Pediatric
`Disorders of the Biliary Tract
`Frederick J. Suchy
`Development of the Liver and Biliary Tract
`Anatomy of the Biliary Tract and Gallbladder
`Congenital Anomalies of the Extrahepatic Bile
`Ducts
`Congenital Anomalies of the Gallbladder
`Disorders of the Biliary Tract in Children
`Diseases of the Bile Ducts
`Diseases of the Gallbladder
`
`Chapter 53
`Motility and Dysmotility of the Biliary Tract
`and Sphincter of Oddi
`Glen A. Lehman
`Stuart Sherman
`Definition
`Anatomy, Physiology, and Pathophysiology
`Frequency
`Clinical Presentation
`Diagnostic Methods (Noninvasive)
`Diagnostic Methods (Invasive)
`Therapy for SOD
`SOD in Recurrent Pancreatitis
`Failure to Achieve Symptomatic Improvement After
`Biliary Sphincterotomy
`Summary
`Future Research
`
`Chapter 54
`Bile Secretion and the Enterohepatic
`Circulation of Bile Acids
`
`Alan E Ho'Mann
`Overview
`Biliary Secretion
`Biliary Excretion
`Impaired Biliary Secretion and Excretion
`Bile Acid Malabsorption
`Increased Bacterial Overgrowth That Causes
`Excessive Bile Acid Deconjugation
`Bile Acid Therapy
`Bile Acid Sequestrants and Bile Acid Transport
`Inhibitors
`
`Chapter 55
`Gallstone Disease and Its Complications
`Lyman E. Bilhartz
`Jay D. Horton
`Epidemiology, Risk Factors, Pathogenesis, and
`Natural History of Gallstones
`Clinical Manifestations of Gallstone Disease
`
`chapter 56
`Surgical Management of Gallstone Disease
`and Postoperative Complications
`Sean J. Mulvihill
`Surgery for Cholelithiasis
`Surgery for Choledocholithiasis
`Bile Duct Stricture
`Postcholecystectomy Syndrome
`Gallstones, Cholecystectomy, and Cancer
`
`Chapter 57
`Nonsurgical Management of Gallstone
`Disease
`Gustav Paumgartner
`
`905 (cid:9)
`
`905 (cid:9)
`906 (cid:9)
`
`909 (cid:9)
`909 (cid:9)
`910 (cid:9)
`912 (cid:9)
`923
`
`929 (cid:9)
`
`929 (cid:9)
`929
`929 (cid:9)
`930 (cid:9)
`930 (cid:9)
`931 (cid:9)
`933 (cid:9)
`934 (cid:9)
`
`934 (cid:9)
`934 (cid:9)
`935
`
`937 (cid:9)
`
`This mata'ia (cid:9)
`Ot t-_ (cid:9)
`E (cid:9)
`Subject (cid:9)
`
`z oied
`E7
`t Laws
`
`881
`882
`
`883
`884
`885
`
`888
`
`895
`
`895
`899
`899
`899
`
`937
`937
`943
`944
`945
`
`946
`946
`
`946
`
`948
`
`948
`956
`
`973
`
`973
`979
`980
`980
`981
`
`984
`
`Ex. 1027 - Page 10
`
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`

`

`xxviii (cid:9)
`
`Contents
`
`General Aspects
`Oral Bile Acid Dissolution Therapy
`Extracorporeal Shock-Wave Lithotripsy
`Extracorporeal Shock-Wave Lithotripsy of Bile Duct
`Stones
`Recurrence of Gallstones
`Choice of Treatment
`
`Chapter 58
`Acute Acalculous Cholecystitis,
`Adenomyomatosis, Cholesterolosis, and
`Polyps of the Gallbladder
`Lyman E. Bilhartz
`Acalculous Biliary Pain
`Acute Acalculous Cholecystitis
`Cholesterolosis of the Gallbladder
`Adenomyomatosis of the Gallbladder
`Polyps of the Gallbladder
`
`Chapter 59
`Sclerosing Cholangitis and Recurrent
`Pyogenic Cholangitis
`Nathan M. Bass
`
`Sclerosing Cholangitis (cid:9)
`Recurrent Pyogenic Cholangitis (cid:9)
`
`985 (cid:9)
`985 (cid:9)
`988
`
`990 (cid:9)
`Chapter 60
`Tumors of the Gallbladder, Bile Ducts, and
`991 (cid:9)
`991 Ampulla
`John P. Cello
`Gallbladder Tumors
`Tumors of the Extrahepatic Bile Ducts (cid:9)
`Malignant Tumors of the Ampulla (cid:9)
`
`993
`
`993 (cid:9)
`995 (cid:9)
`997 (cid:9)
`999 (cid:9)
`1001 (cid:9)
`
`1006 (cid:9)
`
`Chapter 61
`Endoscopic and Radiologic Treatment of
`Biliary Disease
`James W Ostroff
`Jeanne M. LaBerge
`General Principles (cid:9)
`Procedural Techniques (cid:9)
`Treatment of Specific Diseases (cid:9)
`
`VOLUME 2
`Section IX
`Liver
`
`Chapter 62
`Anatomy and Developmental Anomalies of
`the Liver
`Ian R. Wanless
`Surface Anatomy
`Segmental Anatomy
`Variation in Surface Anatomy
`Large Vessels of the Liver
`Lymph Vessels
`Nerve Supply
`Biliary System
`Microanatomy
`
`1055 (cid:9)
`
`Chapter 64
`Inherited Metabolic Disorders of the Liver (cid:9)
`David A. Wiechmann
`William E Balistreri
`a,-Antitrypsin Deficiency (cid:9)
`1055 (cid:9)
`Glycogen Storage Disease (cid:9)
`1055 (cid:9)
`Porphyrias (cid:9)
`1055 (cid:9)
`1056 Tryosinemia (cid:9)
`Urea Cycle Defects (cid:9)
`1058 (cid:9)
`Bile Acid Biosynthesis Defects (cid:9)
`1058 (cid:9)
`Byler Syndrome (cid:9)
`1058 (cid:9)
`Cystic Fibrosis (cid:9)
`1058 (cid:9)
`
`Chapter 63
`Liver Physiology and Metabolic Function
`Andrew Sto/z,
`Hepatic Architecture
`Excretory Pathway
`Introduction to Liver Metabolism
`Carbohydrate Metabolism
`Synthesis and Metabolism of Fatty Acids
`Lipid Transport
`Liver Disease and Lipid Abnormalities
`Serum Proteins Synthesized by the Liver
`Fat-Soluble Vitamins
`Hepatic Regeneration
`Apoptosis
`
`1061
`
`1061
`1062
`1062
`1063
`1067
`1069
`1074
`1074
`1077
`1079
`1080
`
`Thiz "EtE'iEl
`
`Chapter 65
`Hereditary Hemochromatosis
`Bruce R. Bacon
`Robert S. Britton
`Causes of Iron Overload
`Pathophysiology (cid:9)
`Clinical Manifestations (cid:9)
`Diagnosis (cid:9)
`Treatment and Prognosis (cid:9)
`Family Screening (cid:9)
`
`Chapter 66
`Wilson Disease
`Diane W Cox
`Eve A. Roberts
`Clinical Features
`
`1006
`1018
`
`1026
`
`1026
`1029
`1031
`
`1033
`
`1033
`1034
`1042
`
`1083
`
`1083
`1085
`1087
`1090
`1092
`1094
`1094
`1095
`
`1097
`
`1097
`1098
`1099
`1100
`1101
`1102
`
`1104
`
`1104
`
`Ex. 1027 - Page 11
`
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`(cid:9)
`

`

`The Copper Pathway
`The Basic Molecular Defect
`Diagnosis
`Pathology
`Treatment
`Prognosis
`
`Chapter 67
`Biochemical Liver Tests
`Timothy J. Dapern II
`Bruce F Scharschmidt
`Biochemical Liver Tests
`Characteristic Biochemical Patterns: Interpretation
`and Approach
`Frequently Encountered Clinical Problems
`Quantitative Tests of Liver Function
`
`Chapter 68
`Viral Hepatitis A Through G
`Norah A. 'kratlt
`Teresa L. Wright
`Hepatitis A Virus
`Hepatitis B Virus
`Hepatitis C Virus
`Hepatitis D Virus
`Hepatitis E Virus
`Hepatitis G Virus and the GB Agents
`
`Chapter 69
`Liver Abscess and Bacterial, Parasitic,
`Fungal, and Granulomatous Liver Disease
`Raymond 7: Chung
`Lawrence S. Friedman
`Liver Abscess
`Bacterial and Spirochetal Infections of the Liver
`Parasitic Diseases That Involve the Liver
`Fungal Liver Disease
`Granulomatous Liver Disease
`
`Chapter 70
`Vascular Diseases of the Liver
`Daniel E Schafer
`Michael I. Sorrell
`Budd-Chiari Syndrome
`Veno-Occlusive Disease
`Portal Vein Thrombosis
`Ischemic Hepatitis
`Congestive Hepatopathy
`Peliosis Hepatis
`Hepatic Artery Aneurysm
`Atherosclerosis
`Polyarteritis Nodosa
`Polymyalgia Rheumatica
`Conclusions
`
`Contents
`
`xxix
`
`1105
`Chapter 71
`1106 Alcoholic Liver Disease
`1108
`Jacquelyn J. Maher
`1109
`Epidemiology
`1109
`Ethanol Metabolism
`1111
`Pathogenesis of Alcoholic Liver Injury
`Cofactors Influencing the Development of Alcoholic
`Liver Disease
`Diagnosis
`Complications
`Treatment
`Prognosis
`
`1112
`
`1112
`
`1116
`1119
`1121
`
`1123
`
`1123
`1129
`1144
`1155
`1160
`1164
`
`1170
`
`1170
`1173
`1176
`1184
`1185
`
`1188
`
`Chapter 72
`Nonalcoholic Steatohepatitis and Focal
`Fatty Liver
`Patrick Okoio
`
`Anna Mae Diehl
`Nonalcoholic Steatohepatitis
`Focal Fatty Liver
`
`Chapter 73
`Liver Disease Caused by Drugs, Anesthetics,
`and Toxins
`Geoffrey C. Farrell
`Definitions and General Importance of Drugs and
`Toxins as Causes of Liver Disease
`Epidemiology
`Pathophysiology
`Clinicopathologic Features of Drug-Induced Liver
`Disease
`Prevention and Management
`Dose-Dependent Hepatotoxicity
`Drug-Induced Acute Hepatitis
`Chronic Hepatitis
`Drug-Induced Cholestasis
`Chronic Cholestasis
`Liver Disease Caused by Anesthetic Agents and
`Diagnosis of Jaundice in the Postoperative Period
`Drug-Induced Fibrosis and Cirrhosis
`Vascular Toxicity
`Liver Tumors
`Nonproprietary Medications and Environmental
`Agents
`
`Chapter 74
`Pregnancy-Related Hepatic and
`1188
`1191 Gastrointestinal Disorders
`1192
`
`Caroline A. Riely
`1194
`Mary C. Portis
`1195
`Liver Problems Unique to Pregnancy
`1195
`Liver Problems Complicating Pregnancy
`1196
`Gastrointestinal Problems
`1196
`1196
`Chapter 75
`1197 Autoimmune Hepatitis
`1197
`Albert J. Czaja
`
`at (cid:9)
`
`E'3 •-••=7
`
`1199
`
`1199
`1199
`1201
`
`1204
`1205
`1207
`1208
`1210
`
`1215
`
`1215
`1219
`
`1221
`
`1221
`1222
`1223
`
`1226
`1228
`1229
`1232
`1236
`1237
`1239
`
`1239
`1241
`1243
`1245
`
`1247
`
`1253
`
`1253
`1258
`1260
`
`1265
`
`Ex. 1027 - Page 12
`
`

`

`xxx (cid:9)
`
`Contents
`
`Diagnostic Criteria
`Pathogenesis
`Subclassifications
`Variant Forms
`Prevalence
`Prognostic Indices
`Clinical Manifestations
`Treatment
`Treatment Results
`Future Directions
`
`Chapter 76
`Primary Biliary Cirrhosis
`Keith D. Lindor
`Epidemiology
`Pathogenesis
`Clinical Features
`Diagnosis
`Differential Diagnosis
`Associated Diseases
`Complications
`Management
`Natural History and Prognosis
`Conclusions
`
`Chapter 77
`Portal Hypertension and Gastrointestinal
`Bleeding
`Nathan M. Bass
`Kenneth A. Somberg
`Etiology and Pathophysiology of Portal
`Hypertension
`Anatomic Sites of Collateral Formation and
`Bleeding
`Natural History and Prognosis of Variceal
`Hemorrhage
`Diagnosis
`Management
`
`Chapter 79
`Systemic Complications of Liver Disease
`Greg Fitz
`Hepatic Encephalopathy
`Pulmonary Syndromes
`Hepatorenal Syndrome
`Endocrine Dysfunction
`Coagulation Disorders
`
`1265
`1266
`1266
`1267
`1269
`1269
`1271
`1271
`1272
`1273
`
`1275
`
`Chapter 80
`Fulminant Hepatic Failure
`Hal F Yee, Jr
`Steven D. Lidofsky
`Definition
`Causes
`1275
`Clinical Presentation
`1275
`Differential Diagnosis
`1276
`Predictors of Outcome
`1276 Management
`1277
`Chapter 81
`1278
`1278 Hepatic Tumors and Cysts
`Michael C. Kew
`1280
`Hepatic Tumors
`1281
`Tumor-Like Lesions
`1281
`Hepatic Cysts
`Approach to the Patient with Hepatic Mass Lesions
`
`1284
`
`1291
`
`Chapter 82
`1284 Hepatic Manifestations of Systemic Disease
`and Other Disorders of the Liver
`Dwain L. Thiele
`Edwin H. Eigenbrodt
`Hematologic Malignancies
`Hepatic Sarcoidosis
`Hepatic Amyloidosis
`Sickle Cell Disease Involving the Liver
`Hepatic Dysfunction During Systemic Infection
`Postoperative Cholestasis
`Liver Abnormalities in Rheumatoid Arthritis
`Nodular Disorders of the Liver
`
`1292
`1294
`1295
`
`Chapter 78
`Ascites and Spontaneous Bacterial
`Peritonitis
`Bruce A. Runyon
`Pathogenesis of Ascites Formation
`Clinical Features of Ascites
`Complications of Ascites
`Treatment of Ascites
`Summary of Treatment of Cirrhotic Ascites
`Prognosis
`
`Chapter 83
`Liver Transplantation
`John R. Lake
`Jerome Gournay
`Patient Selection for Liver Transplantation
`Controversies in Patient Selection
`Patient Selection Summary
`Post-Transplantation Management
`Complications Related to Immunosuppression
`Post-Transplantation Summary
`
`1310
`
`1310
`1311
`1321
`1327
`1331
`1331
`
`Thiz
`
`f (cid:9)
`
`E" 7. Laws
`
`1334
`
`1334
`1340
`1343
`1347
`1349
`
`1355
`
`1355
`1355
`1356
`1358
`1358
`1359
`
`1364
`
`1364
`1380
`1381
`1383
`
`1388
`
`1388
`1390
`1391
`1395
`1397
`1398
`1399
`1400
`
`1404
`
`1404
`1406
`1408
`1408
`1412
`1415
`
`Ex. 1027 - Page 13
`
`

`

`Section X
`Small and Large Intestines
`
`Contents
`
`xxxi
`
`Chapter 84 (cid:9)
`Anatomy and Anomalies of the Small and
`Large Intestines
`David J. Keljo
`Robert H. Squires, Jr
`Gross Morphology of the Small Intestine
`Gross Morphology of the Colon
`Vascular Supply
`Lymphatic Dr