Additional Information
Book Details
Abstract
Medicine, in terms of both disease pattern and therapeutic practices, shows tremendous geographical variation. Data and recommendations from different socioeconomic settings may not correctly reflect picture at home. There is no existing book devoted to the discipline of tropical hepatogastroenterology from India and this book fulfills this need. It emphasizes on medical management of hepatic and gastric diseases relevant to the tropics. The strength of this book is greater focus on practical management of gastrointestinal diseases in the tropics. It is edited by Dr BN Tandon, who is regarded as the Father of Tropical Gastroenterology in India.
- The book is divided into ten parts: esophagus, stomach, small bowel, large bowel, liver, liver failure, gallbladder and biliary tract, pancreas, pancreatic diseases, and special topics.
- Each chapter extensively reviews epidemiology, etiopathogenesis, clinical features, diagnosis, medical treatment, and surgical treatment.
- Chapters written by more than 50 leading authorities who have worked extensively with the tropical conditions that they have written about.
- Focuses on clinical aspects of diseases important to the tropics.
- Addresses digestive diseases as a discipline rather than as a medical or surgical specialty.
- Provides management of specific clinical situations that are encountered in developing countries.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Front Cover | ||
| Front Matter | i | ||
| Copyright | iv | ||
| Preface | v | ||
| Acknowledgments | vii | ||
| Contributors | ix | ||
| Contents | xiii | ||
| Part I Esophagus | 1 | ||
| Chapter 1 - Cancer of the Esophagus | 3 | ||
| Introduction | 3 | ||
| Epidemiology | 3 | ||
| Incidence and Prevalence | 3 | ||
| Dysplasia/Carcinoma Sequence | 3 | ||
| Risk Factors and Associations | 4 | ||
| Alcohol and tobacco | 4 | ||
| Dietary carcinogens | 4 | ||
| Nutritional deficiencies | 4 | ||
| Environmental factors and pollutants | 5 | ||
| Infections | 5 | ||
| Chronic esophageal irritation | 5 | ||
| Achalasia cardia | 5 | ||
| Corrosive strictures | 6 | ||
| Esophageal diverticula | 6 | ||
| Others | 6 | ||
| Barrett's metaplasia | 6 | ||
| Genetics of esophageal carcinoma | 7 | ||
| Pathology | 7 | ||
| Squamous Cell Carcinoma | 7 | ||
| Adenocarcinoma | 8 | ||
| Uncommon Subtypes | 9 | ||
| Prognostic Factors | 9 | ||
| Symptoms and Signs | 9 | ||
| Diagnostic Investigations | 10 | ||
| Barium Swallow | 10 | ||
| Endoscopy | 11 | ||
| Screening | 11 | ||
| Screening for Squamous Cell Carcinoma | 12 | ||
| Chapter 2 - Corrosive Injuries of the Esophagus and Stomach | 39 | ||
| Epidemiology | 39 | ||
| Pathophysiology51 | 39 | ||
| Clinical Features | 41 | ||
| Investigations | 40 | ||
| Endoscopic Grading of Esophageal Lnjuries[34] | 41 | ||
| Coexistent Gastric Andesophageal Injury | 42 | ||
| Site of Stricture | 42 | ||
| Complications of Corrosive Injuries | 42 | ||
| Malignant Change | 43 | ||
| Mucocele of the Esophagus | 43 | ||
| Prevention of Complications | 44 | ||
| Acute Injuries and Initial Treatment | 44 | ||
| Corticosteroids | 44 | ||
| Stents | 44 | ||
| Dilatation | 45 | ||
| Surgical Treatment | 46 | ||
| Preoperative Preparation | 46 | ||
| Surgical Procedures for EsophagealStrictures | 46 | ||
| Surgical Choices and Procedure (Fig. 2.4) | 47 | ||
| Route of Transfer | 48 | ||
| Direction of Conduit | 48 | ||
| Type of Conduit | 48 | ||
| Stomach | 48 | ||
| Jejunum | 48 | ||
| Colon | 48 | ||
| Other procedures | 49 | ||
| High strictures | 49 | ||
| Corrosive Injuries of the Stomach | 50 | ||
| Chapter 3 - Gastroesophageal Reflux Disease | 57 | ||
| epidemiology | 57 | ||
| Etiopathogenesis | 59 | ||
| Functional Constituents of the Esophagogastric Junction | 59 | ||
| Transient Lower Esophageal Relaxations | 61 | ||
| Hiatal Hernia | 62 | ||
| Gastroesophageal Flap Valve | 62 | ||
| Clinical Features | 64 | ||
| Extraesophageal Presentations of GERD | 64 | ||
| Asthma and Gastroesophageal Reflux | 65 | ||
| Chronic Cough and GER | 65 | ||
| Laryngitis and GER | 66 | ||
| Diagnostic Evaluation | 66 | ||
| Differential Diagnosis | 68 | ||
| Management of GERD | 68 | ||
| Acid Suppressive Medications | 69 | ||
| Pro-motility Therapy | 70 | ||
| Maintenance Therapy | 71 | ||
| 3.6.4 Nonerosive Gastroesophageal Reflux Disease | 72 | ||
| Management of Refractory GERD | 72 | ||
| Endoscopic Therapy for GERD | 73 | ||
| Surgical Therapy | 74 | ||
| Complications of GERD | 75 | ||
| Peptic Strictures | 75 | ||
| Barrett's Metaplasia, Dysplasia, and Adenocarcinoma | 75 | ||
| Pathophysiology | 75 | ||
| Histology | 76 | ||
| Management | 76 | ||
| Conclusion | 77 | ||
| Chapter 4 - Achalasia Cardia | 82 | ||
| Epidemiology | 82 | ||
| Etiopathogenesis | 82 | ||
| Clinical Features | 83 | ||
| Diagnosis | 84 | ||
| Radiological Examination | 84 | ||
| Endoscopic Examination | 85 | ||
| Manometric Examination | 85 | ||
| Differential Diagnosis | 86 | ||
| Treatment | 86 | ||
| Pharmacotherapy | 87 | ||
| Botulinum Toxin (BoTx) Injection | 87 | ||
| Pneumatic Dilatation | 88 | ||
| Surgical Myotomy | 89 | ||
| Transabdominal (open) cardiomyotomy | 90 | ||
| Transthoracic (open) cardiomyotomy | 90 | ||
| Thoracoscopic and laparoscopic approach | 90 | ||
| Should an antireflux procedure be done? | 91 | ||
| Part II Stomach | 95 | ||
| Chapter 5 - Peptic Ulcer Disease and I Nonulcer Dyspepsia | 97 | ||
| History | 97 | ||
| Pathophysiology | 98 | ||
| Acid Secretion | 98 | ||
| Duodenal ulcer | 98 | ||
| Gastric ulcer | 98 | ||
| H. pylori | 98 | ||
| Nonsteroidal Anti-inflammatory Drugs | 99 | ||
| Smoking | 99 | ||
| Genetic Factors | 99 | ||
| Clinical Course | 99 | ||
| Diagnostic Studies | 100 | ||
| Helicobacter Pylori and Peptic Ulcer Disease | 100 | ||
| Epidemiology | 100 | ||
| Diagnosis of H. pylori Infection | 101 | ||
| Treatment of H. pylori Infection | 102 | ||
| H. pylori and Nonulcer Dyspepsia | 104 | ||
| Nsaids | 104 | ||
| Refractory Ulcer | 105 | ||
| Evaluation of Refractory Ulcer | 106 | ||
| Therapy of Refractory Ulcer | 106 | ||
| Surgery for Refractory Ulcer | 106 | ||
| NONULCER DYSPEPSIA | 106 | ||
| Pathophysiology | 107 | ||
| Approach to a Patient with Dyspepsia | 107 | ||
| Therapy of NUD | 108 | ||
| SURGERY FOR PEPTIC ULCER DISEASE | 108 | ||
| Time Trends | 108 | ||
| Operations for Peptic Ulcer and its Complications[98,99] | 107 | ||
| Vagotomy and drainage | 108 | ||
| Gastric resection | 109 | ||
| Complications of Peptic Ulcer Requiring Surgery | 109 | ||
| Bleeding | 110 | ||
| Pyloric stenosis | 110 | ||
| Penetration | 111 | ||
| Chapter 6 - Benign Tumors Of The Stomach | 116 | ||
| Introduction | 116 | ||
| Classification | 116 | ||
| Gastric Polyps | 116 | ||
| Neoplastic polyps | 116 | ||
| Non-neoplastic polyps | 117 | ||
| Hyperplastic polyps | 117 | ||
| Fundic gland polyps | 117 | ||
| Management of gastric polyps | 117 | ||
| Leiomyomas | 118 | ||
| Management | 119 | ||
| Gastrointestinal Stromal Cell Tumors | 119 | ||
| Management | 120 | ||
| Gastric Endocrine Tumors | 120 | ||
| Well-differentiated gastric endocrine tumors | 120 | ||
| Management of well-differentiated gastric endocrine tumors | 121 | ||
| Poorly differentiated endocrine tumors (Neuroendocrine carcinomas) | 122 | ||
| Management of poorly differentiated endocrine tumors (Neuroendocrine carcinomas) | 122 | ||
| Lipomas | 122 | ||
| Management | 123 | ||
| Chapter 7 - Carcinoma of the Stomach | 126 | ||
| Epidemiology | 126 | ||
| Etiology | 126 | ||
| Genetic Factors | 127 | ||
| Precursor Lesions | 127 | ||
| Gastric polyps | 127 | ||
| Autoimmune gastritis | 127 | ||
| Intestinal Metaplasia | 127 | ||
| Multifocal Atrophic Gastritis | 128 | ||
| Prior Gastrectomy | 128 | ||
| Gastric ulcer | 128 | ||
| Environmental Factors | 128 | ||
| Helicobacter pylori | 128 | ||
| Dietary factors | 129 | ||
| Smoking | 129 | ||
| Ionizing radiation | 129 | ||
| Epstein Barr virus infection | 129 | ||
| Occupation | 130 | ||
| Pathogenesis | 130 | ||
| Molecular Biology of Gastriccancer | 130 | ||
| Tumor Suppressor Genes | 131 | ||
| Proto-oncogenes and Other Molecular Changes | 131 | ||
| Pathology | 133 | ||
| Early Gastric Cancer | 133 | ||
| Advanced Gastric Cancer | 134 | ||
| Borrmann's classification | 134 | ||
| Lauren classification (DIO classification) | 134 | ||
| WHO classification | 135 | ||
| Mulligan classification | 136 | ||
| Ming classification | 136 | ||
| Goseki classification | 136 | ||
| Patterns of Gastric Cancer Spread | 136 | ||
| Direct spread | 136 | ||
| Lymphatic spread | 137 | ||
| Hematogenous spread | 137 | ||
| Transcoelomic spread | 137 | ||
| Clinical Features | 137 | ||
| Persistent Indigestion | 137 | ||
| Insidious Onset | 137 | ||
| Obstructive Symptoms | 138 | ||
| Latent Presentation | 138 | ||
| Peptic Ulcer Symptoms | 138 | ||
| Lump | 138 | ||
| Paraneoplastic Syndromes | 138 | ||
| Staging of Gastric Cancer | 138 | ||
| TNM System | 138 | ||
| Japanese Staging System | 139 | ||
| Work Up of a Case of Gastric Cancer | 139 | ||
| Gastroduodenoscopy and Barium Meal Examination | 139 | ||
| Transcutaneous Ultrasonography | 139 | ||
| Contrast Enhanced Computed Tomography (CECT) | 139 | ||
| Endoscopic Ultrasound (EUS) | 141 | ||
| Other Investigations | 141 | ||
| Diagnostic Staging Laparoscopy andLaparoscopic USG (LUS) | 141 | ||
| Other Laboratory Investigations | 142 | ||
| Management | 142 | ||
| Early Gastric Cancer | 142 | ||
| Advanced Gastric Cancer | 143 | ||
| Adjuvant Treatment | 145 | ||
| Part III Small Bowel | 153 | ||
| Chapter 8 - Tropical Malabsorption | 155 | ||
| Introduction | 155 | ||
| Definition | 155 | ||
| Epidemiology | 156 | ||
| Endemic Areas | 156 | ||
| Age and Gender Predisposition | 156 | ||
| Predisposing Factors | 157 | ||
| Epidemics of Tropical Sprue | 157 | ||
| Changing Trends | 157 | ||
| Pathogenesis | 157 | ||
| Infective Hypothesis | 158 | ||
| Nutritional Theory | 158 | ||
| Genetic Hypothesis | 159 | ||
| Unifying Hypothesis | 159 | ||
| Pathology | 159 | ||
| Clinical Features[1,5] | 161 | ||
| Investigations And Diagnosis | 161 | ||
| Differential Diagnosis | 163 | ||
| Treatment | 164 | ||
| Supportive Therapy | 164 | ||
| Specific Therapy | 164 | ||
| Prognosis | 164 | ||
| Future Directions | 165 | ||
| Chapter 9 - Infections of the Small Bowel | 167 | ||
| Bacterial Infections (Including Bacterial Food Poisoning) | 167 | ||
| Staphylococcus aureus Infections | 167 | ||
| Clinical features | 167 | ||
| Bacillus cereus | 168 | ||
| Clostridium perfringens | 168 | ||
| Part IV Large Bowel | 195 | ||
| Chapter 10 - Management of Ulcerative Colitis | 197 | ||
| Introduction | 197 | ||
| Diagnosis | 197 | ||
| Treatment of Ulcerative Colitis | 199 | ||
| Treatment of Ulcerative Colitis | 200 | ||
| Corticosteroids | 200 | ||
| Immunosuppressants | 200 | ||
| Azathioprine and 6-mercaptopurine | 200 | ||
| Cyclosporins | 201 | ||
| Antibiotics | 201 | ||
| Heparin | 201 | ||
| Probiotics | 202 | ||
| Other Drugs | 202 | ||
| Biological Agents | 202 | ||
| Management Guidelines for Ulcerative Colitis | 203 | ||
| Assessment of Disease Activity | 203 | ||
| Assessment of Extent of the Disease | 203 | ||
| Active Distal Ulcerative Colitis | 204 | ||
| Active Mild to Moderate Left Sided or Extensive UC | 204 | ||
| Severe Ulcerative Colitis (Table 10.2) | 205 | ||
| Maintenance of Remission | 206 | ||
| Maintenance Therapy-How Long? | 206 | ||
| Surgery for Ulcerative Colitis | 206 | ||
| Pouchitis | 209 | ||
| Management During Pregnancy | 209 | ||
| Nutrition | 209 | ||
| Management of Extra-Intestinal Manifestations | 209 | ||
| Conclusions | 209 | ||
| Chapter 11 - I Benign Colorectal Tumors | 213 | ||
| Introduction | 213 | ||
| Epidemiology | 213 | ||
| Classification | 214 | ||
| Hyperplastic Polyps | 214 | ||
| Adenomas | 214 | ||
| Polyposis Syndromes | 215 | ||
| Pathophysiology of FAP | 215 | ||
| Epidemiology of FAP | 216 | ||
| Natural history of FAP | 216 | ||
| Juvenile Polyps | 216 | ||
| Clinical Presentation | 217 | ||
| Diagnosis | 217 | ||
| Imaging | 217 | ||
| Endoscopy | 217 | ||
| Medical Management | 218 | ||
| Surgical Options | 218 | ||
| Polypectomy | 218 | ||
| Colonic Resection (Fig. 11.2) | 218 | ||
| Prognosis | 219 | ||
| Chapter 12 - Malignant Colorectaltumors | 221 | ||
| Introduction | 221 | ||
| Epidemiology | 221 | ||
| Etiopathogenesis | 222 | ||
| Genetic Changes | 222 | ||
| Hereditary Syndromes and Predisposing Conditions | 223 | ||
| Familial adenomatous polyposis | 223 | ||
| Hereditary nonpolyposis colorectal cancer | 224 | ||
| Adenomatous polyps (Adenomas) | 225 | ||
| Inflammatory bowel disease | 225 | ||
| Environmental Factors | 225 | ||
| Role of diet | 225 | ||
| Role of drugs | 227 | ||
| Lifestyle factors | 227 | ||
| Screening for Colorectal Neoplasia | 227 | ||
| Fecal Occult Blood Testing | 227 | ||
| Endoscopic Screening Tests | 228 | ||
| Flexible sigmoidoscopy | 228 | ||
| Colonoscopy | 228 | ||
| Emerging Technologies for Screening | 228 | ||
| Diagnosis | 228 | ||
| Clinical Features | 228 | ||
| Tumor Spread, Staging, and Prognosis | 229 | ||
| Stage A (T1N0M0) | 229 | ||
| Stage B | 230 | ||
| Stage C | 230 | ||
| Stage D | 230 | ||
| Carcinoembryonic Antigen | 231 | ||
| Management | 231 | ||
| Scope of Surgery | 231 | ||
| Laparoscopic Surgery forColorectal Cancer (LSCRC) | 233 | ||
| Radiation Therapy | 233 | ||
| Chemotherapy | 233 | ||
| Adjuvant Chemotherapy | 234 | ||
| Comparative trials | 234 | ||
| Neoadjuvant chemotherapy | 234 | ||
| Neoadjuvant chemoradiation | 235 | ||
| Endoscopic Palliation | 235 | ||
| Postoperative Surveillance | 235 | ||
| Management of Less Common Tumors of the Colon and Rectum | 236 | ||
| Part V Liver | 241 | ||
| Chapter 13 - JAUNDICE IN THE INFANT | 243 | ||
| Unconjugated Hyperbilirubinemia | 243 | ||
| Physiological Jaundice of the Newborn | 243 | ||
| Hemolytic Anemia | 243 | ||
| Breast Milk Jaundice | 244 | ||
| Hypothyroidism | 244 | ||
| Gilbert's Syndrome | 244 | ||
| Crigler-Najjar Syndrome | 245 | ||
| Conjugated Hyperbilirubinemia | 245 | ||
| Physiological Cholestasis[7] | 246 | ||
| Neonatal Cholestasis | 246 | ||
| Neonatal Liver Failure | 246 | ||
| Diagnostic evaluation | 247 | ||
| Neonatal Hemochromatosis | 247 | ||
| Neonatal Cholestasis without Liver Failure | 248 | ||
| Approach to neonatal cholestasis | 249 | ||
| Treatment | 250 | ||
| Biliary Atresia | 251 | ||
| Neonatal Hepatitis | 252 | ||
| Intrauterine Infections | 253 | ||
| Bile Duct Paucity | 253 | ||
| Alagille syndrome (syndromic form of bile duct paucity) | 254 | ||
| Nonsyndromic forms of familial bileduct paucity | 255 | ||
| Progressive familial intrahepaticcholestasis 1 (PFIC 1) or Byler's disease | 255 | ||
| Progressive familial intrahepaticcholestasis 2 (PFIC 2) | 256 | ||
| Progressive familial intrahepaticcholestasis 3 (PFIC 3) | 256 | ||
| Alpha 1 antitrypsin deficiency | 256 | ||
| Galactosemia | 257 | ||
| Miscellaneous Conditions | 259 | ||
| Conclusion | 259 | ||
| chapter 14 - Hepatitis Viruses: Virology and Epidemiology | 261 | ||
| Hepatitis a Virus | 261 | ||
| Genomic Organization | 261 | ||
| chapter 15 - Virological Diagnosis of Hepatitis | 269 | ||
| Acute Viral Hepatitis | 269 | ||
| Hepatitis A | 269 | ||
| Hepatitis B | 270 | ||
| Hepatitis C | 270 | ||
| Hepatitis D | 271 | ||
| Hepatitis E | 272 | ||
| Non-A-to-G Hepatitis | 272 | ||
| Chronic Hepatitis | 272 | ||
| Hepatitis B | 273 | ||
| Hepatitis C | 274 | ||
| Hepatitis D | 275 | ||
| HGV and TTV | 275 | ||
| chapter 16 - Hepatitis A Infection | 277 | ||
| Virus Characteristics | 277 | ||
| Spread of the Virus | 277 | ||
| Incubation Period | 278 | ||
| Epidemiology | 278 | ||
| Pathogenesis | 278 | ||
| Clinical Features | 278 | ||
| Anicteric Infection | 278 | ||
| Acute Hepatitis | 279 | ||
| Acute Hepatic Failure | 279 | ||
| Prolonged Cholestasis | 280 | ||
| Laboratory Features | 280 | ||
| Diagnosis | 280 | ||
| Treatment | 280 | ||
| Diet | 280 | ||
| Bed Rest | 281 | ||
| Ursodeoxycholic Acid | 281 | ||
| Alternate Medicine | 281 | ||
| Prevention | 281 | ||
| Preexposure Prevention | 281 | ||
| Postexposure Prophylaxis | 282 | ||
| Conclusions | 283 | ||
| Chapter 17 - Hepatitis B And Dvirus | 286 | ||
| Hepatitis Bvirus | 286 | ||
| History | 286 | ||
| Epidemiology | 286 | ||
| Transmission | 287 | ||
| Virology | 287 | ||
| Structure | 287 | ||
| Genome | 288 | ||
| Pathogenesis | 288 | ||
| Phases of HBV infection | 289 | ||
| Clinical Features | 290 | ||
| Acute infection | 290 | ||
| Serologic markers of HBV infection | 291 | ||
| Diagnostic algorithm | 292 | ||
| Chronic infection | 293 | ||
| Coinfection with hepatitis C virus or hepatitis D virus | 297 | ||
| Treatment of Hepatitis B | 298 | ||
| Interferon therapy | 298 | ||
| Interferon treatment for special groups | 299 | ||
| Nucleoside analogues | 299 | ||
| Other drugs | 300 | ||
| Hepatitis D Virus | 301 | ||
| Virology | 301 | ||
| Genome of HDV | 301 | ||
| Life cycle and replication ofHDV | 301 | ||
| Editing of HDV RNA and the two forms of HDAg | 302 | ||
| Epidemiology and Transmission | 302 | ||
| Pathogenesis | 302 | ||
| Diagnosis | 303 | ||
| Clinical Features | 304 | ||
| Treatment | 305 | ||
| Prevention | 305 | ||
| Medical therapy | 305 | ||
| Transplantation | 305 | ||
| Chapter 18 - Hepatitis C: an Indian Perspective | 311 | ||
| Introduction | 311 | ||
| Virology | 311 | ||
| Epidemiology | 312 | ||
| Transmission | 312 | ||
| Pathogenesis | 312 | ||
| Natural History | 313 | ||
| Clinical Manifestations | 314 | ||
| Acute and Chronic Infection | 314 | ||
| Extrahepatic Manifestations | 314 | ||
| Diagnosis | 314 | ||
| Prevention and Prophylaxis | 315 | ||
| Treatment | 315 | ||
| Goals of Therapy | 315 | ||
| Available Drugs (Table 18.2) | 315 | ||
| Efficacy | 315 | ||
| Predictors of Response to Therapy | 316 | ||
| Characteristics of Patients for whom Therapy is Widely Accepted | 316 | ||
| Characteristics of Persons forwhom Therapy should beIndividualized | 317 | ||
| Characteristics of Persons forwhom Therapy is CurrentlyContraindicated | 317 | ||
| Adverse Effects | 317 | ||
| Recommended Threshold for Drug Dose Reduction in Patients with IFN and Ribavirin for Chronic Hepatitis C | 317 | ||
| Indian Data (Fig. 18.5) | 317 | ||
| Treatment of Special Patient Groups[18] | 318 | ||
| Nonresponders and partial responders | 318 | ||
| HIV coinfected persons | 318 | ||
| Persons with renal disease | 318 | ||
| Persons with solid organ transplantation | 318 | ||
| Persons with decompensated cirrhosis | 318 | ||
| Persons with acute hepatitis C | 319 | ||
| Chapter 19 - Hepatitis E | 321 | ||
| Virology | 321 | ||
| Epidemiology | 321 | ||
| Geographical Distribution | 321 | ||
| Epidemiological Features (Table 19.1) | 322 | ||
| Transmission and Routes of Spread | 322 | ||
| Reservoirs of Infection | 323 | ||
| Seroprevalence Data | 324 | ||
| Clinical Features | 324 | ||
| Pathology | 326 | ||
| Pathogenesis | 326 | ||
| Diagnosis | 326 | ||
| Detection of HEV or HEV Components | 327 | ||
| Detection of Antibodies against HEV | 327 | ||
| Prevention and Treatment | 327 | ||
| Chapter 20 - Hepatic Drug Toxicity | 330 | ||
| Diagnosis of Drug Hepatotoxicity | 331 | ||
| Dechallenge | 331 | ||
| Indications of Liver Biopsy | 332 | ||
| Mechanisms of Drug Hepatotoxicity | 333 | ||
| Phase I Reactions | 333 | ||
| Phase II Reactions | 333 | ||
| Phase III Reactions | 333 | ||
| Classification of Hepatotoxins | 334 | ||
| Dose-dependent or intrinsic hepatotoxins | 334 | ||
| Dose-independent or idiosyncratic hepatotoxins | 334 | ||
| Hepatic Adaptation | 335 | ||
| Dose-dependent Hepatotoxicity | 335 | ||
| Clinicopathological Classification of Drug-Induced Liver Disease | 336 | ||
| Acute Hepatitis | 336 | ||
| Drug-induced Cholestasis | 337 | ||
| Acute drug-induced cholestasis | 337 | ||
| Chronic drug-induced cholestasis | 338 | ||
| Chronic Hepatitis | 339 | ||
| Steatosis | 340 | ||
| Acute microvesicular steatosis | 340 | ||
| Macrovesicular steatosis | 340 | ||
| Hepatic Fibrosis | 340 | ||
| Vascular Disorders | 341 | ||
| Neoplasms | 341 | ||
| Adenomas | 341 | ||
| Hepatocellular carcinoma | 341 | ||
| Management of Hepatic Drug Toxicity | 342 | ||
| Chapter 21 - Toxic Liver Injury | 344 | ||
| Acute Hepatic Necrosis and Renal Failure | 345 | ||
| Carbon Tetrachloride Poisoning | 345 | ||
| Phosphorus Poisoning | 346 | ||
| Toxic Mushroom Ingestion | 346 | ||
| Acetaminophen (Paracetamol)Toxicity | 347 | ||
| Copper Toxicity | 347 | ||
| Acute Hepatic Injury Associated with Microvesicular Steatosis | 347 | ||
| Jamaican Vomiting Sickness | 347 | ||
| Margosa Oil Syndrome | 347 | ||
| Acute Cholestatic Injury | 348 | ||
| Methylenediamine | 348 | ||
| Paraquat | 348 | ||
| Toxic Oil Syndrome | 348 | ||
| Veno-Occlusive Disease | 348 | ||
| Primary Liver Tumors | 349 | ||
| Aflatoxin-B1 | 349 | ||
| Vinyl Chloride | 350 | ||
| Polychlorinated Biphenyls | 350 | ||
| Porphyria Cutanea Tarda | 350 | ||
| Chronic Hepatitis and/or Cirrhosis | 350 | ||
| Herbal Drug Toxicity | 350 | ||
| Acute and Chronic Hepatitis | 351 | ||
| Cholestatic Hepatitis | 351 | ||
| Veno-occlusive Disease | 351 | ||
| Chapter 22 - Hepatic Granulomas | 354 | ||
| Definition | 354 | ||
| Etiology | 354 | ||
| Pathology | 354 | ||
| Clinical Manifestations | 356 | ||
| Laboratory Diagnosis Of Granulomatous Liver Disease | 356 | ||
| Different Conditions Causing Liver Granulomas | 357 | ||
| Tuberculosis | 357 | ||
| Hepatic granulomatous disease | 357 | ||
| Congenital tuberculosis | 357 | ||
| Primary hepatic tuberculosis | 357 | ||
| Disseminated/Miliary tuberculargranuloma | 358 | ||
| Tuberculoma | 358 | ||
| Sarcoidosis | 358 | ||
| Drugs | 358 | ||
| Brucellosis | 358 | ||
| Leprosy | 358 | ||
| Lymphoma | 359 | ||
| Granulomas in Patients with PrimaryParenchymal Liver Disease | 359 | ||
| Granulomatous Disease in Patients with HIV Infection | 359 | ||
| Schistosomiasis | 360 | ||
| Idiopathic Granulomatous Hepatitis[21] | 360 | ||
| Diagnosis | 360 | ||
| Treatment of Hepatic Granulomas | 360 | ||
| Chapter 23 - Autoimmune Hepatitis | 363 | ||
| Pathogenesis | 363 | ||
| Clinical Features | 363 | ||
| Histology | 365 | ||
| Diagnosis | 366 | ||
| Investigations | 367 | ||
| Treatment | 369 | ||
| Chapter 24 - Cirrhosis of the Liver | 375 | ||
| Definition[1] | 375 | ||
| Etiology[2] | 375 | ||
| Classification[1] | 375 | ||
| Pathogenesis[1] | 375 | ||
| Pathophysiology of Portal Hypertension: Ascites, Hepatic Encephalopathy, and Coagulopathy[3-11] | 376 | ||
| Ascites[7,8] | 376 | ||
| Hepatic Encephalopathy[10] | 376 | ||
| Coagulation Disorders[11] | 377 | ||
| Clinical Features and Complications | 377 | ||
| Compensated Cirrhosis | 377 | ||
| Decompensated Cirrhosis | 377 | ||
| Spontaneous Bacterial Peritonitis[12,13] | 378 | ||
| Gastrointestinal and Peripheral Bleeding[14,15] | 378 | ||
| Hepatic Encephalopathy[6,17] | 378 | ||
| Hepatorenal Syndrome[18,19] | 379 | ||
| Hepatopulmonary Syndrome[20] | 379 | ||
| Investigation of Patients With Cirrhosis of the Liver | 380 | ||
| Treatment for Patients With Cirrhosis of the Liver | 380 | ||
| Treatment of Variceal Bleeding | 381 | ||
| Acute Variceal Bleeding[21-23] | 381 | ||
| Long-term Prevention of Variceal Bleeding | 381 | ||
| Drug Therapy for Prevention of Bleeding[24-26] | 382 | ||
| Endoscopic Sclerosis and Band Ligation[27-29] | 382 | ||
| Treatment of Ascites, SBP, and HRS | 383 | ||
| Paracentesis[32,33] | 383 | ||
| Transjugular Intrahepatic Portosystemic Shunts (TIPS)[35] | 383 | ||
| Treatment of Hepatic Encephalopathy[39,40] | 384 | ||
| Liver Transplantation | 385 | ||
| Other treatments of cirrhosis of the liver: general issues | 385 | ||
| Chapter 25 - Noncirrhotic Portal Fibrosis | 388 | ||
| Historical Background And Nomenclature | 388 | ||
| Epidemiology | 389 | ||
| Etiopathogenesis | 389 | ||
| Infection | 389 | ||
| Exposure to Toxins and Chemicals | 389 | ||
| Immunologic Hypothesis | 390 | ||
| Pathology | 390 | ||
| Gross | 390 | ||
| Microscopic | 391 | ||
| Ultrastructure | 392 | ||
| Clinical Features | 392 | ||
| Demography and Symptoms | 392 | ||
| Physical Signs | 393 | ||
| Laboratory Features | 393 | ||
| Blood | 393 | ||
| Imaging | 393 | ||
| Splenoportovenography (SPV) | 393 | ||
| Percutaneous transhepatic portography (PTP) | 394 | ||
| Ultrasound and computed tomography (CT) angiography | 395 | ||
| 25.6.3 Hemodynamic Studies | 395 | ||
| Diagnosis And Differential Diagnosis | 395 | ||
| Special Considerations | 396 | ||
| NCPF in Children | 396 | ||
| Comparison of NCPF Patients with orwithout Spontaneous Shunts | 396 | ||
| Comparison between EHPVO and NCPF | 396 | ||
| NCPF in Pregnancy | 397 | ||
| Management | 397 | ||
| Variceal Bleeding | 397 | ||
| Acute Variceal Bleeding | 397 | ||
| Prevention of Recurrent Bleeding from Esophageal Varices | 398 | ||
| Prognosis | 398 | ||
| Chapter 26 - Extrahepatic Portal Venous Obstruction | 404 | ||
| Introduction | 404 | ||
| Epidemiology | 404 | ||
| Etiology | 404 | ||
| Adult-onset EHPVO | 404 | ||
| EHPVO in Children | 404 | ||
| Coagulopathy | 405 | ||
| Clinical Manifestations | 405 | ||
| Investigations | 406 | ||
| Hemogram | 406 | ||
| Liver Function Tests | 406 | ||
| Ultrasound Abdomen | 406 | ||
| Computed Tomography (CT) andCT Arterial Portography (CTAP) | 406 | ||
| Magnetic Resonance Imaging and MR Portography | 407 | ||
| ERCP and MRCP | 407 | ||
| Treatment | 408 | ||
| Management of the Acute Variceal Bleed | 408 | ||
| Endoscopy | 408 | ||
| Surgery | 408 | ||
| Other therapies | 408 | ||
| Secondary prophylaxis | 408 | ||
| Conclusion | 410 | ||
| Chapter 27 - Budd-Chiari Syndrome | 413 | ||
| Introduction | 413 | ||
| Etiology of Budd-Chiari Syndrome | 413 | ||
| Pathophysiology of BCS Classification[17] | 415 | ||
| Clinical Manifestations | 415 | ||
| Asymptomatic | 416 | ||
| Fulminant | 416 | ||
| Acute | 416 | ||
| Subacute (<6 months) | 416 | ||
| Chronic | 416 | ||
| Diagnosis | 416 | ||
| Ultrasound | 416 | ||
| Computerized Tomography | 417 | ||
| Magnetic Resonance Imaging (MRI) | 417 | ||
| Liver Biopsy | 417 | ||
| Angiography | 417 | ||
| Medical Therapy | 417 | ||
| Thrombolytic Therapy | 417 | ||
| Angioplasty and Stenting | 418 | ||
| Transjugular Intrahepatic Portosystemic Shunt (TIPS) | 418 | ||
| Surgery | 418 | ||
| Dorsocranial Resection (Senning Procedure) | 419 | ||
| Portosystemic Shunts | 419 | ||
| Mesoatrial Shunts | 419 | ||
| Liver Transplantation | 419 | ||
| Prognosis | 420 | ||
| Part VI Liver Failure | 423 | ||
| Chapter 28 - Acute Liver Failure | 425 | ||
| Definitions | 425 | ||
| Complications and Sequelae of ALF | 426 | ||
| Cerebral Edema | 426 | ||
| Encephalopathy | 428 | ||
| Immunologic Break Down and Infectious Complications | 428 | ||
| Metabolic Dysfunction | 429 | ||
| Coagulopathy | 429 | ||
| Cardiovascular Effects | 429 | ||
| Renal Failure | 429 | ||
| Hematologic Disturbances | 430 | ||
| Etiology | 430 | ||
| Hepatitis A (HAV) | 430 | ||
| Hepatitis B (HBV) | 430 | ||
| Hepatitis B Mutants | 431 | ||
| Reactivation of Hepatitis B | 431 | ||
| Hepatitis D (HDV):Superinfection/Coinfection | 431 | ||
| Hepatitis C | 431 | ||
| Hepatitis E | 432 | ||
| Mushrooms | 432 | ||
| Wilson's Disease | 432 | ||
| Other Viruses | 432 | ||
| Drugs | 432 | ||
| Prognostic Criteria | 433 | ||
| Management | 434 | ||
| Neurologic Support | 434 | ||
| Intracranial Pressure Monitoring | 434 | ||
| Reverse Jugular Venous Monitoring | 435 | ||
| Osmotherapy | 435 | ||
| Thiopentone | 435 | ||
| Hypothermia | 436 | ||
| Prophylactic Phenytoin | 436 | ||
| Hyperventilation | 436 | ||
| Ammonia Lowering Measures | 436 | ||
| Other Therapies | 436 | ||
| Prevention and Treatment of Infection | 436 | ||
| Hemodynamic Support | 437 | ||
| Coagulopathy | 437 | ||
| Mechanical Ventilation of Patients with Liver Failure | 437 | ||
| Microcirculation | 438 | ||
| Renal Support | 438 | ||
| Nutritional and Metabolic Support | 438 | ||
| Liver Transplantation | 439 | ||
| Nontransplant Therapies for Liver Support | 439 | ||
| Molecular adsorbent recirculating system (MARS) | 440 | ||
| Conclusions | 440 | ||
| Chapter 29 - Subacute Hepatic Failure | 445 | ||
| DEFINITION | 445 | ||
| Synonyms | 445 | ||
| ETIOLOGY | 445 | ||
| PATHOLOGY | 446 | ||
| INVESTIGATIONS | 447 | ||
| CLINICAL FEATURES | 447 | ||
| Clinical Course and Prognosis | 447 | ||
| TREATMENT | 448 | ||
| Chapter 30 - Benign Liver Tumors | 450 | ||
| Hepatic Adenoma | 450 | ||
| Pathology | 451 | ||
| Clinical Features | 451 | ||
| Imaging of Adenomas | 452 | ||
| Ultrasonography (USG) | 452 | ||
| Computed tomographic (CT) scan | 452 | ||
| Magnetic resonance imaging (MRI) | 452 | ||
| Radionuclide imaging | 452 | ||
| Angiography | 453 | ||
| Treatment | 453 | ||
| Focal Nodular Hyperplasia | 453 | ||
| Pathogenesis | 453 | ||
| Pathology | 453 | ||
| Multiple FNH Syndrome | 454 | ||
| Clinical Features | 454 | ||
| Imaging of FNH | 454 | ||
| USG | 454 | ||
| CT scan | 455 | ||
| MRI | 455 | ||
| Radionuclide imaging | 455 | ||
| Angiography | 455 | ||
| Natural History | 456 | ||
| Treatment | 456 | ||
| Nodular Regenerative Hyperplasia | 456 | ||
| Pathogenesis | 456 | ||
| Pathology | 456 | ||
| Clinical Features | 456 | ||
| Imaging of NRH | 457 | ||
| USG | 457 | ||
| CT scan | 457 | ||
| MRI | 457 | ||
| Treatment | 457 | ||
| Polycystic Liver Disease | 457 | ||
| Pathology | 457 | ||
| Clinical Features | 457 | ||
| Treatment | 458 | ||
| Simple Hepatic Cysts | 458 | ||
| Imaging of Liver Cysts | 458 | ||
| USG | 458 | ||
| CT scan | 458 | ||
| MRI | 458 | ||
| Biliary Microhamartomas (Von Meyenburg Complex) | 458 | ||
| Prevalence | 458 | ||
| Pathology | 459 | ||
| Imaging of Biliary Microhamartomas | 459 | ||
| USG | 459 | ||
| CT scan | 459 | ||
| MRI | 459 | ||
| Bile Duct Adenoma | 459 | ||
| Clinical Features | 459 | ||
| Part VII Gallbladder and Biliary Tract | 467 | ||
| Chapter 31 - Gallstone Disease | 469 | ||
| Composition of Gallstones | 469 | ||
| Composition of Gallstones in India | 470 | ||
| Incidence and Prevalence | 470 | ||
| Risk Factors | 470 | ||
| Genetic and Racial Factors | 470 | ||
| Age and Sex | 471 | ||
| Pregnancy and Parity | 471 | ||
| Obesity, Weight Loss, and Total Parental Nutrition | 471 | ||
| Dietary Factors and Hyperlipidemia | 472 | ||
| Drugs | 472 | ||
| Systemic Diseases | 472 | ||
| pathogenesis | 473 | ||
| Pathogenesis of Cholesterol Gallstones | 473 | ||
| Cholesterol supersaturation | 473 | ||
| Nucleating and antinucleating factors | 474 | ||
| Role of calcium in gallstone formation | 474 | ||
| Gallbladder hypomotility | 474 | ||
| Role of intestinal transit | 475 | ||
| Genetic factors | 475 | ||
| Recent advances in pathogenesisof gallstones | 475 | ||
| Pathogenesis of Pigment Stones | 476 | ||
| Natural History of Gallstone Disease | 477 | ||
| Clinical Manifestations of Gallstone Disease | 477 | ||
| Gallstones and Gallbladder Cancer | 478 | ||
| Gallstones and Xanthogranulomatous Cholecystitis | 478 | ||
| Diagnosis | 478 | ||
| Management of Gallstones | 481 | ||
| Asymptomatic Gallstones | 481 | ||
| Symptomatic Gallstones | 481 | ||
| Acute Cholecystitis | 482 | ||
| Choledocholithiasis | 482 | ||
| Chapter 32 - Gallbladder Cancer and Cholangiocarcinoma | 485 | ||
| Gallbladder Cancer | 485 | ||
| Epidemiology | 485 | ||
| Pathology and Modes of Spread | 487 | ||
| Staging | 488 | ||
| Clinical Presentation | 488 | ||
| Diagnosis | 489 | ||
| Imaging | 490 | ||
| Tumor Markers | 491 | ||
| Cytology | 492 | ||
| Upper Gastrointestinal Endoscopy | 492 | ||
| Laparoscopy | 492 | ||
| Management | 492 | ||
| Surgery | 492 | ||
| Radiotherapy and Chemotherapy | 497 | ||
| Palliation in GBC | 497 | ||
| Prevention | 499 | ||
| Cholangiocarcinoma | 500 | ||
| Incidence | 500 | ||
| Etiology | 500 | ||
| Clinical Presentation | 501 | ||
| Differential Diagnoses | 501 | ||
| Preoperative Work Up and Imaging | 502 | ||
| Cholangiography | 502 | ||
| Laparoscopy | 503 | ||
| Tumor Staging | 503 | ||
| Management | 504 | ||
| Extent of Surgery | 505 | ||
| Preoperative Biliary Drainage (PBD) | 505 | ||
| Portal Vein Embolization (PVE) | 507 | ||
| Orthotopic Liver Transplantation | 507 | ||
| Adjuvant Therapy | 507 | ||
| Palliation | 507 | ||
| Chapter 33 - Choledochal Cysts | 514 | ||
| Introduction | 514 | ||
| History | 514 | ||
| Classification | 514 | ||
| Epidemiology | 515 | ||
| Clinical Features | 516 | ||
| Infants | 516 | ||
| Older Children | 516 | ||
| Adults | 516 | ||
| Investigations | 516 | ||
| Pathology | 517 | ||
| Etiology | 517 | ||
| Abnormal Pancreaticobiliary Duct Junction | 517 | ||
| Oligoganglionosis | 518 | ||
| Heredity | 518 | ||
| Forme Fruste Choledochalcyst | 518 | ||
| Prenatally Diagnosed Choledochal Cyst | 518 | ||
| Complications | 519 | ||
| Rupture of Cyst | 519 | ||
| Pancreatic Complications | 519 | ||
| Carcinoma | 520 | ||
| Treatment | 521 | ||
| Type I Cyst | 521 | ||
| Type II Cysts (Diverticulum) | 522 | ||
| Type III Cysts (Choledochocele) | 522 | ||
| Type IV Cysts | 522 | ||
| Laparoscopic Excision of Choledochal Cysts | 522 | ||
| Chapter 34 - Benign Bile Duct Strictures | 528 | ||
| Operative Bile Duct Injury | 528 | ||
| Incidence | 528 | ||
| Classification of Injuries | 528 | ||
| Presentation | 529 | ||
| Consequences of Prolonged Biliary Obstruction | 529 | ||
| Investigations | 530 | ||
| Cholangiography | 530 | ||
| Other Imaging | 531 | ||
| Management and Outcome | 531 | ||
| Endoscopic Treatment | 531 | ||
| Surgery | 531 | ||
| Part VIII Pancreas | 537 | ||
| Chapter 35 - Acute Pancreatitis | 539 | ||
| Classification of Acute Pancreatitis | 539 | ||
| Development of Acute Pancreatitis[4-6] | 539 | ||
| Pathology | 541 | ||
| Etiology and Risk Factors | 541 | ||
| Biliary Tract Disease | 541 | ||
| Alcohol Abuse | 542 | ||
| Tumors and Other Obstructive Lesions | 542 | ||
| Infections and Infestations | 543 | ||
| Drugs and Toxins | 543 | ||
| Metabolic and Other Disorders | 543 | ||
| Postprocedure | 544 | ||
| Idiopathic Acute Pancreatitis | 545 | ||
| Clinical Features | 545 | ||
| Diagnosis | 545 | ||
| Serum Amylase and Lipase[13,80-83] | 545 | ||
| Other Laboratory Tests | 546 | ||
| Plain X-rays | 546 | ||
| Ultrasonography | 546 | ||
| CT cand MRI | 547 | ||
| ERCP | 547 | ||
| Treatment | 548 | ||
| Immediate Treatment | 548 | ||
| Feeding and Nutrition | 548 | ||
| Endoscopic Papillotomy in Severe Biliary Pancreatitis | 549 | ||
| Recurrence | 549 | ||
| Timing | 550 | ||
| Risks | 550 | ||
| Complications of Acute Pancreatitis | 550 | ||
| Acute Fluid Collection | 550 | ||
| Pseudocyst | 551 | ||
| Pancreatic Necrosis | 551 | ||
| Hemorrhage | 552 | ||
| Infectious Complications | 552 | ||
| Bacteriology | 553 | ||
| Prophylactic Antibiotics | 553 | ||
| Choice of Antibiotics | 554 | ||
| Gut Decontamination | 554 | ||
| Prognosis | 554 | ||
| Ranson's Criteria | 555 | ||
| Apache II Score | 555 | ||
| Ct Grading of Acute Pancreatitis | 558 | ||
| Chapter 36 - Chronic Pancreatitis | 566 | ||
| Introduction | 566 | ||
| Epidemiology of Chronic Pancreatitis | 566 | ||
| Epidemiology of Chronic Pancreatitis in India | 567 | ||
| Etiopathogenesis and Pathology | 567 | ||
| Pathophysiology | 568 | ||
| Pathophysiology of Tropical Chronic Pancreatitis (TCP) | 569 | ||
| Pathology of Chronic Pancreatitis | 570 | ||
| Molecular Events | 571 | ||
| Clinical Manifestations | 571 | ||
| Steatorrhea | 572 | ||
| Diabetes Mellitus | 572 | ||
| Cancer | 573 | ||
| Chronic Pancreatitis in the West and in India | 573 | ||
| Diagnosis of CP | 573 | ||
| Pancreatic Function Tests | 573 | ||
| Direct Tests | 574 | ||
| Imaging in Chronic Pancreatitis | 574 | ||
| Secretin Studies | 576 | ||
| Endoscopic Ultrasound (EUS) (Fig. 36.4) | 576 | ||
| Endoscopic Retrograde Cholangiopancreatography (ERCP) | 577 | ||
| A practical approach to diagnosis in India | 578 | ||
| The Mechanism of Pain in Chronic Pancreatitis | 578 | ||
| Neural Mechanisms | 578 | ||
| Ductal and Parenchymal Pressures | 579 | ||
| Natural Course of Pain in Chronic Pancreatitis | 579 | ||
| Nonsurgical Treatment of Pain in CP | 580 | ||
| Pancreatic enzyme supplements | 580 | ||
| Nerve blocks in the treatment of pain in CP | 580 | ||
| Surgery In CP | 581 | ||
| Surgery for Pain in Chronic Pancreatitis | 582 | ||
| Pancreaticojejunostomy | 582 | ||
| Pancreatectomy | 587 | ||
| Pancreaticoduodenectomy | 588 | ||
| Surgery for Complications of Chronic Pancreatitis | 589 | ||
| Biliary stenosis | 589 | ||
| Duodenal stenosis | 590 | ||
| Colonic obstruction | 590 | ||
| Portal venous obstruction | 590 | ||
| Pancreatic ascites and pleural effusion | 590 | ||
| chapter 37 - Cancer of the Pancreas | 597 | ||
| Epidemiology | 597 | ||
| Risk Factors | 597 | ||
| Age | 597 | ||
| Sex | 597 | ||
| Smoking | 598 | ||
| Diet | 598 | ||
| Diabetes mellitus | 598 | ||
| Chronic pancreatitis | 598 | ||
| Familial factors | 598 | ||
| Molecular biology | 598 | ||
| Genetics | 599 | ||
| Pathophysiology | 599 | ||
| Histological Findings | 599 | ||
| Cystic Lesions | 600 | ||
| Clinical Features | 600 | ||
| History | 600 | ||
| Physical Examination | 601 | ||
| Investigations | 601 | ||
| General Laboratory Studies | 601 | ||
| Tumor Markers | 601 | ||
| Imaging Studies | 601 | ||
| Ultrasound | 601 | ||
| CT scan (Computerized tomography) | 602 | ||
| MRI (Magnetic resonance imaging) | 602 | ||
| ERCP (Endoscopic retrograde cholangiopancreatography) | 602 | ||
| EUS (Endoscopic ultrasonography) | 602 | ||
| PET (Positron emission tomography scanning) | 603 | ||
| Laparoscopy | 603 | ||
| Preoperative Tissue Diagnosis | 603 | ||
| Staging | 604 | ||
| Treatment | 604 | ||
| General Principles | 604 | ||
| Preoperative Biliary Drainage | 604 | ||
| Surgical Treatment | 605 | ||
| PPPD (Pylorus preserving pancreaticoduodenectomy) | 605 | ||
| Resections of portal/mesenteric vein | 606 | ||
| Extended lymph node resection | 606 | ||
| Features suggestive of irresectability | 606 | ||
| Cancer of the Body and Tail of the Pancreas | 606 | ||
| Somatostatin Analogues | 607 | ||
| Adjuvant Therapy | 607 | ||
| Biological Therapy | 607 | ||
| Antiangiogenic therapy | 607 | ||
| Nutritional Support | 607 | ||
| Palliative Therapy | 608 | ||
| Pain | 608 | ||
| Jaundice | 608 | ||
| Duodenal Obstruction | 608 | ||
| Management Algorithm (Fig 37.5) | 609 | ||
| Prevention | 609 | ||
| Prognosis | 610 | ||
| Favorable Prognostic Factors | 610 | ||
| Summary | 610 | ||
| Part IX Parasitic Diseases | 613 | ||
| Chapter 38 - Intestinal and Extraintestinal Amebiasis | 615 | ||
| Introduction | 615 | ||
| Microbiology | 616 | ||
| Biology and Life Cycle | 616 | ||
| Trophozoite | 616 | ||
| Cyst | 616 | ||
| Life cycle | 617 | ||
| Epidemiology | 617 | ||
| Intestinal Amebiasis | 618 | ||
| Pathogenesis | 618 | ||
| Ulcers | 618 | ||
| Molecular events | 618 | ||
| Immunology | 619 | ||
| Clinical Features | 619 | ||
| Intestinal amebiasis | 620 | ||
| Surgical Complications | 620 | ||
| Diagnosis | 620 | ||
| Stool specimen | 620 | ||
| Sigmoidoscopic examination | 621 | ||
| Serology | 621 | ||
| Newer methods | 621 | ||
| Treatment | 621 | ||
| Uncomplicated amebiasis | 621 | ||
| Surgical Complications | 622 | ||
| Vaccine | 622 | ||
| Amebic Liver Abscess | 622 | ||
| Extraintestinal Amebiasis | 622 | ||
| Epidemiology | 622 | ||
| Clinical Features | 622 | ||
| Variants[35] | 623 | ||
| Multiple Liver Abscesses | 623 | ||
| Left lobe abscess | 624 | ||
| Compression lesions | 624 | ||
| Extension of the abscess | 624 | ||
| Diagnosis | 624 | ||
| Treatment | 625 | ||
| Medical therapy | 625 | ||
| Aspiration or drainage of abscess | 625 | ||
| Surgical therapy[29] | 626 | ||
| Long-term follow-up | 626 | ||
| Prognosis | 626 | ||
| Sexually Transmitted Amebiasis | 626 | ||
| Chapter 39 - Hydatid Cyst of the Liver | 629 | ||
| Introduction | 629 | ||
| Epidemiology | 629 | ||
| LIFE CYCLE OF E. GRANULOSUS | 629 | ||
| Development in the Intermediate Host (Humans) | 630 | ||
| Clinical Features | 630 | ||
| Complications | 631 | ||
| Infection | 631 | ||
| Rupture (Internal/External) | 631 | ||
| Diagnosis | 632 | ||
| Ultrasound | 632 | ||
| Cect/Mri | 632 | ||
| Ercp | 632 | ||
| Immunological Tests | 633 | ||
| Management | 633 | ||
| Medical Treatment | 633 | ||
| Efficacy | 634 | ||
| Mechanism of action | 634 | ||
| Dosage | 634 | ||
| Side effects and toxicity | 635 | ||
| Follow-up protocol for medicalmanagement | 635 | ||
| Surgical Treatment | 635 | ||
| Open surgical procedures | 635 | ||
| Laparoscopic surgery | 637 | ||
| Percutaneous Management (PAIR) | 638 | ||
| Chapter 40 - Schistosomiasis | 641 | ||
| Life Cycle of Schistosomes | 641 | ||
| Pathophysiology | 641 | ||
| Immunology of Hepatic Inflammation/Fibrosis in Schistosomiasis | 642 | ||
| Clinical Features | 642 | ||
| Schistosomiasis and Hepatitis | 643 | ||
| Diagnosis | 644 | ||
| Stool Examination | 644 | ||
| Serology | 644 | ||
| Imaging | 644 | ||
| Management | 644 | ||
| Medical Management | 645 | ||
| Reversibility of Schistosomal Hepatic Fibrosis | 645 | ||
| Future Therapies for Schistosomiasis | 646 | ||
| Surgical Management | 646 | ||
| Prevention of Schistosomiasis: Vaccine Development | 646 | ||
| Conclusion | 647 | ||
| Part X Special Topics | 651 | ||
| Chapter 41 - Abdominal Tuberculosis | 653 | ||
| Changing Profile of Tuberculosis | 653 | ||
| Epidemiology | 653 | ||
| World | 653 | ||
| India | 653 | ||
| Pathogenesis | 654 | ||
| Pathologic Appearance | 655 | ||
| Clinical Features | 656 | ||
| Diagnostic Criteria | 658 | ||
| Diagnostic Approach | 659 | ||
| Ascitic Presentation | 659 | ||
| Masses, Obstruction, Nonobstructive, and Vague Presentation | 659 | ||
| Diagnostic Aids | 659 | ||
| Supportive Diagnostic Aids | 659 | ||
| Barium contrast radiography | 659 | ||
| Ultrasonography | 660 | ||
| CT scan | 662 | ||
| Serodiagnosis | 662 | ||
| Biochemical markers of tuberculosis | 663 | ||
| Confirmatory Modalities | 663 | ||
| Histologic diagnosis | 664 | ||
| Upper GI Endoscopy | 664 | ||
| Enteroscopy | 664 | ||
| Laparoscopy | 665 | ||
| Colonoscopy | 665 | ||
| Bacteriologic Diagnosis | 666 | ||
| Smear Examination | 666 | ||
| AFB on Histology | 667 | ||
| Culture | 667 | ||
| Molecular Methods of Diagnosis | 667 | ||
| PCR in Abdominal Tuberculosis | 667 | ||
| Hepatic Tuberculosis | 667 | ||
| Pathogenesis | 668 | ||
| Clinical Presentation | 668 | ||
| Diagnosis | 668 | ||
| Imaging techniques | 668 | ||
| Liver biopsy | 669 | ||
| Laparoscopy | 669 | ||
| ERCP/PTC | 669 | ||
| Treatment | 669 | ||
| Special Situations | 670 | ||
| HIV confection | 670 | ||
| Hepatic disease | 671 | ||
| Pregnancy | 671 | ||
| Multiple drug resistant (MDR)tuberculosis | 671 | ||
| Adjuvants to Antitubercular Therapy | 671 | ||
| Corticosteroids | 671 | ||
| Surgery | 672 | ||
| Chapter 42 - Diarrhea In Children | 678 | ||
| Definition | 678 | ||
| Classification | 678 | ||
| chapter 43 - Nonvariceal Upper Gastrointestinal Tract Bleeding | 703 | ||
| Medical History and Physical Examinatio | 703 | ||
| Laboratory Testing | 704 | ||
| Initial Management | 705 | ||
| Nasogastric Aspiration | 705 | ||
| General Measures | 705 | ||
| Fluid Replacement | 705 | ||
| Transfusion Requirements | 705 | ||
| Acid Suppressive Therapy | 706 | ||
| Endoscopic Means of Hemostasis (Table 43.2) | 706 | ||
| Argon Plasma Coagulation | 707 | ||
| Endoscopic Injection Therapy for Bleeding Peptic Ulcer | 707 | ||
| Mechanical Means of Hemostasis | 708 | ||
| Endoscopic Electrocoagulation (EC) | 709 | ||
| Heater Probe | 710 | ||
| Laser | 710 | ||
| Technique | 710 | ||
| Management of Site Specific Bleeding | 711 | ||
| Peptic Ulcer Disease | 711 | ||
| H. pylori and peptic ulcer bleeding | 711 | ||
| Hemorrhagic Gastritis | 712 | ||
| Mallory-Weiss Tears | 712 | ||
| Dieulafoy's Lesion | 712 | ||
| Angiodysplasia | 713 | ||
| Risk Assessment in UGI Bleeding | 713 | ||
| Second Look Endoscopy | 713 | ||
| Interventional Radiology | 713 | ||
| Surgical Intervention in UGI Bleeding | 714 | ||
| Chapter 44 - Lower Gastrointestinal Bleeding | 722 | ||
| Incidence and Epidemiology | 722 | ||
| Etiology | 722 | ||
| Evaluation And Resuscitation | 726 | ||
| Endoscopy | 728 | ||
| Upper Gi Endoscopy | 728 | ||
| Diagnostic Colonoscopy | 729 | ||
| Radiography | 730 | ||
| Radionuclide Imaging | 730 | ||
| Angiography | 731 | ||
| Small Bowel Evaluation | 732 | ||
| Therapeutic Colonoscopy | 732 | ||
| Surgery | 733 | ||
| Complications | 735 | ||
| Morbidity and Mortality | 735 | ||
| Conclusion | 736 | ||
| Chapter 45 - Hepatorenal Syndrome | 738 | ||
| Historical Perspective Of Hrs | 738 | ||
| Incidence | 738 | ||
| Diagnostic Criteria | 738 | ||
| Classification | 739 | ||
| Pathogenesis | 740 | ||
| Precipitating Factors | 740 | ||
| Clinical And Laboratoryfindings | 740 | ||
| Approach To A Patient Withhrs | 741 | ||
| Management Of Hrs | 741 | ||
| Vasoconstrictors | 741 | ||
| Albumin Infusion along with Vasopressor | 741 | ||
| Transjugular IntrahepaticPortocaval Shunt (TIPS) | 741 | ||
| Liver Transplantation | 743 | ||
| Other Treatment Modalities | 743 | ||
| Prognosis | 743 | ||
| Chapter 46 - Hepatic Encephalopathy | 746 | ||
| Clinical Features | 746 | ||
| Differential Diagnosis | 747 | ||
| Investigations | 748 | ||
| Pathology | 749 | ||
| Prognosis | 749 | ||
| Pathogenesis (Fig. 46.1) | 749 | ||
| Treatment | 750 | ||
| General Measures | 750 | ||
| Control of Precipitating Factors | 750 | ||
| Caloric and Protein-administration, Enemas | 750 | ||
| Pharmacotherapy | 752 | ||
| Reduction of intestinal ammoniageneration | 753 | ||
| Enhancing the ammonia-detoxifying capacity of the liver | 753 | ||
| Reduction of extraintestinal ammonia formation and of false neurotransmitters | 753 | ||
| Inhibition of GABA-receptors | 753 | ||
| Other Treatments | 753 | ||
| Chapter 47 - Ascites In Cirrhosis | 755 | ||
| Clinical Features | 755 | ||
| Pathogenesis of Ascites in Cirrhosis | 755 | ||
| The Underfill Theory | 755 | ||
| The Overflow Theory | 756 | ||
| Forward Theory | 756 | ||
| Definitions | 756 | ||
| Evaluation of Ascites | 757 | ||
| Treatment Modalities | 757 | ||
| Dietary Salt Restriction | 757 | ||
| Diuretics | 758 | ||
| Aquaretics | 758 | ||
| Therapeutic Paracentesis | 758 | ||
| Transjugular Intrahepatic Portasystemic Shunt (TIPS) | 759 | ||
| Peritoneovenous Shunt | 759 | ||
| Liver Transplantation | 759 | ||
| Prognosis | 759 | ||
| Chapter 48 - Malignant Liver Tumors | 761 | ||
| Hepatocellular Carcinoma | 761 | ||
| Epidemiology | 761 | ||
| Risk Factors and Etiology | 761 | ||
| Pathophysiology | 762 | ||
| Clinical Presentation | 763 | ||
| Investigations | 763 | ||
| Staging | 767 | ||
| TNM definitions | 767 | ||
| Management | 768 | ||
| Surgical resection | 768 | ||
| Liver transplantation | 770 | ||
| Resection vs transplantation forpatients otherwise eligible for transplant | 771 | ||
| Percutaneous ethanol injection(PEI) | 771 | ||
| Hepatic artery embolization | 771 | ||
| Transarterial chemotherapy | 771 | ||
| Transarterial chemoembolization (TACE) | 772 | ||
| Radiofrequency ablation | 772 | ||
| Transarterial radioembolization | 772 | ||
| Systemic chemotherapy | 772 | ||
| Immunotherapy | 773 | ||
| Hormonal therapy | 773 | ||
| Survival and Prognosis | 773 | ||
| Fibrolamellar HCC | 773 | ||
| Intrahepatic Cholangiocarcinoma | 773 | ||
| Liver Metastases | 773 | ||
| Surgical Management | 774 | ||
| Malignant Tumors in Children | 775 | ||
| Index | 780 |