Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Acute and Chronic Gastrointestinal Side Effects of Radiation Therapy

Early and late GI organ injury may occur following irradiation of thoracic, abdominal, and pelvic malignancies of GI and non-GI origin. As with all toxicities associated with radiation therapy (RT), GI side effects are categorized broadly into 2 types: early or acute reactions, such as diarrhea and nausea, which can occur during and soon after completion of a treatment course, and late or chronic effects, such…

Gastrointestinal and Hepatic Disorders in the Pregnant Patient

Gastrointestinal and Hepatic Function in Normal Pregnancy The GI tract undergoes dramatic modifications during pregnancy. Intra-abdominal organs must move to accommodate uterine growth, hormonal factors alter motility, and the immunologic adaptation to pregnancy affects response to disease. Heartburn, nausea, abdominal cramps, and altered bowel habits, the most common GI symptoms of pregnant women, are caused by normal physiologic changes in gut motility. These symptoms are usually…

Surgical Peritonitis and Other Diseases of the Peritoneum, Mesentery, Omentum, and Diaphragm

Secondary inflammation of the peritoneum frequently presents with the patient in extremis requiring a procedural intervention and is commonly referred to as “surgical peritonitis.” Primary peritonitis or SBP has a distinct pathophysiology and is discussed in Chapter 93 . This chapter discusses the disease processes that affect the peritoneum, mesentery, omentum, and diaphragm. Anatomy and Physiology Gross Anatomy The peritoneum is the largest serous membrane of…

Vascular Lesions of the Gastrointestinal Tract

Vascular lesions and disorders of the GI tract are being more accurately documented as our diagnostic modalities become more sophisticated. Among the diagnostic techniques commonly used today are upper and lower tract endoscopy, single- and double-balloon enteroscopy (SBE and DBE), video capsule endoscopy (VCE), and advanced radiologic imaging techniques, such as CTA and MRA. Vascular lesions are a common cause of GI hemorrhage and may be…

Gastrointestinal and Hepatic Manifestations of Systemic Diseases

Numerous systemic diseases have GI and hepatic manifestations, but only common diseases and those with recent developments will be discussed in this chapter. Involvement can occur via changes in GI/hepatic structure, function, or both and may relate directly to the systemic disorder or indirectly via effects of therapy. It should be noted that rarer conditions such as PSS (scleroderma) and amyloidosis are likely to be studied…

Gastrointestinal and Hepatic Complications of Solid Organ and Hematopoietic Cell Transplantation

Transplantation of a solid organ is an immunologic mirror of the transplantation of allogeneic hematopoietic cells. Thus solid organs can be rejected by the patient in whom they are placed, whereas allogeneic hematopoietic cells can damage or “reject” the organs of their recipient. There are similarities in the intestinal and hepatic complications of these transplant procedures, particularly regarding infections and the side effects of immunosuppressive drugs.…

Gastrointestinal Consequences of Infection with Human Immunodeficiency Virus

In 1981, the first cases of what we now recognize as AIDS were described. Subsequently, the world witnessed an explosion of cases typically manifested by opportunistic infections (OIs) such as Pneumocystis jiroveci pneumonia and neoplasms such as Kaposi sarcoma, which is caused by human herpesvirus 8 (HHV-8). Over 35 million people have died from AIDS; it is estimated that over 36 million people worldwide are currently…

Neuroendocrine Tumors

Neuroendocrine tumors (NET) originate from the diffuse neuroendocrine system discussed in Chapter 4 . Gastroenteropancreatic NETs (GEP-NETs) can originate in the GI tract (GI-NETs, also known as carcinoid tumors) and pancreas (pNETs). GEP-NETs are characterized by a propensity to produce hormones and other vasoactive substances. Tumors that secrete hormones resulting in a clinical syndrome are also known as “functional tumors” ( Table 34.1 ), whereas tumors…

Gastrointestinal Stromal Tumors

GISTs comprise 1% to 3% of all malignant GI tumors; they are the most common mesenchymal tumor of the GI tract. More than 20 years ago, a seminal discovery was made that began elucidating the pathogenesis of most GISTs at the molecular level. Moreover, this new understanding has been translated into highly effective, molecularly targeted therapies, such as imatinib mesylate and related drugs, for the majority…

Gastrointestinal Lymphomas

Lymphomas are solid malignancies of the lymphoid system and are subdivided into Hodgkin and non-Hodgkin lymphomas (NHLs). It was estimated that in 2017 there would be 8260 and 72,240 new diagnoses of Hodgkin and NHL, respectively, in the US. The GI tract is very rarely involved with Hodgkin lymphoma and will not be discussed in this chapter. ∗ Hsiao C. Li and Robert H. Collins, Jr.…

Protein-Losing Gastroenteropathy

Definition and Normal Physiology Protein-losing gastroenteropathy describes a diverse group of disorders associated with excessive loss of serum proteins into the GI tract. This excess serum protein loss can result in hypoproteinemia and may be manifested by edema, ascites, and malnutrition. Box 31.1 lists disorders associated with protein-losing gastroenteropathy. BOX 31.1 Disorders Associated with Protein-Losing Gastroenteropathy Diseases Without Mucosal Erosions or Ulcerations AIDS-associated gastroenteropathy Acute viral…

Eosinophilic Disorders of the Gastrointestinal Tract

Eosinophilic GI disorders (EGIDs) are defined by selective eosinophil-rich inflammation along the GI tract in the absence of known causes for eosinophilia (e.g., drug reactions, parasitic infections, malignancy) and in association with GI-related symptoms. EGIDs include a spectrum of conditions, named by the anatomic location of the associated eosinophil infiltration; eosinophilic esophagitis (EoE), eosinophilic gastritis (EG), eosinophilic enteritis, and eosinophilic colitis (EC). We reserve the term…

Abdominal Abscesses and Gastrointestinal Fistulas

Abdominal Abscess An intra-abdominal abscess (IAA) is a localized abdominal infection arising in the background of infectious peritonitis. Primary peritonitis (spontaneous bacterial peritonitis, discussed in Chapter 93 ) is not usually associated with development of abscesses, whereas secondary peritonitis , peritoneal infection due to an inflammatory process in the GI tract, is commonly associated with abscess formation (see Chapter 39 ). Most cases of IAA arise…

Foreign Bodies, Bezoars, and Caustic Ingestions

Gastrointestinal foreign bodies (GIFBs) are composed of food bolus impactions and intentionally and unintentionally ingested or inserted foreign objects. Bezoars are ingested materials (food or other materials) that accumulate in a normal or abnormal stomach. Caustic ingestions present following ingestion of acid or alkaline materials, which may result in acute and/or chronic injury to the esophagus and stomach. These topics are discussed in detail in this…

Abdominal Hernias and Gastric Volvulus

A hernia is a protrusion of an organ or structure into an opening or pouch. Abdominal wall hernias protrude through the muscular and fascial walls of the abdomen and have 2 parts: (1) the orifice or defect in the aponeurotic wall of the abdomen, and (2) the hernia sac, which consists of peritoneum and abdominal, contents. Abdominal wall hernias are external if the sac protrudes through…

Diverticula of the Pharynx, Esophagus, Stomach, and Small Intestine

Diverticula are outpouchings from tubular structures. True diverticula involve all layers of the intestinal wall, whereas false diverticula are due to herniation of mucosa and submucosa through the muscular wall. Many diverticula contain attenuated portions of the muscular wall of the intestine, and hence may be difficult to define as true or false. True diverticula are often assumed to be congenital lesions, and false diverticula are…

Cutaneous Manifestations of Gastrointestinal and Liver Diseases

Vesiculobullous Skin Diseases The vesiculobullous skin diseases include pemphigoid, pemphigus, epidermolysis bullosa (EB), erythema multiforme (EM), and the Stevens-Johnsons/toxic epidermolysis spectrum. They may have oral and GI manifestations, as discussed later. Pemphigoid Pemphigoid is a general term for heterogeneous blistering disorders characterized by serum immunoglobulin (Ig)G or IgA autoimmune antibodies directed against 230-kd and 180-kd hemidesmosomal proteins (among other keratinocyte antigens) located at the squamous epithelial…

Oral Diseases and Oral Manifestations of Gastrointestinal and Liver Diseases

Lip Disorders The lips are paired structures that are highly visible in the mid face and function to facilitate mastication, speech, and numerous habits. The lips are symmetric from left to right. Separating the cutaneous aspect of the lip from the vermilion aspect is a slightly raised border called the vermilion border. Cheilitis Cheilitis, inflammation of the lips, may include the vermilion, the mucosa, and the…

Factitious Gastrointestinal Disease

Acknowledgment The authors thank Marc D. Feldman, MD, from the Departments of Psychiatry and Psychology at the University of Alabama, Tuscaloosa, Alabama for his many contributions to this chapter in the 10th edition. An accepted principle of the patient-physician relationship is that the patient should make every attempt to regain health, including faithfully and unreservedly communicating to his or her physician the supposed cause of illness.…

Biopsychosocial Issues in Gastroenterology

This chapter presents an overview of how psychosocial factors are related to GI function, disease susceptibility, clinical illness, and outcomes and provides an integrated approach to the care of the patient with GI illness. Conceptualization of Gastrointestinal Illness Biomedical Model In the practice of medicine, feeling confused, even stuck, when discrepancies exist between what we observe and what we expect is common. This experience may occur…