diseases of the alimentary tractPDF电子书下载

Chapter Ⅰ The mouth and ?sophagus 1

The tongue:coating;lingua nigra;geographical tongue;neurosis;glossitis 1

Aphthous stomatitis 2

Heartburn;dysphagia 4

Achalasia of the cardia 5

Chagas＇disease 11

Diffuse ?sophageal spasm 11

?sophagitis 13

Strictures of the ?sophagus 13

The syndrome of an?mia,glossitis and dysphagia(Plummer-Vinson syndrome) 14

?sophageal webs and rings 15

The presence of gastric mucosa in the ?sophagus 15

Spontaneous rupture of the ?sophagus 15

Cancer of the ?sophagus 16

Chapter Ⅱ The cardia and hiatus hernia 19

Mechanisms preventing reflux at the gastro-?sophageal junction:the anatomy of the hiatus;the intrinsic sphincter of the lower ?sophagus;the angle of entry into the stomach;the position of the cardia;the ?sophagus in animals 19

Hiatus hernia 22

Hiatus hernia in children;hiatus hernia in pregnancy;hiatus hernia and cardiac isch?mia 27

Reflux without hiatus hernia 30

The natural history of hiatus hernia 31

Other types of diaphragmatic hernia 31

Chapter Ⅲ Petic ulcer 32

Why does the stomach not digest itself？ 32

Is decreased resistance of the gastric mucosa of importance？ 33

The r?le of hydrochloric acid 34

Constitutional factors;blood groups and peptic ulcer;the influence of hormones 34

Environmental causes:geographical incidence 36

A psychomatic disease？ 37

Noxious substances in food and drink;other possibilities 38

Incidence of peptic ulcer;historical;present incidence 38

The mechanism of ulcer pain 40

The diagnosis of peptic ulcer 41

Special clinical problems;chronic gastric ulcer,benign or malignant;giant lesser curve ulcers;peptic ulcer in children;post-bulbar duodenal ulceration;gastric and duodenal ulcer occurring together;pyloric obstruction 44

Medical treatment of peptic ulcer 51

The conservative treatment of acute perforated peptic ulcer 56

Chapter Ⅳ Conditions associated with peptic ulcer 59

Multiple endocrine adenomas 59

Hyperparathyroidism 60

The Zollinger-Ellison syndrome(ulcerogenic tumour of the pancreas) 61

Peptic ulcer and hepatic cirrhosis 65

Peptic ulcer and emphysema 65

Carcinoid tumours 66

Peptic ulcer and coronary artery disease 66

Chapter Ⅴ Gastric operations and their metabolic sequel? 67

Gastric operations:Partial gastrectomy;vagotomy and a drainage operation;gastro-enterostomy;vagotomy 67

Sequel? of partial gastrectomy:The dumping syndrome;bilious vomiting;stomal ulcer;obstructive symptoms after polya gastrectomy 72

Cancer in the gastric remnant 75

Loss of weight 75

Pulmonary tuberculosis 76

Mechanisms causing malnutrition:altered kinetics;the r?le of the pancreas;poor mixing of food and enzymes;the blind loop syndrome from a stagnant afferent loop;the jejunal mucosa 77

An?mia after gastric resection:due to iron deficiency;megaloblastic an?mia 81

Chapter Ⅵ Gastritis and other local conditions 84

Gastritis 84

Acute gastritis 85

Acute＂erosive＂gastritis 86

Chronic gastritis 87

Gastritis and peptic ulcer;gastritis and gastric cancer;gastritis and an?mia;gastritis and alcohol;irradiation gastritis 88

Giant rugoe(Menetrier＇s disease;giant hypertrophic gastritis) 90

Gastric atrophy 90

Stress ulcers 91

Neurogenic peptic ulceration;acute peptic ulcers due to burns 94

Gastric polyps 96

Primary pyloric hypertrophy in adults 96

Gastric stasis from medical causes 97

Duodenal diverticula 97

Duodenal stasis(ileus or obstruction) 98

Prolapse of the gastric mucosa 98

Syphilis 99

Chapter Ⅶ Gastric cancer 100

Cancer of the stomach:hereditary;blood groups and cancer of the stomach 100

Environmental causes;soil and geology;food and drink 101

Local factors;malignant change of a simple gastric ulcer;gastric polyps;gastritis and gastric cancer 102

Symptoms;signs;diagnosis 105

Surgery 109

Chapter Ⅷ Gastrointestinal h?morrhage 111

H?matemesis and mel?na:immediate treatment;early diagnosis;differential diagnosis;indications for surgery 111

＂Blind gastrectomy＂ 115

Prognosis of gastro-intestinal h?morrhage 116

Bleeding from unusual or rare causes:the Mallory-Weiss syndrome;blood dyscrasias;vascular disease;Henoch-Schonlein purpura;pseudoxanthoma elasticum;hereditary telangiectasia;?sophageal and gastric varices 117

Acute gastrointestinal bleeding of unknown origin 123

Chapter Ⅸ Problems associated with dyspepsia 124

Food and digestion 124

?rophagy 125

Nervous dyspepsia 127

Anorexia nervosa 128

χ-ray negative dyspepsia(non-ulcer dyspepsia) 129

Chapter Ⅹ The gall-bladder and pancreas 131

Incidence of gall-stones 131

Biliary colic 131

Acute cholecystitis 132

Chronic cholecystitis 132

Motility disturbances of the biliary tract 133

Pancreatitis:?tiology;associated factors 134

Acute pancreatitis 136

Chronic pancreatitis 138

Associated diseases:hyperparathyroidism;hyperlip?mia 141

Cancer of the pancreas 142

Chapter Ⅺ Various gastrointestinal problems 143

The adverse effects of drugs;aspirin;phenylbutazone(butazolidin);corticosteroid therapy;antibiotics 143

Smoking and the alimentary tract 148

The effect of irradiation 148

Gastrointestinal allergy 149

An?mia and the alimentary tract:due to iron deficiency;the r?le of achlorhydria;the macrocytic an?mias 149

Potassium deficiency in gastrointestinal disorders 154

Magnesium deficiency 157

Appendicitis:acute appendicitis;appendicular colic;mucoc?le 157

Appendicitis in children 160

Appendicitis during pregnancy 160

Chronic pain in the right iliac fossa of undetermined origin—＂chronic appendicitis＂ 161

Peritoneal adhesions 162

Constipation 162

Self-induced diarrh?a 165

Intestinal gas 165

Bacterial infections of the alimentary tract:dysentery;food poisoning;cholera 166

Chapter Ⅻ Some rare gastrointestinal disorders 171

Protein-losing gastro-enteropathy(exudative enteropathy) 171

Hereditary multiple polyposis syndromes:the Peutz-Jegherssyndrome;multiple polyposis of the colon;intestinal polyposis withosteomas and soft tissue tumours(the Gardner syndrome) 173

Pneumatosis intestinalis(pneumatosis cystoides intestinalis) 175

Spontaneous rupture of viscera 177

Acute idiopathic retroperitoneal fibrosis 177

Pseudo-membranous enterocolitis 178

Chapter ⅩⅢ Steatorrh?a 180

The small intestine and its functions;radiology of the smallintestine;intestinal biopsy 180

Idiopathic steatorrh?a(non-tropical sprue;primary malabsorptionsyndrome;gluten-induced enteropathy;adult c?lic disease) 186

Nutritional and metabolic consequences of idiopathic steatorrh?a:An?mia;h?morrhage;water and electrolyte disturbances;malignancy due to idiopathic steatorrh?a？;hypoprotein?mia;bone disease;neurologicalmanifestations 199

The r?le of gluten 205

Mechanisms causing malabsorption 210

Bacteria in the small bowel 210

Treatment by the gluten-free diet and other measures 211

Gross pathological changes 215

Prognosis 216

C?liac disease 217

Giardia lamblia 218

Cystic fibrosis of the pancreas(mucoviscidosis) 219

Acanthocytosis(α-β-lipoprotein?mia) 219

Tropical sprue 221

Whipple＇s disease 224

Other conditions causing steatorrh?a:drugs;gastrointestinal infectionand infestation;irradiation of the small bowel;intestinalhurry;hypogammaglobulin?mia;congestive cardiac failure;disease of theliver;enlarged mesenteric lymph nodes;mesenteric arteriosclerosis 228

Chapter ⅩⅣ The＂blind loop＂syndrome and other disorders of the smallintestine 230

Stagnant loop syndromes in man 232

Diverticulosis of the small intestine 233

Gastro-jejuno-colic fistula 234

Resection of the small intestine 236

Meckel＇s diverticulum 238

Intestinal pseudo-obstruction 239

Vascular lesions of the small bowel and their sequeloe 240

Primary non-specific ulcers of the small intestine 243

Neoplasms of the small intestine 243

Carcinoid tumours(argentaffinoma) 244

Chapter ⅩⅤ Crohn＇s disease(regional) 251

Crohn＇s disease in other sites 256

Complications of Crohn＇s disease 263

Treatment and prognosis 265

Crohn＇s disease in childhood 268

Crohn＇s disease in pregnancy 268

Cancer in Crohn＇s disease 268

Chapter ⅩⅥ Ulcerative colitis 270

Topographical types：proctosigmoiditis；proctitis；ulcerative colitis ofthe whole colon 275

Ileocolitis 276

Acute segmental colitis 277

Acute fulminant ulcerative colitis 278

Acute dilatation of the colon 279

Ulcerative colitis in children 281

Ulcerative colitis and pregnancy 282

Local complications 288

Ulcerative colitis and cancer 289

Systemic complications 290

Ulcerative colitis and diverticulitis 295

Medical treatment of ulcerative colitis 295

Indications for surgery in ulcerative colitis 300

Ileostomy 301

Total colectomy and ileo-rectal anastamosis 303

Chapter ⅩⅦ Disorders of the colon 304

Irritable colon 304

Nervous diarrhɑa 306

Proctalgia fugax 307

Polyps of the large bowel 307

Cancer of the colon 308

Diverticulosis and diverticulitis of the colon 309

Cancer and diverticulitis 312

Lymphogranuloma venereum 313

Megacolon and Hirschsprung＇s disease 313

Amɑbiasis 316

Endometriosis of the colon 321

Chapter ⅩⅧ Gastrointestinal tract involvement in some systemicdiseases 322

Metabolic disorders：diabetes mellitus；porphyria；urɑmia 322

＂Collagen＂disorders：polyarteritis nodosa；systemic lupuserythematosus；dermatomyositis(polymyositis)；progressive systemicsclerosis(scleroderma) 326

Granulomas：sarcoidosis；abdominal tuberculosis；actinomycosis；Wegener＇sgranuloma 330

Other conditions：leukamia；amyloidosis 332

Appendix Ⅰ Measurements of the secretion of hydrochloric acid 335

The control of variable factors；the stimulus to gastricsecretion；estimation of hydro-chloric acid 335

Definition of achlorhydria 337

Selection of a suitable test for measuring gastric acidity 337

The augmented histamine test 339

24-hour gastric analysis 341

Measurement of 12-hour nocturnal secretion 341

Tubeless gastric analysis 342

The insulin hypoglyc?mia test 343

Appendix Ⅱ The absorption of radioactive Vitamin B12 344

Appendix Ⅲ Jejunal biopsy by the oral route 346

Appendix Ⅳ The D-xylose excretion test 349

Appendix Ⅴ Tests to detect either defective absorption or deficiencyof folic acid 350

The FIGLU test 351

Appendix Ⅵ The estimation of f?cal fat 352

Appendix Ⅶ Occult blood tests 353

Appendix Ⅷ F?cal blood loss measured by radioactive chromium 354

Appendix Ⅸ Peritoneoscopy 355

Appendix Ⅹ The＂radio pill＂ 356

Appendix Ⅺ The gluten-free diet 357

References 361

Index 397