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