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Chapter Ⅰ The mouth and ?sophagus1

The tongue:coating;lingua nigra;geographical tongue;neurosis;glossitis1

Aphthous stomatitis2

Heartburn;dysphagia4

Achalasia of the cardia5

Chagas＇disease11

Diffuse ?sophageal spasm11

?sophagitis13

Strictures of the ?sophagus13

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

?sophageal webs and rings15

The presence of gastric mucosa in the ?sophagus15

Spontaneous rupture of the ?sophagus15

Cancer of the ?sophagus16

Chapter Ⅱ The cardia and hiatus hernia19

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 animals19

Hiatus hernia22

Hiatus hernia in children;hiatus hernia in pregnancy;hiatus hernia and cardiac isch?mia27

Reflux without hiatus hernia30

The natural history of hiatus hernia31

Other types of diaphragmatic hernia31

Chapter Ⅲ Petic ulcer32

Why does the stomach not digest itself？32

Is decreased resistance of the gastric mucosa of importance？33

The r?le of hydrochloric acid34

Constitutional factors;blood groups and peptic ulcer;the influence of hormones34

Environmental causes:geographical incidence36

A psychomatic disease？37

Noxious substances in food and drink;other possibilities38

Incidence of peptic ulcer;historical;present incidence38

The mechanism of ulcer pain40

The diagnosis of peptic ulcer41

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 obstruction44

Medical treatment of peptic ulcer51

The conservative treatment of acute perforated peptic ulcer56

Chapter Ⅳ Conditions associated with peptic ulcer59

Multiple endocrine adenomas59

Hyperparathyroidism60

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

Peptic ulcer and hepatic cirrhosis65

Peptic ulcer and emphysema65

Carcinoid tumours66

Peptic ulcer and coronary artery disease66

Chapter Ⅴ Gastric operations and their metabolic sequel?67

Gastric operations:Partial gastrectomy;vagotomy and a drainage operation;gastro-enterostomy;vagotomy67

Sequel? of partial gastrectomy:The dumping syndrome;bilious vomiting;stomal ulcer;obstructive symptoms after polya gastrectomy72

Cancer in the gastric remnant75

Loss of weight75

Pulmonary tuberculosis76

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 mucosa77

An?mia after gastric resection:due to iron deficiency;megaloblastic an?mia81

Chapter Ⅵ Gastritis and other local conditions84

Gastritis84

Acute gastritis85

Acute＂erosive＂gastritis86

Chronic gastritis87

Gastritis and peptic ulcer;gastritis and gastric cancer;gastritis and an?mia;gastritis and alcohol;irradiation gastritis88

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

Gastric atrophy90

Stress ulcers91

Neurogenic peptic ulceration;acute peptic ulcers due to burns94

Gastric polyps96

Primary pyloric hypertrophy in adults96

Gastric stasis from medical causes97

Duodenal diverticula97

Duodenal stasis(ileus or obstruction)98

Prolapse of the gastric mucosa98

Syphilis99

Chapter Ⅶ Gastric cancer100

Cancer of the stomach:hereditary;blood groups and cancer of the stomach100

Environmental causes;soil and geology;food and drink101

Local factors;malignant change of a simple gastric ulcer;gastric polyps;gastritis and gastric cancer102

Symptoms;signs;diagnosis105

Surgery109

Chapter Ⅷ Gastrointestinal h?morrhage111

H?matemesis and mel?na:immediate treatment;early diagnosis;differential diagnosis;indications for surgery111

＂Blind gastrectomy＂115

Prognosis of gastro-intestinal h?morrhage116

Bleeding from unusual or rare causes:the Mallory-Weiss syndrome;blood dyscrasias;vascular disease;Henoch-Schonlein purpura;pseudoxanthoma elasticum;hereditary telangiectasia;?sophageal and gastric varices117

Acute gastrointestinal bleeding of unknown origin123

Chapter Ⅸ Problems associated with dyspepsia124

Food and digestion124

?rophagy125

Nervous dyspepsia127

Anorexia nervosa128

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

Chapter Ⅹ The gall-bladder and pancreas131

Incidence of gall-stones131

Biliary colic131

Acute cholecystitis132

Chronic cholecystitis132

Motility disturbances of the biliary tract133

Pancreatitis:?tiology;associated factors134

Acute pancreatitis136

Chronic pancreatitis138

Associated diseases:hyperparathyroidism;hyperlip?mia141

Cancer of the pancreas142

Chapter Ⅺ Various gastrointestinal problems143

The adverse effects of drugs;aspirin;phenylbutazone(butazolidin);corticosteroid therapy;antibiotics143

Smoking and the alimentary tract148

The effect of irradiation148

Gastrointestinal allergy149

An?mia and the alimentary tract:due to iron deficiency;the r?le of achlorhydria;the macrocytic an?mias149

Potassium deficiency in gastrointestinal disorders154

Magnesium deficiency157

Appendicitis:acute appendicitis;appendicular colic;mucoc?le157

Appendicitis in children160

Appendicitis during pregnancy160

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

Peritoneal adhesions162

Constipation162

Self-induced diarrh?a165

Intestinal gas165

Bacterial infections of the alimentary tract:dysentery;food poisoning;cholera166

Chapter Ⅻ Some rare gastrointestinal disorders171

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 viscera177

Acute idiopathic retroperitoneal fibrosis177

Pseudo-membranous enterocolitis178

Chapter ⅩⅢ Steatorrh?a180

The small intestine and its functions;radiology of the smallintestine;intestinal biopsy180

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;neurologicalmanifestations199

The r?le of gluten205

Mechanisms causing malabsorption210

Bacteria in the small bowel210

Treatment by the gluten-free diet and other measures211

Gross pathological changes215

Prognosis216

C?liac disease217

Giardia lamblia218

Cystic fibrosis of the pancreas(mucoviscidosis)219

Acanthocytosis(α-β-lipoprotein?mia)219

Tropical sprue221

Whipple＇s disease224

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 arteriosclerosis228

Chapter ⅩⅣ The＂blind loop＂syndrome and other disorders of the smallintestine230

Stagnant loop syndromes in man232

Diverticulosis of the small intestine233

Gastro-jejuno-colic fistula234

Resection of the small intestine236

Meckel＇s diverticulum238

Intestinal pseudo-obstruction239

Vascular lesions of the small bowel and their sequeloe240

Primary non-specific ulcers of the small intestine243

Neoplasms of the small intestine243

Carcinoid tumours(argentaffinoma)244

Chapter ⅩⅤ Crohn＇s disease(regional)251

Crohn＇s disease in other sites256

Complications of Crohn＇s disease263

Treatment and prognosis265

Crohn＇s disease in childhood268

Crohn＇s disease in pregnancy268

Cancer in Crohn＇s disease268

Chapter ⅩⅥ Ulcerative colitis270

Topographical types：proctosigmoiditis；proctitis；ulcerative colitis ofthe whole colon275

Ileocolitis276

Acute segmental colitis277

Acute fulminant ulcerative colitis278

Acute dilatation of the colon279

Ulcerative colitis in children281

Ulcerative colitis and pregnancy282

Local complications288

Ulcerative colitis and cancer289

Systemic complications290

Ulcerative colitis and diverticulitis295

Medical treatment of ulcerative colitis295

Indications for surgery in ulcerative colitis300

Ileostomy301

Total colectomy and ileo-rectal anastamosis303

Chapter ⅩⅦ Disorders of the colon304

Irritable colon304

Nervous diarrhɑa306

Proctalgia fugax307

Polyps of the large bowel307

Cancer of the colon308

Diverticulosis and diverticulitis of the colon309

Cancer and diverticulitis312

Lymphogranuloma venereum313

Megacolon and Hirschsprung＇s disease313

Amɑbiasis316

Endometriosis of the colon321

Chapter ⅩⅧ Gastrointestinal tract involvement in some systemicdiseases322

Metabolic disorders：diabetes mellitus；porphyria；urɑmia322

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

Granulomas：sarcoidosis；abdominal tuberculosis；actinomycosis；Wegener＇sgranuloma330

Other conditions：leukamia；amyloidosis332

Appendix Ⅰ Measurements of the secretion of hydrochloric acid335

The control of variable factors；the stimulus to gastricsecretion；estimation of hydro-chloric acid335

Definition of achlorhydria337

Selection of a suitable test for measuring gastric acidity337

The augmented histamine test339

24-hour gastric analysis341

Measurement of 12-hour nocturnal secretion341

Tubeless gastric analysis342

The insulin hypoglyc?mia test343

Appendix Ⅱ The absorption of radioactive Vitamin B12344

Appendix Ⅲ Jejunal biopsy by the oral route346

Appendix Ⅳ The D-xylose excretion test349

Appendix Ⅴ Tests to detect either defective absorption or deficiencyof folic acid350

The FIGLU test351

Appendix Ⅵ The estimation of f?cal fat352

Appendix Ⅶ Occult blood tests353

Appendix Ⅷ F?cal blood loss measured by radioactive chromium354

Appendix Ⅸ Peritoneoscopy355

Appendix Ⅹ The＂radio pill＂356

Appendix Ⅺ The gluten-free diet357

References361

Index397