Complaints and Disorders

Anorexia Nervosa and Bulimia Nervosa

Anorexia nervosa and bulimia nervosa are eating disorders that are distinct but related syndromes that have in common an intense preoccupation with food. Patients with anorexia nervosa are characterized by a fear of becoming obese, disturbance in body image, anorexia, extreme weight loss, and amenorrhea. On the other hand, bulimia is characterized by periods of binge eating, alternating with fasting; self-induced vomiting; and the use of diuretics and cathartics.

Diagnosis of Alcoholic Liver Disease

Alcoholic hepatitis is an acute or chronic illness associated with severe chronic alcoholism, involving extensive hepatocellular necrosis, inflammation, and scarring. It is extremely variable in clinical presentation and may be superimposed on other forms of alcoholic liver disease such as fatty liver and Laennec’s cirrhosis. Alcoholic liver disease may occur without any symptoms.

Drug-Related Hepatic Injury

More than 600 drugs have been reported to cause liver injury. Drug-related hepatic injury can mimic almost all patterns of liver injury seen in humans. The injury can be hepatocellular necrosis, cholestatic disease, deposition of microvesicular fat in hepatocytes, or mixed patterns.

Obesity

It is estimated that three of five American adults are overweight or obese (> 100 million persons) and the cost of obesity in the United State is in excess of $100 billion annually. In the last 30 years, the prevalence of obesity has nearly doubled from 12.8% to 22.5% of the U.

Gastrointestinal and Hepatobiliary Diseases

The treatment of human immunodeficiency virus infection has dramatically improved over the last several years with the use of combination therapy of potent antiretroviral agents including protease inhibitors. With this highly active antiviral therapy, human immunodeficiency virus replication can be profoundly suppressed and in some patients, circulating human immunodeficiency virus becomes undetectable.

Acetaminophen Hepatotoxicity

Acetaminophen (Tylenol or Paracetemol) is an analgesic-antipyretic with few side effects when taken in therapeutic doses in most individuals. However, it is a potent hepatotoxin leading to hepatic necrosis when taken in large overdoses.

Postgastrectomy Disorders

Gastrectomy usually means removal of part of the stomach and anastomosis of the gastric remnant with either the duodenum (Billroth I) or a loop of proximal jejunum (Billroth II). These operations typically are performed as surgical treatment of peptic ulcer disease or cancer of the stomach.

Nausea and Vomiting

Nausea is usually defined as the inclination to vomit or as a feeling in the throat or epigastric region alerting an individual that vomiting is imminent. Vomiting is defined as the ejection or expulsion of gastric contents through the mouth, often requiring a forceful event.

Treatment of Nausea and Vomiting

Most cases of nausea and vomiting are self-limiting, resolve spontaneously, and require only symptomatic therapy.

Stress Ulcer

The pathogenesis of stress ulcer is unclear but probably is related to a reduction in mucosal blood flow or a breakdown in other normal mucosal defense mechanisms in conjunction with the injurious effects of acid and pepsin on the gastroduodenal mucosa. Upper gastrointestinal bleeding is the usual clinical manifestation of stress ulceration.

Vascular Disease of the Bowel

Vascular disorders of the gastrointestinal tract typically present as abdominal pain or bleeding, or both. Several of the disorders that cause bleeding, such as ischemic colitis, angiodysplastic lesions, and vascular-enteric fistulas. Mesenteric vascular insufficiency.

Bacterial Infections of the Bowel

Bacterial gastroenteritis may result from the ingestion of a preformed bacterial toxin present in the food at the time of ingestion, by the production of a toxin or toxins in vivo, or by invasion and infection of the bowel mucosa by the bacterial pathogen. In this chapter, the most common bacterial pathogens affecting immunocompetent hosts are discussed. In general, toxigenic bacteria produce watery diarrhea without systemic illness.

Sexually Transmitted Enteric Disorders

Substantial increases in the recognition and prevalence of sexually transmitted enteric disorders have occurred over the past several decades, largely due to increasing freedom of both heterosexual and homosexual expression. The acquired immunodeficiency syndrome (acquired immunodeficiency syndrome) has further augmented the diversity and complexity of sexually related enteric disorders. These disorders are summarized in Table SEXUALLY RELATED DISORDERS OF THE GASTROINTESTINAL TRACT.