-L-	Page 649
lactase, 21, 62, 64t, 201, 203, 233, 240-42 lactate dehydrogenase, 212 lactic acid, 235 lactose: absorption, 200-202; causing diarrhea, 21, 64t, 223t, 362-63;     dietary therapy, 62 lactulose, 21, 223t, 235t, 235, 538-39, 582 lamivudine, 290, 498 lansoprazole, 107t, 108 laparotomy, 258-59, 272, 453 laryngeal exclusion, 115 laryngospasm, 575t larynx, 92 laser therapy, 127, 175, 390 lavage, peritoneal, 418 lax bowels see diarrhea laxatives: abuse, 19t, 20-21, 369; causing diarrhea, 21-22, 23t, 223t, 233,      234t, 238t, 240, 241t, 595; fiber, 368; to treat anal fissures, 389; to treat     constipation, 21, 369, 582; to treat hemorrhoids, 386-87; to treat hepatic     encephalopathy, 538-39; to treat irritable bowel, 364 LCAT see lecithin-cholesterol acyltransferase (LCAT) lecithin, 442, 450 lecithin-cholesterol acyltransferase (LCAT), 52 legs, weak, 25 leiomyoma: esophageal, 123, 124t; small intestine, 259 leiomyosarcoma: esophageal, 124t; gastric,
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174; small intestine, 260 length, infants, 590 LES see esophageal sphincter, lower lesions, oral, 111 leucine, 57, 205 leukocytosis: in biliary colic, 446t; in cholangitis, 342; in cholecystitis, 446t,     450; in choledocholithiasis, 453; in Crohn’s disease, 314, 317; in     hepatitis, 504; in ischemia, 258, 269, 284; in toxic megacolon, 338; in     ulcerative colitis, 325-26, 327-28 leukopenia, 505 leukotrienes, 322 licorice extracts, 155, 159 lifestyle modification, 107t, 108 ligation, 387-88, 529-31 alpha-limit dextrins, 201 limy bile, 452 linitis plastica, 171t, 174 linoleic acid, 71, 208t, 435 lipase, 197, 403, 405, 414, 420, 437, 450 lipid solutions, 72 lipids, 472 lipolysis, 50, 52-54, 197-99, 198f, 403 lipolytic enzymes, 402 lipoma, small intestine, 259 lipoprotein: high-density, 52; low-density, 52, 54; metabolism, 53f, 57; role     of liver, 465; very-low-density, 52 lipoprotein lipase, 52 5-lipoxygenase products, 322 lithocholic acid, 251, 252 lithotripsy, 447, 453 liver: anatomy and function, 183, 462-65, 463t; diagnostic tests, 470-75;     enlarged see hepatomegaly; examining, 45-46; hyperbilirubinemia,     477-78; neoplasms, 550-52; and nutritional disorders, 56, 57t; portal     hypertension, 524-31; transplantation, 456-59, 541-50 liver disease see also specific types; alcohol-induced, 502-6; ascites,     531-37; children, 572; cholestasis, 514-20; chronic, 31, 65-66, 69;     cirrhosis, 520-24; clinical features, 466t, 466-69; in cystic fibrosis, 436-     37; diagnosticapproach, 475-76; diagnostic tests, 470-75; drug-induced,     507-11, 508t, 511; hepatic encephalopathy, 537-40; hepatitis, 479-502;     hepatorenal syndrome, 540-41; inherited, 512-14; and pregnancy,     552-55; vascular, 555-57 liver failure, 459-60, 487-88, 556 liver transplantation: complications, 547-49; contraindications, 544t;     indications, 456-59, 506, 514, 518-19, 524, 535, 537, 540, 543t, 544t;     management, 545-47; procedure, 544-45; results, 549; workup, 542 lobules, 462 loperamide, 166, 293t, 297, 317, 364t, 367, 377 Lucey-Driscoll syndrome, 617 lump in throat see globus Lundh test, 406 lung disease, 369, 409t, 433 lupus erythematosus, 114t lye, 112-13, 126t, 128 lymph nodes, enlarged, 126 lymphadenopathy, 291, 391 lymphangioma, esophageal, 124t lymphatic drainage, esophagus, 89 lymphocytic colitis, 377 lymphogranuloma venereum, 24, 391 lymphoma: causing cholestasis, 516; clinical features, 23t, 34t, 241t;     gastric, 171t, 174; gastrointestinal, 248, 251t, 260; HIV-associated,     301-2 lysine, 205 lysolecithin, 412, 450 -M- M1 antagonists, 107t macroamylasemia, 409t, 409-10 macronodular cirrhosis, 521-22 magnesium: causing diarrhea, 22, 233, 235t, 235; deficiency, 209t, 243t,     245; malabsorption, 212-13; replacement, 220t magnesium citrate, 582 magnesium hydroxide, 21 magnesium sulfate, 235t, 582 magnetic resonance imaging, 474 malabsorption see also malassimilation; malnutrition; about, 24-25; bile     acids, 436; bile salts, 352; calcium, 212-13; carbohydrates, 203, 234t,     235t, 235-36; causes, 252, 260; causing diarrhea, 22, 221; children,     600-607; defined, 206; fat, 199, 203, 314, 352, 464; in Crohn’s disease,     310t; in cystic fibrosis, 433-35, 434t; in giardiasis, 230, 296; in liver     disease, 466t, 467; in pancreatitis, 425; in Whipple’s disease, 256;     intramural, 218-19; investigating, 213-15; and islet cell tumors, 431;     magnesium, 212-13; postsurgical, 164t, 167-69, 248-49; protein,     205-6; vitamins, 58t, 189, 212-13 malaise, 228, 466t, 467, 485, 548 malassimilation see also malabsorption;
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maldigestion; carbohydrates, 209, 211; clinical features, 206-9, 208t-9t;     fat, 211-12; in celiac disease, 243t; investigating, 207t, 213, 214f;     protein, 212; treatment, 219t, 220t-21t; vitamins and minerals, 210t,     212-13 maldigestion see also malassimilation; about, 25; defined, 206; in cystic     fibrosis, 433, 435; intraluminal, 215-18; investigating, 213-15 malignant melanoma, esophageal, 124t Mallory-Weiss tear, 34t, 131, 569 malnutrition see also malassimilation; nutrition; about, 24-25; causes, 22,     54-55; children, 583-92; clinical features, 56-59; effects on GI tract and     pancreas, 60-61; HIV-associated, 303; in celiac disease, 244; in     Crohn’s disease, 310t; in esophageal disorders, 97; in inflammatory     bowel disease, 63, 64t, 311t; in liver disease, 502, 504; in pancreatitis,     419; management, 592; types, 55-56 MALT (mucosa-associated lymphoid tissue) syndrome, 171t maltase, 201, 202 maltose, 201, 240, 403 maltotrioses, 201, 240, 403 manganese, 57 Manning criteria, 362-63 mannitol, 21, 233, 235t manometry, esophageal, 10, 98 marasmus, 55-56, 212, 583 mass, abdominal see abdominal mass Meckel’s diverticulum, 35t, 255 meconium ileus, 434t, 434, 435-36, 608 mediastinal tumor, 9 Medical Research Council of Canada (MRC), 80 megacolon: aganglionic see Hirschsprung’s disease; in inflammatory     bowel disease, 311t; toxic, 230, 284, 286, 326-30, 333, 338, 339t-40t,     340-41 megaloblastosis, 212 megarectum, 370 megestrol acetate, 304 Meissner’s plexus, 89, 137 melanosis coli, 20 melena see also blood in stool, 34, 36, 97, 131, 280, 393, 529 memory loss, 504 Ménétrier’s disease, 170, 171t, 172 menstruation, 18, 28-30, 208t, 362, 466t, 501 mental retardation, 477 meperidine, 108t, 417 6-mercaptopurine, 319t, 321, 337 mesalamine: to treat colonic hemorrhage, 342; to treat inflammatory     bowel disease, 319t, 320t, 320-22, 335-37; to treat ischemic colitis, 285 mesenteric arteries: anatomy, 265-66; arterio-gram, 271f; blood flow,     266-67; thrombosis, 272, 274 mesenteric embolism, 26 mesenteric ischemia see ischemia mesenteric veins: anatomy, 265-66; thrombosis, 257, 258-59, 275-76 metabolic disturbances, 114t, 269, 270, 328, 415 metabolic myopathy, 114t metabolism: carbohydrates, 51f; lipoprotein, 53f; protein, 51f; role of liver,     464-65 Methanobrevibacter smithii, 16 methionine, 57, 205, 250 methotrexate: causing diarrhea, 233; causing liver disease, 507, 508t,     511; to treat inflammatory bowel disease, 319t, 321, 337 methylcellulose, 368 methyldopa, 508t, 509, 511 alpha-methyldopa, 500 methylprednisolone, 546 methyltestosterone, 510 methysergide, 256 metoclopramide: as anti-emetic, 14; to improve gastric emptying, 165; to     treat GERD, 107t; to treat PUD, 157-58 metronidazole: and Clostridium infection, 373; to treat bacterial     overgrowth, 253; to treat colitis, 232; to treat colonic infection, 374, 375;     to treat enteritis, 230, 231; to treat H. pylori infection, 180; to treat hepatic     encephalopathy, 539; to treat infection, 293t, 296; to treat inflammatory     bowel disease, 319t, 321 micelles, 197, 198f, 199, 251, 403 micronodular cirrhosis, 521-22 microscopic colitis, 377 Microsporidium, 293t, 297-98 midesophageal diverticula, 130 migrating motor complex, 184-85 milk of magnesia, 364 mineral oil, 582 minerals: absorption of, 185-90; deficiencies, 208t-9t, 210t; maldigestion,     249; replacement, 220t misoprostol, 107t, 365t mitomycin, 175 mittelschmerz, 29
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molybdenum, 57 monoglycerides, 197, 198f, 403 monosaccharides, 202f, 202 Morgagni’s columns, 378 morphine, 108t motility: colon, 349, 351; esophagus, 90-94; gallbladder, 454-55; small     intestine, 184-85, 236-37; stomach, 139-41 motor disorders, esophagus, 115-19, 116f MRC see Medical Research Council of Canada (MRC) mucin, 443 mucoepidermoid carcinoma, esophageal, 124t mucormycosis, 177 mucosa-associated lymphoid tissue (MALT) syndrome, 171t mucus: in gastric juice, 139, 141, 143-45; in stool, 221, 230, 361-62, 382 multiple sclerosis, 114t Münchausen syndrome, 30, 233 Murphy’s sign, 450 muscarinic-receptor antagonists, 155 muscle wasting: in liver disease, 532; in malassimilation, 206, 208t-9t,     211-12; in malnutrition, 25, 56; in pancreatitis, 419 muscular dystrophy, 114t muscularis mucosa hypertrophy, 311t myalgia, 229 myasthenia gravis, 114t mycobacterial infection, 291-94, 292t, 293-94 Mycobacterium avium-intracellulare, 291, 292t, 293-94 Mycobacterium tuberculosis, 292t, 294 mycophenolate, 547 myenteric plexus, 90, 139 myocardial infarction, 277 myoclonus, 537 myopathy, metabolic, 114t myotomy: cricopharyngeal, 115, 130; esophageal, 10, 117, 130; Heller,     118; pyloric, 176 -N- Na+/K+-ATPase pump see sodium pump narcotics, 524 nasal regurgitation, 95 nausea: about, 12-14; in acute abdomen, 27; in afferent loop syndrome,     166; in cholelithiasis, 445, 449; in diarrhea, 226; in dyspepsia, 10; in     fatty liver, 503, 553-54; in gastritis, 168; in gastroenteritis, 228-29; in     giardiasis, 296; in HIV-associated infection, 298; in ischemia, 258; in     jaundice, 31; in liver disease, 33, 485, 504, 506; in pancreatic cancer,     426; in pancreatitis, 414, 420; in parasitic infection, 376; in RAP, 566; in     ulcerative colitis, 333; and malnutrition, 57, 64t neck surgery, 114t necrosis: biliary tract, 451; liver, 485, 487-88, 489f, 493, 502, 503, 508t,     508, 520; pancreas, 412, 420 neomycin, 539 neonatal hepatitis, 620 neonates see infants neoplasms see also specific types; appendiceal, 255; biliary, 456, 459-60;     brain, 14; brainstem, 114t; clinical features, 29, 35t, 595; colonic, 339t,     341-42, 352-57, 353t, 359; drug-induced, 511; esophageal, 8, 10, 95-97,     103, 106, 110, 112-13, 117-18, 123-28; gastric, 140, 160-63, 164t, 169-     70, 172-75; head and neck, 114t; hepatic, 467, 469, 510t, 550-52, 556;     HIV-associated, 301-2; hypopharyngeal, 128; ileal, 255; in celiac     disease, 243t; in inflammatory bowel disease, 311t; intestinal, 3, 19t,     20, 34t, 221, 234, 248, 255-56, 259-60, 313; islet cell, 21, 23t, 425-26,     430-31; live, 497; mediastinal, 9; neurogenic, 259; oral, 95;     oropharyngeal, 114t; pancreatic, 409t, 410, 420, 425t, 425-29;     postgastrectomy, 164t, 165; rectal, 255, 381 nephrolithiasis, 249, 312t, 314 nephropathy, 505 nerve supply: anus, 379; esophagus, 89; stomach and duodenum, 137-38 neurogenic tumors, 259 neurologic insufficiency, 545 neuromuscular disease, 9 neurotransmitters, 238 niacin, 58t, 126t, 208t-9t, 210t nifedipine, 132 night blindness, 59t, 208t, 210t night sweats, 291, 295, 302 nitrates, 108t, 117, 118, 123 nitrofurantoin, 500 nitrogen, 60, 66-67 nitroglycerin, 10, 132 nitrosamines, 126t nizatidine, 107t nongangrenous ischemic bowel disease: causes, 277, 278t-79t; colitis,     279-86; focal segmental, 277 nongangrenous ischemic colitis: clinical fea-
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tures, 280-84; pathogenesis, 279; treatment, 284-86 nongranulomatous ulcerative jejunoileitis, 247 nonmaleficence (as ethical principle), 75t norepinephrine, 196 norfloxacin, 536 Norwalk virus, 223t, 228, 229 NSAIDs: and bleeding, 35; causing colitis, 280; causing esophagitis, 113;      in PUD, 144, 146, 148, 149t, 158; to treat cirrhosis, 524 nucleolytic enzymes, 402, 404 5'-nucleotidase, 471 “nutcracker” esophagus, 115, 116f, 117 nutrient deficiency see malnutrition nutrition see also malnutrition; dietary therapy, 61-62; enteral, 68-70;     essential concepts, 49-54; HIV considerations, 304; in celiac disease,     62-63; in inflammatory bowel disease, 63-65; in liver disease, 65-66;     parenteral, 71-73; requirements, 66-68; withholding, 76-77 nystatin, 111