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d4T, 290 D-xylose, 60, 245 danthron, 238t dantrolene, 500 ddC, 290 ddI, 290, 303 DDT, 426 debridement, 418 Declaration of Helsinki, 80, 86 defecation, 366f, 579 deferiprone, 513 deferoxamine, 513 deglutition, 90 dehydration: assessing, 596t; children, 569, 571; in colonic obstruction,      358; in constipation, 369; in ischemia, 269; in toxic megacolon, 338; and      laxative use, 21; and malnutrition, 57; management, 596t; and vomiting,      14 delirium, 537 Delta agent see hepatitis D dementia, 58t, 209t, 210t deoxycholic acid, 251 depapillation of the tongue, 25 depression, 19t, 58t, 159, 362 dermatitis, 58t, 206, 208t, 210t, 243t dermatitis herpetiformis, 244 dermatomyositis, 114t dextrins, 201, 404 diabetes: bacterial overgrowth, 251t; Candida esophagitis, 9, 111; celiac      disease, 243; cholelithiasis, 444t; constipation, 369; cystic fibrosis,      434t, 435; diarrhea, 23t, 24, 197, 234t, 241t; hyperamylasemia, 409t;      ischemia, 263, 277; liver, 57t, 502, 512; pancreas, 405, 408, 419,      426-27, 430-31; stomach, 150, 160, 176 diaphoresis see perspiration
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diarrhea (in general): about, 20, 21-24; and colonic function, 358; drug-     related, 231-33; and fecal incontinence, 366; in bacterial infection, 373;     in bacterial overgrowth, 252; in celiac disease, 243t, 244; in colic, 577; in     colitis, 377-78; in colonic infection, 373, 375-76; in cystic fibrosis, 434t;     in disaccharidase intolerance, 240-42; in gastroenteritis, 229; in     giardiasis, 296; in HIV-associated infection, 296-300, 391; in     inflammatory bowel disease, 309-10, 310t, 317-18, 323, 325-28, 330,     333-34; in irritable bowel syndrome, 364t; in liver disease, 504, 506,     538; in malabsorption, 604; in malnutrition, 57, 58t, 64t, 206, 209t, 209,     210t, 211; in pancreatic insufficiency, 408; in pancreatitis, 419, 422; in     RAP, 567; in shigellosis, 371-72; in small bowel ischemia, 259; in     Whipple’s disease, 256; intussusception, 571; investigating, 3, 216f-17f;     ischemia, 283; and neoplasms, 163, 255, 354, 426, 430-31;     postsurgical, 164t, 166-67, 248-49, 455; and stress, 349 diarrhea, acute: about, 221-23; bacterial, 223-29; causes, 223t; drug-     related, 231-33; parasitic, 229-31; viral, 229 diarrhea, choleraic, 352 diarrhea, chronic: abnormal intestinal transit, 22, 233-37; about, 233-34;     exudative, 22, 233-34, 239; investigating, 240, 241t; mechanisms, 234t;     osmotic, 21, 233, 235t, 235-36; secretory, 21-22, 233-34, 237-39, 238t;     self-induced, 239-40 diarrhea, in children: about, 593; assessing, 595-98; management, 596t,     598-600; pathophysiology, 593-95; with cystic fibrosis, 608-9 diarrhea, traveler’s, 22, 24, 228t, 228-29 diazepam, 155, 506 dicarboxylic AA, 205 dichlorodiphenyltrichloroethane (DDT), 426 dicyclomine, 364t dideoxycytidine, 290 dideoxyinosine, 290, 303 diet see also alcohol; abdominal pain, 28-30; affects LES, 108t; anorexia,     14-15; cholelithiasis, 444t; constipation, 20, 368; diarrhea, 21, 242-43,     594; dyspepsia, 10; enteral formulas, 68-69; “fad,” 64t; failure to thrive,     589; heartburn, 5-7; nausea, 14; pancreatic cancer, 426; stool volume,     222; vomiting, 14, 570-71 dietary therapy: anal fissures, 389; celiac disease, 62-63; constipation, 582;     diarrhea, 600; diverticulosis, 357; dumping syndrome, 167; failure to     thrive, 592; fecal incontinence, 367; general principles, 61-62; GERD,     107t, 108; hemorrhoids, 387; infants, 599; inflammatory bowel disease,     63-65, 317-19; irritable bowel syndrome, 364t, 364; jaundice, 624; liver     disease, 65-66, 503, 506, 524, 534, 538, 541; malabsorption, 606-7;     pancreatitis, 422-23 digestion: about, 185, 601-2; carbohydrates, 201f, 601f,602; fats, 601f,     603-4; pancreatic secretions, 404-5; protein, 601f, 602-3; small intestine,     184-85, 204-6, 249-51; triglycerides, 601f, 603-4 digitalis, 23t, 223t, 241t diglycerides, 403 dilation: bile duct, 519; colon, 286, 338; congenital intrahepatic biliary, 456-     57; intestine, 316; lymphatic, 306; peroral, 131; stomach, 175; to treat     achalasia, 10, 118; to treat cholangitis, 459; to treat esophageal ring,     128; to treat esophageal stricture, 7, 10; to treat esophagitis, 112; to treat     portal hypertension, 529 diloxanide, 375 dioctyl sodium sulfosuccinate, 234t, 238t, 582 diphenoxylate, 166, 317, 365t diphenylmethene derivatives, 582 diphyllobothrium latum, 58t direct tube tests, 405-7, 406t disaccharidase deficiencies, 203, 234t, 235t, 235, 240-42, 310t, 594 disaccharidases, 60, 201-2 disaccharides, 202f, 202, 240 discharge, anorectal, 382-83, 391 disopyramide, 233 distal intestinal obstruction syndrome, 610-11 distention see also bloating; by intraesophageal balloon, 119; children,     590; in celiac disease, 244; in disaccharidase deficiency, 241; in     diverticulosis, 356; in gastric disorder, 175-76; in liver disease, 33, 505,     532, 534; in malassimilation, 206, 209t, 211; in toxic megacolon, 340;     ischemia, 280, 283; and obstruction, 27 diuretics: causing diarrhea, 240; causing hepatorenal syndrome, 540; to     treat ascites, 34, 534 diverticula see also specific types; causing bacterial overgrowth, 251t;     cricopharyngeal, 9; esophageal, 128-31; gastric, 177 diverticulitis, 19t, 27, 29, 35t, 359 diverticulopexy, 130
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diverticulosis, 131, 356-57, 357t DNAase, 204 doctor–patient relationship, 74, 289, 568, 578 domperidone, 10, 14, 107t, 165, 364t dopamine, 196 doxorubicin, 175 doxycycline, 113, 228t drooling, 112 drowsiness, 488, 566 drug abuse see drugs drug–drug interactions: cimetidine, 155; diazepam, 155; propranolol, 155;     theophylline, 155; warfarin, 155 drugs see also clinical trials; causing cholelithiasis, 444t; causing     cholestasis, 514-16, 515t; causing constipation, 580; causing diarrhea,     221, 223t, 594; causing hyperamylasemia, 409t; causing jaundice,     31-32; causing liver disease, 479t, 507-11, 508t, 538, 539t; causing     malnutrition, 25; causing nausea, 14; causing vomiting, 14; and     hepatitis, 482-83, 486, 490-91, 499-500; illicit, 289, 291, 299, 303;     metabolized by liver, 465; and PUD, 148, 149t; ulcerogenic, 165 dry skin, 25, 208t Dubin-Johnson syndrome, 477, 478 ductal cell adenocarcinoma, 425 ductal cell carcinoma, 457 ductal cells, 400, 418, 425, 457 dumping syndrome, 23t, 166-67, 241t duodenal atresia, 572 duodenal ulcer disease: and acid secretion, 143, 150-51; childhood, 147;     in cystic fibrosis, 434, 436; pathophysiologic defects, 146-47, 147t;     upper GI bleeding, 34t, 34-35, 393 duodenum: anatomy, 135-38, 183-84; peptic ulcer disease, 146-63, 147t,     154f; physiology, 138-37 Dupuytren’s contracture, 466t, 505 dysentery, 229 dysfibrinogenemia, 466t, 467 dysgammaglobulinemia syndromes, 247 dyspepsia see also gas, 10-12, 18, 28, 180-81 dysphagia: about, 4, 8-10; children, 575t; esophageal, 111, 116-17, 119,     123-24, 126-28, 130-31; in achalasia, 118; in GERD, 7, 106; in HIV-     associated infection, 294, 299, 300; in malnutrition, 25, 212; on treating     portal hypertension, 529; oropharyngeal, 94-95, 97, 113-15, 114t; and     peristalsis mechanisms, 94; postgastrectomy, 164t, 165 dysplasia, 125, 341-42, 354-56 dyspnea, 112, 212, 512 dyssynergia, pelvic floor, 371