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obesity: and cholelithiasis, 444t; and cholesterol, 442; effects on     liver, 57t, 502; heartburn, 5 obstipation see constipation obstruction see also pseudo-obstruction; afferent loop, 166; biliary     see cholestasis; clinical features, 17-18, 27, 29, 31-32, 468;     colonic, 357t, 357, 359t, 368-69; esophageal, 131-32; hepatic,     556; in cystic fibrosis, 434; in PUD, 160-61; intestinal, 256-57,     259-60, 312, 435, 451, 571, 610-11; lymphatic, 254; pancreatic,     412; parasitic, 375-76; postgastrectomy, 164t; pyloric, 160-61 occlusion, mesenteric see ischemia octreotide, 256, 257, 293t, 297, 424, 529 odynophagia: about, 8, 95; in esophagitis, 111-13; in GERD, 106,     575t; in HIV-associated infection, 299, 300; with esophageal     neoplasms, 126 Ogilvie’s syndrome, 358-59 OKT3, 547 oligopeptides, 402, 405 oligosaccharides, 201, 203 oliguria, 540 olsalazine, 336 omeprazole: to treat dysphagia, 10; to treat GERD, 107t, 108, 576;     to treat PUD, 155, 158-59 opiates, 19t, 20 opioids, 364t organ donation, 75-76 organ transplantation, 75-76 oropharyngeal incoordination, 114t oropharynx, 294-95 osteomalacia, 59t, 213, 243t, 244 osteopenia, 212, 425 osteoporosis, 517 ovarian cysts, 409t, 410 ovarian disease, 27 oxalate, 211 oxygen exchange, 193f, 193-95, 194f oxyntic cells, 141-42 oxyphenisatin, 238t, 500 -P- pain, abdominal: acute abdomen, 26-28, 62; afferent loop syndrome,     166; alcoholic cirrhosis, 506; at nighttime, 29; bile duct disease,     456-57, 458-60; celiac disease, 243t, 243-44; children, 28-30,     565-69, 571; cholangitis, 342; cholecystitis, 450, 454;     choledocholithiasis, 452-53; cholelithiasis, 410; cholesterolosis,     455; colitis, 232; colon cancer, 353t; colonic ischemia, 394;     colonic obstruction, 358; congestive heart failure, 555; constipation,     ischemia, 394; 19; Crohn’s disease, 309-10, 317; cystic fibrosis,     434-35; diarrhea, 226; disaccharidase deficiency, 241; diverticulosis,     356-57; during defecation, 580; fatty liver, 503, 553; gallbladder cancer,     456; gastric volvulus, 175-76; gastroenteritis, 227-29; hepatic vein     thrombosis, 556; hepatitis, 485-86; HIV-associated infection, 296-98,     391-92; intestinal neoplasms, 259-60; intussusception, 360; investigating,     3, 26-28; irritable bowel syndrome, 360-63, 364t; ischemia, 257-58,     268, 269, 276, 280; liver disease, 468-69; liver neoplasms, 551;     malnutrition, 64t; pancreas divisum, 432; pancreatitis, 410, 419-24;     parasitic infection, 376; peritonitis, 535; postsurgical, 548; shigellosis,     371; small bowel ischemia, 259; toxic megacolon, 338; ulcerative colitis,     326-27; Whipple’s disease, 256 pain, anorectal: fissures, 388; in homosexual men, 391; investigating,     380; proctalgia fugax, 40-41 pain, back: cholecystitis, 450; cholelithiasis, 444, 449; esophageal cancer,     95; pancreatic cancer, 426; pancreatitis, 414, 419 pain, biliary, 444-46, 450 pain, bone, 206, 209t, 210t, 212-13, 244 pain, chest: achalasia, 118; esophageal disor
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ders, 6-7, 95-96, 105, 111-13, 116-17, 119, 122f, 126, 128, 130-31;     investigating, 14; musculoskeletal disturbances, 6; on treating portal     hypertension, 529 pain, epigastric: cholecystitis, 449; investigating, 10-11, 12; pancreatic     cancer, 426; pancreatitis, 414 pain, kidney stones, 14 pain, on swallowing see odynophagia pain, somatic, 26 pain, visceral, 26 palliative care: esophageal cancer, 127; gallbladder cancer, 456;     gastric cancer, 175; pancreatic cancer, 429 pallor: celiac disease, 243; children, 571, 590; cholelithiasis, 445;     liver disease, 532; malassimilation, 208t, 212; RAP, 566 palpation: abdomen, 44-45; for ascites, 47; liver, 45-46; spleen, 47 pancolitis, 342 pancreas: anatomy, 136, 400-401, 431-32; fetal development, 432f;     function tests, 405-10; islet cell tumors, 430-31; neoplasms, 425-29;     secretions, 401-5 pancreas divisum, 431-32 pancreatectomy, 424, 428 pancreatic atrophy, 418 pancreatic cholera, 21, 239, 431 pancreatic exocrine dysfunction, 434t pancreatic insufficiency: and celiac disease, 247; children, 607-11,     612-13; and cystic fibrosis, 432-36; dietary therapy, 69, 221t; and     malassimilation, 58t, 234t; tests, 405-10, 406t pancreatic polypeptide, 405, 430-31 pancreatic replacement therapy, 221t, 423-24, 424t, 433, 436-38 pancreatitis: acute, 413-18; causes, 411t-12t; children, 572, 611; and     choledocholithiasis, 453-54; chronic, 408, 418-25; clinical features,     22, 23t, 29-30; complications, 414-15, 416t; and cystic fibrosis,     434, 436; dietary therapy, 71; HIV-associated, 303-4; interstitial,     412; malnutrition, 25; and pancreas divisum, 432; pathogenesis,     410-13; and portal vein thrombosis, 557; prognosis, 413t; and     PUD, 160 pancreatoduodenal resection, 428 pancreatojejunostomy, 423 pancreolauryl test, 408 pancreozymin, 401f pancytopenia, 58t panhypothyroidism, 617 pantothenic acid, 58t papain, 165 papaverine, 258, 274-75 para-aminobenzoic acid, 407 paracentesis, 534-35 paralyzed intestines, 18 parasites: causing diarrhea, 223t, 241t; in biliary tract, 443, 458,     460; in colon, 375-77; in GI tract, 229-31; sexually transmitted,     293t, 296-98 parenteral nutrition see total parenteral nutrition (TPN) paresthesias, 25, 206, 209t, 210t, 212 paromomycin, to treat infection, 293t parotid enlargement: in alcoholic cirrhosis, 505; in liver disease,     466t; in malassimilation, 208t; in malnutrition, 56 parvovirus, 223t Paterson-Kelly (Plummer-Vinson) syndrome, 9, 126t, 128, 212 patient autonomy, 75t patient rights, 74 patient–doctor relationship, 74, 289, 568, 578 pectin, 167 peliosis hepatis, 510t pellagra, 58t pellagroid dermatitis, 590 pelvic floor dyssynergia, 371 pelvic inflammatory disease, 27, 29 pemphigoid, 112 pemphigus, 112 penicillamine, 58t d-penicillamine, 514 penicillin, 373, 391 pentagastrin, 150 pentamidine, 298, 303 pentose phosphate pathway, 54 peppermint, 108t peppermint oil, 364t pepsin: formed, 139, 143; in digestion, 204; in gastric juice, 135, 141;     role in PUD, 148 pepsinogen, 144 pepsinogen secretion, 151 pepsinogenemia 1, 147-48 peptic ulcer disease (PUD): chemical factors, 148; clinical features,     8, 10-11, 26, 29; diagnosis, 151-53; duodenal, 146-47, 147t;     gastric, 146, 147t; and H. pylori, 178, 179-80; hereditary factors,     147-48; and islet cell tumors, 430; molecular factors, 140-42;     pathophysiologic defects, 147t; psychosocial factors, 148-49; and     RAP, 566-68; treatment, 155-61, 156f peptidases, 205 peptides, 205, 400, 405, 430
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percussion: abdomen, 45; for ascites, 48; liver, 45; spleen, 46-47 perforation: colon, 230, 311t, 313, 339t; gallbladder, 452; small     intestine, 247, 260; stomach, 160-61 perianal mass, 382 pericarditis, 489, 525t pericholangitis, 311t, 339t, 342, 459 perifollicular hemorrhages, 210t perifollicular papules, 210t perifollicular petechiae, 208t peripheral edema, 25 peripheral neuritis, 243t peripheral neuropathies, 25, 58t, 114t, 369 peristalsis: control mechanisms, 92-94, 93f; and GERD, 105;     hypertensive, 116f, 116-17; primary, 90, 91f; produced, 140-41;     purpose, 90; secondary, 90 peritoneal irritation, 258 peritonitis: after cholecystitis, 451; causing abdominal pain, 27-28;     in Crohn’s disease, 313; in ischemia, 268, 269, 272-73, 277, 284;     spontaneous bacterial, 535-37 peroral dilation, 109 personality changes, 537 perspiration, 12, 445 petechiae, 208t pets, 24 Peyer’s patches, 306 pH reflux studies, 99 pharmaceutical industry see also clinical trials, 77-78 pharyngeal constrictor muscles, inferior, 88 phenobarbital, 477-78, 618 phenolphthalein, 234t, 238t phenothiazines, 14, 509 phenylalanine, 205 phenytoin, 186 phlebotomy, 513 phlegmon, 415, 417 phosphatase, 503 6-phosphogluconate dehydrogenase, 54 phospholipases, 411-12, 450 phospholipids, 52, 197, 198f, 199, 465 phosphorus, 209t photophobia, 208t phototherapy, 127, 618, 624t physiotherapy, 433 phytobezoars, 165 pica, 212 pigment stones: composition, 440-41, 441t; formation, 57t, 443, 452 pigmentation: in celiac disease, 243t; in liver disease, 512; in     malassimilation, 208t; in malnutrition, 56 pilonidal disease, 390 pinworm, 376 pirenzepine, 107t, 155, 158 pit cells, liver, 463-64 plaques: colonic, 232; oral, 111 platelet-activating factor, 322 Plummer-Vinson syndrome see Paterson-Kelly (Plummer-Vinson)     syndrome Pneumocystis carinii, 298 pneumonia, 97, 409t, 574, 575t polidocanol, 529 poliomyelitis, 114t polyarteritis nodosa, 490 polycythemia vera, 277, 556 polyglutamates, 185-86 polymyositis, 114t polypectomy, 355 polyphagia, 206 polyps: adenomatous, 35t, 173, 354-56; colonic, 354-57, 360;     fibrovascular, 123-24, 124t; gallbladder, 456; gastric, 172, 173; hyperplastic, 173 porcelain gallbladder, 452 porphyria cutanea tarda, 499 portal hypertension: causes, 57t, 525t, 525-26; defined, 524-25;     diagnosis, 528-29; in bile duct disease, 456, 458-59; in liver     disease, 466t, 469, 505, 517, 518, 522; in veno-occlusive     disease, 556; management, 529-31; pathophysiology, 526-28 postcholecystectomy syndrome, 455 potassium see also H+/K+-ATPase; absorption, 191, 350; causing     diarrhea, 223t; deficiency, 245; replacement, 334; secretion, 195-96 potassium chloride, 113 pre-eclampsia, 555 preaortic plexus, 379 preclinical studies, 81-82 prednisone, 320, 335, 341, 501 pregnancy see also childbirth; biliary complications, 443, 444t, 454,     510, 515t; ectopic, 27; and GERD, 106; and hyperamylasemia,     409t, 410; and infant vomiting, 569-70; and liver disease, 484,     552-55; nausea in, 14; normal, 552; and vitamin deficiency, 58t procainamide, 233 procelain gallbladder, 456 procidentia, 381 procollagenase, 411 proctalgia fugax, 40-41, 380 proctitis: clinical features, 381; constipation,
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369; diarrhea, 222; in homosexual men, 290, 392 proctosigmoiditis, 325, 327, 356 proctosigmoidoscopy, 384-85 proelastase, 411 proenzymes, 402, 411 professional obligations, 75t proglumide, 142, 155 prokinetic agents, 10, 108, 364t, 576 prolapse: invertebral disc, 26; rectum, 311t, 339t, 367, 371, 381-82, 610 proliferative glomerulonephritis, 489 proline, 205 propantheline, 155 propionate, 351 propionic acid, 236, 250 propranolol, 155 propylthiouracil, 506 prostaglandins: causing diarrhea, 234t, 238t, 238; gastric role, 144;     in cholecystitis, 450; in inflammatory bowel disease, 322; to treat     PUD, 155, 159 proteases, 204 protein: absorption, 197, 204-6; deficiency, 24-25, 57t, 208t-9t, 212,     254-55, 434, 435; digestion, 54, 250-51, 401, 601t, 602-3; hydrolysis,     205f; maldigestion, 249; metabolism, 51f, 464-65; serum biochemical     tests, 471-72 protein-energy malnutrition, 54-57, 583 proteolysis, 50 Proteus, 535 prothrombin, 464 prothrombin time (PT) test, 472, 474, 486, 488, 492, 500, 503, 504,     505, 523, 545 proton pump antagonists, 10 proton pump inhibitors, 157t, 180, 576 proton pump mechanism, 151 protozoa, 223t, 229-31 pruritus: anorectal, 382; in bile duct disease, 459; in cholestasis, 510,     554-55; in gallbladder cancer, 456; in HIV-associated infection, 298;     in liver disease, 31, 466t, 467, 486, 488, 517; in parasitic infection, 376 pseudo-obstruction: causing bacterial overgrowth, 251t; constipation,     19t; intestinal, 256-57; and pancreatitis, 414 pseudocyesis, 18 pseudocyst, pancreatic, 414-15, 417, 419-21 pseudodiverticulum, 153 pseudolymphoma, gastric, 177 pseudomembranous colitis, 373 pseudopolyps, 339t pseudotumor, 18 psychological trauma see also stress, 14, 30 psychomotor changes, 56 psychosis: in celiac disease, 243t; in cystic fibrosis, 434t psychosocial history: childhood RAP, 566; and diagnosis, 3-4; failure to     thrive, 589; malnutrition, 25 psyllium, 221t, 368 PT see prothrombin time (PT) test pteroylglutamates, 186, 187f pteroylglutamic acid see folic acid puborectalis muscles, 364, 365, 378 PUD see peptic ulcer disease (PUD) purpura: in celiac disease, 243t; in malassimilation, 210t; in vitamin     deficiency, 58t pus in stool, 20, 22, 24, 221 pylephlebitis, 557 pyloric sphincter, 140-41 pyloric stenosis, 176 pyloromyotomy, 176 pyloroplasty, 161, 171, 176 pyoderma gangrenosum, 311t, 313, 327, 340t, 344 pyrazinamide, to treat infection, 292t pyridoxine see vitamin B6 pyrimethamine, to treat infection, 293t pyrosis see heartburn pyrroline alkaloids, 556 -Q- quinacrine, 31, 230, 293t, 296 quinidine, 223t, 233