The Digestive System

Dion G. Morton, Margaret E. Smith

Description

This is an integrated textbook on the digestive system, covering the anatomy, physiology and biochemistry of the system, all presented in a clinically relevant context appropriate for the first two years of the medical student course.

One of the seven volumes in the Systems of the Body series.

Concise text covers the core anatomy, physiology and biochemistry in an integrated manner as required by system- and problem-based medical courses.

The basic science is presented in the clinical context in a way appropriate for the early part of the medical course.

Sujets

• Médecine
• Médecine Générale
• Medical

Informations

• Publié par: Churchill Livingstone
• Date de parution: 18 novembre 2011
• Nombre de lectures: 3
• EAN13: 9780702048418
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Table of Contents

Cover image
Front-matter
Copyright
PREFACE
ACKNOWLEDGEMENTS
1. OVERVIEW OF THE DIGESTIVE SYSTEM
2. THE MOUTH, SALIVARY GLANDS AND OESOPHAGUS
3. THE STOMACH
4. THE STOMACH
5. PANCREAS
6. LIVER AND BILIARY SYSTEM
7. THE SMALL INTESTINE
8. DIGESTION AND ABSORPTION
9. THE ABSORPTIVE AND POST-ABSORPTIVE STATES
10. THE COLON
11. GASTROINTESTINAL PATHOLOGY
GLOSSARY
Index
Front-matter

The Digestive System
Commissioning Editor: Timothy Horne
Development Editor: Lulu Stader
Project Manager: Janaki Srinivasan Kumar
Designer/Design Direction: Charles Gray
SYSTEMS OF THE BODY
The Digestive System
BASIC SCIENCE AND CLINICAL CONDITIONS
SECOND EDITION
Margaret E. Smith PhD DSc Professor of Experimental Neurology, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
Dion G. Morton MD DSc Professor of Surgery, Academic Department of Surgery, University Hospital Birmingham, Birmingham, UK
EDINBURGH LONDON NEW YORK OXFORD PHILADELPHIA ST LOUIS SYDNEY TORONTO 2010
Copyright

First Edition © 2010 Elsevier Limited.
Second Edition © 2010 Elsevier Limited. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions .
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).
ISBN 978-0-7020-3367-4
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress

Notices

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.
The Publisher

Printed in China
PREFACE
Many medical schools in the UK and other countries are using systems-based courses. In addition, many are taking a problem-based learning approach to the systems. This textbook provides the basic science needed by the medical students following such courses, and places it in a clinical context. The first edition of The Digestive System is a basic text that has been used on many university courses over the past 8 years, including those taught by the authors at the University of Birmingham. During that time, it has been highly commended by the Royal Society of Medicine and the Society of Authors, and has been translated into Portuguese and Chinese.
Over the past few years, the approach taken in this textbook to emphasize the importance of a knowledge of basic science for the understanding of medicine was found to stimulate the students to think, rather than just learn didactically. It has helped to motivate them at a very early stage in their courses. In the second edition of The Digestive System , much of the material has been updated.
The subject matter of each chapter is illustrated by the problems encountered in carefully selected clinical situations. Additional case studies have been included in this second edition. The clinical cases chosen are those that demonstrate the relevance of many aspects of basic science to the understanding of each specific clinical problem and by inference, to the understanding of medicine as a whole. The clinical problems chosen are ones that illustrate a number of different aspects of each area of the digestive system, and not all of them are common diseases. Indeed, some of them are uncommon, or even rare. However, common, relevant diseases are described (mostly in boxes), where relevant, in the text. This aspect has been expanded in this second edition. The last chapter draws together information on the common diseases of the digestive system. It has been found that this case-based approach stimulates the student to learn more about the system and its diseases and helps to motivate them to study basic science.
The book has a further purpose; to demonstrate the importance of integration of knowledge of the digestive system with that of the other systems of the body. In medicine, no physiological system can be successfully studied in isolation from the others. Various systems and many organs can be involved in a disease state, either as the primary foci of the lesion or the result of secondary complications. Furthermore, the treatment of disease by drug therapy or surgical intervention can have untoward side-effects that affect systems other than manifesting the primary defect. With these considerations in mind, many of the cases and problems given in The Digestive System address relevant aspects of other physiological systems. The approach taken by this book will therefore ensure not only a better understanding of the functioning of body as a whole but also the causes and treatment of disease.
ACKNOWLEDGEMENTS
We are grateful for the help given by various people in the preparation of both editions of this book. Mr John Hamburger of Birmingham University Dental School read The Mouth chapter, and he and Dr Linda Shaw made some useful general suggestions. Mr Hamburger and Dr John Rippin kindly provided the photographs for The Mouth chapter. The late Professor Roger Coleman and Dr Rosemary Waring of the School of Bioscience at Birmingham University provided some useful information for The Liver chapter. Dr Peter Guest, consultant radiologist at the University Hospital, Birmingham provided many of the X-rays and clinical photographs. Professor Cliff Bailey of the Department of Biological Sciences at the University of Aston made useful comments on the Absorptive and Post-absorptive States chapter. Professor Barry Hirst of the Department of Physiological Sciences at the University of Newcastle upon Tyne suggested some important revisions concerning ion transport in Chapter 2 and Chapter 3 of this second edition. Dr Chris Tselepis of the School of Cancer Studies in the University of Birmingham made useful suggestions for revision of the section on iron absorption in Chapter 8 . The encouragement of Dexter Smith and the drawing skills of Dr Imogen Smith (for two of the figures) were much appreciated.
1. OVERVIEW OF THE DIGESTIVE SYSTEM

Chapter objectives

After studying this chapter you should be able to:

1. Understand the key mechanisms of secretion, absorption and motility in the gastrointestinal system.

2. Understand the coordinated and integrated functioning of the digestive system.

3. Understand how function of the digestive system depends on other systems, such as the cardiovascular system.

Introduction: overall function of the digestive system
The cells of the body require adequate amounts of raw materials for their energy requiring and synthetic processes. The raw materials are obtained from the external environment through the ingestion of food. The overall function of the digestive system is to transfer the nutrients in food from the external environment to the internal environment, where they can be distributed to the cells of the body via the circulation. In this chapter, the general principles and basic mechanisms involved in the functioning of the digestive system will be discussed in the context of the system as a whole. The importance of the integration of the digestive system with the other body systems is well illustrated by the problems encountered in non-occlusive ischaemic disease of the gut: a condition in which the defect originates in the vascular system, but serious consequences result from abnormal absorption in the small intestine (see Case 1.1 and Case 1.1 ).
Case 1.1
Non-occlusive ischaemic disease of the gut: 1

An elderly patient, who was being treated with digitalis for congestive heart failure, suddenly developed severe, constant, abdominal pain. The consultant physician examined him and found that he was in circulatory shock, with a low arterial blood pressure, a thready pulse and a sinus tachycardia (rapid heart rate). His abdomen was exquisitely tender to palpitation, with diffuse peritonism (tenderness). The physician suspected from the clinical findings that the pat