AccessMedicine - Preface

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Preface
This book is intended to introduce medical students, taking their first course in human physiology, to the most
critical aspects of gastrointestinal physiology, broadly defined. My goal has been to cover the physiologic principles
and concepts necessary to understand and treat patients with digestive or liver diseases. Pathophysiologic principles
and links to specific disease states affecting the gastrointestinal system are therefore stressed. Moreover, in addition
to classical aspects of GI physiology, such as motility, secretion, and the digestion and absorption of nutrients, it
has also been my objective to include more contemporary topics. These are designed to enable an understanding of
the physiologic functions of the mucosal immune system and the intestinal ecosystem, as well as the transport and
metabolic functions of the liver. There is also a significant focus on functional anatomy. This serves as a foundation
for understanding how the various segments of the gastrointestinal tract and the organs draining into it cooperate to
provide an appropriately coordinated response to the ingestion of a meal.
The book begins with an overview of the integrated response of the GI tract to a meal and an introduction to the
functional anatomy of the gastrointestinal system and mechanisms for its regulation. The body of the text is divided
into chapters addressing secretory and absorptive functions, intestinal immunology and ecology, motility, transport
and metabolic functions of the liver, and digestion. The chapters have a consistent format, including learning
objectives, an overview of the topic to be addressed, organ-level aspects of the relevant physiology, the underlying
cellular and molecular basis of the physiologic process, and links to clinical disorders and pathophysiologic
mechanisms. Key concepts as well as informative diagrams provide for a quick review of the most important topics
addressed in each chapter. Learning is also facilitated by provision of study questions that address both basic
aspects of the material covered as well as application of the principles to clinical settings, such as will later be
encountered in licensing examinations. For the interested reader, there are also lists of reference sources that can
be accessed for more detailed treatments of specific topics than can be accomplished in a monograph format.
The impetus for this volume comes from almost 20 years of experience in teaching GI physiology to medical
students at the University of California, San Diego School of Medicine, as well as graduate students in biomedical
sciences and gastroenterology subspecialty fellows. I hope that the book will be helpful to all of these groups, as
well as other health professional students and internal medicine residents seeking a compact review of key topics.
Certainly, my approach to the text has been formed by my interactions with all of these constituencies. They have
taught me that a true understanding of the gastrointestinal system, with its large number of constituent organs as
well as overlapping and redundant control mechanisms, can sometimes prove challenging. My intent for this text
was to bring some clarity to the subject matter. I am also indebted to several colleagues in the UCSD
Gastroenterology Division and beyond, who have aided in my own appreciation of the beauty of the gastrointestinal
system by sharing either research or clinical insights. In particular, I appreciate the assistance of Drs. Alan Hofmann
and Ravi Mittal, who were kind enough to review drafts of the liver/biliary and motility chapters, respectively. Their
insights and clarifications were most helpful, but any inaccuracies that may remain are entirely my own.
I need to thank a number of additional people who made this project possible. First, I thank two of my editors at
McGraw-Hill, Isabel Nogueira, who first suggested the book, and the supremely patient Jason Malley, who made sure
that it was finally completed. Second, I acknowledge the forbearance of the members of my research group, whose
own needs for my time were sometimes neglected in the interest of completing a few more pages of the draft. Third,
I thank my assistant Glenda Wheeler, who coordinated various details of the project in San Diego with her usual
calm competence. Finally, I offer loving thanks to my wonderful husband, Peter Pierce, whose encouragement
throughout has been inspirational.
Kim E. Barrett, PhD
San Diego, California

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