Ulcerative colitis is a chronic inflammatory bowel disease that affects the colon. It is characterized by inflammation and ulcers in the lining of the rectum and colon. The causes are unknown but likely involve genetic and immune factors. Symptoms include abdominal pain, bloody diarrhea, and weight loss. Diagnosis involves blood tests, colonoscopy, and biopsy. Treatment focuses on reducing inflammation through medications like mesalamine, corticosteroids, immunosuppressants, or biologics. Surgery to remove the colon may be needed for severe cases or cancer prevention. Complications can include toxic megacolon, colon cancer, and extraintestinal manifestations.
Gastro esophageal Reflux Disease (GERD) and its managementDr. Ankit Gaur
In this presentation I have tried to explain in brief about gastro esophageal Reflux Disease (GERD), its etiology, risk factors, diagnosis, and its management via pharmacotherapy.
Crohn's disease is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract. It is characterized by transmural inflammation and ulceration that can lead to abdominal pain, diarrhea, weight loss, and complications like strictures, fistulas, and abscesses. While the exact cause is unknown, genetics and environmental factors like smoking are believed to play a role. Treatment involves medications to reduce inflammation, lifestyle changes, and sometimes surgery.
Ulcerative colitis (UC) is an inflammatory bowel disease. It causes irritation, inflammation, and ulcers in the lining of your large intestine (also called your colon). There's no cure, and people usually have symptoms off and on for life
Crohn's disease is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract. It is more common in western nations and presents most often in teens and twenties. While the exact cause is unknown, it involves a complex interplay of genetic and environmental factors. Common symptoms include abdominal pain, diarrhea, weight loss, and fever. Complications can include strictures, fistulas, abscesses, and small bowel obstruction. Diagnosis involves imaging tests like colonoscopy, capsule endoscopy, and CT scans to identify areas of inflammation and complications throughout the bowels.
This document discusses acute pancreatitis, defining it as a reversible inflammation of the pancreas that ranges from mild to severe. It can be caused by gallstones, alcohol use, metabolic issues, infections, drugs, trauma, and other factors. Symptoms include severe abdominal pain that may radiate to the back. Investigations include blood tests of amylase, lipase, and other enzymes. Treatment focuses on supportive care, pain management, and identifying/treating any complications like infections. The mortality rate ranges from 1% for mild cases to 15-20% overall.
UC is an idiopathic IBD that affects the colonic mucosa.
Hallmark of UC is bloody diarrhea often with prominent symptoms of rectal urgency and tenesmus.
The clinical course is marked by exacerbations and remissions.
The diagnosis of UC is suspected on clinical grounds and supported by the appropriate findings on
Proctosigmoidoscopy or colonoscopy
Biopsy
By negative stool examination for infectious causes
The document provides information on inflammatory bowel disease (IBD), including its classification into ulcerative colitis and Crohn's disease. It discusses the epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, treatment goals, and pharmacological and non-pharmacological treatment approaches for IBD. The major drug therapy types used for IBD include aminosalicylates, corticosteroids, immunosuppressants, TNF inhibitors, and antimicrobials. Surgery may be required for severe cases or complications that do not respond to medical management.
Image result for ulcerative colitis
Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly.
Gastro esophageal Reflux Disease (GERD) and its managementDr. Ankit Gaur
In this presentation I have tried to explain in brief about gastro esophageal Reflux Disease (GERD), its etiology, risk factors, diagnosis, and its management via pharmacotherapy.
Crohn's disease is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract. It is characterized by transmural inflammation and ulceration that can lead to abdominal pain, diarrhea, weight loss, and complications like strictures, fistulas, and abscesses. While the exact cause is unknown, genetics and environmental factors like smoking are believed to play a role. Treatment involves medications to reduce inflammation, lifestyle changes, and sometimes surgery.
Ulcerative colitis (UC) is an inflammatory bowel disease. It causes irritation, inflammation, and ulcers in the lining of your large intestine (also called your colon). There's no cure, and people usually have symptoms off and on for life
Crohn's disease is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract. It is more common in western nations and presents most often in teens and twenties. While the exact cause is unknown, it involves a complex interplay of genetic and environmental factors. Common symptoms include abdominal pain, diarrhea, weight loss, and fever. Complications can include strictures, fistulas, abscesses, and small bowel obstruction. Diagnosis involves imaging tests like colonoscopy, capsule endoscopy, and CT scans to identify areas of inflammation and complications throughout the bowels.
This document discusses acute pancreatitis, defining it as a reversible inflammation of the pancreas that ranges from mild to severe. It can be caused by gallstones, alcohol use, metabolic issues, infections, drugs, trauma, and other factors. Symptoms include severe abdominal pain that may radiate to the back. Investigations include blood tests of amylase, lipase, and other enzymes. Treatment focuses on supportive care, pain management, and identifying/treating any complications like infections. The mortality rate ranges from 1% for mild cases to 15-20% overall.
UC is an idiopathic IBD that affects the colonic mucosa.
Hallmark of UC is bloody diarrhea often with prominent symptoms of rectal urgency and tenesmus.
The clinical course is marked by exacerbations and remissions.
The diagnosis of UC is suspected on clinical grounds and supported by the appropriate findings on
Proctosigmoidoscopy or colonoscopy
Biopsy
By negative stool examination for infectious causes
The document provides information on inflammatory bowel disease (IBD), including its classification into ulcerative colitis and Crohn's disease. It discusses the epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, treatment goals, and pharmacological and non-pharmacological treatment approaches for IBD. The major drug therapy types used for IBD include aminosalicylates, corticosteroids, immunosuppressants, TNF inhibitors, and antimicrobials. Surgery may be required for severe cases or complications that do not respond to medical management.
Image result for ulcerative colitis
Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly.
There are three major forms of liver abscess classified by etiology: pyogenic liver abscess which accounts for 80% of cases, amoebic liver abscess due to E. histolytica accounting for 10% of cases, and fungal abscess accounting for less than 10% of cases. Risk factors include traveling to infection-common areas, older age, medical conditions, medications, alcohol, and poor nutrition. Symptoms include abdominal pain, cough, fatigue, fever, nausea and vomiting, loss of appetite, and jaundice. Diagnosis involves blood tests, imaging, and procedures to drain fluid from the liver. Treatment depends on the cause but may include medications, needle aspiration, catheter drainage, or
This document provides an overview of cholecystitis, including:
1. It defines cholecystitis as the inflammatory condition of the gallbladder and describes the types of acute cholecystitis.
2. It outlines the clinical features of acute cholecystitis including symptoms like colicky pain and signs like Murphy's sign.
3. It discusses the treatment options for acute cholecystitis which include conservative treatment, early cholecystectomy, or emergency cholecystostomy depending on the severity of the case.
This document provides information on cirrhosis of the liver. It defines cirrhosis as a chronic, progressive disease characterized by widespread scarring and nodule formation in the liver. The main causes of cirrhosis include chronic viral hepatitis infections, fatty liver disease, and long-term alcohol abuse. Cirrhosis results in the destruction of liver cells and their replacement with fibrotic scar tissue, impairing blood flow and liver function. Common complications are ascites, bleeding esophageal varices, and hepatic encephalopathy. Diagnosis involves liver enzyme tests, imaging, and biopsy. Treatment focuses on managing complications, restricting alcohol, improving nutrition, and liver transplantation in severe cases.
This document discusses gastroesophageal reflux disease (GERD). It begins by defining GERD as a condition caused by stomach contents refluxing into the esophagus and causing troublesome symptoms or complications. It then discusses the pathophysiology of GERD, noting that the lower esophageal sphincter normally acts as a barrier but can become disrupted, allowing acid to reflux from the stomach into the esophagus. The document outlines the clinical manifestations of GERD including heartburn, regurgitation, and extraesophageal symptoms. It also discusses diagnostic evaluations for GERD including endoscopy, pH monitoring, and manometry. The document concludes by covering treatment options for GERD including lifestyle modifications
This document discusses predisposing factors, pathogenesis, types, clinical features, complications, investigations, differential diagnosis, and management of gallstones. The main types are cholesterol stones, mixed stones, and pigment stones. Risk factors include obesity, female sex hormones, age, pregnancy, certain drugs, and diabetes. Gallstones can cause symptoms like biliary colic or be asymptomatic. Complications involve inflammation of the gallbladder or bile ducts. Treatment options are medical therapy with ursodeoxycholic acid for small cholesterol stones or laparoscopic cholecystectomy.
Peptic Ulcer Disease is caused by stomach acid and pepsin damaging the stomach or duodenal lining. Risk factors include H. pylori infection, smoking, NSAIDs, and age. The two main types are gastric and duodenal ulcers. Patients may experience abdominal pain or bleeding. Diagnosis involves endoscopy, biopsy, and breath testing. Treatment focuses on eradicating H. pylori, reducing acid with PPIs or H2 blockers, and surgery for complications. Lifestyle changes and multi-drug antibiotic regimens are effective at curing ulcers and preventing recurrence.
Cholecystitis refers to inflammation of the gallbladder. It is most commonly caused by gallstones which can block the cystic duct and cause bile to build up. There are two main types - acute cholecystitis which occurs suddenly and causes severe pain, and chronic cholecystitis which is a long-term lower intensity inflammation. Diagnosis involves blood tests, imaging like ultrasound or CT scans. Treatment options include pain medication, antibiotics if infected, and surgical removal of the gallbladder (cholecystectomy) for severe or long-term cases.
Inflammatory bowel disease (IBD) is a group of chronic inflammatory conditions of the gastrointestinal tract that disrupt the ability to digest food and absorb nutrients. The two main types of IBD are ulcerative colitis, which causes inflammation of the inner lining of the large intestine and rectum, and Crohn's disease, which causes transmural inflammation that may affect any part of the gastrointestinal tract from mouth to anus. Diagnosis involves a review of symptoms, physical examination, blood tests, stool tests, endoscopy, biopsies and imaging studies to determine if inflammation is present and if other causes can be ruled out.
This document discusses gastritis, which is inflammation of the stomach lining. It defines acute and chronic gastritis and lists risk factors like smoking, drinking, and medications. Symptoms are discussed as well as diagnostic tests. Treatment focuses on antacids, bland diets, and treating any underlying causes. Chronic gastritis can lead to pernicious anemia or gastric cancer if not properly managed.
Nephrotic syndrome is characterized by proteinuria, hypoalbuminemia, edema, and hyperlipidemia. It can be primary, caused by diseases of the kidney itself, or secondary, caused by systemic illnesses that affect the kidneys. The most common primary causes are minimal-change disease in children and membranous glomerulonephritis in adults. Secondary causes include diabetes, lupus, and infections. Treatment involves controlling edema with diuretics, treating underlying conditions, and using steroids, immunosuppressants, or ACE inhibitors depending on disease type and severity.
This document discusses peptic ulcers, including their causes, symptoms, diagnosis, and treatment. Peptic ulcers are abnormalities in the gastrointestinal tract caused by damage from stomach acid. The most common causes are infection with Helicobacter pylori bacteria and long-term use of nonsteroidal anti-inflammatory drugs. Common symptoms include abdominal pain, nausea, and vomiting of blood. Diagnosis involves tests to detect H. pylori infection and endoscopy to view the ulcers. Treatment focuses on eradicating H. pylori with antibiotics, reducing stomach acid with proton pump inhibitors or H2 blockers, and protecting the lining with sucralfate.
The peritoneum is a membrane that lines the abdominal wall and covers abdominal organs. It consists of parietal and visceral layers composed of mesothelium that secretes fluid allowing organs to glide. Peritonitis is inflammation of the peritoneum caused by infections from medical procedures, ruptured organs, or trauma which leads to abdominal pain and infection symptoms treated with antibiotics and sometimes surgery.
The document discusses cystitis, or urinary bladder inflammation. It defines cystitis as a urinary tract infection that affects the bladder. The most common cause is bacterial infection, which can occur when bacteria enter the bladder from the urethra or anus. Common symptoms include pain or burning during urination, frequent urination in small amounts, and bloody or cloudy urine. Treatment typically involves antibiotics and self-care measures like drinking water and avoiding irritants. Preventative measures include proper hygiene and not delaying urination.
This document discusses acute cholecystitis, which is inflammation of the gallbladder. It defines the condition and discusses its most common causes and risk factors. The main symptoms are abdominal pain in the right upper quadrant, nausea, vomiting, and fever. Diagnosis involves physical exam findings like Murphy's sign as well as imaging tests and bloodwork. Treatment involves intravenous fluids, antibiotics, and early cholecystectomy if symptoms worsen or complications arise. Both open and laparoscopic cholecystectomy are discussed as surgical treatment options.
Fissure in ano is an elongated ulcer in the lower anal canal, most commonly located in the midline posteriorly. It is caused by pressure from hard stool during bowel movements tearing the anal tissues. It can also be caused by inflammation or ischemia. An acute fissure is a deep tear in the anal skin, while a chronic fissure has inflamed, indurated edges and scar tissue at the base. Symptoms include pain with defecation and sometimes bleeding. Treatment aims to relax the internal sphincter and includes topical nitrates, dilatation, and lateral sphincterotomy. Squamous cell carcinoma of the anus can be caused by radiation, HPV, or inflammation. It presents
Ascites is the accumulation of fluid in the peritoneal cavity. The most common cause is portal hypertension due to liver cirrhosis. Clinical signs include abdominal swelling and distension. Diagnosis involves physical exam findings like shifting dullness and diagnostic imaging. Treatment involves restricting sodium intake, diuretics, and paracentesis to remove excess fluid. The nursing management focuses on pain management, fluid and electrolyte balance, preventing complications, and restoring normal gastrointestinal function.
This document discusses liver cirrhosis, including its types, causes, pathophysiology, clinical manifestations, complications, nursing diagnoses, and interventions. Liver cirrhosis is a chronic, degenerative disease characterized by replacement of normal liver tissue with fibrosis that disrupts liver structure and function. Common types are alcoholic cirrhosis and postnecrotic cirrhosis resulting from viral hepatitis. Complications include ascites, hepatic encephalopathy, and esophageal varices, which can lead to life-threatening bleeding if ruptured. Nursing care focuses on reducing metabolic demands, providing adequate nutrition and hydration, preventing infection, and protecting patients from injury and further complications.
Peptic ulcers form when the lining of the stomach or duodenum is corroded by acidic digestive juices. Common symptoms include abdominal pain relieved by food or antacids. While acid contributes to ulcer formation, infection with H. pylori bacteria is now believed to be the leading cause. Other risk factors include NSAID use, smoking, alcohol, and stress. Complications can include bleeding, perforation, and narrowing or obstruction of the stomach outlet. Endoscopy allows visualization and biopsy of ulcers, while treatment aims to eliminate H. pylori infection and reduce acid secretion.
Portal hypertension occurs when there is increased resistance to blood flow through the portal vein, causing elevated pressure. It is defined as a hepatic venous pressure gradient over 5 mmHg. Measurement involves catheterization of the hepatic vein. Causes include cirrhosis and other liver diseases. Complications include variceal bleeding, ascites, and encephalopathy. Treatment of acute bleeding involves vasoactive drugs, endoscopic therapy, and TIPS. Secondary prevention uses beta-blockers to reduce portal pressure and risk of rebleeding.
This document provides information about ulcerative colitis (UC), including:
- UC is a type of inflammatory bowel disease that affects only the large intestine. It causes inflammation and ulcers in the lining of the intestine.
- Symptoms include bloody diarrhea, abdominal pain, and frequent bowel movements. The disease involves periods of remission and flares of symptoms.
- UC is diagnosed through patient history, physical exam, lab tests, endoscopy, and biopsy of the intestine. Treatment aims to induce and maintain remission of symptoms and includes mesalamine, corticosteroids, immunomodulators, and surgery in severe cases.
Ulcerative colitis is a chronic inflammatory bowel disease that causes recurring episodes of inflammation and ulcers in the lining of the colon. The main symptoms are diarrhea mixed with blood, abdominal pain, and urgency. Disease severity can range from mild with a few daily bowel movements to severe with over 10 bloody stools per day and systemic toxicity. Long-term risks include colon cancer, especially with pancolitis extending throughout the entire colon. Treatment aims to induce and maintain remission through medications, with surgery as a last resort for severe cases or cancer prevention.
There are three major forms of liver abscess classified by etiology: pyogenic liver abscess which accounts for 80% of cases, amoebic liver abscess due to E. histolytica accounting for 10% of cases, and fungal abscess accounting for less than 10% of cases. Risk factors include traveling to infection-common areas, older age, medical conditions, medications, alcohol, and poor nutrition. Symptoms include abdominal pain, cough, fatigue, fever, nausea and vomiting, loss of appetite, and jaundice. Diagnosis involves blood tests, imaging, and procedures to drain fluid from the liver. Treatment depends on the cause but may include medications, needle aspiration, catheter drainage, or
This document provides an overview of cholecystitis, including:
1. It defines cholecystitis as the inflammatory condition of the gallbladder and describes the types of acute cholecystitis.
2. It outlines the clinical features of acute cholecystitis including symptoms like colicky pain and signs like Murphy's sign.
3. It discusses the treatment options for acute cholecystitis which include conservative treatment, early cholecystectomy, or emergency cholecystostomy depending on the severity of the case.
This document provides information on cirrhosis of the liver. It defines cirrhosis as a chronic, progressive disease characterized by widespread scarring and nodule formation in the liver. The main causes of cirrhosis include chronic viral hepatitis infections, fatty liver disease, and long-term alcohol abuse. Cirrhosis results in the destruction of liver cells and their replacement with fibrotic scar tissue, impairing blood flow and liver function. Common complications are ascites, bleeding esophageal varices, and hepatic encephalopathy. Diagnosis involves liver enzyme tests, imaging, and biopsy. Treatment focuses on managing complications, restricting alcohol, improving nutrition, and liver transplantation in severe cases.
This document discusses gastroesophageal reflux disease (GERD). It begins by defining GERD as a condition caused by stomach contents refluxing into the esophagus and causing troublesome symptoms or complications. It then discusses the pathophysiology of GERD, noting that the lower esophageal sphincter normally acts as a barrier but can become disrupted, allowing acid to reflux from the stomach into the esophagus. The document outlines the clinical manifestations of GERD including heartburn, regurgitation, and extraesophageal symptoms. It also discusses diagnostic evaluations for GERD including endoscopy, pH monitoring, and manometry. The document concludes by covering treatment options for GERD including lifestyle modifications
This document discusses predisposing factors, pathogenesis, types, clinical features, complications, investigations, differential diagnosis, and management of gallstones. The main types are cholesterol stones, mixed stones, and pigment stones. Risk factors include obesity, female sex hormones, age, pregnancy, certain drugs, and diabetes. Gallstones can cause symptoms like biliary colic or be asymptomatic. Complications involve inflammation of the gallbladder or bile ducts. Treatment options are medical therapy with ursodeoxycholic acid for small cholesterol stones or laparoscopic cholecystectomy.
Peptic Ulcer Disease is caused by stomach acid and pepsin damaging the stomach or duodenal lining. Risk factors include H. pylori infection, smoking, NSAIDs, and age. The two main types are gastric and duodenal ulcers. Patients may experience abdominal pain or bleeding. Diagnosis involves endoscopy, biopsy, and breath testing. Treatment focuses on eradicating H. pylori, reducing acid with PPIs or H2 blockers, and surgery for complications. Lifestyle changes and multi-drug antibiotic regimens are effective at curing ulcers and preventing recurrence.
Cholecystitis refers to inflammation of the gallbladder. It is most commonly caused by gallstones which can block the cystic duct and cause bile to build up. There are two main types - acute cholecystitis which occurs suddenly and causes severe pain, and chronic cholecystitis which is a long-term lower intensity inflammation. Diagnosis involves blood tests, imaging like ultrasound or CT scans. Treatment options include pain medication, antibiotics if infected, and surgical removal of the gallbladder (cholecystectomy) for severe or long-term cases.
Inflammatory bowel disease (IBD) is a group of chronic inflammatory conditions of the gastrointestinal tract that disrupt the ability to digest food and absorb nutrients. The two main types of IBD are ulcerative colitis, which causes inflammation of the inner lining of the large intestine and rectum, and Crohn's disease, which causes transmural inflammation that may affect any part of the gastrointestinal tract from mouth to anus. Diagnosis involves a review of symptoms, physical examination, blood tests, stool tests, endoscopy, biopsies and imaging studies to determine if inflammation is present and if other causes can be ruled out.
This document discusses gastritis, which is inflammation of the stomach lining. It defines acute and chronic gastritis and lists risk factors like smoking, drinking, and medications. Symptoms are discussed as well as diagnostic tests. Treatment focuses on antacids, bland diets, and treating any underlying causes. Chronic gastritis can lead to pernicious anemia or gastric cancer if not properly managed.
Nephrotic syndrome is characterized by proteinuria, hypoalbuminemia, edema, and hyperlipidemia. It can be primary, caused by diseases of the kidney itself, or secondary, caused by systemic illnesses that affect the kidneys. The most common primary causes are minimal-change disease in children and membranous glomerulonephritis in adults. Secondary causes include diabetes, lupus, and infections. Treatment involves controlling edema with diuretics, treating underlying conditions, and using steroids, immunosuppressants, or ACE inhibitors depending on disease type and severity.
This document discusses peptic ulcers, including their causes, symptoms, diagnosis, and treatment. Peptic ulcers are abnormalities in the gastrointestinal tract caused by damage from stomach acid. The most common causes are infection with Helicobacter pylori bacteria and long-term use of nonsteroidal anti-inflammatory drugs. Common symptoms include abdominal pain, nausea, and vomiting of blood. Diagnosis involves tests to detect H. pylori infection and endoscopy to view the ulcers. Treatment focuses on eradicating H. pylori with antibiotics, reducing stomach acid with proton pump inhibitors or H2 blockers, and protecting the lining with sucralfate.
The peritoneum is a membrane that lines the abdominal wall and covers abdominal organs. It consists of parietal and visceral layers composed of mesothelium that secretes fluid allowing organs to glide. Peritonitis is inflammation of the peritoneum caused by infections from medical procedures, ruptured organs, or trauma which leads to abdominal pain and infection symptoms treated with antibiotics and sometimes surgery.
The document discusses cystitis, or urinary bladder inflammation. It defines cystitis as a urinary tract infection that affects the bladder. The most common cause is bacterial infection, which can occur when bacteria enter the bladder from the urethra or anus. Common symptoms include pain or burning during urination, frequent urination in small amounts, and bloody or cloudy urine. Treatment typically involves antibiotics and self-care measures like drinking water and avoiding irritants. Preventative measures include proper hygiene and not delaying urination.
This document discusses acute cholecystitis, which is inflammation of the gallbladder. It defines the condition and discusses its most common causes and risk factors. The main symptoms are abdominal pain in the right upper quadrant, nausea, vomiting, and fever. Diagnosis involves physical exam findings like Murphy's sign as well as imaging tests and bloodwork. Treatment involves intravenous fluids, antibiotics, and early cholecystectomy if symptoms worsen or complications arise. Both open and laparoscopic cholecystectomy are discussed as surgical treatment options.
Fissure in ano is an elongated ulcer in the lower anal canal, most commonly located in the midline posteriorly. It is caused by pressure from hard stool during bowel movements tearing the anal tissues. It can also be caused by inflammation or ischemia. An acute fissure is a deep tear in the anal skin, while a chronic fissure has inflamed, indurated edges and scar tissue at the base. Symptoms include pain with defecation and sometimes bleeding. Treatment aims to relax the internal sphincter and includes topical nitrates, dilatation, and lateral sphincterotomy. Squamous cell carcinoma of the anus can be caused by radiation, HPV, or inflammation. It presents
Ascites is the accumulation of fluid in the peritoneal cavity. The most common cause is portal hypertension due to liver cirrhosis. Clinical signs include abdominal swelling and distension. Diagnosis involves physical exam findings like shifting dullness and diagnostic imaging. Treatment involves restricting sodium intake, diuretics, and paracentesis to remove excess fluid. The nursing management focuses on pain management, fluid and electrolyte balance, preventing complications, and restoring normal gastrointestinal function.
This document discusses liver cirrhosis, including its types, causes, pathophysiology, clinical manifestations, complications, nursing diagnoses, and interventions. Liver cirrhosis is a chronic, degenerative disease characterized by replacement of normal liver tissue with fibrosis that disrupts liver structure and function. Common types are alcoholic cirrhosis and postnecrotic cirrhosis resulting from viral hepatitis. Complications include ascites, hepatic encephalopathy, and esophageal varices, which can lead to life-threatening bleeding if ruptured. Nursing care focuses on reducing metabolic demands, providing adequate nutrition and hydration, preventing infection, and protecting patients from injury and further complications.
Peptic ulcers form when the lining of the stomach or duodenum is corroded by acidic digestive juices. Common symptoms include abdominal pain relieved by food or antacids. While acid contributes to ulcer formation, infection with H. pylori bacteria is now believed to be the leading cause. Other risk factors include NSAID use, smoking, alcohol, and stress. Complications can include bleeding, perforation, and narrowing or obstruction of the stomach outlet. Endoscopy allows visualization and biopsy of ulcers, while treatment aims to eliminate H. pylori infection and reduce acid secretion.
Portal hypertension occurs when there is increased resistance to blood flow through the portal vein, causing elevated pressure. It is defined as a hepatic venous pressure gradient over 5 mmHg. Measurement involves catheterization of the hepatic vein. Causes include cirrhosis and other liver diseases. Complications include variceal bleeding, ascites, and encephalopathy. Treatment of acute bleeding involves vasoactive drugs, endoscopic therapy, and TIPS. Secondary prevention uses beta-blockers to reduce portal pressure and risk of rebleeding.
This document provides information about ulcerative colitis (UC), including:
- UC is a type of inflammatory bowel disease that affects only the large intestine. It causes inflammation and ulcers in the lining of the intestine.
- Symptoms include bloody diarrhea, abdominal pain, and frequent bowel movements. The disease involves periods of remission and flares of symptoms.
- UC is diagnosed through patient history, physical exam, lab tests, endoscopy, and biopsy of the intestine. Treatment aims to induce and maintain remission of symptoms and includes mesalamine, corticosteroids, immunomodulators, and surgery in severe cases.
Ulcerative colitis is a chronic inflammatory bowel disease that causes recurring episodes of inflammation and ulcers in the lining of the colon. The main symptoms are diarrhea mixed with blood, abdominal pain, and urgency. Disease severity can range from mild with a few daily bowel movements to severe with over 10 bloody stools per day and systemic toxicity. Long-term risks include colon cancer, especially with pancolitis extending throughout the entire colon. Treatment aims to induce and maintain remission through medications, with surgery as a last resort for severe cases or cancer prevention.
Ulcerative colitis is an inflammatory bowel disease that causes inflammation and ulcers in the lining of the large intestine. There are four types of ulcerative colitis defined by the part of the colon that is inflamed. Symptoms vary depending on the severity and location of inflammation but can include abdominal pain, bloody diarrhea, and weight loss. Ulcerative colitis is diagnosed through tests such as colonoscopy, biopsy and blood tests. Treatment aims to reduce inflammation and may include medications like mesalamine, olsalazine, sulfasalazine or surgery in severe cases.
This document provides an overview of inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease. It discusses the pathogenesis, risk factors, clinical features, diagnostic assessments, complications, extra-intestinal manifestations, and treatment approaches for IBD. Key points include that IBD involves chronic inflammation of the gastrointestinal tract, the causes are not fully understood but involve genetic and immune factors, and treatment involves drug therapies like 5-aminosalicylates as well as surgery in some cases.
This document provides information about ulcerative colitis (UC) by discussing its epidemiology, morphology, clinical features, complications, diagnosis, comparisons to Crohn's disease, and indeterminate colitis. Key points include that UC is limited to the colon mucosa/submucosa, begins in the rectum and extends proximally, and causes bloody diarrhea, abdominal pain, and weight loss. It has a higher risk of colon cancer than Crohn's disease. Histopathology shows crypt abscesses and a continuous area of colon inflammation. Around 10% of IBD cases are considered indeterminate colitis with overlapping UC and Crohn's features.
Ulcerative colitis is a chronic inflammatory bowel disease that affects the colon. It involves diffuse inflammation and ulceration of the colonic mucosa. The cause is unknown but likely related to genetic and immune factors. Symptoms include bloody diarrhea. Diagnosis involves colonoscopy and biopsy. Treatment involves medications to induce and maintain remission such as mesalamine, corticosteroids, immunomodulators, and biologics. Surgery may be required for severe cases or cancer prevention. Long-term monitoring is needed due to cancer risk.
This document provides an overview of ulcerative colitis, including its epidemiology, pathology, clinical features, investigations, classifications, complications, extraintestinal manifestations, and treatments. Ulcerative colitis is a type of inflammatory bowel disease that causes inflammation and ulcers in the lining of the large intestine. It typically affects the rectum and lower colon. The cause is unknown but believed to involve genetic and environmental factors. Symptoms can range from mild to severe and include abdominal pain, bloody diarrhea, and weight loss. Diagnosis involves endoscopy and biopsy. Treatment includes medications to reduce inflammation as well as colectomy surgery in severe cases.
Inflammatory Bowel Disease ( Pathogensis & Steps of Diagnosis and Management) For Resident at Gastroenterology and Hepatology department at Kafrelsheikh by Dr/ Mohammed Hussien ( Assistant Lecturer).
Inflammatory Bowel Disease (IBD) encompasses two major disorders: Ulcerative Colitis and Crohn's Disease. Ulcerative Colitis causes ulcers in the lining of the rectum and colon and typically starts between ages 15-30. Crohn's Disease causes inflammation of the digestive system from mouth to anus, often affecting the ileum, and seems to run in families. Common symptoms of both disorders include abdominal pain, diarrhea, and weight loss. Symptoms vary depending on the extent and severity of inflammation in the colon and rectum.
Inflammatory bowel disease (IBD) includes two major types: Crohn's disease and ulcerative colitis. Crohn's disease can affect any part of the gastrointestinal tract and often involves the full thickness of the intestinal wall. Ulcerative colitis only involves the innermost layers of the colon and rectum. Both conditions result from an interaction between genetic, immune, environmental, and bacterial factors. Symptoms include diarrhea, abdominal pain, and weight loss. Treatment focuses on inducing remission through medications like aminosalicylates or surgery to remove the colon. Crohn's disease is characterized by "skip lesions" and strictures while ulcerative colitis causes inflammation and ulcers confined to the colon.
Ulcerative colitis is a chronic inflammatory bowel disease that affects the colon. It is characterized by inflammation and ulcers in the lining of the large intestine. The exact cause is unknown but there is a genetic component. Symptoms include diarrhea mixed with blood, abdominal pain, and weight loss. Treatment involves medications to induce and maintain remission of symptoms, with the goal of mucosal healing of the colon. Complications can include toxic megacolon, colorectal cancer, and inflammation in other parts of the body.
Ulcerative colitis explanation, management and therapyYuliaDjatiwardani2
A chronic, inflammatory bowel disease that causes inflammation in the digestive tract.
Ulcerative colitis is usually only in the innermost lining of the large intestine (colon) and rectum. Forms range from mild to severe. Having ulcerative colitis puts a patient at increased risk of developing colon cancer.
Symptoms include rectal bleeding, bloody diarrhoea, abdominal cramps and pain.
Treatment includes medication and surgery.
Ulcerative Colitis is a chronic inflammatory bowel disease that affects the colon. It is marked by periods of remission and relapse. The document defines UC and discusses its epidemiology, etiology, pathology, diagnosis, disease severity, differential diagnosis, complications, and extra-intestinal manifestations. Key points include that UC causes inflammation of the colonic mucosa, risk factors include developed nations and Caucasians, the cause involves genetic and immunologic factors, and complications can include cancer, toxic megacolon, hemorrhage, and pouchitis after colectomy.
This document provides information on Inflammatory Bowel Disease (IBD), which includes Crohn's Disease and Ulcerative Colitis. It discusses the types of IBD, symptoms, investigations, complications, and treatments. The two main types are Crohn's Disease, which causes transmural inflammation of the GI tract, and Ulcerative Colitis, which causes mucosal inflammation confined to the colon and rectum. Symptoms and complications are described for each condition. Investigations include blood tests, endoscopy, and imaging. Treatments aim to induce and maintain remission, and include medications like aminosalicylates, corticosteroids, immunosuppressants, biologics, and antibiotics
Inflammatory bowel disease refers to ulcerative colitis and Crohn's disease, which cause chronic inflammation of the intestines. Ulcerative colitis affects only the large intestine and causes ulcers, bleeding, and diarrhea. Crohn's disease can impact any part of the digestive tract and causes patchy inflammation that may lead to complications like fistulas or strictures. Both conditions are characterized by periods of remission and relapse of symptoms. Their causes are unknown but involve genetic and environmental factors. Diagnosis involves medical history, physical exam, blood tests, endoscopy, and imaging.
Enfermedad Inflamatoria de Intestino ¿Como Diagnosticarla? - www.grupodeapoyo...Grupo De Apoyo EII
Enfermedad Inflamatoria de Intestino ¿Como Diagnosticarla?
Forma parte del taller del Grupo De Apoyo De Enfermedades Inflamatorias Del Intestino. Para mas informacion visita: www.grupodeapoyoeii.org
The document discusses inflammatory bowel disease (IBD), specifically ulcerative colitis (UC) and Crohn's disease. It describes the main differences between UC and Crohn's, including that UC only affects the colon and rectum while Crohn's can affect any part of the gastrointestinal tract. The document provides details on the symptoms, diagnosis, classification, complications, and treatment of UC. Surgical management is discussed as an option when medical treatment is not effective or complications arise.
This document discusses inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease. It covers the pathogenesis, clinical features, diagnosis, and treatment of IBD. Regarding pathogenesis, IBD is thought to involve genetic and environmental factors interacting with the immune system. Clinical features vary depending on disease location and complications. Diagnosis involves endoscopy, imaging, and lab tests. Treatment follows a step-wise approach starting with medications and potentially requiring surgery. Ongoing health maintenance is also important for patients with IBD.
Ulcerative colitis and Crohn's disease are the two major types of inflammatory bowel disease. Ulcerative colitis only involves the colon while Crohn's disease can involve any part of the gastrointestinal tract. Both diseases involve chronic inflammation and can cause abdominal pain, diarrhea, and weight loss. Diagnosis involves blood tests, endoscopy, imaging, and biopsy. Treatments include medications to reduce inflammation like 5-aminosalicylates, corticosteroids, antibiotics, immunosuppressants, and biological therapies. Surgery may be required for complications or drug-resistant disease.
Ulcerative colitis is a chronic inflammatory disease of the colon that causes periods of relapse and remission. It can affect different parts of the colon. The cause is unknown but may involve an autoimmune response triggered by bacteria. Symptoms include bloody diarrhea, abdominal pain, and urgency. Investigations include blood tests, stool culture, endoscopy, and colonoscopy to determine severity and extent of disease. Treatment focuses on reducing inflammation through medications, surgery, or other procedures.
- Inflammatory bowel disease (IBD) includes Crohn's disease and ulcerative colitis, both characterized by chronic inflammation of the gastrointestinal tract. The causes are not fully understood but involve immune dysfunction and genetic factors.
- Crohn's disease can affect any part of the GI tract and cause transmural inflammation and complications like strictures and fistulas. Ulcerative colitis primarily involves only the inner mucosal layer of the colon and rectum.
- Treatment depends on disease severity and includes medications to induce and maintain remission as well as surgery for complications. The goals are to control symptoms, improve quality of life, and prevent disease progression.
ULCEARTIVE COLITIS DIAGNOSIS AND TRAETMENTBY MAGDI SASI 2015cardilogy
Ulcerative colitis is a form of inflammatory bowel disease that causes inflammation and ulcers in the lining of the rectum and colon. It typically presents with bloody diarrhea, abdominal pain, and urgency. The disease involves continuous inflammation starting in the rectum and varies in extent from distal colitis to pancolitis. It is associated with extra-intestinal manifestations affecting the skin, eyes, joints, and liver. The cause is unknown but may involve genetic factors and abnormal immune response. Treatment depends on the severity and extent of disease.
The document discusses inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease. It covers risk factors, clinical features, diagnostic methods, complications, and treatment approaches for IBD. Key points include that IBD is caused by an immune response to gut bacteria in genetically predisposed individuals, smoking protects against UC but increases risk for CD, and treatment involves medications like 5-ASAs or surgery in some cases.
Ulcerative colitis is a chronic inflammatory bowel disease that affects the colon. This document provides an overview of the definition, epidemiology, etiology, clinical features, diagnosis, and management of ulcerative colitis. It defines ulcerative colitis and describes the extent of disease involvement. Key points include that the goal of management is sustained remission through the use of medications such as aminosalicylates, immunomodulators, biologics, and surgery if needed.
Crohn's disease is a chronic inflammatory bowel disease that causes transmural inflammation anywhere in the gastrointestinal tract. It is classified based on location and disease behavior such as inflammatory, stricturing, or fistulizing. Risk factors include family history, smoking, and certain medications. Diagnosis involves evaluating symptoms, laboratory tests, endoscopy, imaging, and biopsy. Treatment depends on disease severity and complications, and may include medications, biological therapy, surgery, or a combination. The goals are to induce and maintain remission while pursuing mucosal healing.
Abdominal TB can involve any part of GIT from mouth to anus, the peritoneum and pancreato-billiary system.
Total EP TB accounts for about 10-12% of total no. of TB cases, out of which 11-16% are abdominal koch.
Sixth most frequent EP TB after lymphatics, genitourinary, bone & joint, milliary & meningeal TB.
Caused by M. tuberculosis, M. bovis & NTM.
Age group 20-40 most commonly affected & slight female preponderance has been described.
Before era of HIV infection > 80% TB was confined to lung
Extrapulmonary TB increases with HIV
40 –60% TB in HIV+ pt are extrapulmonary
Globally, proportion of co-infected pt > 8 %
~ 0.4 million people in India are co-infected.
In one study, 16.6% abdominal TB pt in Bombay was HIV +.
Mechanisms by which M. tuberculosis reach the GIT:
Hematogenous spread from primary lung focus
Ingestion of bacilli in sputum from active pulmonary focus.
Direct spread from adjacent organs.
Via lymph channels from infected LN
Rare Mechanism:
Contiguous spread of infection from a fallopian tube
TB peritonitis as complication of peritoneal dialysis
Ileum > caecum > ascending colon > jejunum
>appendix > sigmoid > rectum > duodenum
> stomach > oesophagus
More than one site may be involved
Ileum > caecum > ascending colon > jejunum
>appendix > sigmoid > rectum > duodenum
> stomach > oesophagus
More than one site may be involved
Ileum > caecum > ascending colon > jejunum
>appendix > sigmoid > rectum > duodenum
> stomach > oesophagus
More than one site may be involved
The document discusses Inflammatory Bowel Disease (IBD), including Ulcerative Colitis and Crohn's Disease, providing details on their etiology, clinical manifestations, investigations, medical and surgical management, and cancer risk. IBD is characterized by idiopathic intestinal inflammation that has genetic and environmental risk factors and can involve any part of the gastrointestinal tract. Management involves a multidisciplinary approach including medications, nutrition, and surgery.
Here are the key steps in the clinical assessment of a fistula-in-ano:
1. Detailed history regarding present illness, bowel habits, abdominal/pelvic surgeries, trauma.
2. Digital rectal examination to identify internal opening and feel tract.
3. Proctoscopy/sigmoidoscopy to directly visualize internal opening.
4. Imaging like MRI fistulogram to classify fistula and rule out other pelvic pathology.
5. Anorectal manometry and ultrasound to assess sphincter integrity if surgery is planned.
The clinical assessment aims to characterize the fistula anatomy, identify any underlying cause, assess sphincter function, and rule out alternative diagnoses to guide
This document discusses carcinoma of the rectum. It begins by explaining the anatomy of the rectum and its blood supply, lymphatic drainage and innervation. It then discusses the epidemiology, risk factors, staging systems including Dukes and TNM classification. Signs and symptoms, diagnostic workup including endoscopic, radiological and biopsy evaluation are explained. Principles of surgical treatment including resection margins are outlined. The goal of surgery is eradication of the primary tumor along with adjacent mesorectal tissue.
The document discusses acute pancreatitis, outlining its epidemiology, pathophysiology, etiology, clinical presentation, workup, severity scoring systems, treatment, prognosis, and complications. It defines acute pancreatitis as an acute condition presenting with abdominal pain associated with raised blood or urine pancreatic enzymes due to pancreatic inflammation. The document also classifies acute pancreatitis as mild or severe based on the presence of organ failure or local complications.
Abdominal tuberculosis is a common extrapulmonary manifestation of tuberculosis that most commonly involves the ileocaecal region of the small intestine. It can present with nonspecific constitutional symptoms like fever, weight loss, or abdominal pain. Diagnosis is challenging as findings can mimic other diseases like Crohn's disease, but imaging modalities like ultrasound, CT scan, and barium studies can reveal features suggestive of abdominal tuberculosis like enlarged lymph nodes, bowel wall thickening, strictures, and ascites. Blood tests are often nonspecific but may show elevated ESR or mild anemia. Sputum tests have low yield for diagnosis but help evaluate for concurrent pulmonary tuberculosis. Tissue sampling is often needed for confirmation.
The document discusses liver anatomy, injuries, and management approaches. It provides details on:
1) The surface anatomy and blood supply of the liver.
2) Common causes and presentations of liver injuries including blunt trauma, penetrating trauma, and associated injuries.
3) Classification systems for grading liver injuries based on CT imaging findings.
4) Treatment approaches including non-operative management with observation for lower grade injuries or angioembolization for bleeding, and operative management using packing, Pringle maneuver, and resection for higher grade or unstable injuries.
The document discusses the workup and diagnosis of liver masses. It describes various benign and malignant liver lesions including hemangioma, focal nodular hyperplasia, hepatic adenoma, liver cysts, hepatocellular carcinoma, and metastases. Multiphasic CT is useful for characterizing lesions based on enhancement patterns in the arterial, portal venous, and delayed phases. Biopsy may be needed to confirm diagnosis of suspicious lesions.
Pyogenic and amebic liver abscesses can develop from a variety of causes. Ultrasound or CT imaging are used to identify abscesses, which appear as hypoechoic or low attenuation areas on scans. Treatment involves intravenous antibiotics along with drainage of larger abscesses via needle aspiration or catheter placement. For pyogenic abscesses, antibiotics are chosen based on culture results and typically include combinations targeting common bacteria. Amebic abscesses are generally treated with metronidazole or other nitroimidazole antibiotics, sometimes along with drainage or other antiparasitic drugs. Complications can arise if abscesses rupture or spread beyond the liver.
This document discusses hydatid cyst, which is caused by the larval stage of Echinococcus granulosus. It can infect the liver and lungs in humans. The life cycle involves dogs and other carnivores as the definitive host, where the adult worm lives in the small intestine, and sheep as the common intermediate host. Humans can become infected through contact with dog feces or contaminated food or water. Symptoms vary but include abdominal pain and hepatomegaly. Diagnosis involves imaging like ultrasound or CT scan. Treatment involves albendazole, surgery to remove the cyst while preventing spillage, or percutaneous drainage with scolicidal agents. Complications include rupture, infection, and anaphylaxis.
This document provides information about goiter (enlargement of the thyroid gland). It begins by defining goiter and discussing the causes, which can be inflammatory, toxic, autoimmune, or physiological. It then classifies thyroid swellings and discusses the pathophysiology, clinical presentation, investigations and treatment of simple goiter. It also discusses hypothyroidism, its causes, symptoms, diagnosis and treatment. Finally, it discusses hyperthyroidism/toxic goiter, the causes including Graves' disease, and discusses Graves' disease in more detail.
The document provides information on the surgical anatomy of the thyroid gland. It discusses the location and structure of the thyroid gland, including that it has two lobes joined by an isthmus. It also describes the vascular supply, lymphatic drainage, innervation and histology of the thyroid gland. The embryological development from the pharyngeal pouches is summarized. Key aspects of the physiology of the thyroid gland including hormone production and regulation are concisely outlined.
This document discusses different types of intestinal obstruction including dynamic and adynamic obstruction. It specifically focuses on paralytic ileus which is defined as neuromuscular failure leading to failure of peristalsis. Paralytic ileus commonly occurs post-operatively and can be caused by infection, metabolic abnormalities, or reflex inhibition. Management involves decompression with nasogastric suction and maintenance of fluid and electrolyte balance. Pseudo-obstruction is also discussed which describes obstruction without a mechanical cause associated with various neuropathies or myopathies.
Intestinal obstruction occurs when the normal passage of intestinal contents is blocked. It can involve the small intestine, large intestine, or both. Obstructions are classified as mechanical, which involve a physical blockage, or dynamic/adynamic, which involve ineffective motility without a blockage. Common causes include adhesions, hernias, tumors, and volvulus. Symptoms vary based on the location and severity of the obstruction but often include colicky abdominal pain, vomiting, distention, and constipation. Diagnosis involves physical exam findings like distention and hyperperistalsis as well as imaging tests showing gas/fluid levels and other signs of obstruction.
1. Acute appendicitis is caused by obstruction of the appendix lumen, leading to increased intraluminal pressure, edema, and bacterial invasion.
2. The classic presentation includes initially vague periumbilical pain that later localizes to the right lower quadrant, accompanied by anorexia, nausea, and low-grade fever.
3. On examination, tenderness is elicited over McBurney's point with guarding and rebound tenderness. Diagnosis is suggested by clinical scoring systems and confirmed by ultrasound or CT scan showing a thick-walled, inflamed appendix.
The document discusses the evaluation and management of acute abdominal pain. It describes how acute abdominal pain can be caused by many different intra-abdominal and extra-abdominal conditions ranging from minor to life-threatening. A thorough history, physical exam, and diagnostic testing are needed to make an accurate diagnosis as the cause is often not apparent initially. Common etiologies of acute abdominal pain discussed include appendicitis, cholecystitis, diverticulitis, pancreatitis, bowel obstruction, renal colic, pelvic inflammatory disease, and ectopic pregnancy.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
2. Refers to two chronic diseases of unknown
etiology that cause inflammation of the
intestine with extra intestinal manifestations
Ulcerative colitis and Crohn's disease.
Although the diseases have some features in
common, there are some important
differences.
INFLAMMATORY BOWEL DISEASE
3. Definition
Ulcerative Colitis (UC) is a chronic inflammatory
condition of the colon that is marked by remission
and relapses.
- It is a form of inflammatory bowel disease
(IBD).
4. Epidemiology
Incidence: 8–15 per 100,000 persons .
Prevalence: 170–230 per 100,000 .
An increased incidence and prevalence is found in
developed nations, northern locale and urban
environments; among Caucasians; and among
persons of Jewish ethnicity.
5. Ulcerative colitis (UC) is a chronic disease of unknown
etiology characterized by inflammation of the mucosa
and submucosa of the large intestine.
The inflammation usually involves the rectum down to
the anal margin and extends proximally in the colon for a
variable distance.
There is no difference between men and women.
The worldwide incidence is 0.5~24 new cases per 100 000
individuals, and prevalence is 100~200 cases per 100 000.
Introduction
6. Ulcerative Colitis: Epidemiology
– High incidence areas: US, UK, northern Europe
– Young adults, commoner in females
INCIDENCE IS ON THE RISE IN ASIAN (INDIA)
POPULATION
7. Rise of Incidence in IBD in India
• Familial aggregation
• Nicotine Consumption
• Oral Contraceptives
• Dietary Habits-Refined sugars, Fast food,
cereals, bakers yeast etc
• Physical inactivity
• Early weaning
• Hygiene
• Infectious diseases- TB, Measles
8.
9. Etiology
The cause of UC remains unclear, although interplay of
genetic, microbial, and immunologic factors clearly
exists.
A limited number of environmental factors have clearly
been proven to either modify the disease or regulate the
lifetime risk of developing it. These include:
Tobacco use. Appendectomy.
Antibiotic use. - Oral contraceptive pills.
10.
11.
12. Pathology
The inflammation is limited to the mucosal layer of the
colon.
The rectum is always involved, with inflammation
extending proximally in a confluent fashion.
The disease is classified by the extent of proximal
involvement into:
- Proctitis: Involvement limited to the rectum.
- Proctosigmoiditis: Involvement of the rectosigmoid.
13. -Left-sided colitis: Involvement of the descending colon up
to the splenic flexure.
-Extensive colitis: Involvement extending proximal to the splenic
flexure.
- Pancolitis (universal colitis): Involvement of the entire colon. It is
may be associated with inflammation of the terminal ileum
(backwash ileitis).
14. Pathology
Gross Description
• Ulceroinflammatory disease, usually limited to colon, diffuse
continuous disease from rectum proximally (pancolitis in
some cases), see exceptions above; ileitis and involvement of
appendix also occurs in continuity with severe colitis;
• Usually no deep fissuring ulceration, no strictures or fistulas,
no sinus tract formation, no small intestinal involvement, no
serositis, no bowel wall thickening, no fat wrapping
• Early: mucosa is hemorrhagic, granular, friable; changes
usually diffuse (similar intensity throughout)
• Late: extensive ulceration along bowel axis; have
pseudopolyps (isolated islands of regenerating mucosa) and
flat mucosa; usually normal wall thickness and normal serosa;
• severe cases may have megacolon or fibrotic, narrow or
shortened colon
18. This is normal colonic mucosa. Note the crypts that are
lined by numerous goblet cells. In the submucosa is a
lymphoid nodule.
19. Histopathology
-Distortion of crypt architecture.
-Inflammation of crypts (cryptitis).
-Frank crypt abscesses.
-Inflammatory cells in the lamina propria.
- Pseudopolyps formation.
20.
21. Symptoms
Rectal bleeding and tenesmus are universally
present.
Diarrhea and abdominal pain are more frequent
with proximal colon involvement.
Nausea and weight loss in severe cases.
Severe abdominal pain or fever suggests
fulminant colitis or toxic megacolon.
22. Clinical Picture
Age: Ulcerative colitis presents at a young age, often in
adolescence. The median age of diagnosis is the fourth
decade of life.
Onset: acute or subacute.
Course: - Most patients experience intermittent
exacerbations with nearly complete remissions between
attacks.
About 5-10% of patients have one attack without
subsequent symptoms for decades.
23. Signs
Pallor may be evident.
Mild abdominal tenderness most localized in the hypogastrium or
left lower quadrant.
PR examination may disclose visible red blood.
Signs of malnutrition.
Severe tenderness, fever, or tachycardia suggests fulminant
disease.
24. Severity of the disease
Mild disease:
Stool frequency is less than 4 times/day with or
without blood.
No systemic signs of toxicity.
There may be mild abdominal pain or cramping.
Normal ESR.
Moderate disease:
Stool frequency is more than 4 times/day.
Minimal signs of toxicity.
Moderate abdominal pain.
25. Severe disease:
Stool frequency > 6 times/day with blood +++.
Fever > 37.5°C.
Tachycardia > 90 per minute.
ESR > 30 mm per hour.
Anaemia < 10 g/dL haemoglobin.
Albumin < 30 g/L.
27. Ulcerative Colitis Crohn Disease
Onset Acute or subacute Insidious
Extension Affects only the colon Can affect any part of the
GIT from the mouth to
the anus
Rectal involvement Always Rare
Distribution of disease Continuous area of
inflammation
Patchy areas of
inflammation
Skip lesions Absent Present
Cobblestone appearance Absent Present
Depth of inflammation Shallow, mucosal May be transmural, deep
into tissues
Comparison between Ulcerative colitis and Crohn disease
28. Ulcerative Colitis Crohn Disease
Diarrhea Bloody Usually not bloody
Abdominal mass Absent May be present
Fistula formation Rare Common
Bile duct involvement Higher rates of PSC Lower rates of PSC
Cancer risk Higher than Crohn Lower than UC
Smoking Lower risk for
smokers
Higher risk for
smokers
31. • Toxic megacolon (transverse colon with a
diameter of more than 5.0 cm to 6.0 cm with
loss of haustration)
32. Colorectal Cancer
Risk Factors:
- Duration, severity and extent of the disease.
- Positive family history.
- Concomitant PSC.
CRC appears after 8-10 years of disease. So, screening
colonoscopy is recommended with surveillance
examination every 1-2 years with 4 quadrant biopsies
every 10 cm throughout the colon.
37. Extra-intestinal Complications of UC
Sweet’s Syndrome (acute febrile neutrophilic dermatosis)
It is a skin disease characterized by sudden onset
of fever, leucocytosis, and tender, erythematous,
well-demarcated papules and plaques which show
dense infiltrates by neutrophil granulocytes on
histologic examination.
- It is named for Robert Douglas Sweet.
Punch biopsy of a skin lesion showing
neutrophilic infiltration in the dermis
with no evidence of vasculitis
38. Extra-intestinal Complications of UC
Sweet’s Syndrome
Pustular lesions with central necrosis on
the left leg of a patient with Sweet's
syndrome
41. Pouchitis
- Occurs in patients who have undergone an IPAA.
- The etiology is unknown bacterial flora may play a role.
- Symptoms include diarrhea, bleeding, urgency,
incontinence, fever, and general malaise.
- Treatment:
- Antibiotics (metronidazole and ciprofloxacin).
- Budesonide.
- Probiotics.
42. Investigations
A) Laboratory Findings
Blood picture may show leucocytosis, anaemia,
thrombocytosis.
Hypoalbuminaemia (in extensive disease).
Elevated ESR and CRP.
Stool analysis: leucocytes and fecal lactoferrin.
Infectious pathogens should be excluded.
P-ANCA–associated ulcerative colitis is more likely to be
medically refractory
43. B) Imaging Studies
1- Plain Abdominal X-ray:
- Useful predominantly in patients with symptoms of
severe or fulminant colitis. So-called thumbprinting
appearance, which is due to thickening of the colonic wall
+ bowel wall edema.
- In toxic megacolon, the bowel is dilated with loss of
haustral markings.
46. 2- Barium Enema:
- It can be useful for detecting active ulcerative
disease, polyps, or masses.
-The colon typically appears granular and
shortened.
47. Double-contrast barium
enema. The entire colon is
ahaustral, with a diffuse
granular-appearing
mucosa. The air-filled
terminal ileum is dilated.
52. Contrast-enhanced CT. A and B. Diffuse thickening and hyperenhancement of the
wall of the colon and terminal ileum. Engorgement of the vasa recti.
A B
Ulcerative colitis with backwash ileitis
53. Coronal MDCT image shows mild
symmetric wall thickening
(arrows) of the left colon with
associated lymphadenopathy in
the mesocolon.
54. C) Colonoscopy
Allows assessment of the extent and severity of the
disease. Multiple biopsies could be taken.
It helps to exclude alternative diagnoses, such as
infectious or ischemic colitis.
Findings include:
Mucosal erythema, edema, and granularity and loss of
normal vasculature.
Hemorrhages, ulcerations and a purulent exudate occurs
with severe disease.
Pseudopolyps in patients with long-standing disease.
62. Endoscopic image of ulcerative colitis affecting the left side of the
colon. The image shows confluent superficial ulceration and loss of
mucosal architecture.
63. Sigmoidoscopic view of moderately active
ulcerative colitis. Mucosa is erythematous and
friable with contact bleeding. Submucosal blood
vessels are no longer visible
69. Goals of Therapy for UC
• Inducing remission
• Maintaining remission
• Restoring and maintaining nutrition
• Maintaining patient’s quality of life
• Surgical intervention (selection of optimal
time for surgery)
70. A) Medical Treatment
1) 5-Aminosalicytes
Used in mild to moderate disease.
Effective in induction and maintenance of remission.
Also, they may decrease the risk for CRC.
Preparations:
71. Side effects: rare
- Interstitial nephritis.
- Pulmonitis.
- Pericarditis.
- Rash.
- Pancreatitis.
- Worsening of colitis.
72. 2) Corticosteroids
- Used in acute treatment of moderate to severe colitis.
-About one third of patients with ulcerative colitis require
steroids.
- Only about 50% of patients will achieve a remission and
about 30% will have a response.
-They should be tapered off once a satisfactory
maintenance medication has been started.
73. Preparations:
- Prednisone 40-60 mg/day.
- Methylprednisolone 40-60 mg/day.
- Hydrocortisone 200-300 mg/day.
- Rectally administered steroid enemas provide therapy for flares of
distal ulcerative colitis without the systemic side effects.
75. 3) Thiopurines (Azathioprine & 6-mercaptopurine)
- Effective for the maintenance of remission but due to their slow onset of action, they are
not appropriate as solo induction agents for patients with severe disease.
- Dose:
* Azathioprine 2 - 2.5 mg/kg/day.
* 6-mercaptopurine 1 - 1.5 mg/kg/day.
- Side effects:
- Leucopenia. - Pancreatitis.
- Hepatitis. - Nausea.
76. 4) Infliximab (Remicade 100 mg vial)
- Its an IgG monoclonal antibody directed against TNF.
- Its effective for the induction and maintenance of remission.
- It offers a less toxic alternative to cyclosporine for patients with severe disease. Also, it can be
used in patients who are steroid refractory or steroid dependent and for patients who are
failing to respond to azathioprine & 6-mercaptopurine.
- Dose:
* Induction of remission: 5 mg/kg IV at weeks 0, 2, 6.
* Maintenance: 5 mg/kg IV every 8 weeks.
77. 5) Cyclosporine
- Its used as last line medical therapy to treat hospitalized patients
with severe ulcerative colitis.
- Dose:
* 2-4 mg/kg/day given as a continuous infusion.
- Side effects:
- Nephrotoxicity.
- Opportunistic infections.
- Seizures.
78. - Surgical options:
- Proctocolectomy and creation of IPAA.
- Proctocolectomy with end ileostomy.
- Proctocolectomy with continent ileostomy.
- Laparoscopic approach.
79. • Uncontrollable colonic hemorrhage
• Failure to control severe attacks or toxic megacolon
• Colonic perforation
• Chronic symptoms despite medical therapy
• Medication side effects without disease control
• Dysplasia or Cancer
• Growth retardation
Surgery in UC : why & when?
80. Surgery in UC : why & when?
Intractability:
- Colitis refractory to medical management
- Often due to side effects of medical treatments
- Most common indication for operation
Dysplasia/Carcinoma:
- high-grade dysplasia : absolute indication
Massive Colonic Bleeding:
- very infrequent; less than 5% of urgent UC colectomies
Toxic Megacolon:
- acute colitis accompanied by significant colonic dilatation
- high fever, severe abdominal pain,tachycardia, leukocytosis
- predisposed to perforation
- treatment: IVF resuscitation, antibiotics, steroids, immunosuppressives
- clinical deterioration despite above : urgent operation
81. ypes of Operations
Total Proctocolectomy with End-Ileostomy:
- removes entire colon, rectum, and anus
- performed in one stage; avoids problems of multiple operations
- disadvantages: permanent stoma, problems with healing perineal wound
Total Abdominal Colectomy with Hartmann’s Closure or Mucous
Fistula:
- used in acutely sick patients (fulminant colitis, toxic megacolon)
Total Proctocolectomy with Ileal Pouch-Anal Anastomosis:
- gold standard
- requires good anorectal function and sphincter tone
- generally performed on patients younger than 65
82.
83.
84.
85. Complications of UC Surgery
• Mortality (<0.5%)
• 3-10 stools/24 hrs so bowel pattern not normal
• Impotence (1.5%)
• Pouchitis (10-60%)
• Small bowel obstruction (20%)
• Decrease in female fertility (56-98%)
• Pouch-vaginal fistula (4%)
87. IBD conclusion
• It is a chronic disorders
• Need to exclude other possibilities
• Need to differentiate between the two
• Need long term management with primary
goal to induce then maintain remission and
prevent complications of both the disease
and drugs.