lower GIT bleeding: is bleeding from a source distal to the ligament of Treitz (duodenojejunal junction), presented as
Hematochezia is blood passed with stool from the anus,
Melena is black, tarry stool produced by the oxidation of heme by intestinal flora; as little as 50 mL of blood may result in melena, and it may persist for 3 to 5 days following resolution of the bleed.
Maroon-colored stool is associated with rapidly bleeding small bowel lesions in which the transit of blood is too fast for complete oxidation.
Currant-jelly stool is associated with ischemic small bowel or proximal colonic lesions such as may be seen in intussusception.
Upper GIT bleeding: is bleeding from a source proximal to the ligament of Treitz (duodenojejunal junction).
Discussion included the definition of bleeding per rectum, it's types according to child age groups, it's presentation, how to diagnose each type and how to treat.
Intestinal duplications are rare congenital anomalies consisting of tubular or spherical structures attached to the intestine with a shared blood supply and intestinal lining. They are classified into 3 categories: localized duplications occurring anywhere in the gastrointestinal tract, duplications associated with spinal cord anomalies, and duplications of the colon associated with urinary/genital anomalies. Clinical manifestations include bowel obstruction, abdominal pain, and palpable masses. Diagnosis is based on history and physical exam. Treatment involves surgical resection and management of any associated defects.
An acute abdomen is severe abdominal pain lasting less than 24 hours with signs of tenderness. It requires rapid diagnosis and treatment as some causes like perforation require urgent surgery. Common causes are hemorrhage, infection, perforation, blockage, and ischemia. Physical exam, lab tests, imaging like CT scans, and diagnostic tools help determine the cause. Indications for urgent surgery include signs of peritonitis, shock, deterioration on conservative care, and radiologic findings suggestive of a condition like perforation requiring operation. Preoperative preparation focuses on IV access, fluid resuscitation, antibiotics, and correcting electrolyte abnormalities.
This document discusses intestinal obstruction, including its causes, classifications, symptoms, diagnosis and treatment. Some key points:
- Intestinal obstruction can be caused by adhesions, hernias, tumors, strictures and more. It is classified by the obstructed site and presence of blood flow issues.
- Symptoms include pain, vomiting, constipation and distension. Signs depend on obstruction location and duration. Strangulated obstructions require urgent surgery to prevent tissue death.
- Diagnosis involves medical history, physical exam, imaging like x-rays and CT scans. Treatment involves resuscitation, nasogastric drainage, and surgery to relieve the obstruction and address the underlying cause. S
The Child with Abdominal Pain: NHS Modernisation AgencyArm inarm
This document provides guidance on evaluating abdominal pain in children. It outlines taking a thorough history and performing a careful physical exam, paying attention to signs of serious conditions like appendicitis. Common causes of pediatric abdominal pain include constipation, infections, and nonspecific abdominal pain, though rarer surgical issues like intussusception may also need consideration. A systematic approach is advocated to identify potential medical or surgical conditions causing a child's abdominal symptoms.
The document provides an overview of the approach to acute abdomen. It defines acute abdomen and outlines the general approach using the SOAP method - taking a history, performing a physical exam, ordering investigations, and creating a treatment plan. Common causes of acute abdomen are then discussed through various case scenarios involving factors like age, location of pain, onset, character, and associated symptoms. A detailed guide is given for examining the abdomen and evaluating vital signs, jugular venous pressure, lymph nodes, and potential referrals from other organ systems. Key blood tests are also outlined to check for indicators of issues like infection, hemorrhage, or electrolyte imbalances.
The document provides information about acute appendicitis including:
1. Appendicitis is an inflammation of the appendix and remains a common acute surgical condition. It has a lifetime occurrence of approximately 12% in men and 25% in women.
2. The cause is unclear but obstruction is thought to play a main role by causing inflammation. This can lead to perforation or gangrene if not treated.
3. The diagnosis is typically based on the patient's history and symptoms of abdominal pain migrating to the lower right quadrant, as well as signs on examination like tenderness at McBurney's point. Imaging studies like CT scans can help diagnose unclear cases.
Delayed passage of meconium can be caused by several intestinal obstructions and diseases. It is suspected in full-term infants who do not pass meconium in the first 24 hours and in premature infants who delay passage for over a week. Diagnostic workup includes abdominal x-rays, ultrasound, and contrast studies to locate the obstruction. Management requires gastric decompression, fluid resuscitation to address dehydration, and monitoring of electrolytes and glucose levels which may become imbalanced. The cause is determined based on the presentation and imaging findings, and treatment involves surgery for structural issues or supportive care for medical conditions.
This document discusses several congenital anomalies of the gastrointestinal tract, including Meckel's diverticulum, Hirschsprung's disease, and pyloric stenosis. Meckel's diverticulum is a true diverticulum of the small intestine resulting from persistence of the vitelline duct. It occurs in 2% of the population and can cause bleeding, obstruction, or inflammation. Hirschsprung's disease is caused by absence of ganglion cells in parts of the colon and is the most common cause of intestinal obstruction in neonates. Pyloric stenosis results from hypertrophy of the pyloric muscle and causes non-bilious vomiting in infants, usually starting after 3 weeks of age.
Intestinal duplications are rare congenital anomalies consisting of tubular or spherical structures attached to the intestine with a shared blood supply and intestinal lining. They are classified into 3 categories: localized duplications occurring anywhere in the gastrointestinal tract, duplications associated with spinal cord anomalies, and duplications of the colon associated with urinary/genital anomalies. Clinical manifestations include bowel obstruction, abdominal pain, and palpable masses. Diagnosis is based on history and physical exam. Treatment involves surgical resection and management of any associated defects.
An acute abdomen is severe abdominal pain lasting less than 24 hours with signs of tenderness. It requires rapid diagnosis and treatment as some causes like perforation require urgent surgery. Common causes are hemorrhage, infection, perforation, blockage, and ischemia. Physical exam, lab tests, imaging like CT scans, and diagnostic tools help determine the cause. Indications for urgent surgery include signs of peritonitis, shock, deterioration on conservative care, and radiologic findings suggestive of a condition like perforation requiring operation. Preoperative preparation focuses on IV access, fluid resuscitation, antibiotics, and correcting electrolyte abnormalities.
This document discusses intestinal obstruction, including its causes, classifications, symptoms, diagnosis and treatment. Some key points:
- Intestinal obstruction can be caused by adhesions, hernias, tumors, strictures and more. It is classified by the obstructed site and presence of blood flow issues.
- Symptoms include pain, vomiting, constipation and distension. Signs depend on obstruction location and duration. Strangulated obstructions require urgent surgery to prevent tissue death.
- Diagnosis involves medical history, physical exam, imaging like x-rays and CT scans. Treatment involves resuscitation, nasogastric drainage, and surgery to relieve the obstruction and address the underlying cause. S
The Child with Abdominal Pain: NHS Modernisation AgencyArm inarm
This document provides guidance on evaluating abdominal pain in children. It outlines taking a thorough history and performing a careful physical exam, paying attention to signs of serious conditions like appendicitis. Common causes of pediatric abdominal pain include constipation, infections, and nonspecific abdominal pain, though rarer surgical issues like intussusception may also need consideration. A systematic approach is advocated to identify potential medical or surgical conditions causing a child's abdominal symptoms.
The document provides an overview of the approach to acute abdomen. It defines acute abdomen and outlines the general approach using the SOAP method - taking a history, performing a physical exam, ordering investigations, and creating a treatment plan. Common causes of acute abdomen are then discussed through various case scenarios involving factors like age, location of pain, onset, character, and associated symptoms. A detailed guide is given for examining the abdomen and evaluating vital signs, jugular venous pressure, lymph nodes, and potential referrals from other organ systems. Key blood tests are also outlined to check for indicators of issues like infection, hemorrhage, or electrolyte imbalances.
The document provides information about acute appendicitis including:
1. Appendicitis is an inflammation of the appendix and remains a common acute surgical condition. It has a lifetime occurrence of approximately 12% in men and 25% in women.
2. The cause is unclear but obstruction is thought to play a main role by causing inflammation. This can lead to perforation or gangrene if not treated.
3. The diagnosis is typically based on the patient's history and symptoms of abdominal pain migrating to the lower right quadrant, as well as signs on examination like tenderness at McBurney's point. Imaging studies like CT scans can help diagnose unclear cases.
Delayed passage of meconium can be caused by several intestinal obstructions and diseases. It is suspected in full-term infants who do not pass meconium in the first 24 hours and in premature infants who delay passage for over a week. Diagnostic workup includes abdominal x-rays, ultrasound, and contrast studies to locate the obstruction. Management requires gastric decompression, fluid resuscitation to address dehydration, and monitoring of electrolytes and glucose levels which may become imbalanced. The cause is determined based on the presentation and imaging findings, and treatment involves surgery for structural issues or supportive care for medical conditions.
This document discusses several congenital anomalies of the gastrointestinal tract, including Meckel's diverticulum, Hirschsprung's disease, and pyloric stenosis. Meckel's diverticulum is a true diverticulum of the small intestine resulting from persistence of the vitelline duct. It occurs in 2% of the population and can cause bleeding, obstruction, or inflammation. Hirschsprung's disease is caused by absence of ganglion cells in parts of the colon and is the most common cause of intestinal obstruction in neonates. Pyloric stenosis results from hypertrophy of the pyloric muscle and causes non-bilious vomiting in infants, usually starting after 3 weeks of age.
1. The document discusses the evaluation and management of various gastrointestinal disorders in children including abdominal pain, vomiting, diarrhea, constipation, and other issues.
2. Key points include recognizing signs and symptoms of conditions like appendicitis, intussusception, Hirschsprung's disease, gastroesophageal reflux, and infectious causes of diarrhea.
3. Management involves considering differential diagnoses, performing appropriate testing, and treating underlying causes or symptoms while monitoring for complications.
Pediatric GI problems
Abdominal pain in children
DDx: Acute abdominal pain
Inflammatory:
• Abdominal infection: appendicitis, gastroenteritis, UTI, mesenteric adenitis (post URTI), mumps pancreatitis, hepatitis.
• Lower lobe pneumonia.
• Autoimmune: IBD, HSP, DKA.
Anatomical:
• GI obstruction, constipation.
• Meckel's complication e.g. obstruction, inflammation. However, Meckel's is usually asymptomatic.
• Renal and genitourinary: hydronephrosis, menstruation.
• Compressed anatomy: strangulated inguinal hernia, testis torsion.
Acute abdominal pain in children often has no specific cause ('non-specific abdominal pain'), and resolves in 24h.
Students can also use this service to download free books and upload slides. For more information, Visit on https://bookapp.page.link/tele.
Inthis playlist, i discussed various causes for Lower GI Hemorrahage like Hemorrhoids, Fissure in ano, diverticulosis, inflammatory bowel disease and colorectal cancer
Peritonitis is an inflammation of the peritoneum caused by bacterial or fungal infection. Left untreated, it can lead to sepsis, multiple organ failure and death. There are three main types: primary occurs spontaneously with liver failure; secondary follows a perforation of abdominal organs; tertiary occurs in immuno-compromised people like with AIDS and tuberculosis. Symptoms include severe abdominal pain, fever, nausea and vomiting. Diagnosis involves medical history, exams, blood tests and imaging scans. Treatment requires intravenous fluids, antibiotics, pain relief, and may require surgery to repair damaged organs and drain infections. With proper treatment outcomes are good, but risks include sepsis, adhesions and organ failure if not addressed promptly.
This document discusses appendicitis, including its causes, symptoms, diagnosis, and treatment. The appendix is a small pouch connected to the cecum in the digestive system. Appendicitis occurs when the appendix becomes blocked and infected, causing swelling. Common symptoms include abdominal pain localized to the lower right side, nausea, loss of appetite, and fever. Doctors use physical exams, blood tests, imaging like CT scans, and ultrasounds to diagnose appendicitis and rule out other potential causes of abdominal pain. Untreated appendicitis can lead to a burst appendix, so surgical removal of the inflamed appendix (appendectomy) is usually required to treat appendicitis.
Intussusception is the invagination of one part of the intestine into another. It most commonly occurs in infants and children between 6 months and 2 years of age. Ultrasound is the preferred method of diagnosis as it can clearly visualize the "coiled-spring" or "bull's-eye" pattern of intussusception. Non-operative reduction using hydrostatic or pneumatic enema under fluoroscopic or ultrasound guidance is the first-line treatment and has high success rates of 80-95%. Surgical intervention is needed if non-operative reduction fails or if there is evidence of intestinal ischemia or perforation.
This document provides an overview of common gastrointestinal abnormalities seen in pediatric patients. It discusses conditions such as vomiting, hypertrophic pyloric stenosis, duodenal atresia, intestinal malrotation, midgut volvulus, meconium ileus, necrotizing enterocolitis, Meckel's diverticulum, intussusception, appendicitis, Hirschsprung disease, mesenteric cysts, and anorectal malformations. For each condition, it provides a brief definition and discussion of relevant physical exam findings, diagnostic approaches, and treatment considerations for pediatric patients.
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
Appendicitis is a common condition in children that requires surgical removal of the appendix (appendectomy). It occurs when the appendix becomes blocked, usually by lymphoid hyperplasia or fecalith, leading to bacterial infection inside the appendix. This causes abdominal pain localized to the right lower quadrant. Left untreated, the infection and pressure can cause the appendix to perforate, spreading infection into the abdomen. An appendectomy is required once appendicitis is diagnosed to prevent perforation or treat one that has already occurred. Pre-operative resuscitation and antibiotics may be needed for severely infected patients before surgery.
Peptic Ulcer complications By Abdullah Farooqi GM20-148.pptxshiv847105
The document discusses complications that can arise from peptic ulcers, including bleeding, perforation, and obstruction. Bleeding occurs when ulcers erode blood vessels, which can lead to vomiting blood or black stools. Perforation happens when an ulcer eats through the stomach or intestinal wall, causing severe abdominal pain and potentially shock. Obstruction develops from scarring that narrows the digestive tract and blocks food passage.
This document provides information on the anatomy, physiology, diagnosis, and treatment of appendicitis. It discusses the typical presentation of acute appendicitis including abdominal pain localized to the right lower quadrant. It also covers complications such as perforation and abscess formation. Treatment is generally surgical removal of the appendix (appendectomy), which can be performed openly or laparoscopically. Prognosis is generally good, though delayed diagnosis and treatment can increase risks of complications.
Around 7-10% of emergency department visits are for abdominal pain. A thorough history and physical exam are important for diagnosing the cause, which could include conditions like appendicitis, diverticulitis, or bowel obstruction. The physical exam involves inspection, auscultation, percussion, and palpation looking for signs of tenderness, guarding, rebound tenderness, or masses. Complications if not treated could include infections, necrosis, fistula, or even death. An accurate diagnosis is important as misdiagnosis increases mortality rates.
TWO MAIN TYPE OF INFLAMMATORY BOWEL DISEASE pptJoshua Owoh
There are two main types of inflammatory bowel disease: Crohn's disease and ulcerative colitis. Crohn's disease causes inflammation of the digestive tract which can affect any area from the mouth to the anus, whereas ulcerative colitis only affects the large intestine and rectum. The causes of inflammatory bowel disease are unknown, but it is believed to involve genetic and environmental factors that trigger an abnormal immune response in the gastrointestinal tract. Symptoms vary between individuals but commonly include abdominal pain, diarrhea, weight loss, and fatigue. Treatment involves medication, nutrition therapy, and sometimes surgery to control inflammation and complications.
This document describes a case of a 12-year-old female who presented with abdominal pain and signs of peritonitis. She underwent an exploratory laparotomy which revealed a Meckel's diverticulum with gastric mucosa and a jejunal perforation. She had a complicated postoperative course requiring a second surgery. Meckel's diverticulum is a common congenital abnormality caused by incomplete vitelline duct obliteration. It can contain heterotopic gastric or pancreatic mucosa and commonly presents in children with GI bleeding. Surgical resection is often required for complications like perforation or obstruction.
This document provides information on urinalysis results and abnormalities seen in urine tests. Normal urine is yellow in color and contains few cells, crystals or proteins. Abnormal results include cloudiness, foul smell, presence of blood, increased specific gravity, proteins, crystals, sugars, ketones, bilirubin or casts. Common urinary tract infections are also discussed, along with their symptoms, diagnostic tests and treatment.
Necrotizing enterocolitis (NEC) is a common gastrointestinal emergency in neonates, especially preterm infants. It involves necrosis of the intestinal mucosa associated with inflammation and infection. Risk factors include prematurity, enteral feeding, and intestinal ischemia. Clinically, NEC presents with abdominal and systemic signs. Diagnosis is based on clinical features and radiographic findings like pneumatosis intestinalis. Treatment involves cessation of feeding, antibiotics, and possible surgery for perforation or failure to improve. Prognosis depends on gestational age and severity of disease. Prevention focuses on exclusive breastfeeding when possible.
Necrotizing enterocolitis (NEC) is a life-threatening condition that affects the intestines of premature infants. It results from necrosis of the intestinal tissue and can range from mild to severe. Risk factors include prematurity, formula feeding, and bacterial or viral infections. Symptoms may include abdominal distension, bloody stools, and temperature instability. Diagnosis involves x-rays showing pneumatosis intestinalis or portal venous gas. Treatment focuses on gut rest, broad-spectrum antibiotics, surgery for perforation or failure to improve, and careful feeding advancement after recovery. Outcomes depend on severity but may include strictures, adhesions, or short bowel syndrome.
Necrotizing enterocolitis (NEC) is a life-threatening condition that affects the intestines of premature infants. It results from necrosis of the intestinal tissue and can range from mild to severe. Risk factors include prematurity, formula feeding, and bacterial or viral infections. Symptoms may include abdominal distension, vomiting, and bloody stools. Diagnosis is confirmed through x-ray evidence of pneumatosis intestinalis or portal venous gas. Treatment involves gut rest, antibiotics, surgery for perforation or failure to improve. Despite advances, NEC remains a major cause of death in preterm neonates.
Intussusception is the telescoping of the proximal bowel into the distal bowel. It is most common in children under 2 years old, with the majority of cases being idiopathic. The classic triad of symptoms includes intermittent abdominal pain, a sausage-shaped abdominal mass, and bloody stools, though this triad is present in less than 15% of cases. Ultrasound is the preferred diagnostic tool, showing a target or doughnut-shaped mass. Treatment involves rehydration and stabilization, with non-operative reduction via hydrostatic or pneumatic enema being first-line for stable patients without evidence of perforation. Surgery is pursued if non-operative reduction fails or if there are signs of
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
1. The document discusses the evaluation and management of various gastrointestinal disorders in children including abdominal pain, vomiting, diarrhea, constipation, and other issues.
2. Key points include recognizing signs and symptoms of conditions like appendicitis, intussusception, Hirschsprung's disease, gastroesophageal reflux, and infectious causes of diarrhea.
3. Management involves considering differential diagnoses, performing appropriate testing, and treating underlying causes or symptoms while monitoring for complications.
Pediatric GI problems
Abdominal pain in children
DDx: Acute abdominal pain
Inflammatory:
• Abdominal infection: appendicitis, gastroenteritis, UTI, mesenteric adenitis (post URTI), mumps pancreatitis, hepatitis.
• Lower lobe pneumonia.
• Autoimmune: IBD, HSP, DKA.
Anatomical:
• GI obstruction, constipation.
• Meckel's complication e.g. obstruction, inflammation. However, Meckel's is usually asymptomatic.
• Renal and genitourinary: hydronephrosis, menstruation.
• Compressed anatomy: strangulated inguinal hernia, testis torsion.
Acute abdominal pain in children often has no specific cause ('non-specific abdominal pain'), and resolves in 24h.
Students can also use this service to download free books and upload slides. For more information, Visit on https://bookapp.page.link/tele.
Inthis playlist, i discussed various causes for Lower GI Hemorrahage like Hemorrhoids, Fissure in ano, diverticulosis, inflammatory bowel disease and colorectal cancer
Peritonitis is an inflammation of the peritoneum caused by bacterial or fungal infection. Left untreated, it can lead to sepsis, multiple organ failure and death. There are three main types: primary occurs spontaneously with liver failure; secondary follows a perforation of abdominal organs; tertiary occurs in immuno-compromised people like with AIDS and tuberculosis. Symptoms include severe abdominal pain, fever, nausea and vomiting. Diagnosis involves medical history, exams, blood tests and imaging scans. Treatment requires intravenous fluids, antibiotics, pain relief, and may require surgery to repair damaged organs and drain infections. With proper treatment outcomes are good, but risks include sepsis, adhesions and organ failure if not addressed promptly.
This document discusses appendicitis, including its causes, symptoms, diagnosis, and treatment. The appendix is a small pouch connected to the cecum in the digestive system. Appendicitis occurs when the appendix becomes blocked and infected, causing swelling. Common symptoms include abdominal pain localized to the lower right side, nausea, loss of appetite, and fever. Doctors use physical exams, blood tests, imaging like CT scans, and ultrasounds to diagnose appendicitis and rule out other potential causes of abdominal pain. Untreated appendicitis can lead to a burst appendix, so surgical removal of the inflamed appendix (appendectomy) is usually required to treat appendicitis.
Intussusception is the invagination of one part of the intestine into another. It most commonly occurs in infants and children between 6 months and 2 years of age. Ultrasound is the preferred method of diagnosis as it can clearly visualize the "coiled-spring" or "bull's-eye" pattern of intussusception. Non-operative reduction using hydrostatic or pneumatic enema under fluoroscopic or ultrasound guidance is the first-line treatment and has high success rates of 80-95%. Surgical intervention is needed if non-operative reduction fails or if there is evidence of intestinal ischemia or perforation.
This document provides an overview of common gastrointestinal abnormalities seen in pediatric patients. It discusses conditions such as vomiting, hypertrophic pyloric stenosis, duodenal atresia, intestinal malrotation, midgut volvulus, meconium ileus, necrotizing enterocolitis, Meckel's diverticulum, intussusception, appendicitis, Hirschsprung disease, mesenteric cysts, and anorectal malformations. For each condition, it provides a brief definition and discussion of relevant physical exam findings, diagnostic approaches, and treatment considerations for pediatric patients.
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
Appendicitis is a common condition in children that requires surgical removal of the appendix (appendectomy). It occurs when the appendix becomes blocked, usually by lymphoid hyperplasia or fecalith, leading to bacterial infection inside the appendix. This causes abdominal pain localized to the right lower quadrant. Left untreated, the infection and pressure can cause the appendix to perforate, spreading infection into the abdomen. An appendectomy is required once appendicitis is diagnosed to prevent perforation or treat one that has already occurred. Pre-operative resuscitation and antibiotics may be needed for severely infected patients before surgery.
Peptic Ulcer complications By Abdullah Farooqi GM20-148.pptxshiv847105
The document discusses complications that can arise from peptic ulcers, including bleeding, perforation, and obstruction. Bleeding occurs when ulcers erode blood vessels, which can lead to vomiting blood or black stools. Perforation happens when an ulcer eats through the stomach or intestinal wall, causing severe abdominal pain and potentially shock. Obstruction develops from scarring that narrows the digestive tract and blocks food passage.
This document provides information on the anatomy, physiology, diagnosis, and treatment of appendicitis. It discusses the typical presentation of acute appendicitis including abdominal pain localized to the right lower quadrant. It also covers complications such as perforation and abscess formation. Treatment is generally surgical removal of the appendix (appendectomy), which can be performed openly or laparoscopically. Prognosis is generally good, though delayed diagnosis and treatment can increase risks of complications.
Around 7-10% of emergency department visits are for abdominal pain. A thorough history and physical exam are important for diagnosing the cause, which could include conditions like appendicitis, diverticulitis, or bowel obstruction. The physical exam involves inspection, auscultation, percussion, and palpation looking for signs of tenderness, guarding, rebound tenderness, or masses. Complications if not treated could include infections, necrosis, fistula, or even death. An accurate diagnosis is important as misdiagnosis increases mortality rates.
TWO MAIN TYPE OF INFLAMMATORY BOWEL DISEASE pptJoshua Owoh
There are two main types of inflammatory bowel disease: Crohn's disease and ulcerative colitis. Crohn's disease causes inflammation of the digestive tract which can affect any area from the mouth to the anus, whereas ulcerative colitis only affects the large intestine and rectum. The causes of inflammatory bowel disease are unknown, but it is believed to involve genetic and environmental factors that trigger an abnormal immune response in the gastrointestinal tract. Symptoms vary between individuals but commonly include abdominal pain, diarrhea, weight loss, and fatigue. Treatment involves medication, nutrition therapy, and sometimes surgery to control inflammation and complications.
This document describes a case of a 12-year-old female who presented with abdominal pain and signs of peritonitis. She underwent an exploratory laparotomy which revealed a Meckel's diverticulum with gastric mucosa and a jejunal perforation. She had a complicated postoperative course requiring a second surgery. Meckel's diverticulum is a common congenital abnormality caused by incomplete vitelline duct obliteration. It can contain heterotopic gastric or pancreatic mucosa and commonly presents in children with GI bleeding. Surgical resection is often required for complications like perforation or obstruction.
This document provides information on urinalysis results and abnormalities seen in urine tests. Normal urine is yellow in color and contains few cells, crystals or proteins. Abnormal results include cloudiness, foul smell, presence of blood, increased specific gravity, proteins, crystals, sugars, ketones, bilirubin or casts. Common urinary tract infections are also discussed, along with their symptoms, diagnostic tests and treatment.
Necrotizing enterocolitis (NEC) is a common gastrointestinal emergency in neonates, especially preterm infants. It involves necrosis of the intestinal mucosa associated with inflammation and infection. Risk factors include prematurity, enteral feeding, and intestinal ischemia. Clinically, NEC presents with abdominal and systemic signs. Diagnosis is based on clinical features and radiographic findings like pneumatosis intestinalis. Treatment involves cessation of feeding, antibiotics, and possible surgery for perforation or failure to improve. Prognosis depends on gestational age and severity of disease. Prevention focuses on exclusive breastfeeding when possible.
Necrotizing enterocolitis (NEC) is a life-threatening condition that affects the intestines of premature infants. It results from necrosis of the intestinal tissue and can range from mild to severe. Risk factors include prematurity, formula feeding, and bacterial or viral infections. Symptoms may include abdominal distension, bloody stools, and temperature instability. Diagnosis involves x-rays showing pneumatosis intestinalis or portal venous gas. Treatment focuses on gut rest, broad-spectrum antibiotics, surgery for perforation or failure to improve, and careful feeding advancement after recovery. Outcomes depend on severity but may include strictures, adhesions, or short bowel syndrome.
Necrotizing enterocolitis (NEC) is a life-threatening condition that affects the intestines of premature infants. It results from necrosis of the intestinal tissue and can range from mild to severe. Risk factors include prematurity, formula feeding, and bacterial or viral infections. Symptoms may include abdominal distension, vomiting, and bloody stools. Diagnosis is confirmed through x-ray evidence of pneumatosis intestinalis or portal venous gas. Treatment involves gut rest, antibiotics, surgery for perforation or failure to improve. Despite advances, NEC remains a major cause of death in preterm neonates.
Intussusception is the telescoping of the proximal bowel into the distal bowel. It is most common in children under 2 years old, with the majority of cases being idiopathic. The classic triad of symptoms includes intermittent abdominal pain, a sausage-shaped abdominal mass, and bloody stools, though this triad is present in less than 15% of cases. Ultrasound is the preferred diagnostic tool, showing a target or doughnut-shaped mass. Treatment involves rehydration and stabilization, with non-operative reduction via hydrostatic or pneumatic enema being first-line for stable patients without evidence of perforation. Surgery is pursued if non-operative reduction fails or if there are signs of
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
2. Overview
gastrointestinal tract bleeding
Gastrointestinal (GI) bleeding occurs rarely in children; severity varies
from the insidious bleeding, with only iron-deficiency anemia
suggestive of occult hemorrhage, to dramatic hemorrhage with
rapidly evolving, life-threatening hypovolemic shock.
Upper GI bleeding is bleeding from a source proximal to the ligament
of Treitz (duodenojejunal junction), presented with Hematemesis that
is vomiting of frank blood and suggests a rapidly bleeding lesion and
Coffee-ground emesis describes the appearance of vomited blood
that has been coagulated by gastric acid.
3. LOWER GIT BLEEDING
is bleeding from a source distal to the ligament of Treitz
(duodenojejunal junction), presented as Hematochezia that is blood
passed with stool from the anus, Melena is black, tarry stool produced by
the oxidation of heme by intestinal flora; as little as 50 mL of blood may
result in melena, and it may persist for 3 to 5 days following resolution of
the bleed. Maroon-colored stool is associated with rapidly bleeding small
bowel lesions in which the transit of blood is too fast for complete
oxidation. Currant-jelly stool is associated with ischemic small bowel or
proximal colonic lesions such as may be seen in intussusception.
4. Blood limited to the outside of otherwise unremarkable stool
suggests a rectal origin; blood mixed throughout the stool suggests a
colonic source.
Occult GI bleeding is bleeding that occurs in the absence of overt
bleeding and is usually suspected due to chronic iron-deficiency
anemia or is identified by hemoccult examination.
Large-volume upper intestinal hemorrhage may present with lower GI
bleeding, particularly in infants, so it is important to consider causes
of upper GI bleeding in the differential diagnosis.
5.
6.
7. LOWER GIT BLEEDING IN NEONATE
Hematochezia or melena in newborns should prompt
concerns for necrotizing enterocolitis, particularly in
premature or critically ill newborns. Bowel obstruction,
such as with midgut volvulus, should also be considered.
8. 31 week GA male baby , delivered by NVD, cried
immediately after birth but owing to poor respiratory
efforts needed intubation and ventilation, on the 7
day of life he was noted to have abdominal distension
that rapidly progress to shiny red abdomen associated
with bloody loose stool.
Q what’s most likely diagnosis?
9. Necrotising enterocolitis
it typically presents with abdominal distension and bile-stained
vomiting, resembling obstruction. The passage of blood per rectum
and a characteristic appearance on abdominal x-ray help to
distinguish necrotising enterocolitis from neonatal bowel obstruction.
10. The radiological findings are
typical. Plain abdominal x-
rays demonstrate dilated
loops of bowel in which
there are intramural bubbles
of gas (pneumastosis
intestinalis). Gas within the
portal vein and/or its radicles
may be visible. Free gas in
the peritoneal cavity, best
seen under the diaphragm, is
present if the intestine has
perforated. Separation of
adjacent loops of bowel
suggests appreciable
11.
12. Case
A 1-day-old baby presents with bile-stained vomiting but no
abdominal distension.
Q What are the causes of a high neonatal bowel obstruction?
13. Volvulus neonatorum
The typical case is a healthy full-term baby who is well for the first few
days of life but then develops feeding difficulties with bile-stained
vomiting. At this early stage, the abdomen is soft and non-distended.
The diagnosis should be suspected at this stage and confirmed with
an urgent upper gastrointestinal contrast study. Abdominal distension
with tenderness and passage of blood per rectum are late features
and indicate major gut ischaemia.
14. Investigations
An upper gastrointestinal
contrast study will
demonstrate the abnormal
position of the duodeno-
jejunal junction and the
contrast may spiral through
the twisted gut . Investigation
is urgent but must not be
allowed to delay the definitive
surgical treatment.
15. Eosinophilic proctocolitis may result from dietary protein intolerance
and may present with painless hematochezia in otherwise healthy-
appearing newborns.
A history of constipation in an infant presenting With bloody diarrhea
may suggest a diagnosis of enterocolitis associated with Hirschsprung
disease.
Hemorrhagic disease of the newborn should be considered in
newborns not receiving vitamin K at birth.
Swallowing of maternal blood, either during delivery or from a
cracked nipple, may give rise to blood in vomit or stool,
masquerading as alimentary tract haemorrhage.
17. Case
A 6-month-old baby presents with pain and rectal
bleeding with defaecation.
Q What is the likely diagnosis and management of
this common problem?
18. Anal fissure
Anal fissure occurs at any age and usually is due to constipation . The
child passes a large, hard stool, which tears the anal mucosa, usually
in the midline, either posteriorly or anteriorly. If old enough, the child
complains of pain on defaecation, and there is bright blood on the
surface of the stool, The fissure may be seen by gently parting the
anus. Rectal examination causes severe pain.
19. Rectal polyp
Juvenile rectal polyps are isolated
benign hamartomas and are a
relatively common cause of rectal
bleeding. Bright bleeding is
produced painlessly at the end of
defecation and is typically
intermittent over long periods. The
polyp is almost always within reach
of an examining finger, and
occasionally prolapses through the
anus
20. Rectal prolapse
Most children with rectal
prolapse have normal pelvic
anatomy. The prolapse rolls out
painlessly only during
defaecation and usually returns
spontaneously; manual
replacement is required
infrequently. The mucosa
may become abraded while it is
prolapsed and cause minor
bleeding
21. A 5-month-old boy has a 48 h history of being unwell and
vomiting. At times, he appears to have been in severe pain. He
looks pale and lethargic. There is a vague impression of a mass on
the right side of his abdomen.
Q1. What is the likely diagnosis?
22. Intussusception
Pain is the most important symptom (85%). It typically commences as
a colicky pain lasting 2–3 min, during which time the infant screams
and draws up his knees. Spasms typically occur at intervals of 15–20
min. The infant becomes intermittently pale and clammy (similar to a
syncopal episode in older children), exhausted and lethargic between
spasms. After 12 h or so, the pain becomes more continuous.
23. A mass (sometimes described as
sausage shaped) is palpable in more
than half the infants and is usually
found in the right hypochondrium,
is most likely to be felt early, before
being concealed by abdominal
distension and increasing abdominal
tenderness.
About half the patients pass a stool
containing blood and mucus (red
currant jelly)
24. The diagnosis is
confirmed on
ultrasonography, which
is usually the first
investigation when
intussusception is
suspected , An air or
contrast enema study
will also confirm the
diagnosis and may be
therapeutic .
25. Gastroenteritis
Patients with severe gastroenteritis also often have vomiting, colic and
specks of blood mixed with the stool. The differential diagnosis of bloody
stool includes infectious causes (e.g., Salmonella, Shigella, Campylobacter,
and Yersinia species; Clostridioides difficile (formerly known as Clostridium
difficile), Escherichia coli 0157:H7, and Entameba histolytica), inflammatory
bowel Disease
Colic and the passage of blood and mucus in severe cases of gastroenteritis
may mimic intussusception, except that the volume of diarrhoea is greater .
in intussusception, the small loose stools passed early in the course of the
disease simply represent evacuation of the stimulated colon beyond the
obstruction. Persistent vomiting and pain without diarrhoea is unlikely to be
gastroenteritis.
26. Case 1
A 6-year-old girl presents with a 1-month history of weight
loss
and mild diarrhea, containing blood and mucus.
Q What is the likely diagnosis
27. Inflammatory Bowel Disease
Crohn disease
Is a chronic inflammatory disorder of unknown aetiology that can
affect any part of the gastrointestinal tract, presents with a broad
spectrum of symptoms and signs. The most common symptoms
include recurrent abdominal pain and bowel disturbance, usually
diarrhoea together with rectal bleeding. However, these symptoms
may be relatively mild, and patients may present with long-term
effects of the disease such as weight loss, growth failure and delayed
onset of puberty.
Endoscopy has a crucial role in diagnosis, initial evaluation and
continuing assessment of Crohn disease.
In patients with ulcerative colitis, the diarrhoea is more prominent,
28. Henoch–Schönlein purpura
This condition causes arthralgia and a typical nonblanching
rash over the extremities and buttocks. Submucosal
haemorrhages in the bowel cause abdominal pain as well as
passage of blood rectally
29. Meckel’s diverticulum
Meckel’s diverticulum occurs in 2% of
the population.
In a small proportion of these
heterotopic gastric mucosa forms
part of the lining of the diverticulum
[Fig. 23.2]. Acid produced by the
gastric mucosa causes ulceration of
the adjacent ileal mucosa. Bleeding
usually presents as painless brick-red
stools with associated marked
anaemia. The patient may require
transfusion, but the bleeding usually
stops spontaneously without an
emergency operation. The definitive
investigation is laparoscopy
30.
31. Tubular duplications
These are much less common than a Meckel’s diverticulum. Tubular
duplications of the small bowel occur in the mesenteric side of the
bowel and communicate proximally or distally with the bowel. They
may be lined by heterotopic gastric mucosa and cause bleeding when
adjacent small bowel mucosa becomes ulcerated. Like a Meckel’s
diverticulum, they may be demonstrated by a technetium nuclear
scan.