This document provides an overview of the digestive system and gastrointestinal diseases. It covers the anatomy and function of the digestive tract, from the esophagus to the colon. It then discusses various gastrointestinal diseases including GERD, peptic ulcers, gastritis, diarrhea, constipation, irritable bowel syndrome, inflammatory bowel diseases like ulcerative colitis and Crohn's disease, celiac disease, intestinal tuberculosis, and more. Diagnostic tests and treatments for these conditions are also mentioned.
Short bowel syndrome (SBS) is a devastating condition in which small intestinal length is inadequate and characterized clinically by inability to absorb adequate enteral nutrition to sustain normal growth and development.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. Topics to be cover
• Digestive system
• GI tract & its anatomy
• Billiary tract
• How to assess GI tract
• GI disease
– Esophageal diseases
– Gastric disease
– Small intestinal disease
– Colonic disease
• Billiary diseases
3. Studied material
• Book: Chapters in Harrison
• Book : Chapters in Clark
• Book: Chapters in IBD
• Journal : ECAB clinical updates
• Gastroenterology 2002,
• IBD: 2008
• Can . J. Gastroenterology 2005
6. Layers of GI tract
– Mucosa (Inner most)
• Absorptive and secretary
(mucus)
– Sub mucosa
• Absorbed molecule of
mucosa picked up by BC
– Muscularis
• Controlled peristalsis
– Serosa (outer most)
• Protective layer &
secretary
9. Functional anatomy of the GI system
- Mechanical digestion:
breaking food in small particles
so they are easily broken down
by enzymes mouth and
stomach
Chemical digestion:
pancreas and duodenum
Nutrient absorption:
small intestine
Water reabsorption:
colon
10. Esophagus
• Pharynx, esophagus: passageway
for food (from mouth to stomach)
• Esophageal sphincters
Upper esophageal sphincter (UES):
Prevents entry of air
Lower esophageal sphincter (LES):
Prevents reflux of corrosive acidic
stomach content.
11. Stomach
• J- shaped structure have 4 specific region for digestion, store foods for 4 hours
– Cardiac region, which receive bolus from esophagus via LES
– Fundus upper part
– Later on whole body
– Last is pyloric region which allow chyme to move towards the duodenum via pyloric sphincter,
when it reaches the right consistency
• Different glands secrete diff. enzyme, for digestion of bolus into chyme
– Parietal cells- HCL
– Chief cells -Pepsin (protein-digesting enzyme needing acid environment)
– Goblet cells secrete mucus
– G cells secrete gastrin
• Imbalance b/w mucus and HCL leads to disorder
12. Gastric mixing and emptying
• Gastric glands begin secretion of gastric juices in 3 phases, before food entry
i.e. cephalic , gastric and intestinal phase
• Chyme = mixture of gastric secretion and food content
• Pyloric valve : - regulates emptying of gastric content
• - Prevents regurgitation of duodenal content
13. Small Intestine
Duodenum : 25 cm (10 in.) long &
receive juices from pancreas, liver .
• To receive chyme from
stomach
• To neutralize acids before
they can damage the
absorptive surfaces of the
small intestine
Jejunum 2.5 meters (8.2 ft) long
• Chemical digestion
• Nutrient absorption
Ileum : 3.5 meters (11.48 ft) long
Ends at the IC valve, a sphincter that
controls flow of material from the
ileum into the large intestine
14. Colon
• Reabsorb water from food and digestive
juices
• Defecation
– Elimination of indigestible substances
from body as feces
15. GI- tract & its disease
GERD, Achalasia, cardia, Barret
esophagus, esophageal cancer
Dyspepsia, Gastritis, gastric
ulcer, Gastric cancer
Duodenal ulcer, Celiac
disease, CD, ITb
Diarrhea, Constipation, IBS,
IBD, CRC
21. Lower GI endoscopy
Colonoscopy, rectosigmoidoscopy, rectoscopy
• Diagnostic
– Bleedings (occult blood or, iron deficiency)
– Chronic diarrhea
– Suspicion of cancer
– Suspicion of inflammatory bowel disease
– Screening for cancer (altered bowel habits, risk
groups for colon cancer)
• Therapeutic
• Removal of polyps, early cancers
22. Ba meal follow through: to visulize t. ileum
& caecum
– Small bowel follow through - drink barium and
take pictures as it transits the small bowel
But now fluoroscopy is superceded by CT and MR enterography
23.
24. Gastro esophageal reflux disease
• Stomach tolerates high acid
content but esophagus
doesn’t – when stomach
contents refluxes into
esophagus (heartburn;
GERD)
• Esophageal: heartburn, chest
pain, regurgitation, acidic
taste in mouth, dysphagia,
Extraesophageal: chr.cough,
asthma, noncardiac chest
pain
25. Peptic ulcer (duodenal, gastric)
• Defect in GI muscularis mucosae
• Dependent on acid peptic activity
• Caused by majorly 2 reason
– H. Pylori
– NSAID
• PUD occurs in gastric & duodenal mucosa
– Gastric
– Duodenal ulcer
• Diagnosis: endoscopy
26. H. Pylori mechanism
– H. Pylori is gram negative, its niche is stomach
– Mechanism involves elucidation of primary
defense i.e. gastric acidity & to counteract
peristalsis to establish persistent infection
– Ph. Imbalance , counteract to peristalsis ,
flagella of H. pylori colonize to stomach, &
duodenum leads to urease production for
persistent infection & cause gastric ulcer,
duodenal ulcer, maltoma & gastric cancer
27. Detection & treatment of H. pylori
• Invasive (Endoscopic Bx)
– RUT
– Urea converted to NH3 by urease containing Bx in 30 min,
detect by pH indicator
• Non-invasive
• Urea breath test
• Treatment
• Triple therapy: PPI (Ranitidine)+ Clarithomycin+
amoxicillin or metrotindazole
28. Pathology of peptic ulcers
• Defend mechanism of GI tract : Acid pepsin secretion
create a balance between inputs from neural, endocrine,
paracrine, & autocrine pathway.
• Imbalance b/w the acid pepsin secretion leads to erosion and
ulcer
• Erosion: Superficial mucosal defect
• Ulcer : Defect extends into submucosa
• Acute lesion: Generally multiple & shallow with minimal
inflammation or fibrosis, but heal early
• Gastritis: Microscopic inflammation of Stomach due to fall
in acid secretion facilititate H. Pylori to colonize which leads
to gastric atrophy
• Chronic Ulcer: Usually Single & surrounded by inflammation
& fibrosis & heal slowly . And reoccur at same location
29. Gastric Ulcer : Due to NSAID, pH imbalance & H.
Pylori
Normal
Erosion and
acute ulcer
Gastric
cancer Chronic
ulcer
30. Diarrhea
• Diarrhea is an increase in the volume of
stool or frequency of defecation.
– Osmotic: Malabsorption , excessive amounts
of solutes are retained in the intestinal lumen,
water will not be absorbed.
– Secretory: Large volumes of water is
efficiently absorbed before reaching the large
intestine. Ex v. cholera
– Inflammatory/ Infectious : defected intestinal
barrier function due to microbial or viral
pathogens lead to in-efficient absorption of
water . Ex, bacteria ( salomonella, shigella)
virus ( rota , corona, hepatitis), parasitic
(amoeba, giardia)
– Deranged Motility: For efficiently absorption,
the intestinal contents must be adequately
exposed to the mucosa. Disorders in motility
accelerate transit time which decrease water
absorption,
31. Constipation
• Constipation usually is caused by the slow movement of stool
through the colon.
• Due, delay in bowel movement more water get absorbed,
which makes stool tight & difficult to defecate..
32. Dyspepsia ( problem of upper gut)
Dyspepsia is discomfort in the upper abdomen, bloating, satiety, &
nausea.
• Pathophysiology
– A delay in emptying the stomach contents into the duodenum may be a
factor
– Acute H. pylori infection
– Anxiety, depression, or stress
– The most common NSAID is ibuprofen and aspirin.
• Treatment
– To, ↓ stomach acid - proton pump inhibitors (PPIs) and H2-receptor
antagonists to be used.
– PPIs include: omeprazole, lansoprazole, pantoprazole, rabeprazole, and
esomeprazole.
– H2-receptor antagonists include: cimetidine, famotidine, nizatidine,
and ranitidine
33. Lactose intolerance
• Inability to digest dairy product containing lactose
due to lack of lactase enzyme
• The lactase enzyme converted lactose into glucose
and galactose — which can be absorbed into
bloodstream.
– congenital ( with birth)
– Primary ( disappear after milk withdrawal from diet)
– Secondary ( due to traumatic or intestinal disease)
• Diagnosis
• H2 breath test
• Lactose tolerance
34. Malabsorption
• Food nutrients are not adequately absorbed in the small
intestine ,
– Protozoal infection (Giardia intstinalis), Helminthis , bacterial
infection ( M. tuberculosis), viral infection & autoimmune mediated.
• Carbohydrate malabsorption
• Fat malabsorption
• Nutrient malabsorption
• Diagnosis : UGIE
– D-xylose test
– Iron deficiency
• Treatment: Antibiotics course
Mucosal malabsorption get resolved with antibiotics If problem still persist, look for
non mucosal causes, celiac, pancreatitis, hepatitis etc.
35. Celiac disease
• Immune mediated enteropathy triggered by gluten in genetically
susceptible individual
• Interplay between genes ( HLA -DQ) & environment (gluten) leads to
intestinal damage
• Extra-intestinal manifestation also responsible for celiac i.e. Skin, liver
and nervous system because genetically susceptible person develop
autoimmune injury of intestine, liver and spleen, skin and other organ
36. Symptoms and diagnosis
Clinical symptom Diarrhea, malabsorption, iron deficiency, short stature,
bloating
Risk Factor ↑ ALT , Seizure, DH, DM, Osteomalacia,
Diagnosis
Serological marker: Anti EMA Ab, Anti-ttg Ab
UGIE: Scalloping of folds in duodenum, cobble stoning in some
Rule out other disease responsible for villous atrophy i.e. tropical sprue,
bacterial growth and parasitic infection
Normal Folds Scalloping of Folds Cobble stoning
37. Disease extent and severity
• Disease severity assessed by Marsh classification
• 1 normal ( C:V-1:3)
• 2 increased IEL
• 3 (3a , 3b, 3c) villous atrophy
• 4 villous atrophy + crypt hyperplasia
• GFD is only treatment with supplement for celiac disease
38. Irritable Bowel Syndrome (IBS) problem of
lower gut
• Abdominal pain associated with disturbed
defecation and relieved with defecation
• Stools looser or more frequent at pain onset
• Feeling of incomplete evacuation
• Mucus per rectum
• Visible abdominal distention (bloating)
• Labs and sigmoidoscopy negative
39. Inflammatory Bowel Disease
• Ulcerative colitis – Effects the
generally mucosa of the colon and
rectum
• Crohn’s disease – This may affect
any segment of the gastrointestinal
tract
• Indeterminate colitis
– 15% patients with IBD
impossible to differentiate
CD UC
40. Ulcerative colitis (UC)
• UC is disease of mucosa and
superficial submucosa, with
deeper layers unaffected
• Symptoms: diarrhea with blood
mucus, diffuse abdominal
discomfort , urgency & tensemus
Diagnosis
Serological test ASCA, & p-ANCA
Colonoscopy
CECT or Ba enema
Rule out infectious causes
41. Ulcerative colitis disease activity & extent
• For disease extent : Three tire
classification
» E1 (Proctotitis)
» E2 ( left sided colitis)
» E3 ( Pancolitits)
• Severity of disease :True love & witts
criteria:
No. of stool ( with or without blood) mucus, fever,
ESR & clinical assessment)
» S0 (Remission)
» S1 (Mild )
» S2 (Moderate)
» S3 (Severe)
42. Crohn’s disease (CD)
– Clinical Symptoms:
• Diarrhea ( 1/4 have blood in stool), oral
ulcer, specific abdominal pain in right
quadrant, fever, arhtlargia, perianl disease
( fistulae or abscess)
– Endoscopic view :
• Disease of skip lesion and deep ulcers
(transmural) , a cobblestone-like mucosal
pattern,
– Radiological view :
• Strictures, thickening of wall
Diagnosis
Serological test , P-ASCA, & ANCA
Colonoscopy, UGIE
CECT or Ba meal follow through
– Rule out infectious causes
44. Crohn’s Disease activity and extent
• For disease extent : Monteral classification
– A (A1, A2 , A3, Age at Diagnosis)
– L (L1, L2, L3, L4 , {TI, C, IC, UGI} Location )
– B (B1, B2, B3 {non- stricture, stricture & penetrating} Behavior)
– P ( P0, P1 { perianl fistulae } Peri-anal disease)
• Severity of disease : Best et al. CDAI score
– On clinical assessment No. and type of stool, extraintesitnal
manifestation, fever, abdominal pain, HCT
– Remission CDAI <150
– Mild CDAI >150-219
– Moderate CDAI >220- 400
– Severe CDAI 400
45. Intestinal tuberculosis ( ITb)
– Clinical Symptoms:
• Diarrhea , specific abdominal pain in right quadrant, fever,
arhtlargia,
• Endoscopic view :
Mostly ulcerative lesion at IC valve
• Radiological view :
Strictures, thickening of wall ( IC valve)
Diagnosis:
Endoscopic, radiologic and histological + clinical symptom
– Rule out infectious causes
– t
– Look like CD BUT, ITb get cure after ATT while CD is
just treatable