This document is a detailed presentation by Prof. Dr. R. R. Deshpande on various digestive tract problems, including dysphagia, abdominal pain, irritable bowel syndrome (IBS), and jaundice, along with their causes, clinical features, investigations, and treatments. It provides both conventional and Ayurvedic treatment options for conditions like peptic ulcer, hepatitis, and bowel colic. The document serves as a comprehensive guide for general practitioners dealing with digestive health issues.

1. Digestive Tract Problems in GP– Part 2
Pain in Abdomen Presented By
• Prof.Dr.
• R.R.Deshpande
• 9226910630
7/19/2015 Prof.Dr.R.R.Deshpande 1

2. 7/19/2015 Prof.Dr.R.R.Deshpande 2
Digestive Tract Problems in GP – Part 2
• Presented By –
• Prof.Dr.R.R.Deshpande (M.D in Ayurvdic
Medicine & M.D. in Ayurvedic Physiology)
• www.ayurvedicfriend.com
• Mobile – 922 68 10 630
• mailme.drrrdeshpande@rediffmail.com

3. Digestive Tract
7/19/2015 3Prof.Dr.R.R.Deshpande

4. 7/19/2015 Prof.Dr.R.R.Deshpande 4
Digestive System Problems in GP
part 1 contains
• 1) Anorexia
• 2) Indigestion
• 3) Aerophagy(Gas)
• 4) Stomatitis
• 5) Hiccoup
• 6) Constipation
• 7) Diarrhoea
• 8) Vomiting

5. 7/19/2015 Prof.Dr.R.R.Deshpande 5
Digestive System Problems in GP –
Part 2 contains
• 9) Dysphagia
• 10) Pain In Abdomen
• 11) IBS
• 12) Jaundice
• 13) Peptic ulcer

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Dysphagia causes 1
• Dysphagia = Difficulty in swallowing.
• Odynophagia = Painful swallowing.
• Acute severe pharyngitis, exudative Tonsillitis,
Peritonsillar abscess (quinsy)
• (All these cases – Pseudo dysphagia)

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Dysphagia causes 2
• True Dysphagia – Oesophagitis
• Mechanical dysphagia -- Cancer of
oesophagus
- (obstruction to passage of solid food) –
Cancer of oesophagus.

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Dysphagia Treatment 1
• Pseudo-dysphagia (due to Infection & pain)
Tab.Roxid (Roxithromycin) – 150 mg – BD (On
empty stomach)
or Tab.Azithral (Azithromycin) 500 mg – O.D. x
3days
• Tab.Voveron SR 100 mg – 1 O.D.
• Gurgaling.

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Dysphagia Treatment 2
• Oesophagitis
• Bland Diet
-Mucaine gel – 3 tsf x 3 hrly
- Cap. Omez – 20 mg x BD
- Tab ciza (cisapride) 10 mg – TDS.
- Tab forcan (flucanazole) – (for HIV patients) –
150 mg x 10 days

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Dysphagia Treatment 3
• If Cancer of Esophagus is suspected –
• Immediately refer to Oncologist.

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Epigastric pain causes
• 1) Gastritis (Drug Alcohol Induced).
• 2) Gastric ulcer.
• 3) Duodenal ulcer.
• 4) Enlarged Left Lobe of Liver.
• 5) Hook Worm.
• 6) Amoebiasis.
• 7) Pancreatitis.
• 8) Gastric malignancies.
.

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Investigations in Epigastric Pain
• 1) USG Abd – Hepatitis,CCF,Amoebic Liver
Abscess
• 2) Gastroscopy – GU,DU,CA of stomach
• 3) Stool Exam – worms,occult blood

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Epigastric pain – Rare causes
Rare causes
- Hepatitis.
- CCF.
- Amoebic Liver abscess.

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Epigastric pain - Treatment
• Cap. Omez 20 mg BD.
• Tab. Cyclopam – 1 TDS.
• Gellucil Liquid – 2tsf TDS.
• T. Zentel – 400 mg – stat.(Albendazole)
• T. Tini 500 mg – BD x 7 days.

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Pain in Right Hypochondrium
• 1) Infective Hepatitis – History of Jaundice epidemic.
• 2) Amoebic hepatitis – History of Amoebiasis
• 3) Alcoholic Hepatitis.
• 4) CCF (Tender liver).
• 5) Duodenal Ulcer.
• 6) Cholecystitis.
- Treatment -
According to above said Causes.

16. Gall stones
7/19/2015 16Prof.Dr.R.R.Deshpande

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Suspect CCF
( Right Ventricular Failure)
• 1) Hepatomegaly
• 2) Oedema over legs (Paedal Oedema in the
evening)
• 3) Engorged neck veins ( JVP increases)
• 4) Breathlessness
• History of Chronic Hypertension or Chronic
Lung disease

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Investigations in pain
in right Hypochondrium
• 1) USG Abdomen
• 2) Liver Function Tests
• 3) 2 D Echo

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Pain in Right Iliac fossa causes
• 1) Amoebic colitis.
• 2) Acute Appendicitis
• 3) Right ureteric colic
• 4) TB at ileo caecal junction

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Suggestive clinical features
• 1) Appendicitis – Vomiting, Fever, Mac
Burney’s tenderness
• 2) Ureteric colic – Dysurea, colicy pain but no
Tenderness

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Pain in Right Iliac fossa - Treatment
• 1) Inj.Voveron – 2 ml I/m.
• 2) Tab. ciprofloxacin 500 mg BD.
(or Inj.Ciprofloxcin I/v, if Vomiting is sever).
• 3) Tab. Tini 500 mg – BD.
• 4)Inj.Gentamycin 80 mg BD – I/V.

22. 7/19/2015 Prof.Dr.R.R.Deshpande 22
Investigations for
Pain in right Iliac Fossa
• 1) USG Abd – Ureteric stone
• 2) WBC count – Leucocytosis – Appendicitis (?)
• 3) Urine R – RBC -- +++ & Crystals +++
• 4) Stool R – E.h –Amoebic Colitis

23. Causes of Generalised pain in Abdomen
• 1) Round worm, Tape worm (Common in pig
meat)
• 2) Amoebiasis, Giadiasis
• 3) IBS
• 4) Abdominal TB
• 5) Ca pancreas / ca colon
• 6) Long term use of purgatives
• 7) Lactose intolerance
7/19/2015 Prof.Dr.R.R.Deshpande 23

24. Hiatus Hernia
7/19/2015 24Prof.Dr.R.R.Deshpande

25. Acute Abdominal Pain without shock
• 1) Abdominal colic -Types :
• i) Intestinal colic ii) Renal colic
• iii) Appendicular colic iv) Biliary colic
• 2) Gynaec pain : Ex. dysmenorrhoea
•
• 3) Referred pain : pain in abdomen due to T.B.
or cancer of spine.
7/19/2015 Prof.Dr.R.R.Deshpande 25

26. Spasmodic Pain in lower Abdomen
7/19/2015 26Prof.Dr.R.R.Deshpande

27. Irritable Bowel Syndrome
7/19/2015 27Prof.Dr.R.R.Deshpande

28. Acute abdominal pain with shock :
• Low BP, feable but thread pulse, sweating cold
extremities
• Called as acute abdomen / surgical abdomen.
• Causes : i) Internal haemorrhage
• ii) Acute intenstinal obstructcion
• a) Strangulation
• b) intu-ssuception
• c) Valvulus
7/19/2015 Prof.Dr.R.R.Deshpande 28

29. Types of Intestinal obstruction
7/19/2015 29Prof.Dr.R.R.Deshpande

30. Acute abdominal pain with shock
• iii) Acute peritonitis
• iv) Acute pancreatitis
• v) Severe gastro-enteritis
• vi) Ectopic pregnancy
•
7/19/2015 Prof.Dr.R.R.Deshpande 30

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Colicky Pain causes 1
• 1) Renal colic – pain in right or left renal angle &
vomiting, USG abd, Urine R – RBCs.
• 2) Ureteric colic – Severe spasmodic pain from loin to
groin. Patient refuses to lie down, Dysuria (USG abd).
• 3) Small Intestinal colic – Colicky pain in central
abdomen. (amoebiasis, worms, Intestinal
obstructions).

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Colicky Pain causes 2
• 4) Large Intestinal Colic – severe colic, away from
centre (may be with h/o dysentery – E.h, shigella,
E.collic).
• 5) Biliary colic – Pain in Right hypochondrium (may
be with Jaundice) – due to Gall stone or Infection
(cholecystitis).
• 6) Spasmodic Dysmenorrhoea – Severe lower
abdominal pain (young unmarried girls).

33. Renal Colic
• Pain is unilateral right or left lumbar region.
• Renal angle tenderness (below 3 fingers of
scapula) with vomiting.
7/19/2015 Prof.Dr.R.R.Deshpande 33

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Colicky Pain Treatment 1
• Renal colic
- Inj.Voveron – 2 ml I/m stat.
- Inj.Reglan – 2 ml I/m stat. (If vomiting).
- Tab. Cyclopam – 1 TDS.
- I/v fluids (If severe vomiting).
- USG – Large stone – Urologist.
• .

35. 7/19/2015 Prof.Dr.R.R.Deshpande 35
Colicky Pain Treatment 2
• Ureteric colic
- Inj.fortwin (pentazocin) – 1 ml stat – I/m.
- Inj.Phenargan – 1 ml – stat – I/m.
• X ray – KUB
If stone < 6mm – Hydrotherapy

36. X ray KUB
• Done on empty stomach in the morning
• Bowel preparation (no gas in abdomen)
• Tab – Dulcolax (3 tab)
• We take only 1 tab of Dulcolax for normal
wash of stomach
• Tab – Gasex of Himalaya 3 tab (with warm
water)
•
7/19/2015 Prof.Dr.R.R.Deshpande 36

37. 7/19/2015 Prof.Dr.R.R.Deshpande 37
Colicky Pain Treatment 3
• Hydrotherapy –
- I/v – 5% Dextrose – 3 pints.
- fast (20 no. needle) In 1½ hrs.
- I/v Lasix & Cyclopam in third pint.
Repeat above procedure for 3 days.
Still, if stone does not pass – Urologist.

38. 7/19/2015 Prof.Dr.R.R.Deshpande 38
Caution
• If stone > 6 mm – Do not give Hydrotherapy
• Stone can cause partial obstruction &
Hydrotherapy may cause Hydronephrosis
• Refer to Urologist -- Lithotripsy

39. 7/19/2015 Prof.Dr.R.R.Deshpande 39
Small intestinal colic
Caution – Admit if vomiting,distension &
absolute constipation
Inj Cyclopam 2ml stat
Tab Tini 500 mg BD
Tab Zentel 400 mg stat

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Large Intestinal Colic
• Inj Cyclopam 2ml IM stat
• Tab Norflox TZ 1 BD

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Biliary Colic -- Treatment
• Biliary colic –
-Inj.Cyclopam – 2 ml I/m or I/v.
-Inj.Mox – 500 mg I/v stat.
-Tab.Flagyl 400 mg TDS
.
Adv – USG Abdomen & Sr.Bilirubin
Metro is used for Amoebic & also in anaerobic
Infections (I/V Metrogyl)

42. 7/19/2015 Prof.Dr.R.R.Deshpande 42
Spasmodic Dysmenorrhoea - Treatment
• 1) Inj.Voveron 2ml – I/m stat.
2) Tab.meftal spas – 500 mg TDS.
3) Hot fomentation – Lower abd.
4) Bed Rest.

43. 7/19/2015 Prof.Dr.R.R.Deshpande 43
Irritable Bowel Syndrome – IBS - causes
• 1) Mental stress & Depression.
• 2) Vague abdominal complaints.
• 3) Visit to many Doctors.
• 4) All Investigations – Normal.
• 5) Diagnosis of Exclusion.

44. 7/19/2015 Prof.Dr.R.R.Deshpande 44
IBS – Treatment 1
• Constipation –
- High fiber Diet, plenty of water.
- Tab.Triphala 2 BD.Softovac 1 tsf BD
• Toilet > 4 times
- Cap.Imosec – 1 BD or,
- Tab.Lomotil – 2.5 mg BD or,
- Kutaja parpati Tab- 2 TDS.

45. 7/19/2015 Prof.Dr.R.R.Deshpande 45
IBS – Treatment 2
• Abdominal pain
- Tab.cyclopam 1 BD.
• Depression
- Cap Fludac (fluoxetine) 20 mg OD.
- Assurance.

46. 7/19/2015 Prof.Dr.R.R.Deshpande 46
Jaundice – Clinical features
• Severe anorexia, Nausea.
• Liver tender (palpable).
• Low grade fever, weakness.
• High colored urine, Sclera-yellow.
• Urine R-Bile salts & Bile pigment.
• Sr.Alkaline phosphatase (obstructive jaundice).
• Hepatitis B & obstructive Jaundice – Refer to
Gastroenterologist.

47. Liver Histology
7/19/2015 47Prof.Dr.R.R.Deshpande

48. Jaundice
7/19/2015 48Prof.Dr.R.R.Deshpande

49. 7/19/2015 Prof.Dr.R.R.Deshpande 49
Jaundice - Treatment
• Bed Rest.
• High carbohydrate, Adequate protein(Glucon-D)
• For fever – T. Nise (Nimu-sulide) – 1 s.o.s.
• Severe vomiting – I/v 10% dextrose with Inj.Reglan.
• T.silybon (silymarin) 140 mg BD.
• Cap.Essentiate (phospholipids) 175 mg – TDS.
• Arogyawardhini 3 TDS.
• Kumari Asav No.1. 3tsf TDS.

50. Icterus of eyes
7/19/2015 50Prof.Dr.R.R.Deshpande

51. 7/19/2015 Prof.Dr.R.R.Deshpande 51
Caution in Jaundice
Hepatic coma (Irreversible)
• Patient – Drowsy
• Sensorium is disturbed,
• sleeping Rhythm or pattern changes
• Tremors

52. Liver Cirrhosis
7/19/2015 52Prof.Dr.R.R.Deshpande

53. Liver Damage
7/19/2015 53Prof.Dr.R.R.Deshpande

54. Ayurvedic IMP Tablet for Liver problems
• Liver problems,Jaundice,Cirrhosis,Any Chronic
disease,to stimulate metabolic process -----
• Tab Arogyavardhini
7/19/2015 Prof.Dr.R.R.Deshpande 54

55. Ayurvedic Medicine for Liver Problems
• Liver & Spleen problems –
• Kumari Asav Number 1
• Kumari Asav Number 2
7/19/2015 Prof.Dr.R.R.Deshpande 55

56. 7/19/2015 Prof.Dr.R.R.Deshpande 56
Duodenal ulcer Treatment 1
& List of Antacids
H. pyloric kit – Helibact –BD for 1 week
Omeprazole + Amoxicillin + Tinidazole
Antacids
1. T. Histac (Ranitidine) 150 mg BD.
2. T. Famocid (famotidine) 20 mg BD.
3. T. Rotane (Roxatidine) 75 mg BD.
4. Cap. Omez (omeprazole) 20 mg BD.
5. Lan (Lansoprazole) 30 mg OD.
6. Pantacid (pentaprazole) 40 mg OD.(Cap Pan D)
7. Rabifast (Rabiprazole) 20 mg OD.

57. Retrosternal burning
7/19/2015 57Prof.Dr.R.R.Deshpande

58. DD OF Ulcer
Points Gastric Ulcer Duodenal Ulcer
Sex Common in female
patients
Common in male
patients
Onset of pain Immediately after
intake food
3-4 hours after
intake of food. Mid
point pain
Periodicity No After every 3-4
hours
Vomiting Spontaneous Induced
7/19/2015 Prof.Dr.R.R.Deshpande 58

59. DD OF Ulcer
Points Gastric Ulcer Duodenal Ulcer
Pointing sign present present
nutrition Poor Not so.
haematemesis common uncmoon
Perforation
Cancer
Rare
Common
Common
Rare
7/19/2015 Prof.Dr.R.R.Deshpande 59

60. Worms
• Common – Round worm, thread worm, hook
worm,Rare – Tape worm
• Adv. – stool – R examination
• Pain in abdomen, nausea, vomiting, loose
motion, urticaria, bronchitis, hypopigmented
patches on face, Excessive hunger but without
putting on weight
7/19/2015 Prof.Dr.R.R.Deshpande 60

61. Worms
• Thread worms – Peri-anal itching, urethral
irritation, vaginal discharge, nocturia.
• Hook worms – Urticaria with itching, bronchitis,
most imp. anemia, depression of bone marrow,
Anasarca (oedema all over the body)
• Tape worms : Abdominal pain, lose motions,
Asymptomatic, White pieces seen in stool by
child or mother
•
7/19/2015 Prof.Dr.R.R.Deshpande 61

62. Round worm
7/19/2015 Prof.Dr.R.R.Deshpande 62

63. Hook worm
7/19/2015 Prof.Dr.R.R.Deshpande 63

64. Thread worm
7/19/2015 Prof.Dr.R.R.Deshpande 64

65. Tape worm
7/19/2015 Prof.Dr.R.R.Deshpande 65

66. Worms
• Treatment :
• Tab Mebex, 1 – 0 – 1 x 3 days
• Tab Zental 400 mg – 1 – stat (albendazole)
7/19/2015 Prof.Dr.R.R.Deshpande 66

67. Ayurvedic Medicines for worms
• 1) Vidangadi Churna
• 2) Dadimashtak Churna
• 3) Tab Krumimudgaras
• 4) Liq Vidangarishta
• 5) Liq Vidangasav
7/19/2015 Prof.Dr.R.R.Deshpande 67

68. Ayurvedic Medicines 1
• Weak digestive fire or Anorexia
(Agnimandya) –
• Lavanbhaskar churna,Ashtangalavan churna,
Chitrakadi Churna, Agnitundi vati, Lashunadi
vati, Panchakolasav, Jeerakadyarishta,Bharangi
Avaleha, Tiktak Ghruta, Shatpal Ghrut, Lashun
Pak ,Kapardik Bhasma
7/19/2015 Prof.Dr.R.R.Deshpande 68

69. Ayurvedic Medicines 2
• Amoebic Dysentry ( Amansha, Pravahika) –
• Gangadhar or Bruhat Gagadhar or Lavangadi
churna, Sanjivani Guti, Kutajarishta,
Jeerakadya rishta, Babbuladyarishta,
Bhallatakadi Kadha, Kutajavleha,
Bilvavleha,Pugapak,Chandan bala lakshadi oil,
Padmakadi oil, Rasa parpati, Shankha bhasma
7/19/2015 Prof.Dr.R.R.Deshpande 69

70. Ayurvedic Medicines 3
• Diarrhoea ( Atisar) –
• Jatiphaladi or Lavangadi or Dhanya panchak
churna, Sanjivani
guti,Shankhodar,Bhallatakasav,Kutajarishta,Ba
bbuladyarishta,Jeerakadyarishta,Kutajavleha,B
ilvavleha,Rasaparpati,loknathras,Shatavarydi
Kwath, Chukra oil
7/19/2015 Prof.Dr.R.R.Deshpande 70

71. Ayurvedic Medicines 4
• Indigestion ( Apachan or Ajirna) –
• Dadimashtak or Panchasam or Pippalyadi or
Bhaskar or Vadvanal or Vaisvanar or
Samudradi or Hinvashtak Churna,
Vatgankusha,Shankha vati, Shulhar vati,
Kapardik Bhasma, Loknathras,Shankha
Bhasma
7/19/2015 Prof.Dr.R.R.Deshpande 71

72. Ayurvedic Medicines 5
• Hyperacidity ( Amlapitta) –
• Avipattikar or Amalakyadi or Vadvanal Churna,
Shatavari kalpa, Triphala churna, Laghusutshekhar
,Sutshekhar, Suvarna sutshekhar, Moraval ( Amalaki
avaleh) ,Kushmand avaleh, Tiktak Ghruta, Akik pishti,
Jajarmohara pishti, Trunakat pishti, Shankha bhasma,
Suvarna makshik bhasma, Kamaduha, Praval
panchamruta, Bhunimbadi Kadha, Abhayarishta
7/19/2015 Prof.Dr.R.R.Deshpande 72

73. Ayurvedic Medicines 6
• Piles ( Arsha) –
• Samasharkar churna, Swadishta virechan
churna, Sukhasarak or Hinvashtak churna,
Kankayan Guti, Bolbaddha ras,
Bhallatakasav,Kutajarishta,Rohitakarishta,Bhall
atakadi kadha, Shatpal Ghruta,Bhallatak oil
,Kandarp pak, Bhallatakavleh
7/19/2015 Prof.Dr.R.R.Deshpande 73

74. Ayurvedic Medicines 7
• Vomitting ( Chardi) –
• Eladi churna, Sutshekhar,
Bruhatvatachintamani, Kapardik bhasma,
Shankha bhasma, Jaharmohara pishti,
Mayurpiccha mashi
7/19/2015 Prof.Dr.R.R.Deshpande 74

75. Ayurvedic Medicines 8
• Jaundice ( Infective Hepatitis =Kamala) –
• Arogyavardhini, Kumari Asav Abhayarishta,
Eranda oil, Kandarp pak
7/19/2015 Prof.Dr.R.R.Deshpande 75

76. Ayurvedic Medicines 9
• Grahani ( Enteritis or Colitis) –
• Gangadhar or Pippalyadi or Bruhat gangadhar or
Lavangadi churna,Sanjivani Guti,
Panchakoasav,Bhallatakasav,Kutajarishta,Jeerakadyari
shta,Babbuladyarishta,Bhallatakadi kadha, Agastya
haritaki avaleh, Kutajav leh, Bilbav leh, Kapardik
bhasma, Shankha bhasma, Shatpal Ghruta,
Panchamrut parpati, Rasa parpati, Loknath ras,Loha
parpati, Suvarn Parpati
7/19/2015 Prof.Dr.R.R.Deshpande 76

77. Ayurvedic Medicines 10
• Udar ( Ascites) –
• Gomutra haritaki or Narayan churna,
Ashvakanchki or Icchabhedi or Naracha ras,
Arogyavardhini,Kumari asav,
Punarnavasav,Abhayarishta,Punarnavadyarisht
a,Punarnavadi Kadha, Punarnava mandur, ras
parpati
7/19/2015 Prof.Dr.R.R.Deshpande 77

78. 7/19/2015 Prof.Dr.R.R.Deshpande 78
Ayurved for General Practioner
• Very very popular Book
in Medical Practioners
• 100 common symptoms
of General Practice with
causes,Investigations &
Ayurvedic Treatments

79. 7/19/2015 Prof.Dr.R.R.Deshpande 79
Clinical Examination
• Systemic Examination of
8 systems
• Ayurvedic Srotas
Examination
• Clinical significance of
Lab Tests &
Radiology,USG,2D Echo

80. 7/19/2015 Prof.Dr.R.R.Deshpande 80
Notes on Medicine Part 1
• Very very useful Book
for all Medical
Practioners
• Guidelines with
causes,symptoms,Ayurv
edic & Modern
Treatments to treat
Fever,Pain in Abdomen
& Arthritis

81. 7/19/2015 Prof.Dr.R.R.Deshpande 81
Best Book for
Medical Students & Practioners
7/19/2015 81Prof.Dr.R.R.Deshpande

82. Health Tips for 365 Days
7/19/2015 Prof.Dr.R.R.Deshpande 82
• This Book is very useful
from Common man to
Doctors
• It covers all imp aspects
mentioned in Ayurveda
• Open as per date &
complete reading of
one page only

83. Prof.Dr.Deshpande’s
Popular Links on Internet
• Just Start Internet on Desk top or Lap top or
on your mobile . Copy Following Link & Paste
as Web address –URL
• http://www.youtube.com/user/deshpande19
59
• http://www.slideshare.net/rajendra9a/
• http://www.mixcloud.com/jamdadey/
7/19/2015 Prof.Dr.R.R.Deshpande 83

84. Prof.Dr.Deshpande’s
Popular Links on Internet
• Just Start Internet on Desk top or Lap top or
on your mobile . Copy Following Link & Paste
as Web address –URL
• http://professordeshpande.blogspot.in
• http://professordrdeshpande.blogspot.in/
• http://www.mixcloud.com/rajendra-
deshpande
• https://soundcloud.com/professor-deshpande
7/19/2015 Prof.Dr.R.R.Deshpande 84

85. Prof.Dr.R.R.Deshpande
• Sharing of Knowledge
• FOR
• Propagating Ayurved
7/19/2015 85Prof.Dr.R.R.Deshpande