Gastroenterology deals with conditions of the digestive tract and associated organs. Common complaints include abdominal pain, nausea, vomiting, diarrhea, and GI bleeding. Management may involve medical or surgical treatment to differentiate benign from serious processes. Conditions asked about in the first week include abdominal pain, GI bleeding, diarrhea, and gastroesophageal reflux disease. A thorough history and physical exam are essential to make an accurate diagnosis and guide appropriate treatment.
This is a powerpoint slideshow discussing some of the commonest disorders of colon; namely Hirschsprung's disease, Diverticular diseases of colon, ulcerative colitis, pseudomembranous colitis and ischemic colitis.
Intestinal obstruction is a significant or mechanical blockage of intestine that occurs when food or stool can not move through the intestine.
These obstruction may be complete or partial.
This is a powerpoint slideshow discussing some of the commonest disorders of colon; namely Hirschsprung's disease, Diverticular diseases of colon, ulcerative colitis, pseudomembranous colitis and ischemic colitis.
Intestinal obstruction is a significant or mechanical blockage of intestine that occurs when food or stool can not move through the intestine.
These obstruction may be complete or partial.
PARALYTIC ILEUS (Adynamic Intestinal Obstruction)
DEFINITION
It is a state in which intestines fail to transmit peristalsis due to failure of neuromuscular mechanism,
i.e. Auerbach’s and Meissner’s plexus.
It may be localised or generalised
Lecture on the various hernia afflicting humans for medical students. Encompasses basic sciences, various classifications, clinical presentations including complications and types of repair. Another pet topic of the author.
Bowel obstruction, also known as intestinal obstruction, is a mechanical or functional obstruction of the intestines which prevents the normal movement of the products of digestion. Either the small bowel or large bowel may be affected. Signs and symptoms include abdominal pain, vomiting, bloating and not passing gas.
PARALYTIC ILEUS (Adynamic Intestinal Obstruction)
DEFINITION
It is a state in which intestines fail to transmit peristalsis due to failure of neuromuscular mechanism,
i.e. Auerbach’s and Meissner’s plexus.
It may be localised or generalised
Lecture on the various hernia afflicting humans for medical students. Encompasses basic sciences, various classifications, clinical presentations including complications and types of repair. Another pet topic of the author.
Bowel obstruction, also known as intestinal obstruction, is a mechanical or functional obstruction of the intestines which prevents the normal movement of the products of digestion. Either the small bowel or large bowel may be affected. Signs and symptoms include abdominal pain, vomiting, bloating and not passing gas.
Diarrhea is an increased frequency and decreased consistency of fecal discharge as compared with an individual’s normal bowel pattern.
It is often a symptom of a systemic disease.
Acute diarrhea is commonly defined as shorter than 14 days’ duration.
Persistent diarrhea as longer than 14 days’ duration.
Chronic diarrhea as longer than 30 days’ duration.
Most cases of acute diarrhea are caused by infections with viruses, bacteria, or protozoa, and are generally self-limited.
HIV discrimination among health providers in Malaysia by Dr RubzDr. Rubz
Although doctors took oath that they will treat everyone the best they can and without judging anyone but discrimination still exist especially in HIV affected people. Due to this issue, Pertubuhan Advokasi Masyarakat Terpinggir Malaysia has taken a step to engage with doctors at government sector and desensitize them and find the line to stand together.
Testicular cancer for public awareness by Dr RubzDr. Rubz
A presentation prepared for Charity Dinner with Fun Charity. All the profits of the event will go to FReHA (a NGO which supports women's and reproductive health.)
Prostate cancer for public awareness by DR RUBZDr. Rubz
A presentation prepared for Charity Dinner with Fun Charity. All the profits of the event will go to FReHA (a NGO which supports women's and reproductive health.)
Breast Cancer for public awareness by Dr RubzDr. Rubz
A presentation prepared for Charity Dinner with Fun Charity. All the profits of the event will go to FReHA (a NGO which supports women's and reproductive health.)
This is the first phase (qualitative) of the current project we are working on with the supervision of University Malaya and Yale School of Medicine.It will be publish as IBBS 2013 by end of the year. This slide is just a rough picture of what we are doing at the moment. This is copyright protected!
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. What’s it all about?
Gastroenterology is a subspecialty of internal medicine. It deals with conditions and diseases of
the organs of the digestive tract and associated solid organs such as the pancreas, liver, and
gallbladder. The most frequent complaints seen in the clinic and the hospital include abdominal
pain, nausea, vomiting, diarrhea and GI bleeding.
Management of gastrointestinal problems can be both medical and surgical. A key aspect of GI is
learning to differentiate benign processes from those that are more serious and possibly needing
a procedure or surgical intervention.
Conditions you may be asked about in the first week
The conditions you will usually be asked about in your first week are the more common
complaints and diagnoses. The most important things you will be asked involve differential
diagnoses, and how to work up the problem. The most common problems in gastroenterology
include:
• abdominal pain,
• differentiating and working up a GI bleed,
• diarrhea, and
• gastroesophageal reflux disease.
You may also come across other common conditions as you progress, such as: peptic ulcer
disease, appendicitis, diverticulitis, colon cancer, hepatitis, cirrhosis, cholecystitis, pancreatitis,
irritable bowel syndrome and inflammatory bowel syndrome.
Abdominal pain
PQRST
• Presentation: ‘How?’ and ‘Where?’
• Quality: ‘Is the pain sharp, dull, burning, colicky?’
• Radiation: ‘Does the pain radiate anywhere (e.g. groin, back, shoulder)?’
• Severity: ‘How bad is the pain on a scale of 1 to 10?’, ‘What makes it better or worse?’
• Timing: ‘When does it occur?’, ‘How long?’, ‘Associations?’
The chronological sequence of events in the patient's history is often more important than
emphasis on the location of pain.
Careful attention should be paid to the extra-abdominal regions that may be responsible for
abdominal pain. An accurate menstrual history in a female patient is essential.
Abdominal examinations are mandatory in every patient with abdominal pain.
Pelvic and rectal examinations are recommended in patients with lower abdominal pain
especially if the pain is acute.
Differential diagnosis
Some causes of abdominal pain are obvious, some less so. It’s best to associate pain with
quadrants. The following guidelines are meant to be general, because all disorders have been
known to present atypically.
• Right upper quadrant: Biliary colic, cholangitis, cholecystitis, pyelonephritis, renal colic,
renal infarct, pneumonia, hepatic abscess, hepatitis, retrocecal appendicitis, pelvic
inflammatory disease (PID).
3. • Left upper quadrant: Splenic infarct, pancreatitis, pyelonephritis, renal colic, renal
infarct, pneumonia, PID.
• Epigastric: Gastritis, gastric ulcer, duodenal ulcer, pancreatitis, carcinoma, pancreatic
cancer, reflux esophagitis (sub-sternal pain).
• Right lower quadrant: Appendicitis, ovarian cyst/torsion, ectopic pregnancy, salpingitis,
urinary tract infection (UTI), renal colic, Crohn’s disease, colitis, cancer, PID.
• Left lower quadrant: Diverticulitis, colitis, sigmoid volvulus, ovarian cyst/torsion, ectopic
pregnancy, renal colic, UTI, PID.
• Suprapubic: Appendicitis, diverticulitis, salpingitis, uterine fibroid, ovarian cyst, cystitis,
PID.
GI bleed
The first step in working up a GI bleed is to assess your patient’s age:
• patients under the age of 60 have a mortality of <1%;
• patients over 80 have a mortality of >20%
Check also for shock, renal disease, liver disease and cardiovascular disease (including
hypertension) – these all increase the chances that your patient may die.
Check your patient’s vital signs and make sure they are stable. Initial resuscitation requires
restoration of intravascular volume, correction of coagulopathy and airway protection.
Once it has been determined that the patient is stable, initial work-up includes nasogastric (NG)
aspiration, rectal exam and Hemoccult, endoscopy and colonoscopy, barium studies, radionuclide
imaging (this can detect a bleeding rate as low as 0.1 mL/min, but is only positive about 45% of
the time) and angiography (a bleed must exceed 0.5 mL/min to be detected). Weigh up the
significant pros and cons of each of the above.
Upper GI bleeding
• Hematemesis, melena > hematochezia, tachycardia, hypotension.
• Evaluation: endoscopy if stable (this is urgent in patients with an active bleed and/or liver
disease), NG tube and NG lavage.
• Common causes: peptic ulcer disease, gastritis, esophageal varices, vascular
abnormalities, Mallory-Weiss tear, neoplasm, esophagitis, stress ulcer.
• Initial management: protect airway, stabilize with IV fluids, blood products.
• Further management: endoscopy followed by therapy directed at underlying cause.
Lower GI bleeding
• Hematochezia > melena, but can be either.
• Rule out upper GI bleed with NG tube and NG lavage, colonoscopy if stable.
• Common causes: diverticulosis, arteriovenous malformations, colon cancer, inflammatory
bowel disease, anorectal disease, mesenteric ischemia.
• Initial management: stabilize patient with IV fluids, blood products if necessary.
• Further management: rule out upper GI bleed; colonoscopy and management directed at
underlying cause (eg. surgical resection of cancer, diverticula).
4. Diarrhea
Hx should include duration, frequency, estimated volume and consistency of each bowel
movement, relation to meals, associated fever, pain, nausea, vomiting, blood in stool, history of
travel, medication use.
Major types of diarrhea are secretory, osmotic, exudative.
• Secretory: Enterotoxins (Cholera, E. coli, S. aureus), gastric hypersecretion, laxative
abuse.
• Osmotic: Malabsorption.
• Exudative: Shigella, Salmonella, C. difficile.
Infection is the most common cause of diarrhea, and is usually caused by food poisoning.
Initial workup includes CBC with differential, chemistry panel with BUN and creatinine. WBCs in
stool indicate CHESS organisms:
• Campylobacter.
• Hemorrhagic E. coli.
• Entamoeba histolytica.
• Salmonella.
• Shigella.
Treatment consists of correction of fluid and electrolyte abnormalities and reduction of symptoms.
Avoid antibiotics in enteric salmonella infection because a prolonged carrier state may be
induced. Antimotility agents should be used cautiously with inflammatory diarrhea.
Gastroesophageal reflux disease
Gastroesophageal reflux disease is symptomatic reflux of gastric contents into the esophagus. It
is one of the most common conditions you will see . Symptoms include heartburn, chest pain,
regurgitation, belching, dysphagia, and halitosis. Additional pulmonary symptoms including
chronic cough, hoarseness, wheezing and asthma. If you see a patient who complains of chronic
tickle in the back of the throat with associated cough, consider gastroesophageal reflux disease
after ruling out other possibilities. Ask your patient whether pain wakes them up at night—this
generally is NOT reflux and more likely associated with ulcer disease.
Risk factors include smoking, drinking alcohol, eating chocolate or mints, hiatal hernia, obesity,
increased intra-abdominal pressure, and increased plasma progesterone levels.
Diagnosis is usually based on history.
• Barium swallow: least sensitive test.
• 24hr pH monitoring: gold-standard for measuring GERD (pH <4).
• Manometry: may detect transient lower esophageal sphincter (LES) relaxation, hiatal
hernia.
• Esophagogastroduodenoscopy (EGD) with biopsies, if patient has long-standing
symptoms – to rule out Barrett’s esophagus and adenocarcinoma.
• Acid-perfusion test (Bernstein test) can be done but is becoming less common.
5. Treatment includes lifestyle changes, drug management and surgery.
• Lifestyle: weight loss, elevate head of bed, avoid certain foods.
• Drugs: antacids, H2-receptor antagonists or proton pump inhibitors (PPIs).
• Surgery: nissen fundoplication if refractory or severe disease.
Complications include ulceration, strictures, upper GI bleeding, aspiration and risk of pneumonia,
Barrett’s esophagus (which may lead to adenocarcinoma of the esophagus).
Do’s and Don’ts
• ALWAYS remember to ask women about their menstrual cycle and sexual activity since
many gynecological and obstetrical conditions can mimic GI complaints.
• Do perform a rectal exam in association with Hemoccult. No-one likes having a rectal
exam, but it is almost always pertinent, especially when ruling out GI bleeding.
History and physical examination
Ask about bowel habits and any changes in them, flatus, nausea, vomiting, dark or tarry stools,
and association of symptoms with eating or types of food. Ask the patient to point to the location
of the pain before initiating the exam.
• Inspect the abdomen, particularly noting the contour, any scars and locations, and
noticeable masses or bulges.
• Listen for bowel sounds as well as abdominal aortic and renal bruits.
• Percuss the abdomen; tympanic abdomen suggests obstruction.
• Always start palpation away from areas of pain.
• Do light palpation followed by deeper palpation; note any masses or muscle rigidity
(“guarding”).
Percussion is also a good way to test for “rebound” tenderness or acute abdomen. Some
physicians may try to bump the bed or exam table to assess for peritoneal inflammation, as well
as asking their patient to cough or just percuss the abdomen; these will usually elicit “rebound” as
well. BUT always consider your patient’s comfort – testing for rebound causes additional pain and
you should make sure that it is absolutely necessary.
Author
By Matthew Reinersman, Southern Illinois University School of Medicine.