GIT

Anorexia Loss of Appetite

Loss of desire to eat

Causes depression

psycological eg

chronic Infections TB HIV etc

Hepatitis Infective Hepatitis

Alcoholic Hepatitis

Anemia

Drugs Induced eg metronidazole digitalis

Sitophobia fear of eating because eating

leads to pain

oral ulcer acute gastritisetc

eg
Multivit Appetizer Digestive Enzymes

Treatment

Multivitamins for nutritional deficiency

a
TemeconolMDf

folic Acid 5mg

Methylcobalamin 500mg Biz

Pyridoxine BI

Vit Ds 1000 IU F 140110tab

Biz vit Indications Bo Indications 141tab

d d

Biz defn anaemia sideroblastic anaemia

peripheral Nuropathy pyridoxine dependant Epilepsy

Diabetic
Nusopathy problems of Isoniazid

Mushroom poisoning

Omegaaoldcapsi Bayberry Pharma

lipoic acid Antioxidant

Alpha 175fticecap

Biotin 200Mcg 1751cap

Folic Acid 1.5mg

B12

Ba

Vit Ds 1000 IU

107 10tabs

Tab Nweobion Forte

Bcomplex c Biz


Alphalipoicacide Indication

Antioxident

Diabetic Nuropathy 1 numbness of legs arms

Memory loss

chronic fatigue

It restore the Vit Ek in the body

3 Cap ritacore 57 CMutivittmultiminerals tIEItab

ro

Cap Predvit 4G Il r65Ef

b_

Tb Narokind plus gotta

sachet

cap Nurokind Gold I Nurokind Gold

892110tab
Tab Health OK boff stab Health ok sallet 307

8 Ibap Hosit XT Iron preparation far IDA 1582

PregnancyrelatedAnaemia

Tb Enerzosh grape seed extract

mangnesium for fatigue

Resveratrol PE muscle cramps

uit D

multivitamin syrup's

E177 200M

syr Cycoberry

lycopene Antioxident B.PH Heart disease chronic Infection

Vit B complex

Syr lycored E 2321200mL sugarfree

Iodine 75Mcg Hyperthyroidism

selenium 35 mcg osteoarthritis

Mangnase 2.75mg carbohydrate metabolism

Zinc 7.50mg Acne Diarrhoea Anaemia

Nutritional
Copper 1.1mg suppliment

Lycopene 1000Mcg

Vitacore 57 capsules

O
Biotin 30 MCG+Boric acid 150 MCG+Choline 10 MG+Cyanocobalamin 750 MCG+Docosahexaenoic
acid 60 MG+Eicosapentaenoic acid (EPA) 90 MG+Garlic oil 2 MG+Gingko biloba 40 MG+Ginseng 42.5
MG+Grape seed extract 15 MG+Green tea powder 10 MG+L-glutamic acid 20 MG+Lycopene 10000
MCG+Niacinamide 15 MG+Piperine 5 MG+Ribo avine 1 MG+Tin 2 MCG+Vanadium 10 MCG+Vitamin
A 1600 IU+Vitamin C 12.5 MG+Vitamin D3 400 IU+Zinc sulphate 15 MG

cholinas Reduce inflammation Analgesic Antipyretic

anti-parasitic, prescribed for trichomoniasis, giardiasis, bacterial vaginosis, and amebiasis

Tin

Tab Narokind Plus

Use various symptoms like pain associated with neurological disorders, numbness, tingling, diabetic polyneuropathy, and

mental disorders and prevent anaemia

Content Methylcobalamin/mecobalamin + alpha lipoic acid + vitamin b6 (pyridoxine) + folic acid

Nurokind Gold sachet

Main Use Male Infertility mm

9sperm concentration 9 sperm motility

Asperm morphology asperm clumping

P spermatogenesis

501
2 sachet

tab

2inomuitu.iuit.muu.imin9uoahl5tab6Hta f

XSyr.L'ncouit MRP 127

Tab A toZ 1052115tab El 7 tab

multiuit t multimineral Antiox

Ato 2 Zoomt E 133 100mL 65E

Syr 3524100mL

10724200Mt

Syr Fruitiobin sun pharma

uit t protein iron
mineral

6971100Mt

Syr Zella C Wanbury Pharma

1224200mL

Biz Vit Bl

folic acid Vit E

niacinamide vie D skin soft

Haile

BG Iodine ravater content in

Vita zinc a elasticity

Selenium Manganese

Molybdenum

L lysine

D panthenol

1554200mL Akumentis Healthcare

Syr starmyne gold

Syr Cobadex 919 0 1451 A to Z

Bcomplex FA Caler Syr

Syr Visyneral I 611100mL

cap Becosales

L E 34 20caps

rien

nicotinamide
op.gn.m.a

11224200mL
ciplactinplus

AppetizeTj f og

SyrI Tab Ciproheptadine 4mg cidactinIPractin

Syr Hungree9677

TDS before food Yzhr

uselzoomet

avoid in Asthmatic patients

Syr Eupep

Syr Longefene Buclizine

Syr congefene A Ayurvedic Appetizer

Mankind

ggF 200mL
 me
E165200

5025

4525 3625 multivit

4625
props

IronDrops

DzDrops 1

Dsmustforte

715
3825

3125

M7 Inno

1
I7ntiamatim

553T problems
Digestive digestive

Tiny drops
n antispasmodic
qq.gqq.jfygI.IE

ntiheimenthi .qgy
IYY.to toeagidase
g

got got

Digestiveenzyts 119251200m

Syr Digeplex Diastase Pepsin After food

Syr Aglozyme saloon

fungal diastase Break the larger protein

pepsin into smaller one

improves absorption utilization

Unienzymes Bestozymes Before food

Syr g.GEzoow gimlsoon

Tab Digiplex Tissa

Pancreatin 500mg side effect SIE

i diarrhoea

indigetion I

asashoeas

digestive Enzyme
Pepsin

fitfinajintopaffiteasepreakdownotrotein

cap Dipep on

ChronicIndigetion
Z

Gastritis

caused

Life style

Hepatitis cholebithiasis

pancreatitis

zooms mrp 10425 mrp ggas

Treatment zooms

find out cause

Lifestyle management

Antacids
syromeelsyrAntacid
Syr Gelusil I Digene

Afterfood

Syr Gelusil Extra cool

Syr Gavisconawalnoord

sodium Alginate 250mg

Gastric Reflux

fortming
rigid raft in stomach

Bicarbonate

sodium Antacid

carbonate
calcium nogomJ7Iofu

eesyr.axid.oesa.ua91

SYR Sakral o It sakraefa

too
omg

Sakralfate form a coating in stomach used

1000mg Before

Syr Mucain Get astatzoon food


aD43T wk2
Mtmm9zomg
Rabi DI

Eap Repouin D Rabo DSR omeprazole

t Rabeprozole t Domperidoneomg pentaprozole

once in a I ste extrapyramidal

day nomadwks Increse gastric Tremmers etc

g Motility and

Relaxes the spinsters

Hat.ua rksasT 2nEeiget

Digestive Enzymes 07901 92 industry

291

MEET UET 21
single dose

TabAlbendazole 400mg

Avoid of alcohol tobacco spices

and hot foods

stomatitis

Inflammation Oral Ulcers

aphthous ulcers Recurrent

B complex deficiency

Iron deficiency Iron Rich Diet Ado

Oral candiditis Oral thrush OrathygeneD

submucal fibrosis tobacco chewing quitTob

Infections ProperdietIencerci

Traumatic Ulcer

Drug reaction

Treatment If pain give analgesic to treat

Topical sueralfate susp is also used

5MtX4timeslday

Betadine wocadine gargle Betakindgargee

9525150N

OroTGargi s

Ayurvedic Gargle by Himalaya

Macopain Oint Coral Gel

58 before food Benzocaine

4A I

Oroflora LA Oint Oracef GelI2ytee not use its

grin 575 pregnancy


torte

TESS Get Triancinolone ulcers 7525 perobion

Becomes

B complex tables for days

cap Rennifol 41 Istrip IX BD Avoid spices tobacco

Folic acid hot food

Lactobacillus soft 2992144

Niacinamide anasst Hennig

jarful

Pyridoxine Dist ERT DIETZ

HIT

Kenacort Ointment Trimcinolone 2 3 oral hygiene c

Oral paste chlorhexidinemouth

wash

swelling Ld dai

Oral corticosteroids
x BDITDS

Tb Betamethasone long Hedd

taperingdose

Tb x BD

Wysolone long

Oral thrush Clotrimazole candid oral paintHo

Tb Flucos 150mg once in a week

Tb Itraconazole200mg XOD fo fzordayg weeks

large hard to feel non tender

Ulcer single

chances of Malignant

Tetracycline250mgCap mixEwates gargating

IHiccoughT Hiccup Alcoholic

Dengue

Involuntary spasm of inspiratory muscles followe

by abrupt closure of glottis

Irritation of Diaphram

Treatment

Valsalva Manoeuvre

closed nose mouth

µa Last

Hold slow deep Breathing

Breathing
cold sali

gastric Lavage c ice

Cold water Ice cream

water q4hrly

Drops NeoOctinum 30 drops in a glass of

Tb Liofene CBN BD or TDS Hab

long

Batdofen muscle relaxant

Avoid in Alcoholic or CNS Depressants

mucainced

Antacid gel c xylocain

Tb Largactil derivative chlorpromazine stat Sos

Tremors d

zmgls.mg
Benwdizepene
anxiety
overs
1om d.eeiuium.uenuusiondis
lomgfzs.mg 5omg

a d

Tab Valium2mg MDs use to treat schizophrenia

Dizepam t

Amyl Nitrate Inhalation Block the action ofdopamine

for angina I

t a chemical

used in Rare massenger in the brain that affects

cases
thoughts and mood

If not relief

Pass Nasogastric tube in stomach

Reduce prevent abrupt

distention closure of glottis

The Geleen'll Digene cont I TDS

inadequate Exercise
physical Inactivity1

Cause

Ccow fibrefood

wrong life style food habits low water intal

9725mm

perianal abscess fissure piles cream

smuth

pregnancy 4

T Sachet Sachet

Find out cause pencelax1320 Green

CadiloseBUT

Perianal abscess fissure 2

Treatment

f M
Eva Q If Hard stool 10mF 15mL Hs poetloom
Syr

gg

Lactitol
long

drawing water into intestine by osmosis

to

make
smexBD
stool soft
2ionexBD nl

asyrs 1681150
syr
Duph z
tours 2 souord 10Mt X TDS

3.35gm15M
90

Lactulose

Increase the pressure in the colon

Ayurvel Laxative Powder

Hs
Tb

Dakotax 5mg 110mg I 2 tab HS

d
BOX

104251 I

Increase the motility of colon

2 tab Ceasex for KOB 21 2 tab

Xray HS

Tab Gasex I 2 X BD or TDs

Lactifidr 30025 2 3 Tsp x HS 61041

Alternative mpp

Lactitol comes 3850

Ispaghul9

Peglec Powder Nutritizing stomach all'd

Increase the frequency

very strong of bowel

edaigffueingffatffoorindeae Do'Ewingwattergeinfonodinotn

Sodium chloride

Sodium sulphate reFN

suppo

Enema Proctolax Enema pukolaxµ.ge

aid
up


Dulcolax 1 Glycerin suppository

Associated c Abd pain vomiting

think for Intestinal obstruction

Ayurvedic Preparations Amalki tablets ItrifphalaO

cap

Isabgol Powder

softovac Naturolax powder

I tap ghee c lake warm water milk

10 glasses of water daily

Bran 56 5373111

foods c high fiber helpful

Apple

carrots beets

ifinjffion 0.7979

green vegetables

eaT
IDiarrho

Increased stool water zoomldaily

Increase frequency
increase fat content
c stool

steatorrhoea

pale colour

Mal odorous

difficult to flush away

Ilium
Acute c chronic

I constipation

E alternate loose stool

suspect gastroenteritis 4

travel change in suggest Irritable bowel

food History

infection's of colors c E coli

Bloody diarrhoea

others like Camphylobactor

CA colon less chances

Perianal disease

No Piles
Fresh PR Bleeding

Diverticulitis etc

Mucus Occurs in Its

Pus cell in stool Slo Inflammatory bowel disease

CIBD

fistula Labcess etc

Small Bowel Symptoms

Large Bowel Symptoms

t periumbelical RIF Palin

watery stool c Blood Mucus decreses after defication

Urgency for stool

Pelvic Region pain dafter

defecation

D ucedD ed

Antibiotics

PPI's

Cimetidine

propranolol

Bloodiest

CBC chronic diarrhoea

Biz absorption decreses

TMCU

WBC T in Infective

ESR P IBD

CRP 8 Infections IBD

Sr Electrolytes

Stool IMO

Treatment

oral Rehydration

is ORS powder

Ornidazole Soong Tb Mahacef 02

Tab Cefixime zoo 1

XBD

Tinidazole 1000mg i x BD

To Facsigyn DS

Cefixime or oftox

Tb Oz oftox Ornidazole

woong soong


Tb Enteroflora IX TDs

lactobacilli Bacillus Clausii

a
cap Econorm IX TDs

SaccharomycesBoulardii 250mg in gut

electrolytes

Reduces excessive secretion of water

Tb Redotrilloomg Ix BD TDs

Racecadotril 100mg Anti secretory

non responde to above

abdominal bloating

If along c

Drugs
ztab stat single dose

then Tb Sechil Forte

If weight less than

sechidazole Igm

55kg then

I I

6021tab i tab afternoon

1 tab HS
Inj Magnet forte
Bj51

If not respondemotdhermate to sever

This Monocet Igm x BD t 1 Info

pas
4.5 TDS

Ih'sTawcare

Trig Annika 500 OD1750 OD z 25

TDS

Metro 100mL x TDs

Ihs

IX TDs

Tb Gut 0K

Lactobacilli Refaxemine

Tbs 400mg x BD
Tb Rifagut 200mg
Travelers diarrhea

of choice in

drug

shock Ivf's

se potensicn stlypovo14mic

lampule

DsTo This Dopamine

I
lo iz microdrops I

min

watch on urine output Bull creatlElectrolytes



Diarrhea E fever

Slo Infective diarrhoea

Tb Ciprofloxacin 50mg x BD

Tb Norflox 400mg x BD

Tb Metronidazole Flagged omg x TDs

Tb Tinidazole 500mg Tini x BD

HIV associated Diarrhoea

Tb Ciplin DS TMP SMX TDs x 7 days

cap Nutrilin

lactobacilli i B complex

x BD in sprue

Cap Doxicycline loocong

1

is disease of small intestine causing

a

malabsorbtion due to inflammation of

lining of small Intestine

Ing Dexa 6mg x BD or 8mg stat

Reduces the frequency

work of action unknown

Bacterial Dysentery
ein stool

Stool c mucus c blood RedGetty Abd cramps fever Rey

G'proteose 500mg Cisnglkg xBD

Cefridxon 50 100mg1kg

Tb Azee500mg XODx5dhys

NitotuzEntoin

set agatha dont oldest at diagnosis 2 ET

chapter avi page no go

Infectious

DAY
Diarrhoea

DAEC

St us

12hr5

a
IIP

stomach small bowel

diarrhoea vomiting

Large volume watery

Ecoli.shige.lt

bloody diarrhoea e Abd cramps

2 systemic upset

dysentery

Clostridium difficile Infection CDC

Hospital aquired Antibiotics Broadspectrum

stool for CD Toxins CDT

mild to lifethreating

Hypouolemic Shock HRT BPL

aggresive Ivf

Alsoconsider intmabdomina sepsis

Renal impairments

Acute Injury
renalacutekidneyHeat
Hypovol pre

t AKI

not
nephrotoxicdruse

d

diuretics ACEInn NSAID

Ivf urineoutput 1 UTE

Vomiting

History

a causes

main cause Gastric

to
SABC.DE f GHI

othercheifcauses
A Acute Renal

failure

Addison's Disease

B Brain AICP
myocardia infract

C Cardiac

D Diabetic ketoacidosis

Meniere's disease

E Ears Clabysinthitis

substances alcohol Drugs eg opiates

F foreign

q Gravidity Gastric

µ Hypercalcemia Hyponatremia

UTI meningitis

I Infections

Bloodiest

a CBC

Orin

readcreate Isr Electrolytes

FT

Ca2e

n amylase

Abdominal x Mo intestinal obstruction

Ray

Upper GI endoscopy if persistent vomiting

a Head CT Brain

Temporarily

Treatment TVBM

Anti Emetics
Receptor Antagonist Dose Notes

Hn Cyclizine 50mg 18hr19 OIIMIIU GI causes

Cinnarizine 30mg18hr19 oral vestibular disorders

D2 Metoclopramide long18hr19 olImlIU GI causes j prokinetic

Domperidone zong 16hr19 oral also prokinetic
Procloperazine 12.5mg IIM vestibular GI causes
5mg18hr79 orally
Haloperidol 1.5mg Bb orally chemical causes eg opioids
5HT3 Ondansetson 4mg 8holy IUlo Doses can be higher

others Hyoscine hydro 200 600mg Selim Antimuscarinic also anti

bromide spasmodic antisecretary
don't prescribe E prokinetic

Dexamethasone G long Id orallyIIe unknown action

midazolam 2 4mgId Iu Unknown action antiemetic
effect

Condansetson BDITDs IainOrton slow Io

Ih's Conset 4mg 18mg
v Iml Im

n Tb Lofer MD 4mg 8mg NDS e 2mg

2tsp XTDS
B

n
Syr Aglozyme

NBM advise for dry food Toast's Biscuits O

Total mm

Antacid liquids
o is into
yes
entry

waterheadache

watch for win output Orin ketones excessive

coma's
malaise Death

Sr Electrolytes If Nad Th Sodomint 2XTDS brain seizures

Kd Kesol
Syr ReglanIPerinorm

If severe In's metoclopramide long

IIM stat

Cap Omez D Esemoprozole I Domperidone

Tb SampraZD 20140

Hyper emesis gravidarum vomiting in pregnancy NOlong

Pregnidoxine

Tb Doxylamine Doxynate 2µs for 2 3 weeks Tb

Tb Medicine CPregnidoxin 12.5mg TDS

Tb Stageron 25mg cinnarazine 25mg x TDs

112 TDS


Tb stemetil MD procloperazine 5mg x BD TDS

MRP 71 10tabs

Inj Dexa 4mg 8mg IV IM OD

Ing Medaz Iml Iv

ImIIe gshady

Metodopramidelong

In's Reglanlong

Dysphagia

Difficulty its swallowing

causes oral Pharyngeal inoesophageal

Odynophagia painful swallowing

needed

Investigation always

pharyngitis peritonsillar Abscess

commonly tonsillitis

Dysphagia

t in swallowing

difficulty

solid a Liquid

if Both

Upper GIscopy

Refluseoesophagitis

s peptic ulcers

1 weeks

Tb Sompraz DUO x BD for 2

kit i kit for 7days

Ty H pilory

ftp.atnfuf
aesoomgxoDx2days 5days nidDc M

Amory dew025 X BD of guy arim

lansoprazoteyffmyo.my
cap Corot d

dine Iwokadine Himalaya Gargle

Beta combination

Antiinflammatory
Dido etc

Semisolid diet PrednisolonelBetamethasone if swelling

t

corticosteroids

Mucain Get anaesthetic gel ztspxtDs Bf

Sukralfate 2tspx TDS

Syr

Pain stolpepticaleersJM 70 H pylori

abd

DLb_ chronic upper

Bf Before food


Rt Hypochondripacain EinpigafftrdoicmenRegion Lf Hypochondriac

1 Choklithiasis Tdetitisdenitis D Peptic Ulcers
2 gastric or colonic
2
Biliary colic pancreatitis
cancer splenic
3 Hepatitis 3 Peptic ulcers flexure
4 Colonic cancer 3 splenic Rupture
Hepaticflexure 4 gallbladder
disease
5 Aortic aneurysm
6 MI Pleural Pathology
Rt Lumbar Reg Umbelical Region Lf Lymbate Reg
D above P causes DMesentric ischaemia D Renal colic
1 2 Abdominal Aneurysm pyelonephritis
2 stones
3 pancreatitis

3 Renal colic
pyelonephritis

Rt Iliac Region Hypogastric Region Lf Iliac Region

1 All causes of D Diverticulitis
A Iliac Region 1 DOTI Urological
a voluolus
a Appendicitis
3 Crohn's Metis
g sRfotheention
3 Colon cancer
abscess
g menstruation g pelvic
5 Pregnancy Inflammatory Bowel
G endometriosis Disease
7 salpingitis 6 Hip pathology
colic
8 Endometritis Renal
g ovarian cyst torsion 8 UTI

sedw

c Gastroenteritis

2 Irritable bowel syndrome q µ

3 Peritonitis

4 Constipation Infection's

5 Enteric Fever


Treatment

DAntacidy

a Ranitidine group Pentaprozole Esemoprozole

b PPI Rabeprozole

Pomperidone

2 Muscle Relaxant 1 Pain killer

Dicyclomine hydrochloride 20mg

a Tb Cyclopam

Paracetamol 500mg

Cyclopam plus BDtDS

f Tb
Dicyclomine 20mg

Paracetamol 500mg

Metenamic Acid 250mg

of A X TDS

Tb Buscopan 70mg

c Meftal spaz
Tb hyodine butylbromide

Dicyclomine long

mefenemic Acid 250mg

BDITDs E cyclopam if pain

d Tb Colospa not Reduced

Mebeverine 135ngor pain Related to

e Tb Dotrine 80mg Intestine

Drotaverine 80mg

Injectables 75mgpreamp C Pain killermefenemicAcid

Tramadol

D Iris Dy paypal.AM coomlnsdri

Ilm Wmgtml imam
IVIIM
r.nlAmp
sc
ssomglml
start IV very slowly

2 Ing Buscopan because it may cause

1Mt IIM IV

g Ied Fortwin I Phenatgan must use it Rea

at tsanaphylatic

inflammationhighercentrew

4 Ing Dexa LL the

Antacid liquids

IDs Ms Albendazole400mg single Dose

Tab Metro400mg

Sadative's if pain is not reduce

Hydrotherapy

stones less than 6mm

Thvestigs

D Usa Abd Pelvis Borderline stomach

2 CIC E CRI

Appendicitis WBC T

stones RBC's in Urine

pancreatitis Sr Amylase Sr Lypase

DU Peptic Deadened Ulcers

Upper GI scopy PO

Liver Pathology IFT's

Blood

stool Examinations worm's occultstool Slo

E Histolytica in

Ct abdomen amoebiccolitis

Xray Abdomen pelvis

stones Usa Abd

Inflammatory changes

in Abd cavi

I neatophilia

ofAbd
DID

pain

Radiated

Pain from
Diaphram ureters

GB I

Diagnosis need diet problem edict 31241T HI ETchaptdiet

page no 24

cholelithiasis Cholecystitis

Acute sdeuouer.hr

Gallbladder GB

d 1

Asymptomatic only stones stones 1 swelling

get

Rt Quadrant

Contineous Pain in upper

i fever

Murphy's sign

2 finger's RUG

t in

tell patient Breath

to

d of inspiration
c arrest

severe pain

1 LUG

Do the same procedure on

No pain

1 positive

Murphy's sign

phlegmon
be palpable

This inflammed mass may

Investigations

cholecystitis E CRP

co BC 9 may slo

USG Abd e pelvis

plain AXR

CT Abdomen

Treatment Bed Rest

NBM Bites are required for fat digetion

Lot fat Diet Fat free diet

IU Inj MagnexForte IvxBD

Cepfoperawne

Cefuroxime 1.5g18h IV Tarocare4.5 xTDS 225
TDS

laparoscopic cholecystectomy

Cholecystectomy prefer

E help of 4 probe's

must

1
if deutopsperitonitis t to complication's

or If not done leads
fails medicaltreatment
obstructive Jaundice

for 48 hrs
y

Stone's CBD d

https://youtu.be/qNEbypney3w
cholangitis

Acute cholecystitis

chronic cholecystitis y

Acute inflamation

I 1

chronic Inflammation severe pairs

I Colic I

manage c
pain killers

and low fat
diet

Cholecystectomy

Pain Killers

tramadolloynapastfortwin

Refer's to surgeon
µ
sensitivity

38mg IV slowly After

If

Yonosms
test
IHIM

tis uit B complex
a.io
ein
riiI
nqgeojef.na.aigfg gg

cystic duct HEIUtecht G B distention

T
1Biliary colic gallstone t
l 6 a shallot

I

ATE iHHd4lTh4Ht intense dull Roos orepigastricpaintradiating

at HIM satto the back scapula

I jaundice

No changes in left

Bb
1

USG confirms


Charcotistriardts sepsiscfeuerjtJaundibddiscomfort

obstruction in CBD

Cursodeoxycholic Acid

Tb Hepakind 150mg

type of

dissolve certain gallston

from forming

prevent them

bile acid which

It is a

helps breakdown cholesterol

into

which has formed

your gallbladder

stones in

Pancreatitis

Unpredictable
radiatesto Back

Epigastric central abdominal Pain

vomiting

Causes GET SMASHED

38 G Gallstones total 75

app

35

C fthagnmola

1.540T

S steroid's

Mashing'ismomnmfiteuenom

mas

affpotoximately

te Hyperlipiddemia

Hypothermia

Hypercalcaemia

E CRCP 5

D Drugs

other Pregnancy

Investigation's

wiser feukocytosis

serum Amylase 9

renal failure will also 4 level

but

maybe normal

because level's start to fall

1st 24 48 hr's

within

it disturb the fun of Insuline secretion

BSL Must


Sr more sensitive specific foe pancreat

Lipase

USG Abd pelvis

orAXR plain

to assess sevirity low density changes

CT

LET'S
oxygenation acid base status

ABG monitor

Treatment

mucosal Atrophy

TPN total t pareteral Nutrition gut

N BM feeding feeding tube radiographically

Postpyloricenteral to the third portion of deodenum

1 introduced

Tube to decrease pancreatic

Nasogastric

stimulation

of fluid 0.940saline

NS IV f give Iot's to prevent

failure
complication like Renal

until signs
vital satisfactory

to h
730mi

at

urine output stays

catheter

Urinary

TPRIBP charting tirly urine output

creat calcium glucose amylase ABG

Daily CBC Urea

CRCP 1 gallstone removal

Jaundice T

Pain killers

Tb Creon 1000mg x BD

Repeat usuallyCT in order to monitor progress

Pancreatic secretions

In'sAtropin 0.6mg Ilm To reduce gastric duodenal

to relieve spasm of sphincter of Oddi

Antibiotic Iv meropeneum

Glasgow criteria for severity of pancreatitis

PANCREAS
e

Pa02 L8kPa

Age 755 yrs

Neutrophilia WBC 15000

Calcium 22mmol Iiit

16 mmol1L

Renal function Urea

LDH 600 iull j AST 3200 iy L

Enzymes

Albumin 23291L serum

Blood glucose 710mmolIL

Sugale

d detected in 48hr5
factors

3 or more positive

suggest severe pancreatitis

1 nes

criteria for pancreatitis ca.usedbyg.ae

and alcohol

gallstone

140 or then think for GI.ee

Tips Alcoholic

on clinic's

t
Age

WB find then go for

BSL if changes
t

BUL Sr Calcium

Sr Albumin

Lipid profile

Renal calculi Nephrolithiasis

Crtystals aggregates stone

Formation

Renal Pelvis to Urethra

Pelviureteric Junction

Pelvic Brim

Vesicoureteric Junction

eecB_uirim ReccurentstonefBgBBfd .once

stone

form another
one

within

s form

next 7 g yrs

composition

most imp 75
calcium oxalate

Uric Acid g types 5 logo

infection stories 2 20

struvite

The Stone Formation

Factors Affecting

Factors

Intrensic

Obese Person

of stone promoting substances

9 Urinary excretion

eg Ca Ox Uric acid etc

t substances
of stone preventing

tr excretion

eg citrate

format
Encourages stone

Lower urinary pH

AGI chances

more

20 50 yrs

see than females

males affecting 3x more

secretion

Male T Testesteron

1 of oxalate in Live
leads to A production

concentration

Females Higher urinary citrate

1 less

Ca Ox stone
formation chances are

Genetic

Asian people more chances

Extrinsic factors

summer

more Heat

Concentrated Urine encourage crystallization

low pH

T cystine and
uric acid stone formation

Low water Intake 41200Mt day

Diet

Protein Intake

High animal
t

Increse the risk of stone disease

High Salt Intake

d transport mechanism
sodium calcium

co

Hypercalciusia

symptoms

Asymptomatic

Renal colic

Loin to Groin pain

c or 5 nausea vomiting

Renalobstraetion PUT Junction

pain in Loin Reg

at level of 12th rib

specific movement 1 pressure on a spot 9 pain

mid Ureter obstruction

pain like appendicitis diverticulitis

obstruction of lower Ureter

scrotum

Bladder irritability and pain in

penile tip

obstructioninBladderororet

pelvic pain

dysuria void

desire but inability to

strangury

interrupted flow

UTI

Rigors 10in Pain Nausea vomiting

Pyelonephritis fever
nephrosis

Pyonephrosis infected Hydro

Heamaturia I Anuria


Examination

No pain Tenderness on palpation

Renal Angle Tenderness

percussion on

if Inflammation

Tests at Renalangle
Purcusssion 12thRib

CBC

Orin RB

BUL citrate

24 hee Urine for calcium oxalate urate

KOB ming on empty stomach

tray early

Tb alveolar 2 tables

Tb Ceaser

t visible uric AcidSton

8040 Stones are are notvisible

Usa Abd Pelvis

CT Abd gg stones are visible

Analgesic's diclofenac 75mg IMI Iu 100mg suppository

IU fluids prefer oral intake

59m18holy IU

If infn antibiotics eg cefuroxime 1

Cefoperazone Igm 1 Sulfpactum500mg

IN

Iu's Magnex Forte

stones 25mm in Lower Ureter

90 95 chances to pass

I
Intake

only increse fluid

Stones 5mm Pain not resolving

Medical Expulsive Therapy

or d blockers

nifedipine 10mg18hrly orally

Tamsulosin0.6mgId

prednisolone I inflammation promote Expulsion

If not in 48 hrs

Then think of Shockwave LithotripsyCESWD if Ltcm

tu

SIE may cause Renal

Injury

T BP and DM

If not Possible

Then Percutaneous Nephrolithotomy MNL

https://youtu.be/0hKRYVrlfdI

to

keyhole surgery to remove stone

to

large multiple complex stones

https://youtu.be/_ErekbbmOUA
Rarely

Tb cydop.am cydopamplus meftalspazXTDs BD

Tb Colospa ixtDsIBD

Tb Dotrin80 mg x BD

Antispasmodic Analgesic Ilv IM

I b

Ing BuscopanKc DynapasAS IMIIU

em

Tb Prednisolone omg x BD Tb Defcort6mg ODIBD

l

a Ini Lasix long lung foe Hydrotherapy

Acute Gastritis

Epigastric tenderness

Endoscopy

Treatment

Bed Rest

Bland soft Diet

satsato IGaviscon Tab SukralfateIgmTDs

mucainldigene set aspxtbs Isyr

PPI

Achalasia Cardio

absence of esophageal Peristalsis

motility disorder

Impaired relaxation of Lower esophageal spincter

LES

symptoms

sternal Discomfort
Retro

esophagus dilated pressure on trachea bronchii

cough dyspnea

aspiration of material into lungs as no peristalsis

Barium meal dilatation of esophagus c narrowing esophagogustricJun

manometry is gold standard

Treatment

aim Reducing hypertonicity oftheLES

Tb Buscopan IXTDs 112 hr beforemeal

Tb Nifedipine long xTDs also beneficial

Avoid Irritant substances salicylates

NSAID's

Alcohol

spicyfood

swallowing unchewed food particle

Avoid lying down for 2 3 hrs aftertaking

food

Endoscopic dilatation using pneumatic bag fluoroscopic guidance

Botox therapy who cannot risk surgery

Acute mesentric Lymphadenitis

Inflammation of Mesentric lymph nodes

pain umbelical I Rt iliac fossa childo E tenderness

Anorexia nausea vomiting fever

marked leukocytosis

n Hlo recent RTI

Treatment

supportive hydration Analgesics

Broad spectrum antibiotics

gmove Doxycycline
Fluoroquinolones Aminoglycosides

3rd Gen Cinflox1Norfloxottox f f

cephalosporins gmove Sle diarrheal

1 nausea

pretein vomiting

synthesis op d
Bacteria

child teeth

I Colourcharge

thrikaein t
p l
gentamycin prostatitis

streptomycin sinusitis

Pelvicinflamatory

disease

Ache

gonorrhea

cetiximet
Doxy

Acuteorganicsmallbowelobestruction

of small bowel

mechanical obstruction

prevent transmission of digested product

colicky abd pain vomiting constipation

Tender distended abdomen

Audible peristalsis

evidence of gas 5 movement

say sometimes X dont CT confirms

Treatment

Naso gastric suction INBM

IVF

Broad spectrum antibiotics if stagnation

Needs immediate surgery

Bowel sounds

t
all 4 quadrants c stethoscope

t

in systematic manner

start from Rug

till sound heard

Bowel sound if no sound heard

listen for 1 3 mins

high pitched a gargling

noise

irregular vary in

frequency

pitch intensity is

about 5 30 times

a min

Irritable Bowel syndrome

abdominal complaints from many years

consult c
many Dss

d ButNorma
before

lots of Investigation done

associated c mental stress Depression

need to reassure that it is not

mtiI.oatineIe

i.LY

Ina
g

Diagnostic criteria above do attest

for 2 months

signs General abdominal tenderness

Treatment of IBS

Reassure the patient

Diet High fibre diet

Avoid stress

Avoid fried foods alcohol tea coffee

Regular food
c adequate sleep

Tb ColospacMebeverine 100mg xTDs foranyantispasmode

Tb Spasril 1xTDS Chlordiazepoxide5mg Clidinium bronfideng

or sedativespeday brain

Tb Librax Ix TDs

Tb Ispaguela or Isogel i once or

tsp twice day

If do LM of

a volume
bowel
Imodium Reduces

OD IBD in 20kg

Tb Loperamide Imosec 2mg discharge

TDs
i3
Imodium
liq s 1mg BID 2ndday

ose
Or 2 yrs 2mg
thenfrom

G gars reducedodrse

phosphate x OD BD opioidanalgesia

Tb Codeine 30mg

or

Tb Diphenoxylate Lomotil OD
2.5mg IBD
age

causes severe

Ondansetron RSICNS Depression

g His antagonist like inching

effective in diarrhoea dominent IBS

antipsycotic medications like

OD

Cap Fluxtine CFludac 20mg

or

Tb Imipramine Depsonil 25mg x Tbs



or

clozapine

or

Olanzapine

always start in IBS If little signs of dipression

is present

50 of Recovering chances

Rarely

If unsuse Refer the patient

Tb Rifagut 200mg TDs 400mg BD

Tab Luperamide

4mg 2mg after each stool Max 16mg

TDs

liq Coperamide 2 5 yrs

ing on 1stday

87,47 I zmmgg.BG

under ups from 2nd reduce dose

dry ut

only if watery diarrhoea.fr

Hepatic

Renal constipation in 2.6 Pt

angioedema

Impairment rashes urticaria

shock in somecases

anaphylitic

paralytic illias

HepC Infection
Jaeyndi

causes Alcoholic

Pasthepatic

Hepatic 1

Prehepatic I cholestasis

t Hepatocellular

hymolysis Dysfunction

impaired

teriditary Acquired transport across

t hepatocytes cellulardamage

PDDeth Immune I

canaliculi
halasseamia

Drugs Dapsone Biliary liver failure
Infn malaria obstruct
ickel

cell encephalopathy

1
Coagalopathy

A.LT AST INR 1 5
normalcolourcerin

to

black stool

ALP199T
biochemically
Uncojugated Bitt

AlcoholicHepatitisT VivalHepatitis

d
l malaise Arthalgia

constitutionupset

Headache anorexia

Tender Hepatomegaly
1

Fever A E virus most

common

confirmby serology

Xoimmuneqd.it 3 6 w'eeks recovery

I

cirrhosis 25 a 10 if HepB

common infemales
80 of HepC

IgG T

Serum autoantibodies T

Cardiacfai
WilsonbiseaseLT

hepatic injury

metabolism
due to

disorder of copper vascularcongeti

Sr Caeraloplasmin t highlysuggestive d

MALT

Jaundice

mucosa

yellow pigmentation of skin sclera

Anorexia Molester's

hemolysis
1 I

liver may I may not palpable Prehepatic hepatocellular posthepat

dysfunction
L

Bilirubin t hepatic

unconjugated conjugated

I 1

Water Insoluble Hepatocyte damaged

1 t

not centre in Urine virus ALBICLE

overproduction due to DragInduced

Rifampicin
Antimaterials

haemolysis

pcm overdose

conjestive cardiac failuatl anti TB

I
Deth suphonytureas

glucoronyl transferase Alcoholic

1 cirrhosis

neonatal Jaundice liver Abcess

physiological

short life span ofRBC's L

water soluble Make

Bil conjugation not properly

urine dark

dev d
less conjugates gut

311994T

liver eat gyro makes stool pale

Liver seed Taial

liver eat ricked

Aldol

Clinically
Any kind of drugs

BT Travel

Hepatomegaly splenomegaly ascites palpable

gallbladder
cholestatic Jaundice

pale stool c dark urine

tests

liver cause

INR Indicates Hepatic synthetic fans

Albumin

damage

slept 1590T t Hepatocyte

Alk Phos obstructive Jaundice

some times in Hepatocellle

pregnancy

Urine for Bile salt Bile pigments

cause

Bilirubin absent prehepatic

Acholusic Jaundice

Urobilinogen absent obstructive Jaundice

Bile salt Bile Pig T conjugated

Blood

A means heamolysis

CBC c Reticulocyte count occurs in the

body

IFT
Bile duct dialated 76mm

USG Abd If

May be obstructi

LET's not improving

ERCP


CT Abdomen

Treatment

Bed Rest c gradual Returns

CghkonD

Plenty of oral Iuloologlucose

Low fat diet

B complex Uit k

for l 2 months

Syr Liu 52

vomiting D 2540 c Antiemetics

If

Hepatocellular Regeneration

140mg BD

Tab silymasin Silybon

or
Essentiate 175mg x BD

cap Phospholipids

If Jaundice is progressive

then use

2x TDs x 5days

Prednisolone 5mg
X 5days

1 X TDS

l X BD X 5 days

l X OD X 5days

If Restlessness

phenobasbitone

then use

If Itching

1 phenol c calamine Lotion

01

cholestyramine 4g daily

Australia Antigen

Tb Udiliu 150 300 x BD Itb Hepakind

mg

Tb viboliu 500mg xBD

Ii

Metadoxine use to treat alcoholic fatty

It is antioxidant

It works by protecting the

liver from Harmful chemical

substances increses alcoh

Prophylaxis elimination
Immunoglobin 0.002mL1kg

Hepatitis A Human Normal

IIM soon after exposure

Engerix B giver IM in deltoid

Hepatitis B vaccine

all in 3 doses

Same dose for ages

Ist O

Ind after one month

1st dose

3rd 6 month after

Tb Hepakind 150mg x BD

alcoholic Hepatitis

Jaundice due to

Anorexia nausea abdominal discomfort

Tender Hepatomegaly

Fever splenomegaly ascities encephalopathy

abdominal pain and Tenderness

Alkaline Phosphatase PM

Sr Bilirubin 9

Sr Globulin T

Albumin d

CTIBT PTIINR

Management

Avoid Alcohol

Hydration

Uit k if prothrombin time 99

10mg IMI IV

Vit B Thiamine folic Acid

Tb Benalgyl forte

sedative

Tb Librium long BDI TDs Tb librax Tho

Tb Udiliv 300 X BD

x BD

Tb Viboliv 500mg

for 4 weeks

Tb Pentoxyphyllin 400mg x TDs

IU Dextrose

Ing Medaz

Tb Solopose 0.5 X BD

HS CAlprazolam

Tb Taika 0 25 0.5
Lorazepam

Tb Ativan 1mg12mg Hs

IVI multivitamin mankind

Nerve up

Hosit

optineuron

Tb Rifagut 400mg I 200mg x BD

Laxative for constipation

Ascities cirrhosis

Accumulation of fluid

is Irreversible damage Loss of normal Hepatic architecture

fibrosis
anaemia nausea vom abd pain
Anorexia
signs
left r or palpable liver c blunt edges
Amenorrhea impotence sterility
Leuconychia
spider nevi palmar erythema
PTI INR splenomegaly

I Albumin Flapping Tremors dysarthria

drowsiness coma
d WBC delerium
1 platelets Tests
LDH T
Sr Electrolytes shot T
ALP 9 BilirubinT
Hepatitis serology Albumind
Immunoglobulins 266,264 69T 9
555
Autoantibodies ANA AMA SMA

L fetoprotein
Ceruloplasmin in patients 240425

Ascitic Tap Ascitic fluid for Microids

I
Nutrophills 2501mm

sptonteneous
SBP Bacterial peritonitis
USG Abd Pelvis
due to fluid t
Not show much
CT abdomen
diffuse fibrosis
liver Biopsy shows
IgA T in alcoholic liver disease
T in AIM Autoimmune Hepatitis
IgG
IgM t in PBC primary Billiary chirrhosis
AMAT
Anti mitochondrial Antibodies
Wilsons Disease Sr Copper 1 ceruloplasmind

400g
I stop alcohol High protein diet
Albumins
if required Ihj
OI 2040 IU
upto500mgfday
I Frusemide
If anaemia Iron folicAll
Tb Propanolol Inderal longbo
to deduce X BD
portal pressure

10mg IMI IV
 Ifascitis
Tb spironlactone Aldactone too 200M
perday
increasing by cooing every 3 days
It no improvement
suggested by 1kg wt loss in 3days

If no response
add furosemide Zong incresed t
a maximum homey
cheek Sr Electrolytes for Hypokalemia
and alkalosis
If ascieties persists then
HermanSr Albumin 5 20 50 100Mt IV

ascites Paracentesis
In large
If Hematemesis present
L
Vit K IV for 2 days
Inj long
Ing Pitressin 20cm's diluted in
100Mt 540 Glucose over 10mins
or
for
Ing Glypressin 2mg IV 6 holy
maximum 4 dose
Balloon Tamponade L uiligant supervi
endoscopic sclerotherapy
ies if Bleeding is
Emergency
High
a Propanalot is given in increasing
daily dosage to achieve a
pulse rate of 601min to check
rebleeding
shunt and liver
Tran inplantation
surgery
suitable cases
 If pre coma is suspected Restrict protein

Neomycin Igml6hrly orally or through Nasogasts

Tube
or
streptomycin Igm Lohrey
or
Ampicillin 500mg I Ghrly
or
actulose 30mL TDS

metrogyl 800mg day

PBC Primary Biliary Cirrhosis

Autoimmune disease of Liver
Insidious onset
Pruritus followed by Jaundice
Hepatosplenomegaly
Serological tests reflect cholestasis E T ALP
5 nucleotidase cholesterol Bilirubin
AMA ve

IgM9
USG Abd
cholangiopancreatography
MRCP magnetic Resonance
CT
liver biopsy
Mainly in ladies of Age Group 40 60 yrs

Ursodeoxycholic Acid co is mglkglday in 2 4 divide doses

a Cholestyramine to relieve Pruritus
adm
Vit A K 8D for steatorrhea Parentarat
corticosteroids Azathioprine in selected cases
q above some treatment for cirrhosis
liver Transplantation
 Cirrhosis
Secondary Biliary
Extra Hepatic biliary ducts obstruction
surrounded by fibrous Septa
Regeneration nodules
cholestasis
term
long ve
AMA

management
Remove the causative factor
Herpetic stomatitis