Constipation

Defination

Patients having bowel movements less frequently

than 3 a If is h.ardanddiffic.nl

to

pass patient is constipated whatever be thefrequen

Causes

Acute chronic

Dehydration

Acute intestinal
obstruction

Acuteappendicitis

Func
organic

A Endocrine Metabolic Diseases

u s

Rectal colonic IBS DM

faulty habits foodIntaked Hypercalcaemia

Painful anal Low fibrediet

area Hyperparathyroidism

B Myopathic causes

abnormal
muscle tissuesneutamyloidprotee

buildsuit

Amyloidosis diarrhoea
weloss
tongue enlargement

genetic

Myotonic dystrophy
affectmusclefunctions

muscles weak

c Neurologic Diseases

Autonomic Neuropathy Nerve

damage

in disturb
dailyfun

Parkinson's Disease

spinal cord diseases

D Structural Diseases

Anal fissure

Haemorrhoids

Inflammation ofdiverticula

Diverticulitis whichis deviop in largeintestine

E Psycological

Depression

F Medicines

antacids opioids antidepressants

calcium

G other

Tumours in rectum

Investigations

CBC stool exam c occult blood

BSL sigmoidoscopy Colonoscopy

TSH
Ugg Abdomen Pelvis

Calcium
Sr Abdominal

Xray

creatinine

Treatment

Eliminate offending medication

Find out cause and treat

Non pharmacological treatment laxatives

educate about daily lifestyle A Bulk laxative

Lifestyle management Pectin

or
ispaghula

Adequate hydration
absorb water from intestin

Adequate exercise lumen to increase stoo

mass and soften stool

consistency

SIE bloating gases

B Stoners

docusate sodium

docusate calcium

allow water to enter the

bowel

ON Useful in painfaldefecat

I in 1

go piles fissure

c mineral oil

not recomended

D Osmotic laxatives

hyperosmolar agent

secretion of water into L

by osmosis


Magnesium hydroxide

milk of Magnesia

Magnesirate

sodiumbiphosphate

avoid in congestive heart

failure Renal failure

sorbitol Lactulose

Polyethylene glycol

E stiaxatives

Senna Castor oil

EE

bisady1

increase intestinal motility

and secretion of water

TI

a sie Hypokalaemia

F Prokinetic Agents

increase GI motilityby

increasing frequency of

contractions in small

intestine

Mosapride itopride

G Others

r Linaclotide

Labiprostone


Diarrhoea

Deth

Acute diarrhoea is defined as stool with increased

water content volume at least zooglday or

frequency at
least thrice
per day lasts 22 Week
that

If stool's
fat content that is increased called steatorrhoe

Causes

Acute Chronic

Toxin

Induced Due to changes

AGE in mucosa

Staphylococcus aureus Rotavirus

Bacillus cereus

Norwalk agent

Vibrio cholerae

Shigella

E coli
centerotoxic

E coli

clostridium difficile

Campylobacter

Salmonella

of
diarrh a

causes
other causes

children
in

Heavy metals arsenic Lactase intolerance

During dentition
Monosodium glutamate

Bacterial pan

Mushrooms
Vipuf

rot Antibiotic

p

Lactose intolerance

1 Chronic enteric infections

Salmonella

Streptococcus

Fungi

Viruses

2 Parasitic causes

Amoebic colitis

GiardiasisGiardia duodenitis

Lishmania donovans

Cryptosporidium

Isospora

3 syndrome
Malabsorption

4 Post operative Centerocolostomy

5 Intestinal biliary gastric fistulae

6 Pallaegra

7 Inflammatory Bowel Diseases

Ulcerative colitis

Crohn's disease

8 Intestinal TB

9 Diverticulitis

10 Drugs Mercury arsenic

Hr others hyperthyroidism carcinoid etc

Antibiotics PPIs Propranolol

Laxatives

Osmotic Diarrhoea Mucosal

Secretory Injury

to do

stool

output stool
output
diminishes

c
persists dispite

reduced

oral intake

reduction in oral

intake

clinical features

Acute 43 weeks chronic C73weeks duration

usually infectious or drug induced needs extensive history cresting

Travel sex ingestion of well prior
or bowel
surgery familyhistory

water or indaquate cooked food for

Testing stool examination

HH Lactoferrin parasites

Clostridium difficile

Exposure to ill contacts
toxin

steatorrheg foul smell
stool


Large Bowel Symptoms Small Bowel symptoms

stool I Blood or muck periumbdical RCB Pain

Watery

pelvic pain relieved by defecation pain not relieved by defeat

defecation

tenesmus feeling of incomplete watery stool or

Urgency steatoorhea

Examination

Look for wt loss anaemia dehydration oral ulcers

clubbing rashes abdominal scars

Feel for Enlarged thyroid or an abdominal mass

Rectal Examination rectal mass C rectal carcinoma

any

overflow diarrhea

Impacted feces E

Test stools for fecal occult blood

Investigations

WBC Slo Bacterial infection

Blood CBC

look for evidence of iron deficiency or celiac sprue

No

Sr Electrolytes

Cl

stool

For pathogens difficile

C toxin

for
testing stool examination

lactoferrin parasites

Clostridium difficile

Toxin

Note Clostridium difficile unexplained diarrhea after

hospitalisation or antibiotic use

during

Colonoscopy barium Enema

Diagnosis

1 Incubation period Toxogenic diarrhea casually c vomiting

shorter incubation period

Inflammatory diarrhea

large 2 12 hrs

2
Toxogenic Diarrhoea Inflammatory

1 d

sudden onset subacute

fever abdominal tenderness

3 colitis severe


tenesmus

4 Toxogenic diarrhoea sudden vommitting c

fever headache

Blood mucus Pus

IBS Inflammatory bow

Campylobacter

colonic adenocarcinoma disease

Shigella

Salmonella polyps Diverticulitis

E Coli

amebiasis

Malignancy

Inflamatory bowel disease

colitis

management

treat causes

Oral rehydration is preferable to Iv rehydration

Antibiotics in infective diarrhoea

or Antisecretory drugs

Lacto Bacilli

Irritable Bowel Syndrome IBS

Defination
• A functional disorder of GIT is one for which

no structural , infective or biochemical cause can

be found. C. No organic cause found)

Benign chronic symptom complex of altered

bowel habits and abdominal pain

patients shows an exaggerated response to

stimuli like meals distension stress etc

Aetiology

Altered GI motility in the form of gastrocolic

incresed small

reflux altered gastric emptying

bowel contraction and incresed small bowel transit

Neurotransmitter serotonin imp factor

stimulates intestinal secretion and

peristalsis

psycological disturbance is main cause

Clinical Features

• Usually a ects 20-40 yrs old

* females more frequently a ected

• Classic patient symptoms:

Left iliac Region

A Abdominal Pain
Right iliac Region

bloating or abdominal discomfort

Change in bowel habit

present and stable for atleast 6 months

* Pain is provoked by food & Relieved by defecation

• In constipation predominant IBS, stool are pallet like,

ribbon like or pensil like

• abdominal distension , excessive atus, dyspepsia,

heart burns, frequency & dysuria.

• headache, backpain , fatigue, myalgia

Diagnostic criteria for IBS

Investigations

Management

honest with patient → reassurance

Constipation → high bre diet

Diarrhoea → symptomatic treatment

Dyspepsia → Antacids

Psycological → assurance & Anti depressant.

constipation predominant Diarrhea predominant IBS

IBS

u
constipation predominant IBS stool are pallet like

ribbon like or pensil like

Diseases

Inflammatory Bowel

Defination

are inflammatory disorders GIT of characterised

by

a relapsing and course

remitting

most common conditions

Ulcerative Colitis Crohn's Disease

Ulcerative colitis "UC"

Defination

Uc is a relapsing and remitting in amatory disorder

of colonic mucosa, may a ect just the rectum (proctitis)

or extend proximally to involve part of entire

colon (pancolitis) without small bowel involvement.

• But lo-15% cases may involve terminal ilium /ileocecal value

Aetiology


Genetic Smoking

I
n

Diatory factors psycological

Occurance in

t Stress
monozygotic

twins
de ciency or
excess of

Infections

certain nutrients

[butyric acid,

i sulphide,

Mycobacterium
glutamine)
Defective Immune

measels virus

Regulation

yeast

E. coli

Immunologic'd abnormal

Stimulation of

macrophages

production of

cytokines

symptoms

Gradual onset of diarrhoea I blood and mucus

Abdominal discomfort

systemic symptoms fever malaise anorexia

weight loss

Urgency aation
tenesmus occur E rectal disease constipation
absolute

In
rectum

a Proctitis occasionally present as obstipation

may

or constipation associated c
urgency 1 tenesmus

Signs

Fever and a tender distented abdomen

tachycardia

in severe UC

Extraintestinal signs

Clubbing aphthous oral ulcers erythema nodosmus

pyoderma gangrenosm conjunctivitis episcleritis

fatty liver

iritis large joint arthritis sacrolitis

PSC cholangiocarcinoma

Investigations

Blood CBC

ESR 9

c reactive protein CRP

FT

Blood cultures

consider iron studies

Stool

Fecal leukocytes

fecal lactoferrin

Calprotectin

Ova and parasites

routine culture

c difficile

To exclude infectious diarrhoea

Abdominal

tray

to exclude toxic dictation of colon

may help access disease extent in UC

Barium Enema

ulceration

Pseudopolyps and strictures

Chronic stage shortening of bowel

narrowing of bowel lumen rigidity

asymmetric and tabular pipe stem appearance

Sigmoidoscopy

Loss of mucosal vascularity

exudate of mucus pies blood

mucosal friability

Shallow but small or confluent ulcers

pseudopolyps

Colonoscopy

in mild to moderate disease is safe to do

in moderate to severe condition chancess

of bowel perforation and flexible

is safer

sigmoidoscopy

Pseudopolyps are projecting masses of scar tissue that develop from granulation tissue during the healing phase in repeated cycle of
ulceration

Rectal biopsy

shows mucosal inflammation

Serological markers Perinuclear like

antineutrophilic

cytoplasmic antibody ANCA Cp

GO 70 patients tied positive

Anti cell
goblet antibodies in 30 40 of cases of

UC

Complications

Perforation Bleeding complications serious

Toxic colon mega means Colon dialation of

diameter 76cm

Colonic Cancer

Management

Aim induction maitenance and of remission

steroids

reduced use of cancer risk mitigated

improved overalls of and life

quality

when possible mucosal healing

Treatment based on is disease severity of

Mild Uc UC Moderate
severe Uc

fulminantUC

Crohn's Disease

Defination

is characterised by patchy and

transmural

inflammation

which may affect any part of

the

GIT

It
may be by location
defined terminal ileal

colonic and ileocolic upper gastrointestinal or

pattern of disease inflammatory fistulating

by

or stricturing

Aetiology

smoking
Genetic

Diatory factors psycological

occurance in d
stress

monozygotic

defn or excess of

twins
certain nutrients

Infections

butyric acid sulphide

I glutamine

Mycobacterium

Detective Immune

measels virus

Regulation

Yeast
de

E coli Immunological abnormalities

Stimulation of

macrophages

production of

cytokines

Prevalence

Active smoking increases risk 3 4 fold

symptoms

Diarrhoea

s Pain Imumfonneritoneae involvement

oroinsteffington

awbdjgmiu.nu

fever

occur with active disease

Malaise

anorexia

signs

Look for afthous ulcers

abdominal tenderness

right iliac fossa mass

perianal abcess.es fistulae1skintags

and I rectal strictures

Extra intestinal signs so

clubbing

erythema nodosum

pyoderma gangrenosum

conjunctivitis

episcleritis

iritis

arthritis

g

sacroiliitis

ankylosing spondylitis

liver

fatty

cholangitis

renal stones

osteomalacia

malnutrition

complications

small intestinal obstruction

toxic dialatation

abscess formation abdominal pelvic or

ischiorectal

colovesical bladder Colovaginal Penland

fistulae enterocutaneous

perforation

rectal hemorrhage

colonic carcinoma

Investigations

CBC ESR CRP BMP left Blood culture

Sr Iron Biz folate if anaemia

A ESR

MCRP

A WBC

albumin


fecal calprotectin fecal lactoferrin

stool microscopy culture and Clostridium difficile toxins

CDT to exclude infectious diarrhea

a
colonoscopy and bioscopy should be performed even

the is macroscopically normal

when mucosa

small bowel imaging

to detect proximal and distal small bowel

disease

strictures small bowel dialatation inflammatory

mass abscess fistula

CT
enterography or MR enterography

Barium Enema

May show Cobblestoning rose thorn ulcers

and colonic strictures with rectal sparing

Management

High protein High energy diet

Low fat diet

in
Drug treatment

e coperamide anti secretory

5 ASA as a maintenance


g ally app ng
eg methotrexate

Immunosuppressants cyclospori

corticosteroids like budesonide

Metronidazole 400mg TDS

surgical management

surgical management is indicated in

repeated obstruction abscess perforation

Peptic Ulcers Acid peptic disease

Defination

it is refers to an in the
ulcers

lower oesophagus stomach or deodenum in the

jejunum after surgical anastomosis to stomae

and in the ileum adjecent to a

Meckel's diverticulum

Incidence to of all adult males

approx 90 caused by Helicobacter pylori

or
by NSAID's use

Aetiopathology

Heredity

Acid pepsin versus mucosal resistance

normally mucosa capable of

resisting acid to digest

mucosa digest Peptic ulcers

Gastric Hypersecretion

Zollinger Ellison syndrome

1
High acid secretion

gastric mucosal barrier

Mucosal Resistance by

Prostaglandin
Important Role Mucosal resistance

for

Inhabits

Aspirin tin bicarbonate consumption

prostaglandins

synthesis

other risk factor smoking

Alcohol

Helicobacter Pylori

majority of gastric ulcers

mode of transmission oral oral

Faecooral

causes an inflammatory responce

in gastric mucosa

Stress Ulcers

Clinical features

Epigastric pain

localise the site c one

finger

pointing signs

Hunger Pain

stomach

7

pain relieved by food

Night pain

pain relief

pain relieved by food

Periodicity episodic pain

occurs in episodes Cstog times a year

lasting l 3 weeks

other symptoms

water brash heart barns anorexia

vomiting

complications

Upper GI bleed

Perforation

a Gastric outlet obstruction

Gastric malignancy

Pancreatitis

Investigations

Double contrast barium meal

Endoscopy to visualise ulcers

test

Tests for H pylon ERf.pl oogyrease

culture

H pylori stool antigen test

Sr Gastrin and gastric acid analysis

Zollinger Ellison syndrome

Management

General measures avoid smoking

avoid NSAID's

Antacids

Histamine Hz receptor Antagonists

cimetidine ranitidine

proton pump Inhibitors

Prostaglandin Analogues

Collidal Bismuth compounds

antimicrobial effect against H Pylori

Sakralphate

Treatment of H Pylori

H pylon ki't for 10 to 14 days

Difference beth GO DO


Dysphagia

Defination

It is defined as a subjective sensation

of difficulty or abnormality in swallowing

odynophagia is defined as pain while

swallowing

Causes

mechanical

block Motility disorders

malignant strictures Achalasia

a Esophageal

cancer Diffuse esophagealspasms

Benign strictures systemic sclerosis

Esophageal web

gravis
Myasthania

peptic stricture Bulbar Palsy

Lung cancer

a Retrosternal goiter

Left Atrial enlargement

others

Esophagitis

eosinophilic esophagitis

Infections Candida herpes simplex

Reflux esophagitis

Dysphagia 73 weeks needs detailed investigate

clinical features

Careful history 9 dysphagia odynophagia

or

9 oropharyngeal or esophagiat

dysphagia occur within Isec of swallowing

Slo oropharyngeal location

Retrosternal location

Slo esophageal source

difficulty in swallowing solid Liquid

No

yes

motility disorder structural abnormality

like strictures

Painful swallowing

Slo mucosal disease

esophageal ulcers infections swelling

Intermittent or progressive

implies esophageal spasm



Investigations

Hb peripheral smear for anaemia

chest radiograph retrosternal goiter

mediastinal lymph nodes

aortic aneurism
malignancy of lungs

Barium swallow tumors

strictures

Oesophagoscopy visualisation biopsy of

Tumors

Ulcers

Strictures

CT scan of Thorax

Biopsy

oesophageal manometry oesophageal motility

studies

Gastro oesophageal reflux disease GERD

Defination

The deutopment of signs or complications

related the retrograde passage of

to gastric

contents

into the esophagus is termed GERD

Extremely common equal in

both genders

but males predominance for

complications

causes

sliding hitus hernia

Smoking alcohol pregnancy obesity

large meals myotomy ofthe lower

esophageal spincter for achalasia

drugs tricyclics anticholinergic nitrates

sclerosis

systemic

symptoms

Heartburn retrosternal discomfort

or

belching

Acid brash acid or bile regurgitation

water brash excessive salivation


dy p g

a Noctural asthana coughl wheeze c apparently

minimal inhalation of gastric content

Complications

Esophagitis

n
ulcers

Iron defn Anaemia

Benign strictures

in
Barrett esophagus

eosinophilic esophagitis

esophageal adenocarcinoma

Investigations

Endoscopy

to Rio oesophagitis

strictures

Barrett's mucosa by biopsy

Barium swallow hiatus hernia

Bernstein Test

done when clinically suspicious

but negative endoscopy

EGG Rio IHD

Ischemic heart disease

Resting stress

Test

Oesophageal motility studies



Treatment

Lifestyle management

Drugs Antacids

Prokinetic Drugs for gastric empting

eg metodopramide

Sukralfate

surgery

Hiatus Hernia

Defination

It is herniation of part of stomach into

the thoracic cavity through the diaphragm

Aetiology

unmown

obesity pregnancy ascitis

Clinical features

majority asymptomatic

predisposes to gastroesophageal reflux

symptom presents

complications

Volvulus of stomach

bleeding from gastric ulcers

gastritis

Respiratory complications delete mechanical

compression

Investigations

XR fundal airfluid level in chest

Barium swallow

Endoscopy

Management

not require treatment

any

GERD Ttt of GERD

Surgical repair of hernia in selected cases

Hiccough

Defination

due to

causes

Hasty ingestion of food

Irritation of phrenic nerve

Local irritation of the diaphragm Acute MI

peritonitis

Psycogenic

Treatment

symptomatic treatment

Valsalva manoeuvre

cold water ice creame

Drug therapy

Antispasmodic

Antacids c local anaesthetics

on sedatives

Haematenesis

Defination

the vomiting of blood

Upper GI bleeding indicates bleeding proximal to the

duodenojejunal junction

Aetiology

Oesophageal Causes

S varices

tyg

so p g

Oesophagial carcinoma

Gastroduodenal causes

Erosive gastritis 1 duodenitis

stress ulcers

Peptic ulcer

Gastric carcinoma

other causes

Rupture of aortic aneurysm

coagulation defects

Clinical features

haematemesis and or melaena

colour of vomitus Bright Red rapid sizeable

haemorrhage

coffeeground small bleed

Melaena Black stool

Dizziness extreme pallor shock angina or

syncope

Severe Bleeding

Clots in vomitus

fresh blood in Nasogastric tube

Haematocheria massive bleed1rectum

Hypotension 1 tachycardia

Diagnosis

No alcohol Drugs NSAID's

antiplatelet drugs Casprin clopidogrel

a
anticoagulant

tho peptic ulcers

r
Hlo jaundice pedal edema abdominal

distension

ascities dialated abdominal veins

Hlo dysphagia

I g

Investigations

Hb

haematocrit

BUL L creat

CT BT PT INR

platelets

IFT

If absence of renal failure

Urea to creat ratio

472 indicates GI bleeding

ECG

a Nasogastric aspirate

Upper GI scopy

Angiography

management

massive bleeding Aim maintain Hb above

7 8 gm1dL

a TPR IBP monitoring

Gastric lavage

water


Dont do vigorous suction for

aspiration risk of mucosal damage

Endoscopy for diagnosis sclerotherapy in

esophageal variceal bleed

thermocoagulation

Angiography or radionuclide scan if endoscopy

fails

PPI

fresh frozen plasma and platelets

Balloon tamponade vasopressin octreotide

surgery

Malabsorption syndrome

Defination

Malabsorption means defective mucosal uptake

and transport of digested nutrients vitamins

and trace elements

In practice it means impairment of

digestion and or absorption from GIT

Disorders of

v I l l l

Introluminal Transport Transport Systemic

Drags

Aetiology Digestion trommucIosnaterstinal

mfryoffalcey Diseases

Disorders of Intraluminal Digestion

Enzyme deficiency a chronic pancreatitis

pancreatic cancer

Cystic fibrosis

Enzyme inactivation Lollinger Ellison syndrome

severe peptic ulcer disease related to cell

B funmdooaffinge

Rapid transit of food from Gat

gastroenterostomy

i Partial gastrectomy

Reduction in bile synthesis

parenchymal liver disease

Reduced bile secretion i cholestatic jaundice

Increased bile salt loss in faeces

Lack of intrinsic factor

Incresed vit Bez consumption ingut

Disorders of transport in the intestinal

Mucosa

a Lactase deficiency

coeliac disease

Tropical sprue

Giardiasis

AIDS

Disorders of transport from mucosal cell

Abdominal lymphoma

Tuberculosis

Drugs causing malabsorption

Neomycin

Methotrexate

Laxatives

Colchicine

Systemic Diseases Associated with Malabsorpti

Addison's Disease

Thyrotoxicosis

Hypothyroidism

DM

clinical features

Diarrhoea abdominal Pain distension loss of

weight anemia

Due to defective absorption

protein pitting pedal oedema

Fat Loss of weight diarrhea

pale bulky stool that

float on water

Diseases due to vitamins deficiency

Minerals and eletrolytes

sodium Muscle cramps hypotension

potassium cardiac arrhythmias

calcium tetany osteomalacia

magnesium

tetany

Linc Anorexia impaired taste

Iron Anaemia

water Dehydration

Investigations

Barium meal

to Ho structural abnormalities like

Crohn's disease diverticula strictures

Tests for fat absorption

Sudan Staining of stool for fat globules

Sr Vit A I DIE 1K fat soluble uit

Tests for carbohydrate absorption

Glucose tolerance test

a BSL

Lactose tolerance test

Hydrogen breath Test to do Lactase defn

Tests for protein absorption

Sr albumin

protein t

Urine

Others

Sr Biz folic acid

wireless capsule endoscopy

detailed evaluation of small bowel

Treatment

Gluten free Diet

Pancreatic supplements

Treat anaemia

vitamins or mineral suppliments

r
treat dehydration

Acute Pancreatitis

Defination

This unpredictable disease is characterised by

self perpetuating pancreatic enzyme mediated

autodigestion oedema and fluid shifts cause

hypovolaemia as extracellular fluid is

trapped in the gut peritoneum and

retroperitoneum

80 cases mild

20 severe lifethreatening

causes

GET SMASHED mnemonic

G Gallstones 35

35

E Ethanol

T Trauma 1.5

s steroids

m Mumps

A Autoimmune

s scorpion Venum

H Hyperlipidaemia hypothermia hypercalcemia

Endoscopic retrograde

E CRCP and Emboli cholangiopancreatography

endoscopy funoscopy

of ductal system

D Drug Sulphonamide Tetracyclines

Steroids Oestrogen frusemide etc



Others Pregnancy

No cause found in to 30 cases

symptoms

Gradual or sudden severe epigastric or

central abdominal pain

tradiates to back sitting forward may relieve

Prominent vomiting

signs

HR 8

a
fever

Jaundice

Shock

ileus

rigid abdomen locall general tenderness

I

Periumfelical bruising Cullen's sign or

ftanks grey turners sign from blood

vessels autodigestion and retroperitoneal

haemorrhage

Investigations

Sr Amylase 9 100001mL

not related severityto

may be normal in severe pancreatitis

a
levels starts falling in 2g 48hrs

excreted from kidney so 9 in renal

failure

lesser rises in cholecystitis

mesenteric infections etc

Sr Lipase 9

more sensitive and specific for

pancreatitis speediaby when related

to alcohol

moniter BSL

ABG

Oxygenation Acid base status

A XR

to Ho retro peritoneal fluid

Sentineal loop

erect air performed for the

Erect XR assessment
of subdiaphragmatic

free gas

P

CT

standard choice of imaging to

access severity e complications

USG

if gallstones PAST

CRcp

if LET's worsen

CRP

3150mg IL at 3Ghr after

hospitalisation is a
predictor of

severe pancreatitis

Complications

Early complications

Shock

ARDS acute respiratory distress syndrome

Renal failure

sepsis

9 Glucose

21
d


Late complications

Pancreatic necrosis

pseudocyst

Abcesses

Bleeding

Thrombosis

Fistulae

Recurrent oedematous pancreatitis

Note Glasgow criteria to predict severity of

pancreatitis

Management

NBM will by mouth

NJ feeding decrease pancreatic stimulation

Nasojejunal

Maintain urine flow at 30 ML hr

Analgesics

If pancreatic necrosis

parenteral Nutrition

laparotomy debridement

CRCP gallstone removal if progressive

Repeate CT to monitor progress

Chronic Pancreatitis

Epigastric pain radiates to the back

relieved by sitting forward or HWBF

on epigastrium 1 back

bloating steatorrhea t weight brittle diabetes

worsen

symptoms relapse

causes

Alcohol

smoking

autoimmune rarely familial

cystic fibrosis

haemochromatosis

is Pancreatic duct obstruction stones tumour

Congenital

Tests

Ultrasound I CT

MRCP

AXR

Complications

Pseudo
cyst

diabetes

biliary obstruction

Local arterial aneurysm

splenic vein thrombosis

gastric varices

pancreatic carcinoma

treatment

Drugs analgesics

lipase

Fat soluble vitamins

Insulin

Diet No alcohol

Low fat diet

surgery
pancreatectomy or unremitting

Pain

Pancreaticojejunostomy necrotic abuse

d weight

Duodenal Ulcers

4 fold commoner than 90

risk factor

major H pylori 90

Drugs NSAIDs steroids

minor A Gastric acid secretion

Gastric emptying

blood 0

group

smoking

symptoms

Asymptomatic or epigastric pain relieved by

antacids I 1 weight

signs

Epigastric Tenderness

Diagnosis

Upper GI endoscopy

Test for H pylori

Gastrin concentration

b D

Non ulcer dyspepsia

duodenal Crohn's

r
TB

Lymphoma

Pancreatic cancer

Stomatitis

Defination

It is an
inflammatory process

affecting a mucosal membrane of mouth

and lips with or without oral ulceration

Acute Abdomen

Defination

someone who becomes acutely ill and

in whom symptoms and signs are

chiefly related to abdomen has an

acute abdomen

causes

clinical syndromes that usually requires laprotomy

I Rupture of organ spleen aorta ectopic

pregnancy

Shock

blood loss

abdominal swelling

find out Hlo Trauma

2 Peritonitis perforation of peptic ulcer

duodenal ulcer diverticulum appendix

bowel or gallbladder

that
may not require

syndromes a laparotomy

L Local peritonitis

diverticulitis

cholecystitis


PI 91

appendicitis later need surgery

2 Colic

regularly waxing and waning pain

caused by muscular spasm in a

hollow viscus

eg gut uterus salpinx ureteretc

Obstruction of Bowel

The medical Acute Abdomen

Irritable bowel syndrome main cause

other causes

MI Pneumonia sickle cell crisis

AGI UTI Diabetes mellitus IDKA

Roster malaria TB Typhoid fever

etc

Gastralgia

Rt Hypochondriac Epigastric Region A Hypochondriac

Dcholelithiasis DGastritis duodenitis 1 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

A Iliac Region Hypogastric Region Lf Iliac Region

1 All causes of 1 Diverticulitis
A Iliac Region 1 DOTI Urological
a voluolus
a Appendicitis
3 Crohn's Metis
g theotheention
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