Vomiting

Vomiting in adults

The most common causes of vomiting in adults include:

 foodborne illnesses (food poisoing)

 indigestion

 bacterial or viral infections,

 like viral gastroenteritis, which is often referred to as a “stomach bug”

 motion sickness

 chemotherapy

 migraine headaches

 medications, like antibiotics, morphine, or anesthesia

 excessive alcohol consumption

 appendicitis

 acid reflux or GERD

 gallstones

 anxiety

 intense pain
 exposure to toxins, such as lead

 Crohn’s disease

 irritable bowel syndrome (IBS)

 concussion
 food allergies

 Head injury

 Brain tumor
  Meningitis

 Encephalitis

 And many more

Vomiting during pregnancy include:


 morning sickness

 acid reflux

 foodborne illnesses (food poisoning)

 migraine headaches

 sensitivity to certain smells or tastes

 extreme morning sickness, known as hyperemesis gravidarum, which is caused by rising
hormones
Vomiting during menstruation

 Hormone changes during menstruation can make you nauseous and make you throw up.

 Some women also experience migraine headaches during their periods, which can also cause
vomiting.
Medical emergencies

 Vomiting accompanied by the following symptoms should be treated as a medical emergency:

 severe chest pain

 sudden and severe headache

 shortness of breath

 blurred vision

 sudden abdominal pain

 Stiff neck and high fever

 Haemtemsis

 Infants younger than 3 months who have a rectal fever of 100.4ºF (38ºC) or higher, with or
without vomiting, should see a doctor.
Lecture#4

Diarrhea

What is diarrhea in adults ?

Diarrhea is loose, watery stools (bowel movements).

You have diarrhea if you have loose stools three or more times in one day. Acute diarrhea is
diarrhea that lasts a short time. It is a common problem. It usually lasts about one or two
days, but it may last longer. Then it goes away on its own

Diarrhea lasting more than a few days may be a sign of a more serious problem.

Chronic diarrhea -- diarrhea that lasts at least four weeks -- can be a symptom of a chronic
disease.

Chronic diarrhea symptoms may be continual, or they may come and go.

Causes of diarrhea?
The most common causes of diarrhea include

 Bacteria from contaminated food or water

 Viruses such as the flu, norovirus, or rotavirus .

 Parasites, which are tiny organisms found in contaminated food or water

 Medicines such as antibiotics, cancer drugs,

 and antacids that contain magnesium

 Food intolerances and sensitivities, which are problems digesting certain ingredients
or foods.
 An example is lactose intolerance.

 Diseases that affect the stomach, small intestine, or colon, such as Crohn's disease

 Problems with how the colon functions, such as irritable bowel syndrome
 Some people also get diarrhea after stomach surgery, because sometimes the
surgeries can cause food to move through your digestive system more quickly.
 Sometimes no cause can be found. If your diarrhea goes away within a few days,
finding the cause is usually not necessary.

Lecture # 5

Constipation
you have not had a stool pass for at least 3 times during the last week

The stool is often large and dry, hard or lumpy

Or

you are straining or in pain when you pass the stool

Then you have constipation

What causes constipation

 Constipation in adults has many possible causes.

 Sometimes there's no obvious reason.

 The most common causes include:

 not eating enough fibre – such as fruit, vegetables and cereals

 not drinking enough fluids

 not moving enough and spending long periods sitting or lying in bed

 being less active and not exercising

 often ignoring the urge to go to the toilet

 changing your diet or daily routine

 a side effect of medicine

 stress, anxiety or depression
 Constipation is also common during pregnancy and for 6 weeks after giving birth.
How you can treat and prevent constipation:

Making simple changes to your diet and lifestyle can help treat constipation.
To make your stool softer and easier to pass:

 Drink plenty of fluids

 increase the fibre in your diet

 add some wheat bran, oats or linseed to your diet

 Improving your toilet routine

 Keep to a regular time and place and give yourself plenty of time to use the toilet
 Do not delay if you feel the urge to stool
 A daily walk or run can help you stool more regularly.
Lecture#6

Indigestion

The main symptom of indigestion is pain or a feeling of discomfort in upper

abdomen
(dyspepsia).

Patient often experience the associated feeling of burning behind the sternum
(heartburn), but this may occur on its own.
These symptoms usually come on soon after eating or drinking,
Heart burn is due to acid that passes from stomach into oesophagus.
Indigestion may have following symptoms:

 feeling uncomfortably full stomach

 or heavy
 belching
 or flatulence(passing wind)

 bringing food or fluid back up from stomach (reflux)

  bloating

 nausea

 vomiting

Lecture#7

Haematemesis
Haematemesis is defined as

 “vomiting blood”.

It is caused by bleeding from part of the upper portion of the GIT .

It has multiple causes,

depending on the site of blood loss

and the tissue that is actively bleeding.

Oesophageal Varices

Oesophageal varices refer to dilations of the porto-systemic venous anastomoses in the

oesophagus.

These dilated veins are swollen, thin-walled and hence prone to rupture,

with the potential to cause a catastrophic haemorrhage.

The most common underlying cause for oesophageal varices is portal hypertension resulting
from cirrhosis of liver. 

Gastric Ulceration
Gastric ulceration is responsible for about 60% of haematemesis cases.

Ulceration can result in erosion into the blood vessels supplying the upper GI tract (most
commonly on the lesser curve of the stomach (20%)

or posterior duodenum (40%))

and can result in significant haemorrhage.

Patients may present with

known active ulcer disease

H. Pylori positive,

History of NSAID or steroid use,

or previous epigastric symptoms suggesting peptic ulceration.

Mallory-Weiss Tear

A Mallory-Weiss tear is a relatively common phenomenon,

There are episodes of severe or recurrent vomiting,

then followed by minor haematemesis.

Such forceful vomiting causes a tear in the epithelial lining of the oesophagus, resulting in a
small bleed.

Oesophagitis
Oesophagitis is a condition that describes inflammation of the intraluminal epithelial layer of
the oesophagus,

most often due to either gastric acid reflux (GERD) or

less commonly from infections (typically Candida Albicans,

medication (such as bisphosphonates), radiotherapy,

ingestions of toxic substances,

or Crohn’s disease.
Other Causes
Other causes are

gastritis,

 gastric malignancy,

Meckel’s diverticulum,

or vascular malformations.

Inj Transmin and Inj vit. K are injected to stop bleeding

Lecture #8
Melena
Melena refers to

the dark black, tarry feces

that are associated with upper gastrointestinal bleeding

The black color and characteristic strong odor are caused by hemoglobin in the blood being
altered by digestive enzymes and intestinal bacteria.
Causes:
The most common cause of melena is

 peptic ulcer disease

 However, any bleeding within the upper gastrointestinal tract or the ascending colon
can lead to melena

 Melena may also be a complication of anticoagulant medications, such as warfarin .

 Causes of upper gastrointestinal bleeding include

 malignant tumors affecting the esophagus, stomach or small intestine,

 Hemorrhagic blood diseases, such as thrombocytopenia and hemophilia,

 Gastritis,

 Stomach cancer,

  esophageal varices,

 Meckel's diverticulum and

 Mallory-Weiss syndrome.
 Causes of "false" melena include

 iron supplements,

 Pepto-Bismol, and lead,

 blood swallowed as a result of a nose bleed (epistaxis),

 and blood ingested as part of the diet, as with consumption of black pudding (blood
sausage), or with the traditional African Maasai diet, which includes much blood drained
from cattle.

Lecture# 9
Urinary retention :

Urinary retention is a condition in which bladder does not empty completely even if it’s full
and patient often feel like really have to urinate.

There are two forms

1. Acute

2. chronic.
symptoms of Acute retention

 It happens suddenly and can become life-threatening.

 Patient feel like need to urinate badly, but you can’t go at all.

 This causes a lot of pain and discomfort in your lower abdomen.

 Get emergency medical care to release the buildup of urine.

Chronic
  Chronic urinary retention occurs over a long period of time.

 Patient can urinate, but bladder doesn’t empty completely.

Chronic urinary retention can lead to complications.
 Patient need examination and follow up if he have one or more of the following
symptoms:

 Patient feel like have to urinate frequently, often eight or more times a day.
 It’s hard to start urine stream.
 urine stream is weak or start and stops.
 Patient feel like need to urinate again right after finish urinating.
 Patient have to get up several times during the night to urinate.
 Urine leaks from bladder throughout the day.
 Patient have urge incontinence,

 or the strong feeling you have to urinate immediately followed by the inability to stop
from urinating.


 Patient can’t tell when his bladder is full.

 Patient have an ongoing mild discomfort or a feeling of fullness in pelvis/lower
abdomen.

Surgical causes of bladder obstruction

Causes of obstruction common in both women and men include:

 urinary tract stones

 urethral stricture

 a mass or cancer in your pelvis or intestine

 severe constipation

 a blood clot from bleeding in your bladder

 a foreign object inserted into the urethra

 severe inflammation of the urethra

Use of Medication causing symptoms include:

 
 amphetamines

 antihistamines

 medication to treat Parkinson’s disease

 medication to treat urinary incontinence

 muscle relaxants

 nonsteroidal anti-inflammatory drugs (NSAIDs)

 pseudoephedrine
 some antipsychotics

 antidepressants

 some opioid pain medications like morphine
Nervous weakness causing urinary retention.
Some things that can cause nerve problems in your bladder include:

 stroke
 brain or spinal cord injury
 delivering a baby
 long-term diabetes
 multiple sclerosis
 Parkinson’s disease

Obstruction
Specific to men

There are a number of potential causes of obstruction in men:

 benign prostatic hypertrophy (BPH)

 benign prostatic enlargement (BPE) (noncancerous growth of the prostate)

 prostate cancer

 Urethral stricture
Infection and Inflammation
 In bladder (cystitis)
 In urethra
 (urethritis)
 or an infection of in prostate,Prostatitis can obstruct the urethra.

Causes specific to women

Urinary retention is less common in women,

but there are a few typical causes.

A mass or cancer in your uterus can push into your bladder outlet or urethra and cause an
obstruction.

A cystocele or rectocele can create a blockage.

A cystocele is when your bladder sags and bulges into your vagina. A rectocele is when your
rectum pushes out and bulges into your vagina.

When your uterus moves down from its normal position, this is known as a prolapse. It can
obstruct your bladder outlet.

Infection
Vulvovaginitis, or an infection of the outer part of your vagina, can cause urinary retention
in women.

Bladder infections, as well as cystitis, can also lead to urinary retention.