GIT 4 -PART1 ( IBD - Ascites - functional gastrointestinal disorders ) upload.pdf

8/13/2019 GIT 4 -PART1 ( IBD - Ascites - functional gastrointestinal disorders ) upload.pdf

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G.I.T.

6182013

inflammatory bowel disease

Inflammatory Bowel Disease

Inflammatory bowel disease


etiologyetiologyinflammatory bowel disease

Actually, two diseasesUlcerative colitis

Croh nsregional ileitis

two diseasescause


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genetics

geneticshigh incidence

family history

High associationHLA B27genetic element

allergy to certain types of food

disease


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this is the first time I have seen a doctor advise by smokingthis is the only case in the whole world that the smoking is the treatment

Ulcerative colitis

ulcerative colitispathology

pathologyulcerative colitisulcerative colitis

pathology

gross picturesdiseaseUlcerative colitis

rectumrectumrectum

ulcerative colitisrectum

rectumbleeding

rectum


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rectumtransverseLesioncontinuous

skip lesion

as regardsite

colonaffectedinflammationMucosa

ulcerative colitisMucosa


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Proliferating


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Interstitial lung fibrosisinterstitial lung fibrosis

heartanemiageneral constitutional manifestations

abdomenLiverauto immune hepatitis

gall bladdercholecystitissclerosing cholangitisHigh incidence of cholangio carcinomakidneyoxlate stonesKidney

skinpyoderma gangrenosumerythema nodusum

jointsankylosing spondylitisrheumatology

Inflammatory bowel diseasearthritisankylosing spondylitis picturesremissionexacerbationG.I.T.

manifestationsarthritisKneeankleremissionexacerbation

G.I.T. manifestations

Inflammatory bowel diseaserheumatology

intestinal manifestation s

complicationscomplicationsinflammatory bowel diseaseHemorrhagePerforation

toxic megacoloncancer

toxic megacolontoxic megacolonparalytic ileus

paralytic ileussmall intestinetoxic megacolonLarge intestine

absolute constipation

disease


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Investigationsinvestigationsinvestigationsdysentery

stool analysisdysentery


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doseOraldysentery60

intravenous

Intravenousfulminant colitistoxic megacolon

intravenous

enemacorticosteroid enemacorticosteroid enema

enema

inflammation


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sulphasalazine

side effectssulphonamide

5 aminosalicyclic acid

sulphonamide

aminosalicyclic acidorallysulphonamide

during the attack

antispasmodicanti diarrheal agentsSymptomatic treatment

In between the attackcortisone

sulphasalazine

In between attacksattacks

cortisonesulphasalazine

recentaminosalicyclic acidcorticosteroidsimmune suppressant

Azathioprinecyclophosphamidecyclosporine

corticosteroidsaminosalicyclic acid

other immune suppressantAzathioprinecyclophosphamidecyclosporine

tumor necrosis factors alpha inhibitorinflixmab


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And finallySurgical treatment

surgery

failed medical treatmentfulminant colitisfailed medical treatment

total coloectomy

total coloectomymalignancy

failed medical treatmentfulminant colitiscomplications

surgical treatmentfulminant colitis

high risk of cancercomplications

Total coloectomy

Terminal ileostomy

rectumMucosaterminal ileum

Hartmann cuff cuff of musclesmucosa

Ulcerative colitis

Ulcerative colitis15


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Cronhns Disease ( Regional enteritis )

Regional ileitis

regional ileitisCrohns disease


Oral cavityanus

terminal ileumregional ileitis

terminal ileumterminal ileumright sided colon

right sided colonJejunum

Legionspatchyskip


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Inflammationgranulomatouscaseation

Granulomatous lesionscaseation

mucosa

mucosafissured

cobblestone arrangement

cobblestones

cobblestone arrangement

inflammationthe whole thicknessInflammationthe whole thicknessPerforationIntestine

inflammationthe whole thicknessperforationintestine

regional ileitisfistula

small intestinescolon

Fistulaintestinevagina

Anal fistulaswhole thickness

microscopic examinationinflammationthe whole thickness of the intestine

Non caseating


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clinical pictures

Typical ulcerative colitisUlcerative colitis

Ulcerative colitis

massright iliac fossaterminal ileumappendicular masssmall intestinemalabsorption syndrome

Ulcerative colitismalabsorption syndrome

massright iliac fossa

extra intestinal manifestations

rate of complications

cancercancer

PerforationHemorrhagecancer

risk of cancer

pseudo polyps

Investigationsinvestigations

Typical ulcerative colitis

BariumBarium swallowBarium meal

terminal ileumcaecum

terminal ileum


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String sign

post evacuation film

fissurescobblestone arrangement

fissurescobblestone arrangement

investigationsUlcerative colitis

bariumfistulasfistulasCrohns diseaseulcerative colitis

fistulasCrohns disease

ulcerative colitis

treatmentTypical ulcerative colitis

TypicalMetrinidazole

proliferation of bacteriamalabsoprtion

surgical treatmentfailed medical treatment

complications

routine surgery10risk of cancer

risk of cancersurgical treatment


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diseaseresection anastomosis

adhesions

abdomenabdominal wall

fibrosisadhesion

extensive fibrosisadhesions

resection anastomosisboweldisease

anastomosis

incisionLoops of intestine

recurrenceLoopsfistula

skinskin

woundwoundLoops

fistulawound

fistulawound


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fistulawound

appendicitis

regional ileitis

adhesions

as regardregional ileitis

dysentery

Ascitesascites

Collection of Collection of fluid in the peritoneal cavity

fluidTransudate

ExudatesChylous

hemorrhagic


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chylous ascitesObstruction of thoracic duct

obstruction


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osmotic pressureplasma proteins

Plasma proteinsMalabsorptionmalnutritionNephroticliver cell failure

hydrostatic pressurehydrostatic pressureheart

Right sided heart failureTricuspid stenosis, tricuspid regurge

Constrictive pericarditisPortal hypertension

Portal hypertensionascitesHypoalbuminemia

transudateprotein content of the fluid3 gram percentage

specific gravity1016cells1000LDH200


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ascites

Symptomsascites

Abdominal distention

abdominal distentionascitesdyspnea

Lower limb edemadyspepsia

symptoms of the cause

signsLocal and general examination

Local examinationInspection

Abdominal distentionWide subcostal angles

Divercuation of rectiShift of the umbilicus

Umbilical herniaCaput medosa

inspection

palpationorgans by dipping

masses

Percussion

dullnessflanksshifting dullness

transmitted thrill

auscultationvneous humsuccession splash


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succession splash

succession splash

comatosed

comatosedcomatosed

AnywayinspectionpalpationPercussionauscultation


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treatment of ascitesLiver cell failure

treatment of ascitesLiver cell failure

Does not reduce mortality

treatment of ascitesliver cell failuredoes not reduce the mortality

dose not reduce mortalityascites

treatmentascites

ascites

treatment dose not reduce mortalitytreatmentfor symptomatic reasons only

ascites

dyspnea

treatment of ascitestreatmentcomplicationstreatment

treatmenttreatmentascitesLiver cell failure

bed rest

bed restLoadLiverMetabolic demandLiver

decreased metabolic demandliverLiverMachineryalbumin


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Justbed rest

fluid

fluid

liter fluid

diuretics

bed restdiet

dietsodium

sodium80

80AlreadyNaturally

Which means


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fluid restriction

fluid restrictionHypovolemicfluidsblood vessel

Peritoneal cavity

actually HypovolemicHe is actually Hypovolemic

fluid restrictionsevere massive ascites

fluid restrictionhepatorenal syndrome

Kidney

fluid restriction

severe casesumbilical hernia

salt restriction Proteinsproteins

hepatic encephalopathy

hepatic encephalopathydiet

dietbed restdiuretics

diureticsSpironolactone

spironolactone


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potassium sparing

potassium sparingHepatic encephalopathy

precipitating factorsHypokalemia

spironolactoneHypokalemiaHepatic encephalopathy

spironolactonespironolactone

weak diureticsDiuretics

diuresishepato-renal

diuresisgradualsudden

diureticssudden diuresishypovolemia

hepato-renal

diureticsgradualspironolactone

potassium retainingweak diuretics

spironolactone

lasixlasixspironolactone


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lasixspironolactone

potassium

diureticsAlbumin

Human albumin

plasmaplasmaalbumin

albuminplasma

PlasmaAIDSHepatitisplasmareplacementalbumin

albuminHuman albumin

AIDShepatitis

plasmarisk of hepatitis

Plasma volume overloadalbumin

albumin500volume overloadheart

albuminalbumin

Tappingpara centesis

severe respiratory distressUmbilical hernia about to rupture

failed other measures

tappingascetic fluid


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8hepato-renal

hepatic encephalopathyPara centesisgradual

Umbilicusrupture

fluids

ascetic fluid6- 8 gram albumin intravenous

Ascites prevent ascites

blood vesselPeritoneum

According to the pressure gradient

ascitesPressure

pressure gradient

ascitesabdomenpressureabdomen

transudation

blood vesselperitoneal sac

According to pressure gradientPressure

massive ascitesPressureabdomen

blood vessel


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peritoneumfluidPressurePeritoneal sac

pressureblood

hepato-renalHepatic encephalopathy

fluidsalbumin

albuminosmotic pressureblood vesselretainfluidsblood vessels

fluids6 - 8 gram albumin

refractory ascites

refractory ascitesascites not responding to medical treatmentNot responding to medical treatment

refractory ascitesascites not responding to medical treatment

Spontaneous bacterial peritonitisT.B. peritonitis

Malignancy

end stage liver diseaseLiversevere hyponateremiahyponateremialasix

diureticsUrine

hyponateremiaglomerular filtrate


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spontaneous bacterial peritonitisT.B. peritonitis

malignancyrefractory ascites

Malignancymalignancyascitesascites

ascetic fluid

Intra venous

fluidascetic fluid

intra venoushypoalbuminemiaascetic fluid

fluiddirtyascetic fluiddirtyE.Coli

intra venousE.Coli

septecemiaD.I.C.

ultra filtration re-infusion

Le veenshuntShuntPeritoneumvena cava

Shunt


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D.I.C.sepsishypervolemia

Liver transplant

Liver transplantTIPSS

Transjugular intrahepatic portosystemic stent shunting

TIPSSTIPSSTIPSS

ascites

ascitestreatmentcausescausetreatmentascites

dysentery

functional gastrointestinal disorders

Functional Gastrointestinal Disorders

Functional gastrointestinal disorders

functional gastrointestinal disordersdisordersorganic cause

G.I.T. manifestationsorganic cause

esophagusesophagusGlobus hystericus


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globus hystericuslumbrepeated swallowingsaliva

clearLumbBut it does not clear

reassurance only

just reassurance

chest pain of esophageal origincorkscrew esophagus

Esophageal spasmpainpainangina

calcium channel blockersNitrates

regurgegastroesophageal reflux

excessive regurgemassive salivationgastroesphageal reflux

GERD

gastrointestinal disordersstomachduodenumerophagiaerophagia


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P

erophagia

Non ulcerative dyspepsiafeaturesfeaturespeptic ulcer

featurescholecystitisNon ulcerative dyspepsia

functional vomitingfunctional vomitingpsychogenic problem

femlaesIam talking about females

femalesfemales

Females


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functional vomitingreassurance

colonintestine

Functional colonic or intestinal disordersflatulance

flatulancefunctional diarrhea

functional diarrhea

Once


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No way

anxietyfunctional diarrhea

functional diarrhea

stool

functional gastrointestinal disordersirritable bowel syndrome

irritable bowel syndrome


Irritable bowel syndromediseasecommunitydisease

functional gastrointestinal disordersfunctional gastrointestinal disordersirritable bowel syndrome

Irritable bowel syndrome



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it is a G.I.T. manifestations without an organic cause in which the patient may present by constipationor diarrhea or alternating constipation and diarrhea

Associated with abdominal pain

irritable bowel syndromeabdominal pain

changebowel habitsconstipation

diarrheaalternating constipation and diarrhea

etiology

theoriespsychological



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PainPainabdomen

abdomencolics

sigmoidsigmoidspastic

paindiarrheaconstipation

constipation

constipationcolonspasticstool

stoolRibbon shaped

colonspastic

spasm

stoolstoolrabbit like stool

alternatingconstipationAt the same time

painchange of bowel habitsflatulence

Excessive eructationvery common

Associated type A personalityAnxious, irritability

bad odour of mouth ( Halitosis )


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dysmenorrheadysparonia

Tension headachetype A personality

investigationsStool analysis

colonoscopy

to exclude other lesions

irritable bowel

criteriacriteria

irritable bowel syndromecriteria

abdominal painabdominal pain

paindefecationchangestool consistencyhardsoft

changebowel frequencycriteriairritable bowel syndrome

diseaseabdomen

dysenteryabdominal pain

paindefecation

changebowel frequencychangebowel consistency

dysenterycriteria

criteriacriteria


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famousFor nothing

Justpioneer

congenital

Coronariesvalve lesions

valve lesionscoronaries

congenitalvalve lesionscoronaries

coronariesvalve lesionscareer

research

center


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criteria

irritable bowel syndromeirritable bowel syndrome

Symptomatic

abdominal colic

anti spasmodic

Motility of the bowelbran

bran

distentioncolonperistalsis

spasticperistalsisspasticwaves

waves

distention of the colonbran

distentioncolon

diarrheaamytriptyline

constipationlaxativeserotonin

serotonin reuptake inhibitorSeroxat

Serotonin reuptake inhibitornormalizationPeristalsis waves

constipationlaxative

serotonin reuptake inhibitors


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serotonin receptor agonist

diarrheaanti diarrheal agent

amytriptyline

as regard irritable bowel syndromefunctional gastrointestinal disorders

colorectal polypsMCQs

intestinal obstructionparalytic ileus


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haematemesishaematemesis

Vomiting of a blood due to a lesion proximal to the ligament of Teritz

Vomiting of a blood due to a lesion proximal to the ligament of teritz

haematemesisfresh blood

coffee ground

Haematemesisfresh blood

Melanemesiscoffee ground

haematemesisfresh blood

melanemesiscoffee ground

rectummelena

fresh blood

haematemesis

esophagus

Esophageal varicesgastroesophageal reflux

TraumaTumors


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Ruptured aortic aneurysmesophagusMallory weiss syndrome

Mallory weissLongitudinal tear in the mucosa

Longitudinal tear in the mucosavomiting

esophagusstomach

stomachhaematemesisPeptic ulcer

Fundal varices

AngiodysplsiastomachCarcinoma of the stomach

Gastritis

stomachduodenum

duodenal ulcer

duodenal ulcer

AngiodysplsiaduodenumPolyposisduodenum

Peutz-Jaegh erspolypsduodenumPeutz-Jaeghers

Familial polyposis coli

haematemesisHaemorrhagic blood disease

haemophiliaPurpuraWhatever

haematemesismelena

melena


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Black tarry stool

black tarry stoolmelena

haematemesis

differential diagnosisblack stoolIron

CharcoalHaemolytic anemia

causes of false haematemesisfalse haematemesis

Upper problemrespiratory tractsinusitisbleeding nose

bloodvomiting

false haematemesis

haematemesisABC

airwayairway obstructionventilator

wide bore cannulablood matchinglab

salinefresh blood

OmeprazoleK

vitamin Kmedical tradition

endoscopyband ligation

vasoconstricting drugsvaso pressinsomatostatinSangstakentube

surgical treatment

peptic ulcerOmeprazole


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adrenalineulcer

partial resection by partial gasterectomy

approach to a patient presenting with a case of haematemesis

haematemesis

G.I.T.

31232013

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GIT 4 -PART1 ( IBD - Ascites - functional gastrointestinal disorders ) upload.pdf

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