MEDICAL NOTES

HIV PEP(Post-exposure prophylaxis):

2012-02-12T04:28:00.001-08:00

Post-exposure prophylaxis (PEP) has its greatest effect if begun within two hours of exposure, it is essential to act immediately. The prophylaxis needs to be continued for four weeks. Exposure must be immediately reported to designated authority and therapy administered. Never delay start of therapy due to debate over regimen. Begin with basic 2-drug regimen & expanded 3-drug regimn.

Basic regimen:Zidovudine 300mg BD(twice a day) + Lamivudine 150mg BD(twice a day)

Expanded regimen:Zidovudine 300mgBD + Lamivudine 150mg BD + Lopinavir 400mg BD

Expanded regimen should be used if there is cut or needle stick injury penetrating gloves,inserting a cathether which was previously used for a HIV infected patient.

Types of facies:

2012-02-12T04:27:00.000-08:00

1.Moon face(Cushingoid facies)
*2.Mouse facies - CRF
*3.Ashen Grey facies - Myocardial infarction
*4.Potter facies-Oligohydromnia

5.Mask like-parkinsonism
6.Leonine-leprosy
7.frog like facies-ethmoidal polyps,NP angiofibroma..
8.gargoyle facies - hurler's syndro
9.meflat facies - down's syndrome
10.Hippocratic face (also known as "Hippocratic facies"; eyes are sunken, temples collapsed, nose is pinched with crusts on the lips and the forehead is clammy) 11.snarling facies - myasthenia gravis
12.torpid facies - myxoedema

13.chipmunk facies- untreated thalassemia major, bullimia nervosa.
14.bird facies..(typically small mandible)- Pierre Robin symdrome
15.ashen gray facies- MI
16.adenoid facies-adenoids,other causes of b/l nasl obs.
17.facies mitrale-MS

PATHOGNOMONIC SIGNS of diseases:-

2012-02-09T09:07:00.000-08:00

Pathognomonic signs
1. COPD - Barrel-Chested
2. Pneumonia - Greenish Rusty Sputum
3. Pernicious Anemia - Beefy Red Tongue (Schilling’s Test)

4. Kawasaki Dieases - Strawberry Tongue
5. Typhoid - Rose Spot
6. Tetany - Chvostek Sign (Muscle Twitching Face)
- Trosseau’s Sign (Jerky Mov’ts)
7. Pancreatitis - Cullen Sign (Bluish discoloration preumbilical area)
8. Appendicitis - McBurney’s Point (rebound tenderness)
- Rovsing Sign (RLQ pain w/ palpation in LLQ)
- Psoas Sign(pain on lying down putting pressure on MB pt)
9. Thrombophlebitis - Homan’s Sign
10. Hepatitis - Icteric Sclera (yellowish discoloration of sclera)

11. Meningitis - Burdzinski Sign (Pain on nape)
- Karnig Sign (pain on leg/ knee area)
12. Pyloric Stenosis - Olive-Shaped Mass
13. Hyperthyroidism - Exopthalmus
14. Addison’s Disease. - Bronze-like skin
15. Cushing Syndrome- Boffalo Hump
16. Cholera - Rice Watery Stool
17. SLE - Butterfly Rashes
18. Leprosy - Leoning Face (contracted face)
19. Bulimia Nervosa - Chipmunk Face
20. Liver Cirrhosis - Spider Angioma
21. Asthma - Wheezing Inspiration
22. Hyperpituitarism - CAROTENEMIA (Discoloration of skin)
- XANTHAMIA
23. Down Syndrome- Single Crease on Palm
24.TOF - Clubbing of Fingernails
Ventricular Septal Defect
Pulmonary Stenosis
Overriding of Aorta
Right Ventricular Hypertrophy
25.Cataract - Blurry Vision / Hizzy Vision
26.Glucoma - Tunnel-like Vision
27. PTB - Low grade fever in a ternoon
28. Cholecystitis- Murphy’s Sign (pain RUQ)
29. Myasthemia Gravis (MG) – Ptosis (inability to open upper eyelids)
30. Dengue - Petechiae
31. Parkinson’s Diease. - Pill Rolling Tremors
32. Measles - Koplick’s Spot

Normal blood values

2012-01-29T08:58:00.000-08:00

Please note: normal values may differ between hospitals. This is simply a guide.

Full blood count

Haemoglobin
- Male = 13-18g/dL
- Female = 11.5-16g/dL
Mean corpuscular (cell) volume (MCV) = 76-96fL
Mean corpuscular haemoglobin (MCH) = 27-31pg
White cell count (WCC) = 4-11×10^9/L
Platelet count = 150-400×10^9/L

Serum biochemistry

Sodium = 135-145mmol/L
Potassium = 3.5-5mmol/L
Chloride = 95-105mmol/L
Urea = 2.5-6.7mmol/L
Creatinine = 70-150umol/L
eGFR = >90
Glucose (fasting) = 3.5-5.5mmol/L
Calcium = 2.12-2.65mmol/L
Phosphate = 0.8-1.4mmol/L
Bicarbonate = 22-28mmol/L
Uric acid = 0.18-0.42mmol/L
Protein (total) = 60-80g/L
Albumin = 35-50g/L
Bilirubin = 3-17umol/L
Osmolality = 280-296mosmol/L

T4 = 70-140mmol/L
TSH = 0.5-5.7mU/L

Enzymes

Alkaline phosphatase = 30-150iU/L
Aspartate aminotransferase (AST) = 5-35iU/L
Alanine aminotransferase (ALT) = 5-35iU/L
Lactate Dehydrogenase (LDH) = 70-250iU/L
Gamma-glutamyl transpeptidase (GGT)
- Male = 11-51U/L
- Female = 7-33U/L
Creatine kinase = 25-195iU/L
Troponin T = <0.1ug/L

Tests for clotting

Three tests are normally carried out to assess clotting:

1) Platelet count

Deficiencies in platelets cause purpura (3-10mm)

2) Prothrombin Time (PT)

Normal = 12-15s
Measures extrinsic pathway and factors V, VII and X
Prolonged in vitamin K deficiency
Used to monitor anticoagulation with warfarin
International Normalised Ratio (INR)
- Patient’s PT / Reference standard
- e.g. 30 / 12 = 2.5 INR

3) Activated Partial Thromboplastin Time (APTT)

Measures intrinsic pathway and factors V, VII-XII
Used to monitor anticoagulation with heparin
Prolonged in haemophiliacs

RESPIRATORY ALKALOSIS

2011-12-05T00:15:00.000-08:00

High pH is characterised by a decrease pCO2,primarly due to hypdrventilation.Compdnsatory renal responses lead to increase excretion and decreased serum bicarbonate levels.Sever respiratory alkalosis may result in light headedness parasthesia ,numbness,tetany ,convulsion.

CAUSES :-
1) stimulation of respiratory centre caused by fever , anxiety or cerebral tumour.
2) drugs such as salicylates and theophylline
3) hypoxia caused by sever anemia or high altitude .
4) pulmonary disorders such as asthma , pneumonia , bronchiolitis
5) fulminant gram negative septicemia

MANAGEMENT :-
Directed at underlyin disorder.

CRANIOCYNOSTOSIS

2011-12-05T00:14:00.000-08:00

Coronal ,saggital and lambdoid sutures of skull close during 2nd decade of life. One or more these sutures may close prematurely due to which growth of calvarium arrested in a direction right angles to fused sutures classification :-) 1 primary=present since birth with genetic basis 2 secondary=idiopathic hypercalcemia hypophosphatasia rickets,microcephaly diagnosis=prominent ridges over closed suture, asymmetry,confirmed by x ray of skull effects of craniosynostosis :- *cosmetic defects 1 dolichocephaly 2 brachycephaly 3 trigonocephaly 4 oxycephaly *proptosis and hypertelorism=growing brain within prematurely stenosed cranium exerts pressure causes displacement of greater wings of sphenoid bone
3) Growth of maxilla is interfered resulting in small nasopharynx.
4) arrested development of brain
5) optic atrophy.

Associated clinical syndrom:-
1) crouzon syndrome
2) alpert syndrome
3) carpenter syndrome

Treatment :-
-linear craniectomy along the affected suture should be performed early.
- orbital decompression is needed in some cases to prevent development of optic atrophy

MENTAL RETARDATION

2011-12-05T00:12:00.001-08:00

Defined as significant sub average general intellectual function,existing concurrently with deficits in adaptive behaviour n manifest during developmental period. Classification acc 2 severity- w mild iq 50-70, moderate 35-50, severe 20-35, profound<20. Atiology-chromosomal abnormalities,metabolic n endocrine causes,multiple cong anomaly syndrome,teratogens in preg,cns malformations,perinatal difficulties-extreme prematurity,hypoglycemia,hyperbilirubinaemia. Post natal injury 2 brain-asphyxia,head injury. Unknown etiology. Associate deficit-visual,communication deficit,seizure cerebral palsy,feeding problems. Diagnostic tests-1.Metabolic screening 2.Neuroimaging-ct mri 3.Karyotype 4.Molecular testing. Management-aim-relieve anxiety n stress,encourage development.Plan of action-assesing childs capabilities,early stimulation n education,behavioural modification technique,school placement n home educ,employment.Genetic counselling. Supporative treatment.Prevention of mr-general n socio economic improvement,nutritional improvement 2 preg mothers,prevention frm drugs n radiation,good obst care,prevent consanguineous marriages.

Scabies

2011-12-05T00:11:00.000-08:00

Scabies is a parasitic infestation of skin caused by colonization of skin by mite sarcoptes scabies.
It is common in children younger than 2 year.
CLINICAL FEATURE.-
-itching nd visible lesion appear several days after infection.
-SKIN LESION R OF FOLLOWING TYPES.
1.Edema,rednes nd vesicle formation,papules on palms nd finger webs of hands,wrists,elbox.Scatter lesions may b seen on legs,ankles and feet.
2.Reddish nodules on upper part of trunk and groins.
3.Linear or serpiginous tracks of burrows formed by female mite are mostly on distal arm nd wrist or about axilla.The lesions may b secondary infected with streptococi.
TREATMENT.-
1.5% permethrin topical cream in childrem beyound 2 months.
It is applied locally overnight and allowed to remain on the lesion for atleast 10 hour. Repeat after 1or 2 weeks later.
In children below 2 months sulphur and crotamiton creams.
All members of family to b treated even in absence of disease. All clothes and bed linen should be boiled or put out in sun and subject to hot ironing.

Turner syndrome

2011-12-05T00:10:00.001-08:00

Turner syndrome has 45 X0 chromosomal pattern.
C/O-
the disorder may b recognizable at birth.A newborn present with lymhedemd of dorstm of hand n feet n loose skin fold at the nape of neck..An older child wl hav short stature,short webbed neck,low posterior hailine.Ear are anamolous n prominent.Palate is high arched n mandible is small.Chest is broad shield like with widely spaced hypoplastic nipples. There is increase crying at angle at elbow.Knee anamolies include medial tibial exostosis.The 4th metcapal n metatarsal are short.At puberty sexual maturation fails to occure.Adult stature is less than 145 cm.
Management_
cardiac evaluation including BP n echocardiography is recommended at base line and every yr.Ht should b monitor.Evaluatio of cardiac function.
Growth harmone therapy is useful n may increase the final ht by 8-10 cm..Counselling regarding behavioral problem.,amenorrhoea n sterility is intriagal part of management.Ovarian harmone replacement therapy should b started on 14 yrs.Prophylactic gonadoctomy is done.

Proteinuria

2011-12-05T00:09:00.001-08:00

Proteinuria
Small amount of protein is filtered but the factors preventing proteinuria are - 1 reabsorption by proximal tubules 2 capillary walls 3 anionic charge along membrane protein concentration of 100-1000mg/m-m /day -mild to moderate . >1000heavy causes:) mild transient =fever, dehydration ,heavy exercise
mild urinary tract infection hydronephrosis,renal TB.heavy proteinuria in glomerular disease. Important causes :) 1 orthostatic proteinuria 2 chronic glomerular disease 3 reflux nephropathy 4 renal hypoplasia how to measure :- protein to creatinine ratio in first morning urine specimen is below 0.1 mg/dl a ratio of 0.1-1 indicates mild to moderate and >1 indicates heavy proteinuria chronic renal damage from vesicoureteric reflux,UTI manifest as proteinuria then glomerulosclerosis may cause persistent asymptomatic proteinuria hematuria present for diagnosis renal biopsy indicated and long term observation of renal function . ?

HEMATURIA

2011-12-05T00:08:00.001-08:00

Presence of blood in urine.
CAUSES OF HEMATURIA-
a) RENAL- GLOMERULAR- acute GN, crescentic GN, Alport syndrome, membranoproliferative GN
RENOVASCULAR- renal vein thrombosis..
b)HEMATOLOGICAL- DIC, thrombocytopenia, sickle cell dis
c) URETERIC, VESICAL- calculi, hemorrhagic cystitis, idiopathic hypercalciuria
d) other- polycystic kidneys, hydronephrosis, birth asphyxia, renal trauma.
$ DIAGNOSTIC EVALVATN-
urine for red cells,red cell cast & protein. No red cells in myoglobinuria or hemoglobinuria.
Glomerular disease- urine dysmorphic red cells, of dif shapes.signifficant proteinuria &/ or red cell cast. Hypercalciuria excluded.
Plain x-ray or usg of abdo to exclude renal & urinary tract anomalies & calculi.
Renal biopsy- indicatn
hematuria a/w persistent or heavy proteinuria, h/o renal disease in family or evidence of chr. renal disease
Renal pelvis / lower urinary tract, red cells maintain normal physiology.

FLOPPY INFANT

2011-12-05T00:07:00.001-08:00

Infant wd markd hypotonia of all muscles.
CAUSES
1)Central nervous sys
perinatal asphyxia,neonatal encephalopathy,kernicterus, crbl palsy,intracrnl hmrge,chrmsml anamolies lk Downs ,aminoaciduria
2)SPINAL CORD Anamol
ant hrn cell dis-werding hoffman spinal mus atropy,poliomyelitis
3)PERIPHERAL NERUES
acute polyneuropaty ..cong snsry neuropaty
4)MYONEURAL JUN
neont mystenia grvis,infantle botulism
5)MUSCLES
muscle dystrpy,cong myotonic dstrps,cong myopatis,polymyositis,glyco storg dis
6)MISCELLAN
PEM,rikets,prader willi syn,malab syn,cretinism
DIGNOSIS Clinicaly reltve immobilty,bizzre unusl postures
POSTURE frog leggd posn
on vent susp rag doll posn
MOVEMETS
flabby muscles
SCARRF Sign elbow easly crss midline
HEAD LAG whn pull to sit
TREATMT
manage compli of svre weakness
motor neurotropic agnts &embryonic grafts
gabapentin,rilozule

newer vaccines

2011-12-05T00:06:00.000-08:00

Following r-
hemophilus influenzae-h.Influenzae causes meningitis n pneumonia,hib capusular polysaccharide induces production of antibodies,started at 2mths of age repeated doses at 8wk interval n bosster at 12 18 mth. Varicella prepared frm oka strain age 1 -2 yrs adverse effects r few,indication r immunocompromised host,adult n adolescents 0.5ml s.C.
Rota virus live attenuated tetravalent orally,each dose 2.5ml administered 2,4,6mth oraly.
Cholera strain ogawa,inaba,no upper age limit, shld not be given before 1yr, 0.5ml bosters every 6mth s.C deltoid 2 types killed n live attenuated.
Meningococcal quadrivalent 50microgm single s.C 0.5ml children older than 2yrs.
,pneumococcal polyvalent sc or im
,japanese encephalities 3types of vaccine sc in 2 doses of 0.5ml boster after 1yr,influenza children older than 6mth

HYPONATREMIA

2011-12-05T00:04:00.000-08:00

When serum sodium level falls below 120mEq/L
Cause-adrenal insuff.
Diabetic Ketoacidosis
portal HT, Liver failure,nephrotic syndrome, malnutrition, water intoxication
C/f : confusion, restlessness
cerebral oedema> headache,drowsiness, seizure, coma
acute case-hypotension, circulatory failure

management: water intake restricted if water overloading, renal failure, SIADH. Dont restrict water,if hypoproteinemia.
Expand vol. By iv isonatremic solution
or, WHO ORS if pt. Can drink.

3% hypertonic saline,if acute hyponatremia to raise serum sod.level by 5mg%. dose 6ml/kg

chronic.case-treat in 48hrs at rate of less than 25mEq/L otherwise central Pontine myelinolysis
sod. Deficit=(desired Na - present Na) multiplied by wt.& 0.6

PICA

2011-12-05T00:02:00.000-08:00

Child may develop habit of eating non edible subtances like wall plaster clay paint earth. Child wth pica have history of neonatal insult.They r slow in motor n mental development n show neurologic defect n deviant behaviour.Tasting or mouthing of strange object is normal in infant n child upto 2 yrs.Persistance of this habit beyond 2 yrs may b manifestation of parenteral neglect poor supervision or lack of affection.Common in lower socioeconomic strata n malnorished n mentaly subnormal child.These child prone 2 lead poisioning n complaint of chronic abdo pain n pallor.No tretment

Necrotising enterocolitis

2011-12-05T00:01:00.001-08:00

premature infant under stress in first wk patho 1mucosal injury due to ischemia infec e coli klebsiella salmonella 2 formula feed @clinical after 1 wk lead to fulminant death three stage 1 suspect unstable temp apnea omniting abd distension 2 definite above and bowel sound metabolic acidosis 3 advanced above and low bp dic anuria peritonitis with abd edema@management oral feed withheld nasogastric tube to relieve distension aspiration fluid electrolite blood csf urine stool culture shock treat plasma platelev sequel perforatino stricture

respiratory acidosis

2011-12-04T23:59:00.001-08:00

Low ph characterised by prim incre in pco2 n compensatory responses leading 2 elevated bicarbonate either by generation or by renal resorption of bicarbonate.Manifestation-raised ict asterixis n plethora
CAUSES-1)decresed resp drive-cerebral diseases drug neuromuscular diseses 2)pul diseses with alveolar hypoventilation-asthama pneumothorax 3)respiratory fatigue
MANAGEMENT-correction of cause n mechanical ventilation bicarbonate must not b infused because it generates more co2

NEPHROTIC SYNDROME

2011-12-04T23:57:00.001-08:00

I.. Minimal change nephrotic syndrome
II. Nephrotic syndrome with significant lesion -

I.. Minimal change nephrotic syndrome

80 % of neph syndromes
- Clinical features
edema around eye, pitting, graduallly generalised, sustained elevation of BP
LAB findings-
heavy proteinuria, gross hematuria, hyaline casts, blodd level of igg low , igm high, protein selectivity low ratio
MANAGEMENT
- high protein diet
- no extra salts
rapid fliud losss should nt be attempted
- furosemide 1-4 mg / kg
- prednosolone 2mg/kg

management of relapse
- prednisolne 2mg/kg 2 wks
- treatment of frequent relapses
* Alternate day prednisolone 0.3- 0.7 mg/kg 10 mnths

COMPLICATIONS

1. Edema
2. infection
3. thrombotic complication
4. steroid toxicty
5. Acute renal failure

. II. Nephrotic syndrome with significant lesion -

Significant glomerular abnormalities
1. Mesangial proliferative GN
2. Focal segmental glomerulosclerosis
3. Membranoproliferative GN

Supportive care of resistent nephrotic syndrome
i.v. albumin
ACE inhibitors

Lithium

2011-12-04T23:56:00.000-08:00

-is an element which is the smallest alkali ion .
Discovered by Arfuedson in 1817 and is used for the treatment of gout , cardiac disease but has fatal toxicity .
Then it is used in treatment of mania . Often called as antimanic and also as mood stabilizing agent .
Indications - 1 treatment of acute mania 2 prophylaxis of bipolar mood disorder 3 prophylaxis of unipolar mood disorder 4 treatment of cyclothymia 5 treatment of acute depression 6 treatment of impulsive aggression 7 cluster headache , cyclical vomiting , hyperthyroidism .
Pharmacokinetics - very rapidly absorbed from GI tract. Peak betn 30min to 3hrs . It is not protein bound . There is no metabolism of lithium in the body and excreted entirely by kidneys .
Mechanism of action -
1 it affects Na-K ATPase and accumulates intracellularly as a substitute of Na .
2 it inhibits adenylate cyclase and decrese cAMP 3 accelerates the presynaptic reuptake .
4 inhibit release of catecholamines at synap
5 stebilizes the cell membrane .
Clinical use -
Preparations - 1 lithium carbonate 300mg and 400mg sustain release
2 lithium citrate 300mg or 5ml liquid .
Investigate at repeated intervals when pt is started on it like , CBC , RFT , TFT , EKG , URINE .
Side effects - A neuro-.1tremor 2 muscular weakness 3 cogwheel rigidity 4 seizures .
B renal - 1 polyuria ,polydipsia 2 tubular changes 3 nephrogenic DI 4 nephrotic syndrome
C cvs -t wave depresion in EKG .
D endocrine - 1 goitre 2 hypothyroidism 3wt gain
E GI -nausea , vomiting , diarrhea , abdo pain .
F teratogenicity during pregnancy .
Contraindications - 1 presence of cardic , renal , thyroid disease .
2 blood dyscrasia .
3 during first trimester of pregnancy and lactation

pellagra-niacin def.cl ft-

2011-12-04T23:54:00.000-08:00

constit sympt.dermal lesion-hyperkerato,bilat,symetrcal,photosens.sunexposd part casal necklace.
Diarhea-mucous memb inflam,glositis,stomat,gastratis.
Dementia-haluc,delerim,sp paraplag.mental depresn.
Trt-nicotinic acid100mg.prevent-replace maiz

splenomegaly causes

2011-05-16T09:24:00.000-07:00

A>mild splenomegaly
1>infective-typhoid infective endocarditis septicemia
2>hematological-early stages of hemolytic anaemia
3>malignancy-early stages of lukemia
B>moderate-massive splenomegaly
1>infective-chornic malaria kala azar toxoplamosis
2>hematological-hemolytic anaemia thalasemia major/intermedia
3>malignancy-chronic myeloid leukemia hodgkins disease
4>congestive-portal HTN
5>metabolic-gauchers disease

JAUNDICE

2011-05-16T09:22:00.000-07:00

Definition=jaundice defined as yellowish pigmentatn of skin,mucous membrane nd sclera by bilirubin ,rusulting frm elevated levels of bilirubin in blood.
Clinical jaundice occurs when serum bilirun is more than 2.5 mg %.
Latent jaundice is when serum bilirubin is more than 1 mg % but than 2.5 mg %
Classification=
1..Based on underlying derangement of bilirubin metabolism
a..Predominantly unconjugated hyperbilirubinaemia
b..Predo conjugated hyperbilirubinaemia
2..Based on pathology
a..Haemolytic jaundice
b..Hepatocellular jaundice
c..Cholestatic jaundice
A..HEMOLYTIC jaundice=
it results frm increased distructn of red cells resulting in increased bilirubin production
Unconjugated bilirubin accumulates in plasma.
Causes=
1..Intraerythocytic-
spherocytosis,sickle cell disease ,thalassaemia ,g6pd defi
2..Extraerythocytic_
autoimmune haemolytic anemia ,malaria ,prosthetic valves ,PND..
Clinical feature=

.Pallor
.Mild jaundice
.Hepatosplenomegaly
.Dark stool
Investigatn=
.No bilirubin in urine
.Urobilinogen increased
.Serum bilirubin incr
.Unconjugated bilirubinemia
.Normal liver functn test
B..Hepatocellular jaundice
.Results frm inability of liver to transport bilirubin into bile leading to liver cell damage..
Here both conjugated nd unconjugated bilirubin level rises.
Causes=
.Viral hepatitis
.Alcoholic hepatitis
.Chr hepatitis
.Cirrhosis
C..Cholestatic jaundice
.Means failure of bile flow ,coz may lie anywhere btw hepatocytes nd duodenum
.It is usually a surgical jaundice.
Causes=
1.Small duct obstructn due to=
drugs ,alcohol ,viral hepatitis ,cirrhosis ,chr hepatitis ,hodgkins disease
2..Large duct obstructn duue to=
gall stone ,carcinoma head of pancrease ,ca of ampulla of vater ,stricture bile ducts ,ca of bile ducts
.C/F=
symptoms=
.Jaundice
.Pruritus
.Dark urine
.Fever with chils nd rigors
.Wt loss
.Haemorrhagic tendency
.Bone pains
.Signs=
.Deep jaundice
.Xanthelasmas on eyelids
.Xanthomas
.Palpable gall bladder
.Hepatomegaly
.Signs of liver cell failure
.Investigatn=
.Bilirubin in urine
.Urobilinogen absent in urine
.Ser bilirubin raised
.Conjugated hyperbilirubinemia
.Ser alkaline phosphates rised
.Ultrasonography
.Liver biopsy

GERD

2011-05-16T09:21:00.000-07:00

The reflux of gastric contents into the lower esophagus is called GERD.

Causes
1.sliding hiatus hernia-in this type of hernia the esophagogastric junction slides up through the diaphragm.this results in....a. Loss of obliquity of entry of eso into stomach.b.loss of reinforcing effect of intra abdo. pressure on d lower eso. sphincter.these 2 factors facilitates reflux.
2. Cardiomyopathy and vagotomy
3. Pregnancy,obesity,ascites,wt lifting,straining.
4. Cig smoking,alcohol,fatty foods,caffeine
5. Large volume meals.
6. Systemic sclerosis.
7. Drugs lik aminophylline,beta agonist,nitrates,ca channel blockers.
8. H.pylori.

C/f
-heart burn is deply placed burning pain behind the sternum radiating to the throat.it occurs after meals brought on by bending lifting weight and straining. It occurs on lying down in bed at night and relieved by sitting up.
-regurgitation of contents into mouth.
-aspiration pneumonia
-odynophagia
-persistant n transient dysphagia
-anemia due to bld loss
-hoarseness,sore throat,cough,laryngitis,otitis media.

Investigations
-endoscopy
-barium swallow and meal for hiatus hernia
-eso. pH
-bernstein test
-resting ECG n stress ECG
-eso motility studies.

Treatment
General
-weight reduction. Cessation of smoking
-small volume feeds.
-avoid alcohol.fatty food.weight lifting.
-avoid late night meals

Medical
-liquid antacid 10 to 15ml, 1 and 3 hrs. After meals.
-H2 antagonists lik cimetidine 400mg or ranitidine 150mg twice daily
-proton pump inhibitors lik omeprazole 20-40mg/day,lanso 15-30,panto 40,esomeprazole 40
-metoclopramide/domperidone 10mg thrice daily.
-h.pylori Rx regime
-oral iron for anemia

Surgical
-resection of strictures
-surgical return of lower eso sphincter to abdo.
-fundoplication

BLIND LOOP SYNDROME

2011-05-16T09:19:00.000-07:00

Also called small bowel bacterial ovnrgrowth..
Disorders which impair normal physiological mechanisms controlling bacterial overgrowth.
.Most imp coz r 1. loss of gastric acidity
.2.Impaired intestinal motility
.3..Structural abnormalites
.C/F=
.Pt present with watery diarrhoea nd steatorrhoea with anemia due to b12 vitamin defi.
.INVESTIGATion =
.Serum vitamin b12 conc low
.Barium study or small bowel enema reveal blind loops or fistulae
.Endoscopic duodenal biopsies exclude mucosal disease
.Endoscopic aspiratn of jejunal contents
.MANAGEMENT =
.Tetracycline 250 mg 6 hry for 7 days
.Metronidazole 400 mg 8 hrly
.Intramuscular vita.B12 supplementatn

SCEROSING CHOLANGITIS

2011-05-16T09:17:00.000-07:00

Def...it is characterisd by development of multiple stricture, dilatation of CBD with features of fibrous thickening of CBD

¤ Types
1. Primary
no cause is found but occurs with folowing conditions
e.g. Ulcerative colitis, crohns dis,graves dis, sjogrens syndrom
2. Secondary
due to stones or injuries

¤Complications
due 2 long standing obstruction biliary cirrhosis and cholaniocarcinoma develop

¤Diagnosis
1. Ultrasound 4 intrahepatic dialation
2. MRCP shows multiple strictures and dilatation
3. ERCP is d invst. of choice shows strictures in d CBD and dilation whch described as beaded appearance

¤Rx.
Stenting is the choice