GIT Dr.

Shaf3y

G.I.T. 2013 24 6

malabsorption

Malabsorption syndrome
By definition Malabsorption syndrome Failure to absorb one or more of the nutrients Failure to absorb one or more of the nutrients

malabsorption syndrome

Failure to absorb one nutrient is called malabsorption malabsorption syndrome One nutrient and it is usually associated with steatorrhea steatorrhea Fatty diarrhea steatorrhea malabsorption etiology etiology

malabsorption syndrome stomach stomach

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GIT Dr. Shaf3y

reservoir stomach

suddenly << intestine absorption digestion

intestine absorption

gradually digestion

gasterectomy gasterectomy intestine Which means absorption digestion dumping

Following gasterectomy dumping absorption digestion malabsorption syndrome

disinfectant HCL intestine intestine proliferate intestine proliferate glucouronidase bile salts

bile salts

enzymes

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GIT Dr. Shaf3y

bile salts fat absorption steatorrhea HCL intestine enzymes proliferation bile salts enzymes diarrhea Malabsorption syndrome Stomach causes stomach causes pylrous storage HCL atrophic gastritis HCL HCL proliferate bile salts

bile salts

gasterectomy

gastric carcinoma

enzyme

HCL Zollinger Ellison syndrome duodenum HCL bile HCL alkaline media bile neutralization

pancreatic enzymes

HCL duodenum acidity neutralization

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bile

stomach HCL duodenum

GIT Dr. Shaf3y

enzymes alkaline media duodenum HCL neutralization bicarb acidic << duodenum Which means pancreatic enzymes absorption digestion

gasterectomy

Pylrous HCL HCL

duodenum duodenum pancreatic duct bile duct

haemochromatosis

pancreatic carcinoma

damage pancreatic enzymes pancreatectomy pancreatitis bile absorption obstructive jaundice Liver cirrhosis bile malabsorption gastric bile pancreatic small intestine

malabsorption malabsorption

small intestinal causes small intestinal causes

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GIT Dr. Shaf3y

small ii stagnant loop syndrome small intestine small ii stagnant loop syndrome S stagnant loop Intestine peristalsis stagnant << content Proliferation of bacteria glucouronidase bile salts absorption stagnant loop syndrome scleroderma diabetic autonomic neuropathy myxedema S

stricture content stagnation

stricture

superior mesenteric artery

stagnant loop syndrome Short gut syndrome intestine extensive resection intestinal tumors superior mesenteric occlusion sigmoid duodenum Left colon transverse colon left colon transverse colon sigmoid duodenum short gut syndrome small intestine

absorption

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GIT Dr. Shaf3y

miscellaneous drugs cholestyramine Neomycin Drug cholestyramine Bile salt chelator fat absorption

congestive heart failure portal hypertension G.I.T. congestion absorption miscellaneous amyloidosis << a Amyloidosis of the intestine Intestine amyloidosis absorption lactose intolerance << L Lactose intolerance L lactase digestion

thickened

wall

diarrhea

lactose intolerance Is more common This is very strange

lymphatic obstruction << L fat absorption intestine lymphatic Whipples disease Lymphoma lymphatic obstruction fat absorption lymphatic obstruction Whipples disease Lymphoma
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GIT Dr. Shaf3y

Whipples disease Whipples disease lymphatic lymphatic Macrophages Whipples disease malabsorption syndrome intestine lymphatic vacuoles macrophages electron microscope << Organism

malabsorption syndrome macrophages intestine

large macrophages

Infection organism organism

Organism macrophages

macrophages macrophages Lymphatic impaction intestine Lymphatic

malabsorption syndrome Whipples disease clinical pictures Malabsorption syndrome pictures Lymphadenopathy Cranial nerve affection arthritis fever

malabsorption syndrome

lymphadenopathy Arthritis Cranial nerve affection fever clinical pictures investigations

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GIT Dr. Shaf3y

malabsorption investigations intestine biopsy organism PCR

tetracycline << Antibiotics

Lymphatic obstruction

lymphatic obstruction

ii small ii lactose intolerance LL eye ii infection irradiation inflammation immunological

malabsorption

infection organism T.B. enteritis

solium Infection

Gardia tinea saginata

irradiation end arteritis obliterans Intestine irradiation blood vessels malabsorption

inflammation inflammatory bowel disease

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GIT Dr. Shaf3y

regional ileitis Ulcerative colitis Crhons disease malabsorption regional ileitis malabsorption intestine

immunological Coeliac disease gluten - sensitive enteropathy or non tropical sprue coeliac disease gluten sensitive enteropathy wheat gluten gliadin gliadinase gluten enzyme gliadin wheat gluten intestine gliadinase coeliac disease gliadinase gliadinase enzyme gliadin lumen gliadin gluten gliadin gliadin

intestine villi direct toxic effect

villi
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lymphocyte

activation

gliadin

GIT Dr. Shaf3y

antibodies villi lymphocyte damage

antibodies

lamina properia

villi lymphocyte

direct toxic effect gliadin Induce immunological reaction villi villi damage

as malabsorption << represent clinically disease Other autoimmune features auto immune thyroiditis insulin dependent diabetes pernicious anemia vitiligo dermatitis herpetiformis

pellagra Coeliac disease

pellagra Coeliac disease

Coeliac disease

dermatitis herpetiformis

teenager

at young age

manifestations adult life

disease

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GIT Dr. Shaf3y

investigations malabsorption syndrome investigations antibodies Endomysial antibodies anti gliadin antibodies

antibodies

Lymphocytes anti gliadin antibodies endomysial antibodies treatment malabsorption gluten free diet steroids gluten free diet gluten diet

gluten

Coeliac disease tropical sprue infection tropical sprue

recommended

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GIT Dr. Shaf3y

tropical sprue diarrhea angular stomatitis

antibiotics infection stool naked eyes stool Egyptian organisms Infection Organism It has not been isolated

clinical pictures of malabsorption syndrome malabsorption syndrome clinical pictures 3 G.I.T. manifestations excessive intestinal sounds flatulence abdominal colics diarrhea accentuated intestinal sounds Offensive
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greasy << stool

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GIT Dr. Shaf3y

greasy does not flush does not flush fat stool stool greasy

greasy offensive bulky stool

diarrhea

colic

G.I.T. manifestations G.I.T.

clinical pictures of the underlying cause Whipple disease clinical pictures of Coeliac disease clinical pictures of the cause

deficiencies deficiencies Hypoglycemia rapid loss of body weight fat viscero-ptosis rapid loss of body weight floated kidney organs Viscero-ptosis protein albumin edema White nails Muscle wasting sodium Hypotension
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minerals muscle cramps

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GIT Dr. Shaf3y

muscle weakness up to paralysis Constipation up to paralytic ileus Arrhythmia

osteomalacia arrhythmia tetany

iron iron deficiency anemia vitamins vitamin A Night blindness vitamin D Osteomalacia vitamin E cerebellar ataxia primary biliary cirrhosis impotence vitamin K Bleeding tendency vitamin B complex Beri Beri B1 peripheral neuritis B6 sub acute combined degeneration B12 pellagra peripheral neuritis deficiency manifestations

malabsorption
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investigations investigations Investigations

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GIT Dr. Shaf3y

Underlying cause

malabsorption Underlying cause

investigations Investigations

deficiency glucose level hypoglycemia malabsroption

glucose cause cause Hypoglycemia Malabsorption

malabsorption glucose orally glucose

absorption malabsorption intestine

Oral glucose malabsroption syndrome diabetes

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GIT Dr. Shaf3y

diabetic curve pancreatic flat curve intestinal

fat fat stool malabsorption stool absorption stool fat 6

fat

malabsorption steatorrhea

fat diet Lipase

absorption intestine non split

fat lipase free fatty acids free fatty acids fat fat

stool

fat

intestine

fat

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GIT Dr. Shaf3y

intestine unsplit fat pancreatic split fat intestinal Proteins proteins albumin

globulins

X ray osteoporosis <<

Underlying cause malabsroption osteoporosis << X ray

underlying cause minerals Minerals deficiency anemia vitamins vitamin A

Investigations

vitamin D hypocalcemia Osteomalacia X ray investigations vitamin E vitamin K prothrombin time prolongation

Underlying cause
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GIT Dr. Shaf3y

vitamin K vitamin K injection liver intestine

liver vitamin K as a therapeutic test hypoprothrombinemia vitamin K deficiency haematology vitamin K malabsorption Liver vitamin K deficiency Liver

Liver vitamin K Underlying cause Vitamin B12 deficiency megaloblastic anemia folic acid deficiency megaloblastic anemia Underlying cause

Underlying cause

stomach

intestine

B12 deficiency Schilling test Schilling test

proliferation of bacteria
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GIT Dr. Shaf3y

Intrinsic factors intrinsic factor

Underlying cause

investigations investigations causes stomach

endoscopy gastric carcinoma

stomach gastritis H. Pylori gastric function test

acidity endoscope

MRCP

PTC

ERCP

bile

pancreatic function test lipase serum amylase

small intestine Enteroscope

enteroscope specialty interventional cerebral angiography radiodiagnosis cerebral interventional

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GIT Dr. Shaf3y

Intensive care P tropical

endocrinologist American certified

enteroscope enteroscope small intestine biopsy enteroscope 4 3 enteroscope

enteroscope

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GIT Dr. Shaf3y

enteroscope

biopsy

enteroscope

intestine

biopsy

stool

stool stool biopsy

stool

stool

stool biopsy

intestine intestine wall video scopic capsules

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GIT Dr. Shaf3y

Barium << intestine barium malabsorption syndrome dilated << intestine gases proliferating bacteria distended << Intestine Loops diameter 25

Post evacuation film is atrophic << villi feathery pattern

feathery pattern

small intestine

colon

barium intestine Barium Large intestine small intestine haustration large intestine feathery villi small intestine villi feathery pattern

barium

pentose oral 25

pentose metabolism pentose metabolism

enzyme urine

human human being pentose

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GIT Dr. Shaf3y

Pentose

Urine

pentose

25 Urine Urine intestine 25 5 absorption small intestine breath test ) 14 14 C - glycocholic acid breath test

bile salts bile salts

14 14 orally

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GIT Dr. Shaf3y

bile salts 14 intestine bacteria proliferating bond bile salts 14 intestine Proliferating bond free oxygen carbon dioxide carbon dioxide growth of bacteria small intestine Investigations

treatment malabsorption treatment symptomatic anti spasmodic Anti diarrheal agents G.I.T. manifestations deficiency << deficient factors

parentral

And finally Treatment of the cause Coeliac disease Whipples disease Whatever the disease underlying cause malabsorption syndrome malabsorption Discuss Coeliac disease Discuss Whipples disease

malabsorption syndrome
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GIT Dr. Shaf3y

discuss Coeliac or Whipples disease

malabsorption

malabsorption

Coeliac disease Discuss Coeliac disease Coeliac disease malabsorption clinical pictures investigations Investigations

Jaundice

Jaundice
definition of jaundice Yellowish discoloration of the skin and mucous membranes due to hyperbilirubinemia yellowish discoloration of the skin and mucous membranes due to hyperbilirubinemia yellowish discoloration caroteinemia

normal 3

Bilirubin

jaundice 3 Hyperbilirubinemia Jaundice 3 Hyperbilirubinemia Jaundice 2 << bilirubin 1 1

yellowish discoloration of the skin and mucous membranes

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GIT Dr. Shaf3y

discoloration 3 jaundice threshold

Jaundice threshold

globin

Heme

heme Protoporphyrin Iron Protoporphyrin Bileverdine indirect bilirubin bileverdine Indirect bilirubin liver Direct bilirubin bile stercobilinogen direct bilirubin intestine

absorption Liver enterohepatic circulation Urine urobilinogen

Jaundice

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GIT Dr. Shaf3y

Hemolytic Obstructive Hepatocellular

hemolytic cause of hemolytic jaundice Hemolytic anemia repeated blood transfusion hemolytic jaundice Hemolytic anemia repeated blood transfusion Purpura haemophilia

Hemolytic

heme Protoporphyrin

direct

indirect Liver direct

Liver indirect bilirubin intestine direct bilirubin stercobilinogen stercobilinogen dark stool

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GIT Dr. Shaf3y

Urobilinogen dark urine on standing Hemolytic obstructive jaundice obstructive jaundice extra hepatic intra hepatic

extra hepatic lumen wall Lumen stone

parasite

stricture

wall Cholangiocarcinoma

lymph nodes

Cancer head of pancreas extra hepatic

obstructive jaundice

Intra hepatic Primary biliary cirrhosis Post hepatitis cholestasis Pregnancy induce cholestasis ( contraceptive pills Drugs hepatocellular carcinoma biliary atresia

congenital Dubin-Johnson syndrome Dubin-Johnson obstructive jaundice Congenital

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GIT Dr. Shaf3y

Pigment Liver deposition

Rotor syndrome congenital obstructive jaundice Liver

obstructive jaundice

heme Normal bileverdine Normal Indirect bilirubin normal direct bilirubin Normal Obstruction direct bilirubin urine bile salts direct bilirubin Intestine clay stool urobilinogen stercobilinogen urobilinogen

dark

urine frothy

Urine stercobilinogen

hepatocellular jaundice etiology Hepatitis Cirrhosis

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GIT Dr. Shaf3y

cirrhosis Gilbert syndrome Gilbert syndrome Hepatitis

Gilbert syndrome Indirect bilirubin direct bilirubin Liver Liver indirect Z and Y proteins

Liver

Z and Y proteins indirect bilirubin congenital deficiency Z and Y protein Gilbert Syndrome Familial hyperbilirubinemia

familial hyperbilirubinemia Z and Y proteins 4 3.5

Gilbert syndrome bilirubin indirect bilirubin

direct bilirubin

enzyme glucoronyl transferase indirect bilirubin enzyme

congenitally deficient enzmye Criggler- Najjar Syndrome

type two material glucoronyl transferase

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type one females inhibition

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GIT Dr. Shaf3y

Placenta materials intra uterine jaundice Lucy - Driscoll syndrome

Lucy - Driscoll syndrome glucoronyl transferase inhibitors Female Placenta jaundice Intra uterine

breast milk breast milk jaundice breast milk jaundice

hepatocellular

Hepatocellular hepatocellular cirrhosis Hepatitis Dubin Johonson syndrome Lucy Driscoll syndrome hepatocellular Normal Normal << heme normal << bileverdine normal normal Normal indirect bilirubin Indirect bilirubin Normal Liver Indirect bilirubin

Criggler Najjar syndrome Gilbert

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GIT Dr. Shaf3y

direct bilirubin Liver Liver direct hepatocellular Indirect direct biphasic stercobilinogen variable urobilinogen is variable << urobilinogen

stercobilinogen stercobilinogen urobilinogen hepatocellular Liver disease indirect bilirubin stercobilinogen stool

direct bilirubin

Urobilinogen

intestine

direct bilirubin stercobilinogen

urobilinogen

stercobilinogen Liver

Liver disease
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GIT Dr. Shaf3y

stercobilinogen

Liver Liver

stercobilinogen Urine Urobilinogen

normal urine Liver Liver disease stercobilinogen

Liver entero-hepatic circulation Liver

variable << urobilinogen Liver direct bilirubin

hepatocellular

Gilbert

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GIT Dr. Shaf3y

Liver indirect Z and Y proteins indirect bilirubin Gilbert

Liver

Indirect direct

Criggler Najjar syndrome direct enzyme Indirect hepatocellular

obstructive hepatocellular hemolytic indirect hyperbilirubinemia direct

direct and indirect hyperbilirubinemia

Approach to diagnose a patient presenting by jaundice

obstructive

cause of jaundice jaundice etiology hepatocellular hemolytic

the most common causes are causes the most common causes are hemolytic anemia hemolytic jaundice
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GIT Dr. Shaf3y

approach to diagnose a patient presenting by jaundice causes of jaundice causes of jaundice the most common causes hemolytic anemia hemotlyic jaundice gall bladder stones obstructive jauncdice cirrhosis hepatitis hepatocellular jaundice

cancer head of pancreas

Personal history Personal history age Hemolytic Young gall bladder stone Middle age female forty fertile cancer Old age hepatitis Any age cirrhosis Mild to old age Personal history sex Hemolytic sex G6PD is more common in males

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GIT Dr. Shaf3y

gall bladder stones Females cancer head Males hepatitis Any sex cirrhosis Any sex more common in females << primary bilirary cirrhosis

special habit special habit

Special habit Hemolytic anemia gall bladder stone

Fatty meals Fatty meals fatty meals It is a habit fatty meals fatty meals fatty meals special habits cancer head of pancreas smoking alcohol Hepatitis Drug addiction cirrhosis alcoholic Residence
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gall bladder stones

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GIT Dr. Shaf3y

female, fatty, forty, fertile

residence Occupation hemolytic anemia hemolytic anemia lead poisoning occupation gall bladder stones occupation

occupation

cancer head of pancreas

Hepatitis doctors and nursing Occupation doctors and nurses Homosexual Prostitutes Personal history present history present history Onset, course, duration duration course Onset related symptoms related symptoms Urine Urine stool

stool

Pain and puritis

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urine

stool

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GIT Dr. Shaf3y

other features fever

Personal history present history Present history duration course onset onset Onset hemolytic anemia Acute gall bladder stones Acute cancer head of pancreas Gradual hepatitis Acute cirrhosis Gradual course course course

Hemolytic regressive progressive Hemolytic

Intermittent

course Attacks

gall bladder stones Intermittent bile duct stone Partial obstruction Inflammation inflammation

total << bile duct

total << bile duct

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bile duct

stone

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GIT Dr. Shaf3y

inflammation edema Inflammation bile duct edema obstructive jaundice gall bladder stones jaundice Jaundice jaundice

edema

inflammation edema

stone obstruction inflammation obstruction

Inflammation obstruction cholangitis

Intermittent

attacks

gall bladder stones

cancer head of pancreas Progressive hepatitis Regressive cirrhosis Progressive duration variable << Hemolytic duration short duration << gall bladder stones cancer head short duration <<< cancer head of pancreas cancer head jaundice short duration << Hepatitis stool
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colic

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GIT Dr. Shaf3y

Hemolytic dark << stool Clay colored hemolytic dark on standing << urine

dark frothy

Pain bone pain Hemolytic anemia colicy pain Obstructive jaundice radiating to the back << dull aching pain << epigastric cancer head of pancreas right hypochondrium pain hepatitis Pain cirrhosis Puritis Obstructive Hepatocellular

hemolytic anemia pyrogen stones

fever fever RBCs

cholangitis cancer head of pancreas cancer Pyrogen low grade fever malignant hepatitis fever cirrhosis bacteremia
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GIT Dr. Shaf3y

chills sign Hemolytic anemia features fatty dyspepsia symptoms of metastasis Other features hemolytic anemia gall bladder stones cancer head Hepatitis cirrhosis hepato- renal syndrome

thrombophlebitis migrans

anorexia to cigarette smoke hepatic encephalopathy features of liver cell failure

abdomen examination gall bladder ascites spleen

examination local examination local examination Liver abdomen liver hemolytic Hepatomegaly gall bladder stones

cancer head of pancreas metastasis large

Hepatitis tender enlarged cirrhosis Shrunken spleen hemolytic Splenomegaly gall bladder stone Normal cancer head of pancreas
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GIT Dr. Shaf3y

splenic vein thrombosis spleen cancer head

splenic vein

cancer head of pancreas splenic vein thrombosis Portal hypertension splenomegaly

Hepatitis 20 % just plpable spleen cirrhosis splenomegaly

Portal hypertension

ascites ascites cirrhosis malignant

stones exceptions

cancer

gall bladder cancer Courvoisiers law

features of hemolytic

general examination hemolytic anemia mongloid features gall bladder stones xanthelasma cancer head of pancreas Virchow lymph nodes sign Hepatitis

general examination

cirrhosis features of liver cell failure

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GIT Dr. Shaf3y

Plamar erythema spider navei

investigations

investiations investigations lab hemolytic Indirect obstructive direct hepatocellular Biphasic

enzymes enzymes LDH LDH Hemolytic enzyme

obstructive alkaline phosphatase

hepatocellular SGPT SGOT

lab

stercobilinogen hemolytic

Urobilinogen Hemolytic obstructed variable << hepatocellular

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GIT Dr. Shaf3y

sonar MRCP Investigations PTC ERCP

laparoscopy laparotomy approach to a patient presenting by jaundice

approach to a patient presenting by obstructive jaundice obstructive jaundice

Approach to a patient presenting by obstructive jaundice obstructive jaundice

vomiting

Vomiting
vagus impulses vomiting vomiting CTZ

CTZ Chemoreceptor trigger zone Medulla vomiting centre vomiting CTZ Center afferent efferent

medulla vagus vagus

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GIT Dr. Shaf3y

vagus irritation CTZ impulse CTZ irritation vagus

vomiting

vomiting

peripheral causes

causes of vomiting vagus irritation CTZ irritation central causes

vomiting

vagus

irritation

retropharyngeal abscess

tonsillitis

meningitis glaucoma myocardial infarction Laryngitis pharyngitis Peptic ulcer gastritis pancreatitis cholecystitis salpingio-oophritis vagus stimulation peripheral causes

CTZ

central causes irritation opiate

CTZ

irritation

blurring of vision

Increase intra cranial tension vomiting headache Cerebellar ataxia Vertigo CTZ irritation

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GIT Dr. Shaf3y

CTZ irritation tumor bad sight bad smell

combined combined Kidney Renal failure nausea and vomiting renal failure irritation of CTZ Irritation of vagus kidney

electrolytes hypocalcemia hypokalemia Hyponateremia acid base balance alkalosis acidosis Mixed causes CTZ vagus irritation Kidney causes of vomiting constipation

Constipation
stool colon stool stool defecation defecation inter defecatory period defecation defecation defecation defecation stool

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GIT Dr. Shaf3y

sgmoid colon stool caecum peristalsis wave sigmoid colon rectum sigmoid colon distention stool

straining abdominal muscles contraction anal canal rectum stool anal canal involuntary pelvic floor muscles contraction

involuntary Pelvic floor muscles expulsion

colon

stool waves stool conduction rectum distention sensory phase contraction of abdominal muscles pelvic floor muscles expulsion constipation By definition
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GIT Dr. Shaf3y

constipation defecate constipation Less than usual habit

3 constipation

type of food

system

bowel habit bowel habit

constipation constipation 3
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GIT Dr. Shaf3y

hard stool say hard stool

straining

He has to strain

incomplete evacuation

manual evacation

manual evacuation

enema

enema enema stool softening enema defecation

enema

stool

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GIT Dr. Shaf3y

Mobile

stool

stool

causes of constipation constipation Propulsion perisatalsis Propulsion

propulsion

Propulsion Constipation Propulsion

colon

stool wall

distention distention Impulses impulses pelxus

colon stool colon

afferent vagus vagus efferent Myenteric plexus Auerbach's

impulses

mediators Serotonin
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Mediators

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GIT Dr. Shaf3y

Non adrenergic non cholinergic transmission

plexus

vagus Impulses acetyl choline serotonin plexus Peristalsis

propulsion

peristalsis constipation stool stool fibers in his diet fibers fibers

bulk of stool digestion Lumen bulky stool distention peristalsis

intestine

enough << diet colon

fibers stool distention peristalsis

nerve diabetes Peripheral neuritis autonomic neuropathy plexus Hirschsprung disease

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GIT Dr. Shaf3y

toxic megacolon

scleroderma << muscles scleroderma << peristalsis muscles

Myxedma

Motility mechanical lumen wall

lumen

wall Cancer

Tumor or lymph nodes Propulsion affection affection of propulsion Peristlasis

sensory phase rectum stool rectum distention

inertia

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GIT Dr. Shaf3y

desire of defecation neglect

stool

200

rectum stool 200

rectum

rectum

200 << stool desire neglect

stool 400 rectum

400

distended

rectum

400
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GIT Dr. Shaf3y

400

defecation

defecation

neglection of desire to defecate constipation desire neglection painful anal condition Fissure, piles history of child abuse

constipation mechanism causes Diarrhea

Diarrhea
diarrhea 200 gram stool Lose stool Increase diarrhea

frequency

Mechanism of diarrhea mechanism of diarrhea

white coated organism Works as blood carrier, useless, but extremely harmful when left with a patient alone And he eats resident remanents

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GIT Dr. Shaf3y

diarrhea motility thyrotoxicosis Motility M

inflammation infection G.I.T. inflammation Infection diarrhea

secretory S secretory diarrhea pancreatic cholera intestinal secretions toxins tumor Intestinal secretion osmotic O Osmotic diarrhea lactose intolerance

lactulose

Osmotic diarrhea fasting

Osmotic diarrhea Osmotic diarrheal drugs lactose diarrhea causes of chronic diarrhea causes of acute diarrhea

infection

causes of acute diarrhea acute diarrhea infection acute diarrhea Shigella Salmonella rota virus echo virus Giardiasis Parasite Infection

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GIT Dr. Shaf3y

Poisoning Arsenic poisoning

lead poisoning

acute diarrhea spicy food

intestinal ischemia diarrhea

acute diarrhea chronic diarrhea Intestinal causes Small intestinal causes causes of malabsorption chronic diarrhea small intestinal causes colon dysentery

malabsorption

chronic diarrhea colon dysentery

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GIT Dr. Shaf3y

small intestine malabsorption endocrinal thyrotoxicosis diarrhea

diabetes

pancreatic cholera

diarrhea

vitamin deficiency pellagra sub acute combined degeneration acute diarrhea chronic dyspepsia

Dyspepsia
dyspepsia

definition is G.I.T. comfortable related to meals << dyspepsia

heart burn

nausea Pain dyspepsia non specific

dyspepsia Pancreatic causes Pain pancreatitis gastric causes biliary causes esophageal causes duodenal causes dyspepsia dyspepsia
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GIT Dr. Shaf3y

non ulcerative dyspepsia functional high emotions stress

G.I.T.

dyspepsia etiology etiology

warning symptoms of dyspepsia what are the red flags of dyspepsia red flags

dyspepsia dyspepsia old age Persistent vomiting absolute constipation loss of body weight dyspepsia hemorrhage

dyspepsia

cancer red flags of dyspepsia Investigations Upper and lower endoscopy Barium sawllow manometry

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GIT Dr. Shaf3y

dyspepsia treatment Underlying cause

functional dyspepsia cause reassurance anxiety perimperan functional dyspepsia 60 %

metoclopramide

20 % Serotonin reuptake inhibitors 20 % dyspepsia

medical causes of acute abdomen

G.I.T.

2013

26

www.facebook.com/dr.tafreegh
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