::IN THE NAME OF ALLAH,THE MOST GRACIOUS THE MOST MERCIFUL::

::This is Our Great Honor to Put All we Know in Reviewing Internal Medicine In A very Easy Way To Simplify This Large and Broad science in Medicine By An Up-to-date Illustration:: This Effort are collections of All juices of Most and Highly Active Members Minds and Also their Hard Times spent in Understanding it to Reach to You By This Way.. We Hope To make this large and First Work Only To Allah and we neither waiting for praise nor Price. Just For Our Little Time In Live..And The Best Thing You Can Ever Get From Life is The Du3a2 From Your Brother and Sister In God and You didnt see or listen to him /her when She/he Was Praying

::This Effort is done by Tanta Doctors Group Members:: And All Right Reserved No Problem in Publishing this Document to any Forum or Site But Without any Returning Benefit. And Please Keep Our Privacy On as Regard The Names and The Group. Just all We need Tanta Doctors Group The Exorcist MiDo Dr.ShaboMania
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Tanta Doctors Group Production

First Branch: Gastroenterology Golden Notes Peptic Ulcer Clinical Picture Symptoms and signs Symptoms Pain+ vomiting + appetite + Chronicity Signs May be absent or May be localized Tenderness over the site of the ulcer. Just According to pain Character +site+ relation to meals+ relief of pain Character- pointing pain burning sensation ,stabbing or dull aching pain Relation To meals Duodenal ulcer 3 hyperacidity Which Increase During Fasting Because the HCL will be undiluted Hcl Diluted
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 Hunger sensation Weight Gain Gastric Ulcer Trauma DU loss of Weight Vomiting Complications:: 3P+One for DU+ One For GU Bleeding+ perforation + penetration+ For DU- Pyloric Obstruction For GUGastric Carcinoma Notes On Investigations:: Barium meal:: Endoscopy DU-Never malignant GU If malignant, it is malignant from the start.

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Bloody Diarrhea::

Amobic Colitis Bacillary Ulcerative Mesenteric artery occlusion Pseudo membranous colitis Although In Chronic Pancreatitis the ONLY Serum finding is Elevated Serum Amylase. There are a lot of rules to take it Firstly It Must Be markedly elevated 5 folds or more >1000 after 3-5 days This means that it is not specific It may also be elevated in perforated peptic ulcer Mesenteric vein occlusion So what is the specific for Pancreatitis? It is Lipase It is more specific

Hepatology Palmer erythema Does it specific for LCF

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No It is also present in

Pegnancy , Thyrotoxicosis and RA Keep This Scheme in Mind Clinical Picture Of Hepatic Come .:: Taking Him Very S P E A D to Irritable Come::. S:Slurred Speech P:Personality Changes E:Emotional and Intellectual Deterioration A:Ataxic Gate D:Disturbed Consciousness. On His Way To Irritable coma He will see HHFF Hypertonia and Hyperreflexia + Fetor Hepaticas and Flapping Tremors Then To Irritable come. So What are the irritable coma?? Hypoglycemic coma and Hepatic Coma Highly irritable Stages:: Stage 1
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Stage 2 Stage 3 semicomatosed

::Liver Function Tests:: Albumin Acute or Chronic Acute - Normal Level Chronic Markedly Decreased Markedly decreased A/G ratio 1---------------------------- Globulin Immunoglobulin

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Acute

 Chronic May be mildly Increased Mildly Increase 2------------------------------------------- A/G Ratio Albumin to Globulin ration Normal is 2/1 In Acute Chronic 2 & 1 Reversed Bilirubin

Test More specific

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SGPT

OR AlT Which one is more specific AST OR ALT? The answer as vide supra If the Question which test is more specific in LCF? The answer must be as follows WE have 2 tests must be done simultaneously First ALK phosphatase Normal is 3-13 KAU( King Armstrong Unit) With more elevation >30 in Obstructive Jaundice But This is not specific because it is also elevated in Bone Diseases so We must do the 2nd Test Serum 5 neucleotidase This is For DD from Bone or Liver Disease It is elevated only in liver disease

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Hepatitis Markers

If the problem come to us and suggest Viral Infection First of all ,We should remember these Golden Notes Causes of Liver Cell Failure = Causes of Liver Cirrhosis= Causes of Viral Hepatitis = Prolonged Obstructive Jaundice Causes of Hepatocellular jaundice = Hepatology All Imagine-------> Yes 1-Causes of Acute LCF 2-Causes of Chronic LCF 3-hereditary as Familial non hemolytic hyperbilirubinemia as Gilbert's and Crigler-Najjar Gilberts in sum Problem in Uptake so indirect Bilirubin increase so can't we put it in DD Of hemolytic anemia? Yes why not Let Your mind thinks

What does Chronic Hepatitis mean??? 1-Viral hepatitis 2-Autoimmune 3-Chronic alcoholic What are the causes of Chronic hepatitis?? = the same as liver cirrhosis

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So it is a must to Understand the Hepatitis Markers coz it is our key to understand and put the provisional diagnosis lemme put the abstract of this Here First of All we have to know initially we have Viruses A,B,C,D,E markers of A ,E,D are the same Ig M ----------->for recent infections Ig G ------------>For old infections so wut about D?? also the same as A and E but as we know the patient must have B virus to have D virus as it is superadded so In hepatitis D ---->Hepatitis Marker for B will be positive

Hepatitis C:: 2 Words PCR + antibody against C but it may be falsely increase and the patient is almost free of it that is what we called Autimmune Hepatitis Hepatitis B da ba2'a Nela Begad bas momken neshofoh ma3 ba3d be el 6aryka dy First we have SEC S: SURFACE E:ENVELOPE C:CORE and For Each one we have Ag and Ab just assuming

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so we have HBS Ag and HBS Ab Hepatitis B surafe antigen and Hepatitis B surface Antibody

HBS Ag appear in serum after one and half month and disappear after 3 month and diaapear after 6 month But If we found it in serum After 6 month This Indicate Chronicity

Ya3ny men el a5er dah test awel 7aga beyet3emel 3alashan a3raf eza kan fe infection or not besarf el nazar eza kanet el infection dey acute or chronic HBS Ab :: appear after 3 month and persist for life ya3ny law la2'ytoh +ve da ma3nah 7aga men three 1-Acute 2-Chronic 3-wa7ed wa5ed Vaccine

2ndly HBE Hepatitis B Envelope 2'olna en 3andena leh Ag and Ab

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bas Ag howa el bene3meloh practically SO as a rule E------------->Envelope indicate Replication

Tertiary:: HBC Hepatitis B Core 2'olna en 3andena leh Ag and Ab bas Ab howa el bene3meloh practically why?? coz HBC Ag core el awal ya3ny da5el el hepatocytes ya3ny me7tag Biopsy 3alshan a3meloh so it is inpractically but present as HBE Ab present also but inpractically So As A rule C----------->Core ya3ny inside liver ya3ney law la3yetoh dah ma3nah fe 5alaya betetkasar gamed we 7asab no3 el Antibody ba2'dar a7ded Type of Infection IgM------------> RECENT Ig G------------> Old we fi el a5er PCR = DNA Is the most sensitive

Some Questions:: e7na kona 8olna en HBs Ag appear after 1 and half month and disappear after 3 month ya3ny feh wa9t beyezhar gradullay we ba3den beya5tafy 3and 3 month

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we kona 8olna bardoh en HBs Ab appear after 3 month Ya3ny Beyzhar fi el wa8t elly Beya5tafy feh El HBs Ag so Momken wa7ed yegy 3andoh Hepatitis B we 3ameloh investigations we Yetla3 - ve 5o9o9a (specailly) en awel test howa dah elly bene3meloh tayeb dah momken yekon eh?? El Fatra dy named Window Gap elly Beya5tafy feha el Ag We Beyzhar feha el Ab so the patient came in Window gap

Kona 9olna en ay test mesh hayfarak eza kan el patient 3andoh infection or wa5ed Vaccine so wut the solution???? 3ameloh HBC Ab to Ig G WHY??? ZAY ma8olna en Core means inside liver ya3ney lazem 2al8eh fe el patinet el 3ando hepatitis ama elly wa5ed vaccine ana mesh badeyloh el VIRUS ana badeloh El Surafce Beta3oh we betally haykawen IgG against surface only

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inspite of limiting of time It is a must to do this now Becoz it is the only Method to understand this important

Topic .::Waiting For The Rest ISA::. Best Regards The Exorcist MiDo

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