General Pathology and Gastrointestinal Pathology DIMS NOTES BY: DR.AMEER HAMZA DOCTOR BOOK SHOP (Opp. Sheikh Zayed Hospital Gate # 6 (U.H'S) Near By DIMS Academy Lahore 1300-9480694, 0321-1011294 (AIAffidevits Available for PMDC Step IGIT PATHOLOGY INDEX Liver cirrhosis 32 Wilson disease Hepatic insufficiency 35 | Haemochromatosis Porto systemic shunt 37 | Autoimmune hepatitis Hepatic encephalopathy 40 PCB Jaundice 41 | Primary sclerosing cholangitis eo] of sf ap wle Metabolism of bilirubin 43 | Bud Chiari syndrome 11 | Grey baby syndrome 44 | D/D of UGIT bleed 12 | interpretation of LFT’s 7 Peptic ulcer 15 | Stages of acute hepatitis 49 | Dyspepsia 17 (| HBV 50 | Malabsorption 22 | HCV 54 | Celiac sprue | 24 [HDV, HGV js5 |1BD ] 25 [AL 57 | Crohn’s disease 28 | Alcoholic hepatitis 60 | Ulcerative colitis 29° | Alcoholic cirrhosis DOCTOR BOOK SHOP Opp. Shaikh Zayed Hospital Gate # 6 (U.H.S) Near By DIMS Academy Lahore 0300-9480694 , 0321-1011294 (AIL Affidavits Available For PMDC Step 1, I Il) DIMS NOTES BY: DR. AMEER HAMZA AMEER Published by dr-notes.com2 | liver cisshosis Posto Systemin shunt Hepotic encephatopathy Jaundice Metabolism d Bilirubin wilson Disease ala alsles sel L [ssa [sisis|2[ Any Long standing lives Injusy Inflamm otion ku Phies 4 ITo cell into zoblast | Bibsosts_“ _, space of Disse clr Stigmota 4 CLD Hepatic Insufficiency Postal HTN (i) Jaundice 2(Lack df 0) Acites metabelic 4 Bilisubi n) Factos @) Spides Navi Ye Civ) Palmas ergthema Both tot the Level estsogen ,due tots metabolism. Oestoogen is an Angiogenic Hormone. () Gyanecomast ta Wi) Teshewex ateephy Wii) Ascites. (i) Bleeding Lack 4 chthing ii) Hepatic encephalopathy (8) GIT Bleeding UGIT—» Oesophageal Vesices LOGIT - Haemorrhoids wi) Spleenomegaty ©) Hyper spleanisrr poncytopenia+ spleeno megan + Nosmal Maxsow @Ix cizshosis Shtunken coaase (Nodulay) Echotex tuse USG abd ‘ Dilated postal vein Asates , Spleenomegaly Additional CBc ,LFT's pr/APTT Lx , cause. [Asates] ++ Accumutat tone albnoxmal Grrouct o Fiuid in pesitoneal space. Pathogenesis Q) Hepatic InsuPficieny Cv oncoke paassuse) Lacks of psotein synthesis. T Lovet aldostesone Lack oh its mefabotism Diug os choice Fox Ascites in CLD Pt, is ~» Spisonolact one (i) postal HTN (Ct Hydsostedic pressure) (s.A-A-G) + Sesum Ascites Abumin gaadiert . Sesom albumin. |.) suggestive 4 Ascites albumin Taansudec 2. Ascites postal HTN Cu) 4) Published by dr-notes.comPosto Systemic shunt Posto cewal Postal venous| |S a venous system Systemic. venous Sustem wrich stast at system = Venules % which ends at venules,, Postal vein ive Lange vein ; Z [5 emit Superios Common iliac Vein Large vein mesenteric} WA vein = —— intesnel iWac infesios mesenteric vein small vein | ‘ xaereln_! vein (small vei middie | infecical R 1 ver [fecal vein Lasgest vein. x Superiow Giiddte and Infestos + _ Rectak Rectal Plexus a Postal Venous Pents 4 venules Csmatie st vein) Sustem Psain ‘smallest vei * inte intestine Grmeitest veins) SV. Deains all and Desivative. extsa intestinal system abdomen, * That's why all GIT Matignandes 1st metastasise to Lives, #all extva intestinal mali gnandes ist Metastasise to Wags. (5Note] :- Ancthes poztal venous system is peesert at hypothalamic pituitary at 6 sites Posto -caval Shunts anes, « 3 sites which aze clinically Impostont ,, ty _Ledft_gasteic Lower eosephageat A2YMS gv. vein vein( postal) mucosa systemin (Oesophageal Vanices) 4) Pes: umbilical Epigastsicuein TT vein (postal) ambit ea (systemic) Ny “> — caput Medussae i) _S. Redal vin mise nf (Postal) Mucosa | Rectal vein syst eric) Hemosrhoide DOCTOR BOOK SHOP a inet ‘Opp. Shaikh Zayed Hospital Gate # 6 Dilated veins in sectal mucosa (U.H.S) Near By DIMS Academy Lahore 2 - osoo.sesocsssosziroliaye, «IE IS one 4 the manifestation (AW Afidaits Avaliable For PHIDC Step 1) 4% portak HTN 3 clinically Non impoatent poste caval Shuats ase present azound (4) kidney s 6) @) Base asea @ Uver @) Flexurez 4 Colon Published by dr-notes.com2 tlepabie Encephalo am L& Asoc Due fo lives Faiuse Etiopathogenesis 7 level 4 Nitsag enous sub stances in Bosain Uke (i) Nit rates Ca) Nitei GD aueutes \ esrtor] Gy Hepatic insuPFiciency lives ig unable to Destroy Nitzogenous Substance | Postal HTN | These nitsogenous substance by pass Lives , Hhaough open posto cauak Shunt 4 Reach Brain Diseckly. Tsiggeas T Protein inteke , GIT Bleeding , Constipational’, elect solute Imbalance ,Naxcotics Sedation , infections Suagesy Redosis. C/E GRADE +I i DOCTOR BOOK SHOP Confusion Opp. Shaikh Zayed Hospital Gate#6 * I Dsowsiness (U.H.S) Near By DIMS Academy Lahore a Is or 0300-9480694 , 0321-1011294 CAIL Affidavits Available For PMDC Step 1.11.11) * 1 ComMA G 2 > = m m alLOlE | (i) Fetes hepaticus _ C smeu 4 alcohol) (i) Flapping Tsemess. S/ Ns Levet Jaonnice RS Ginical_ Sign. te : Yellowish Discolasation skin Sclesa When Sesum total bilisubin Level. exceed mose than > 2mg/dl ox 750 mmol ft Normal *STB upto 12 mg {dt #1T mmol [LE a STB|= sesum total Bib cam Bil subin|—> By product 4 Heme metabolism. DOCTOR BOOK SHOP Opp. Shaikh Zayed Hospital Gate # 6 (U.H.S) Near By DIMS Academy Lahore 0300-9480694 , 0321-101 1294 (Al AfidaitsAvalable For PMDC Step I, I!) Published by dr-notes.comAftes Reaching GIT (3 Facts) G) 7S. stools Cstewce bitin) | absoabed into Blood eiscutation (postal Vein) Ly 207. again reabsoxped in enteohepotic circulation @a25% Ss]. Remove via kidney 4 ufe any * Jaundice on tsk D @ 24 */. metabolism 4 Heme (vie coagugaton) Poectuct. (tives) Lis a - Gt -rok Jucosenylel Tran sferase IL Infective 25y ths op albumin is caster S [> For insowble aA ALBeeaiN, Bil sudin 24 (cassies) gu Poxphy sin Fe** ay os y Can stable) Added to ison & 3 (Insowble) J contents x Bilivesdin 34 | Bitivesdlin Reductase enzyme 2s————__—ts— Etrologies rr rees ee 4 peoduction v excretion | Post hepabic Bile Duete obstruction impaled] 7 gaill stone 2Ae. Bact. cholengitis > Paimasy Release seterosing > Ca gall neongental] — Biadder ‘? eholengio CA 2) Thalassemia * Sickle cell anemia * GOPD be. Anaemia * Exyhsoblasto sis v uptake Impaise d 3) Congenital gilbest syndsome Dublin LilMalignany 4 Bileduct Fetatis Criglas najos cant it Lyleading cause at get inte | syndrome. Thomsen YN cod head 4 pancrease in New “bean cant.coqugate | “RIPE SYN LN entonged Babies Deugs ii) Aequised Lipesta hepatis. Dsugs wv Bileduct Uepakitis contsactt on Antimalasial » chtesomphenicol viene >Flusidie Acid, stezoids ic SED Aa Metabolic ¥C 0- Amoxiclave 7OcP paepenense boos chospa Bazine APS0NE J Sud) urea, T Physstgicad | Deugs] 7 Swtpnengt These doug cause % Jaundice | Psocitamol hemouy sis in G Isoniazid ,kefampasin, pyeazinemide G These is cestain Halothane, vatp soie acid,[ statins. | sep Deh. Protein in milk thal Qa GT Flucoluyariuine, pitayesitis 1 (4 conjugated Hyper bitigubinemia.) Hepatitis Published by dr-notes.comlf psegnant Female give chlosamphenteol its csosses placenta and fts issewes sibuy inhibit Baby a: GT & Baby within Y8 hes. It isa genetic pdefects MOI-» autosomal secessive. His characterise by partial Deficiency 4 entay channel Fox insoluble — Bilixubin in al yeas old male is having off {on Hepatocytes. Jaundice since Bisth .LFT Reveal mile Ly Ralsed unconjugated Bilisubiny, aay genetic Defect autosomal sessesive absolute Deficiency 4 ad gtnco tony Txansferase * They Die € in 2 yeas. OT syndvome | Autosomal Re cessive genetic Defect congenital absence 4 exit channels. Fos solble bileubin 4 hepatocytes, te again o postal Defects. Physfolegical Jaundice la: GT takes 4 week to mature os wosk after birth, in term Baby § 2 week in paeterm babies P.T alusays appear (i on second Day 4 Ufe, End by 7 Days in Team and 14 Days in preteym Babies.CTawndice) Clinical Appsoach Pre- hepatic | Hepasic Post - hepatic Hemo ty tre Hepatitis Bile duct Anaemia Jaundice Obst suctions. Taundi Pain RUC Taundice + Pru sitis aundirce + Nausea ti . Anaemia | venta. Deposition 4Bite J Salts in Skin Anorexiq + Feves Malaise Clay cotoused Stool Due tolack ofe 4 Bisubin 7 + Tendes Xanthomas Hepato megaly Skin macsophages Filled & cholestevol. Intespsetation 4 LFTs LET'S — | Pee-hepake epee Post — pepe Bile duct obstruction | 4) 8.78 At ttt | TTT Lyconj +t + | tt Lunconj <— t << Specific tf ; | ALT - 197 ast eact | AlLaninine /Aspentate Ate TH) a 2y! Teancominate .iyco i) a ST 7 Alconotic pepe Ie | Clo-4o) | | eM eparitis [hepatocyte o/miid D i) Alkaline <> |e erT (itd) t11Ttt phosphat ase. Becor to upto ISO -10 intsa ibis enzyme Hepake Bivaey Billa Channel chomea 12) Published by dr-notes.comAST comes In alcoholic hepatitis additional Fsom alcoholic casdiomayopathy A- GAT is synthesized ox made By hepatocytes 7 4 Release in Bile +» Alcohel ,Feny tain 4 its product Lon # only saised unconjugated Bilisubin in LET'S is a maskex 4 Hemoty ais as it Suggest pee hepatic Jaundice. #e hapatitis Trese is Mixed Gilisubinemea | Additional LFT'S Poe . Post ¥ at hepatic Hepatic Hepatic O- glutanyl o " mrons —_— If T palcohotic tt Fanstesase Hepatitie PT(ias) | <2» t T vit -k Time Def. APTT (335) Time 7 T [3/Atbumin | BS-4Sg ue | <> L —_ Q> which & Following LET caxsing prognostic values. key» PT Cit is Ast Test To Deassanged) ofter Liver Injus: secovesy. ‘d 4 clotting Fades fs 7-72 hes chostest Ufe 4& ufe 4 Thesis 4 Facto « 7. (13Features HAV HBV ucv HDV HEV HGV Agents RNA DNA RNA RNA RNA RNA Family | Picosna Hepadna Flavi Defective Hepe Flavi Blood Bosne | BloodBarne Blood Bosne M.0.T | Feco-oxal Transmit stl stl Feco- oval parenteral Verticat | Vertical Vestical oad Boane Incubation - Pesiod IS-US Days | [-6manths | 6-7weexs | Ro- 4o Days Indefinite oo , Aute Ac. Hepatitis C nm eel enctte [Mpentic® lthachewe | Spots’ | Acute petaaces” Disease | Hepattis EL AePHE che. Hee/ infect Hay | Hepatitis Significant Hee/ lives Cis,| Lives Céschosis Uvex Injury 41. secoves TT Ae. FHE NON out come Tae FHE geaph Pregnant, 307 pseq. Lx | Sesotogy Seaceni ret Anti-Hbv | Gesology) Anti HAV Anh -Hev Ab. Ab . IgM eve Ix 4 choice Ant HEV Iym (Active Anti) PCR-HEV-RNA Active Hav Ig Gwe If visal Load T Ant HEV Ig Gave > Quan tative R exe Recovery) Couentiatve © Recovery) PER » check serotype (6) Rx Supposhive Suppostive. 4) Published by dr-notes.comStages of Acute hepatitis Incubation | Asy mpto matic pesiod | mid ,ALT'S AST TTT Poe- Feves matise Anoseaia IN aulse.c.,vomitting Ictesic stage ofE hepatomegaly Tendew tctesic Jaundice sets in Stage | + Prusitis Clay colos stool, xanthoma Convalscence Recoveay Takes 8-4 weeks Sh. Acute Fulminant hepatic Failuse 2 Is Defined as Devetopment of hepatic encephalopathy Postel HTN <& weeks of onset 4 any Type 4 Lives Injusy (Tx ts only ver Transplant ) 191; Tecovery ? Because Liver has Remarkable degenerative abiuity Causes of Jaundice in psegnan 4) HEV 2) cholestatic Taundice A pregnancy Reason > psogesteton slow Down Bile duct contoaction 3») Acute Fatty Lives oh psegnan 4) Hemotysis, Elevated LFT'S Low Platelets as HELLPNote:-] Vaccine is a Substance made From Pathogens hauing Anti gene city But Do net have pathogenecity, Tseatment HAV Suppoatve Ww fluids , Anti emetics Suppostive sIf pregnant (FHF) > Induced abostion | TOP Active Immuni 2ation Post exposure Passive Psophy Laxis Inj - HAV vaccine Immunization Active tame xIM ‘Tmmuini 20ki0N [Indication T HAW vaccine Inj. HOV -1G ——_ I-o yeass 0-02 ml/kg 2) Food hondles \ xh, xonce 2) Sewesage workers [HndieaFon | 3) Teawelless ~ hepadna MoT] + Blood Boone , STI, vestical 1 P J 30- 80 Days. outcome HBV Infections Acute hepatitis Acute hepatitis 70-80"). 20-30% Subclinical clinica Aftes 6 months sut0'. S-107. 80-407. cassiet Chaonic pessi stant Hepatitis Recov eny | Active Hepatitis Lives ae i Cischosis ‘duo Recovery HBV Da Visal Markes 4h AMEER — envelop beak CE) Protein coat He Std Hbshy fustratia Antigen, susface ¢ Ag HbeAg, (a coveCh. H Foiuse to genes ate Ant bodies against Suaface 4 E Ankgen Beyond 6 months. Ik is pessistence 4 Sus ace § @ Antigen Beyond 6 menths is known as Hepatitis B Nlosphotogical Types CAH Mass Inf lammation Hepatocytes neceosis oAschitectuse Distroyed cPH Mild Inflammation Mild hepatocyte necsosis Aochitectuse wel} paesesved (Acute Hepatitis B) DOCTOR BOOK SHOP Opp. Shaikh Zayed Hospital Gate # 6 (U.H.S) Near By DIMS Academy Lahore 0300-9480694 , 0321-101 1294 CAI Affidavits Avallable For PMDC Step I, I Il) Published by dr-notes.comb dst vizal maskes to oppear. HbsAq | significance] Active infective (uev) Second Viral Masker bo eppear | _Hbeag Significance] Active vigal Replicatton Hbchg Neves appear in Blood cisculation Anti Hbc | 3rd visal Mazker to oppeas/ 4st Antibodies | Antibedy te appeas in cizetlation Anti Hbs | -—-—Becovery Antibody | L=arhen’) psevious Infection Anti He Soar Diminished aroon, |(SeRece] Rimes * Hep B Vaccine only contain susface Antigen IE Do not hawe pathegene sis. —_al what is window pextod ? o Itisa pestod during Fecovesy in which all Visel maskers axe negative except For Anti Hepatitis B coze Antibody Ibs cola] tieng [mnues|iseas | Sil PL [ae Acute _ _ —_— | hep 8 + + + | Revery |} = | &) om | bl + Ch. Hep - -_ _ fel + + + Cartier | -|;~-\+ - + 4 Zamuni —_-|— — _— zation | | +Scseening Test LbsAq IF 4ve Check vical Maxkes PER Rx Acute hep B Po not treat Ch. hep B Antvisals Carzies Tx it e° Antvivels [Rx] Nudeotide Nudeoside (Analogue oval) ast Une entacavis [serocomersion -20 7, 0-8 -4mg [day Recovery (48 weeks) Bo7/. 4 Susvival (v viral Load) > Inj, Pegylated Intesfeson 2nd Une » Teno Fovis & Adenovis * Lameuvdine 0) Published by dr-notes.comHBV PRO PHYLA XIS Active Immunization, Post exposuse prophylaxis i) Aftex Bisth. Tny HBV vaccine 0.5 mi x Im qat 6% 10" 14 weexs ¥) Non Immunized adult check. Hbshg If-ve Proceed HBV Vaccine 10-26 ugm KIM (schedule) O,4 4 6 months Ost § 12 months {2 months 0, 7,Al Days then (Aftes Immunization) check HbsAg itis vesy effective Vaccine give high Titoe 4 Ant HbsAg For >2 Decades while working Cotleages get needle pric From HAV-4ve pt. > This will get post exposuse HBV @ Wash Damage asea Fos S minutes IQ check Ag Ubs Ag If -ve proceed. D check Hbsag @ Active + passive Immunization HBV Vaccine + Inj HBV-1G OTA Day 40.06 milk (2 mooths Vv once, 72 Has. ® Recheck Ubs Ag at $4 Id weeks. (21Paegnan BY (No antivisal) > ony monitor LETS Mode A child Bisth 3 (c Section) Ly Last Layer of utewus should be Dissected, Buunt Ly. &f > Aftes Bisth in Baby Should Recieive RNA (Active 5 passive Lmmuni zation) = Flavi ~> Blood Bosne vertical, STI 6-7 weeks HCV Visus ALT 22) Anti Hey Antibodies ave protective in onuy 20-30% eases. Published by dr-notes.comAcute hep Treat with only Anti Viral ch. hep? Rx] Antivisal. Cuid line qs 7, cuse Rate Antivisa Ci) Sofos Bwix x4oomg xdaily WU) Daclatasvix x Som gx days, (wn) L (Nor. witb) Type L Type I, lv i Common in usa , eusope Pakistan Rx} 6-12 months Dusation 3-6 months NON -aleohol'c steoto hepatitis OM , obe sty >t Upids >Pregnaney sLactic addosis (7 Ed >| =| mi ml aAlcoholic 4 abticl & PAcetaldenyde > Bind e7 Native psoteins § altezed them - Formation 4 new Antigen. Immune Response. 28 Acetaldehyde} — metabolism in mitochondsig Impaiss ~cellulae Respisation (Free Radicals) ~jt has ability to Damage cell stauetuse (em) 4 QAreohal | Distsupt cellulas Tran spost acetaldehyde Sy stem By entering in Micgo tubules SB Alcohol Metabolism in Down Regulate (eos) cestain Dsug he paracetamel excessive Toxic level Despite Thesapeutic Dose. 28) Published by dr-notes.comAlcoholic Cirshosis Long standing alcoholic hepatitis Conversion % ITO} kuffer cells into Fibsoblast —-» Fibsosis C/F | Alcoholic Alcohovic Fatty lives Hepatitis Ciszho sis Asymptomatic Jaundice Postal HTN [o/e] Nausea,vomit hepatic hepatomegaly Anorenia Insuffici enay Fevex OLE Hallmosk Mataise oe Dupyteser's Tendex contscctuse Hepato megaty Fibsosis i almas Ix Fatty lives | P' Fascia Sezeening TesT Alcoholic Uver Moy ttt Hepatitis cise hosis Y- aT 117 LET's UusG Deasranged | Sh sunken - Coarse LFTs Nosmal AST: ALT ver 2: Ascites 4SG Abd paTetr spleeno meg: Fatty lives ~ Dilated Postal vein C4e € leading cause 4s Confusion warld wide is hypoglycemia in non alcoholic & wesnicke's encephalopathy in alcoholic Tat is why 4st Une Lx For confusion in non alcoheucs Should be Blood Sugay Uvet | Tx should be Dext Sose water,, Effects] | othes System Confuston ,abaxia, opthalmeplagia weanick's encephalopathy —> Oue to Thiamine Deficiency] (vit B) in alcoholic Fos confuscon alway dct give Yiamine and lhen Dextsose water If Dextsose water given 41st Wwernicke's be L_ in encephalopathy Result will kossakoff Syndzome| Itis sesult A mi Management dy wesnicke's syndsome. kroosakoff dsome [Featuees] > Shoat Jezm memory lose. + confabulation 29 Published by dr-notes.comD-c-mM.P Assythmias , Hhsombo embolisms SC-.D ,T BP, Athezosclesosis. CVS GIT] Aeid peptic Disease GIT Malignancy Ac. panceeatitrs Blood circulation] T MCV, Bone Masrow Suppsession Sidyoblastic anaemia, Psegnancy Featal alcohol Syndrome, micsoencephaly , 4 I.@ absent Filtsum, oblique pelpebral Fissure ,Low set eas, Rx Psychotherapy (geoup therapy) Osugs iste] Acampsosate v Craving 2nd_Uine] Disulfisam © acetaldenyde Denydsogenase enzyme. t Ace taldehyde —» Induce Nausea/ Vomitting DOCTOR BOOK SHOP Opp. shah Zayed Hospital Gate #6 Dysy (31 (U.H.S) Near By DIMS Academy Lahore 0300-9480694 , 0321-101 1294 CAT Affidavits Available For PMC Step I, II)| WILSON's DISEASE | [Lis an Inhesited genetic Disosdex chasactes- tized by coppes Deposition in Uvex Brain and eye. Fact s Ccoppes Total body coppern 2 &ma Daity copper Intake 3mg/day. 50/ absovbed , Cpoatel cscatation) copper ta. glo bulin 2 in hepatocyte = a5 1 Total Body coppes. cesuloplasmin v Added in systemic ci sculakion Function|+- unknown * (Free Copper de not stay in Blood \ Chrautation Note] :- paskin sonism can be primasy ond Second ary } [Primary ]—> iddopathetic = Known as Parkinson Disease, Degenesative Disease Secondasy —» When there is underly ing Disease 32) Published by dr-notes.comVia hepatic Artexy —» cesuloplasmin - Retusn to Lives in hepatocyte, ceruloplasmin is Bésoken into Coppes and A. globutin 4 than copper i's Release. | Biliaay exczetion Etiology genetic Defect ~ ch.No 13 - autosomal] Recessive . pes Txansposting ATpase This enzyme is Responsible to selease Faee Coppes Fsom hepatocytes into Biliary channel. lives Brain Eyes ! ent f yeas — | Basel gangtion | Dace e gane Acute Late Teens 4 cosnea Hepakitis Paskinsonism holden» Yetlous chroni Ri Hepatitis Ly Secondasy “a Rest Kayser Fletschet cirshosis/ | Taemes Rigidity |] Rin (Hellmask) Hee and Bradykinesia | suit Lamp examMemoay Lose, Psychiatey | personauty changes oHematly sis, asthyitis, WY P.T.H , Blue Nails. Menstrual (sxegulavities / Abortion Parkinsonism in young Age is = wilson Disease. Lx] 3(coppex X Ove es osy $/ cesuloplasmin Xx <> orb Suggestive Luis synthetic Function 4 Lives. [24 houss usinasy Coppes excretion > loougm/day| Noemaly <40 gm /day, Ix & choice genetic Analysis. [ Aa Rx Osug -»[Penicillamine] (chetation) Daily Soo mg [6-8 holy unkhl 24he Usinaxsy coppes Ex —Noxmol C4 s/E 4 Penseillamine} $.L-€ Once Coppers exam 's nosmol in usine then start using zine life Leng. 34) Published by dr-notes.comPea Bo Haemoch somato sis Defect 4, t Intestinal absozpt ton 4 Laon. It is an ion ovesload candition which is choractersized by Deposition 4 Resulting in multi -oxgan DysFunction ee ft Types > Peimasy Secondasy [Here di teay | Repeated Blood genetic Defects —» Ch Noo Teansfuston f5€ MOL ,Autosomal Resse sive * Talassemta Defect * Sickles “ * lyukemia. Responsible to encode Igon segulating protein ciaculation Hepeidin ony 10‘/. Ingested [son is absorbed in Blood Qs,(y @) 40 yeass Male (HH) Female which having hcan Live Asymptomatic ufe. (Hit) > Hereditosy Haemo cheomat osis Pituitesy atsophy Ch sonic Tenning 4 skin Hepedlitis Dc.MP cto Hee. Buonze DM Testhcutay atsophy | ___» asthsitis ostea asthsitis 39 ys old has peesented em change Complexion % Taundice tn Skin on examination he has Multple Spides Neval Ascites § swollen Tendes ft knee Joint. 43 yea old poesented 7 progsessive Dyspnea osthopnea T rvP 4 atop Rhythm exam Reveals testculas atsophy 5 swoKen Tendex Rt knee Toints. By) 47 y male psesented e- weight gain Despite poos Apitite | Cold Intolezance Jaundice 36) Multiple spider Nevais Ascites and Aallep Rhythm his Blood Sugax (wel are Derainged. Published by dr-notes.com[1x] Leon studies > 8[loon 11 >3/ Ferratin tT >T.ILBC be genetic (Hold standasd) Analysis 4 ®) we Poimasy (H-H)} venesection | unti pt. become oon Deficient os (s/ Feasatin < 50 ugm|t) -> they every 2-3 months Cufe Leng) « ” @) | chelation | Despexoxamine [aut inmune Hepatitis B Ikis an Immune mediated Ditosdes , It is chasacte size by hepatocyte Necso sis Degeneration leading to Eventually cisshosis, Etiology autoimmune HLA, Bg ,DR3,DRyPatho genesis cle 20-4o yeass ,F 2M 3: Pse ~existing autoimmune) Qsaves Addison je. Disease Qjiogsen Syndsome Asymptomatic 347. Symptomatic | Acne, Hissutism stsca (cutaneous) Type I usr QO. chronic Spider Navi Hepato megauy Supexaded veal Rmenosshea Infection presentation 08 hepatotoxic Drug intake (Extea hepatic Faituse) * asthaitis * Nephaitis * Skin esruption *# 2MEN Multple endocsine Neoplasm NYS PGSTE > Addison , Uypothy serdi sm IDOM + Insutine Dependent Om. At LETS ALT/AST 111 USG + swollen oedematous (ves) 38) Te vtie vas Published by dr-notes.comType | 80°. Type IL A°), < 30 yeass 9 Ant smooth ruscdes © Ant Lives kidney Ank bodies (ASMA) microsomal Ab specific (Ant ALKM ab) AN. A > 4ve Type 4 Vasiants @ sevese vasiants :- Eavly lives cisshosis. Ant sousle Uvex (Antigen sta) AnBnody, @ Associated e [Pa sz] poly gtand ular Syndeome (f) Addison Disease - Gi) Hypoparathysoidism | © nkeynemane (i) candidiasis (Ant vives — Uvex cytosol Type I Ab +tve) Rx stexoid —» psednisolone (Ants Inflammatory) Immuno supp ses ert > Azathioprine. G4primasy Bilcaxy Cyrhosis It fs an Immune mediated Disoxdes chasacterized b tn flammotton Intya- hepatic Biliary channel 84 Now caseating gsanulomas. Etiology > autoimmune Pathogenesis — Type 4 HSR 40-60 yeas Peak age Eom qi Pre existing —A:I Disease -Addison geaves IDpm RA Vitigo. insidious onset a) Asympto mate —~» Routine LET settt cost. alkaline phosphatase , AF 27 old PF oteswise healthy is Pound to hae T Billian channel, allx aline phosphatase. Gi) Symptomatte Intsa hepotic cholestasis Jaundice ,psusitis, clay coloused stool a Xanthomas MalabsospHon Vit Dk Def cirehosis [HCC 40) Published by dr-notes.comIx cET'S Conjugated Bili 117 ALK phosphatase ttt — Oedemotous Enlarged liver Emmunology Anti mitochandvicl Antibody +ve. (18 7. specific) [fiver wiepsy > Raxely Needed Rx (4 Antipsusitic Rx choles tysamine Rifampadn Naloxone. (alt ase Bile Salt Bindex.) @ Doug 4 choice 7 Susvival usode oxy cholicacid == UC/ ch. Bloody Diasshea. i< chacactesized by intra § Eatoa hepatic Bilary chamels P.S.c i g cholang tis It is immune mediated Disosdes invowement &y neczo izing inflammation leading to cholestasis % eventual) Creshasis,, aEbology Autoimmune Pathogenesis Tgpe IE us-R CIF | Insidious onset Routine LET'S (t Atk phos’) Symptomatic Jaundice, prasitis, c Lea Coloused Usine , stool and Kanthomas. Malabsosption Vit ADK Deficiency ciavhosis [Hee ce ulcesakive Couit's — cheenic Boody Diarahea fs ve unitill proven otherwise, Additional . “Acute Bacterial cholangitis (C:B-D) . Cholangio cA + Colosactal cA (uc) Ix Let's USG -abd -odematous Livery Dilated “Bc . Tmmunology > NON Specific ANA + Noy Specific .¢ -ANK —> Cytoplasmic 42) Ank -Aleutsophilic Antibody. Published by dr-notes.comIx of choice Calso inva sculi tis) [invase] — ence < mach [pint invasie) EBD] (Be added Appeas ance) Anual -» CAl9-4 4 Colonoscopy Ly Tumor maskex of cholengia carcinema, Rx| Bile salt, Usogeoxy cholic acid. Bud chiazi Syndaame Ikis occuluston of hepatic yein at will lecd to congestive hepatomegaly » Hepatvcytes Necsosis and event uclly cishosis,, DOCTOR BOOK SHOP Etro logy Opp. Shaikh Zayed Hospital Gate # 6 (U.H.S) Near By DIMS Academy Lahore 0300-9480694 , 0321-101 1294 @) TReombus ©) Mabig nancy siotemainiche resem Risk Factos Pootein C, protein S, Anti Theomsin Def. pregnancy , OC's, Pav, Nephrotic Syn. C/F | Risk Factor sudden onset, pain RHC, Tendes hepatomegaly * Ascites, En caph oto pathy Spleenomegaly * GIT Bleedi "9 postal HTN Dopples USG- Hepatic Vein. a3Lowes git Bleed Below the level , Ugam ent contain Faesh P/R Bleed. GIT pathology Did vart ~Bleeding Bleeding From GIT, above Teeitz, the Level o Ugament Tseitz, (Doudenc Tujenal Junction) Haematemest’s + Blood Vomit s Maleng -» Blact Teasy Stool Degensative Action 4 HCL on Blosd “17 Veold @ has presented ©” projectile hematemesis ofter sepeotedepisodes 4 Vomitting o/E she stables, > case 4 mallory weiss syndtome. Ibis Basically a longitudinal ulcer sh post . gesophogeal mucosa. Reason Repeated 7 jn Intea Oesophageal psessuse (Repeated Vo mitting ) Clinically pryecile Haematemesis Published by dr-notes.comOfE Shable Dx . Oesophagoscopy t Repair te S67 ys old alcoholic presented e~ non stop Dematemesis O/E have hTN Tachy casdiac. These is coepites on skin Oy Neck | chests case 4, 2 Bosheave syndrome 3 “ oesophageat Raptused,, Cle old age , alcoholic (Repeated Vomitting ) psofused haematemesis. o/e * shock * Subcutaneous emphysema, Ix CT Neck 4 chest. BOys old CO" psesented e” Hematemesis Feom last 6 months heis hawing Betsostesnal busning | N/V tfd cont ws46) Endescepy 4 oesophagus Reveal cotomnas mete. Plasio 4 Lowex oesophagus . case + |Bosset's 0@ soph agitis (tis condition Cs psemalignant ) 5 | Oesophageal Vasices (CLD) Sl ysatd oF Suffesing Feom Hev has psesented e- 2 episodes 4 hematemesiis since Mosning o/e he has Jaundice Multiple Spidex nei palmas esythema,qynacomasta 4 Ascites, 6 CA 4 Stomach 62 ys old smokes has psesented e° the hematemesis examination Reveal enlarged Lt Supsa, clLaviculas L-N 7 CA 4 esophagus. SS ysold 9 has psesented ean episodes hematemesis From Last Y months she is having proguessive DY sphagia weight Loss 4 Cesvical Uimphadene pathy % GIT mucosa can heal up ein 24 has. DOCTOR BOOK SHOP Opp. Shaikh Zayed Hospital Gate # 6 (U.H.S) Near By DIMS Academy Lahore 0300-9480694 , 0321-1011294 CAILASfidaitsAvalable For PMDC Step III) Published by dr-notes.com2 [Peptic _uices 1S Bseech in mucosa Ay Any past 4 GIT. Commonest| Gastsic >Doudenal. Risk Factor (i) Genetic Brood group 0 HLA -B8s steess, Anxiety, emotions Ui ce co curling ulcer] Type A peasonatity T pooductton ~ stsess heosmeone costisol i,e@ Buan. di) [pathocogicai cer, cord, t PTH Cushing syndsome. ‘S “Imbalance b/w Pefensive Forces on GIT., patho gene and Aggsesstve Forces acting DOCTOR BOOK SHOP Opp. Shaikh Zayed Hospital Gate # 6 (U.H.S) Near By DIMS Academy Lahore 0300-9480694 , 0321-101 1294 (AI Affidavits Available For PMOC Step I 1 I) (Cr > 4 ml m aDefensive Fosce Gastric M Aggsessive Fosce ucosa Omueus psoductcon © pepsin -Break down mucus Busning pain ~epigastsic © Additional Hco3s7 ® specialized Apical © Hct pseduction \ Surface inhibit HeL (hs cases) THEL Penet cation Panceeotic gost sinoma Okemaskable Reg enesation [EUNICE CM son Synck cu @ Helicobacter pyioei abitity reticle y @ prostagiancdin psedluction ants penetwate UCOosa OH © NSAIDS stesoid intake| Production 9 Optestastanti ny ian lefe PEPTIC VICER Gastsic ulcers Doudenal ulces umblUcal Nausea Vomé thing GIT upset 4 Nausea * vomiting after 2-3 hus ofter Timing 3.6 mints. eating P aftey eating keep 09 eating obese/ afraid 4 eating over weight Thin § Lean 48) Published by dr-notes.comL european society 4 gasleevnteo logy (Cundti ne) APD Coesophageal, gastvic, GU, DU, GERD) 25S yeass ow alarm sign | 25S years ox Harm S199} No YES Advices 4) Stop smoking [alcohol 2) stop NSAID's , steroids 4) Antacids, Mg Trisillicate 16mi x Bhaly 4 Weeks Not impsoving Improving | Ne Fusthes Action Test H-pylosi Secology usea bseath test PPL - Omepesazole He Pyloai jcati Boma xdaily ({ weeks) sles! eradication Omepararole Impsoving | Gari thsomycin xTdays Metronidazole. No Furthes Rx Re test-H pytosi_ UBT -velh [ave - a Fagg Serieay Foe Hyon Indication] | Jmpzovingl| no mose RX a4 UGIT endoscopy ; Loif ulcer always fake 6 matiple edge Biopsy 4 ulcer.fe Malabsos Itis an Inadeq vate taanspoat 4 ene on moze con stituents 4 Diet From intes tral lumen through Inteshnal Mucosa in its Caculatcon ,, Phy stological Absospttory luminal phase constituents (Diet) 4) 2) 3) y 9 5 ? mineral Vitamins wates Soluble A lase . . Casbohyd rate "SE, Oligodisacchaside —y ——___, wakes r diffustons —__{Mlucosal phase Proteins ____Psotease , Tri, Di, psotein—__s rates —_—-L/P@8@__, Fatty acids + Vitamins Bile gcc Fat Sowbte [Salt] Ys Hydrophic (micelle Formation) “Hide Fat Sowble vitamin = m m a (sI* Baby who is not tolrating mother mille This will be a case 4 Lactose intelexance. Cle Malabsosptive 3 nds ome Gi) chdiasshea (> 2 week) (i) Steatosshea -» Lasge Bulky stods _ , undes -Digested Fats. cul) weight Loss Gv) abd pain Specific Deficiency lyon def. vy Cat Osteomatasioa Bleeding Vrt kK, Vit Bn [Folic add + Approach to Malabsosption is investigation Based [Approach || Matlab sosption, Ix Based, Faeces Fat Analy s*5| <4 (mort Sensibve jndicotes, DOCTOR BOOK SHOP Opp. Shaikh Zayed Hospital Gate # 6 (U.H.S) Near By DIMS Academy Lahore 0300-9480694 , 0321-1011294 CAI Affidavits Available For PMC Step I II!) Published by dr-notes.comFoeces Fat Analy sts Most Sensitive indicatess sudon II stain @dngiven (00 gram Fat [day on sfool Smear Detect undigested eo wWhese fs the Leston PE Ts given 25 gx0m (D- xylose) x orally and itis usinasy excretion is check x Next Shas. [Nowmal] Abnosmal Qualitative Extsaction > S gram is Stool. es 2 4sg © Luminal phase patholoay Pp mucosal Transpost phase pothelegy [zx] «usa Abd “CT's abd Ix -Next page ° LETS . S/Omylase © Sweat test G34st Ix mucosal Ix] uppes GIT endoscopy + Biopsy Faom Lesminal ileom. phase Subtotal villous atro pry Hallmos ik Hallmask Tuopical Celliac Sprue Spoue AAN FLU Intestinal macsophages gqramuoma, PAs+ ve ee Intest Hallmas lk nkes tine. whipple Disease Periodic Acid Seni fl [Non caseating] | Abypical Nesmal Crohn's lymphocytes [sewn] 0 ng Disease Lymphoma. goge if Lymph eng iogaaphy oIga mediated Disoxdeos eHLA D@e « gluten > taken as Anhgen. (cetinc spaue © Desmaktis Hexpetifexmis @ 134 nephsopathy su) (© Hensch Schontein puspusa (HS?) Published by dr-notes.com(wheat, Basley, Rye) Ix] Anti endomy seal / glaindin Ank body Ant TTG C Tissue Tran sguuta minase) Ab -98 7. specific as gusten Foee Diet Rice, maize. Tropical Spsue Probably Infection E-colu Rx} Abx. whipple Di sease Tosphysema whippele Rx} ABu group of Disoxdess charact erize by Immune mediated — Inflammeat tort 4 GIT. 3 Disorders. + Cychn's Disease * Ulcesative collitis * Tntexmedi ote colitis (ssMoxphology| Netter CO No Uc Ettlegy] puto immune Risk Factos s|_, Epidemological Triad (1) 2 Micro —oxganism -Rotavizus cmv, EBV [Host = 1) HLA Bar ty famitat i) Smoking , cD iv) Ned smastes Uc G)§ Environment Stress Refined diet Pseudomonas pooteus , Eco klebsiella NSAIDS 56) Published by dr-notes.com| Czuohn'sS Disease ' J eS te leis an Immune mediated , chgonic Relapsing Rem ting Disordes ,which Can Involve any Past of GIT Ibis characterized by Transmusal Inflammation’ e Farmation 4 Now - Caseating ranulomas. Pathogene si's| Delayed Type IZ WSR Mesphotogy LA OETA Ang past 4 GIT ott C1) Lcommenest + Teeminal ileum + esohn's rlertis colts Ci) 2ndcommonest +» Celon cRoh'ns 2)|Characteristics Featuses Inveluemert - Segmental / pa fey Nosmal asea Blw Inflammation geea is known as Skip Leston » (isa) Gi) Initially mucosa. will become cedematous Hypesemic % Boggy (a) Smell apthous ulces Formation G7Then small Ap thous ulces —___ — Combine — lasge ry Sezspentine ulcex (iv) Nosmal Mucosa Biw ee BALES These ulces. cobble stone appearance [changes] [eete] ciy T Fibsosis ft Rigidity _ Difficult to Scope. @) Barium studie a Exteeme Nasvo wing 4 wmen (staing sign 4) Kantor Micsoscopic W Tsansmursal Inflamm ation @) Non caseating granuloma. [Hallmask Pee existing autoimmune Disease. ¢(F *|Malabsoaptive j psesentotion ch. Diasrhea , stetosshea, weight Loss, abd Pain (RIF) + | Constitutional set©Y Fever malaise Anoxrenia, Note] :- autoimmune disease Comes in buncles. DOCTOR BOOK SHOP Opp. Shaikh Zayed Hospital Gate # 6 (U.HSS) Near By DIMS Academy Lahore 58) 0300-9480694 , 0321-101 1294 AI affidavits Avallable For PMDC Step 1, 11,1) Published by dr-notes.comExtsa Intestinal Featuyes (4) Cbbing @) Esythema Ned osum () Pyoderma gangsenosum - Ibis pus contain gangrenous ulces not Responding to Abx “) Uveltts ¢ Differential & Red eye) S) Aatheitis Csacsoilitis spondy Uti s) (9 Cxatate stone Ct intestinal Absouption) Hallmask | It ig malobsosphve syn. e- Anal cannal pathology iscolled Caohn's disease. Ix 4 choice Endo scopy + Biopsy Rx > stesords + Immuno suppresant. 64 a >I Z| im mi ZUleesative Colti ee [Lis an Immune mediated chaenic RelLapsin Remitting Disordex whichis chasacterized by neccotizing Inflamm ation 4 UleexatioN in Mucosa | Submucose 4 Colon, Pothogene sis Type Mus. (Aisite] Coton Bo7 Rectum Paoctitis SO‘. atone 30, e- Coutis Loy. panctitis (2) | chasactesistic Featuses Inflammation Diffuse No skin Leston (3) Changes Gi) Mucosa 4 Inflammed Congested 4 B Fosmati on W) Small Apthous Ulees 60) Published by dr-notes.com(ili) These small apthous ulcer combine (road Based ulces) WW) Islands 4, Nosmal Mucosa, known asl Pruedopowps| _—_— IPFFa Changes late as easly Micso scopre , Findings -» [Hallmask] > caypt Abscess Fac Jf Supp ton! AT Bace 4 ulces. c{F | 20-4o FM 3:1 NON smokes. psesentation | chsonic , Diasrhea € Blood Is UC unbit Psoven otheswise- Feves, malaise, Anoseaia, Extse Intestinal Featuse ae crohn's exp t Back Lash fleftis Complicatvons cD/ uc L) Haemorsrhage U-C 3) pea foration oD 2 Malignaryy UC WPerifenitis oD D absteuctioy OD ) Fistula oo 1) Toxic mega colon. Ix q choice endoscopy + Bropsy (41 Rx] steroids 4 Immuno suppressants.Published by dr-notes.com(il) These smatl apthous ulcer eombine CBsoad Based ulces) tiv) Islands 4 Normal Mucose known as Psued opalyps. changes Late as easly [Hatimask] > [crypt Abcesses F 4 Seppuration 8 $f Ulees. CIF 20-40 fom az] Pre-existing TO Nod smokes AT Disease UC™ Ps.c DOCTOR BOOK SHOP Opp. Shaikh Zayed Hospital Gate # 6 (U.H.S) Near By DIMS Academy Lahore 0300-9480694 , 0321-1011294 CAT Adois Ava For PMD Seo) Gl