Pain with swallowing
How does oropharyngeal dysphagia present
More difficulty initiating the swallowing of liquids than solids
How does esophageal dysphagia present in terms of swallowing
Difficulty swallowing both liquids and solids
What are the causes of oropharyngeal dysphagia
Neurologic disorders (muscular, cranial nerve diseases), Zenker diverticulum,thyromegaly, sphincter dysfunction, oropharyngeal cancers ,
What is a Zenker diverticulum
Pharyngeal or esophageal outpouching of the muscular wall. Pulsion diverticulum secondary to pressure from swallowing.
What are the signs and symptoms of Zenker diverticulum
Halitosis, neck mass on the left, dysphagia, aspiration
How is Zenker diverticulum diagnosed
Clinical palpation of a left-sided neck mass or a barium swallow
What is the treatment for Zenker diverticulum
Cricopharyngeal myotomy or surgical excision
What are the causes of esophageal dysphagia
2. Problem with esophageal motility: achalasia, diffuse esophageal spasm, or scleroderma
How do symptoms of mechanical dysphagia differ from dysphagia secondary to motility problems
Patients with mechanical dysphagia have more difficulty with solids than liquids whereas motility disorders cause difficulty with both solids and liquids
What is the most common motility disorder often seen in patients with scleroderma
Esophageal hypomotility
What defines achalasia
Loss of esophageal peristalsis with an inability of the lower esophageal sphincter to relax due to ganglionic loss ofAuerbach plexus.
What is the diagnostic feature seen on barium swallow in a patient with achalasia
“Bird’s beak” appearance (dilation of the proximal esophagus with narrowing of the distal esophagus)
What would manometry demonstrate in a patient with achalasia
Increased pressure at the lower esophageal sphincter with no relaxation with swallowing
How is achalasia treated
Balloon dilatation, sphincter myotomy, local botulinum toxin
What is the diagnostic feature seen on barium swallow in a patient with diffuse esophageal spasm
“Corkscrew pattern”
What is the treatment for diffuse esophageal spasm
Nitroglycerin, calcium channel blockers
What is Schatzki ring
Narrowing of the lower esophageal ring
What is Plummer-Vinson syndrome
Esophageal webs, atrophic glossitis, and dysphagia associated with iron deficiency anemia
What are the underlying causes of gastroesophageal reflux disease (GERD)
Incompetent lower esophageal sphincter, obesity, hiatal hernia, pregnancy, decreased esophageal motility, delayed gastric emptying
What are the signs and symptoms of GERD
Postprandial epigastric (chest) burning worse in supine position, cough, hoarse voice, regurgitation
How is GERD diagnosed
It is a clinical diagnosis.
What is the treatment for GERD
First-line treatment : lifestyle modification; weight loss;avoidance of instigating foods such as caffeine, fatty foods; avoid eating right before going to sleep
Last resort: Nissen fundoplication
What can be the long-term effects of chronic GERD
Barrett esophagus, peptic stricture, and esophageal cancer
What is Barrett's esophagus
Transformation of normal squamous epithelium to columnar epithelium
What is the risk with Barrett esophagus
10% lifetime risk of transforming into esophageal adenocarcinoma
التوقيع
اللهم إنك عفو كريم تحب العفو فاعف عنى
خللى بالكم يا شباب سادسة من الجرعات دى مهمة جدااااااااااااااااااااا فى النسا
Mg Sulfate as anticonvulsant in ttt of PET
IV 4-6 gm slowly (over 15-20 min) then 1-2 gm/hr by drip
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,, Oxytocin as ecbolic
most commonly used in (saline , dextrose , lactated ringer)
start by small dose at slow rate then gradualy increase
.5 - 2 mIU /min then increase by 1-2 mIU/30-60min
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, دكتور أبو عمار
التعديل الأخير تم بواسطة ahmeid ; 04-06-2009 الساعة 11:50 PM.
Inflammation of the gastric mucosa
What are the signs and symptoms of gastritis
May be asymptomatic; otherwise symptoms are epigastric pain, weight loss, nausea, vomiting, hematemesis,coffee ground emesis
How is gastritis diagnosed
Endoscopy
What is the treatment for gastritis
It depends on the etiology.
If caused byH. pylori —triple therapy with PPI, two antibiotics, and bismuth compound
If caused by NSAID use—discontinue NSAID use; start sucralfate, PPI, or H2 blocker
If caused by stress—intravenous (IV) H2 blocker
If caused by pernicious anemia—vitamin B12treatment
What are the two types of peptic ulcers
Duodenal ulcer and gastric ulcer
Which type of ulcer is more common
Duodenal ulcers are twice as common
What is the underlying pathology in a patient with a duodenal ulcer
Most have increased acid production
How does the underlying pathology of gastric ulcers differ from that of duodenal ulcers
Gastric ulcers are not caused by increased acid production. Patients are more likely to have
decreased mucosal protection.
What bacterial infection is found in 90% of patients with duodenal ulcers
H. pylori
What percentage of gastric ulcers are associated withH. pylori infection
70%
What test can determine if a patient is infected withH. pylori
Stool H. pylori antigen, urea breath test, serum IgG test
What is drawback of the H. pylori blood test
It does not indicate anactive infection. It will be positive even if the patient was infected in the past and is not currently infected. The test also has a low sensitivity.
What are the two most common causes of peptic ulcer disease
H. pylori infection and frequent NSAID use
What are the risk factors for a peptic ulcer
Smoking, significant alcohol use, frequent NSAID use, significant physiologic stress (examples are surgery, trauma, burns), and hypersecretory states
Name three hypersecretory states
Zollinger-Ellison syndrome, multiple endocrine neoplasia type I (MEN I),and antral G cell hyperplasia
What are the signs and symptoms of a duodenal ulcer
Burning epigastric pain that is usually 2–3 hours postprandially; relieved by food or antacids; pain may radiate to the back; pain awakens patient at night; nausea and sometimes vomiting; hematemesis/melena if patient has a gastrointestinal (GI) bleed
What are the signs and symptoms of a gastric ulcer
Same as that for a duodenal ulcer except that pain is greater with meals, so patients often lose weight
What tests would you order if you suspected a peptic ulcer
Complete blood count (CBC) to make sure patient is not anemic; upper GI endoscopy or upper GI series; H. pylori screening
What should be ruled out in a patient with a gastric ulcer
Malignancy
How can malignancy be ruled out
A biopsy of the ulcerated region should be done during endoscopy
What is a gastric ulcer in a burn patient called
Curling ulcer
What is a gastric ulcer in a patient with central nervous system (CNS) damage called
Cushing ulcer
How is peptic ulcer disease treated
Avoidance of instigating factors such as smoking and NSAIDs; H2 blockers or PPIs mucosal protectors such as bismuth; and antibiotics if the patient is infected withH. pylori
How is anH. pylori infection treated
Triple therapy:PPI + bismuth compound + two antibiotics for 14 days
For example: omeprazole + amoxicillin (or metronidazole) + clarithromycin + bismuth
compound
What are some complications of peptic ulcer disease
Hemorrhage, obstruction, perforation
When would you suspect a perforated duodenal ulcer
Severe epigastric pain that radiates to the back
What studies would you order if you suspected a perforated ulcer
Abdominal series or upper GI series with contrast (do not use barium)
What would you expect to see on an abdominal series if there was a perforated
Free air under the diaphragm
What is the treatment for a perforated ulcer
npo (nothing by mouth), IV fluids, antibiotics, emergent surgery
What are the typical symptoms of gastric outlet obstruction
Nausea, vomiting, weight loss, distended abdomen
What is the most serious complication of a posterior duodenal ulcer
Erosion into the gastroduodenal artery can lead to a massive hemorrhage.
What symptoms could be a red flag for a gastric malignancy
Early satiety with weight loss
What are the risk factors for gastric cancer
Diets with high nitrosamines or salt content, history of chronic gastritis, low fiber diets
What blood group type is more likely to develop gastric cancer
Type A
In what part of the stomach is gastric cancer usually found
In the antrum of the stomach
What is the most common type of gastric cancer
Adenocarcinoma
What is the most fatal form of gastric cancer
Linitis plastica (diffusely infiltrating gastric cancer)
Name the physical findings associated with metastatic gastric cancer described below
التوقيع
اللهم إنك عفو كريم تحب العفو فاعف عنى
خللى بالكم يا شباب سادسة من الجرعات دى مهمة جدااااااااااااااااااااا فى النسا
Mg Sulfate as anticonvulsant in ttt of PET
IV 4-6 gm slowly (over 15-20 min) then 1-2 gm/hr by drip
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,, Oxytocin as ecbolic
most commonly used in (saline , dextrose , lactated ringer)
start by small dose at slow rate then gradualy increase
.5 - 2 mIU /min then increase by 1-2 mIU/30-60min
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, دكتور أبو عمار
التعديل الأخير تم بواسطة ahmeid ; 05-06-2009 الساعة 12:09 AM.
اللهم إنك عفو كريم تحب العفو فاعف عنى
خللى بالكم يا شباب سادسة من الجرعات دى مهمة جدااااااااااااااااااااا فى النسا
Mg Sulfate as anticonvulsant in ttt of PET
IV 4-6 gm slowly (over 15-20 min) then 1-2 gm/hr by drip
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,, Oxytocin as ecbolic
most commonly used in (saline , dextrose , lactated ringer)
start by small dose at slow rate then gradualy increase
.5 - 2 mIU /min then increase by 1-2 mIU/30-60min
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, دكتور أبو عمار
اللهم إنك عفو كريم تحب العفو فاعف عنى
خللى بالكم يا شباب سادسة من الجرعات دى مهمة جدااااااااااااااااااااا فى النسا
Mg Sulfate as anticonvulsant in ttt of PET
IV 4-6 gm slowly (over 15-20 min) then 1-2 gm/hr by drip
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,, Oxytocin as ecbolic
most commonly used in (saline , dextrose , lactated ringer)
start by small dose at slow rate then gradualy increase
.5 - 2 mIU /min then increase by 1-2 mIU/30-60min
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, دكتور أبو عمار
Drugs (such as thiazide diuretics)
What are the signs and symptoms of pancreatitis
Epigastric pain that radiates to the back;nausea, vomiting, decreased bowel sounds, fever
What is Grey Turner sign
Ecchymoses seen on the patient flank in hemorrhagic pancreatitis
What is Cullen sign
Periumbilical ecchymosis seen in hemorrhagic pancreatitis
What laboratory findings are consistent with pancreatitis
amylase, lipase, hypocalcemia
What would you expect to see on an abdominal x-ray
Sentinel loop or colon cutoff sign
What is a sentinel loop
Dilated bowel or air fluid levels near the pancreas
What is the colon cutoff sign
Transverse colon distended with no colonic gas distal to the splenic flexure
What is the best study to evaluate pancreatitis
Abdominal CT
What test should be ordered if there is a suspicion of gallstone pancreatitis
Right upper quadrant (RUQ) ultrasound
What is the treatment for pancreatitis
npo, NG tube for ileus or vomiting, IV fluid hydration, and treat the underlying cause
What do we use to determine the prognosis of a patient with pancreatitis
Ranson criteria (predicts risk of mortality based on risk factors)
How is the risk of mortality calculated based on Ranson criteria
< 3 risk factors: 1% mortality
3–4 risk factors: 16% mortality
5–6 risk factors: 40% mortality
7–8 risk factors: close to 100% mortality
التوقيع
اللهم إنك عفو كريم تحب العفو فاعف عنى
خللى بالكم يا شباب سادسة من الجرعات دى مهمة جدااااااااااااااااااااا فى النسا
Mg Sulfate as anticonvulsant in ttt of PET
IV 4-6 gm slowly (over 15-20 min) then 1-2 gm/hr by drip
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,, Oxytocin as ecbolic
most commonly used in (saline , dextrose , lactated ringer)
start by small dose at slow rate then gradualy increase
.5 - 2 mIU /min then increase by 1-2 mIU/30-60min
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, دكتور أبو عمار
التعديل الأخير تم بواسطة ahmeid ; 05-06-2009 الساعة 12:16 AM.
اللهم إنك عفو كريم تحب العفو فاعف عنى
خللى بالكم يا شباب سادسة من الجرعات دى مهمة جدااااااااااااااااااااا فى النسا
Mg Sulfate as anticonvulsant in ttt of PET
IV 4-6 gm slowly (over 15-20 min) then 1-2 gm/hr by drip
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,, Oxytocin as ecbolic
most commonly used in (saline , dextrose , lactated ringer)
start by small dose at slow rate then gradualy increase
.5 - 2 mIU /min then increase by 1-2 mIU/30-60min
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, دكتور أبو عمار
اللهم إنك عفو كريم تحب العفو فاعف عنى
خللى بالكم يا شباب سادسة من الجرعات دى مهمة جدااااااااااااااااااااا فى النسا
Mg Sulfate as anticonvulsant in ttt of PET
IV 4-6 gm slowly (over 15-20 min) then 1-2 gm/hr by drip
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,, Oxytocin as ecbolic
most commonly used in (saline , dextrose , lactated ringer)
start by small dose at slow rate then gradualy increase
.5 - 2 mIU /min then increase by 1-2 mIU/30-60min
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, دكتور أبو عمار
اللهم إنك عفو كريم تحب العفو فاعف عنى
خللى بالكم يا شباب سادسة من الجرعات دى مهمة جدااااااااااااااااااااا فى النسا
Mg Sulfate as anticonvulsant in ttt of PET
IV 4-6 gm slowly (over 15-20 min) then 1-2 gm/hr by drip
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,, Oxytocin as ecbolic
most commonly used in (saline , dextrose , lactated ringer)
start by small dose at slow rate then gradualy increase
.5 - 2 mIU /min then increase by 1-2 mIU/30-60min
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, دكتور أبو عمار
اللهم إنك عفو كريم تحب العفو فاعف عنى
خللى بالكم يا شباب سادسة من الجرعات دى مهمة جدااااااااااااااااااااا فى النسا
Mg Sulfate as anticonvulsant in ttt of PET
IV 4-6 gm slowly (over 15-20 min) then 1-2 gm/hr by drip
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,, Oxytocin as ecbolic
most commonly used in (saline , dextrose , lactated ringer)
start by small dose at slow rate then gradualy increase
.5 - 2 mIU /min then increase by 1-2 mIU/30-60min
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, دكتور أبو عمار
اللهم إنك عفو كريم تحب العفو فاعف عنى
خللى بالكم يا شباب سادسة من الجرعات دى مهمة جدااااااااااااااااااااا فى النسا
Mg Sulfate as anticonvulsant in ttt of PET
IV 4-6 gm slowly (over 15-20 min) then 1-2 gm/hr by drip
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,, Oxytocin as ecbolic
most commonly used in (saline , dextrose , lactated ringer)
start by small dose at slow rate then gradualy increase
.5 - 2 mIU /min then increase by 1-2 mIU/30-60min
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, دكتور أبو عمار
برامج لا غني
عنها :
جميع الحقوق محفوظة المنتدى لا يتبع أى أسرة أو تيار داخل أو خارج الكلية
يحق لك أخي المسلم الاستفادة من محتويات الموقع في الاستخدام الشخصي غير التجاري
عدم ذكرك
للمصدر ......حرمان غيرك من الثواب
المواضيع المتشابهه
دكتور أبو عمار 
العرض العادي
