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GIT Dr. Shaf3y
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G.I.T.
6182013
inflammatory bowel disease
Inflammatory Bowel Disease
Inflammatory bowel disease
Inflammatory bowel disease
etiologyetiologyinflammatory bowel disease
Actually, two diseasesUlcerative colitis
Croh nsregional ileitis
two diseasescause
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genetics
geneticshigh incidence
family history
High associationHLA B27genetic element
allergy to certain types of food
disease
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this is the first time I have seen a doctor advise by smokingthis is the only case in the whole world that the smoking is the treatment
Ulcerative colitis
ulcerative colitispathology
pathologyulcerative colitisulcerative colitis
pathology
gross picturesdiseaseUlcerative colitis
rectumrectumrectum
ulcerative colitisrectum
rectumbleeding
rectum
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rectumtransverseLesioncontinuous
skip lesion
as regardsite
colonaffectedinflammationMucosa
ulcerative colitisMucosa
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Proliferating
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Interstitial lung fibrosisinterstitial lung fibrosis
heartanemiageneral constitutional manifestations
abdomenLiverauto immune hepatitis
gall bladdercholecystitissclerosing cholangitisHigh incidence of cholangio carcinomakidneyoxlate stonesKidney
skinpyoderma gangrenosumerythema nodusum
jointsankylosing spondylitisrheumatology
Inflammatory bowel diseasearthritisankylosing spondylitis picturesremissionexacerbationG.I.T.
manifestationsarthritisKneeankleremissionexacerbation
G.I.T. manifestations
Inflammatory bowel diseaserheumatology
intestinal manifestation s
complicationscomplicationsinflammatory bowel diseaseHemorrhagePerforation
toxic megacoloncancer
toxic megacolontoxic megacolonparalytic ileus
paralytic ileussmall intestinetoxic megacolonLarge intestine
absolute constipation
disease
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Investigationsinvestigationsinvestigationsdysentery
stool analysisdysentery
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doseOraldysentery60
intravenous
Intravenousfulminant colitistoxic megacolon
intravenous
enemacorticosteroid enemacorticosteroid enema
enema
inflammation
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sulphasalazine
side effectssulphonamide
5 aminosalicyclic acid
sulphonamide
aminosalicyclic acidorallysulphonamide
during the attack
antispasmodicanti diarrheal agentsSymptomatic treatment
In between the attackcortisone
sulphasalazine
In between attacksattacks
cortisonesulphasalazine
recentaminosalicyclic acidcorticosteroidsimmune suppressant
Azathioprinecyclophosphamidecyclosporine
corticosteroidsaminosalicyclic acid
other immune suppressantAzathioprinecyclophosphamidecyclosporine
tumor necrosis factors alpha inhibitorinflixmab
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And finallySurgical treatment
surgery
failed medical treatmentfulminant colitisfailed medical treatment
total coloectomy
total coloectomymalignancy
failed medical treatmentfulminant colitiscomplications
surgical treatmentfulminant colitis
high risk of cancercomplications
Total coloectomy
Terminal ileostomy
rectumMucosaterminal ileum
Hartmann cuff cuff of musclesmucosa
Ulcerative colitis
Ulcerative colitis15
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Cronhns Disease ( Regional enteritis )
Regional ileitis
regional ileitisCrohns disease
Inflammatory bowel disease
Oral cavityanus
terminal ileumregional ileitis
terminal ileumterminal ileumright sided colon
right sided colonJejunum
Legionspatchyskip
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Inflammationgranulomatouscaseation
Granulomatous lesionscaseation
mucosa
mucosafissured
cobblestone arrangement
cobblestones
cobblestone arrangement
inflammationthe whole thicknessInflammationthe whole thicknessPerforationIntestine
inflammationthe whole thicknessperforationintestine
regional ileitisfistula
small intestinescolon
Fistulaintestinevagina
Anal fistulaswhole thickness
microscopic examinationinflammationthe whole thickness of the intestine
Non caseating
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clinical pictures
Typical ulcerative colitisUlcerative colitis
Ulcerative colitis
massright iliac fossaterminal ileumappendicular masssmall intestinemalabsorption syndrome
Ulcerative colitismalabsorption syndrome
massright iliac fossa
extra intestinal manifestations
rate of complications
cancercancer
PerforationHemorrhagecancer
risk of cancer
pseudo polyps
Investigationsinvestigations
Typical ulcerative colitis
BariumBarium swallowBarium meal
terminal ileumcaecum
terminal ileum
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String sign
post evacuation film
fissurescobblestone arrangement
fissurescobblestone arrangement
investigationsUlcerative colitis
bariumfistulasfistulasCrohns diseaseulcerative colitis
fistulasCrohns disease
ulcerative colitis
treatmentTypical ulcerative colitis
TypicalMetrinidazole
proliferation of bacteriamalabsoprtion
surgical treatmentfailed medical treatment
complications
routine surgery10risk of cancer
risk of cancersurgical treatment
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diseaseresection anastomosis
adhesions
abdomenabdominal wall
fibrosisadhesion
extensive fibrosisadhesions
resection anastomosisboweldisease
anastomosis
incisionLoops of intestine
recurrenceLoopsfistula
skinskin
woundwoundLoops
fistulawound
fistulawound
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fistulawound
appendicitis
regional ileitis
adhesions
as regardregional ileitis
dysentery
Ascitesascites
Collection of Collection of fluid in the peritoneal cavity
fluidTransudate
ExudatesChylous
hemorrhagic
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chylous ascitesObstruction of thoracic duct
obstruction
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osmotic pressureplasma proteins
Plasma proteinsMalabsorptionmalnutritionNephroticliver cell failure
hydrostatic pressurehydrostatic pressureheart
Right sided heart failureTricuspid stenosis, tricuspid regurge
Constrictive pericarditisPortal hypertension
Portal hypertensionascitesHypoalbuminemia
transudateprotein content of the fluid3 gram percentage
specific gravity1016cells1000LDH200
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ascites
Symptomsascites
Abdominal distention
abdominal distentionascitesdyspnea
Lower limb edemadyspepsia
symptoms of the cause
signsLocal and general examination
Local examinationInspection
Abdominal distentionWide subcostal angles
Divercuation of rectiShift of the umbilicus
Umbilical herniaCaput medosa
inspection
palpationorgans by dipping
masses
Percussion
dullnessflanksshifting dullness
transmitted thrill
auscultationvneous humsuccession splash
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succession splash
succession splash
comatosed
comatosedcomatosed
AnywayinspectionpalpationPercussionauscultation
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treatment of ascitesLiver cell failure
treatment of ascitesLiver cell failure
Does not reduce mortality
treatment of ascitesliver cell failuredoes not reduce the mortality
dose not reduce mortalityascites
treatmentascites
ascites
treatment dose not reduce mortalitytreatmentfor symptomatic reasons only
ascites
dyspnea
treatment of ascitestreatmentcomplicationstreatment
treatmenttreatmentascitesLiver cell failure
bed rest
bed restLoadLiverMetabolic demandLiver
decreased metabolic demandliverLiverMachineryalbumin
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Justbed rest
fluid
fluid
liter fluid
diuretics
bed restdiet
dietsodium
sodium80
80AlreadyNaturally
Which means
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fluid restriction
fluid restrictionHypovolemicfluidsblood vessel
Peritoneal cavity
actually HypovolemicHe is actually Hypovolemic
fluid restrictionsevere massive ascites
fluid restrictionhepatorenal syndrome
Kidney
fluid restriction
severe casesumbilical hernia
salt restriction Proteinsproteins
hepatic encephalopathy
hepatic encephalopathydiet
dietbed restdiuretics
diureticsSpironolactone
spironolactone
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potassium sparing
potassium sparingHepatic encephalopathy
precipitating factorsHypokalemia
spironolactoneHypokalemiaHepatic encephalopathy
spironolactonespironolactone
weak diureticsDiuretics
diuresishepato-renal
diuresisgradualsudden
diureticssudden diuresishypovolemia
hepato-renal
diureticsgradualspironolactone
potassium retainingweak diuretics
spironolactone
lasixlasixspironolactone
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lasixspironolactone
potassium
diureticsAlbumin
Human albumin
plasmaplasmaalbumin
albuminplasma
PlasmaAIDSHepatitisplasmareplacementalbumin
albuminHuman albumin
AIDShepatitis
plasmarisk of hepatitis
Plasma volume overloadalbumin
albumin500volume overloadheart
albuminalbumin
Tappingpara centesis
severe respiratory distressUmbilical hernia about to rupture
failed other measures
tappingascetic fluid
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8hepato-renal
hepatic encephalopathyPara centesisgradual
Umbilicusrupture
fluids
ascetic fluid6- 8 gram albumin intravenous
Ascites prevent ascites
blood vesselPeritoneum
According to the pressure gradient
ascitesPressure
pressure gradient
ascitesabdomenpressureabdomen
transudation
blood vesselperitoneal sac
According to pressure gradientPressure
massive ascitesPressureabdomen
blood vessel
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peritoneumfluidPressurePeritoneal sac
pressureblood
hepato-renalHepatic encephalopathy
fluidsalbumin
albuminosmotic pressureblood vesselretainfluidsblood vessels
fluids6 - 8 gram albumin
refractory ascites
refractory ascitesascites not responding to medical treatmentNot responding to medical treatment
refractory ascitesascites not responding to medical treatment
Spontaneous bacterial peritonitisT.B. peritonitis
Malignancy
end stage liver diseaseLiversevere hyponateremiahyponateremialasix
diureticsUrine
hyponateremiaglomerular filtrate
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spontaneous bacterial peritonitisT.B. peritonitis
malignancyrefractory ascites
Malignancymalignancyascitesascites
ascetic fluid
Intra venous
fluidascetic fluid
intra venoushypoalbuminemiaascetic fluid
fluiddirtyascetic fluiddirtyE.Coli
intra venousE.Coli
septecemiaD.I.C.
ultra filtration re-infusion
Le veenshuntShuntPeritoneumvena cava
Shunt
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D.I.C.sepsishypervolemia
Liver transplant
Liver transplantTIPSS
Transjugular intrahepatic portosystemic stent shunting
TIPSSTIPSSTIPSS
ascites
ascitestreatmentcausescausetreatmentascites
dysentery
functional gastrointestinal disorders
Functional Gastrointestinal Disorders
Functional gastrointestinal disorders
functional gastrointestinal disordersdisordersorganic cause
G.I.T. manifestationsorganic cause
esophagusesophagusGlobus hystericus
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globus hystericuslumbrepeated swallowingsaliva
clearLumbBut it does not clear
reassurance only
just reassurance
chest pain of esophageal origincorkscrew esophagus
Esophageal spasmpainpainangina
calcium channel blockersNitrates
regurgegastroesophageal reflux
excessive regurgemassive salivationgastroesphageal reflux
GERD
gastrointestinal disordersstomachduodenumerophagiaerophagia
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P
erophagia
Non ulcerative dyspepsiafeaturesfeaturespeptic ulcer
featurescholecystitisNon ulcerative dyspepsia
functional vomitingfunctional vomitingpsychogenic problem
femlaesIam talking about females
femalesfemales
Females
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functional vomitingreassurance
colonintestine
Functional colonic or intestinal disordersflatulance
flatulancefunctional diarrhea
functional diarrhea
Once
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No way
anxietyfunctional diarrhea
functional diarrhea
stool
functional gastrointestinal disordersirritable bowel syndrome
irritable bowel syndrome
irritable bowel syndrome
Irritable bowel syndromediseasecommunitydisease
functional gastrointestinal disordersfunctional gastrointestinal disordersirritable bowel syndrome
Irritable bowel syndrome
irritable bowel syndrome
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it is a G.I.T. manifestations without an organic cause in which the patient may present by constipationor diarrhea or alternating constipation and diarrhea
Associated with abdominal pain
irritable bowel syndromeabdominal pain
changebowel habitsconstipation
diarrheaalternating constipation and diarrhea
etiology
theoriespsychological
irritable bowel syndrome
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PainPainabdomen
abdomencolics
sigmoidsigmoidspastic
paindiarrheaconstipation
constipation
constipationcolonspasticstool
stoolRibbon shaped
colonspastic
spasm
stoolstoolrabbit like stool
alternatingconstipationAt the same time
painchange of bowel habitsflatulence
Excessive eructationvery common
Associated type A personalityAnxious, irritability
bad odour of mouth ( Halitosis )
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dysmenorrheadysparonia
Tension headachetype A personality
investigationsStool analysis
colonoscopy
to exclude other lesions
irritable bowel
criteriacriteria
irritable bowel syndromecriteria
abdominal painabdominal pain
paindefecationchangestool consistencyhardsoft
changebowel frequencycriteriairritable bowel syndrome
diseaseabdomen
dysenteryabdominal pain
paindefecation
changebowel frequencychangebowel consistency
dysenterycriteria
criteriacriteria
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famousFor nothing
Justpioneer
congenital
Coronariesvalve lesions
valve lesionscoronaries
congenitalvalve lesionscoronaries
coronariesvalve lesionscareer
research
center
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criteria
irritable bowel syndromeirritable bowel syndrome
Symptomatic
abdominal colic
anti spasmodic
Motility of the bowelbran
bran
distentioncolonperistalsis
spasticperistalsisspasticwaves
waves
distention of the colonbran
distentioncolon
diarrheaamytriptyline
constipationlaxativeserotonin
serotonin reuptake inhibitorSeroxat
Serotonin reuptake inhibitornormalizationPeristalsis waves
constipationlaxative
serotonin reuptake inhibitors
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serotonin receptor agonist
diarrheaanti diarrheal agent
amytriptyline
as regard irritable bowel syndromefunctional gastrointestinal disorders
colorectal polypsMCQs
intestinal obstructionparalytic ileus
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haematemesishaematemesis
Vomiting of a blood due to a lesion proximal to the ligament of Teritz
Vomiting of a blood due to a lesion proximal to the ligament of teritz
haematemesisfresh blood
coffee ground
Haematemesisfresh blood
Melanemesiscoffee ground
haematemesisfresh blood
melanemesiscoffee ground
rectummelena
fresh blood
haematemesis
esophagus
Esophageal varicesgastroesophageal reflux
TraumaTumors
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Ruptured aortic aneurysmesophagusMallory weiss syndrome
Mallory weissLongitudinal tear in the mucosa
Longitudinal tear in the mucosavomiting
esophagusstomach
stomachhaematemesisPeptic ulcer
Fundal varices
AngiodysplsiastomachCarcinoma of the stomach
Gastritis
stomachduodenum
duodenal ulcer
duodenal ulcer
AngiodysplsiaduodenumPolyposisduodenum
Peutz-Jaegh erspolypsduodenumPeutz-Jaeghers
Familial polyposis coli
haematemesisHaemorrhagic blood disease
haemophiliaPurpuraWhatever
haematemesismelena
melena
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Black tarry stool
black tarry stoolmelena
haematemesis
differential diagnosisblack stoolIron
CharcoalHaemolytic anemia
causes of false haematemesisfalse haematemesis
Upper problemrespiratory tractsinusitisbleeding nose
bloodvomiting
false haematemesis
haematemesisABC
airwayairway obstructionventilator
wide bore cannulablood matchinglab
salinefresh blood
OmeprazoleK
vitamin Kmedical tradition
endoscopyband ligation
vasoconstricting drugsvaso pressinsomatostatinSangstakentube
surgical treatment
peptic ulcerOmeprazole
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GIT Dr. Shaf3y
adrenalineulcer
partial resection by partial gasterectomy
approach to a patient presenting with a case of haematemesis
haematemesis
G.I.T.
31232013
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