Lec 1.pdf

Internal Medicine Based on Kirkuk University Lectures Presented By Dr. Mohammed Alaa By Next Lecture GERB Patient doctor relationship 1st step  Some barrier to good & communication in health care -55 The c...

Internal Medicine Based on Kirkuk University Lectures Presented By Dr. Mohammed Alaa By Next Lecture GERB Patient doctor relationship 1st step  Some barrier to good & communication in health care -55 The clinician / gi Dismissive attitude 8.dbi Is Hurried approach (i) - Use of jargon Ste Inability to speak 1st language Patients cultural - background -  The patient Anxity Reluctant to dicuss sensitive or seemingly trivial issues Goodinvironment 5906? & sajoj e 8, > Mis conception #dis · enj Conflicting sources of information Cognitive impairment & Hearing, visual, speech impairment - - -  GIT DISEASES -4 -l Underdeveloped countries & Developed country 15% of G.P work load & - - & => - & - - -  GIT COMMEN SYMPTEMS Dysphagia is the medical term for the symptom of difficulty in swal owing, Dysphagia T but not hurting. Odynophagia is the medical term for painful swal owing. Iodine phagic digestin -15) => Difficulty problem but not hurt paint Heart burn Stomach return - chronic 65- so sid Dyspepsia & indigestion - feelings of stomach pain, over-ful ness and - bloating during and after eating. Flatulence - sensation ef acid js - · involuntary sounds Hiccups made by spasms of the diaphragm. backing up into your throat or mouth without nausea or for reful Vomiting or regurgitation ??vomiting contraction b no caracter  1 Diarrhea 3X] Steatorrhoea Constipation lack of Boulmation Abdominal pain 40 Abdominal distention Weight loss is it significant ???? Black - any Bleeding: hematemesis, melena, - - - bleeding per rectum, occult blood un intensionaly Weight loss of more than - 5% of usual body weight - over 6–12 months is - Occult blood means that you can't see it with the naked eye. clinically important and can = indicate the presence of an naked underlying disease. & eye  pariteal peritonium easly localized Abdominal pain o Visceral: sensitive to distention, * contraction ,twisting and stretching, mid line - --- - - o Parietal pain: inflammation infection or - neoplasm, sharp well localised pain - o Referred pain : gall bladder pain referred to - - & > - shoulder - - F o Psychogenic pain: cultural , emotional , & - psychological, can not diagnosed the cause , associated with depression  ( & abdomen : The acute T G 50 % of urgent admission to general surgical unit - & - inflammation appendicitis perforation & Peptic ulcer obstruction obstruction others Extra intestinal * *Extra intestinal causes of abdominal pain Kidman retroperitoneal Aortic aneurysm aorta 2- - - psychogenic - depression locomotors Vertebral compression fracture metabolic DKA DM 5/5) & Abdominal pain usually happens drugs when sickle cells block blood flow LEAD spoisinig and prevent oxygen delivery to the abdomen. hematological Sickle cell anemia O2 ↓ Ischumin & ? win neurological Spinal cord compression - palpitation o diarrhea frequency diarch lactose intolerance diarrhea ↑ & 1995kj9  Signs CLINICAL EXAMINATION Inspection Palpation Percussion Auscultation Back rectal exam vaginal + scrotal per murnia lymph mode  troisier's Sign leftSupraclavicular Lymph Nodes & Virchow's node is an enlarged, => hard, left supra- clavicular lymph node which can contain metastasis of abdominal malignancy.  Per rectal examination Anal tag & Ext. hemorrhoid Fissure Fistula Stool color Prostate Cervix ,uterus - is , & CLINICAL INVESTIGATION 8 2 -. Plain x rays Endoanal ultrasound is primarily used in the - evaluation of anal fistula and anal sphincter - => Barium studies contrast Xray pathology, in individuals presenting with faecal incontinence. Ultrasound: Transabdominal,EUS ,Endoanal ultrasound CT - - MRI,MRA,MRCP, contraindications ?? - - Endoscope therapeutic diagnostic g , & Hos Esophageal PH monitoring & manometry +j GERD ERCP - Wireless vedioendoscopy *vedio capsule endoscopies ,non invasive , record on belt - & - - Jap Sensor 91Js & function of musch here · & Sh  EndoscopeRetrograd drink water and doctor - Se Sphincter and othere thing S 05, - 24h recio cap, it 10 -- / Y Barium swallow & Swallow Barium meal & Barium follow through - Small intesting & 70 - - · I I  Salivary glands disorder A lack of normal salivary flow may lead to complaints of mouth Xerostomia dryness, oral burning, swallowing difficulty & Infection mumps Calculus Tumors duct  S:, 255 The mouth Common Trivial Sever symptoms Aphthous ulcers are superficial and painful; they occur in - any part of the mouth. Recurrent ulcers occur in around - 20% of the population and are particularly common in Stomatitis women prior to menstruation. - - Recurrent aphthous ulceration -Non infective: un known, trauma, ill fitting denture, vit. dificiences, systemic diseases. Squamous cell carcinoma, smoking, alcohol ,acute leukemia -Infective: viral: Herpes simplex type ,coxackie virus, Herpes.z.virus Bacterial, *Vincent s stomatitis( Borrelia vincentii, bacillus fusiformis) and TB Fungal :Candida albicans. thrush Oral white patches Atrophic glossitis smooth sore tongue dinos Geographic tongue depapilation of tongue surface Periodontal dsorders gam Examination of oral cavity  Pharynx & esophagus 25 cm Muscles Stratified sq.namous epith Upper esoph. Sphinctor , cricoph. The upper esophageal sphincter (UES) is Lower esoph. Sph composed of the cricopharyngeus (CP), thyropharyngeus (TP; inferior pharyngeal constrictor [IPC] in humans) High resting pressure ,prevent. reflux in - esophagous to prevent gastric condent from returning to esoph  Anatomy Ja Post. Mediastinum Behind trachea & lt main bronchus Behind heart in front of aorta T1o ;through hiatus phrenicoesophageal lig. From diaph.transversalis fascia Fixation of LOS within diaph. hiatus ESOPHGEAL ANATOMY Food, -Relaxation of UOS & -Primary peristalsis -Secondary peristalses, distension by the bolus -Tertiary non peristaltic, in dysfunctional and involves irregular, elderly diffuse, simultaneous contractions. Relaxation of LEG sphinctor - - ↳ GEJ stratified Squamous Barret esophagore ↓ GERD Simple columner Symptoms of esophageal disorder painful Dysphagia ody no phagea dysphagia Heart burn Painful swallowing, candidiasis herps ,drugs  8 biz Na Jig. 109 !. 51 bilateral impairment of function of the lower cranial nerves IX, X, XI and XII, which occurs due to lower motor neuron lesion either at nuclear or fascicular level in the medulla or from bilateral lesions of the lower cranial nerves outside the brain-stem.  Causes of dysphagia Disease of mouth Neuromuscular disorder Motility disorders Achalasia Extrinsic pressure Morbic anurysm/ Intrinsic lesion, fb. stricture , ring ,web , foriegn pouch body  Signs of esophageal disorders Very few signs Weight loss Surely ju Sj5 I 6-12 month 800) meal Swallow enema follow throw Investigation of oesophgeal disorders CXR Barium swallow dysmotility Oesophgoscopy infla. + Manometery dysmobility Acid perfusion study GER : normal esophagus  Gastroesopheal reflux disease GERD Reflux occurs normally ,follow & by & & peristaltic wave , saliva , no symptom alkalim Disease occurs when esoph. mucosa exposed to gastric contents for prolonged periods of time resulting :symptoms ,esophagitis  Factors involved in GERD  Abnormalities of LOS  Delayed esoph. Clearance  Gastric contents: FAT coffe choclate , ,  Defective gastric emptying Pregnancy and obesity are - established predisposing  Increased intraabd. pressure ? causes. Weight loss may & improve symptoms. - Dietary fat, chocolate, alcohol,  Dietary & environmental factors - tea and coffee relax the lower & & oesophageal sphincter and may provoke symptoms  Hiatus hernia : types Loss of pressure gradient &angle disappears Types of : HAITUS HERNIA  Clinical features Heart burn & regurgitation acid ↑ food reflex & bending , lying down. - - & Water brush ? & - chocking develop to odynophagia - dysphagia Weight gain? asthma due to GERD horsness -5 & voic Choking during sleep ? Odenophagia , dysphagia ? Atypical chest pain:esoph. Spasm Chronic cough? - memic angina "Solos  Barret ’s oesophagus is a pre-malignant Complications condition, in which the normal squamous lining of the lower oesophagus is replaced by columnar mucosa Esophagitis Barrett s esophagus CLO / (columinal lining esophgus) The relative risk of oesophageal cancer is increased 40–120-fold, but the Premalig ,change. Metaplasia-dysplasia absolute risk is low (0.1%–0.5% per year). Anemia ,large H.H *Cameron lesion Benign oesoph stricture erosive-ulcerative Cameron lesions are a rare cause of upper GI alterations bleeding that isoflocalized gastric mucosa occurring body in Gastric volvulus ,twist H.H to the gastric mucosa of patients patients with large with large hiatal hernias hiatal hernia,  investigation Young no worrying features :emprical treat. OGD endoscopy 24H , PH monitoring ,PH less than4 more than 6-7% of study time is diagnostic. 1024hison ins Young patients who present with typical symptoms of gastro-oesophageal reflux, without worrying features such as dysphagia, weight loss or anaemia, can be treated - & empirically without investigation. Investigation is advisable if patients present over - the age of 50–55 years, if symptoms are atypical or if a complication is suspected. - & Endoscopy is the investigation of choice. - manometry test of musch function P - 5join wi , eb % 10 5s A.  including weight loss, avoidance of dietary items that worsen symptoms, elevatio bed Beforestigation head in those who experience nocturnal symptoms, avoidance of late meals cessation of smoking. Patients who fail to respond to these measures should be offered ppi Heart Lacid burn reflex) Management including weight los , avoidance of dietary items that worsen symptoms, elevation of the anbacid bed head in those who experience nocturnal symptoms, avoidance of late meals and ces ation of smoking. Patients who fail to respond to these measures should be of ered PPIs Life style advise omiprazol Proton pump inhibitor X - Haantagonist G Maintenance ? Recurrence is Histamin acid release & common. Antireflux surgery : gas bloat syndrome Gas-bloatGas-bloat uncomfortable syndrome symptomsthree-faceted feeling the patient is a set syndrome that create a ofto a refers bloated, clinical picture: in the upper feels bloated; the abdomen abdomen after antireflux surgery. distends; and the Endoscope intervention i Patients may “too8 early satiety, report individual & distention,discomfort mayabdominal verbalize the as suffering an inability much gas.” postprandial to belch "5 from or vomit, fullness, - - - nausea, or upper abdominal pain. - - GEJ Your are most welcome to medicine the most charming field NEXT LECTURE Onwards and Upwards CONTACT US @nextlecturesupport [email protected] www.nextlecture.org