Hand Out | FOM 2025

. ملف مجمع لتفريغات الرينال #Nephro_Lec_Hand_out

_First line of treatment in PBC ,PSC ....... UDCA and Obtecholic acid (to decrease progression) _First line of treatment in Achalasia....... POEM من برا التيم 💚💙 #Git_Notes

10 finding in PR examination: 🌼A = Anal tone. 🌼P = Prostate / Polyp / Piles / Pelvic floor muscle. 🌼S = Sphincteric reflexes / Stool examination. 🌼R = Rectal vault. 🌼F = Fissures. بطريقة مبسطة

10 finding in PR examination ; 🌼A = anal tone 🌼P= prostate /polyp /piles /pelvic floor muscle 🌼S= sphincteric reflexes /stool examination 🌼R= rectal vault 🌼F=fissures بطريقة مبسطة من برا التيم #Git_Notes

فى الباطنه نخلى بالنا أن SMA,ANA_ Abمع الautoimmune hepatities . _AMA مع primary biliary cholangitie. _P ANCAمع primary sclerosing cholagities . من برا التيم 💚💙 #Git_Notes

COMPLICATIONS OF GALLSTONES: ---+---+---+---+---+---+---+---+---+---+---+--- » Obstructive complications: 📍Mucocele/Empyema. 📍Obstructive jaundice. 📍Acute pancreatitis. 📍Intestinal obstruction (gallstone ileus). 📍Mirizzi syndrome. » Ulcerative complications: 📍Chronic peptic ulcer. 📍Internal biliary fistula (stomach, duodenum or colon). 📍External biliary fistula (skin). » Infective complications: 📍Acute cholecystitis. 📍Chronic cholecystitis. 📍Ascending cholangitis. » Neoplastic complications: 📍Cancer gallbladder (rare, 1%). 🚨🚨 دي اجابة د. جمال الشيمي

Gastroesophageal reflux disease (GERD): ---+---+---+---+---+---+---+---+---+---+---+---+---+--- Clinical Presentations: » Classic symptoms: 📍Heartburn. 📍Regurgitation. • Aggravated by change in position. • Prompt relief by antacids. » Extra-esophageal manifestations: *Pulmonary: 📍Asthma. 📍Aspiration pneumonia. 📍Chronic bronchitis. 📍Pulmonary fibrosis. *ENT: 📍Hoarseness. 📍Laryngitis. 📍Pharyngitis. 📍Chronic cough. 📍Globus sensation. 📍Dysphonia. 📍Sinusitis. 📍Subglottic stenosis. 📍Laryngeal cancer. *Other: 📍Chest pain. 📍Dental erosion. » Complicated GERD (Alarm signs): 📍Dysphagia. 📍Odynophagia. 📍Loss of weight. 📍Bleeding → IDA. 📍Hematemesis. Diagnostic tests: 📍1. Barium Swallow (not diagnostic): Useful first diagnostic test for patients with dysphagia. 📍2. Endoscopy (not diagnostic): *Indications for endoscopy: •Alarm symptoms. •Empiric therapy failure. •Preoperative evaluation. •Detection of Barrett’s esophagus. 📍3. Ambulatory 24 hr. pH Monitoring (Gold standard). 📍4. Wireless, Catheter-Free Esophageal pH Monitoring. 📍5. Esophageal Manometry (preoperative): Limited role in GERD. Complications: 📍Erosive & ulcerative esophagitis. 📍Esophageal (Peptic) stricture. 📍Barrett’s esophagus. 📍Adenocarcinoma. 📍Aspirations pneumonia. 📍Dental erosion.

Hepatic encephalopathy: ---+---+---+---+---+---+---+---+---+--- Precipitating factors: 📍Sepsis. 📍GI hge. 📍Dietary protein overload. 📍Dehydration. 📍Constipation 📍CNS-active drugs. 📍Hypokalemia/Alkalosis. 📍Poor compliance with lactulose therapy. 📍Post-anesthesia. 📍Postportal decompression procedure Intestinal obstruction or ileus. 📍Uremia. Clinical features: 📍Type A ➡️ Associated with Acute liver failure. 📍Type B ➡️ Associated with Portosystemic shunting. 📍Type C (most Common type) ➡️ Associated with Cirrhosis and Chronic liver disease. 📍Persistent HE ➡️ Defined as mental status changes lasting > 2 weeks: » Low-grade HE (minimal HE + grade I HE): Mental status changes without disorientation. » High-grade HE (stages II to IV): Mental status changes with disorientation. 📍Acquired hepatocerebral degeneration. 📍Spastic paraparesis. Treatment: 📍Hospitalization. 📍Exclusion of other causes of encephalopathy and treatment of any that are discovered: Sepsis, Hypoxia. 📍Identification and treatment of correctable precipitating factor. 📍Emperic treatment (1st line): » Gut cleansing with enemas and gastric aspiration or lavage. » Low-protein or zero-protein diet. » Lactulose: 15 mL orally or by nasogastric tube every 2 hours until loose bowel movements are initiated and then 30 mL orally two to three times daily titrated to produce two to three bowel movements per day. 📍Second-line therapy, if needed: » Hepamerz. » Antibiotics: Rifaximin, Metronidazole. 📍Liver transplantation.

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