Showing posts with label GIT. Show all posts
Showing posts with label GIT. Show all posts

Nov 27, 2017

Irritable Bowel Syndrome (IBS) Definition, Causes, Diagnosis and Treatment

Irritable Bowel Syndrome (IBS) is defined as a functional bowel disorder in absence of structural pathology.


The etiology is uncertain:-
(1) Psychological disturbances e.g. anxiety and somatisation are evident.
(2) Altered GI motility.
(3) Visceral hypersensitivity
(4) Luminal factors: eg. abnormality in gut flora.

Clinical Picture of IBS:

(long history with long symptom-free intervals).
1. Recurrent abdominal pain: it is classically situated in the left iliac fossa.
2. The pain is decreased by defecation or passing flatus.
3. There is constipation or diarrhea with feeling of incomplete evacuation.
4. The stools may be ribbon like with passage of mucus.
5. Abdominal distention is extremely common.
6. Abnormal stool passage e.g. straining or urgency.
7. Tenderness over the sigmoid colon.
8. Features of irritable person usually present.

Diagnostic Criteria of IBS ( Rome  Criteria ):

Abdominal discomfort or pain that has two of three of the following features:
Relieved with defecation and/Or:
Onset associated with a change in frequency of stool, and/or:
Onset associated with a change in form or appearance of stool.
Abnormal stool frequency i.e. > 3/ day and < 3/ week.
Abnormal stool form (hard, loose, watery, lumpy).

Non GI features of Irritable Bowel Syndrome:

- Dysmenorrhoea.
- Premenstrual tension.
- Headache.
- Bad breath.
- Unpleasant taste in the mouth.
-  Poor sleeping and Fatigue.
- Urinary symptoms e.g. frequency, urgency.

Factors that can trigger IBS:

GI infection.
Antibiotic therapy.
Psychological stress.
Mood disorders.
Eating disorders.
Pelvic surgery.
No positive findings .
- Recurrent pain in the right hypochondrium is usually not due to gall bladder
disease, but to the irritable bowel syndrome.
- Recurrent pain in the right iliac fossa is not due to chronic appendicitis, but to
the irritable bowel syndrome.

Treatment of Irritable Bowel Syndrome

1. Patients must be reassured of the benign nature of the condition.
2. A high fiber diet and bran are helpful.
3. Smooth muscle relaxants for pain e.g. Mebeverine.
4. Selective serotonin reuptake inhibitor paroxetine (Seroxat) in constipation
5. Tricyclic antidepressant e.g. amytriptyline (Tryptizole) 10-25 mg or
nortiptyline 75mg in diarrhea-predominant.
6. Tegaserod which is serotonin receptor agonist it activates serotonin
receptors in GIT (zelmac), 6mg/12hr, it can be used also in constipation -

Other GI symptoms suggestive of Psycho-somatic (Functional) disorders:

Nausea alone.
Abdominal bloating.
Vomiting alone.
Chronic right hypochondrial pain.
Chronic left iliac fossa pain.

Aug 4, 2015

Peptic ulcer treatment approach , medical and surgical

This is a full approach to treatment of Peptic ulcer including different types of drugs with doses and indications of surgical intervention .

A• Medical treatment :

The aim of medical treatment is to relief pain, induce ulcer healing and to prevent recurrence and complications .
1. Diet
- Soft bland diet. It is better to be small and frequent.
- Avoid irritant foods and smoking.
- Avoid excessive milk intake as it may increase acidity due to its calcium content.

2. H2 Blockers 
( for 4-6 weeks to ensure ulcer healing)
- Ranitidine (ZantaC®) 300 mg/D.
- Famotidine (Antodine®) 20-40 mg/D .

3. Proton pump inhibitors (PPIs)
- for 4-8 weeks .
- Omeprazole (LoseC®) 20 mg/D.
- Pantoprazole (ControloC®) 40 mg/D.
- Lanzoprazole (Lanzor®) 30 mg/D.

4. Eradication of H.pylori 
 ( Triple therapy for 2 weeks)
- A proton pump inhibitor e.g omeprazole 20-40mg/D .
- Also 2 antimicrobials are used; Metronidazole 400mgITIDplus amoxycillin 750mg rnD or clarithromycin 500mg/TID are used. Heli-cure is a drug in the market containing tinidazole, omeprazole and clarithromycine, it is given one tab/12hr for 2 weeks .

5. - Avoid NSAIDs, or use selective COX-2 inhibitors.
    - Cessation of smoking.

Aug 3, 2015

Peptic Ulcer symptoms,signs, investigations and complications

This article to discuss the clinical picture of Peptic ulcer ( symptoms and signs ) , the routine investigations and complications in order to achieve a good approach to diagnosis of the disease.

Symptoms of Peptic ulcer 

1. Epigastric pain :
- Character :.burning, stabbing, or dull ache .
- Site : patient points to the epigastrium .  The patient can indicate its site with two or three fingers (the pointing sign). Back pain suggests penetrating ulcer .

- Relation to meals :
Duodenal ulcer: it is worse when the patient is hungry & at night.
Gastric ulcer: It occurs 0.5-1 hr after meals .

- Night pain : Pain wakes the patient from sleep suggests DU.
- Pain relief : 
Duodenal ulcer: Food, antacids and vomiting.
Gastric ulcer: fasting, antacids and vomiting.
2. Nausea : may accompany the pain.

3. Vomiting : It is infrequent but often relieves the pain. Some patients learn to induce vomiting for pain relief.

4. G.I bleeding : 
- It may be manifested by hematemesis or melena. Also chronic undetected blood loss may occur leading to anemia.

5. Appetite is variable :
-  Duodenal ulcer: It increases in most cases. Also the patient may identify the pain as hunger pain and obtains relief by eating, weight gain may occur.

- Gastric ulcer: Patient suffers from sitophobia for fear of pain, weight loss may occur.

6. Heart burn : It occurs due to acid regurgitation. Water brash also may occur .

7. Episodic pain ( Periodicity ) :
This will occur especially in duodenal ulcer. The pain occurs in (on again/off again) episodes lasting 2-3 weeks at a time, three or four times in a year. Between episodes the patient feels well.

8. Manifestations of Complications 
In some patients the ulcer is completely silent, presenting for the first time with complication .

Signs of Peptic ulcer 

( May be negative )
Tender epigastrium .
Signs of anemia.
Signs of peritonitis with perforation.

Investigations :

1. Upper Endoscopy :
- For exclusion of GERD or malignancy & to differentiate between benign & malignant gastric ulcers.
- All gastric ulcers should be biopsied .

2. Barium meal  : less commonly used 
Gastric ulcer : Ulcer niche on the lesser curvature with serial films.Notch on the greater curvature opposite the niche .
Duodenal ulcer :deformity of the duodenal cap with serial films.

3. Investigations for Helicobacter pylori :
1. Serum antibodies: detect IgG antibodies (sensitive and specific) but are not useful for eradication.
2. Urease test: biopsies are added to a urea solution; in positive cases the urease splits urea to release ammonia giving color change in the indicator, as ammonia raises the pH of the solution .
3. Culture: biopsies obtained can be cultured.
4. Histology: H. pylori can be detected histologically by (Giemsa) stained sections of gastric mucosa obtained by biopsy.

Non invasive method to diagnose H. pylori is 13C urea breath test by measuring of the breath after ingestion of  C13 urea. It is a quick, easy screening test.

Complications of Peptic ulcer
1. Hemorrhage, hematemesis, melena or anemia .
2. Fibrosis and obstruction 
- a) Gastric outlet obstruction.      b) Hour-glass stomach.

3. Perforation (common in duodenal ulcer) 
This causes generalized peritonitis, or subphrenic abscess. Plain chest X ray showing pneumoperitoneum. 

4. Penetration : Pain usually is sudden and radiates to the back, with rise of serum amylase.

Peptic Ulcer definition, causes and pathogenesis

- HCI is secreted in the stomach by the parietal cells through the action of the Hydrogen-potassium ATPase (proton pump).
- Secretion of HCI is under neural and hormonal control. Both stimulate acid secretion through the direct release of histamine stimulating the parietal cells. Acetylcholine and gastrin also release histamine.

- Somatostatin inhibits both histamine and gastrin release decreasing acid secretion.
- Gastrin is secreted by G cells in the antrum, it stimulates HCI secretion.

Definition of Peptic Ulcer

It is an ulcer in the duodenum, stomach, lower esophagus or in the Jejunum after gastrojejunostomy with exposure to acid-peptic juices with a defect in the mucosa that extends through the muscularis mucosa into the submucosa or deeper.

Aetiology of  Peptic ulcer

The proteolytic enzyme pepsin and gastric acid were initially identified as the key factors involved in the pathogenesis of peptic ulcer. So the concept of no acid, no ulcer has been widely used and accepted for many years, recently,the role of factors other than acid and pepsin in the pathogenesis of peptic ulcer has been recognized. e.g. :

A. Helicobacter Pylori (H.Pylori) :

H. pylori is a spiral-shaped, gram negative, urease producing organism.
The organism is found under the mucus layers in close to gastric epithelial cells.
It is transmitted by faeco-oral or oral-oral (saliva) routes.
30-60% of western populations are affected and the prevalence is higher in underdeveloped countries. The older populations are more liable.
Pathogenetic factors of  H.pylori infection :
 Increase gastrin release.
Increase pepsinogen secretion.
Cytotoxin release.
An alteration in the mucus protective layer.
Decrease in somatostatin from the antral cells (somatostatin inhibits both histamine and gastrin release).
The organism produces urease enzyme. which splits urea producing ammonia which raises the pH around it to protect itself.

B. Non-Steroidal anti-inflammatory drugs (NSAIDs)

Prostaglandins have important several mechanisms to protect gastric mucosa. They stimulate bicarbonate & mucus secretion from the gastric mucosa. Also they increase the microvasculature of the mucosa. All these mechanisms are called the mucosal barrier.
NSAIDs act by inhibiting cyclo-oxygenase enzyme (COX) leading to decrease prostaglandins at the site of inflammation.
NSAIDs decrease gastric and duodenal prostaglandins, so mucosal erosions & ulcerations will occur.
The cyclo-oxygenase enzyme (COX) has 2 types, COX-2, which is present at sites of inflammation and COX-1, which is present in the stomach.So COX-2 inhibitors will not affect the gastrointestinal mucosa .

C. Smoking 
D. Other factors :
 Reflux is responsible for ulcers at lower esophagus.
Gastrinoma (Zollinger-Ellison syndrome).
Peptic ulcer (PU) is more common in men than women .
Familial incidence especially in duodenal ulcer (DU).
Peptic ulcer is more common with blood group O .

Globus and Mallory Weiss syndrome definition and causes

These are two known esophageal diseases .

What is meant by esophageal globus ?

(Globus hystericus is an old name)
- It is persistent or intermittent sensation of a lump or foreign body in the throat, this sensation is present between meals.

Absence of dysphagia on swallowing.
- In the majority, it is probably a functional disease .
- It is treated by reassurance with anti-reflux therapy.

What is Mallory Weiss syndrome  ?

- It is a linear mucosal tear at the esophageo-gastric junction produced by a sudden increase in the intra-abdominal pressure.

- It usually occurs after a bout of coughing, retching or after an alcohol binge.
- It is diagnosed by endoscopy.

- The hemorrhage stops spontaneously. Rarely surgery with oversewing of the tear may be required.

How to differentiate esophageal (GERD) from cardiac causes of chest pain

Chest pain is one of the common symptoms of both Myocardial ischemia and Gastro-esophageal reflux disease (GERD) , and here , we are going to discuss the difference between both cases .

A. Characters of Pain in case of GERD :

Burning pain produced by bending, stooping or lying down.
Pain seldom radiates to the arm.
Pain precipitated by drinking hot liquids or alcohol .
Relieved by antacid, and aggravated by nitrates.
No dyspnea.

B. Characters of Pain in case of Myocardial ischemia :

Compression or crushing pain.
Pain radiates into neck, shoulder and both arms.
Pain produced by exercise.
Relieved by rest and nitrates.
Dyspnea may present.

Aug 1, 2015

Gastroesophageal reflux disease (GERD) causes,diagnosis and treatment

Definition of GERD :

 Reflux of gastric contents into the esophagus which allows prolonged contact of these contents with the lower esophageal mucosa. It is the most common disorder of the esophagus.

Causes and Pathogenesis of GERD 

(failure of antireflux mechanisms)
1. The resting lower esophageal sphincter (LOS) is low and fails to increase when lying flat .
2. Decrease esophageal clearance of acid due to poor esophageal peristalsis.
3. Delayed gastric emptying.
4. Hiatus hernia may impair the pinchcock mechanism of the diaphragm.
5. The lower esophageal sphincter tone fails to increase when intra abdominal pressure is increased by tight clothes or pregnancy .

Factors associated with increased reflux :

- Obesity                 - Fat, peppermint
- Pregnancy             - Chocolate
- Coffee (Caffeine)  - Smoking
- Anticholinergics    - Ca channel blockers
- Nitrates                   - Hiatus hernia

How to diagnose GERD ?

a. Clinical Picture :
1. Heart burn: It is the most cardinal symptom of GERD, it is due to direct stimulation of the hypersensitive esophageal mucosa.

2. Chest pain: similar to angina (due to reflux or esophageal spasm).

3. Odynophagia: (painful swallowing).
4. Dysphagia: due to disturbed motility or structure.

5. GIT bleeding, Iron deficiency anaemia (esophagitis).
6. Pulmonary: cough, aspiration pneumonia may occur.

b. Investigations :
GERD is a clinical diagnosis and many patients can be treated without investigations .
- Endoscopy. to confirm the presence of esophagitis.
- 24 hour intra-luminal pH monitoring of the esophagus.
- Esophageal manometry.
- Barium study: It may show a hiatus hernia.

Complications of GERD :

1. Stricture of esophagus.
2. Esophageal ulceration.
3. Barrett's esophagus: columnar metaplasia of the lower esophagus.It is a premalignant leading to adenocarcinoma.
4. Reflux induced laryngitis.

Treatment of Gastro-Esophageal reflux disease (GERD)

I. Simple Lifestyle measures :

50% of patients can be treated by:
- Cessation of smoking, loss of weight and simple antacids.
- Avoid alcohol, fatty meals & drugs e.g. nitrates.
- Avoid heavy meals especially before sleep.
- Raising the head of the bed at night.
- Avoid any other precipitating factor.

II. Pharmacological therapy 

1. Drugs that reduce gastric acidity :
Prolonged therapy is usually needed .
- Antacids: Mg trisilicate and aluminium hydroxide, also alginate containing antacids forming a gel with gastric contents reducing reflux.
- H2 blockers: Ranitidine (Zantac (300mg at bed time) .
- Proton pump inhibitors: Omeprazole (20-40mg/day),Lanzoprazole (30mg/day) or pantoprazole (20- 40mg/day). They inhibit the gastric hydrogen-potassium ATPase .

2. Drugs that increase esophageal peristalsis and LOS pressure ( Prokinetic) :
- Cisapride (Prepulsid): not available now!? It leads to arrythmia.
- Metoclopramide or Domperidone.

III. Surgery :

Nissen fundoplication (antireflux surgery) is performed laparoscopically
for severe cases with repair of hernia if present. The gastric fundus is warraped around the abdominal oesophagus.

Jul 31, 2015

Cancer Esophagus causes, pathology, diagnosis and treatment

Cancer esophagus is one of the most lethal of all cancers (Carcinoma of the esophagus) .

Predisposing factors:

It is more common in old males (60-70 years).
Smoking, alcohol, achalasia or reflux and Barrett's esophagus. i.e. columner metaplasia of the lower esophagus  .
Tylosis (hereditary disorder of squamous epithelium) with hyperkerosis of palms and soles.
Corrosive strictures.
Plummer-Vinson syndrome .

Pathology of Carcinoma of the esophagus

- Macroscopically: The lesion is usually ulcerative & it extends around the wall of the esophagus, causing narrowing.

- Microscopically: It is usually squamous cell carcinoma. Also adenocarcinoma may arise in columnar epithelium of Barrett's esophagus, due to longstanding reflux

Spread: Direct, haematogenous or through lymphatics.

How to diagnose Esophageal carcinoma ?

Clinical features :
- Progressive dysphagia, first to solids and eventually to fluids.
Weight loss, due to dysphagia and anorexia.
Mediastinal syndrome.
Late the esophageal obstruction causes difficulty in swallowing and coughing with pulmonary aspiration.
Investigations :

1. Barium swallow: - Irregular filling defect with shouldering sign.
                                 - Rat-tail appearance may occur.
2. Esophagoscopy: with biopsy.
3- CT scan of chest & abdomen for size of the tumor & spread outside the esophagus.

Treatment approaches of Cancer Esophagus 

A. Surgical resection: If the tumor has not infiltrated outside the esophageal wall followed by chemotherapy and radiation, but unfortunately most patients presented late.

B. Other methods of restoring swallowing, in cases of metastatic disease:

1. Radiotherapy is limited for squamous cell carcinoma of the upper and middle third.
2. Chemotherapy (5-fluouracil and cisplatin) can be used with radiotherapy.
3. Palliative maneuvers: stent application or by-pass operation to allow fluids and soft food to be eaten or local destruction of the tumour by laser.

Esophageal achalasia pathology, clinical features, investigations and treatment

Definition of Esophageal achalasia :

It is a motility disorder of the esophagus characterized by failure of relaxation of the lower esophageal sphincter with aperistalsis in the body of the esophagus (atony).

1) Degeneration in the myenteric nerve plexus of the esophageal wall.
2) Lesion in the nitric oxide containing neurons.

How to diagnose Esophageal achalasia ?

Clinical picture of Esophageal achalasia  :

(The disease is more common in middle-aged females).
- Intermittent dysphagia to fluids &to solid foods.
- Retrosternal chest pain occurs with vigorous non peristaltic contraction of the esophagus .
- Putrefaction of the retained food leads to halitosis.
- Chest infections may occur due to aspiration during sleep, due to regurgitation.
- Weight loss is usually not marked.

Investigations :

1. Chest x ray showing: Absence of gases in the fundus of the stomach.

2. Barium swallow shows Dilated esophagus, the lower end gradually narrows (bird's beak
3. Upper endoscopy:
For diagnosis & to exclude cancer esophagus in achalasia the endoscope can pass easily through the narrowing without resistance.
4. Manometry: It shows aperistalsis with failure of the lower esophageal sphincter to relax.

How to manage a case of Esophageal achalasia ?

1. The treatment of choice is endoscopic dilatation.
2. Endoscopic botulinum toxin injection in the lower esophageal sphincter.
3. Laparoscopic cardiomyotomy if these measures fail (Heller's operation). i.e. division of the muscle at the lower end of the oesophagus, it can be done laparoscopically.
4. In old age Ca Ch blockers (Nifedipine) can be tried initially.

Jul 30, 2015

Hiatus Hernia types,clinical picture,investigations and treatment

Definition of Hiatus Hernia :

This describes the herniation of a part of the stomach into the chest.

I. Sliding Hiatus hernia 

There is herniation of the gastro-esophageal junction through the esophageal hiatus in the diaphragm into the thorax.
This will affect the valvular mechanism of the gastro-esophageal junction leading to reflux of gastric contents into the esophagus.

Clinical features :

Heart burn (Pyrosis): It is a burning retrosternal pain occurring in lying down Qr leaning forward, it is severe during sleep.
Dysphagia may occur due to esophageal stricture.
Bleeding e.g. haematemesis, melena or presented with iron deficiency anemia due to esophagitis.
It may be asymptomatic.

Investigations :

1-Barium swallow.            2-Upper endoscopy


A. Medical :
 Weight reduction, also meals should be small.
Sleeping in sersl-slttlnq position.
H2 blockers and proton. pump inhibitors.
Prokinetic drug: Domperidone (motilium) .
B. Surgical 
Indicated in resistant cases, (fundoplication) .

II. Para-oesophageal (Rolling) hernia

A small part of the fundus of the stomach rolls up alongside the esophagus through the hiatus.
The gastro-esophageal junction remains in normal position, so there is no reflux.
It may lead to mediastinal syndrome if severe.
Also gastric volvulous or strangulation may occur.
Surgery is indicated in severe cases.

Structure of the esophagus and mechanism of swallowing

Structure of the esophagus

The esophagus is a hallow muscular tube, about 25 cm long connecting the pharynx to the stomach, it has no significant absorption or secretory function.
It is lined by stratified squamous epithelium except near the gastro- esophageal junction lined by columnar epithelium.
The esophagus is separated from the pharynx by the upper esophageal sphincter (UES) which is normally closed by the cricopharyngeus muscle contraction .
The lower esophageal sphincter (LOS) consists of an area of the distal end of the esophagus with a high resting tone to prevent reflux .
The relaxation and reduction of LOS tone that occurs during swallowing is under the control of vagus and other hormonal mechanisms. The presynaptic neurotransmitter is acetylcholine. The postsynaptic neurotransmitters which cause relaxation are nitric oxide and vasoactive intestinal peptide.

Mechanism of Swallowing 

The act of swallowing begins with propulsion of the chewed bolus into the posterior oropharynx by the tongue.
During the next phase of  swallowing several actions occur : 
- The soft palate elevates to close the nasopharynx .
- The epiglottis close over the larynx .
- The UES relaxes .
- The pharyngeal constrictors contract to propel the bolus into the eosophagus .

Jul 29, 2015

Diseases of the Salivary glands,definition, causes and management

Here is a list of the diseases that affect the salivary glands, with definition, causes and management of each .


- It is  Excessive salivation .
- Causes :
- Psychogenic.
- Prior to vomiting.
- Secondary to oral pathology e.g. stomatitis.


- It is dryness of the mouth .
Causes :
- Dehydration.
- Psychogenic.
- Sjogren's syndrome .
- Radiotherapy.
- Drugs e.g. anticholinergics and antihistaminics.


- It is inflammation of the salivary glands .
- Acute sialadenitis may be due to mumps (parotitis) or bacteria.

Salivary Calculi

- These occur occasionally in the submandibular gland or its ducts.
Clinical picture :
Painful swelling of the submandibular gland after eating.
Stones can sometimes be felt in the floor of the mouth.
Investigations :
Sialography and Plain X-ray will show the stone.

Treatment : Surgical removal.

Tumors of of  Salivary glands

- The majority occur in the parotid gland.
- The pleomorphic adenoma is the commonest which may turn malignant.
- Malignant tumors usually result in lower motor neurone lesion of facial nerve.

Sarcoidosis can involve salivary gland. e.g. in cases of Heerfordt's and Mikulicz syndromes .

Diseases of the tongue : Glossitis,Leukoplakia and Tumors

This is a list of the different types of diseases that affect the tongue.

1. Glossitis 

- It may be involved in stomatitis due to nutritional deficiency.
- Glossitis is a red, smooth, sore tongue seen in 812, folate and iron

2. Leukoplakia:

It is a chronic lesion (White, firm smooth patches).
It usually starts at the side of the tongue.
Early it is not painful but later become tender.
It is associated with alcohol and smoking.
It may precede the development of carcinoma.
Isotretinoin may reduce disease progression.

3. Black hairy tongue:

It is due to proliferation of chromogenic microorganisms causing brown staining of elongated filiform papillae.
It is of Unknown etiology .

4. Functional disorders of the tongue :

Glossodynia (painful tongue) and glossopyrosis (burning sensation in the tongue) if the tongue looks normal the cause may be depression.
Bad taste in the mouth is sometimes due to drugs or sinusitis but it may reflect anxiety or depression.

5. Tumors of the tongue :

Squamous cell carcinoma.
Kaposi's sarcoma in AIDS.

Jul 28, 2015

Stomatitis causes,types, diagnosis and treatment | Mouth diseases

- The mouth contains many of commensal micro organisms. So, oral hygiene is essential. Negligence
of oral hygiene may lead to bacterial proliferation causing stomatitis.

- Stomatitis may also occur when resistance to the commensal population is lowered e.g. in the immune-compromised host.
- Stomatitis may also occur due to nutritional deficiency.

What is meant by stomatitis ?

It is inflammation of the mucous lining of any of the structures in the mouth, which may involve the gums,cheeks, tongue, lips, and roof or floor of the mouth .

1. Ulcerative stomatitis

Clinical Picture :

- It occurs in adults with malnutrition and poor dental hygiene.
- There are ulcers on the gum, palate, lips and the inner aspects of cheeks.
- Halitosis ( odor from the mouth ) .
Investigations :
- A stained smear shows spirochetes and fusiform bacilli.
Treatment :
- Metronidazole or penicillin .

2. Viral Stomatitis

-  Herpes simplex may cause herpes labial is in normal persons.
- It can lead to severe stomatitis in immune-compromised patients.
- Coxsackie virus causes herpangina with acute pharyngitis, ulcers of the soft palate and pharyngeal mucosa.

3. Candidiasis (Moniliasis) 

Etiology :
- The fungus candida albicans is a normal commensal in the mouth. It may proliferate to cause thrush in babies and in debilitated patients.

- Also thrush is common in patients receiving prolonged treatment with antibiotics and in patients who are immunosuppressed by corticosteroids or AIDs.

Clinical picture :
- White patches on the tongue and buccal mucosa.
- In severe infection the pharynx and esophagus can be affected causing dysphagia .
Treatment :
Treatment of the cause .
Lozenges or suspension of nystatin. .
Systemic antifungal in severe infection.
4. Stomatitis due to Nutritional deficiency

- This occurs due to deficiency of niacin, riboflavin, folic acid and vitamin B12.
- When the deficiency is acute and severe the tongue is red and painful because of atrophy of the papilla .
- Angular stomatitis often accompanies glossitis especially in severe riboflavin and iron deficiency.

What is Angular Chelitis (Angular stomatitis ) ?

 It is erythema or crusting of the labial angles. It is also caused by candida. It is associated with.intraoral candidasis. It is treated with topical with or without systemic. antifungal drugs, iron and vitamin supplements.

What does Chelitis mean ?

Painful vertical fissures mainly of lower lip caused by malnutrition. It may occur in crohn's disease or with·exposure to sunlight and wind .

5. Recurrent Aphthous Ulceration 

- It affects 20% of population .
- Unknown etiology.
- Emotional stress may precipitate the attack.
- May occur during the premenstrual phase.
- May occur in association with Crohn's disease, ulcerative colitis or Behcet's disease.
- Nutritional deficiencies with or without GI disorders are occasionally found.
- The ulcers are recurrent at intervals of days to a few months.
Clinical picture :
- Multiple shallow rounded ulcers, they are PAINFUL .

- Minor ophthous ulcers are < 10mm with grey white center with thin erythematous halo and heal with 14 days without scarring .
- Major aphthous ulcers > 10mm persist for weeks or months and heal with carring
Treatment :
- Hydrocortisone hemisuccinate lozenges .
- To ical anesthetics .
- Colchicine .

Aug 22, 2013

Intussusception def., causes, diagnosis, pathology, types, treatment

In this article, we are going to discuss Intussusception which is a serious disorder and it can cause intestinal obstruction with its known complications.
We are going to discuss the definition, aetiology (causes), pathology, clinical picture (symptoms and signs), investigations, differential diagnosis, and treatment (management) of Intussusception .

What is meant by Intussusception ?

Definition: One portion of gut becomes invaginated into another immediately adjacent portion .
Primary intussusception
1.      Idiopathic:
2.      Infant between 6th – 7th months.
3.      In terminal 50 cm of ilium
4.      Theories: à Change of diet, Seasonal incidence
Secondary intussusception (Occurs 2ry to):

1.      Polyp.
2.      Submucous lipoma.
3.      Papilleferous carcinoma.
4.      Inverted Mickle’s diverticulum.


·         The intussusception is made up of: Entering layer, Returning layer, Outer sheath, Apex., Base.
·         The apex is the part which advances.
·         The base of the sheath will contract on the intussusceptum constricting its lumen & its mesenteric vessels.
Types of intussusception:

Diagnosis of Acute intestinal obstruction - symptoms, signs, investigations

Here is an approach to diagnosis of acute intestinal obstruction in which, we are going to discuss the symptoms, signs and diagnostic investigations of I.O .

Clinical Picture Of Acute IO

: Characterized by Pain, Vomiting & Absolute constipation.
1. suddenly severe colicky pain (in bouts)
2. more in Small IO > Large IO
3. starts allover the abdomen but mainly around the umbilicus
4. absent in paralytic ileus, in strangulation à ischemic stabbing

Apr 20, 2013

Causes of Dysphagia ( Difficult Swallowing )

Here we will discuss the definition and causes of Dysphagia which is a common GIT symptom .

 Definition: It means Difficulty in swallowing


A. Causes in the Mouth :

  1. Stomatitis
  2. Glossitis.
  3.  Neoplasm of Tongue & Cheek.

B. Causes in the Pharynx:

 1. Pharyngitis.
 2. Pharyngeal Diverticulum.
 3.Retro-pharyngeal Abscess.

Dec 15, 2012

Peptic Ulcer causes and risk factors (Acute)

What is  Peptic Ulcer ?
It is ulceration of mucosa bathed in gastric juice.

Where does Peptic Ulcer occur ?

Site :  A- Duodenum à (commonest).
            B- Stomach.
            C- Rarely in: Jejunum, Esophagus, Mickle’s diverticulum .

What are the Causes and predisposing factors of  Peptic Ulcer ?

Nov 14, 2012

Tuberculous Peritonitis causes , clinical picture , investigations and treatment

This is a brief review of Tuberculous Peritonitis , which is a serious medical case that results in many serious complications .
Here , we will discuss the Aetiology , Pathology , Diagnosis and management of the disease , so let's start .


- Age: usually 5-20 years. 
- Sex: equal.
- Mode of infection:

-- Secondary to: Tuberculous mesenteric LNs, tuberculous ente . tuberculosis of fallopian tubes or pulmonary tuberculosis.

-- Primary (Rare): Occurs in children taking infected milk.