"My help comes from the LORD, who made heaven and earth"

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1) Discuss the indications contraindications preparation • Ensure that all accessories and instruments needed for the
and procedure of endoscopy. (2) procedure, such as biopsy forceps and hemostatic clips, are
Preparation: available and in working condition.
Patient Preparation: • Follow standardized protocols for cleaning, disinfection,
• Advise the patient to adhere to fasting guidelines typically and sterilization of reusable instruments to prevent cross-
ranging from 6 to 12 hours before the procedure, depending contamination.
on the type of endoscopy. Procedure:
• Provide clear instructions regarding medication 1. Pre-procedure: Administer sedation and anesthesia as per
adjustments, especially anticoagulants or antiplatelet the patient's requirements and the healthcare provider's
agents. orders. Position the patient appropriately for the type of
• Inform the patient about the procedure, its purpose, endoscopy being performed.
potential risks, and obtain informed consent. 2. Insertion of Endoscope: Gently insert the endoscope
• Assess the patient's medical history, allergies, current through the appropriate orifice (mouth for upper endoscopy,
medications, and comorbidities to identify any factors that anus for colonoscopy) and advance it into the
may affect the procedure or sedation. gastrointestinal tract.
Endoscopy Room Preparation: 3. Visualization and Examination: Carefully maneuver the
• Ensure that the endoscopy suite is equipped with necessary endoscope to visualize the mucosa of the esophagus,
instruments and supplies, including endoscopes (upper stomach, duodenum (in upper endoscopy), or colon (in
endoscope or colonoscope), biopsy forceps, insufflation colonoscopy). Insufflate air or carbon dioxide to distend the
equipment, suction devices, and monitors for vital sign lumen for better visualization.
monitoring. 4. Biopsy and Intervention: Perform biopsies of suspicious
• Verify the functionality and cleanliness of all equipment lesions, polypectomy for polyps, hemostasis for bleeding
and ensure that endoscopes are properly sterilized or high- sites, and other therapeutic interventions as indicated.
level disinfected according to guidelines. 5. Withdrawal of Endoscope: Slowly withdraw the
• Set up the room to facilitate safe patient positioning, access endoscope while inspecting the mucosa for any
to emergency equipment, and easy maneuverability of the abnormalities. Remove excess secretions or debris with
endoscope. suction as needed.
Instrument Preparation:
• Verify the functionality and integrity of the endoscope,
including its light source, camera, and suction channels.
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Post-Procedural Care: Contraindications:

• Monitor the patient's vital signs, including heart rate, blood • Absolute Contraindications: Patients with severe
pressure, respiratory rate, and oxygen saturation, until they cardiovascular instability, severe respiratory compromise,
meet discharge criteria. or recent myocardial infarction are generally considered
• Assess for any signs of post-procedural complications such unfit for endoscopic procedures due to the risks associated
as bleeding, perforation, or adverse reactions to sedation. with sedation and the procedure itself.
• Provide appropriate pain management and reassurance to • Relative Contraindications: Patients with significant
the patient. coagulopathy, thrombocytopenia, or taking anticoagulant
Indications: medications pose an increased risk of bleeding during
• Diagnostic: Endoscopy is indicated for various endoscopy. Furthermore, patients with significant throat or
gastrointestinal symptoms such as abdominal pain, esophageal obstruction, recent abdominal surgery, or severe
gastrointestinal bleeding, dysphagia, odynophagia, changes comorbidities may have higher risks associated with the
in bowel habits, and unexplained weight loss. It allows procedure and should be evaluated on a case-by-case basis.
direct visualization of the gastrointestinal tract, aiding in the Complications:
diagnosis of conditions such as gastroesophageal reflux • During Procedure: Potential complications during
disease (GERD), peptic ulcers, inflammatory bowel disease endoscopy include bleeding, perforation, aspiration,
(IBD), and malignancies. adverse reactions to sedation, and cardiopulmonary events
• Therapeutic: Endoscopy serves as a therapeutic modality such as arrhythmias or hypoxemia.
for interventions such as polypectomy, dilation of strictures • After Procedure: Post-procedural complications may
(e.g., in achalasia or Crohn's disease), hemostasis for include bleeding, infection, perforation, abdominal pain,
gastrointestinal bleeding (e.g., peptic ulcer bleeding), and adverse reactions to sedation, and exacerbation of
foreign body removal. underlying medical conditions.
• Screening: Endoscopy is used for screening and Scientific Principle: The scientific principle behind endoscopy
surveillance purposes in certain populations. Colonoscopy lies in the use of optical technology to visualize the internal
is recommended for colorectal cancer screening in average- structures of the body. Endoscopes are slender, flexible or rigid
risk individuals starting at age 50 in most guidelines. instruments equipped with a light source and a camera that can
Additionally, upper endoscopy may be indicated for transmit images in real-time to a examine the interior of hollow
surveillance of high-risk patients for esophageal or gastric organs or body cavities.
cancer, such as those with Barrett's esophagus or a family
history of gastrointestinal malignancies.
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2) Infection control and Hygiene protocol of endoscopy o Sterile items should be handled with care, using
room and write briefly on patient preparation for designated sterile fields and techniques to prevent contact
gastro- endoscopies. (4) / Surgical Asepsis – principles with non-sterile surfaces or objects.
and methods in relevance to the endoscopy room (2) 4. Cleaning and Disinfection:
Infection control and hygiene protocols • Endoscopic equipment, accessories, and environmental
Infection control and hygiene protocols in the endoscopy room surfaces should be thoroughly cleaned and disinfected
are essential to prevent the transmission of infections between between each patient procedure.
patients and healthcare providers. These protocols aim to • High-touch surfaces such as endoscopy carts,
maintain a clean and safe environment, minimize the risk of countertops, and doorknobs should be cleaned and
contamination, and ensure patient safety during endoscopic disinfected regularly using approved disinfectants.
procedures • Endoscopic equipment should undergo manual cleaning
1. Hand Hygiene: followed by high-level disinfection or sterilization, as
• All healthcare providers should perform hand hygiene recommended by manufacturers and infection control
before and after patient contact, after removing gloves, guidelines.
and after touching potentially contaminated surfaces. 5. Single-Use Devices:
• Hand hygiene should be performed using soap and water • Whenever possible, single-use disposable devices and
or alcohol-based hand sanitizer, following the accessories should be used to minimize the risk of cross-
recommended techniques for thorough hand washing. contamination between patients.
2. Personal Protective Equipment (PPE): • Single-use devices should be properly disposed of after
• Healthcare providers should wear appropriate PPE, each procedure according to waste management
including gloves, gowns, masks, and eye protection, guidelines.
during endoscopic procedures to prevent exposure to 6. Environmental Controls:
infectious agents. • Adequate ventilation and air exchange should be
• PPE should be worn according to standard precautions maintained in the endoscopy room to reduce the
and changed between patient procedures or when visibly concentration of airborne contaminants and ensure a safe
soiled. working environment.
3. Aseptic Technique: • Environmental monitoring should be conducted regularly
o Healthcare personnel should practice aseptic technique to assess air quality and infection control measures.
when handling sterile instruments and supplies to avoid
contamination.
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7. Standard Precautions: 12 hours, to ensure the stomach is empty. Clear fluids may
• Standard precautions should be followed at all times to be allowed up to a certain point before the procedure.
prevent the transmission of infectious agents, including • Medication Management: Review the patient's
proper handling and disposal of sharps, safe injection medication list, particularly anticoagulants or antiplatelet
practices, and appropriate use of personal protective agents, and provide instructions regarding their use before
equipment. the procedure.
• Healthcare providers should be trained on infection • Medical History Assessment: Conduct a comprehensive
control practices and receive regular updates on infection assessment of the patient's medical history, allergies,
prevention guidelines and protocols. current medications, and comorbidities to identify any
8. Staff Education and Training: factors that may affect the procedure or anesthesia.
• Healthcare providers working in the endoscopy room • Informed Consent: Discuss the risks, benefits, and
should receive education and training on infection control alternatives of the procedure with the patient and obtain
principles, including hand hygiene, PPE use, cleaning and informed consent before proceeding.
disinfection techniques, and safe handling of medical • Pre-procedure Evaluation: Assess the patient's vital
devices. signs, including heart rate, blood pressure, respiratory
• Regular staff education sessions and competency rate, and oxygen saturation, and ensure baseline
assessments should be conducted to ensure compliance investigations such as blood tests and imaging studies are
with infection control protocols. obtained as needed.
9. Documentation and Quality Assurance: • Patient Education: Provide the patient with information
• Endoscopy units should maintain documentation of about the procedure, including what to expect during and
cleaning and disinfection procedures, equipment after the procedure, potential risks and complications, and
maintenance, and infection control audits. post-procedure instructions regarding diet, activity, and
• Quality assurance programs should be implemented to follow-up care.
monitor compliance with infection control protocols and
identify areas for improvement.
Patient Pre-procedure Preparation for Gastro-
Endoscopies:
• NPO Status: Instruct the patient to fast for a specified
period before the procedure, typically ranging from 6 to

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3) Acute pancreatitis 3. Fever and Tachycardia:

Acute pancreatitis is a sudden inflammation of the pancreas, • Fever and rapid pulse are indicative of systemic
characterized by severe abdominal pain and potentially life- inflammation and may be present, especially in severe
threatening complications. Here's an overview covering causes, cases or if complications develop.
symptoms, diagnosis, treatment, and complications: 4. Abdominal Tenderness and Guarding:
Causes: • Physical examination may reveal abdominal tenderness,
• Gallstones: One of the most common causes, where rigidity, or guarding upon palpation, particularly in the
gallstones block the pancreatic duct, leading to epigastric region.
inflammation. 5. Ileus:
• Alcohol consumption: Chronic heavy alcohol use is • Bowel sounds may be diminished or absent due to
another significant cause of acute pancreatitis. paralytic ileus, a common finding in acute pancreatitis.
• Trauma: Injury to the pancreas, such as from a car 6. Jaundice:
accident or physical trauma, can trigger inflammation. • In severe cases, jaundice may develop due to obstruction
• Medications: Certain medications, such as of the common bile duct by edema, inflammation, or
corticosteroids, diuretics, and some antibiotics, can cause gallstones.
pancreatitis. Investigations:
• Other causes: These include high levels of triglycerides, 1. Total leucocyte count:There may be leucocytosis (count
infections, autoimmune diseases, and genetic factors. between 15000-20000 cells/µL).
Clinical Features: 2. Serum amylase and lipase. They are raised.
1. Abdominal Pain: 3. Blood sugar. It may be normal or elevated (hyperglycaemia)
• Characterized by sudden-onset, severe, persistent 4. Serum bilirubin and serum hepatic enzymes (SGOT/SGPT).
epigastric or upper abdominal pain that may radiate to the They may be elevated.
back or flanks. 5. Serum calcium. It is low.
• Pain is often described as piercing or stabbing and may 6. Plain X-rays of aldomen may show gall stones, a sentinal
worsen with eating, particularly fatty foods. loop (a segment of air filled small intestine most commonly in
2. Gastrointestinal Symptoms: left upper quadrant), the "colon cut off sign" (a gas filled
• Nausea and vomiting are common, with vomiting not segment of transverse colon abruptly ending at the area of
relieving the pain. pancreatic inflammation).
• Anorexia and subsequent weight loss may occur due to
decreased oral intake and gastrointestinal symptoms.
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7. Ultrasonography/CT/MRI scan which show an enlarged, risk of infectious complications. Nutritional

swollen pancrease with or without pseudocyst. supplementation should commence cautiously once the
Complications: patient's pain and gastrointestinal symptoms improve.
• Necrotizing pancreatitis: Severe cases may lead to tissue 2. Treatment of Underlying Causes:
necrosis (death) of the pancreas, which can result in • Gallstone Pancreatitis: Patients with gallstone
infection, abscess formation, or systemic inflammatory pancreatitis may require endoscopic retrograde
response syndrome (SIRS). cholangiopancreatography (ERCP) with sphincterotomy
• Pancreatic pseudocyst: Accumulation of fluid and debris and stone extraction or surgical intervention to remove
around the pancreas, which may become infected or cause obstructing gallstones.
obstruction of nearby structures. • Alcohol Cessation: Patients with alcoholic pancreatitis
• Organ failure: Acute pancreatitis can lead to must abstain from alcohol consumption to prevent
complications such as respiratory failure, renal failure, or recurrent episodes and mitigate disease progression.
shock, requiring intensive care and supportive measures. 3. Monitoring and Complication Management:
Treatment • Intensive Care Unit (ICU) Admission: Severe cases of
1. Supportive Care: acute pancreatitis, especially those complicated by organ
• Fluid Resuscitation: Intravenous fluids, typically failure, necrosis, or infection, necessitate ICU admission
isotonic crystalloids, are administered aggressively to for close monitoring and supportive care.
restore intravascular volume and prevent hypovolemic • Management of Complications: Complications such as
shock. Goal-directed fluid therapy is crucial to maintain infected necrosis, pseudocysts, or multiorgan failure
adequate tissue perfusion without exacerbating edema or require prompt diagnosis and appropriate interventions,
causing complications like pulmonary edema. which may include surgical debridement, drainage
• Pain Management: Analgesics such as opioids or procedures, or organ support measures.
nonsteroidal anti-inflammatory drugs (NSAIDs) are used
to alleviate severe abdominal pain. However, caution is 4) Alcoholic Liver Disease
necessary to avoid respiratory depression and other Alcoholic liver disease occurs after prolonged consumption of
adverse effects, especially in patients with respiratory alcohol (e.g. chronic alcoholics) and varies between
compromise or renal impairment. individuals. It is more common among males than females, but
• Nutritional Support: Early enteral feeding is preferred females are more susceptible to it. The upper safe limit in
over total parenteral nutrition (TPN) to maintain gut women is 30-40 gm and in men (60 gm). Each alcoholic drink
integrity, prevent bacterial translocation, and decrease the contains about 8 gm in one unit.
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Alcohol metabolism and pathogenesis: followed by fibrosis due to which the liver achitect or structure
Alcohol is metabolised in the liver to acetaldehyde by alcoholic gets disorganized and small nodules formed (micronodular
dehydrogenase enzyme and then into acetate and, thus, disturbs cirrhosis). Ultimately liver cell carcinoma develops in 10-15%
the fat metabolism. As a result of fat disturbance, serum of patients with alcoholic corrhosis.
triglycerides level rise and leads to alcohol-induced fatty Symptoms and Signs
change. 1. Early liver involvement in the form of fatty liver does not
produce any symptom. Only liver may be enlarged.
2. Patients with alcoholic hepatitis may have symptoms
pertaining to G.I tract, e.g. anorexia, morning retching or
nausea and occasional diarrhoea. The liver is enlarged and
tender. If acute alcoholic hepatitis develops often following a
alcoholic bout (binge), the patient can quickly becomes
severely ill with fever, pain abdomen, jaundice, a tender
enlarged liver and signs of acute hepatic. Leucocytosis with
large number of neutrophils may appear or patient may develop
pancytopenia (anaemia, leucopenia and thrombo- cytopenia)
due to hypersplenism in which all the three blood cells (RBCs,
WBCs and platelets) are destroyed. The bilirubin and serum
enzymes are also raised especially gamma glutamyl transferase.
3. Patients with alcoholic cirrhosis may show stigmata of
cirrhosis and may develop signs of portal hypertension (e.g.
Stages of ALD fetor hepaticus, abdominal collateral veins called caput
i. Fatty change in the liver due to fatty infiltration. medusae, ascites and splenomegaly). These patients ultimately
The stage is reversible if drinking is stopped. may develop chronic hepatic encephalopathy due to
ii. If drinking continues, the fatty change is followed by decompensation of the liver cells and may develop malignancy
alcoholic hepatitis in which liver becomes enlarged and tender of liver (hepatoma) later on if they survive.
due to inflammation. The liver cells undergo degeneration and Treatment
necrosis (death of the cells). 1. Abstinence from alcohol: The cornerstone of treatment for
iii. If drinking continues, the alcoholic hepatitis leads to ALD is complete cessation of alcohol consumption to
cirrhosis of the liver in which the necrosis of the liver is prevent further liver damage and promote liver regeneration.
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2. Nutritional support: Patients with ALD may benefit from 1. Write a note on colonoscopy.
dietary interventions to address malnutrition and Colonoscopy is a diagnostic and therapeutic procedure used to
deficiencies in vitamins (especially thiamine) and minerals. examine the interior lining of the colon and rectum. It involves
3. Pharmacotherapy: In severe cases of alcoholic hepatitis, the insertion of a flexible, lighted tube called a colonoscope
corticosteroids (e.g., prednisolone) or pentoxifylline may be through the anus and into the colon.
used to reduce inflammation and improve short-term Procedure:
survival. 1. Preparation: Prior to the procedure, patients are instructed
4. Management of complications: Treatment of to follow a bowel preparation regimen to cleanse the colon
complications such as ascites, hepatic encephalopathy, and ensure optimal visualization. This typically involves a
variceal bleeding, and hepatorenal syndrome may require clear liquid diet, laxatives, and/or enemas to empty the
specific interventions and close monitoring. bowels completely.
5. Education and counseling: Raise awareness about the risks 2. Sedation: Colonoscopy is usually performed under
of excessive alcohol consumption and provide support for conscious sedation, where medications are administered to
individuals seeking to reduce or quit drinking. help the patient relax and minimize discomfort during the
6. Liver transplantation is the last option in patients with procedure. In some cases, deep sedation or general
intractable cirrhosis. anesthesia may be used, particularly for complex or
prolonged procedures.
3. Insertion of Colonoscope: The colonoscope, a long,
flexible tube with a camera and light source at the tip, is
inserted into the rectum and advanced through the colon.
The scope is maneuvered carefully to navigate through the
twists and turns of the colon while minimizing patient
discomfort.
4. Visualization: As the colonoscope is advanced, the
physician examines the lining of the colon on a video
monitor in real-time. The scope allows visualization of the
entire colon, including the cecum, ascending colon,
transverse colon, descending colon, sigmoid colon, and
rectum.

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5. Biopsy and Intervention: During the procedure, the • Evaluation of symptoms such as rectal bleeding,
physician may perform various interventions as needed, abdominal pain, changes in bowel habits, or unexplained
including: weight loss.
• Biopsy: Small tissue samples (biopsies) may be taken for • Diagnosis and monitoring of inflammatory bowel disease
further analysis if suspicious lesions or abnormalities are (e.g., Crohn's disease, ulcerative colitis).
identified. • Evaluation of unexplained anemia or positive fecal occult
• Polypectomy: Polyps, abnormal growths on the colon blood test (FOBT).
lining, can be removed using specialized instruments Complications: Although colonoscopy is generally safe,
passed through the colonoscope. This helps prevent the complications may occur, including:
development of colorectal cancer. • Bleeding: Biopsy or polypectomy sites may bleed,
• Hemostasis: If bleeding is encountered, measures such as requiring intervention to control bleeding.
cauterization, clipping, or injection of hemostatic agents • Perforation: Rarely, the colonoscope may cause a
may be performed to control bleeding. perforation or tear in the wall of the colon, necessitating
6. Withdrawal and Documentation: After complete surgical repair.
examination of the colon, the colonoscope is slowly • Adverse reactions to sedation or medications used during
withdrawn while the lining of the colon is carefully the procedure.
inspected. The findings are documented, and any relevant • Infection: Although rare, there is a risk of infection,
images or videos may be captured for further review and particularly if biopsies or interventions are performed.
documentation.
Post-Procedure Care: After the procedure, patients are 2. Write a note on sigmoidoscopy.
monitored in a recovery area until the effects of sedation wear Sigmoidoscopy is a diagnostic procedure used to examine the
off. They may experience some mild bloating, gas, or interior lining of the sigmoid colon and rectum. It involves the
abdominal discomfort initially, which typically resolves insertion of a flexible, lighted tube called a sigmoidoscope
quickly. Patients are advised to resume their normal diet and through the anus and into the lower portion of the colon.
activities unless instructed otherwise by their physician. Procedure:
Indications: Colonoscopy is recommended for various 1. Preparation: Prior to the procedure, patients may be
indications, including: instructed to follow a bowel preparation regimen to cleanse
• Screening for colorectal cancer and polyps in the rectum and sigmoid colon. This may involve enemas,
asymptomatic individuals. laxatives, or dietary restrictions to ensure optimal
visualization.
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2. Patient Positioning: The patient is positioned on their left Post-Procedure Care: After the procedure, patients are
side with knees bent, allowing for easy insertion of the typically able to resume their normal activities immediately.
sigmoidoscope into the rectum. They may experience some mild bloating or gas initially, which
3. Insertion of Sigmoidoscope: The sigmoidoscope, a long, typically resolves quickly. If biopsies or polypectomies were
flexible tube with a camera and light source at the tip, is performed, patients may be instructed to avoid strenuous
gently inserted into the anus and advanced through the activities or heavy lifting for a short period.
rectum into the sigmoid colon. The scope is maneuvered Indications: Sigmoidoscopy is recommended for various
carefully to navigate through the colon while minimizing indications, including:
patient discomfort. • Screening for colorectal cancer and polyps, particularly in
4. Visualization: As the sigmoidoscope is advanced, the individuals at average risk or with symptoms limited to
physician examines the lining of the sigmoid colon and the lower colon and rectum.
rectum on a video monitor in real-time. The scope allows • Evaluation of symptoms such as rectal bleeding, changes
visualization of the mucosal lining, blood vessels, and any in bowel habits, or unexplained abdominal pain localized
abnormalities present. to the lower abdomen.
5. Biopsy and Intervention: During the procedure, the • Diagnosis and monitoring of inflammatory bowel disease
physician may perform various interventions as needed, (e.g., ulcerative colitis), which primarily affects the
including: rectum and sigmoid colon.
• Biopsy: Small tissue samples (biopsies) may be taken for Complications: While sigmoidoscopy is generally safe,
further analysis if suspicious lesions or abnormalities are complications may occur, including:
identified. • Perforation: Rarely, the sigmoidoscope may cause a
• Polypectomy: Polyps, abnormal growths on the colon perforation or tear in the wall of the colon, necessitating
lining, can be removed using specialized instruments surgical repair.
passed through the sigmoidoscope. • Bleeding: Biopsy or polypectomy sites may bleed,
6. Withdrawal and Documentation: After complete requiring intervention to control bleeding.
examination of the sigmoid colon and rectum, the • Adverse reactions to sedation or medications used during
sigmoidoscope is slowly withdrawn while the lining of the the procedure.
colon is carefully inspected. The findings are documented, • Infection: Although rare, there is a risk of infection,
and any relevant images or videos may be captured for particularly if biopsies or interventions are performed.
further review and documentation.

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3. Specific instruments used in endoscopic and • The snare is positioned around the base of the polyp,
colonoscopic procedures. tightened, and then electrocauterized or mechanically
Endoscopic and colonoscopic procedures involve the use of excised to remove the lesion.
specialized instruments to visualize and manipulate the 4. Injection Needle:
gastrointestinal tract during diagnostic and therapeutic • Injection needles are used to deliver medications, contrast
interventions. Here are some specific instruments commonly agents, or saline solutions into the submucosal layer of the
used in these procedures: gastrointestinal tract.
1. Endoscope: • Injection of saline solution (saline lift) can create a
• An endoscope is a flexible or rigid tube with a light source cushion beneath the mucosa, facilitating dissection and
and camera at its tip, allowing direct visualization of the resection of lesions during endoscopic procedures.
interior lining of the gastrointestinal tract. 5. Grasping Forceps:
• Types of endoscopes include: • Grasping forceps are used to manipulate tissues, grasp
• Upper gastrointestinal endoscope foreign bodies, or retrieve objects from the
(esophagogastroduodenoscope) for examining the gastrointestinal tract.
esophagus, stomach, and duodenum. • Types of grasping forceps include rat-tooth forceps,
• Colonoscope for examining the colon and rectum. alligator forceps, and oval-cup forceps.
• Enteroscope for examining the small intestine. 6. Endoscopic Retrograde Cholangiopancreatography
• Sigmoidoscope for examining the sigmoid colon and (ERCP) Accessories:
rectum. • ERCP accessories are specialized instruments used for
2. Biopsy Forceps: diagnostic and therapeutic interventions in the biliary and
• Biopsy forceps are used to obtain tissue samples pancreatic ducts.
(biopsies) from abnormal areas or lesions identified • Examples include:
during endoscopic procedures. • Cannulas and guide wires for accessing the bile duct or
• Types of biopsy forceps include cup forceps, fenestrated pancreatic duct.
forceps, and cold biopsy forceps. • Balloon dilators for widening strictures or
3. Polypectomy Snare: obstructions.
• A polypectomy snare is a wire loop attached to the end of • Biliary and pancreatic stents for relieving ductal
the endoscope, used to remove polyps or other abnormal obstruction or facilitating drainage.
growths from the gastrointestinal tract.

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7. Endoscopic Hemostatic Devices: • Upper GI endoscopy helps identify the source of

• Endoscopic hemostatic devices are used to control bleeding, such as peptic ulcers, esophageal varices,
bleeding from gastrointestinal lesions or vascular Mallory-Weiss tears, or gastritis.
abnormalities. 3. Evaluation of Anemia: Unexplained iron deficiency anemia
• Examples include hemostatic clips, thermal coagulation or occult gastrointestinal bleeding, which may indicate
probes (e.g., heater probe, argon plasma coagulation), and underlying pathology in the upper GI tract, such as gastric or
injection therapy (e.g., epinephrine injection). duodenal ulcers, gastritis, or esophagitis.
8. Ligation Devices: 4. Dysphagia: Difficulty swallowing (dysphagia), which may
• Ligation devices are used to ligate esophageal varices, result from structural abnormalities (e.g., strictures, tumors),
hemorrhoids, or other vascular lesions to control bleeding motility disorders (e.g., achalasia), or inflammatory
or prevent rebleeding. conditions (e.g., esophagitis).
• Examples include band ligation devices for variceal 5. Reflux Symptoms: Persistent or severe symptoms of
banding or rubber band ligation of hemorrhoids. gastroesophageal reflux disease (GERD), such as heartburn,
regurgitation, or chest pain, especially if refractory to
4. What are the indications for upper GI endoscopy? medical therapy or associated with alarm features (e.g.,
Upper gastrointestinal (GI) endoscopy, also known as dysphagia, weight loss).
esophagogastroduodenoscopy (EGD), is a procedure used to 6. Evaluation of Barrett's Esophagus: Screening or
visualize the upper GI tract, including the esophagus, stomach, surveillance of individuals at increased risk of Barrett's
and duodenum. It is commonly performed for diagnostic and esophagus, a premalignant condition characterized by
therapeutic purposes. The indications for upper GI endoscopy metaplastic changes in the esophageal mucosa secondary to
include: chronic GERD.
1. Dyspepsia: Persistent or recurrent symptoms of dyspepsia, 7. Evaluation of Gastric Ulcers: Diagnosis and surveillance
including epigastric pain, heartburn, bloating, nausea, or of gastric ulcers or lesions identified on imaging studies
early satiety, especially if not responsive to empiric therapy. (e.g., abdominal ultrasound, CT scan) or during barium
2. Gastrointestinal Bleeding: studies.
Acute or chronic gastrointestinal bleeding, manifested by 8. Evaluation of Upper Abdominal Pain: Persistent or
symptoms such as hematemesis (vomiting blood), melena recurrent upper abdominal pain, which may be indicative of
(black, tarry stools), or hematochezia (fresh blood in stools). peptic ulcers, gastritis, esophagitis, or other structural
abnormalities in the upper GI tract.

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9. Evaluation of Motility Disorders: Assessment of • Sterile attire helps prevent contamination of the surgical
esophageal motility disorders, such as achalasia, diffuse field by shedding skin cells, hair, or respiratory droplets.
esophageal spasm, or scleroderma esophagus, which may 3. Hand Hygiene:
cause dysphagia or chest pain. • Thorough hand hygiene is essential before and after
10. Screening for Esophageal Cancer: Screening of performing sterile procedures.
individuals at increased risk of esophageal cancer, such as • Healthcare workers must perform surgical hand
those with a history of Barrett's esophagus, chronic GERD, scrubbing or use alcohol-based hand rubs to reduce the
or other risk factors (e.g., tobacco use, heavy alcohol transient and resident flora on their hands.
consumption). 4. Sterile Technique:
• All instruments, supplies, and equipment used during
5. Surgical asepsis sterile procedures must be sterile.
Surgical asepsis, also known as sterile technique, is a set of • Sterile items should be handled with care and only by
practices and procedures designed to maintain a sterile personnel wearing sterile gloves.
environment during surgical procedures and other invasive • Any breach of sterility (e.g., torn packaging, accidental
medical interventions. The primary goal of surgical asepsis is contamination) requires immediate remedial action to
to prevent the introduction of microorganisms into sterile areas, maintain aseptic conditions.
tissues, or the bloodstream, thereby reducing the risk of surgical 5. Antiseptic Solutions:
site infections (SSIs) and other complications. • Antiseptic solutions, such as chlorhexidine or iodine, are
Key Principles: used to disinfect the skin at the surgical site before
1. Sterile Field: incision.
• A sterile field is an area free from microorganisms, • Proper skin preparation reduces the microbial load on the
achieved through the use of sterile drapes, sterile gloves, skin surface and helps prevent surgical site infections.
and other sterile barriers. 6. Surgical Draping:
• Only sterile items should come into contact with the • Sterile drapes are used to create a barrier between the
sterile field to maintain its integrity. surgical field and non-sterile surfaces.
2. Sterile Attire: • Draping prevents contamination of the surgical site by
• Healthcare personnel involved in sterile procedures must airborne microorganisms or contact with non-sterile
wear appropriate sterile attire, including surgical gowns, surfaces.
gloves, masks, and caps.

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Applications: Surgical asepsis is utilized in various healthcare Clinical Features:

settings and procedures, including: • Many individuals with acute HBV infection may be
• Operating room surgeries (e.g., open-heart surgery, asymptomatic or experience mild, flu-like symptoms such as
abdominal surgery). fatigue, nausea, vomiting, abdominal pain, and jaundice.
• Invasive medical procedures (e.g., central line insertion, • Chronic HBV infection can lead to persistent liver
urinary catheterization). inflammation, which may result in nonspecific symptoms
• Wound care and dressing changes. such as fatigue, malaise, anorexia, and right upper quadrant
• Sterile compounding of medications in pharmacy abdominal pain.
settings. • Chronic HBV infection can progress to liver cirrhosis, liver
failure, or hepatocellular carcinoma (HCC) over time,
6. Hepatitis B leading to symptoms such as ascites, hepatic
Hepatitis is an inflammation of liver. encephalopathy, and signs of portal hypertension (e.g.,
Cause: It is caused by hepatitis B virus (hepadna virus, DNA variceal bleeding).
virus) Investigations:
Mode of spread: • Serological tests: Detection of HBV-specific markers in the
o It is transmitted by blood and blood products, contaminated blood, including hepatitis B surface antigen (HBsAg),
needles and syringes used in surgical and dental procedures, hepatitis B e antigen (HBeAg), hepatitis B surface antibody
tattooing and acupuncture, hence, called transfusion (anti-HBs), hepatitis B e antibody (anti-HBe), and hepatitis
hepatitis. B core antibody (anti-HBc).
o It can also be transmitted by kissing and sexual act. Vertical • Molecular tests: Measurement of HBV DNA viral load
transmission through placenta from mother to foetus is using polymerase chain reaction (PCR) assays to quantify
known. viral replication and monitor disease activity.
o It can be transmitted through breast milk also • Liver function tests: Evaluation of serum levels of liver
(breastfeeding). enzymes (AST, ALT, ALP, bilirubin) to assess liver
Incubation period: It is long (4-26 weeks), hence, called long function and detect signs of liver inflammation or injury.
incubation hepatitis. • Imaging studies: Ultrasound, CT scan, or MRI may be
Source of infection: Carrier state is known. Human carriers are performed to assess liver health, detect liver cirrhosis, and
the only source of infection in addition to those incubating or evaluate for the presence of hepatocellular carcinoma.
suffering from hepatitis.

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Treatment o Immunisation Both active and passive immunization is

There is no specific anti-viral agent known. Treatment is necessary.
symptomatic.
▪ Barrier- care: As these cases are highly infectious, hence, 7. HCV
barrier-nursing care should be enforced with proper Hepatitis is an inflammation of liver.
disposal of urine and faeces as the virus is excreted in the Cause: It is caused by hepatitis C (Non A-Non B) virus which
stools. is RNA virus.
▪ Bed rest: Unnecessary bed rest should not be advised for Mode of spread:
mild disease. Bed rest is advised to severely ill patients, o It is transmitted by blood and blood products, contaminated
pregnant woman and those having other associated needles and syringes used in surgical and dental procedures,
illnesses. tattooing and acupuncture, hence, called transfusion
▪ Diet: Due to anorexia, these patients usually do not accept hepatitis.
solid diet, hence, liquid diet in the form of soft drinks, fruit o It can also be transmitted by kissing and sexual act. Vertical
juice and glucose is acceptable. Normal diet should be transmission through placenta from mother to foetus is
advised as soon as appetite returns. Intravenous glucose known.
may be advised for few days to those persons who have o It can be transmitted through breast milk also
severe vomiting. (breastfeeding).
▪ Drug: Lamivudine (anti-retroviral agent) may be used in o Haemophilics and chronic parenteral drug abusers are at
acute severe hepatitis B. No drug therapy should be given risk.
unnecessarily. Phenothiazines for vomiting and other Incubation period is intermediate between hepatitis A and
hepatotoxic drugs should be avoided. Antacids and H2 hepatitis B. It is 2-20 weeks.
receptor blockers may be used for relief of local symptoms, Source of infection: Carrier state is known. Human carriers are
e.g. vomiting, nausea. the only source of infection in addition to those incubating or
Prophylaxis suffering from hepatitis.
o All sorts of sexual activity and kissing is prohibited. Clinical Features:
o Proper sterilisation of the syringes and needles or disposable • Acute HCV infection may be asymptomatic in many cases,
sets of syringe and needle may be employed. or it may present with mild flu-like symptoms such as
o The nursing staff, doctors and paramedical staff should wear fatigue, nausea, abdominal pain, and jaundice.
gloves while handling the blood or blood products of such
cases.
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• Chronic HCV infection is often asymptomatic in the early pregnant woman and those having other associated
stages but can lead to progressive liver damage, cirrhosis, illnesses.
liver failure, and hepatocellular carcinoma over time. ▪ Diet: Due to anorexia, these patients usually do not accept
• Symptoms of advanced liver disease may include ascites, solid diet, hence, liquid diet in the form of soft drinks, fruit
hepatic encephalopathy, easy bruising or bleeding, juice and glucose is acceptable. Normal diet should be
jaundice, and signs of portal hypertension (e.g., variceal advised as soon as appetite returns. Intravenous glucose
bleeding). may be advised for few days to those persons who have
Investigations: severe vomiting.
• Serological tests: Detection of HCV-specific antibodies ▪ Direct-acting antiviral (DAA) therapy: Oral antiviral
(anti-HCV) in the blood indicates exposure to HCV medications targeting specific components of the HCV
infection. Further confirmation of active infection requires replication cycle are highly effective in curing HCV
HCV RNA testing. infection. Treatment regimens typically involve
• Molecular tests: Quantitative measurement of HCV RNA combinations of DAAs tailored to the patient's HCV
viral load using PCR assays to assess viral replication and genotype, previous treatment history, and presence of liver
monitor treatment response. cirrhosis.
• Liver function tests: Evaluation of serum levels of liver Prophylaxis
enzymes (AST, ALT, ALP, bilirubin) to assess liver function o All sorts of sexual activity and kissing is prohibited.
and detect signs of liver inflammation or injury. o Proper sterilisation of the syringes and needles or disposable
• Imaging studies: Ultrasound, CT scan, or MRI may be sets of syringe and needle may be employed.
performed to assess liver health, detect liver cirrhosis, and o The nursing staff, doctors and paramedical staff should wear
evaluate for the presence of hepatocellular carcinoma. gloves while handling the blood or blood products of such
Treatment cases.
There is no specific anti-viral agent known. Treatment is o Immunisation Both active and passive immunization is
symptomatic. necessary.
▪ Barrier- care: As these cases are highly infectious, hence,
barrier-nursing care should be enforced with proper
disposal of urine and faeces as the virus is excreted in the
stools.
▪ Bed rest: Unnecessary bed rest should not be advised for
mild disease. Bed rest is advised to severely ill patients,
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8. Anatomy of hepato-portal system. Inferior Mesenteric Vein (IMV):

The hepatoportal system, also known as the portal venous The IMV is a smaller tributary of the portal vein, draining
system, is a unique vascular arrangement in the body that plays blood from the descending colon, sigmoid colon, and
a crucial role in the circulation of blood to and from the liver. It rectum.
consists of a network of veins that carry blood from the It typically joins the splenic vein or the superior mesenteric
gastrointestinal tract, spleen, and pancreas to the liver for vein before entering the portal vein.
processing and detoxification. Function of the Hepatoportal System:
Components of the Hepatoportal System: Nutrient Absorption: The hepatoportal system facilitates the
Portal Vein: transport of absorbed nutrients, including glucose, amino acids,
The portal vein is the main vessel of the hepatoportal vitamins, and minerals, from the gastrointestinal tract to the
system, responsible for carrying nutrient-rich blood from liver for metabolism and storage.
the gastrointestinal organs to the liver. Detoxification: Blood from the portal vein carries various
It is formed by the confluence of the superior mesenteric substances absorbed from the intestines, including drugs,
vein and the splenic vein behind the neck of the pancreas. toxins, and metabolic byproducts, to the liver for detoxification
The portal vein divides into smaller branches within the and elimination.
liver, known as intrahepatic portal veins, which further Metabolic Functions: The liver plays a central role in
divide into sinusoids that perfuse the hepatic lobules. metabolism, including carbohydrate, lipid, and protein
Superior Mesenteric Vein (SMV): metabolism, as well as the synthesis of clotting factors, bile
The SMV is one of the major tributaries of the portal vein, acids, and other essential molecules.
draining blood from the small intestine, cecum, ascending Regulation of Blood Glucose: The hepatoportal system allows
colon, and part of the transverse colon. the liver to regulate blood glucose levels by storing excess
It joins the splenic vein to form the portal vein posterior to glucose as glycogen or releasing glucose into the bloodstream
the neck of the pancreas. as needed.
Splenic Vein: Clinical Relevance:
The splenic vein is another major tributary of the portal Portal Hypertension: Conditions such as liver cirrhosis can
vein, draining blood from the spleen, pancreas, and part of lead to increased pressure within the portal vein, resulting in
the stomach. portal hypertension. This can lead to the development of
It courses along the posterior aspect of the pancreas and varices, ascites, and other complications.
merges with the SMV to form the portal vein.

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Portal Vein Thrombosis: Occlusion or thrombosis of the inflammation and ulceration in the rectum and colon,
portal vein can disrupt blood flow to the liver, leading to liver leading to rectal bleeding.
ischemia and potentially life-threatening complications. • Colorectal Polyps or Cancer: Growth of abnormal
Portal Venous Gas: Presence of gas within the portal venous tissue or tumors in the colon or rectum, which may bleed
system, often indicative of bowel ischemia or necrosis, is a when irritated or ulcerated.
radiological finding associated with various gastrointestinal • Anal or Rectal Trauma: Injury to the anal or rectal area,
emergencies. such as from anal intercourse, foreign body insertion, or
instrumentation.
9. Bleeding per rectum. • Infectious Causes: Infections of the gastrointestinal tract,
Bleeding per rectum, also known as rectal bleeding or such as bacterial colitis, viral gastroenteritis, or parasitic
hematochezia, refers to the passage of bright red blood through infections (e.g., amebiasis), can lead to rectal bleeding.
the rectum. It can vary in severity, ranging from mild spotting • Coagulopathies: Disorders of blood clotting, such as
to profuse bleeding, and may be associated with various hemophilia or thrombocytopenia, can predispose
underlying causes. individuals to spontaneous bleeding from the rectum.
1. Causes: 2. Clinical Features:
• Anal Fissures: Tears or cracks in the lining of the anal • Bright red blood passed through the rectum during or after
canal, often caused by trauma during defecation or bowel movements.
passage of hard stools. • Blood may be mixed with stool or appear on toilet paper
• Hemorrhoids: Swollen and inflamed blood vessels in the after wiping.
rectum or anus, commonly due to straining during bowel • Depending on the underlying cause and severity, rectal
movements, constipation, or pregnancy. bleeding may be accompanied by symptoms such as
• Anal Fistulas: Abnormal connections between the anal abdominal pain, changes in bowel habits (diarrhea or
canal and surrounding skin or tissues, often secondary to constipation), tenesmus (the sensation of incomplete
infection or inflammation. bowel emptying), or weight loss.
• Diverticulosis: Small pouches (diverticula) that form in • Profuse bleeding per rectum may lead to symptoms of
the wall of the colon, which can bleed when inflamed or anemia, such as fatigue, weakness, and shortness of
irritated (diverticulitis). breath.
• Inflammatory Bowel Disease (IBD): Conditions such as
ulcerative colitis and Crohn's disease can cause

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3. Diagnosis: • Endoscopic interventions: Endoscopic techniques such

• Medical history: Inquire about the onset, frequency, as band ligation, sclerotherapy, or electrocoagulation may
severity, and associated symptoms of rectal bleeding, as be used to treat bleeding from hemorrhoids, diverticula,
well as relevant medical conditions and medications. or angiodysplasia.
• Physical examination: Perform a digital rectal • Surgical procedures: Surgical intervention may be
examination (DRE) to assess for anal fissures, necessary for severe or refractory cases of rectal bleeding,
hemorrhoids, rectal masses, or signs of inflammation. particularly in the setting of colorectal cancer, diverticular
• Laboratory tests: Blood tests to evaluate for anemia, bleeding, or hemorrhoidal disease resistant to
coagulopathies, or signs of infection. conservative measures.
• Endoscopic procedures: Colonoscopy or flexible 5. Complications:
sigmoidoscopy may be performed to visualize the rectum • Chronic or recurrent rectal bleeding can lead to
and colon, identify the source of bleeding, and obtain complications such as iron deficiency anemia, electrolyte
tissue samples (biopsies) for further evaluation. imbalances, and hemodynamic instability.
• Imaging studies: In cases of suspected diverticular • In cases of massive or uncontrollable bleeding,
bleeding or colorectal cancer, imaging modalities such as emergency medical attention is required to prevent
CT scan, MRI, or angiography may be used to localize hypovolemic shock and other life-threatening
and characterize the bleeding source. complications.
4. Treatment:
• Conservative measures: Analgesics, stool softeners, and 10.Write a short note on physiology of defecation.
dietary modifications may be recommended for mild Defecation is the process of expelling feces from the rectum
cases of rectal bleeding due to anal fissures, hemorrhoids, through the anus, completing the final stage of digestion and
or constipation. waste elimination. The physiology of defecation involves a
• Topical therapies: Application of topical agents (e.g., complex interplay of neural, muscular, and hormonal
corticosteroids, anesthetics, astringents) or suppositories mechanisms coordinated by the enteric nervous system and
may help alleviate symptoms and promote healing of anal central nervous system.
fissures or hemorrhoids. 1. Storage of Fecal Material:
• Medications: Depending on the underlying condition, • After digestion and absorption of nutrients in the small
medications such as antibiotics (for infectious causes), intestine, undigested food particles, water, and waste
anti-inflammatory drugs (for IBD), or coagulation factors products are transferred to the colon (large intestine) for
(for coagulopathies) may be prescribed. further processing.
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• Fecal material accumulates and is stored in the • Signals from the cerebral cortex inhibit or facilitate the
descending colon, sigmoid colon, and rectum until it is defecation reflex, allowing individuals to delay or initiate
expelled during defecation. bowel movements as needed.
2. Rectal Filling and Distension: • Voluntary control also involves relaxation of the external
• As fecal material accumulates in the rectum, it distends anal sphincter (EAS), which is under conscious control,
the rectal walls, triggering sensory receptors known as allowing feces to be expelled from the anus.
stretch receptors. 5. Coordination of Muscular Contraction:
• Distension of the rectal walls stimulates the defecation • Contraction of the rectal muscles (rectal contraction)
reflex, signaling the need for bowel evacuation to the increases intra-rectal pressure, facilitating the expulsion
central nervous system. of fecal material from the rectum.
3. Defecation Reflex: • Simultaneous relaxation of the internal anal sphincter
• The defecation reflex is a neural reflex mediated by the (IAS) and external anal sphincter (EAS) allows feces to
enteric nervous system and coordinated by the spinal cord pass through the anal canal and be expelled from the
and brainstem. body.
• Distension of the rectal walls activates sensory neurons, 6. Hormonal Regulation:
which transmit signals to the spinal cord via the pelvic • Hormones such as serotonin, prostaglandins, and peptide
nerves (parasympathetic fibers). YY play a role in regulating gastrointestinal motility,
• In response to these sensory signals, motor neurons in the fluid secretion, and bowel function, influencing the
spinal cord are activated, leading to contraction of the physiology of defecation.
rectal muscles (rectal contraction) and relaxation of the • Serotonin, for example, acts as a neurotransmitter and
internal anal sphincter (IAS). modulates intestinal peristalsis and sphincter function,
4. Voluntary Control: contributing to the coordination of bowel movements.
• While the defecation reflex initiates rectal contraction and
relaxation of the internal anal sphincter, voluntary control 11.Hematemesis
allows individuals to regulate the timing and coordination Hematemesis refers to the vomiting of blood, typically
of bowel movements. originating from the upper gastrointestinal tract, including the
• Voluntary control is mediated by higher brain centers in esophagus, stomach, or duodenum. It is a medical emergency
the cerebral cortex, particularly the prefrontal cortex and that requires prompt evaluation and treatment due to the
motor cortex. potential for significant blood loss and associated
complications.
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Causes: • The severity of symptoms depends on the amount and rate

1. Peptic Ulcer Disease: Ulcers in the stomach or duodenum of bleeding, with massive hemorrhage potentially leading to
are common causes of hematemesis, often due to erosion of hemodynamic instability and shock.
blood vessels within the ulcer crater. Diagnostic Evaluation:
2. Esophageal Varices: Dilated, tortuous veins in the lower • History and Physical Examination: Assessment of vital
esophagus, commonly seen in individuals with liver signs, medical history (including liver disease, peptic ulcer
cirrhosis, can rupture and lead to massive upper GI disease, or previous gastrointestinal bleeding), medication
bleeding. use (e.g., NSAIDs, anticoagulants), and recent trauma or
3. Mallory-Weiss Tears: Tears in the mucosal lining of the surgery.
lower esophagus or upper stomach, often associated with • Laboratory Tests: Complete blood count (CBC),
severe retching or vomiting, can cause hematemesis. coagulation profile, liver function tests, and serum
4. Gastroesophageal Reflux Disease (GERD): Severe reflux of electrolytes.
gastric contents into the esophagus can lead to esophagitis • Imaging Studies: Upper gastrointestinal endoscopy
and erosions, which may result in bleeding. (esophagogastroduodenoscopy, EGD) is the gold standard
5. Gastritis: Inflammation of the stomach lining, often due to for identifying the source of bleeding and guiding therapy.
infection (e.g., Helicobacter pylori), NSAID use, alcohol Other imaging modalities, such as abdominal ultrasound or
consumption, or other causes, can lead to mucosal erosions CT angiography, may be used in select cases.
and bleeding. Treatment:
6. Esophageal or Gastric Cancer: Malignant tumors in the • Resuscitation: Stabilization of the patient's airway,
esophagus or stomach may erode blood vessels and cause breathing, and circulation is the initial priority, with
hematemesis, particularly in advanced stages. aggressive fluid resuscitation and blood transfusion as
7. Coagulopathy: Disorders of coagulation, such as liver needed to maintain hemodynamic stability.
disease, thrombocytopenia, or anticoagulant therapy, can • Endoscopic Therapy: Interventional endoscopy, including
predispose individuals to bleeding from the upper GI tract. injection therapy, thermal coagulation, hemostatic clipping,
Clinical Presentation: or band ligation, may be performed to achieve hemostasis
• Hematemesis is characterized by the presence of bright red and control bleeding.
or coffee-ground-like material in vomitus. • Pharmacological Therapy: Administration of proton pump
• Patients may report symptoms such as abdominal pain, inhibitors (PPIs) and octreotide may be considered to reduce
nausea, vomiting, dizziness, weakness, or syncope. gastric acid secretion and splanchnic blood flow,
respectively.
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• Surgical Intervention: In cases of refractory bleeding or constipation. One example is prucalopride, a selective
hemodynamic instability, surgical intervention (e.g., serotonin (5-HT4) receptor agonist approved for the
angiographic embolization, surgical resection) may be treatment of chronic constipation in adults.
necessary to control bleeding and remove the source of
hemorrhage. 2. Management of Cholera
Cholera is an acute diarrheal illness caused by the bacterium
1. List 3 drugs used for the treatment of constipation. Vibrio cholerae, primarily transmitted through contaminated
Three drugs commonly used for the treatment of constipation food and water. Management of cholera involves prompt
include: rehydration therapy and appropriate antibiotic treatment to
1. Laxatives: reduce the duration and severity of symptoms, prevent
• Laxatives are medications that promote bowel complications, and limit the spread of the disease. Here's an
movements and relieve constipation by increasing stool overview of the management of cholera:
frequency and softening stool consistency. Examples 1. Rehydration Therapy:
include: • Oral Rehydration Solution (ORS): The cornerstone of
• Bulk-forming laxatives (e.g., psyllium, cholera management is oral rehydration therapy with
methylcellulose) add bulk to stool, promoting ORS, a solution containing a precise balance of salts
peristalsis and bowel movement. (sodium, potassium, chloride) and glucose to replace fluid
• Osmotic laxatives (e.g., polyethylene glycol, lactulose) and electrolyte losses caused by diarrhea and vomiting.
draw water into the intestine, softening stool and ORS can be administered orally in large quantities to
facilitating bowel evacuation. patients with mild to moderate dehydration.
• Stimulant laxatives (e.g., bisacodyl, senna) stimulate • Intravenous Fluids: In cases of severe dehydration or
intestinal motility and increase fluid secretion in the inability to tolerate oral fluids, intravenous (IV) fluid
bowel, promoting bowel movements. replacement may be necessary to rapidly restore fluid and
2. Stool Softeners: Stool softeners, also known as emollient electrolyte balance. IV fluids should contain appropriate
laxatives, help soften stool by increasing the incorporation concentrations of salts and glucose, similar to ORS.
of water and fat into the stool, making it easier to pass. 2. Antibiotic Treatment:
Examples include docusate sodium and docusate calcium. • Antibiotics are used to reduce the duration and severity of
3. Prokinetic Agents: Prokinetic agents enhance cholera symptoms, shorten the duration of shedding of
gastrointestinal motility and transit, helping to facilitate the Vibrio cholerae bacteria in stool, and decrease the risk of
movement of stool through the intestines and relieve
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transmission to others. Antibiotic treatment is particularly • Primary or secondary.

important in severe cases or outbreaks of cholera. 4. Dyserythropoietic anaemia (anaemia due to bone marrow
• Commonly used antibiotics for the treatment of cholera infiltration).
include: • Leukaemia, lymphomas
• Azithromycin: A single dose of azithromycin is • Myelofibrosis/myelosclerosis
effective in treating cholera and is recommended by • Multiple myeloma
the World Health Organization (WHO) as a first-line 5. Haemolytic anaemias
treatment for adults and children. • Congenital or acquired
• Doxycycline: Another antibiotic option for the 6. Anaemia of chronic infections/disorders
treatment of cholera, particularly in areas where • Rheumatoid arthritis, chronic infections, renal and liver
azithromycin resistance is prevalent. diseases, and malignancy.
• Ciprofloxacin: Effective against Vibrio cholerae and
can be used as an alternative treatment option for 4. Which bacteria causes gastritis? How to eradicate it?
cholera, particularly in regions with high rates of / What are the treatment options for gastritis? / What
resistance to other antibiotics. diet advice will you give to patients with gastritis?
Helicobacter pylori (H. pylori) Infection: H. pylori is a
3. Write 3 causes for anemia. bacterium that infects the lining of the stomach, leading to
Definition: It is defined as a state in which the haemoglobin inflammation and irritation. It is one of the most common
level is below the normal range for the age and sex of the causes of gastritis.
individual. Treatment of Gastritis:
Causes: 1. Antibiotics (for H. pylori Infection): If gastritis is caused
1. Haemorrhagic anaemia (blood loss) by H. pylori infection, a combination of antibiotics (such
• Haemorrhage due to trauma or injury as clarithromycin, amoxicillin, or metronidazole) and
• Blood loss (acute or chronic) due to piles, haematemesis, proton pump inhibitors (PPIs) is used to eradicate the
menorrhagia and hookworm. bacteria.
2. Anaemia of haemopoietic factors deficiency 2. Proton Pump Inhibitors (PPIs): PPIs, such as
• Iron deficiency anaemia omeprazole, lansoprazole, and pantoprazole, reduce
• Megaloblastic anaemia (vitamin B₁₂ and folic acid stomach acid production and help relieve symptoms of
deficiency) gastritis.
3. Aplastic anaemia (bone marrow aplasia)
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3. Antacids: Antacids, such as calcium carbonate, 5. Small, Frequent Meals: Eating smaller, more frequent
magnesium hydroxide, or aluminum hydroxide, can help meals throughout the day can help prevent overloading the
neutralize stomach acid and provide symptom relief. stomach and reduce symptoms of gastritis.
4. H2 Receptor Antagonists: H2 receptor antagonists, such 6. Hydration: Drinking plenty of water throughout the day
as ranitidine or famotidine, reduce stomach acid production can help soothe the stomach lining and prevent
and can help relieve symptoms of gastritis. dehydration, especially if vomiting or diarrhea is present.
5. Avoiding Trigger Foods: Avoiding spicy foods, acidic 7. Avoiding Triggers: Avoiding trigger foods and beverages,
foods, caffeine, alcohol, and NSAIDs can help prevent such as spicy foods, caffeine, alcohol, and NSAIDs, can
irritation of the stomach lining and reduce symptoms of help prevent irritation of the stomach lining and reduce
gastritis. symptoms of gastritis.
6. Stress Management: Stress management techniques, such
as relaxation exercises, meditation, and counseling, can 5. Forward viewing in endoscopy
help reduce stress-related gastritis. Forward viewing in endoscopy refers to the direction in which
Dietary Recommendations for Gastritis: the endoscope's camera and optics are oriented during a
1. Low-Acid Diet: Avoiding acidic foods and beverages, procedure. In forward-viewing endoscopy, the camera at the tip
such as citrus fruits, tomatoes, vinegar, and carbonated of the endoscope captures images and transmits them directly
drinks, can help reduce irritation of the stomach lining. to the endoscopist for visualization. This configuration allows
2. Soft, Bland Foods: Consuming soft, bland foods that are for direct visualization of the target anatomy and lesions as the
easy to digest, such as oatmeal, rice, bananas, applesauce, endoscope is advanced through the gastrointestinal tract.
and boiled potatoes, can help soothe the stomach.
3. High-Fiber Foods: Eating high-fiber foods, such as fruits, 6. Importance of socioeconomic history.
vegetables, whole grains, and legumes, can help promote 1. Health Disparities: Socioeconomic status strongly
digestive health and prevent constipation, which may correlates with health disparities, where individuals from
worsen gastritis symptoms. lower socioeconomic backgrounds often experience poorer
4. Probiotics: Consuming foods rich in probiotics, such as health outcomes compared to those from higher
yogurt, kefir, and fermented vegetables, may help restore socioeconomic groups.
the balance of healthy bacteria in the gut and support 2. Access to Healthcare: Socioeconomic factors such as
digestive health. income, education level, employment status, and health
insurance coverage significantly impact access to healthcare

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services, with lower SES individuals facing barriers to anti-inflammatory drugs (NSAIDs), can lead to erosion of
primary care, preventive services, and specialty care. the stomach lining and gastrointestinal bleeding.
3. Health Behaviors and Lifestyle Factors: Socioeconomic 3. Some other causes:
status influences health behaviors and lifestyle factors, o Esophageal Varices o Duodenal Cancer
affecting access to healthy food, opportunities for physical o Mallory-Weiss Tears o Dieulafoy's Lesion
activity, and exposure to health-promoting environments. o Esophagitis o Medications
4. Environmental Exposures: Socioeconomic factors can o Gastric Cancer o Vascular Disorders
influence exposure to environmental hazards and pollutants,
with individuals in low-income neighborhoods facing 8. What is constipation and diarrhea?
disproportionate risks of air pollution, lead contamination, Constipation:
and other environmental toxins. Definition: Constipation is defined as delay in evacuation of
5. Social Support and Networks: Socioeconomic status the bowel. Atleast two or more of the following symptoms for
affects social support networks, social cohesion, and access at least 3 months may be present:
to community resources, which can impact mental health 1. Infrequent passage of stools (2 motions/week)
outcomes, coping mechanisms, and overall well-being. 2. Hard stools
3. Straining at stool
7. What is melena? Write 2 causes for it. 4. Incomplete evacuation
Melena refers to the passage of black, tarry stools that result Diarrhoea
from the presence of digested blood in the gastrointestinal tract. Definition: The term "diarrhoea" is defined as frequent loose
Melena is a clinical sign rather than a specific diagnosis and can motions, i.e. more than 3 stools in a day. Quantitatively, it is
indicate bleeding from the upper gastrointestinal tract, typically defined as faecal output > 200 gm/day. Diarrhoea is common
originating from the esophagus, stomach, or duodenum. symptom of many intestinal diseases where the stools remain
Causes: unformed and passed frequently.
1. Peptic Ulcer Disease (PUD): Peptic ulcers are open sores
that develop in the lining of the stomach, esophagus, or 9. What is endoscopic unit?
duodenum. When these ulcers bleed, the blood mixes with An endoscopy unit refers to a dedicated area where medical
stomach acid and digestive enzymes, resulting in melena. procedures are performed with endoscopes, which are cameras
2. Gastritis: Inflammation of the stomach lining, often due used to visualize structures within the body, such as
to infection with Helicobacter pylori bacteria, excessive the digestive tract and genitourinary system. Endoscopy units
alcohol consumption, or prolonged use of nonsteroidal
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may be located within a hospital, incorporated within other • Management of portal hypertension involves treating the
medical care centres, or may be stand-alone in nature. underlying cause, relieving symptoms, and reducing the
risk of complications such as variceal bleeding.
11. Purpura
• Purpura refers to purple or red discolorations on the skin 13. Signs of liver cell failure.
caused by bleeding underneath the skin. • Signs of liver cell failure, also known as liver
• It occurs when small blood vessels leak blood into the skin. decompensation, may include jaundice (yellowing of the
• Purpura can be caused by various factors, including platelet skin and eyes), ascites, hepatic encephalopathy (confusion,
disorders, coagulation disorders, vasculitis, and certain altered consciousness), and coagulopathy (impaired blood
infections. clotting).
• Types of purpura include petechiae (small pinpoint spots), • Other signs may include pruritus (itching), easy bruising,
ecchymoses (larger bruises), and purpura fulminans (a fatigue, weakness, and abdominal pain.
severe form associated with disseminated intravascular • Liver cell failure can result from chronic liver disease,
coagulation). acute liver injury, or liver cirrhosis.
• Diagnosis and treatment of purpura depend on identifying
the underlying cause. 14. Standard healthcare precautions.
• Standard healthcare precautions, also known as standard
12. Portal Hypertension. precautions, are infection control practices designed to
• Portal hypertension is an increase in pressure within the reduce the risk of transmission of infectious agents in
portal vein system, which carries blood from the digestive healthcare settings.
organs to the liver. • Key components of standard precautions include hand
• It often results from liver cirrhosis, a condition in which hygiene, use of personal protective equipment (such as
scar tissue replaces healthy liver tissue, leading to gloves, masks, and gowns), safe injection practices,
obstruction of blood flow through the liver. proper handling and disposal of sharps, and
• Signs and symptoms of portal hypertension may include environmental cleaning and disinfection.
ascites (accumulation of fluid in the abdomen), • Standard precautions apply to all patients, regardless of
splenomegaly (enlargement of the spleen), varices their perceived or confirmed infectious status, and are
(enlarged veins in the esophagus or stomach), and hepatic essential for preventing healthcare-associated infections.
encephalopathy (brain dysfunction due to liver disease).

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15. What are the features of inflammation? sleep apnea, osteoarthritis, and other metabolic and
• Inflammation is a complex biological response to harmful psychological disorders.
stimuli, such as pathogens, damaged cells, or irritants. Management of obesity involves lifestyle modifications (such
• Key features of inflammation include redness (rubor), as dietary changes and increased physical activity), behavioral
heat (calor), swelling (tumor), pain (dolor), and loss of therapy, pharmacotherapy, and, in some cases, bariatric
function (functio laesa). surgery.
• Inflammation is characterized by the recruitment of
immune cells, release of inflammatory mediators (such as 17. Pedigree chart.
cytokines and chemokines), increased blood flow to the A pedigree chart is a diagram that represents the genetic
affected area, and activation of the immune response to relationships within a family, typically spanning multiple
eliminate the threat and promote tissue repair. generations. It is commonly used in genetics and medical
• Acute inflammation is a short-term response to injury or genetics to analyze inheritance patterns of genetic traits,
infection, while chronic inflammation persists over a disorders, and diseases. Here's an overview of the components
longer period and can contribute to the development of and symbols used in a pedigree chart:
various diseases, including autoimmune disorders, Components of a Pedigree Chart:
cardiovascular disease, and cancer. 1. Individuals: Each individual in the family is represented
by a symbol on the chart. Males are typically represented
16. Obesity. by squares, while females are represented by circles.
• Obesity is a medical condition characterized by excessive 2. Generations: The pedigree chart is organized into
accumulation of body fat, resulting in an increased risk of multiple generations, with each row representing a
health problems and chronic diseases. different generation. The oldest generation is usually
• It is typically defined by body mass index (BMI), with placed at the top, with subsequent generations appearing
BMI values equal to or greater than 30 kg/m^2 considered below.
obese. 3. Lines: Lines connecting individuals indicate family
• Obesity is a multifactorial condition influenced by relationships, with horizontal lines representing
genetic, environmental, behavioral, and socioeconomic marriages or partnerships and vertical lines representing
factors. parent-child relationships.
• Health consequences of obesity include an increased risk Symbols Used in a Pedigree Chart:
of cardiovascular disease, type 2 diabetes, certain cancers, 1. Square (□): Represents a male individual.
2. Circle (○): Represents a female individual.
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3. Filled-In Symbol (▣ or ●): Indicates an individual indigestion, and occasionally jaundice if stones obstruct
affected by the trait or condition being studied. The filling the bile ducts.
may vary depending on the specific trait or condition • Diagnosis of gallstones is typically made through
being analyzed. imaging studies such as ultrasound, CT scan, or MRI.
4. Half-Shaded Symbol (□ or ○ with half shaded): • Treatment options for gallstone disease include
Indicates an individual who is a carrier of a genetic trait observation, medications (such as bile acid therapy),
or condition but does not exhibit symptoms of the trait and surgical removal of the gallbladder
themselves. (cholecystectomy) in symptomatic or complicated
5. Double Horizontal Line (═): Represents a marriage or cases.
partnership between two individuals.
6. Vertical Line (│): Represents a parent-child relationship, 19. GERD.
connecting parents to their biological or adopted children. • GERD is a chronic condition characterized by the reflux
7. Diagonal Line (╱ or ╲): Represents consanguinity, of stomach contents, including acid and bile, into the
indicating that the parents are closely related by blood esophagus, leading to symptoms such as heartburn,
(e.g., cousins, siblings). regurgitation, chest pain, and difficulty swallowing.
• GERD occurs when the lower esophageal sphincter

18. Gas bladder stone disease. (LES), a muscular ring at the junction of the esophagus
• Cholelithiasis, commonly known as gallstone disease, and stomach, becomes weak or relaxes inappropriately,
refers to the formation of stones (calculi) in the allowing stomach contents to flow backward into the
gallbladder or bile ducts. esophagus.
• Gallstones can vary in size and composition, with the • Risk factors for GERD include obesity, hiatal hernia,

most common types being cholesterol stones and pregnancy, smoking, certain medications (such as
pigment stones. NSAIDs and calcium channel blockers), and dietary
• Risk factors for gallstone formation include obesity, factors (such as spicy foods, fatty foods, caffeine, and
rapid weight loss, female gender, pregnancy, age, alcohol).
genetics, and certain medical conditions (such as • Diagnosis of GERD is typically based on symptoms

metabolic syndrome and liver disease). and may be confirmed with additional tests such as
• Symptoms of gallstone disease may include right upper upper endoscopy (EGD), esophageal pH monitoring, or
abdominal pain, nausea, vomiting, bloating, esophageal manometry.

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• Treatment of GERD involves lifestyle modifications

(such as weight loss, dietary changes, and elevating the
head of the bed), medications (such as proton pump
inhibitors, H2 receptor antagonists, and antacids), and,
in severe cases, surgical interventions (such as
fundoplication).

20. HbA1c.
HbA1c, or glycated hemoglobin, is a term used in medicine to
describe a form of hemoglobin that is chemically linked with
glucose. It is typically measured as a percentage of total
hemoglobin in the blood and serves as a marker of average
blood glucose levels over the past two to three months.Normal
value of HbA1c is below 5.7%.

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