GIT Dr.

Shaf3y

G.I.T. 2013 17 27 Liver cirrhosis Biliary cirrhosis

Bililary Cirrhosis
biliary cirrhosis Prolonged biliary obstruction cirrhosis biliary obstruction Primary Secondary primary biliary cirrhosis secondary biliary cirrhosis

secondary biliary cirrhosis obstructive jaundice biliary atresia stricture gall bladder stones

primary biliary cirrhosis

Primary biliary cirrhosis primary

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GIT Dr. Shaf3y

hepatic lobule Portal area hepatic artery central vein Hepatocytes Primary biliary cirrhosis Primary biliary cirrhosis Portal area portal area bile duct granuloma Portal area granuloma heal granuloma healing by fibrosis bile duct

bile duct

portal vein

bile duct fibrosis

primary biliary cirrhosis bile duct granuloma portal area And this granuloma heals by fibrosis Causing obstruction of the bile duct

granuloma auto immune disease environmental elements viral infection not has been recorded It is auto immune process
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GIT Dr. Shaf3y

clinical pictures clinical pictures

6 MCQs

primary biliary cirrhosis 6 MCQs

Primary biliary cirrhosis clinical pictures obstructive jaundice cirrhosis auto immune

clinical pictures

obstructive jaundice cirrhosis auto immune obstructive jaundice primary biliary cirrhosis

Arthalagia and fatigue fatigue arthalagia females Non specific fatigued fatigued middle age females

middle aged females fatigue Middle aged

fatigue Non specific pruitis

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GIT Dr. Shaf3y

Primary biliary cirrhosis manifestation

obstructive jaundice arthalagia fatigue arthalagia

fatigue common presentation females

Pruitis female jaundice Pruitis

Pruitis

obstructive jaundice clay colored << stool dark << urine Obstructive jaundice

obstructive jaundice steatorrhea << malabsoprtion

bile fat absorption steatorrhea

failure to absorb fat soluble vitamins fat soluble vitamins AKED vitamin A Vitamin A deficiency Keratomalacia

conjunctiva
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GIT Dr. Shaf3y

conjunctiva Keratinization keratin conjunctiva

Vitamin A deficiency conjunctiva keratinization

hyper keratosis skin night blindness

Vitamin D deficiency Vitamin D deficiency osteomalacia Vitamin E deficiency impotence cerebellar ataxia Vitamin E deficiency cerebellar ataxia Lymphocyte dysfunction impotence vitamin K deficiency bleeding tendency

obstructive jaundice pruitis dark << urine clay colored stool steatorrhea vitamins deficiency cirrhosis manifestations of liver cell failure portal hypertension
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GIT Dr. Shaf3y

auto immune Clubbing clubbing autoimmune

pernicious anemia

Other auto immune features Vitiligo Addisonian other auto immune features Interstitial lung fibrosis auto immune features

Investigations Obstructive jaundice obstructive jaundice alkaline phosphatase 3 30 Obstructive jaundice << 30 13

13

alkaline phosphatase Gamma G.T. obstruction obstruction MRCP ERCP PTC obstruction

obstructive jaundice stercobilinogen stool Urobilinogen urine Liver function test investigations investigations for portal hypertension Investigation for the cause anti mitochondrial antibodies
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antibodies

auto immune

GIT Dr. Shaf3y

Anti mitochondrial antibodies 90 % Ig M antibodies Mitochondria of the hepatocyte directed against MCQ Anti mitochondrial antibodies antibodies << Ig M Directed against mitochondria very common 95 % anti nuclear antibody

What is your treatment obstructive jaundice Pruitis Cholestyramine Ursofalk << bile salt chelating agent Ursodeoxycholate anti oxidant Pruitis bile salt chelating

obstructive jaundice

anti histaminic

Liver cell failure Portal hypertension autoimmune cortisone Which is absolute contraindication

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GIT Dr. Shaf3y

Osteomalacia vitamin D osteoporosis cortisone

Immune suppressive cyclosporine Azathioprine corticosteroids And finally Liver transplantation Liver cirrhosis Primary biliary cirrhosis Haemochromatosis Wilson chronic hepatitis

Chronic Hepatitis
chronic hepatitis hepatitis Inflammation of the liver chronic More than 6 months liver Inflammation

Liver

inflammation Hepatitis B, C and D

auto immune hepatitis alpha methyl dopa drugs alpha one antitrypsin deficiency

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GIT Dr. Shaf3y

etiology chronic hepatitis pathology chronic hepatitis etiology pathology pathology Mild form severe Mild Mild form Hepatic lobule portal area Portal area hepatic artery

bile duct Portal vein

central vein hepatocytes columns chronic hepatitis mild form infiltrated by lymphocyte portal area

Portal area infiltrated by lymphocyte Periphery apoptosis Liver Periphery

hepatic lobule edges piece meal necrosis piece meal necrosis

Pathology

etiology

chronic hepatitis

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GIT Dr. Shaf3y

mild form Pathology Mild form pathology etiology mild chronic hepatitis asymptomatic Mild phase Asymptomatic Mild phase asymptomatic << chronic hepatitis B mild phase asymptomatic << chronic Hepatitis C asymptomatic shrunken liver shrunken liver hepatomegaly Mild phase

splenomegaly

severe form severe form piece meal necrosis Mild lymphocytic infiltration of the portal area Mild central vein central vein fibrous mass central vein Portal vein fibrous bands Portal vein Portal vein fibrous tissue Hepatocytes rosette severe form of chronic hepatitis Piece meal necrosis features Portal vein Portal vein Porto-central central vein fibrous band Portal vein central veins bands rosette

infiltration of portal area by lymphocytes

hepatocyte

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GIT Dr. Shaf3y

cells degeneration regeneration fibrosis cirrhosis cirrhosis severe form of chronic hepatitis severe form Portal hypertension manifestations of liver cell failure

shrunken liver and splenomegaly

clinical pictures chronic hepatitis C asymptomatic Mild phase shrunken liver Hepatomegaly severe form manifestations of liver cell failure Portal hypertension

chronic hepatitis C

clinical pictures of the cause

acute attack anicteric Hepatitis C

Hepatitis C acute attack History

Hepatitis C Other associated extra hepatic manifestations glomerulonephritis cryoglobinemia

chronic hepatitis B

clinical pictures Mild phase Asymptomatic

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11

GIT Dr. Shaf3y

shrunken liver and splenomegaly shrunken liver Hepatomegaly Manifestations of liver cell failure severe form Portal hypertension

hepatitis B History Hepatitis B History of jaundice icteric hepatitis B auto immune auto immune Lupoid hepatitis disease auto immune hepatitis systemic lupus

Lupoid hepatitis

systemic lupus

clinical pictures Mild form Asymptomatic manifestations of liver cell failure Portal hypertension clinical pictures of the cause auto immune Other auto immune features Systemic lupus, auto immune thyroiditis, interstitial lung fibrosis, Addisonian, Pernicious anemia Other auto immune features

auto immune

females auto immune hepatitis disease

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GIT Dr. Shaf3y

ten ages Perimenopausal disease

investigations Investigations typical << cirrhosis Liver function tests Investigations for portal hypertension Investigations for the cause Hepatitis C positive RT PCR Hepatitis C antibodies Hepatitis B hepatitis B surface antigen Hepatitis B core antibodies hepatitis B surface antibodies antibodies chronic hepatitis

hepatitis B surface antigen hepatitis B Core antibodies hepatitis B surface antibodies hepatitis B surface antibody

chronic hepatitis

auto immune hepatitis

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13

GIT Dr. Shaf3y

auto immune hepatitis

anti nuclear antibodies antismooth muscle antibodies Liver kidney microsomal antibodies anti nuclear antibody << antismooth muscle antibody << liver kidney microsomal antibodies << antibodies antibodies against soluble liver antigen Soluble liver antigen antibodies auto immune

cirrhosis cirrhosis

chronic hepatitis chronic hepatitis

treatment mild phase treatment Once severe phase cirrhotic cirrhosis Liver cell failure << Liver transplant Portal hypertension

<< Mild phase

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14

GIT Dr. Shaf3y

corticosteroid << auto immune Mild phase Mild phase << Auto immune corticosteroids 1 << dose

corticosteroids

Loading dose 30 15 << dose corticosteroid 3

corticosteroids

side effects

corticosteroid other immune suppressant Azathioprine

auto immune mild Once severe form Liver transplant

mild

Hepatitis C Hepatitis C Interferon

Mild form

Hepatitis C

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15

GIT Dr. Shaf3y

replication of the virus

go home RNA DNA

6 Interfere interfere immune reaction

mechanism of action of interferon unknown mechanism of action interferon Unknown

virus

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16

GIT Dr. Shaf3y

function Human function Immune system inhibition immune system suppression interferon

Lymphocyte

virus virus replicate antigen

immune system

wall

Immune system

viral replication

viral replication We have no idea

is not clear

mechanism of action

subcutaneous mild only

mild Liver enzymes Mild

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biopsy

virus

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GIT Dr. Shaf3y

Liver biopsy blood RT PCR liver enzymes <<

subcutaneous

40,000 << course 25 % << success rate

25 % << success rate 40,000 << 6 4

success rate 3 success rate

level

Level fluctuation replication between doses << virus success rate

interferon level in between << replication of virus Pegylated interferon Pegasys

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18

GIT Dr. Shaf3y

Pegaasys Pegylated interferon sustained << level 60 % success rate success rate 60 % success rate interferon

Ribavirin Viracure

success rate

side effects

interferon

bone marrow depression Thyroid dysfunction Muscle pain and arthalagia flu like pictures Generalized fatigue bone marrow failure

joint pain bone marrow failure Thyroid dysfunction hepatitis B

stage

mild stage mild stage Liver enzymes treatment treatment 30 % << success rate Pegylated interferon hepatitis B result

liver

biopsy

Positive << PCR

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GIT Dr. Shaf3y

Xifax Lamivudine success rate success rate

Lamivudine interferon combination Hepatitis C combination

hepatitis C Viracure hepatitis B

interferon Lamivudine severe form transplantation

chronic hepatitis cirrhosis

Liver fatty liver

Fatty Liver
fatty liver

fatty liver

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GIT Dr. Shaf3y

Fatty liver fatty liver

Steatosis Steatosis

hepatocyte

fat

Steatosis

Steatosis steatosis hepatocyte fat

Hepatocyte

Lobule Nucleus signet ring macro vesicular type

fat

Macro vesicular type Lobule fat micro vesicular type

Nucleus

lobule lobule

Steatosis fat in the liver macro vesicular Micro vesicular

Just fat in the liver steatosis << by inflammatory cells << infiltration
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Liver

fat

21

GIT Dr. Shaf3y

Steato-hepatitis hepatoctye fat lymphocyte << hepatocyte inflammation steato-hepatitis

steato-hepatitis

steatosis << just fat << infiltration by lymphocytes fat

fatty liver By definition Fatty liver is accumulation of fat in the hepatocyte (Steatosis) Which is usually macro vesicular type Which may be associated by infiltration by inflammatory cell (Steato-hepatitis) Fatty liver is accumulation of fat in the hepatocyte (Steatosis) Which is usually macro vesicular type Which may be associated by infiltration by inflammatory cell ( Steato-hepatitis) etiology etiology

fatty liver

micro vesicular Reyes syndrome

Acute fatty liver of pregnancy fulminant hepatic failure Fulminant hepatic failure

micro vesicular type Reyes syndrome fatty liver of pregnancy

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GIT Dr. Shaf3y

fulminant hepatic failure

macro vesicular type

macro vesicular type etiology alcohol etiology etiology causes Non alcoholic fatty liver disease

Alcohol

Non alcoholic fatty liver disease non alcoholic fatty liver disease hyperlipidemia starvation Diabetes Mellitus

Obesity

obesity

Lipolysis

Diabetes mellitus insulin Liver fat

liver

fat

Keto acidosis

starvation 17
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GIT Dr. Shaf3y

rapid loss of over weight 25

stress atherosclerosis

fatty liver Is accumulation of fat in hepatocyte Steatosis accumulation of fat micro vesicular

macro vesicular

micro vesicular fatty liver of pregnancy Reyes syndrome fluminant hepatic failure

macro vesicular type alcohol Hyper obesity non alcoholic fatty liver disease starvation rapid loss of weight fatty liver diabetes trigylceridemia

fat Liver metabolism keton bodies fatty liver

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fat

24

GIT Dr. Shaf3y

non alcoholic fatty liver disease

macro vesicular asymptomatic macro vesicular Nothing Nothing pain stretch stretch

right hypochondrium

right hypochondrium Liver pain Liver

GP GP

GP Obese GP << General practitioner GP crepitation examination GP

chest infection <<

GP

GP

GP

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GIT Dr. Shaf3y

GP

Liver function test

GP Liver function test GP GP GP

liver function test liver enzymes two or three folds

Liver enzymes

70 65

40 << Normal

SGOT

enzyme

Normal normal << albumin normal << bilirubin normal normal << prothrombin time

Normal

68

40 28

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GIT Dr. Shaf3y

fatty liver

MRI MRI radiology MRI fatty liver

Biopsy

fatty liver Lymphocyte infiltration Liver cells fat steatohepatitis cirrhosis

just fatty liver Macro vesicular infiltration by lymphocyte high incidence of cirrhosis non alcoholic steatohepatitis NASH Non alcoholic fatty liver disease

Non alcoholic steatohepatitis Lymphocytic infiltration biopsy GP

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GIT Dr. Shaf3y

non alcoholic fatty liver disease NASH

rapid loss of body weight

gradually diabetes

control

aggressive Vitamin E Anti oxidant fatty liver

portal hypertension

Portal Hypertension
Portal hypertension treatment of hematemesis etiology

Portal hypertension

etiology

Infra hepatic, hepatic, supra hepatic infra hepatic

portal hypertension Portal hypertension Pre hepatic, hepatic, post hepatic Pre hepatic cause
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GIT Dr. Shaf3y

Portal hypertension Portal vein

pressure 12 10

11 20

Portal hypertension It is increase in the pressure of portal vein or one of its branches More than 11 mmHg

intestine

splenic vein superior mesenteric vein Portal vein two branches

Portal vein Right Left right Liver

Left lobes of the liver

Hepatic lobule bile duct portal vein hepatic artery

sinusoids

central vein Hepatocyte

splenic vein

superior mesenteric Portal liver portal vein

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GIT Dr. Shaf3y

sinusoids Portal vein central vein

right ventricle

right atrium

central veins hepatic veins inferior vena cava inferior vena cava

causes of portal hypertension portal hypertension Is increase in pressure of portal vein or one of its branches portal vein Pressure its branches

splenic vein splenic vein splenic vein thrombosis Cancer pancreas spleen tail of pancreas splenic vein thrombosis splenic vein

superior mesenteric

superior mesenteric vein

thrombosis

Portal pyemia

Portal pyemia appendicitis

portal vein hypercoagulable status

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GIT Dr. Shaf3y

Protein C, protein S deficiency very rare Membrane congenital web

Portal vein

inflammation of the umbilicus portal vein thrombosis left portal umbilical vein

inflammation of the umbilicus umbilical vein spread Portal vein left portal branch Pre hepatic Pre hepatic causes

Portal area portal vein Portal vein

Portal vein

bilharzial granuloma fibrosis peri-portal fibrosis Biliharziasis

Arsenic poisoning lymphoma Leukemia Portal area fibrosis

sinusoids cirrhosis sinusoid cirrhosis

Veno occlusive disease

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central vein

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GIT Dr. Shaf3y

hepatic vein Budd Chiari syndrome, tricuspid stenosis, Tricuspid regurge, right sided heart failure

Pre hepatic, hepatic, post

Pre sinusoids, sinusoids ( cirrhosis ) Post sinusoids veno occlusive etiology of portal hypertension

How to treat portal hypertension Portal hypertension Pre hematemesis During hematemeis Post hematemeis hematemesis varices beta blocker beta blocker blood flow

cardiac output G.I.T. beta receptors

vasoconstriction

beta blocker alpha receptors vasoconstriction G.I.T. blood vessels portal vein

G.I.T. Portal vein

propranolol 120 40

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GIT Dr. Shaf3y

Propranolol Band ligation injection sclerotherapy band ligation injection band ligation

hematemesis

trachea

bleeding already bleeding ABC Make sure that you have patent airway larynx bleeding patent airway sure endotracheal intubation

Make sure that the patient is adequately breathing by monitoring the oxygen saturation oxygen saturation ventilator breathing << B C wide bore cannula << cannula cannula vein cannula investigations cross matching fresh blood saline blood saline

ryle ryle to make sure

bleeding is continuous
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GIT Dr. Shaf3y

And assess the amount of the blood loss hepatic encephalopathy G.I.T. hepatic encephalopathy blood urinary catheter fluid assess to make sure that we are giving enough fluid to the patient CVP central venous pressure CVP volume overload

central line Peripheral cannula peripheral cannula central line central line cannula

blood blood Peripheral

Liver Liver Peripheral cannula diameter central line Lumen transfusion rate resuscitation fluids central line

central line

resistance

Omeprazole vitamin K peptic ulcer varices zantac

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GIT Dr. Shaf3y

liver cell failure common

Vitamin K medical tradition

liver vitamin K coagulation factors vitamin K 3 vitamin K Liver It is a medical tradition

varices band ligation available

hemorrhage

source of bleeding failed endoscopy urgently << cannot perform endoscopy somatostatin Vasopressin Glypressin

is not available << endoscopy failed visulalize the site of bleeding by endoscopy

failed endoscopy

band ligation

vaso pressin bleeding bleeding

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GIT Dr. Shaf3y

bleeding vessel band ligaiton band ligation

bleeding recurrent bleeding from esophageal varices

injection sclerotherapy bleeding bleeding vasopressin failed endoscopy tube Sangstaken triple lumen

Minnesota

saline Sangstaken blackmore tube varices 24 esophageal perforation

bleeding

Sangstaken tube

bleeding

esophageal transaction anastomosis stapling esophageus shunt surgery shunt peripheral shunt

central shunt

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36

GIT Dr. Shaf3y

Porto-caval encephalopathy Operation Operation surgery TIPSS Trans jugular intra hepatic porto systemic stent shunting bleeding control beta blockers frequently band ligation varices

Management of hematemesis portal hypertension treatment etiology

Portal hypertension

treatment

etiology

Hepatocellular Carcinoma ( Hepatoma )

risk factors of hepatocellular carcinoma Cirrhosis hepatocellular carcinoma cirrhosis Haemochromatosis Post hepatitis Post hepatitis haemochromatosis cirrhosis
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GIT Dr. Shaf3y

Hepatitis Hepatitis hepatocellular carcinoma Hepatitis B and C

incidence in B is higher than C However the number of cases from C is higher than B

B 100 hepatocellular carcinoma 10 %

10 % C

C 50,000 hepatocellular carcinoma 0.3 % hepatocellular carcinoma hepatitis B C total number

3,000

hepatocellular carcinoma

cirrhosis aflatoxin

hepatitis

Anabolic steroids Contraceptive pills

clinical pictures
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GIT Dr. Shaf3y

hepatocellular carcinoma completely asymptomatic clinical pictures

hepatocellular carcinoma cirrhosis early detection of cancer

hepatocellular carcinoma cirrhosis refractory ascites not responding to treatment << refractory encephalopathy hepatocellular carcinoma cirrhotic Refractory ascites Refractory encephalopathy

abdominal pain capsule invading << tumor regular enlarged << Liver para malignant << manifestations Para malignant polycythemia hypercalcemia Cushing, ACTH

hyper para thyroidism like material

para malignant thrombophlebitis migrans metastasis

Investiagtions << Liver enzymes cryphosphatase alkaline phosphatase SGOT SGPT Gamma G.T. bilirubin alpha fetoprotein biopsy biopsy New tumor marker Des gamma carboxy prothrombin
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39

GIT Dr. Shaf3y

Non operable non operable cancer Non operable Operable lobe Operable

Operable

Operable operable Operability cancer distant metastasis local infiltration to surroundings fit for surgery cancer

distant metastasis infiltration to surroundings confined to one lobe two lobes confined to one lobe tumor

5 3 3

single tumor Multiple tumors

operable One lobe single

tumor tumor

Multiple tumors 3 3 2.25 1.5 2 nodules 2.25 3 Operable

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GIT Dr. Shaf3y

operable Lobectomy Lobectomy cirrhotic

Lobe lobe on table

operable

cirrhotic transplant liver

Non operable Chemotherapy chemo-embolization Photocoagulation tumor alcohol injection cryotherapy

hepatocellular carcinoma case

Causes of liver enlargement

causes of liver enlargement causes of tender liver enlarged tender liver congestive causes Infective causes congestive causes infective causes

Malignancy

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GIT Dr. Shaf3y

malignancy enlarged tender liver congestive causes Infective causes

Liver Transplant
liver transplantation

indications cirrhosis liver cirrhosis cirrhosis Post hepatitis, haemochromatosis, Wilson disease, alcoholic cirrhosis cirrhosis

Fulminant hepatic failure toxins drugs infection

cause

cirrhosis enumeration fulminant hepatic failure

Hepatocellular carcinoma indication but cirrhotic << operable

Glycogen storage disease primary amyloidosis

Indications

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GIT Dr. Shaf3y

Cadaveric cadaveric cadaveric

transplant

transplant

available

available for liver transplant << cadaveric 2,000 400,000

Left lobe

child

right lobe adult Lobe

cadaveric child Left lobe adult Liver Liver right lobe

split liver transplant from adults <<

genetic engineering natural viruses

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GIT Dr. Shaf3y

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GIT Dr. Shaf3y

level Liver transplantation

animals infection

infection animals

infection organism human being

infection

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45

GIT Dr. Shaf3y

solution solution cadaveric Liver solution donor blood supply necrosis

vein artery vein solution

artery

artery nutrition

solution

metabolism

artery vein

solution

circulated

metabolic rate 6 hours << Liver solution Liver

solution solution

say 18

cold ischemic
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GIT Dr. Shaf3y

Liver liver primary graft failure cold ischemic time as much as you can liver Say

ventilator

recipient living donor recipient

donor complications liver

recipient Liver donor recipient

lobe recipient liver

donor liver

liver anastomosis artery Artery vein vein bile duct bile duct anastomosis warm ischemic time solution
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GIT Dr. Shaf3y

warm ischemic time cold ischemic time Metabolic rate

transplanatation

malignancy

infection

complications complications transplant Rejection Complications of immune suppressive therapy immune suppressant malignancy infection complications Recurrence of original disease

stricture

vessels thrombosis vessels Leakage bile duct stricture bile leakage

contraindication contraindications for liver transplantation metastatic cancer hemorrhagic pancreatitis fatal disease hemorrhagic pancreatitis surgical hemorrhagic pancreatitis hemorrhage necrotic tissue necrotic tissue blood vessel erosion hemorrhage surgical necrotic material debridment
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GIT Dr. Shaf3y

necrosis

hemorrhage You have to explore for necrotic tissue And this is the only chance for survival mortality rate

hemorrhagic pancreatitis metastatic sepsis severe cardio pulmonary disease

Liver transplant

as regard

drugs and liver

Drugs and Liver

Liver disease drugs drug diseases diseases Hepatitis hepatitis Alpha methyl dopa chronic hepatitis INH fulminant Halothane fatty liver Steroid and anabolic steroid

hepato-cellular carcinoma
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GIT Dr. Shaf3y

anabolic steroids

hepatotoxic hepatotoxic

Anti tuberculous drugs anti epileptic drugs contraceptive pills cholestatic jaundice

Amoebic liver abscess

Amoebic liver abscess

Liver

systemic diseases liver affection liver disease systemic affection

liver

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GIT Dr. Shaf3y

C.N.S. liver

dementia

hepatic encephalopathy << prolonged liver cell damage parkinsonism

eye eye Jaundice manifestations of liver cell failure Organs Liver manifestations of liver cell failure

Liver C.N.S.disease hepatotoxic << anti epileptic drugs disease treatment diseases peripheral neuritis

hepatomegaly

tricuspid regurge tricuspid stenosis congestive cirrhosis Liver

Liver cardio right sided heart failure constrictive pericarditis

Liver rheumatology hepato-splenomegaly liver hematology leukemia haemolytic anemia

lymphoma
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GIT Dr. Shaf3y

Liver nephro hepatitis dialysis endocrine fatty liver diabetes thyrotoxicosis Hashimoto auto immune thyroititis primary biliary cirrhosis

Liver

autom immune hepatitis

G.I.T.

G.I.T.
G.I.T. esophagus esophagus esophagus causes of dysphagia Gastroesophageal reflux Disease GERD dysphagia

GERD

achalasia stomach Peptic ulcer investigations etiology

treatment

etiology etiology Helicobacter pylori non steroidal anti inflammatory drugs

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GIT Dr. Shaf3y

Zolinger blood group O type A personality smoking Ellison syndrome, liver cell failure

Helicobacter pylori

Non steroidal

investigations Endoscopy Barium 4 quadrant biopsy << biopsy investigations gastrin level Zolinger Ellison syndrome Helicobacter pylori ulcer Ulcer stomach Biopsy

gastric

biopsy Stool analysis

blood test stool Helicobacter pylori against << antibodies antibodies Even after the treatment for 12 - 18 months Helicobacter pylori 18 12 antibodies

infection

Which means antibodies

Helicobacter pylori

antibodies Infection

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GIT Dr. Shaf3y

18 12 Organism antibodies

stool

active infection antigen active infection stool Organism antigen Ulcer ulcer microscopic examination culture urea splitting test urea indicator

urea

biopsy urea

organism urea

Urea splitting test carbon 14 urea breathing test treatment medical treatment H2 blockers Proton pump inhibitors cytoprotective agents cytoprotective agents sucralfate Prostaglandin medical treatment

stomach acute cholecystitis

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Peptic ulcer gall bladder

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GIT Dr. Shaf3y

acute cholecystitis sclerosing cholangitis

Sclerosing Cholangitis
Sclerosing cholangitis disease Sclerosing cholangitis Primary sclerosing cholangitis primary unknown cause Sclerosing fibrosis Cholangitis Inflammation of bile duct disease disease bile duct fibrosis stagnation of bile Infection stagnation of bile cholangitis disease

ANCA

unknown cause autoimmune auto immune antibodies

Etiology disease

anti neutrophilic cytoplasmic antibodies vasculitis

High incidicene of inflammatory bowel disease auto immune << disease clinical pictures
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GIT Dr. Shaf3y

asymptomatic fever cholangitis Charcot triad rigors associated manifestations of inflammatory bowel disease Investigations investigations ERCP ANCA MRCP jaundice

stricture

PTC

treatment immune suppressant therapy corticosteroids stent dilatation << marked stenosis primary sclerosing cholangitis acute cholecystitis

acute pancreatitis acute pancreatitis

intestine dysentery dysentery

Dysentery
dysentery dysentery diarrhea abdominal colic tenesmus blood mucous stool

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GIT Dr. Shaf3y

mucous blood tenesmus colics Dysentery diarrhea stool dysentery causes of dysentery dysentery dysentery dysentery Amoebic dysentery Bacillary dysentery Bilharizial Malaria Infective

stool

mucous

blood

colics

diarrhea

dysentery

infective dysentery inflammatory bowel disease

cancer colon Arsenic poisoning

Amoebic dysentery Organism Entamoeba Histolytica mode of transmission Feco-oral Predisposing factors Loss of food hygiene

Amoeba vegetative form

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GIT Dr. Shaf3y

cyst

environment

vegetative cyst

G.I.T.

Amoeba stool infection vegetative

cyst

vegetative of amoeba HCL HCL resist cyst

colon

amoeba

pathology organism Proliferate amoeba amoeba damage

toxins toxins

is proliferating << amoeba toxins damaged Mucosa Ulcer compeitition Normal cells For nutrition

Proliferating amoeba

Normal

Proliferating amoeba For nutrition overlying mucosa necrosis

toxins

amoeba

proliferating amoeba
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mucosa

just

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GIT Dr. Shaf3y

damage healthy << mucosa in between healthy Mucosa

clinical pictures clinical pictures acute amoebiasis chronic amoebiasis acute amoebiasis acute diarrhea

acute dysentery

acute amoebiasis acute diarrhea acute dysentery acute dysentery Diarrhea Diarrhea

diarrhea dehydration

stool

abdominal colics tenesmus mucous blood acute amoebiasis

acute dysentery

chronic amoebiasis Present by acute acute diarrhea

chronic dysentery

chronic chronic diarrhea Flatulence, constipation, pain Flatulence flatus

abdominal distention
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GIT Dr. Shaf3y

Constipation amoeba constipation chronic amoebiasis constipation is 20 times more common than diarrhea 20 times more common than diarrhea << chronic amoebiasis constipation flatulence abdominal pain amoebiasis pain

amoeba Until proved otherwise << amoebiasis stool analysis amoeba amoebiasis abdomen pain amoebiasis abdominal pain amoeba anyway abdominal pain amoebiasis right iliac fossa Pain appendix pain caecum colon right hepatic flexure cholecystitis transverse colon peptic ulcer diverticulitis
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amoeba

Pain

pain

sigmoid

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GIT Dr. Shaf3y

Left appendix diverticulitis

diseases

amoebiasis

Pain Diseases

differential diagnosis

Investigations stool analysis vegetative form

Mucous

blood

Serology amoeba antibodies CBC Esinophilia Infection ulcers healthy mucosa amoebiasis Liver complications intestinal amoebiasis Portal vein amoebic liver abscess colon perforation rare

hemorrhage

amoebiasis prevention Food hygiene

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GIT Dr. Shaf3y

cyst passes community

screening stool analysis

specific treatment dysentery anti spasmodic anti diarrheal agent Symptomatic treatment specific anti amoebic drugs

specific

anti amoebic drugs Luminal amoebicidal colon Lumen amoeba wall Lumen community Lumen amoeba spread of infection Diloxamide Furamide tissue amoebicidal colon wall amoeba tissue amoebicidal

Liver

severe vomiting

dehydration

vomiting

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GIT Dr. Shaf3y

<<

Metronidazole luminal and tissue amoebicidal

3 anti amoebic drugs metronidazole Anti amoebic drugs metronidazole anti amoebic drugs Bacillary dysentery inflammatory bowel disease Bacillary organism

genetics

Pure Pure

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GIT Dr. Shaf3y

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GIT Dr. Shaf3y

Bacillary dysentery inflammatory bowel disease

Bacillary organism Shigella bacteria dysentery flexion of the colon Shigella dysenteriae Shigella flexneri Shigella boydii Shigella sonnei Shigella

Mode of transmission Feco-oral organism organism toxins intestine Organism amoeba toxins Mucosa amoebic bacillary dysentery Organism damage

clinical pictures bacillary dysentery 15 << diarrhea Which means dehydration Abdominal colics Tenesmus Blood Mucous And pus in the stool

neutrophils
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Pus

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GIT Dr. Shaf3y

dead neutrophils amoeba 15 dehydration diarrhea Pus Pus

amoeba

bacillary desentery toxemia fever

toxis

investigations Stool analysis stool analysis Excess WBCs and RBCs culture and sensitivity Faecal culture demonstrates the organism amoeba RBCs WBCs RBCs amoeba

CBC leucocytosis esinophilia amoeba

pseudo membrane bleeding surface

healthy mucosa
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Ulcers

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GIT Dr. Shaf3y

antibodies antibodies serology

blood stream

complications Bacillary dysentery bacteremia urinary tract infection

treatment anti diarrhea anti diarrhea prevention food hygiene

anti spasmodic anti diarrheal << anti diarrheal agent amoebic

toxins

maintain

bacillary dysentery

treatment siprofloxacin << antibiotic

baillary dysentery

amoebic

Bilharzial dysentery inflammatory bowel disease

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GIT Dr. Shaf3y

Bilharzial dysentery story Bilharziasis

Bilharziasis of the liver story

Haematobium Mansoni Japonicum

stool

life cycle Life cycle urine ova

skin

penetration

skin

penetration

Liver

whatever

Mansoni

blood stream Haematobium

liver adult worm

Japanocium

Mansoni

haematobium Liver adult worm Liver

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GIT Dr. Shaf3y

Liver colon urinary bladder Mansoni Haematobium

colon Urinary bladder

Mansoni Haematobium

Organ

adult worm

final organ Liver

Haematobium Urinary bladder Mansoni colon

Bilharziasis of the urter Bilharziasis of the urinary bladder Bilharziasis of the prostate

colon adult worm down eggs esinophils , lymphocytes and macrophages bilharzial granuloma Bilharzial granuloma polyp

colon

Polyp

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Peristalsis Peristalsis diarrhea

colon

Peristalsis tenesmus

polyp

peristalsis bleeding bleeding dysentery

diarrhea

tenesmus

polyps

Mucous

urinary bladder Polyp

Ova Haematobium bilharzial granuloma urinary bladder

contract contraction frequency urinary bladder

Urine

urinary bladder

contraction

urinary bladder Strangury colon Tenesmus

diarrhea << colon frequency << urinary bladder tenesmus << colon strangury << urinary bladder
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dysentery G.I.T. hematuria bleeding << colon << urinary bladder

rectum

stool rectum

Ova polyps

bleeding per rectum fresh bleeding per rectum rectum bilharzial polyps

Urethera

ova urethera stricture

prostate Bilharzial prostatitis epididymis epididymis ureter Ureter

bilharziasis

beaded

hydro-ureter hydro-nephrosis

ova colon Portal vein Liver Liver Portal area Hepatic artery, portal vein, bile duct Portal vein granuloma
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poral vein ova

ova

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fibrosis Portal veins branches portal hypertension Periportal fibrosis portal hypertension cirrhosis cirrhosis double blood supply Liver Portal vein hepatic artery supply degeneration, regeneration

Liver Ova Peri portal fibrosis Portal hypertension

Haemtobium internal iliac veins right atrium Ova right ventricle right atrium Pulmonary artery right ventricle pulmonary artery lung bilharzial cor pulmonale bilharzial cor pulmonale Haematobium

Mansoni

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Portal hypertension collateral Inferior vena cava collaterals Ova right atrium right ventricle bilharzial cor pulmonale

bilharzial cor pulmonale Haematobium intestinal bilharziasis Organism Mansoni

Mode of transmission Penetration of the skin

Predisposing factors Contact with contaminated water clinical pictures stool mucous blood colics diarrhea

right iliac fossa

mass

right iliac fossa masses appendicular mass bilharzial granuloma amoeboma cancer caecum cancer mesenteric lymphadenitis Anyway mass

portal hypertension

Liver

ova complication

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investigations Stool analysis ova esinophilia blood serology circum oval precipitation test antibodies detect Polyps biopsy

Anti spasmodic Anti diarrheal praziquntel bilharziasis of the liver

Bilharziasis of the liver 3 Organism Mansoni Mode of transmission Portal blood Liver intestine

Peri portal Fibrosis portal hypertension

Portal hypertension splenomegaly Pain

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pan cytopenia

splenomegaly

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congestion << G.I.T. dyspepsia malabsoprtion

collaterals Caput medosa bleeding varices bleeding per rectum ascites ascites Portal hypertension

Portal hypertension Hypo albuminemia

hypo albuminemia

G.I.T.

congestion malabsoprtion dyspepsia

portal hypertension poverty

poverty Malnutrition cirrhosis on top hepatitis Mixed pathology cirrhosis Bilharzasis Hepatitis on top of Bilharziasis

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investigations intestinal investigations Liver biopsy shrunken liver portal hypertension liver cell failure Praziquantel Mixed pathology

G.I.T. 42 2013 18

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