The NEET PG 2018 Result has just been declared. If you were one of the aspiring candidates who gave the NEET PG 2018, then you can check your result here.
Check Your Result Here
You can check the result on the official website of NatBoard or NBE. All you have to do is:
While most of Delhites have learnt to live with the Covid-19, there has been an unconquerable increase in the number of cases in the past few months. Doctors and Medical staff are turning their efforts towards saving every precious life in hospitals, where Rajeev Gandhi Super Specialty Hospital, Tahirpur, stands the finest in East Delhi. Under the leadership of Dr. Ajeet Jain, the infrastructure has set the very foundations of what we may call the beginning of the new era: Covid Free India!
Filled with enthusiasm and an untiring zeal, Doctors here are working tirelessly, to not only treat their patients, but to create an atmosphere of assurance amidst the chaos. To watch them remove their PPE kits during doffing procedure, where the sweat drags itself on the floors, is like looking at a lake of efforts.
Under the leadership of our esteemed Director, Dr. BL Sherwal and Dr. Ajeet Jain, Nodal officer of the hospital, who works more than 12hrs a day, to guide everything in a direction of integrity, making sure everyone is safe and sound. Dr. Vikas Dogra, Head of Pulmonology department, can be seen throughout the premises of hospital, making sure patients needs are met genuinely. In a sound mind, it definitely is an exquisite hospital where other government hospitals might fail to meet the standards.
Despite 382 Doctors losing their lives fighting against Covid 19, our community isn’t losing the pace. We will keep believing in the simple notion of rebuilding everything once again.
Perhaps RGSSH is one of the leading hospital where Remdesivir Therapy and Plasma Therapy are being performed with highest cure rates and most preferable outcomes. A whole lot of protocols have been set up for the safety and consequences of the therapy, for one is accountable for every action he takes towards saving a life.
To conclude, we will honour the work our Doctors are doing everyday while we sleep peacefully looking at the bright side of life. Let’s not forget the ones we have lost, and leave the footprints on sands of time, for the seeds planted today will definitely bear the fruits tomorrow. Stay safe, stay healthy.
Anemia is the most mutual medical ailment of pregnancy. The occurrence of anemia in pregnancy ranges from 40-80 % in tropics likened to 10-20% in developed countries.
“Anemia is a reduction in red blood cells (erythrocytes) which in turn decrease the oxygen carrying capacity of the blood. It reflects an abnormality in red blood cell number, structure or function”.
According to WHO, “Anemia in pregnancy is present when the hemoglobin concentration in the peripheral blood is 11g/100ml or less. Keeping in mind the socio-economic status, the level is brought down to 10g/100ml or less”. Or “Anemia is defined as a reduction below normal in the number of red blood corpuscles per cubic millimeter, the quantity of hemoglobin and the volume of packed red cells per 100 ml of blood”.
Classification of Anemia
Practically
Anemia is classified into two:
Physiological anemia of pregnancy.
Pathological anemia: it is further divided into:
Deficiency anemia (isolated or combined)
Hemorrhagic
Hemolytic (Lack of bile pigment in urine)
Bone marrow insufficiency
Hemoglobinopathies
Causes of Anemia During Pregnancy
Inadequate iron reserve
Increase demand of iron
Disturbed metabolism
Pre pregnant health status
Condition requiring excess demand
Faulty dietetic habit
Iron loss
Clinical Features
Symptoms
Lassitude and a feeling of exhaustion or weakness may be earlier manifestation.
Anorexia
Palpitation
Indigestion
Dyspnea
Gigginess
Swelling of leg
Pallor of mucus membrane
In examination
There is pallor glossitis and stomatitis.
There may be adima of leg.
A soft systolic mermer may be geared.
Crepitation may be heard.
Diagnosis of a Case of Iron Deficiency/Anemia
Hematological examination
Hemoglobin
Total red cell count
Packed cell Volume
Peripheral blood smear
MCHC, MCB and MCH values
Serum Iron
Total iron binding capacity
Serum ferritim
Examination of stool
To detect anemia due to hookworm infestation
Urine examination
To check infection and presence of protein, sugar and pus cell
Complication of Severe Anemia
During pregnancy:
Pre-eclampsia
Intercurrent infection
Heart failure
Preterm labor
Abortion
During labor:
Uterine inertia
PPH
Cardiac failure
Shock
During puerperium:
Puerperal Sepsis
Sub involution
Failing lactation
Puerperal Venus Thrombosis
Effects on Baby:
There is increased incidence of low birth weight
There are chances of intra uterine death
Nursing Management
The pregnant women should get her hemoglobin level checked at the first antenatal visit, then at 28th week and finally at 36th week.
The mother should be given iron protein and vitamin rich diet like
Liver
Meat
Egg
Green vegetable
Figs
Beans
Whole wheat
Green Plantains
Onions stalks
Jaggery
Ground nuts
She should be given oral preparation in the form of tablets and capsules
Advise the mother to continue iron preparation.
Dietary advice must be anthesised and reinforced as told earlier like richer source of iron and folic acid are to be given taken before, during and after pregnancy.
While administration of parenteral iron check for advert reaction like rigor chest pain, hypertension.
Apart from the most used book for pharmacology, K.D Tripathi, there comes another book which is one of the finest books to read in Second year of MBBS for pharmacology. Goodman and Gilman provides beautiful insights and explanations to the students. Below are the links given to Goodman and Gilman free eBook in PDF format for Pharmacology.
Goodman and Gilman Pharmacology PDF Book
The Goodman and Gilman has 15 sections covering 65 chapters and appendices which are listed as below:
Section I: General Principles
Pharmacokinetics and Pharmacodynamics: The Dynamics of Drug Absorption,
Distribution, Action and Elimination
Membrane Transporters and Drug Response
Drug Metabolism
Pharmacogenetics
The Science of Drug Therapy
Section II: Drugs Acting at Synaptic and Neuroeffector junctional sites
Neurotransmission: The Autonomic and Somatic Motor Nervous Systems
Muscarinic Receptor Agonists and Antagonists
Anticholinesterase Agents
Agents Acting at the Neuromuscular Junction and Autonomic Ganglia
Adrenergic Agonists and Antagonists
5-Hydroxytryptamine (Serotonin): Receptor Agonists
and Antagonists
Section III: Drugs Acting on Central Nervous System
Neurotransmission and the Central Nervous System
General Anesthetics
Local Anesthetics
Therapeutic Gases: Oxygen, Carbon Dioxide, Nitric Oxide, and Helium
Hypnotics and Sedatives
Drug Therapy of Depression and Anxiety Disorders
Pharmacotherapy of Psychosis and Mania
Pharmacotherapy of the Epilepsies
Treatment of Central Nervous System Degenerative Disorders
Opioid Analgesics
Ethanol
Drug Addiction and Drug Abuse
Section IV: Autocoids: Drugs therapy of Inflammation
Histamine, Bradykinin, and Their Antagonists
Lipid-Derived Autacoids: Eicosanoids and Platelet-Activating Factor
Analgesic-Antipyretic Agents; Pharmacotherapy of Gout
Pharmacotherapy of Asthma
Section V: Drugs affecting Renal and Cardiovascular Function
Diuretics
Vasopressin and Other Agents Affecting the Renal Conservation of Water
Renin and Angiotensin
Treatment of Myocardial Ischemia
Therapy of Hypertension
Pharmacotherapy of Congestive Heart Failure
Antiarrhythmic Drugs
Drug Therapy for Hypercholesterolemia and Dyslipidemia
Section VI: Drugs affecting Gastrointestinal Function
Pharmacotherapy of Gastric Acidity, Peptic Ulcers, and Gastroesophageal
Reflux Disease
Treatment of Disorders of Bowel Motility and Water Flux; Antiemetics;
Agents Used in Biliary and Pancreatic Disease
Pharmacotherapy of Inflammatory Bowel Disease
Section VII: Chemotherapy of Parasitic Infections
Chemotherapy of Protozoal Infections: Malaria
Chemotherapy of Protozoal Infections: Amebiasis, Giardiasis, Trichomoniasis,
Trypanosomiasis, Leishmaniasis, and Other Protozoal Infections
Chemotherapy of Helminth Infections
Section VIII: Chemotherapy of Microbial Diseases
General Considerations of Antimicrobial Therapy
Sulfonamides, Trimethoprim-Sulfamethoxazole, Quinolones, and Agents
for Urinary Tract Infections
Penicillins, Cephalosporins, and Other β-Lactam Antibiotics
Aminoglycosides
Protein Synthesis Inhibitors and Miscellaneous Antibacterial Agents
Chemotherapy of Tuberculosis, Mycobacterium avium Complex Disease,
and Leprosy
Antifungal Agents
Antiviral Agents (Nonretroviral)
Antiretroviral Agents and Treatment of HIV Infection
Section IX: Chemotherapy of Neoplastic Diseases
Antineoplastic Agents
Section X: Immunomodulators
Immunosuppressants, Tolerogens, and Immunostimulants
Section XI: Drugs acting on the Blood and Blood-Forming Organs
Hematopoietic Agents: Growth Factors, Minerals, and Vitamins
Blood Coagulation and Anticoagulant, Thrombolytic, and Antiplatelet Drugs
Section XII: Hormones and Hormone Antagonists
Pituitary Hormones and Their Hypothalamic Releasing Factors
Thyroid and Antithyroid Drugs
Estrogens and Progestins
Androgens
Adrenocorticotropic Hormone; Adrenocortical Steroids and Their Synthetic Analogs;
Inhibitors of the Synthesis and Actions of Adrenocortical Hormones
Insulin, Oral Hypoglycemic Agents, and the Pharmacology of the
Endocrine Pancreas
Agents Affecting Mineral Ion Homeostasis and Bone Turnover
Section XIII: Dermatology
Dermatological Pharmacology
Section XIV: Ophthalmology
Ocular Pharmacology
Section XV: Toxicology
Principles of Toxicology and Treatment of Poisoning
Heavy Metals and Heavy-Metal Antagonists
Appendices:
I. Principles of Prescription Order Writing and Patient Compliance
II. Design and Optimization of Dosage Regimens; Pharmacokinetic Data
Overview
Unlike KD Tripathi, Goodman and Gilman has a lot of text clustered together with some flow charts and some images. The book has over 2047 pages with deep explanations and it’s download size is 33.2 Mb. However, we still recommend that you use KD Tripathi if you are a second year MBBS student struggling to pass the prof exams.
Suggestions to those studying pharmacology in Second year MBBS are as follows:
Most of the pharmacology is mugging up, you will end making a number of mnemonics for them. But do not miss important topics, including the drugs for cardiology, anti-biotics, etc.
You can download the Goodman and Gilman Pharmacology book by link given below. If the link is not working, do let us know using the comments section, we will readily update it. If you are unable to locate the links, please refresh the page.
Please note these are external links and we do not host any downloads on our website. If you are the owner of the content or have disputes regarding the terms, please read our complete Disclaimer page or leave us a message via our Contact Us page. Any violation or infringement will be immediately removed upon confirmation.
The NMC or National Medical Commission Bill 2019 has recently been passed from Lok Sabha on 29th July and is ready to be passed in Rajya Sabha too. The fraternity of doctors is protesting massively against the bill, however, it seems the government and the doctors are bound to clash. We explore the key points of NMC bill 2019 pdf as we try to explain you why it is a disaster for the entire medical community in India.
We have been following news of EXIT exam since years, but the bill was thought to never pass at first stage. And when the rumors have become alive, the ones preparing day and night for Post-Graduation after MBBS are furthermore in stress. We have made a quick review on the updates of NMC Bill 2019 below:
1. The National Medical Commission Bill was introduced in Lok Sabha in July 22, 2019 by Dr. Harsh Vardhan, Minister of Health and Family Welfare, to replace the 63-year old MCI which was alleged to be full of corruption.
2. The Commission or the Board is to be of 25 members, who will be appointed by central government. The Bill has to be regulated within 3 years of passing, and state governments will establish State Medical Councils at the state level.
3. Apart from the basic functioning of NMC board, it will also frame guidelines for determination of fees of up to 50% seats in private colleges and universities.
4. So far, the Ayush Doctors through Bridge course has not been included in the bill after the previous wide-spread protest by MBBS doctors, however, they have not withdrawn completely and has been proposed in Lok Sabha. It will allow mid-level practitioners to prescribe for a limited level, however for others, they will need to be supervised under Registered Medical Practitioners.
5. There will be a uniform National Eligibility-cum-Entrance Test (NEXT exam) for admission to under-graduate and post-graduate education. All MBBS graduates after finishing they 5.5 years of graduation will be required to give NEXT exam to practice as physicians and register themselves in the state board, while also applying for the PG courses with the rank. In short, NEXT exam will serve as both providing license to practice and Post-Graduation after finishing final prof of MBBS.
6. It also has been postulated to regard final prof marks as the basis for admission to PG courses, however, this has not been clear so far.
We saw a protest by IMA leaders including Dr. Santanu Sen, IMA President, and thousands of students against the NMC bill. However, they were arrested by the police outside the Nirman Bhawan in Delhi, and medical community called it a black day.
IMA President Dr. Santanu Sen being arrested with other students at Nirman Bhawan, Delhi
Dr. Santanu Sen with other students arrested for protesting against NMC Bill 2019
There is nothing government can do when reservation protests are done, there is nothing when a doctor is beaten in the hospital, but yes, the government can call arrest of every single doctor protesting peacefully against a stupid bill that aims at destroying the medical community in India. Do we really need to NEXT examafter MBBS just to show we are eligible to work as doctors after 5.5 years of hard work? Why not same criteria for other services? Why not same for politicians drowned in countless criminal cases?
We are currently looking forward to this grave issue, while IMA has announced a wide-spread strike by withdrawal of non-emergency services all over in India on 31st July 2019. The strike will be peaceful as it was last time, when doctors demanded from government the safety at work after the incident at West Bengal. A Bench of Justices Deepak Gupta and Surya Kant said there was no urgency in the matter as the strike had been called off.
Do you support the notion of bringing this NMC Bill 2019 into act or you stand against it? Share your opinions in the comments below.
We are often drew back when it comes to Biochemistry during First year of MBBS. It’s not simply a confusing subject, but you have to mug up a lot from this. Some even get to the brink of failing and start looking out for only important topics, so it’s much easier to pass out in the semester. For such students, we have got the list. Below are the important topics to study for Biochemistry during First year of MBBS.
Before we go, we hope you’ve got some important Biochemistry books in your pocket. If not, you can get them here for free:
A huge amount of population suffers Kidney Stones, also known as Nephrolithiasis. We doctors commonly see patients coming up in ER with their hands on their flanks and telling us how painful it is. We do manage the situation, but what advice would you give to ones who have kidney stones? What would you tell them to eat or drink or do regarding their vulnerability to Kidney Stones?
Below are some key points that were summarized and scripted out from the Bible of Medicine, Harrison. The following points are authentic and have been validated, and do share the information to others to let them know what to do and what not to when they have Kidney Stones. Meanwhile you can also check out post on Gall Stones.
For the Doctors, here are some:
Kidney stones cause pain only when the stone moves in the ureter. Pain is actually a good sign.
0-5mm stones pass 100%, 5-10 pass 70% and decreases further with size.
Surgical intervention is only required when there is UTI, intractable pain or anatomical abnormality.
T. Tamsulosin 0.4mg hs is quoted in Campbell and some articles to be relieve distal ureter stones, but not established yet.
For the People, here are Wise Words from The Gandalf!
Diclofenac is the best drug for pain in kidney stones.
Drink atleast 2L water, 500ml more than you pee.
Tomatoes and Potatoes and Spinach are most common sources of stones, but an Indian simply cannot avoid them. What to do? Take Curd with these foods. Note: While Dietary calcium is good, supplement calcium actually contributes to stones. Shouldn’t exceed 1200ng.
It’s better to use lemon on tomato in salad, and avoid tomato seeds.
If you are non-vegetarian, perhaps you should try taking less of animal protein.
Less of Sodium (salt) diet is mandatory. Sucrose and fructose are other culprits.
The Vishram Singh Anatomy was one of the books a first year student during his MBBS would grab to read and look the insights as he opens BD Chaurasia sideways. Although not the bible of anatomy, it still holds its place throughout the learning process of the initial semesters. You can grab your own copy of Vishram Singh Anatomy Second Edition from this post. Just scroll down as the Google Drive links of the pdf version are given below for free.
Vishram Singh Anatomy PDF Book
The Second Edition of Vishram Singh Anatomy contains three parts, Upper Limb and Thorax, Abdomen and Lower Limb and Head, Neck and Brain. The three parts of book consists of following:
Vishram Singh: Upper Limb and Thorax
The book is 375 pages long with contents as follows:
Chapter 1 Introduction to the Upper Limb
Chapter 2 Bones of the Upper Limb
Chapter 3 Pectoral Region
Chapter 4 Axilla (Armpit)
Chapter 5 Back of the Body and Scapular Region
Chapter 6 Shoulder Joint Complex (Joints of Shoulder Girdle)
Chapter 7 Cutaneous Innervation, Venous Drainage and Lymphatic Drainage of the Upper Limb
Chapter 8 Arm
Chapter 9 Forearm
Chapter 10 Elbow and Radio-ulnar Joints
Chapter 11 Hand
Chapter 12 Joints and Movements of the Hand
Chapter 13 Major Nerves of the Upper Limb
Chapter 14 Introduction to Thorax and Thoracic Cage
Chapter 15 Bones and Joints of the Thorax
Chapter 16 Thoracic Wall and Mechanism of Respiration
Chapter 17 Pleural Cavities
Chapter 18 Lungs (Pulmones)
Chapter 19 Mediastinum
Chapter 20 Pericardium and Heart
Chapter 21 Superior Vena Cava, Aorta, Pulmonary Trunk, and Thymus
Chapter 22 Trachea and Esophagus
Chapter 23 Thoracic Duct, Azygos and Hemiazygos Veins, and Thoracic Sympathetic Trunks
Vishram Singh: Abdomen and Lower Limb
The book is 521 pages long with following contents:
Chapter 1 Introduction and Overview of the Abdomen
Chapter 2 Osteology of the Abdomen
Chapter 3 Anterior Abdominal Wall
Chapter 4 Inguinal Region/Groin
Chapter 5 Male External Genital Organs
Chapter 6 Abdominal Cavity and Peritoneum
Chapter 7 Abdominal Part of Esophagus, Stomach, and Spleen
Chapter 8 Liver and Extrahepatic Biliary Apparatus
Chapter 9 Duodenum, Pancreas, and Portal Vein
Chapter 10 Small and Large Intestines
Chapter 11 Kidneys, Ureters, and Suprarenal Glands
Chapter 12 Posterior Abdominal Wall and Associated Structures
Chapter 13 Pelvis
Chapter 14 Pelvic Walls and Associated Soft Tissue Structures
Chapter 15 Perineum
Chapter 16 Urinary Bladder and Urethra
Chapter 17 Male Genital Organs
Chapter 18 Female Genital Organs
Chapter 19 Rectum and Anal Canal
Chapter 20 Introduction to the Lower Limb
Chapter 21 Bones of the Lower Limb
Chapter 22 Front of the Thigh
Chapter 23 Medial Side of the Thigh
Chapter 24 Gluteal Region
Chapter 25 Back of the Thigh and Popliteal Fossa
Chapter 26 Hip Joint
Chapter 27 Front of the Leg and Dorsum of the Foot
Chapter 28 Lateral and Medial Sides of the Leg
Chapter 29 Back of the Leg
Chapter 30 Sole of the Foot
Chapter 31 Arches of the Foot
Chapter 32 Joints of the Lower Limb
Chapter 33 Venous and Lymphatic Drainage of the Lower Limb
Chapter 34 Innervation of the Lower Limb
Vishram Singh: Head, Neck and Brain
The book has over 460 pages and contents of:
Chapter 1 Living Anatomy of the Head and Neck
Chapter 2 Osteology of the Head and Neck
Chapter 3 Scalp, Temple, and Face
Chapter 4 Skin, Superficial Fascia, and Deep Fascia of the Neck
Chapter 5 Side of the Neck
Chapter 6 Anterior Region of the Neck
Chapter 7 Back of the Neck and Cervical Spinal Column
Chapter 8 Parotid Region
Chapter 9 Submandibular Region
Chapter 10 Infratemporal Fossa, Temporomandibular Joint, and Pterygopalatine Fossa
Chapter 11 Thyroid and Parathyroid Glands, Trachea, and Esophagus
Chapter 12 Pre- and Paravertebral Regions and Root of the Neck
Chapter 13 Oral Cavity
Chapter 14 Pharynx and Palate
Chapter 15 Larynx
Chapter 16 Blood Supply and Lymphatic Drainage of the Head and Neck
Chapter 17 Nose and Paranasal Air Sinuses
Chapter 18 Ear
Chapter 19 Orbit and Eyeball
Chapter 20 Vertebral Canal and Its Contents
Chapter 21 Cranial Cavity
Chapter 22 Cranial Nerves
Chapter 23 General Plan and Membranes of the Brain
Chapter 24 Brainstem
Chapter 25 Cerebellum and Fourth Ventricle
Chapter 26 Diencephalon and Third Ventricle
Chapter 27 Cerebrum
Chapter 28 Basal Nuclei and Limbic System
Chapter 29 Blood Supply of the Brain
Download Size: Upper Limb and Thorax: 45mb Abdomen and Lower Limb: 45mb Head, Neck and Brain: 39mb
Vishram Singh, MS, PhD Professor and Head, Department of Anatomy Professor-in-Charge, Medical Education Unit Santosh Medical College, Ghaziabad Editor-in-Chief, Journal of the Anatomical Society of India Member, Academic Council and Core Committee PhD Course, Santosh University Member, Editorial Board, Indian Journal of Otology Medicolegal Advisor, ICPS, India Consulting Editor, ABI, North Carolina, USA Formerly at: GSVM Medical College, Kanpur King George’s Medical College, Lucknow Al-Arab Medical University, Benghazi (Libya) All India Institute of Medical Sciences, New Delhi
Overview
Vishram Singh Anatomy Book gives the First year students another option apart from the traditional BD Chaurasia book. The book has super illustrations and also holds special as it has MCQ based questions along with it. The drawings are so fine and clear with different colors to explain the details. The book also depicts clinical pictures of the same as the reader gets deep into the book. It’s a good book if you are preparing for NEET PG exams as well.
Suggestions to those studying anatomy in First Year MBBS are as follows:
Try drawing more of diagrams and 3d visualizing everything you learn. The more you draw and imagine, the more you can recall them easily.
There are plenty of YouTube videos around and then there are some animations, which help understand the most important topics. Just don’t skip them, you will need them in your entire medical career.
If you are preparing for PG Exams, do read this book. It will pave the way of better learning. Although BD Chaurasia still remains the bible of anatomy in India.
Clinically correlating it with cadavers during dissection halls posting is a great way to remembering anatomy.
If you need help, following are some posts that can greatly help you in clinical anatomy. They have been made short but explained to the level of a medical student. These are:
You can download the Vishram Singh Anatomy book by links given below. If the link is not working, do let us know using the comments section, we will readily update it. If you are unable to locate the links, please refresh the page.
Please note these are external links and we do not host any downloads on our website. If you are the owner of the content or have disputes regarding the terms, please read our complete Disclaimer page or leave us a message via our Contact Us page. Any violation or infringement will be immediately removed upon confirmation.
With Great Power Comes Great Responsibility, and on becoming Doctor, one needs to give up his life for the joy of others. At least that’s what we found after graduating from our MBBS.
It was a beautiful hostel life though, and we explored so many talents inside us throughout the college years. Here, i am bringing you one of my friend presenting her latent gift which she explored gradually over the college years.
Just seeking out your love and affection for this one, meanwhile i request you all to not let your gifts get buried under the sands of time. Instead, envy them, embrace them and explore them as you move on with your medical life.
Lower Gastrointestinal Tract Bleeding or LGI or Lower GI Bleeding is one of the most common serious presenting complaint by patients in emergency or OPD, to differentiate and treat according through the protocol is the art a doctor should learn. We will discuss the topic in detail along with the protocol or approach followed for same.
Definition
Lower GI (LGI) bleeding is the loss of blood from the GI tract distal to the ligament of Treitz in the form of bright red or maroon rectal bleeding called Hematocheia.
Significance
Lower GIT bleeding being a common problem not just in the multifaceted Surgical Specialities,but as well in “Emergency Medicine”,should be considered potentially life threatening until proven otherwise and accorded utmost significance.
Epidemiology
Common,seen in an incidence of 36 per 1 Lakh people – Elderly Female are most vulnerable.
Causes/Etiology
The causes in order of frequency are as follows:
Anal lesions such as Hemorrhoids, Fissure
Rectal Trauma
Colitis/Proctitis
Colonic Polyps
Carcinoma Colon
Angiodysplasia
Diverticular Disease
Intussusception
Solitary Ulcer
Blood dsycrasia
Vasculitis
Connective Tissue Disorders
Neurofibroma
Amyloidosis
Anti-coagulation
Lower Gi Bleeding Protocol / Approach
The following image reads out loud the Protocol of Lower GI Bleeding:
Source: Harrison Medicine
History
General
History elicited includes past GI bleeding and a history of pain, trauma, ingestion or insertion of foreign bodies, and recent colonoscopies.
Specific Indications
Weight
loss and changes in bowel habits may suggest Malignancy.
History
of an aortic graft may suggest the possibility of an aortoenteric fistula.
Medications, such as salicylates, nonsteroidal anti-inflammatory drugs, and warfarin, increase the risk of LGI bleeding.Patients on Beta Blockers or poorly controlled hypertension might present with subtle signs of pathognomic symptoms.
Consumption of iron or bismuth can simulate melena, and certain foods, such as beets,can simulate hematochezia. However, stool guaiac testing in those cases will be negative.
Examination
General Examination
May appear Emaciated with signs of Pallor and Weakness, Altered Mental Status.
Systemic Examination
Gastrointestinal Tract
Tenderness, Masses, Ascites or Organomegaly. Lack of Abdominal tenderness might indicate Vascular causes such as diverticulosis or angiodysplasias, while its presence associated with Inflammatory Bowel Disorders. Digital Rectal Examination might detect gross bleeding and sources viz -a- viz laceration, masses, hemorrhoids, fissures or trauma.
Cardiovascular System
Hypotension, tachycardia, angina, syncope.
Skin Appearance
Signs of petechiae and purpura might provide clues on an underlying Coagulopathy or liver disease. Cool, pale skin with increased capillary refill may signal Shock.
Lab Testing
Order laboratory tests which include CBC, coagulation studies, and typed and cross-matched blood. An ABG is always helpful.
In
acute, brisk bleeding, the initial hematocrit level would not reflect the
actual amount of blood loss.
Coagulation profile, including prothrombin
time, partial thromboplastin time, and platelet count, is vital in patients
taking anticoagulants or those with underlying liver disease.
Routine
tests such as blood urea nitrogen, creatinine, electrolytes, glucose, and liver
function studies.
Bleeding
from a source in the upper GI tract may elevate blood urea nitrogen levels
through digestion and absorption of hemoglobin.
Silent
ischemia can occur secondary to the decreased oxygen delivery accompanying
significant GI bleeding and an Electrocardiogram is a must,in suspected
population.
Radiology
Diagnostic
Procedure of Choice – Angiography,Scintigraphy or Endoscopy.
Scintigraphy
appears more sensitive than angiography and can localize the site of bleeding
at as low a rate as 0.1 mL/min. It also has potential value over angiography if
bleeding occurs intermittently but requires a minimum of 3 mL of blood to pool.
Technetium
Labelled Red Cell Scans – detects Obscure Hemorrhage.
Radiographs like Chest Xray and Xray Abdomen are of limited value,unless indicated.
The DAMS Handwritten Notes are here for free Download in PDF Format for your mobile phone and computer. Grab the latest notes from DAMS teachers for year 2017 and 2018 NEET PG exam now!
Read our exclusive guide on Courses and Careers you can opt after MBBS. Start with Post-graduation, Research, Hospital management, Foreign studies and Clinical practice.
Read our list of Emergency drugs used in Casualty wards. The list is made according to India with detailed drug class and uses. Find the life saving drugs in Cardiology, Respiratory, GIT, Obstetrics, Painkillers, Allergy, CNS and Antibiotics.
Indeed you are a medico, but do you know MBBS has been selected as the toughest course in Guinness Book of World Records? Do you even know what is the history of MBBS and what does the word literary means? Find it here.
The NEET PG Results 2018 are out! Those who have appeared for the Post-Graduation exam after MBBS in December can now check their results here. Wish you all the best!
