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Digestive Tract Problems in GP– Part 2
Pain in Abdomen Presented By
• Prof.Dr.
• R.R.Deshpande
• 9226910630
7/19/2015 Prof.Dr.R.R.Deshpande 1
7/19/2015 Prof.Dr.R.R.Deshpande 2
Digestive Tract Problems in GP – Part 2
• Presented By –
• Prof.Dr.R.R.Deshpande (M.D in Ayurvdic
Medicine & M.D. in Ayurvedic Physiology)
• www.ayurvedicfriend.com
• Mobile – 922 68 10 630
• mailme.drrrdeshpande@rediffmail.com
Digestive Tract
7/19/2015 3Prof.Dr.R.R.Deshpande
7/19/2015 Prof.Dr.R.R.Deshpande 4
Digestive System Problems in GP
part 1 contains
• 1) Anorexia
• 2) Indigestion
• 3) Aerophagy(Gas)
• 4) Stomatitis
• 5) Hiccoup
• 6) Constipation
• 7) Diarrhoea
• 8) Vomiting
7/19/2015 Prof.Dr.R.R.Deshpande 5
Digestive System Problems in GP –
Part 2 contains
• 9) Dysphagia
• 10) Pain In Abdomen
• 11) IBS
• 12) Jaundice
• 13) Peptic ulcer
7/19/2015 Prof.Dr.R.R.Deshpande 6
Dysphagia causes 1
• Dysphagia = Difficulty in swallowing.
• Odynophagia = Painful swallowing.
• Acute severe pharyngitis, exudative Tonsillitis,
Peritonsillar abscess (quinsy)
• (All these cases – Pseudo dysphagia)
7/19/2015 Prof.Dr.R.R.Deshpande 7
Dysphagia causes 2
• True Dysphagia – Oesophagitis
• Mechanical dysphagia -- Cancer of
oesophagus
- (obstruction to passage of solid food) –
Cancer of oesophagus.
7/19/2015 Prof.Dr.R.R.Deshpande 8
Dysphagia Treatment 1
• Pseudo-dysphagia (due to Infection & pain)
Tab.Roxid (Roxithromycin) – 150 mg – BD (On
empty stomach)
or Tab.Azithral (Azithromycin) 500 mg – O.D. x
3days
• Tab.Voveron SR 100 mg – 1 O.D.
• Gurgaling.
7/19/2015 Prof.Dr.R.R.Deshpande 9
Dysphagia Treatment 2
• Oesophagitis
• Bland Diet
-Mucaine gel – 3 tsf x 3 hrly
- Cap. Omez – 20 mg x BD
- Tab ciza (cisapride) 10 mg – TDS.
- Tab forcan (flucanazole) – (for HIV patients) –
150 mg x 10 days
7/19/2015 Prof.Dr.R.R.Deshpande 10
Dysphagia Treatment 3
• If Cancer of Esophagus is suspected –
• Immediately refer to Oncologist.
7/19/2015 Prof.Dr.R.R.Deshpande 11
Epigastric pain causes
• 1) Gastritis (Drug Alcohol Induced).
• 2) Gastric ulcer.
• 3) Duodenal ulcer.
• 4) Enlarged Left Lobe of Liver.
• 5) Hook Worm.
• 6) Amoebiasis.
• 7) Pancreatitis.
• 8) Gastric malignancies.
.
7/19/2015 Prof.Dr.R.R.Deshpande 12
Investigations in Epigastric Pain
• 1) USG Abd – Hepatitis,CCF,Amoebic Liver
Abscess
• 2) Gastroscopy – GU,DU,CA of stomach
• 3) Stool Exam – worms,occult blood
7/19/2015 Prof.Dr.R.R.Deshpande 13
Epigastric pain – Rare causes
Rare causes
- Hepatitis.
- CCF.
- Amoebic Liver abscess.
7/19/2015 Prof.Dr.R.R.Deshpande 14
Epigastric pain - Treatment
• Cap. Omez 20 mg BD.
• Tab. Cyclopam – 1 TDS.
• Gellucil Liquid – 2tsf TDS.
• T. Zentel – 400 mg – stat.(Albendazole)
• T. Tini 500 mg – BD x 7 days.
7/19/2015 Prof.Dr.R.R.Deshpande 15
Pain in Right Hypochondrium
• 1) Infective Hepatitis – History of Jaundice epidemic.
• 2) Amoebic hepatitis – History of Amoebiasis
• 3) Alcoholic Hepatitis.
• 4) CCF (Tender liver).
• 5) Duodenal Ulcer.
• 6) Cholecystitis.
- Treatment -
According to above said Causes.
Gall stones
7/19/2015 16Prof.Dr.R.R.Deshpande
7/19/2015 Prof.Dr.R.R.Deshpande 17
Suspect CCF
( Right Ventricular Failure)
• 1) Hepatomegaly
• 2) Oedema over legs (Paedal Oedema in the
evening)
• 3) Engorged neck veins ( JVP increases)
• 4) Breathlessness
• History of Chronic Hypertension or Chronic
Lung disease
7/19/2015 Prof.Dr.R.R.Deshpande 18
Investigations in pain
in right Hypochondrium
• 1) USG Abdomen
• 2) Liver Function Tests
• 3) 2 D Echo
7/19/2015 Prof.Dr.R.R.Deshpande 19
Pain in Right Iliac fossa causes
• 1) Amoebic colitis.
• 2) Acute Appendicitis
• 3) Right ureteric colic
• 4) TB at ileo caecal junction
7/19/2015 Prof.Dr.R.R.Deshpande 20
Suggestive clinical features
• 1) Appendicitis – Vomiting, Fever, Mac
Burney’s tenderness
• 2) Ureteric colic – Dysurea, colicy pain but no
Tenderness
7/19/2015 Prof.Dr.R.R.Deshpande 21
Pain in Right Iliac fossa - Treatment
• 1) Inj.Voveron – 2 ml I/m.
• 2) Tab. ciprofloxacin 500 mg BD.
(or Inj.Ciprofloxcin I/v, if Vomiting is sever).
• 3) Tab. Tini 500 mg – BD.
• 4)Inj.Gentamycin 80 mg BD – I/V.
7/19/2015 Prof.Dr.R.R.Deshpande 22
Investigations for
Pain in right Iliac Fossa
• 1) USG Abd – Ureteric stone
• 2) WBC count – Leucocytosis – Appendicitis (?)
• 3) Urine R – RBC -- +++ & Crystals +++
• 4) Stool R – E.h –Amoebic Colitis
Causes of Generalised pain in Abdomen
• 1) Round worm, Tape worm (Common in pig
meat)
• 2) Amoebiasis, Giadiasis
• 3) IBS
• 4) Abdominal TB
• 5) Ca pancreas / ca colon
• 6) Long term use of purgatives
• 7) Lactose intolerance
7/19/2015 Prof.Dr.R.R.Deshpande 23
Hiatus Hernia
7/19/2015 24Prof.Dr.R.R.Deshpande
Acute Abdominal Pain without shock
• 1) Abdominal colic -Types :
• i) Intestinal colic ii) Renal colic
• iii) Appendicular colic iv) Biliary colic
• 2) Gynaec pain : Ex. dysmenorrhoea
•
• 3) Referred pain : pain in abdomen due to T.B.
or cancer of spine.
7/19/2015 Prof.Dr.R.R.Deshpande 25
Spasmodic Pain in lower Abdomen
7/19/2015 26Prof.Dr.R.R.Deshpande
Irritable Bowel Syndrome
7/19/2015 27Prof.Dr.R.R.Deshpande
Acute abdominal pain with shock :
• Low BP, feable but thread pulse, sweating cold
extremities
• Called as acute abdomen / surgical abdomen.
• Causes : i) Internal haemorrhage
• ii) Acute intenstinal obstructcion
• a) Strangulation
• b) intu-ssuception
• c) Valvulus
7/19/2015 Prof.Dr.R.R.Deshpande 28
Types of Intestinal obstruction
7/19/2015 29Prof.Dr.R.R.Deshpande
Acute abdominal pain with shock
• iii) Acute peritonitis
• iv) Acute pancreatitis
• v) Severe gastro-enteritis
• vi) Ectopic pregnancy
•
7/19/2015 Prof.Dr.R.R.Deshpande 30
7/19/2015 Prof.Dr.R.R.Deshpande 31
Colicky Pain causes 1
• 1) Renal colic – pain in right or left renal angle &
vomiting, USG abd, Urine R – RBCs.
• 2) Ureteric colic – Severe spasmodic pain from loin to
groin. Patient refuses to lie down, Dysuria (USG abd).
• 3) Small Intestinal colic – Colicky pain in central
abdomen. (amoebiasis, worms, Intestinal
obstructions).
7/19/2015 Prof.Dr.R.R.Deshpande 32
Colicky Pain causes 2
• 4) Large Intestinal Colic – severe colic, away from
centre (may be with h/o dysentery – E.h, shigella,
E.collic).
• 5) Biliary colic – Pain in Right hypochondrium (may
be with Jaundice) – due to Gall stone or Infection
(cholecystitis).
• 6) Spasmodic Dysmenorrhoea – Severe lower
abdominal pain (young unmarried girls).
Renal Colic
• Pain is unilateral right or left lumbar region.
• Renal angle tenderness (below 3 fingers of
scapula) with vomiting.
7/19/2015 Prof.Dr.R.R.Deshpande 33
7/19/2015 Prof.Dr.R.R.Deshpande 34
Colicky Pain Treatment 1
• Renal colic
- Inj.Voveron – 2 ml I/m stat.
- Inj.Reglan – 2 ml I/m stat. (If vomiting).
- Tab. Cyclopam – 1 TDS.
- I/v fluids (If severe vomiting).
- USG – Large stone – Urologist.
• .
7/19/2015 Prof.Dr.R.R.Deshpande 35
Colicky Pain Treatment 2
• Ureteric colic
- Inj.fortwin (pentazocin) – 1 ml stat – I/m.
- Inj.Phenargan – 1 ml – stat – I/m.
• X ray – KUB
If stone < 6mm – Hydrotherapy
X ray KUB
• Done on empty stomach in the morning
• Bowel preparation (no gas in abdomen)
• Tab – Dulcolax (3 tab)
• We take only 1 tab of Dulcolax for normal
wash of stomach
• Tab – Gasex of Himalaya 3 tab (with warm
water)
•
7/19/2015 Prof.Dr.R.R.Deshpande 36
7/19/2015 Prof.Dr.R.R.Deshpande 37
Colicky Pain Treatment 3
• Hydrotherapy –
- I/v – 5% Dextrose – 3 pints.
- fast (20 no. needle) In 1½ hrs.
- I/v Lasix & Cyclopam in third pint.
Repeat above procedure for 3 days.
Still, if stone does not pass – Urologist.
7/19/2015 Prof.Dr.R.R.Deshpande 38
Caution
• If stone > 6 mm – Do not give Hydrotherapy
• Stone can cause partial obstruction &
Hydrotherapy may cause Hydronephrosis
• Refer to Urologist -- Lithotripsy
7/19/2015 Prof.Dr.R.R.Deshpande 39
Small intestinal colic
Caution – Admit if vomiting,distension &
absolute constipation
Inj Cyclopam 2ml stat
Tab Tini 500 mg BD
Tab Zentel 400 mg stat
7/19/2015 Prof.Dr.R.R.Deshpande 40
Large Intestinal Colic
• Inj Cyclopam 2ml IM stat
• Tab Norflox TZ 1 BD
7/19/2015 Prof.Dr.R.R.Deshpande 41
Biliary Colic -- Treatment
• Biliary colic –
-Inj.Cyclopam – 2 ml I/m or I/v.
-Inj.Mox – 500 mg I/v stat.
-Tab.Flagyl 400 mg TDS
.
Adv – USG Abdomen & Sr.Bilirubin
Metro is used for Amoebic & also in anaerobic
Infections (I/V Metrogyl)
7/19/2015 Prof.Dr.R.R.Deshpande 42
Spasmodic Dysmenorrhoea - Treatment
• 1) Inj.Voveron 2ml – I/m stat.
2) Tab.meftal spas – 500 mg TDS.
3) Hot fomentation – Lower abd.
4) Bed Rest.
7/19/2015 Prof.Dr.R.R.Deshpande 43
Irritable Bowel Syndrome – IBS - causes
• 1) Mental stress & Depression.
• 2) Vague abdominal complaints.
• 3) Visit to many Doctors.
• 4) All Investigations – Normal.
• 5) Diagnosis of Exclusion.
7/19/2015 Prof.Dr.R.R.Deshpande 44
IBS – Treatment 1
• Constipation –
- High fiber Diet, plenty of water.
- Tab.Triphala 2 BD.Softovac 1 tsf BD
• Toilet > 4 times
- Cap.Imosec – 1 BD or,
- Tab.Lomotil – 2.5 mg BD or,
- Kutaja parpati Tab- 2 TDS.
7/19/2015 Prof.Dr.R.R.Deshpande 45
IBS – Treatment 2
• Abdominal pain
- Tab.cyclopam 1 BD.
• Depression
- Cap Fludac (fluoxetine) 20 mg OD.
- Assurance.
7/19/2015 Prof.Dr.R.R.Deshpande 46
Jaundice – Clinical features
• Severe anorexia, Nausea.
• Liver tender (palpable).
• Low grade fever, weakness.
• High colored urine, Sclera-yellow.
• Urine R-Bile salts & Bile pigment.
• Sr.Alkaline phosphatase (obstructive jaundice).
• Hepatitis B & obstructive Jaundice – Refer to
Gastroenterologist.
Liver Histology
7/19/2015 47Prof.Dr.R.R.Deshpande
Jaundice
7/19/2015 48Prof.Dr.R.R.Deshpande
7/19/2015 Prof.Dr.R.R.Deshpande 49
Jaundice - Treatment
• Bed Rest.
• High carbohydrate, Adequate protein(Glucon-D)
• For fever – T. Nise (Nimu-sulide) – 1 s.o.s.
• Severe vomiting – I/v 10% dextrose with Inj.Reglan.
• T.silybon (silymarin) 140 mg BD.
• Cap.Essentiate (phospholipids) 175 mg – TDS.
• Arogyawardhini 3 TDS.
• Kumari Asav No.1. 3tsf TDS.
Icterus of eyes
7/19/2015 50Prof.Dr.R.R.Deshpande
7/19/2015 Prof.Dr.R.R.Deshpande 51
Caution in Jaundice
Hepatic coma (Irreversible)
• Patient – Drowsy
• Sensorium is disturbed,
• sleeping Rhythm or pattern changes
• Tremors
Liver Cirrhosis
7/19/2015 52Prof.Dr.R.R.Deshpande
Liver Damage
7/19/2015 53Prof.Dr.R.R.Deshpande
Ayurvedic IMP Tablet for Liver problems
• Liver problems,Jaundice,Cirrhosis,Any Chronic
disease,to stimulate metabolic process -----
• Tab Arogyavardhini
7/19/2015 Prof.Dr.R.R.Deshpande 54
Ayurvedic Medicine for Liver Problems
• Liver & Spleen problems –
• Kumari Asav Number 1
• Kumari Asav Number 2
7/19/2015 Prof.Dr.R.R.Deshpande 55
7/19/2015 Prof.Dr.R.R.Deshpande 56
Duodenal ulcer Treatment 1
& List of Antacids
H. pyloric kit – Helibact –BD for 1 week
Omeprazole + Amoxicillin + Tinidazole
Antacids
1. T. Histac (Ranitidine) 150 mg BD.
2. T. Famocid (famotidine) 20 mg BD.
3. T. Rotane (Roxatidine) 75 mg BD.
4. Cap. Omez (omeprazole) 20 mg BD.
5. Lan (Lansoprazole) 30 mg OD.
6. Pantacid (pentaprazole) 40 mg OD.(Cap Pan D)
7. Rabifast (Rabiprazole) 20 mg OD.
Retrosternal burning
7/19/2015 57Prof.Dr.R.R.Deshpande
DD OF Ulcer
Points Gastric Ulcer Duodenal Ulcer
Sex Common in female
patients
Common in male
patients
Onset of pain Immediately after
intake food
3-4 hours after
intake of food. Mid
point pain
Periodicity No After every 3-4
hours
Vomiting Spontaneous Induced
7/19/2015 Prof.Dr.R.R.Deshpande 58
DD OF Ulcer
Points Gastric Ulcer Duodenal Ulcer
Pointing sign present present
nutrition Poor Not so.
haematemesis common uncmoon
Perforation
Cancer
Rare
Common
Common
Rare
7/19/2015 Prof.Dr.R.R.Deshpande 59
Worms
• Common – Round worm, thread worm, hook
worm,Rare – Tape worm
• Adv. – stool – R examination
• Pain in abdomen, nausea, vomiting, loose
motion, urticaria, bronchitis, hypopigmented
patches on face, Excessive hunger but without
putting on weight
7/19/2015 Prof.Dr.R.R.Deshpande 60
Worms
• Thread worms – Peri-anal itching, urethral
irritation, vaginal discharge, nocturia.
• Hook worms – Urticaria with itching, bronchitis,
most imp. anemia, depression of bone marrow,
Anasarca (oedema all over the body)
• Tape worms : Abdominal pain, lose motions,
Asymptomatic, White pieces seen in stool by
child or mother
•
7/19/2015 Prof.Dr.R.R.Deshpande 61
Round worm
7/19/2015 Prof.Dr.R.R.Deshpande 62
Hook worm
7/19/2015 Prof.Dr.R.R.Deshpande 63
Thread worm
7/19/2015 Prof.Dr.R.R.Deshpande 64
Tape worm
7/19/2015 Prof.Dr.R.R.Deshpande 65
Worms
• Treatment :
• Tab Mebex, 1 – 0 – 1 x 3 days
• Tab Zental 400 mg – 1 – stat (albendazole)
7/19/2015 Prof.Dr.R.R.Deshpande 66
Ayurvedic Medicines for worms
• 1) Vidangadi Churna
• 2) Dadimashtak Churna
• 3) Tab Krumimudgaras
• 4) Liq Vidangarishta
• 5) Liq Vidangasav
7/19/2015 Prof.Dr.R.R.Deshpande 67
Ayurvedic Medicines 1
• Weak digestive fire or Anorexia
(Agnimandya) –
• Lavanbhaskar churna,Ashtangalavan churna,
Chitrakadi Churna, Agnitundi vati, Lashunadi
vati, Panchakolasav, Jeerakadyarishta,Bharangi
Avaleha, Tiktak Ghruta, Shatpal Ghrut, Lashun
Pak ,Kapardik Bhasma
7/19/2015 Prof.Dr.R.R.Deshpande 68
Ayurvedic Medicines 2
• Amoebic Dysentry ( Amansha, Pravahika) –
• Gangadhar or Bruhat Gagadhar or Lavangadi
churna, Sanjivani Guti, Kutajarishta,
Jeerakadya rishta, Babbuladyarishta,
Bhallatakadi Kadha, Kutajavleha,
Bilvavleha,Pugapak,Chandan bala lakshadi oil,
Padmakadi oil, Rasa parpati, Shankha bhasma
7/19/2015 Prof.Dr.R.R.Deshpande 69
Ayurvedic Medicines 3
• Diarrhoea ( Atisar) –
• Jatiphaladi or Lavangadi or Dhanya panchak
churna, Sanjivani
guti,Shankhodar,Bhallatakasav,Kutajarishta,Ba
bbuladyarishta,Jeerakadyarishta,Kutajavleha,B
ilvavleha,Rasaparpati,loknathras,Shatavarydi
Kwath, Chukra oil
7/19/2015 Prof.Dr.R.R.Deshpande 70
Ayurvedic Medicines 4
• Indigestion ( Apachan or Ajirna) –
• Dadimashtak or Panchasam or Pippalyadi or
Bhaskar or Vadvanal or Vaisvanar or
Samudradi or Hinvashtak Churna,
Vatgankusha,Shankha vati, Shulhar vati,
Kapardik Bhasma, Loknathras,Shankha
Bhasma
7/19/2015 Prof.Dr.R.R.Deshpande 71
Ayurvedic Medicines 5
• Hyperacidity ( Amlapitta) –
• Avipattikar or Amalakyadi or Vadvanal Churna,
Shatavari kalpa, Triphala churna, Laghusutshekhar
,Sutshekhar, Suvarna sutshekhar, Moraval ( Amalaki
avaleh) ,Kushmand avaleh, Tiktak Ghruta, Akik pishti,
Jajarmohara pishti, Trunakat pishti, Shankha bhasma,
Suvarna makshik bhasma, Kamaduha, Praval
panchamruta, Bhunimbadi Kadha, Abhayarishta
7/19/2015 Prof.Dr.R.R.Deshpande 72
Ayurvedic Medicines 6
• Piles ( Arsha) –
• Samasharkar churna, Swadishta virechan
churna, Sukhasarak or Hinvashtak churna,
Kankayan Guti, Bolbaddha ras,
Bhallatakasav,Kutajarishta,Rohitakarishta,Bhall
atakadi kadha, Shatpal Ghruta,Bhallatak oil
,Kandarp pak, Bhallatakavleh
7/19/2015 Prof.Dr.R.R.Deshpande 73
Ayurvedic Medicines 7
• Vomitting ( Chardi) –
• Eladi churna, Sutshekhar,
Bruhatvatachintamani, Kapardik bhasma,
Shankha bhasma, Jaharmohara pishti,
Mayurpiccha mashi
7/19/2015 Prof.Dr.R.R.Deshpande 74
Ayurvedic Medicines 8
• Jaundice ( Infective Hepatitis =Kamala) –
• Arogyavardhini, Kumari Asav Abhayarishta,
Eranda oil, Kandarp pak
7/19/2015 Prof.Dr.R.R.Deshpande 75
Ayurvedic Medicines 9
• Grahani ( Enteritis or Colitis) –
• Gangadhar or Pippalyadi or Bruhat gangadhar or
Lavangadi churna,Sanjivani Guti,
Panchakoasav,Bhallatakasav,Kutajarishta,Jeerakadyari
shta,Babbuladyarishta,Bhallatakadi kadha, Agastya
haritaki avaleh, Kutajav leh, Bilbav leh, Kapardik
bhasma, Shankha bhasma, Shatpal Ghruta,
Panchamrut parpati, Rasa parpati, Loknath ras,Loha
parpati, Suvarn Parpati
7/19/2015 Prof.Dr.R.R.Deshpande 76
Ayurvedic Medicines 10
• Udar ( Ascites) –
• Gomutra haritaki or Narayan churna,
Ashvakanchki or Icchabhedi or Naracha ras,
Arogyavardhini,Kumari asav,
Punarnavasav,Abhayarishta,Punarnavadyarisht
a,Punarnavadi Kadha, Punarnava mandur, ras
parpati
7/19/2015 Prof.Dr.R.R.Deshpande 77
7/19/2015 Prof.Dr.R.R.Deshpande 78
Ayurved for General Practioner
• Very very popular Book
in Medical Practioners
• 100 common symptoms
of General Practice with
causes,Investigations &
Ayurvedic Treatments
7/19/2015 Prof.Dr.R.R.Deshpande 79
Clinical Examination
• Systemic Examination of
8 systems
• Ayurvedic Srotas
Examination
• Clinical significance of
Lab Tests &
Radiology,USG,2D Echo
7/19/2015 Prof.Dr.R.R.Deshpande 80
Notes on Medicine Part 1
• Very very useful Book
for all Medical
Practioners
• Guidelines with
causes,symptoms,Ayurv
edic & Modern
Treatments to treat
Fever,Pain in Abdomen
& Arthritis
7/19/2015 Prof.Dr.R.R.Deshpande 81
Best Book for
Medical Students & Practioners
7/19/2015 81Prof.Dr.R.R.Deshpande
Health Tips for 365 Days
7/19/2015 Prof.Dr.R.R.Deshpande 82
• This Book is very useful
from Common man to
Doctors
• It covers all imp aspects
mentioned in Ayurveda
• Open as per date &
complete reading of
one page only
Prof.Dr.Deshpande’s
Popular Links on Internet
• Just Start Internet on Desk top or Lap top or
on your mobile . Copy Following Link & Paste
as Web address –URL
• http://www.youtube.com/user/deshpande19
59
• http://www.slideshare.net/rajendra9a/
• http://www.mixcloud.com/jamdadey/
7/19/2015 Prof.Dr.R.R.Deshpande 83
Prof.Dr.Deshpande’s
Popular Links on Internet
• Just Start Internet on Desk top or Lap top or
on your mobile . Copy Following Link & Paste
as Web address –URL
• http://professordeshpande.blogspot.in
• http://professordrdeshpande.blogspot.in/
• http://www.mixcloud.com/rajendra-
deshpande
• https://soundcloud.com/professor-deshpande
7/19/2015 Prof.Dr.R.R.Deshpande 84
Prof.Dr.R.R.Deshpande
• Sharing of Knowledge
• FOR
• Propagating Ayurved
7/19/2015 85Prof.Dr.R.R.Deshpande

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Digestive tract problems in GP

  • 1. Digestive Tract Problems in GP– Part 2 Pain in Abdomen Presented By • Prof.Dr. • R.R.Deshpande • 9226910630 7/19/2015 Prof.Dr.R.R.Deshpande 1
  • 2. 7/19/2015 Prof.Dr.R.R.Deshpande 2 Digestive Tract Problems in GP – Part 2 • Presented By – • Prof.Dr.R.R.Deshpande (M.D in Ayurvdic Medicine & M.D. in Ayurvedic Physiology) • www.ayurvedicfriend.com • Mobile – 922 68 10 630 • mailme.drrrdeshpande@rediffmail.com
  • 4. 7/19/2015 Prof.Dr.R.R.Deshpande 4 Digestive System Problems in GP part 1 contains • 1) Anorexia • 2) Indigestion • 3) Aerophagy(Gas) • 4) Stomatitis • 5) Hiccoup • 6) Constipation • 7) Diarrhoea • 8) Vomiting
  • 5. 7/19/2015 Prof.Dr.R.R.Deshpande 5 Digestive System Problems in GP – Part 2 contains • 9) Dysphagia • 10) Pain In Abdomen • 11) IBS • 12) Jaundice • 13) Peptic ulcer
  • 6. 7/19/2015 Prof.Dr.R.R.Deshpande 6 Dysphagia causes 1 • Dysphagia = Difficulty in swallowing. • Odynophagia = Painful swallowing. • Acute severe pharyngitis, exudative Tonsillitis, Peritonsillar abscess (quinsy) • (All these cases – Pseudo dysphagia)
  • 7. 7/19/2015 Prof.Dr.R.R.Deshpande 7 Dysphagia causes 2 • True Dysphagia – Oesophagitis • Mechanical dysphagia -- Cancer of oesophagus - (obstruction to passage of solid food) – Cancer of oesophagus.
  • 8. 7/19/2015 Prof.Dr.R.R.Deshpande 8 Dysphagia Treatment 1 • Pseudo-dysphagia (due to Infection & pain) Tab.Roxid (Roxithromycin) – 150 mg – BD (On empty stomach) or Tab.Azithral (Azithromycin) 500 mg – O.D. x 3days • Tab.Voveron SR 100 mg – 1 O.D. • Gurgaling.
  • 9. 7/19/2015 Prof.Dr.R.R.Deshpande 9 Dysphagia Treatment 2 • Oesophagitis • Bland Diet -Mucaine gel – 3 tsf x 3 hrly - Cap. Omez – 20 mg x BD - Tab ciza (cisapride) 10 mg – TDS. - Tab forcan (flucanazole) – (for HIV patients) – 150 mg x 10 days
  • 10. 7/19/2015 Prof.Dr.R.R.Deshpande 10 Dysphagia Treatment 3 • If Cancer of Esophagus is suspected – • Immediately refer to Oncologist.
  • 11. 7/19/2015 Prof.Dr.R.R.Deshpande 11 Epigastric pain causes • 1) Gastritis (Drug Alcohol Induced). • 2) Gastric ulcer. • 3) Duodenal ulcer. • 4) Enlarged Left Lobe of Liver. • 5) Hook Worm. • 6) Amoebiasis. • 7) Pancreatitis. • 8) Gastric malignancies. .
  • 12. 7/19/2015 Prof.Dr.R.R.Deshpande 12 Investigations in Epigastric Pain • 1) USG Abd – Hepatitis,CCF,Amoebic Liver Abscess • 2) Gastroscopy – GU,DU,CA of stomach • 3) Stool Exam – worms,occult blood
  • 13. 7/19/2015 Prof.Dr.R.R.Deshpande 13 Epigastric pain – Rare causes Rare causes - Hepatitis. - CCF. - Amoebic Liver abscess.
  • 14. 7/19/2015 Prof.Dr.R.R.Deshpande 14 Epigastric pain - Treatment • Cap. Omez 20 mg BD. • Tab. Cyclopam – 1 TDS. • Gellucil Liquid – 2tsf TDS. • T. Zentel – 400 mg – stat.(Albendazole) • T. Tini 500 mg – BD x 7 days.
  • 15. 7/19/2015 Prof.Dr.R.R.Deshpande 15 Pain in Right Hypochondrium • 1) Infective Hepatitis – History of Jaundice epidemic. • 2) Amoebic hepatitis – History of Amoebiasis • 3) Alcoholic Hepatitis. • 4) CCF (Tender liver). • 5) Duodenal Ulcer. • 6) Cholecystitis. - Treatment - According to above said Causes.
  • 17. 7/19/2015 Prof.Dr.R.R.Deshpande 17 Suspect CCF ( Right Ventricular Failure) • 1) Hepatomegaly • 2) Oedema over legs (Paedal Oedema in the evening) • 3) Engorged neck veins ( JVP increases) • 4) Breathlessness • History of Chronic Hypertension or Chronic Lung disease
  • 18. 7/19/2015 Prof.Dr.R.R.Deshpande 18 Investigations in pain in right Hypochondrium • 1) USG Abdomen • 2) Liver Function Tests • 3) 2 D Echo
  • 19. 7/19/2015 Prof.Dr.R.R.Deshpande 19 Pain in Right Iliac fossa causes • 1) Amoebic colitis. • 2) Acute Appendicitis • 3) Right ureteric colic • 4) TB at ileo caecal junction
  • 20. 7/19/2015 Prof.Dr.R.R.Deshpande 20 Suggestive clinical features • 1) Appendicitis – Vomiting, Fever, Mac Burney’s tenderness • 2) Ureteric colic – Dysurea, colicy pain but no Tenderness
  • 21. 7/19/2015 Prof.Dr.R.R.Deshpande 21 Pain in Right Iliac fossa - Treatment • 1) Inj.Voveron – 2 ml I/m. • 2) Tab. ciprofloxacin 500 mg BD. (or Inj.Ciprofloxcin I/v, if Vomiting is sever). • 3) Tab. Tini 500 mg – BD. • 4)Inj.Gentamycin 80 mg BD – I/V.
  • 22. 7/19/2015 Prof.Dr.R.R.Deshpande 22 Investigations for Pain in right Iliac Fossa • 1) USG Abd – Ureteric stone • 2) WBC count – Leucocytosis – Appendicitis (?) • 3) Urine R – RBC -- +++ & Crystals +++ • 4) Stool R – E.h –Amoebic Colitis
  • 23. Causes of Generalised pain in Abdomen • 1) Round worm, Tape worm (Common in pig meat) • 2) Amoebiasis, Giadiasis • 3) IBS • 4) Abdominal TB • 5) Ca pancreas / ca colon • 6) Long term use of purgatives • 7) Lactose intolerance 7/19/2015 Prof.Dr.R.R.Deshpande 23
  • 25. Acute Abdominal Pain without shock • 1) Abdominal colic -Types : • i) Intestinal colic ii) Renal colic • iii) Appendicular colic iv) Biliary colic • 2) Gynaec pain : Ex. dysmenorrhoea • • 3) Referred pain : pain in abdomen due to T.B. or cancer of spine. 7/19/2015 Prof.Dr.R.R.Deshpande 25
  • 26. Spasmodic Pain in lower Abdomen 7/19/2015 26Prof.Dr.R.R.Deshpande
  • 27. Irritable Bowel Syndrome 7/19/2015 27Prof.Dr.R.R.Deshpande
  • 28. Acute abdominal pain with shock : • Low BP, feable but thread pulse, sweating cold extremities • Called as acute abdomen / surgical abdomen. • Causes : i) Internal haemorrhage • ii) Acute intenstinal obstructcion • a) Strangulation • b) intu-ssuception • c) Valvulus 7/19/2015 Prof.Dr.R.R.Deshpande 28
  • 29. Types of Intestinal obstruction 7/19/2015 29Prof.Dr.R.R.Deshpande
  • 30. Acute abdominal pain with shock • iii) Acute peritonitis • iv) Acute pancreatitis • v) Severe gastro-enteritis • vi) Ectopic pregnancy • 7/19/2015 Prof.Dr.R.R.Deshpande 30
  • 31. 7/19/2015 Prof.Dr.R.R.Deshpande 31 Colicky Pain causes 1 • 1) Renal colic – pain in right or left renal angle & vomiting, USG abd, Urine R – RBCs. • 2) Ureteric colic – Severe spasmodic pain from loin to groin. Patient refuses to lie down, Dysuria (USG abd). • 3) Small Intestinal colic – Colicky pain in central abdomen. (amoebiasis, worms, Intestinal obstructions).
  • 32. 7/19/2015 Prof.Dr.R.R.Deshpande 32 Colicky Pain causes 2 • 4) Large Intestinal Colic – severe colic, away from centre (may be with h/o dysentery – E.h, shigella, E.collic). • 5) Biliary colic – Pain in Right hypochondrium (may be with Jaundice) – due to Gall stone or Infection (cholecystitis). • 6) Spasmodic Dysmenorrhoea – Severe lower abdominal pain (young unmarried girls).
  • 33. Renal Colic • Pain is unilateral right or left lumbar region. • Renal angle tenderness (below 3 fingers of scapula) with vomiting. 7/19/2015 Prof.Dr.R.R.Deshpande 33
  • 34. 7/19/2015 Prof.Dr.R.R.Deshpande 34 Colicky Pain Treatment 1 • Renal colic - Inj.Voveron – 2 ml I/m stat. - Inj.Reglan – 2 ml I/m stat. (If vomiting). - Tab. Cyclopam – 1 TDS. - I/v fluids (If severe vomiting). - USG – Large stone – Urologist. • .
  • 35. 7/19/2015 Prof.Dr.R.R.Deshpande 35 Colicky Pain Treatment 2 • Ureteric colic - Inj.fortwin (pentazocin) – 1 ml stat – I/m. - Inj.Phenargan – 1 ml – stat – I/m. • X ray – KUB If stone < 6mm – Hydrotherapy
  • 36. X ray KUB • Done on empty stomach in the morning • Bowel preparation (no gas in abdomen) • Tab – Dulcolax (3 tab) • We take only 1 tab of Dulcolax for normal wash of stomach • Tab – Gasex of Himalaya 3 tab (with warm water) • 7/19/2015 Prof.Dr.R.R.Deshpande 36
  • 37. 7/19/2015 Prof.Dr.R.R.Deshpande 37 Colicky Pain Treatment 3 • Hydrotherapy – - I/v – 5% Dextrose – 3 pints. - fast (20 no. needle) In 1½ hrs. - I/v Lasix & Cyclopam in third pint. Repeat above procedure for 3 days. Still, if stone does not pass – Urologist.
  • 38. 7/19/2015 Prof.Dr.R.R.Deshpande 38 Caution • If stone > 6 mm – Do not give Hydrotherapy • Stone can cause partial obstruction & Hydrotherapy may cause Hydronephrosis • Refer to Urologist -- Lithotripsy
  • 39. 7/19/2015 Prof.Dr.R.R.Deshpande 39 Small intestinal colic Caution – Admit if vomiting,distension & absolute constipation Inj Cyclopam 2ml stat Tab Tini 500 mg BD Tab Zentel 400 mg stat
  • 40. 7/19/2015 Prof.Dr.R.R.Deshpande 40 Large Intestinal Colic • Inj Cyclopam 2ml IM stat • Tab Norflox TZ 1 BD
  • 41. 7/19/2015 Prof.Dr.R.R.Deshpande 41 Biliary Colic -- Treatment • Biliary colic – -Inj.Cyclopam – 2 ml I/m or I/v. -Inj.Mox – 500 mg I/v stat. -Tab.Flagyl 400 mg TDS . Adv – USG Abdomen & Sr.Bilirubin Metro is used for Amoebic & also in anaerobic Infections (I/V Metrogyl)
  • 42. 7/19/2015 Prof.Dr.R.R.Deshpande 42 Spasmodic Dysmenorrhoea - Treatment • 1) Inj.Voveron 2ml – I/m stat. 2) Tab.meftal spas – 500 mg TDS. 3) Hot fomentation – Lower abd. 4) Bed Rest.
  • 43. 7/19/2015 Prof.Dr.R.R.Deshpande 43 Irritable Bowel Syndrome – IBS - causes • 1) Mental stress & Depression. • 2) Vague abdominal complaints. • 3) Visit to many Doctors. • 4) All Investigations – Normal. • 5) Diagnosis of Exclusion.
  • 44. 7/19/2015 Prof.Dr.R.R.Deshpande 44 IBS – Treatment 1 • Constipation – - High fiber Diet, plenty of water. - Tab.Triphala 2 BD.Softovac 1 tsf BD • Toilet > 4 times - Cap.Imosec – 1 BD or, - Tab.Lomotil – 2.5 mg BD or, - Kutaja parpati Tab- 2 TDS.
  • 45. 7/19/2015 Prof.Dr.R.R.Deshpande 45 IBS – Treatment 2 • Abdominal pain - Tab.cyclopam 1 BD. • Depression - Cap Fludac (fluoxetine) 20 mg OD. - Assurance.
  • 46. 7/19/2015 Prof.Dr.R.R.Deshpande 46 Jaundice – Clinical features • Severe anorexia, Nausea. • Liver tender (palpable). • Low grade fever, weakness. • High colored urine, Sclera-yellow. • Urine R-Bile salts & Bile pigment. • Sr.Alkaline phosphatase (obstructive jaundice). • Hepatitis B & obstructive Jaundice – Refer to Gastroenterologist.
  • 49. 7/19/2015 Prof.Dr.R.R.Deshpande 49 Jaundice - Treatment • Bed Rest. • High carbohydrate, Adequate protein(Glucon-D) • For fever – T. Nise (Nimu-sulide) – 1 s.o.s. • Severe vomiting – I/v 10% dextrose with Inj.Reglan. • T.silybon (silymarin) 140 mg BD. • Cap.Essentiate (phospholipids) 175 mg – TDS. • Arogyawardhini 3 TDS. • Kumari Asav No.1. 3tsf TDS.
  • 50. Icterus of eyes 7/19/2015 50Prof.Dr.R.R.Deshpande
  • 51. 7/19/2015 Prof.Dr.R.R.Deshpande 51 Caution in Jaundice Hepatic coma (Irreversible) • Patient – Drowsy • Sensorium is disturbed, • sleeping Rhythm or pattern changes • Tremors
  • 54. Ayurvedic IMP Tablet for Liver problems • Liver problems,Jaundice,Cirrhosis,Any Chronic disease,to stimulate metabolic process ----- • Tab Arogyavardhini 7/19/2015 Prof.Dr.R.R.Deshpande 54
  • 55. Ayurvedic Medicine for Liver Problems • Liver & Spleen problems – • Kumari Asav Number 1 • Kumari Asav Number 2 7/19/2015 Prof.Dr.R.R.Deshpande 55
  • 56. 7/19/2015 Prof.Dr.R.R.Deshpande 56 Duodenal ulcer Treatment 1 & List of Antacids H. pyloric kit – Helibact –BD for 1 week Omeprazole + Amoxicillin + Tinidazole Antacids 1. T. Histac (Ranitidine) 150 mg BD. 2. T. Famocid (famotidine) 20 mg BD. 3. T. Rotane (Roxatidine) 75 mg BD. 4. Cap. Omez (omeprazole) 20 mg BD. 5. Lan (Lansoprazole) 30 mg OD. 6. Pantacid (pentaprazole) 40 mg OD.(Cap Pan D) 7. Rabifast (Rabiprazole) 20 mg OD.
  • 58. DD OF Ulcer Points Gastric Ulcer Duodenal Ulcer Sex Common in female patients Common in male patients Onset of pain Immediately after intake food 3-4 hours after intake of food. Mid point pain Periodicity No After every 3-4 hours Vomiting Spontaneous Induced 7/19/2015 Prof.Dr.R.R.Deshpande 58
  • 59. DD OF Ulcer Points Gastric Ulcer Duodenal Ulcer Pointing sign present present nutrition Poor Not so. haematemesis common uncmoon Perforation Cancer Rare Common Common Rare 7/19/2015 Prof.Dr.R.R.Deshpande 59
  • 60. Worms • Common – Round worm, thread worm, hook worm,Rare – Tape worm • Adv. – stool – R examination • Pain in abdomen, nausea, vomiting, loose motion, urticaria, bronchitis, hypopigmented patches on face, Excessive hunger but without putting on weight 7/19/2015 Prof.Dr.R.R.Deshpande 60
  • 61. Worms • Thread worms – Peri-anal itching, urethral irritation, vaginal discharge, nocturia. • Hook worms – Urticaria with itching, bronchitis, most imp. anemia, depression of bone marrow, Anasarca (oedema all over the body) • Tape worms : Abdominal pain, lose motions, Asymptomatic, White pieces seen in stool by child or mother • 7/19/2015 Prof.Dr.R.R.Deshpande 61
  • 66. Worms • Treatment : • Tab Mebex, 1 – 0 – 1 x 3 days • Tab Zental 400 mg – 1 – stat (albendazole) 7/19/2015 Prof.Dr.R.R.Deshpande 66
  • 67. Ayurvedic Medicines for worms • 1) Vidangadi Churna • 2) Dadimashtak Churna • 3) Tab Krumimudgaras • 4) Liq Vidangarishta • 5) Liq Vidangasav 7/19/2015 Prof.Dr.R.R.Deshpande 67
  • 68. Ayurvedic Medicines 1 • Weak digestive fire or Anorexia (Agnimandya) – • Lavanbhaskar churna,Ashtangalavan churna, Chitrakadi Churna, Agnitundi vati, Lashunadi vati, Panchakolasav, Jeerakadyarishta,Bharangi Avaleha, Tiktak Ghruta, Shatpal Ghrut, Lashun Pak ,Kapardik Bhasma 7/19/2015 Prof.Dr.R.R.Deshpande 68
  • 69. Ayurvedic Medicines 2 • Amoebic Dysentry ( Amansha, Pravahika) – • Gangadhar or Bruhat Gagadhar or Lavangadi churna, Sanjivani Guti, Kutajarishta, Jeerakadya rishta, Babbuladyarishta, Bhallatakadi Kadha, Kutajavleha, Bilvavleha,Pugapak,Chandan bala lakshadi oil, Padmakadi oil, Rasa parpati, Shankha bhasma 7/19/2015 Prof.Dr.R.R.Deshpande 69
  • 70. Ayurvedic Medicines 3 • Diarrhoea ( Atisar) – • Jatiphaladi or Lavangadi or Dhanya panchak churna, Sanjivani guti,Shankhodar,Bhallatakasav,Kutajarishta,Ba bbuladyarishta,Jeerakadyarishta,Kutajavleha,B ilvavleha,Rasaparpati,loknathras,Shatavarydi Kwath, Chukra oil 7/19/2015 Prof.Dr.R.R.Deshpande 70
  • 71. Ayurvedic Medicines 4 • Indigestion ( Apachan or Ajirna) – • Dadimashtak or Panchasam or Pippalyadi or Bhaskar or Vadvanal or Vaisvanar or Samudradi or Hinvashtak Churna, Vatgankusha,Shankha vati, Shulhar vati, Kapardik Bhasma, Loknathras,Shankha Bhasma 7/19/2015 Prof.Dr.R.R.Deshpande 71
  • 72. Ayurvedic Medicines 5 • Hyperacidity ( Amlapitta) – • Avipattikar or Amalakyadi or Vadvanal Churna, Shatavari kalpa, Triphala churna, Laghusutshekhar ,Sutshekhar, Suvarna sutshekhar, Moraval ( Amalaki avaleh) ,Kushmand avaleh, Tiktak Ghruta, Akik pishti, Jajarmohara pishti, Trunakat pishti, Shankha bhasma, Suvarna makshik bhasma, Kamaduha, Praval panchamruta, Bhunimbadi Kadha, Abhayarishta 7/19/2015 Prof.Dr.R.R.Deshpande 72
  • 73. Ayurvedic Medicines 6 • Piles ( Arsha) – • Samasharkar churna, Swadishta virechan churna, Sukhasarak or Hinvashtak churna, Kankayan Guti, Bolbaddha ras, Bhallatakasav,Kutajarishta,Rohitakarishta,Bhall atakadi kadha, Shatpal Ghruta,Bhallatak oil ,Kandarp pak, Bhallatakavleh 7/19/2015 Prof.Dr.R.R.Deshpande 73
  • 74. Ayurvedic Medicines 7 • Vomitting ( Chardi) – • Eladi churna, Sutshekhar, Bruhatvatachintamani, Kapardik bhasma, Shankha bhasma, Jaharmohara pishti, Mayurpiccha mashi 7/19/2015 Prof.Dr.R.R.Deshpande 74
  • 75. Ayurvedic Medicines 8 • Jaundice ( Infective Hepatitis =Kamala) – • Arogyavardhini, Kumari Asav Abhayarishta, Eranda oil, Kandarp pak 7/19/2015 Prof.Dr.R.R.Deshpande 75
  • 76. Ayurvedic Medicines 9 • Grahani ( Enteritis or Colitis) – • Gangadhar or Pippalyadi or Bruhat gangadhar or Lavangadi churna,Sanjivani Guti, Panchakoasav,Bhallatakasav,Kutajarishta,Jeerakadyari shta,Babbuladyarishta,Bhallatakadi kadha, Agastya haritaki avaleh, Kutajav leh, Bilbav leh, Kapardik bhasma, Shankha bhasma, Shatpal Ghruta, Panchamrut parpati, Rasa parpati, Loknath ras,Loha parpati, Suvarn Parpati 7/19/2015 Prof.Dr.R.R.Deshpande 76
  • 77. Ayurvedic Medicines 10 • Udar ( Ascites) – • Gomutra haritaki or Narayan churna, Ashvakanchki or Icchabhedi or Naracha ras, Arogyavardhini,Kumari asav, Punarnavasav,Abhayarishta,Punarnavadyarisht a,Punarnavadi Kadha, Punarnava mandur, ras parpati 7/19/2015 Prof.Dr.R.R.Deshpande 77
  • 78. 7/19/2015 Prof.Dr.R.R.Deshpande 78 Ayurved for General Practioner • Very very popular Book in Medical Practioners • 100 common symptoms of General Practice with causes,Investigations & Ayurvedic Treatments
  • 79. 7/19/2015 Prof.Dr.R.R.Deshpande 79 Clinical Examination • Systemic Examination of 8 systems • Ayurvedic Srotas Examination • Clinical significance of Lab Tests & Radiology,USG,2D Echo
  • 80. 7/19/2015 Prof.Dr.R.R.Deshpande 80 Notes on Medicine Part 1 • Very very useful Book for all Medical Practioners • Guidelines with causes,symptoms,Ayurv edic & Modern Treatments to treat Fever,Pain in Abdomen & Arthritis
  • 81. 7/19/2015 Prof.Dr.R.R.Deshpande 81 Best Book for Medical Students & Practioners 7/19/2015 81Prof.Dr.R.R.Deshpande
  • 82. Health Tips for 365 Days 7/19/2015 Prof.Dr.R.R.Deshpande 82 • This Book is very useful from Common man to Doctors • It covers all imp aspects mentioned in Ayurveda • Open as per date & complete reading of one page only
  • 83. Prof.Dr.Deshpande’s Popular Links on Internet • Just Start Internet on Desk top or Lap top or on your mobile . Copy Following Link & Paste as Web address –URL • http://www.youtube.com/user/deshpande19 59 • http://www.slideshare.net/rajendra9a/ • http://www.mixcloud.com/jamdadey/ 7/19/2015 Prof.Dr.R.R.Deshpande 83
  • 84. Prof.Dr.Deshpande’s Popular Links on Internet • Just Start Internet on Desk top or Lap top or on your mobile . Copy Following Link & Paste as Web address –URL • http://professordeshpande.blogspot.in • http://professordrdeshpande.blogspot.in/ • http://www.mixcloud.com/rajendra- deshpande • https://soundcloud.com/professor-deshpande 7/19/2015 Prof.Dr.R.R.Deshpande 84
  • 85. Prof.Dr.R.R.Deshpande • Sharing of Knowledge • FOR • Propagating Ayurved 7/19/2015 85Prof.Dr.R.R.Deshpande