DR MANISH-2.pdf laser proctology piles and fistula
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Get the best piles and fistula treatment in Jaipur with advanced laser proctology techniques. Dr. Manish Rajput, a renowned specialist, provides painless, quick, and highly effective treatments for piles, fissures, and fistula. Using cutting-edge laser technology, the procedures ensure minimal discomfort, no stitches, and faster recovery, helping patients return to their daily lives with ease. Dr. Rajput is committed to offering personalized care and long-term solutions, ensuring lasting relief and improved quality of life. With his expertise and modern facilities, you can expect safe and reliable treatment for all proctological conditions.
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I. Introduction
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While PUD typically involves mucosal erosion in the stomach or proximal duodenum due to Helicobacter pylori infection or NSAID use, GERD arises from the reflux of gastric contents into the esophagus due to incompetent lower esophageal sphincter tone. Both conditions necessitate a thorough understanding of their etiopathogenesis for rational therapy and long-term management. This document explores the latest, evidence-based treatment paradigms, structured with clarity and clinical relevance.
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II. Peptic Ulcer Disease (PUD)
Definition and Epidemiology
Peptic ulcers are breaks in the mucosal lining of the stomach or duodenum that penetrate the muscularis mucosa. Gastric ulcers typically occur on the lesser curvature of the stomach, while duodenal ulcers are found in the first part of the duodenum.
Globally, the prevalence of PUD has declined, largely due to H. pylori eradication, yet NSAID-related ulcers persist, especially among the elderly.
Etiology and Risk Factors
Helicobacter pylori infection – Present in ~90% of duodenal and 70% of gastric ulcers.
NSAIDs – Inhibit prostaglandin synthesis, compromising mucosal defense.
Smoking – Impairs mucosal healing.
Stress (critical illness) – Leads to stress ulcers.
Zollinger-Ellison Syndrome – Gastrinoma with excess acid secretion.
Corticosteroids, alcohol, and genetic predisposition are other contributors.
Pathophysiology
The balance between aggressive factors (acid, pepsin, H. pylori, NSAIDs) and defensive mechanisms (mucus, bicarbonate, blood flow, prostaglandins) determines mucosal integrity.
H. pylori causes chronic inflammation and epithelial damage. NSAIDs decrease prostaglandins, reducing mucosal blood flow and bicarbonate production.
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III. Clinical Features of Peptic Ulcer
Epigastric pain: Most common symptom; burning or gnawing in nature.
Duodenal ulcers: Pain relieved by food, occurs 2–3 hours after meals.
Gastric ulcers: Pain worsens with food intake.
Nausea, bloating, early satiety
Complications:
Bleeding: Hematemesis, melena.
Perforation: Sudden severe abdominal pain.
Gastric outlet obstruction
Penetration into adjacent organs (e.g., pancreas)
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IV. Diagnosis of Peptic Ulcer
Endoscopy: Gold standard for diagnosis and biopsy to rule out malignancy.
Rapid urease test, histology, urea breath test, stool antigen – for H. pylori.
Serologic testing (less preferred).
Barium study
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Autocoids mcq.ankush goyal gmc patiala punjabDr Ankush goyal Lipid Autocoids: A Comprehensive Overview
Introduction
Lipid autocoids, also known as eicosanoids and related lipid mediators, are bioactive molecules derived from polyunsaturated fatty acids (PUFAs). These molecules play crucial roles in inflammation, immunity, hemostasis, cardiovascular function, and various physiological and pathological processes. Unlike classical hormones, lipid autocoids act locally, exerting their effects at or near their site of synthesis.
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Classification of Lipid Autocoids
Lipid autocoids are broadly classified into the following categories:
1. Eicosanoids (Derived from Arachidonic Acid)
Prostaglandins (PGs)
Thromboxanes (TXs)
Leukotrienes (LTs)
Lipoxins (LXs)
2. Specialized Pro-resolving Mediators (SPMs)
Resolvins
Protectins
Maresins
3. Endocannabinoids
Anandamide (AEA)
2-Arachidonoylglycerol (2-AG)
4. Platelet-Activating Factor (PAF)
5. Sphingolipid-Derived Mediators
Sphingosine-1-Phosphate (S1P)
Ceramides
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Lipid autocoids are derived from membrane phospholipids through enzymatic pathways:
1. Phospholipase A2 (PLA2) Activation:
PLA2 catalyzes the release of arachidonic acid (AA) from membrane phospholipids.
2. Cyclooxygenase (COX) Pathway:
Converts AA into prostaglandins and thromboxanes.
COX-1: Constitutive enzyme (housekeeping functions).
COX-2: Inducible enzyme (inflammation and pain response).
3. Lipoxygenase (LOX) Pathway:
Converts AA into leukotrienes and lipoxins.
5-LOX: Leads to leukotrienes (inflammation, bronchoconstriction).
12-LOX & 15-LOX: Lead to lipoxins (anti-inflammatory action).
4. Cytochrome P450 (CYP) Pathway:
Converts AA into epoxyeicosatrienoic acids (EETs), which regulate vascular tone.
5. Endocannabinoid Biosynthesis:
Derived from membrane phospholipids via enzymatic reactions.
Degraded by fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MAGL).
Physiological Roles of Lipid Autocoids
1. Inflammation and Immune Response
Prostaglandins (e.g., PGE2) modulate fever and pain.
Leukotrienes mediate allergic responses and asthma.
Lipoxins and resolvins promote resolution of inflammation.
2. Cardiovascular System
Thromboxanes (TXA2) induce platelet aggregation and vasoconstriction.
Prostacyclin (PGI2) inhibits platelet aggregation and promotes vasodilation.
EETs regulate blood pressure and vascular homeostasis.
3. Pulmonary Function
Leukotrienes (LTC4, LTD4, LTE4) are potent bronchoconstrictors.
PGE2 has bronchodilatory effects.
4. Renal Function
Prostaglandins regulate glomerular filtration rate and sodium excretion.
EETs contribute to natriuresis.
5. Neurotransmission and Pain
Endocannabinoids modulate pain perception and neuroprotection.
Prostaglandins contribute to central pain sensitization.
6. Reproductive System
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1. Instrument Calibration: Regular calibration and validation of automated instruments.
2. Data Entry and Management: Guidelines on recording, storing, and retrieving data in compliance with regulatory standards.
3. Sample Handling: Ensuring standardized procedures for sample collection, processing, and storage.
4. Software Usage and Maintenance: Guidelines on software validation, updates, and troubleshooting.
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DR MANISH-2.pdf laser proctology piles and fistula
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