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Programme Schedule :

Programme Schedule :. SURAH HASHAR AYAH 22 :. SURAH HASHAR AYAH 23 :. SURAH HASHAR AYAH 24 :. TRANSLATION. I seek refuge with Allah from accursed satan In the name of Allah the most beneficent and the most merciful

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Programme Schedule :

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  1. Programme Schedule:

  2. SURAH HASHAR AYAH 22:

  3. SURAH HASHAR AYAH 23:

  4. SURAH HASHAR AYAH 24:

  5. TRANSLATION • I seek refuge with Allah from accursed satan • In the name of Allah the most beneficent and the most merciful • He is Allah, other than whom there is no deity, Knower of the unseen and the witnessed. He is the Entirely Merciful, the Especially Merciful.

  6. He is Allah, other than whom there is no deity, the Sovereign, the Pure, the Perfection, the Bestower of Faith, the Overseer, the Exalted in Might, the Compeller, the Superior. Exalted is Allah above whatever they associate with Him. • He is Allah, the Creator, the Inventor, the Fashioner; to Him belong the best names. Whatever is in the heavens and earth is exalting Him. And He is the Exalted in Might, the Wise.

  7. A young female patient with persistent retrosternal discomfort. 18th April, 2018 CPC by Surgical Unit – I, Benazir Bhutto Hospital, Rawalpindi

  8. Patient XYZ

  9. Presenting Complaints

  10. History: • Pain in upper abdomen: • Epigastric pain • Gradual in onset • Initially, mild; severity grew overtime • Intermittent in nature • Non radiating • Dull aching

  11. Pain epigastrium: • Aggravated by food intake particularly after large meals • Pain developed on eating food that lead to restriction of diet for fear of pain • Vomiting associated with pain • Both symptoms were relieved temporarily by medications from local General Practitioners

  12. Heartburn: • Dyspepsia occurred after food intake • Epigastricfullness after meals, relieved after regurgitation • Restriction of food intake secondary to heartburn and pain

  13. Regurgitation: • Regurgitation of sour fluid • Occurring after half an hour to one hour after food intake • Especially on lying down • Containing undigested food particles • Persistent sore - throat

  14. Associated History: • Easy fatigability • Depression and anxiety • Insomnia due to regurgitation • Undocumented Weight Loss with good appetite No history of: • Recurrent cough • Aspiration pneumonia • Dysphagia • Odynophagia • Jaundice • Hematemesis • Altered Bowel Habit • Melena

  15. Past Medical and Surgical History: Psychiatry consultation, BBH – Psychogenic Vomiting ? ? ?

  16. Family History Hypertension Diabetes Hepatitis C - Mother No such history in siblings

  17. EXAMINATION • A young, emaciated female patient, lying comfortably on the bed, well oriented in time, place and person.

  18. General Examination: • HR = 87bpm RR = 17/min • BP = 120/75mmHg Temp = 98 F No: • Pallor + • Jaundice • Cyanosis • Clubbing • Goiter • Raised JVP • Palpable Lymph Nodes

  19. Body Mass Index: Age = 18 years Gender = Female Height = 5 feet 4 inches Weight = 94.5 pounds BMI = 16.3 kg/m

  20. Anthropometric Measurements: • Triceps Skin Fold Thickness = 11.3mm (normal 16.5mm) • Mid-arm circumference = 23.6 cm (normal 28.5cm) • Waist – to – Hip Circumference Ratio = 52 / 72 = 0.72

  21. Systemic Examination: • Abdomen • Chest • CVS • CNS Unremarkable

  22. Differential Diagnosis: ???

  23. Provisional / Differential Diagnosis: • Gastro Esophageal Reflux Disease • AchalasiaCardia • Hiatus Hernia

  24. INVESTIGATIONS:

  25. Investigations: Complete Blood Picture: • Hemoglobin: 14.7g/dl • Hematocrit: 42.5% • TLC: 9.0 x 10 / L • Platelets: 259 x 10 / L ESR: • 25mm in 1st hour

  26. Liver Function Tests: • Bilirubin: 0.6 • ALP: 73 Renal Function Tests: • Blood Urea Nitrogen: 20 • Creatinine: 0.5 PT / APTT: 14 / 35

  27. ECG ECHOCARDIOGRAPHY X- RAY NORMAL STUDY

  28. Radiologic Investigations: • Chest X- Ray • Ultrasound Abdomen and Pelvis • Barium Swallow • CT Abdomen

  29. X-Ray Chest

  30. Ultrasound Abdomen & Pelvis: No pathology detected sonographically. Barium Meal study was advised to rule out APD or GERD.

  31. Barium Meal Study: Stomach: Normal site, size and shape No ulcer or filling defect Duodenum: Duodenal cap well outlined

  32. CT Chest & Abdomen

  33. Gastroenterology Consultation: • Upper GI Endoscopy • Esophageal Function Tests • Medical / Conservative Treatment

  34. Upper GI Endoscopy: Esophagus: Patulous Lower Esophageal Sphincter Stomach: Gastroesophageal Reflux Duodenum Normal study

  35. Histopathology of Gastric Mucosa: Helicobacter Pylori associated Chronic Mild Gastritis

  36. Esophageal Function Tests:

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