Dyspepsia

Dyspepsia covers pain, fullness, early satiety, bloating, and nausea. It can occur with gastric and duodenal ulceration (section 1.3) and gastric cancer but most commonly it is of uncertain origin.
Urgent endoscopic investigation is required if dyspepsia is accompanied by ‘alarm features’ (e.g. bleeding, dysphagia, recurrent vomiting, or weight loss). Urgent investigation should also be considered for patients over 55 years with unexplained dyspepsia that has not responded to treatment.
Patients with dyspepsia should be advised about lifestyle changes (see Gastro-oesophageal reflux disease, below). Some medications may cause dyspepsia—these should be stopped, if possible. Antacids may provide some symptomatic relief.
If symptoms persist in uninvestigated dyspepsia, treatment involves a proton pump inhibitor (section 1.3.5) for 4 weeks. A proton pump inhibitor can be used intermittently to control symptoms long-term. Patients with uninvestigated dyspepsia, who do not respond to an initial trial with a proton pump inhibitor, should be tested for Helicobacter pylori and given eradication therapy (section 1.3) if H. pylori is present. Alternatively, particularly in populations where H. pylori infection is more likely, the ‘test and treat’ strategy for H. pylori can be used before a trial with a proton pump inhibitor.
If H. pylori is present in patients with functional (investigated, non-ulcer) dyspepsia, eradication therapy should be provided. However, most patients with functional dyspepsia do not benefit symptomatically from H. pylori eradication. If symptoms persist, treatment with either a proton pump inhibitor (section 1.3.5) or a histamine H₂-receptor antagonist (section 1.3.1) can be given for 4 weeks. These antisecretory drugs can be used intermittently to control symptoms long-term

ABO Blood Group System

Blood Groups 

• Inherited character of the red cell surface. detected by a specific antibody . 
• Most blood groups are organized into blood group systems. 
• Most blood group antigens are protein or glycoprotein. 
• Some blood group antigens are carbohydrate structures on proteins or lipids. 
• The two most important blood group systems from the clinical point of view are ABO and Rh. 

Discovery of ABO Groups (1901) 

• Inheritance of ABO Blood Groups 
• Three allelic genes -A, B & O 
• Follows Mendelian principles 
• A and B genes co-dominant 
• O gene is amorphic 
• ABO gene on chromosome 9q34 
• Discovered by Yamamoto in 1990 

Structure of the Red Cell Membrane

• Development of ABO 
• Antigens & Antibodies 
• Antigens - 6th week of fetal life 
• Full expression -3 years after birth 
• Glycoproteins, 
• Can be Glycolipids or Glycosphingolipids 
• Present on most tissues 
• RBC, endothelial cells, platelets, lymphocytes, epithelial cells. 
• Soluble form in secretions 
• Saliva, tears, urine, bile, milk, digestive juice, amniotic fluid 
• Antibodies- after first few months of life 
• Too low for detection until 3- 6 months of age 
• Antibody levels- peak at 5 to 10 years of age 
• Immunoglobulin class – usually IgM and few IgG 
• Activate compliments 
• Naturally occurring antibodies 

Bombay Phenotype

• First reported by Bhende, Bhatia et al in Bombay in 1952 
• Red cells lack A, B and H antigens 
• Serum has anti-A, anti-B and anti-H antibodies 
• Red cells show no reaction with anti-H 
• Frequency of this group in Bombay estimated to be about 1 in 7600 while in South West districts of Maharashtra about 1 in 4500 

Clinical significance 

• Cause immediate intravascular red cell destruction 
• Which can give rise to severe and fatal HTR. 

The ABO Blood Group System

Blood Grouping

1. Cell grouping-

• To detect the presence or absence of A and B antigens on red cells.
• Test RBCs with Standard monoclonal antisera

   2.Serum grouping-

• To detect the presence or absence of Anti A and Anti B naturally occurring antibodies in the serum.
• Test serum with known cells
• Discrepancy if cell and serum grouping do not agree
• Conventional tube method
• Results in Tube method
• Reading in tube method

Matching blood groups for Transfusion

• Rh and other important Blood Group Systems
• The most complex blood group system and second most important blood group system.
• More than 50 Rh related antigens.
• Rh D is the most important antigen, Other important antigens are C, E,c and e.
• —Non glycosylated proteins.
• —Rh antibodies - immune antibodies
• ( IgG, 370C reactive, Do not bind compliments)
• — Clinical significance- dhtr and HDN

Direct Antiglobulin Test

• Detect in vivo sensitization of red cells with IgG and / or C3d
• Perform DAT using polyspecific AHG reagent.
• EDTA sample should be used for DAT testing

Antibody Screening

• SSerum is tested against a panel of single donor group O red cells
• SPanel should express antigens considered clinically relevant in the population
• SAn antibody is considered to be clinically significant if examples with that specificity are known to have caused HDN, NTR or unacceptably short survival of red cells
• SAntibodies reactive at 37oC and/or in IAT are more likely to be clinically significant
• SShould also have cells with homozygous expression of antigens that are dangerous and show dosage – Jka, Jkb, Fya, Fyb, K

Interpretation

• Negative Antibody Screen
• SProvides a high degree of confidence that the patient’s plasma is free of unexpected antibodies
• Positive Antibody Screen
• SIndicates the presence of a red cell antibody
• SAn antibody investigation is necessary to identify the specificity of the antibody
• SThe antibody screen does not identify the antibody
• Compatibility Test
• Donor red cells are tested with recipient plasma to detect ABO antibodies in the recipient plasma that will agglutinate or sensitise the infused donor red cells
• 1.Albumin/Saline Method
• drops serum, 2 drops albumin, I drop cell 45 mins
• LISS additive Method
• 2 drops serum, 1 drop cells, 2 drops LISS additive, 10 mins
• Spun and read after incubation - IgM direct agglutination
• AHG added - spun and read - IgG sensitisation

Urinary Tract Infections in Pregnancy

What is urinary tract infections

If your kidney , ureter , bladder get infected with infections it is called urinary tract infection 

if it invole kidney or ureter it is called upper urinary tract infection 

if it is involed bladder it is called lower urinary tract infection

Lower abdominal pain in pregnant women

Lower abdominal pain in pregnant women

What are the common causes for my  abdominal pain

1. Labour pain / Preterm labour pain

How do i identify labour pain 

• It is on and off pain 
• Once you feel pain it persist few seconds to min and disappear
• Start form your back and come to front of your lower abdomen and end up in your groin 
• Severity of you pain will increase in your consequent pain
• Your pain commonly Associated with following symptoms
• Mucus blood stain Vaginal discharge (show)
• watarry vaginal discharge ( Dribbling )
• If you have above features most probably you in labour. if you are in before 37 weeks of pregnancy you are in preterm labour , if you are in after 37 weeks of pregnancy you are in trem labour

2. Pain due to urinary tract infection

How do i identify urinary tract infection

You will have

• Constant pain in lower abdomen not like pain it persisting pain
• And it is associated with
• Burning type pain during urination ( Dysuria )
• Increased urination frequency
• Decrease amount of urine pass during at one time
• Some time you will red colour urine

3.  Uterine rupture

How do I identify uterine rupture 

• If you haven't undergone any previous surgery involving you uterus This is unlikely . But it is possible
• You will feel sever unbearable pain 
• It constant pain not like on and off pain
• This associated with bleeding in to you abdomen therefore you will have clinical features due to severe blood loss 
• . dizziness 
• . faintness 
• . And you will collapse 
• And you will have bleeding from vagina and urethra 

5. Placental abruption ( separation of placenta from uterus )

How do I identify Placental abruption 

• You will have constant pain 
• It may be associated with bleeding from vagina
• And you will have symptoms due to bleeding as in uterine rupture

6. Preeclampsia

How do I identify Preeclampsia

• If you don't have increased blood pressure this is unlikely ,  Preeclampsia occurs due to increased blood presser
• You will feel pain usually in upper abdomen rather than lower abdomen 
• and associated with 
• Headache 
• Visual disturbances 
• Fits 

4. Other causes due to non - gynecological causes like 

• like appendicitis
•  bowel obstrucion

b m, mn

What it feels like: temporarily losing consciousness or vision, sometimes
preceded by feeling faint or giddy.
What can make it worse: coughing, urination, head-turning, exertion,
pain, a fright, food, hitting your head.
Your Doctor Visit
What your doctor will ask you about: seizures, changes in vision,
changes in sensation or movement, urination and bowel movements,
chest pain, hunger, sweating, dizziness when standing, head injuries.
Your doctor will want to know if you or anyone in your family
has had any of these conditions: seizures, neurologic disease, diabetes,
cardiovascular disease, lung disease.
Your doctor will want to know what happened when you
blacked out, including what position you were in, and whether
anyone watched you black out.
Your doctor will want to know if you’re taking any of these medications:
digitalis, antiarrhythmics, anticonvulsants, antidepressants,
blood pressure medications, insulin, diuretics, oral hypoglycemic
agents.
Your doctor will do a physical examination including the following:
blood pressure, pulse, listening to your heart with a
stethoscope, testing your stool for blood, thorough neurological
examination.
19
Blackouts
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Nitrofurantoin

Nitrofurantoin has the following interaction information:

Magnesium Salts (oral)	absorption of nitrofurantoin reduced by oral magnesium salts (as magnesium trisilicate)
Probenecid	excretion of nitrofurantoin reduced by probenecid (increased risk of side-effects)
Sulfinpyrazone	excretion of nitrofurantoin reduced by sulfinpyrazone (increased risk of toxicity)

Nitrofurantoin belongs to Antibacterials and will have the following interactions:

Oestrogens	antibacterials that do not induce liver enzymes possibly reduce contraceptive effect of oestrogens (risk probably small, see section 7.3.1)	Interactions of combined oral contraceptives may also apply to combined contraceptive patches
Typhoid Vaccine (oral)	antibacterials inactivate oral typhoid vaccine –see under Typhoid vaccines, section

Antacids, Calcium Salts).

Additional information interactions (Antacids, Calcium Salts).

hepatic impairment
Antacids (usually containing aluminium or magnesium compounds) can often relieve symptoms in ulcer dyspepsia and in non-erosive gastro-oesophageal reflux (see also section 1.1); they are also sometimes used in functional (non-ulcer) dyspepsia but the evidence of benefit is uncertain. Antacids are best given when symptoms occur or are expected, usually between meals and at bedtime, 4 or more times daily; additional doses may be required up to once an hour. Conventional doses e.g. 10 mL 3 or 4 times daily of liquid magnesium–aluminium antacids promote ulcer healing, but less well than antisecretory drugs (section 1.3); proof of a relationship between healing and neutralising capacity is lacking. Liquid preparations are more effective than tablet preparations.
Aluminium- and magnesium-containing antacids (e.g. aluminium hydroxide, and magnesium carbonate, hydroxide and trisilicate), being relatively insoluble in water, are long-acting if retained in the stomach. They are suitable for most antacid purposes. Magnesium-containing antacids tend to be laxative whereas aluminium-containing antacids may be constipating; antacids containing both magnesium and aluminium may reduce these colonic side-effects. Aluminium accumulation does not appear to be a risk if renal function is normal (see also Appendix 3).
The acid-neutralising capacity of preparations that contain more than one antacid may be the same as simpler preparations. Complexes such as hydrotalcite confer no special advantage.
Sodium bicarbonate should no longer be prescribed alone for the relief of dyspepsia but it is present as an ingredient in many indigestion remedies. However, it retains a place in the management of urinary-tract disorders (section 7.4.3) and acidosis (section 9.2.1.3 and section 9.2.2). Sodium bicarbonate should be avoided in patients on salt-restricted diets.
Bismuth-containing antacids (unless chelates) are not recommended because absorbed bismuth can be neurotoxic, causing encephalopathy; they tend to be constipating. Calcium-containing antacids (section 1.1.2) can induce rebound acid secretion: with modest doses the clinical significance is doubtful, but prolonged high doses also cause hypercalcaemia and alkalosis, and can precipitate the milk-alkali syndrome.
Simeticone (activated dimeticone) is added to an antacid as an antifoaming agent to relieve flatulence. These preparations may be useful for the relief of hiccup in palliative care. Alginates, added as protectants, may be useful in gastro-oesophageal reflux disease (section 1.1 and section 1.1.2). The amount of additional ingredient or antacid in individual preparations varies widely, as does their sodium content, so that preparations may not be freely interchangeable.
See also section 1.3 for drugs used in the treatment of peptic ulceration.

Interactions

Antacids should preferably not be taken at the same time as other drugs since they may impair absorption. Antacids may also damage enteric coatings designed to prevent dissolution in the stomach. See also Appendix 1 (antacids, calcium salts).

Low Na⁺

The words low Na⁺ added after some preparations indicate a sodium content of less than 1 mmol per tablet or 10-mL dose.

Sub-sections

• Aluminium- and magnesium-containing antacids
• Aluminium-magnesium complexes
• Antacid preparations containing simeticone
• Simeticone alone