Hiatus Hernia with Anemi - 220 - Abhijit Gaikwad.pptx

Hiatus Hernia with Anemi - 220 - Abhijit Gaikwad.pptx

1. Case Study on Hiatus Hernia with Anemia By – Abhijit A. Gaikwad Roll No - 220 1

2. A hiatal hernia is when stomach bulges up into chest through an opening in diaphragm, the muscle that separates the two areas. The opening is called the hiatus, so this condition is also called a hiatus hernia. There are two main types of Hiatal Hernias : Sliding Hiatus Hernia & Para Esophageal Hiatus Hernia. 2

3. 3

4. Causes C auses might include: Being born with a larger hiatal opening than usual Injury to the area Changes in diaphragm as one age A rise in pressure in belly, as from pregnancy, obesity, coughing, lifting something heavy, or straining on the toilet 4

5. Signs and Symptoms Many people with hiatal hernia don’t notice any symptoms. But may experience: Heartburn from gastro esophageal reflux disease (GERD) Chest pain Bloating Burping Trouble swallowing Bad taste in mouth Upset stomach and vomiting Shortness of breath 5

6. Diagnosis To diagnose a hiatal hernia: Barium swallow Endoscopy Esophageal manometry 6

7. Treatment If the patient remains asymptomatic, there might be no need for a specified treatment . But if there is excessive acid reflux then it is managed by : 1. Proton pump inhibitors like pantoprazole, lansoprazole , rabeprazole etc. 2. Antacids like gelusil and milk of magnesia. 7

8. Anemia 8

9. Anaemia is defined as a haemoglobin concentration in blood below the lower limit of the normal range for the age and sex of the individual. In adults, the lower extreme of the normal haemoglobin is taken as 13.0 g/dl for males and 11.5 g/dl for females. 9

10. The most common types of anemia are: Iron deficiency anaemia Thalassaemia Aplastic anaemia Haemolytic anaemia Sickle cell anaemia Pernicious anaemia Fanconi anaemia 10

11. 11

12. A few general signs are common to all types of anemia: 1.Pallor 2. Cardiovascular system. A hyperdynamic circulation may be present with tachycardia, collapsing pulse, cardiomegaly. 3. Central nervous system. attacks of giddiness, headache, tinnitus, drowsiness, numbnes. 4. Ocular manifestations. Retinal haemorrhages 5. Reproductive system. Menstrual disturbances such as amenorrhea. 12

13. 6. Renal system. Mild proteinuria. 7. Gastrointestinal system. Anorexia, nausea, constipation and weight loss may occur. 13

14. Iron Deficiency Anemia 14

15. Iron deficiency anemia is the most common type of anemia, and it occurs when body doesn’t have enough of the mineral iron. The symptoms of moderate to severe iron deficiency anemia include: G eneral fatigue W eakness P ale skin S hortness of breath D izziness Ti ngling or crawling feeling in the legs T ongue swelling or soreness Cold hands and feet F ast or irregular heartbeat B rittle nails H eadaches 15

16. * Pathophysiology * 16

17. 17

18. Inadequate iron intake Pregnancy or blood loss due to menstruation Internal bleeding Inability to absorb iron Endometriosis Causes 18

19. Diagnosis A complete blood count (CBC) is usually the first test a doctor will use. A CBC measures the amount of all components in the blood, including: red blood cells (RBCs) white blood cells (WBCs) hemoglobin hematocrit platelets the iron level in blood RBC size and color (RBCs are pale if they’re deficient in iron)   ferritin levels  total iron-binding capacity (TIBC) 19

20. Treatment Iron deficiency anemia is treated by following methods: Iron supplements Treating the internal cause of iron malabsorption . Blood transfusions Roll No 20

21. Case Study Demographic Details Name - ABC Age – 55 yrs. Gender - Female Weight- 56 kg. Height - 142 cm DOA - 23/1/2020 21

22. Chief Complaints- Weakness, diarrhea, severe anemia, oedema and slight dysponea Past Medical History: Non-pitting oedema with severe anemia. Past Medication History: Hematocrit administration on 15th and 17 th January 2020 Social History: Patient is clean. Provisional Diagnosis: C/O, H/O non-pitting oedema with severe anemia 22

23. 23 rd Jan Day 1 O/E Bp- 130/80 PPO2 100% 1 Unit PCV transfused H/O bilateral non-pitting oedema and dysponea O/E with outside Hb- 2.5 g% H/O of black stools since 50 days H/O of weight loss (1 to 2kg since 2 months) No H/O of haemorroids No H/O of constipation IV ns 500ml IV Optineuron 1 ampule inj started on 23 rd Clinical notes 23

24. 24 th Jan Day 2 H/O dysponea and pitting oedema 1 PCV administered on 23 rd Gastroscopy planned on 25th January IV ns 500 ml Optineuron 1 ampule inj 3ml 24

25. 25 th Jan Day 3 Gastroscopy S/O hiatus hernia with enteral duodenal nodularity NS 500 ml Optineuron inj 3ml Vibact BD Pan 40 BD 25

26. * Treatment * Sr.No Drug Ingredient Route Frequency Indication 1. Optineuron 1 Ampule inj Vit.B1(100mg) +Vit B6(100mg)+ Cynocobalamin(100mg)+Vit B2(5mg)+Nicotinamide(100mg)+D-Panthenol. I.V OD Nutritionl Supplement used to treat Vit B12 deficiency. 2. Vibact Streptococcus faecalis,Clostridium butyricum,Bacillus mesenteric & Lactobacillus sporogenes. Oral BD Pre & Probiotics, Prevention of diarrhea. 3. Pan 40 Pantoprazole Oral BD Reduce amount of acid in stomach. 26

27. Patient Counseling Patient is advised to : Include green leafy vegetables and meat in diet as they are high sources of iron and vitamin B12. Do not self administer any medication without informing your doctor 27

28. Bibliography www.medscape.com www.healthline.org 1 MG android app www.haematology.org. 28

29. 29