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Download PG Medical ( Post Graduate Medical degree) 4th Year Medicine Handwritten Notes

This post was last modified on 02 August 2021

Medical PG Handwritten Notes 1st Year, 2nd Year, 3rd Year and 4th Year (Study Material)


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Suppress Hormone

Gland

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Diagnosis of Endocrine disorders.

PITUITARY GLAND

All anterior pituitary hormones are under stimulatory control of hypothalamus except Prolactin (under -ve influence of Dopamine)

[PROLACTIN Under -ve influence of DOPAMINE]

Hypothalamus.

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*Pituitary stalk damage

Vascular

mode of

control

Neurogenic

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ADH

Recovery

Initially (Scandixation)

SIADH (transient)

Finally

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due to desfraction

of vesicles in pitcit

Permanent lesion

SIADH

ADH

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ADH

receptors Aquaporinsessive reabsorption H2O

(Mostly in the medullary )

AMP Renin Aldosterone Nether

H2O plasma volume?

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MG

Patient of SIADH generally do not have edema

SIADH Euvolemlo Hypauricenia

True Hyponatremia (due to H2O)

Urine Na 20-40 Meg/l (Should be above 20)

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Urine asre > Plasma asm.

Single most imp parameter for plasma amolality Na

PLASMA OSM 2 (Na) + Glu + BUN

18 2.8

OY 2 (Na+k) + Glu + BUN

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18 2.8

Testing for SIADH :-

Jstater laading Sert sok remains high formally ADH)

Confirme diagnosis of SIADH.

True about GLADH are HEL

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1) pters are class of drugs appresed for

Urine Ma il N to t

3) The plasma Na con be as low as 125 mesi

4) Walin Loading test can be used for diagnosi

1) Headache Q:- Fluid restriction. moder

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3) Samnolence Mat Correction. off

3) Altered Sensorium... Vaatass

4) Lerzeirer CONIVARTAN Selective va receptors

TOLVAPIAN blockers

Rapid Correction of Sadrien asly caus Devrelacycline

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cover "Control Pantine Myclinesis

Payuria: >40-50. ad /lg/day

> 3 litres / day

Crine aereolabily

<300 masa/1 >300mm/L

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Free water loss Solute loss.

Bimary polydipsia Diabclis Insipidlit

1) Psychogeric polydipsia Central Nephrogerie

Plasma Nat conc.: ? Plasma Nat cone. ?

may be @ but never Nat or @ bat never Not

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War deprivation test

(1hr & 3hrs after crater deprivation)

Urine osm ? Urine Osm 11

(should Smprove by of least ox I by <50%.

[5020) te tay primary paydipsia). Central Nephrogenic

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Urine Osm 11 Urine Osm

R:- Dermopressin B Thiazider

Spray ?

Thiazides help by

causing Na loss in scie

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Reffer Nat abreratten in pa

Polyuria

urine <300mOsm/L

ADH

ADHT

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?

Nephrogenic Di

ADH

?

Brimary pelydipsia

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Mannitol infusion ezill

never case hypernatrenia.

although it I plasma asm.

Central DI

MRI of pituitary to cot

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(post: pituitary normally appears bright);

Bright spot Bright spat

Brimary palydipsia Central Di

Travosa +

Polyuria. (31/day)}

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Cerebral Salt Wasting Syod.

?

Urine Sadivern t

Unat > 20meg/L.

Diabetes Triipidur

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UNA

UNA <20 Meg/1

rent / M SNot 4/1

Both urine Not 1 x 8. Not ? Mic coure Sative in Gurion

PROLACTH:

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Mic functiesal lusor of pituitary: Belactiseesa

Prolactio Galactorrhea

GARH &

?

FSH

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?

Addteagent Extregon k

Prolactinemas (me)

Prolactin levels (sceogg/cal) Physiological state

Dopamine blocker dr dong history...

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Hypathyroidism Arst lurale) causes of

?ll th

Prolactina

PROLACTINOMA

Zorfertility Aorgiacchaa

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CF &

? Erectile dysfunction Galactorrhea

Galactorrhea (157) Prolactinerra deesn't cause Gynaecomastia

Prolactinema

(1/cm)

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Miemadenoma Macroadenoma

FM = 2011 FMEIL

Q: f.ac.il Dopeerior agoneta Cabergeline line (D.0.0 in non-monast

Macroadenoma

Visual Syedans

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Cabengaline

Casseer after few mantre)

Visual Symptoms persist Visual symptoms

Surgery Continue treatment

Trans-spheroidal resection.

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Pregnancy Prodacten kurale to paygaaney-dan't

Brolactinoma.- correlate & severity/progno

Micrcadepsana Maercaderama

Oxxocromptine free follow up..

Visual fields

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Trare sebencidal resection

ACROMEGALY

Growth Hormone

Liver IGET

Epiphyseal growth seal growth Bene size/ lepath I

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I protein synthesis

Growth honosone

Na & insulin lipalysis

sutintion serectivity

Fasulla Argintere

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Like activity

Antilipolytic C/E-

TGH Muscle mass 1

Fat

Skull size ? Mandirlagroutthi gape

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Finger" + gape Wo Seeth

Feet Squaring of Mandible.

Enlarged Wall size Laget's discare Selle lurcice 1

Reconegsity Entanged sella turcice

Heet pad Thicknces 20m.

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Flezsky patere

I guicase. + Inralin resistance Dlabctée Mellitus

Na 1 + Systranc mecihr resistance Hypertension.

Cardiomyopathy Zechanic heart disease

Colonic polypr I sites of Ca Colon

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Motst daugby handsbake

Investigations.

8. Growth hormone levels axe not useful. In asecerment.

Screening test IGF 1 levels.

N

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Rule out disease Confirmatary test

Nil ovat overnight fasting

75 Togin glucose

GH & suppressed after thr

compared to bareline

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Seromegaly

OGII may be also used to describe the cenfiornatory list).

is Surgery

Drugs:- Sarmatastation anteques. (Octreotide, lanticstide)

MAT

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Resectable Men Resectable

Trass Sphenoidal Resection. Garima korife Surgery

(ne bongfit)

GH receptor blocken Legrisamarts).

GUSHINGS

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disease: Corticosteroid excers due to pitcilary ademama

Cushing syndrome: Entire spectrum of Corticosteroid exces disorders.

M.c. cause of Cueling syndrome: Patregenic

ACTH ? ACTH

Pituitary aderersa Adrenal

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Ectopic ACTH Syndrome No pigmentation

Pigmentation

Pitulary adenoma Ectopic. ACIM.

ACTH 1

Iasichiour Rapid anset Cortisol ? Mineralocorticor

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? bydroxylase

Cortisone Ne oriceralb

Hypokalemic Hypalsalemic

metabolic alkalosis metabolic alkalesie

40% 90%

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Insidious course hade Rapid course Ne indiction of UB-OH lase

-ta induction of B-bydraglase

which doesn't lead to rise in mineralocorticoids I mineralocorticoid activity.

F:M = 4:1 FM = 1:1 AF: M = A:1.

Obesity obesity ± obesity +

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(if obesity is absent it

is due to malignant cachexia)

Eartist manifestation of Culing's lah Jass of diurnal variation

cortisol levels.

west manifestation / cartiest /F atgaiy (glur constitutional features)

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[48 Centrál obezily Praedo Casting

Thin skin Easy bruisabilily alcoholics.

Moon facies

Strali abdamen

Thin extremeties

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Buffale hump

Ostiopecoris farthralgiai

Cushing Superted.

Overnight / low dare Dexa Suppresion Lect.

Img Dexamethaerine 11pm.

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8 am Cortisol

Coctisol Rule out Cruel

Cushing Cushing

ACTH ACTH

Pituitary adenoma Adrenal cause..

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Ectopic ACTH

High dase Dexa Supp. lest NCCT-abdomen...

<6cm >60m

Lituitary Benign Malignant

Ectopic 17 Ketasteroid II

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(ambiguous)

Petrous vein ACTH

Pexipheral vein ACIN

Petrous: Peripheral > 2:1 Pikuilery

44: Ectopic

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Pasiccatide alte through Sematistatin receptoce

Ketoconazole

Metyropane 19 hydroxylase inhibitors.

R.A.C Surgery

DISORDERS DE SEXUAL DEFERENTIATION (DSD)

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XX DSD XY DAD.

XY DSD: BRY gene on Y- ohromasome development of tatis

Jeevie Mullerian Inhibiting Factor.

Jestosterone.

5 a lestosterone reductare.

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Dihydroxy textosterone.

Astrogen receptors (x-chr-codes for androgen recepti

genitalia

Wolffour duct female structures

Wolffour duct Male structures

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External Genitalia develops from commen Embryonia Structurce

Of there is no Y-chromosome the Internal and external)

will lomate structures.

MIE bloks the Mutterian development

Testosterone pronadir development of Wolffion duct..

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DHT required for the external gerilitia to become mate

5° reductare deficiency.

caternal genitalia

MIE No mullerian development & internal,

Testosterone + Wolffian development A

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No DHI Denbiguous est genitalia (since the arklian

Androgen Receptor In Sensitivity

to dev inf

Testosterone

develop extigeritalia is creak) ()

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Testosterone + Na action on receptors 0 Wolffias Duct tabecot

MIF + Mullerian dict No mullerian systém

DHT + No action is receptors i cotermal genitalia

Testis are present in the abdomen / undiscended.

Will present at puberty with Minnany amenorrhea and blad ingreal pers

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Proast development will be sorasal. (esteggen dependent).

Axillary pubic hair will be absent (aadrages dependent)

Testicular feminization syndrome Karyotype xx

The testie axe either widescended Laser à Indirect in Sagedaal trovia

and have a 30 fold Afghar xists of maltenary (Sorsicana)

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Testicular Feminization Syndrome MRKH Syndrome

Xx Mullerian agenesis XX

IG Assort Int genitalia Absent

Ext genitalia Absent Ext: genitalia

Breast Breast

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Axillary/Pubic hair Asical Axillax Pubic.bair (N

inguinal hernias int (androger xcopter @)

Gonadal Dysgenesis Pure gonadal dragoncesi dysgences's

Mired ixed gonadal gonadal dysgencies.

Pure genadel dysgenesi Streals testis

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No testosterone, No MIF

Bath Int. cxt geritatia are fecrality default

Breast development - absent

Ari: / Aible hair growth - 1 (due to ansingens frens adrenal)

Mixed Gonadal Dozgenesis

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Qve Lielli (genad) & streak, one gonad i normal

General masculine picture, not proper masculinization because

Just ane ganad se present (virilization Hon i not completar)

Hypespadias As clamor

Range Normal nale to Male

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any phenotype in betrecer

XX D.SD.

Maternal couc Androgen producing tumor

Androgenic drugs

Eetal cave Congenital Adrenal Hyperplasia

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210 OR deficiency

14. 2014 Eyftinny Andenges

3. Bere deficiency

Cytochrome P450 oxidereductase

Aromatase defect Glucocorticoid receptor gene mutation.

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GEAWARSA CELL

FSH. Aromatase ESTROGEN

DHEA

H

Theca cells. TESTOSTERONE

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CAH

Cholestiral 17 lydroxy ketosteroids.

Pregnenelone 17-OH pregnene H pregnenolone D?

3BOH deryd Progeilesane 17-OH pengertirone Androstenedione

21 a hydroxylase 410ydrocoylase

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Deoxy corticosterone Deoxy Cortisol Testosterone

Portisone 804 delydrogenate

Medulla Reticularis Fasciculata. Glomerulosa.

Ses Merside. / Glucocorticoids / Mineralocorticity)

Most cancer enz defect. 210 bydroxylase deficiency.

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Autosomal recessive

Any defect of hacizantal enz will & formation of Corted

ACTH will constantly stimulate adrenal cortés

CAH

21004/11 Bar deficiency 17 K Katasteroid levels will ?

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Can be used for evaluation in care of

ambiguous genitalia

(17:04 progesterone crore proferred than 17:08 pxegreachzu

Deary corticosterone (Doc) hae mineralororticoid action

21204 11204

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Androgens 1 Padringens 1

Xx Ambigueur genitalia xx- ambiguous genitalie.....

XY precociou puberty. -de-

Metabolic acidars Metabdic alkalesi

Hyperkalemia Hypokalemla

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HTN

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PHAEOCHROMOCYTOMA / PARAGANGLIOMA

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Phacchromocytema is for timers of adrenal & extra-adrenal reglass

Paragangliona is for head and neck Linoy

95%

Asdomical Extra abdominal

90% 5%

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Adveral Extra-adresal

Urinary bladder

Rule of 10: 10% Extraadrenal

10% Bilateral

105 Children

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10 tegast malignast at the time of diggnosis

Tyrosine

DOPA

?

Dopamine

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?

Mor Adrenaline.

PrNMT not present in extra-adrenal

tissue, 80 in such tumors adrenalin)

is notpresent

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? Para ethetidamine methyl aferase (PNMT)

Adrenaline

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Extra-adrenal Adrenal Phaco

Nor adrenaline aug size 4 tass

<3cm >3cm

Epinephrine Noradrenaline

Tor MEN Syndrome, Phaes are adrenal? So adrenalin is produerd

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Malignant Phaco :- 4/cratie

Milotic Spindler Do not heth to differentiale

Capsular invasion

Metastore's only way to differentiati

Ipmauction of combrajante /primitive metabolilée Mitsi z

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HF: Headache Emic gyoyatorn).

Triad. Palpitation

Surcating

Wt. loss (differential for at Jers) fors

Phacochromocytama Thyrotoxicosis

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Catetiols 1 Catichale

Hyperadrenergic features Hyperadrenergic features.

? BMR ? IBMR.

Wt. loss Wt. Joss.

Tacky-CoVTI

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HTNS Sustained

Episodic Sustained

Tremor occassional Fromor

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Orthostatic hypotension abrent

(due to udume contrition)

Law 24 hoc urine catecholamine & Metanephrine seray ? T.O.C.

(fradtonalid)

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Plasma extechatamine & free asetrosphilae assay

Chromogranin A levelet in plasma.

Optional Inv for pharachiramaytona ? abderainal MRT (

lacatization it true if-ve.

MIBG (to look for ameti)

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Best suvestigation:- DOPA PET

X Bladers

Cirectvity

MIBG. (soultivity 8176)

Phexaxybenzamine (Rarter to achieve full offert)

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Prazasin

Phentolamine

Q-Blockade.

B. blockers Surgery

CONN'S - PRIMARY HYPERALDOSTERONISM

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Aldosterone 1

Not + TO ANP ? Natho

? kt? ?H++ (metabolic alkalosis)

HIN Renin

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As Conn's pimary hyperaldastèrantem (cana) do not have sedema.

Spironolactone, Eplerenone (Aldo xcceptor blocker)

Primary byperaldasteranian (Alde seula)

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Abdominal inagprag

8/1 - adrenal evitaregensert (7016)

caser ? Should only be wed for Adrenal adenome (3070)8

not for adornal hyperplasia

Auto Prusune Polyglandular Ayndrome

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APS 1 APS 2.

Early Childhood, infant Aldo Adolescent

Hype parathyroidism Cocliar Sprave, Dermatitie Herpaty

Asplenism Graves disease.

Mueacutaneous candidia's Hyperparathyroid.

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Hypogenadien -do-

Autoimmune Hyraidite -do -

Alopecia -do

Hypogonadisis. -do

type I diabetie - do

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Adcliran's disease - de

Vitiligo

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MEN-1 MEN-2A MEN 20. MEN-4

Werner Syndrome Sipple Syndr

Parathyroid adenona (c) MTC MTC PTH-adenaosa

Multicentric Phacochromeytarma Phaeachromocytoma Pituitary alien

Enteropancreatic problem. PTHadenoma Jicken - Amyloid Marfanoid

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Gottrinama eutascous lesion Mucoset/GT

Inscelinoma * Hirskpring's. neuroma Cax

Rituitary adename, * Hirskpring's. 2 Adrenal Her

Carcinoide

Mc. entire estère pancreatic tumor In MEN 1 Gastrinama

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M-e-parercatie Aunor In MENI Insulinoma.

M-C- tumor in MENT Parathyroid adenoma

Gastrinoma Gattrin

?

1. Baral acid output

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?

Peptic ulcer discare.

I. Serum Gartrin on cair be due to 2-1. PPT

2) Pernicious araemia...

3) Atrophic gastritie

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If Stomach PM <2.0 Serum Gastrin in 21000pg/ml.

M. c. site for Gasteinara Gartrinoma

A Pavercas PPI -Pet, Surgery.

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Jasulinema: Episodes of Hypoglycaemia.

Insulin: 72 wr fasting (1.0.0)

?

: Glucose 30.3. (Checks insulin: glucose ratio eve

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possibility of inrutinana.

Tasulinoma Factitious Hypoglycaemia

B-cells. ? Sulphonyl urea

pro-insulin Insulin

insulin Opeptide B-cell Opeptide &

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? ?

20.9ugjat 20.Ing/ml

2200pmol/L 5200 ?/L

[2]: Diazonide + Carbohydrate dict

Surgery (insuliname accrire equally in all parts of paverear)

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occurs

Metastatic - Streptozocin. + 5E0

Surgery Localisation of Surror in paccocess

EUS

CI (Contrant CT) ?1.0.C.

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?Tatra-operative Ultrasound.

Gold Standard Adeniagmoky

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CARCINOID.

location 2/3 GIT ileus 2

rectum 3

colon (4)

13 Jung appendix

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ovary (5)

(Carcinoid syndrome il vero in rectal carcinoide.

M-c. complaiat of Carcinoid timer: Abdominal pain

M.c. complaint of Carcinoid Syadmme: Flushing & diarrhea

Carciavid Syndrome

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F: Diazrihea

Hushing

Asthara like wheezing episodes..

Dada Mya

rdial fibrosis - RV

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Myocardial

TR > TS > PR > PS Serotonin

In: Bert: PET Seas.

1.O.C: Scintigraphy.

4:- Surgery

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?(Aum)

Tryptophan

Niacin

Pellagra

Diarrhea

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Dermatitis

Dementia.

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