Raiyyan Tahsan

Raiyyan Tahsan
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Gastroenterology Case No 3. ð†ðšð¬ð­ð«ð¢ðœ ð”ð¥ðœðžð« নাকি ðƒð®ð¨ððžð§ðšð¥ ð®ð¥ðœðžð«?

ð†ðšð¬ð­ð«ð¢ðœ ð”ð¥ðœðžð« নাকি ðƒð®ð¨ððžð§ðšð¥ ð®ð¥ðœðžð«â‰ï¸

2 ulcer a  à¦à¦‡ Abdominal Pain থাকবে কিনà§à¦¤à§ কিভাবে বà§à¦œà¦¬à§‹ Gastric নাকি Duodenal Ulcer***

In case of ð†ðšð¬ð­ð«ð¢ðœ ð”ð¥ðœðžð«:-

Pain বাড়বে ⬆ï¸à¦–াওয়ার পর ,so পেশেনà§à¦Ÿ খেতে চাইবে না Weight loss হবে..Carcinomar Risk থাকে ☠ï¸

-Malignancy à¦à¦° রিসà§à¦• বেড়ে যায়

• মহিলা পà§à¦°à§à¦· Both Sex ঠকমন!

• Hametemesis( বà§à¦²à¦¾à¦¡ðŸ©¸vomiting)হতে পারে*

• Hemorrage✅>Lesser curvature involving

Left Gastric artery

• Night pain থাকে না

মà§à¦²à¦¤à¦ƒ H pylori জনিত Infection (Common Cause)..NSAID induced ও হতে পারে!

In case Of ð——ð˜‚ð—¼ð—±ð—²ð—»ð—®ð—¹ ð˜‚ð—¹ð—°ð—²ð—¿:-

💥না খেলে বà§à¦¯à¦¾à¦¥à¦¾ (pain)বাড়বে ⬆ï¸à¦®à¦¾à¦¨à§‡ খালি পেটে(Empty stomach) ঠবà§à¦¯à¦¾à¦¥à¦¾ বাড়ে! So পেশেনà§à¦Ÿ বেশি বেশি খাবে কারণ খাওয়ার সাথে pain কমতে থাকে ⬇ï¸à¦¬à§‡à¦¶à¦¿ বেশি খাওয়ার জনà§à¦¯ weight gain করতে থাকবে,,

• পà§à¦°à§à¦·à¦¦à§‡à¦° বেশি Common*

• Melena(Black or bloody🩸 Stool )হতে পারে!

• Usually Benign হয়ে থাকে; Carcinomar risk থাকে না…

• রাতে বেথা হয়

• Hemorrage✅ > (Posterior wall > Anterior wall)

involving gastroduodenal artry

• রাতে বà§à¦¯à¦¥à¦¾ হয়ে থাকে,মাà¦à¦°à¦¾à¦¤à§‡

• 4 Times more common Than Gastric ulcr*

Treatment হিসেবে

Antacid,,Triple Therapy,,PPI,,Sucralfate,কমনলি Prescrived Drug*✅

Tablet 1:Entacyd Plus Chewable Tablet (400mg+400mg+30mg) (AS A Aluminium Hydroxide +Magnesium Hydroxide+Simethicone. As a Antacids.).

Indications of Tablet :Entacyd Plus Chewable Tablet (AS A Aluminium Hydroxide +Magnesium Hydroxide+Simethicone. As a Antacids.).

This is indicated for symptomatic relief of hyperacidity associated with the peptic ulcer, gastritis, peptic oesophagitis, gastric hyperacidity, heartburn, sour stomach or hiatus hernia. It is effective in the prevention of stress ulceration and GI bleeding. It acts as an antiflatulent to alleviate the symptoms of gas including post operative gas pain. This rapidly relieves acid pain, disperses gastric foam and facilitates eructation of gas and air.

Pharmacology of Tablet :Entacyd Plus Chewable Tablet (AS A Aluminium Hydroxide +Magnesium Hydroxide+Simethicone. As a Antacids.).

This is the mixture of non-systemic acid neutralizing substances and antiflatulent. This preparation offers reliability as well as long action. Aluminium Hydroxide and Magnesium Hydroxide induce the relief of ulcer by neutralizing gastric acid secreted from parietal cells of the stomach. The clinical use of simethicone is based on its antifoam properties. Simethicone spreads on the surface of aqueous liquids, forming a film of low surface tension and causing collapse of foam bubbles. Simethicone repeatedly allows mucous surrounded gas bubbles in the GI tract to coalesce and be expelled.

This is used in the treatment of flatulence and meteorism for the elimination of gas, air or foam from the gastro-intestinal tract prior to radiography and for the relief of abdominal distension and dyspepsia.

Simethicone is physiologically inert; it does not appeared to be absorbed from the GI tract to interfere with gastric secretion or absorption of nutrients. Following oral administration, the drug is excreted unchanged in the feces.

Side Effects of Tablet :Entacyd Plus Chewable Tablet (AS A Aluminium Hydroxide +Magnesium Hydroxide+Simethicone. As a Antacids.).

Gastrointestinal side effects are uncommon. Occasionally, if excessive amount is consumed, diarrhea, constipation or regurgitation may occur.

Tablet 2.-Esonix 20 mg (AS A Esomeprazole AS A  proton pump inhibitors.)

Indications of Tablet .Esonix 20 mg (AS A Esomeprazole AS A  proton pump inhibitors.):-

Esonix is indicated:

  • To relieve from chronic heartburn symptoms and other symptoms associated with GERD
  • For the healing of erosive esophagitis
  • For maintenance of healing of erosive esophagitis
  • In combination with amoxicillin and clarithromycin for eradication of Helicobacter pylori infection in patients with duodenal ulcer disease.
  • Zollinger-Ellison Syndrome
  • Acid related Dyspepsia
  • Duodenal & Gastric ulcer

Pharmacology of Tablet .Esonix 20 mg (AS A Esomeprazole AS A  proton pump inhibitors.):-

Esomeprazole is a proton pump inhibitor that suppresses gastric acid secretion by specific inhibition of the H+/K+-ATPase in the gastric parietal cell. Esomeprazole (S-isomer of omeprazole) is the first single optical isomer of proton pump inhibitor, provides better acid control than racemic proton pump inhibitors.

Absorption: Esomeprazole capsules contain an enteric-coated pellet formulation of esomeprazole magnesium. After oral administration peak plasma levels (Cmax) occur at approximately 1.5 hours (Tmax). The Cmax increases proportionally when the dose is increased, and there is a three-fold increase in the area under the plasma concentration-time curve (AUC) from 20 to 40 mg. At repeated once daily dosing, the systemic bioavailability is approximately 90% compared to 64% after a single dose. The AUC after administration of a single dose of esomeprazole is decreased by 33-53% after food intake compared to fasting conditions. Esomeprazole should be taken at least one hour before meals.

Distribution: Esomeprazole is 97% bound to plasma proteins. Plasma protein binding is constant over the concentration range of 2 20 mmol/L. The apparent volume of distribution at steady state in healthy volunteers is approximately 16 L.

Metabolism: Esomeprazole is extensively metabolized in the liver by the cytochrome P450 (CYP) enzyme system. The metabolites of esomeprazole lack anti-secretory activity. The major part of esomeprazole’s metabolism is dependent upon the CYP2C19 isoenzyme, which forms the hydroxy and desmethyl metabolites. The remaining amount is dependent on CYP3A4 which forms the sulphone metabolite.

Excretion: The plasma elimination half-life of esomeprazole is approximately 1–1.5 hours. Less than 1% of parent drug is excreted in the urine. Approximately 80% of an oral dose of esomeprazole is excreted as inactive metabolites in the urine, and the remainder is found as inactive metabolites in the faeces.

Combination Therapy with Antimicrobials: Esomeprazole magnesium 40 mg once daily is given in combination with clarithromycin 500 mg twice daily and amoxicillin 1000 mg twice daily for 7 days. The mean steady state AUC and Cmax of Esomeprazole increased by 70% and 18%, respectively, during triple combination therapy compared to treatment with Esomeprazole alone. The pharmacokinetic parameters for clarithromycin and amoxicillin are similar during triple combination therapy and administration of each drug alone. However, the mean AUC and Cmax for 14-hydroxyclarithromycin are increased by 19% and 22%, respectively, during triple combination therapy compared to treatment with clarithromycin alone. This increase in exposure to 14-hydroxyclarithromycin is not considered to be clinically significant.

Side Effects of Tablet .Esonix 20 mg (AS A Esomeprazole AS A  proton pump inhibitors.):-

The most frequently occurring adverse events reported with Esonix include headache, diarrhoea, nausea, flatulence, abdominal pain, constipation and dry mouth. There are no difference in types of related adverse events seen during maintenance treatment upto 12 months compared to short term treatment.

Tablet 3.Protecto 1000mg (As a Sucralfate AS A  Chelating complex).

Indications of Tablet .Protecto 1000mg (As a Sucralfate AS A  Chelating complex).

Protecto is indicated in adults and adolescents over 14 years old for treatment of-

  • Duodenal ulcer
  • Gastric ulcer
  • Chronic gastritis
  • The prophylaxis of gastrointestinal hemorrhage from stress ulceration in seriously ill patients.

Pharmacology of Tablet .Protecto 1000mg (As a Sucralfate AS A  Chelating complex).

 

Sucralfate is non-systemic as the drug is only minimally absorbed from the gastrointestinal tract. The minute amount which absorbed primarily excretes in the urine. Sucralfate promotes the healing of gastric and duodenal ulcers by the formation of a chemical complex that binds to the ulcer site to establish a protective barrier. Besides, Sucralfate inhibits the action of pepsin and bile.

Side Effects of Tablet .Protecto 1000mg (As a Sucralfate AS A  Chelating complex).

 

The most common adverse event was headache (3.4%) followed by nausea (2.3%), abdominal pain (2.3%), constipation (1.1%), diarrhea (1.1%), and urticaria (1.1%). The majority of patients who reported bezoars, had underlying medical conditions that may predispose to bezoar formation (such as delayed gastric emptying) or were receiving concomitant enteral tube feedings. Episodes of hyperglycemia have been reported in diabetic patient.

Raiyyan Tahsan â¤ï¸ Date:23-12-2024 Tuesday Time:06-25-35 PM.

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