Subscriber since 2013, always great content! Thank you so much! Blessings from Germany!

@drimranulhoda4173

2 жыл бұрын

Hello sir , I am a doctor in India , following Dr Bolin’s videos since 2013 , I have to ask you something about practice medicine in Germany.

@Paul Bolin, just want to thank you for your channel. I’m a PA that went through some things after PA school and didn’t take my exam for two years. I was feeling really defeated when it came to starting to study for the board exam. I watched all of your videos after I did all of my initial studying and you helped me SO MUCH! I went to that exam and it seemed “so easy!” 😂 thank you!! I am contributing to your channel and pray you keep your videos going and continue to help people in their journey. Thank you!!!!

First comment here! 🙋🏻‍♀️ Thank you for all of your videos Dr. Paul Bolin! 💕

Thank you very much for your content! Your review series helped me a lot on my exams)

Sir can you please make a review on copd and tb ...

thank you.

I am a new subscriber Is these channels contents are helpful in preparation of FRCPC exam ?

Where are you sir , no recent update or videos , miss you

where I can find his presentations as PPT or PDF ?

Great

My life savior 🥰🥰

❤️

Paul, are you still taking contributions to your Patreon channel?

@pwbmd

2 жыл бұрын

Indeed

Thursday, November 10, 2022. Gastroenterology: Irritable Bowel Syndrome (IBS) is the Irritation of the Digestive System (Diagnosis Of Exclusion) manifesting as Chronic Abdominal Pain (Persisting > 3 Months [Intermittently or Continuously]) After Having Investigated Accordingly for Aetiology Clinically or Via Laboratory Investigations. IBS is Also known as 1) Spastic Colon (Pain Syndrome Thereof), Nervous Colon (Gut-Brain Interaction or Mesenteric/Enteric/Intrinsic Autonomic Nervous System) and other characterizations. Ax is consensually Idiopathic, but Many Associations and Risk Factors Have Been Assessed, leading to Hypotheses of a Psychiatric Aetiology and/or Genetic Causation (Stress Diathesis Model). SSx: 1) Abdominal Pain/Discomfort, 2) Cramping and Bloating, 3) Excessive Gas in the Abdomen, 4) Indigestion, 5) Changes in the Pattern of Bowel Movement, 6) Diarrhea in Alternation with Constipation, and 7) Mucus within the Feces; In Approach to IBS Stigmata (Abdominal Pain), Pain Factors or Characteristics of Pain are Important: 1) Location of Pain (Generalized, RLQ, RUQ and the Like); 2) Quality of Pain (Sharp, Stabbing, Dull, Aching, Cramping, et al); 3) Timing (Postprandial, Preprandial, Perimenstruation, etc); 4) Frequency; 5) Factors Aggravating (Worsen) or Alleviating (Relieving) the Pain (Wheat and Milk as an example); Also, Stool Investigations during Physical Examination prove Useful (Therefore, Interrogation on this Subject): 1) Stool Quality (Color, Consistency etc.); 2) Stool Frequency (Defecations Per Diem); 3) Other Factors In GI Review Of Systems (ROS): GERD SSx, Emesis/Vomiting, Bloating, Changes in Appetite (Anorexia); 4) Constitutional Symptoms (Fever, Unintentional Weight Loss, Nocturnal Hyperhidrosis/Sweating); and 5) History of Abdominal Surgery (Aetiology of Adhesions for Obstruction); Diagnostic (Presumptive Diagnosis) Investigations via Laboratory: 1) Stool Analyses: 1) Fecal Fat (Steatorrhea/Malabsorption); 2) Blood (Inflammation/Anemia); 3) Ovum and Parasite (O&P) for Parasitic Causes; 4) Culture (Infectious Agents); 5) Fecal Calprotectin (IBD Differential); 6) C. Diff Toxin if Antibiotics [ABX] in History); 2) Complete Blood Count (CBC); 3) Basic Metabolic Panel (BMP); 4) Serum Calcium (Hypercalcemia can present with Abdominal Pain); 5) Liver Function Tests (LFT); 6) Thyroid Stimulating Hormone (TSH); 7) Urinalysis; and 8) other Tests are Possible Depending on the Patients Presentation (Serology for any Autoimmune Causes according to the American College Gastroenterologist [ACG] Recommendations); IBS Differential Diagnosis (DDx): When Symptoms worsen when Eating 1) GERD (Some Relief with Antiacids; SSx: Regurgitation and Emesis); 2) Gastric Ulcer (Usually Mild Relief with Antiacids); 3) Lactose Intolerance due to Lactase Deficiency (Dairy Product Consumption); 4) Celiac Disease (Gluten Enteropathy) has Malabsorptive Diarrhea, Bloating and Inflammation (Autoimmune Mechanism or Gluten Hypersensitivity); 5) Chronic Pancreatitis has an Association with Alcoholism, Acute Pancreatitis, leading to Malabsorptive Diarrhea. Dx can have Lipase and Amylase Abnormality; 6) Cholelithiasis (Cholesterol Gallstones) has RUQ Pain Predominantly, Abrupt Colicky Profile and ERCP for Dx and Tx; and 7) Chronic Mesenteric Ischemia has a History of Atherosclerosis, Peripheral Artery Disease (PAD) and Anorexia/Cachexia Stigmata due to Severe Pain with Eating; When Abdominal Pain is Relieved when eating, 8) A Duodenal Ulcer is usually the Cause because of the Bicarbonate Ameliorating Effect upon release into the Duodenum; Gynecologic Aetiology of Chronic Abdominal Pain follow: 9) Pelvic Inflammatory Disease (PID) is due to Infection of the Uterus, Fallopian Tubes, Ovaries, and Cervix, otherwise a Female Genitourinary Infection; Hx has Sexually Transmitted Infections (STIs; Gonorrhea and Chlamydia Pathogens) or Intrauterine Devices (IUD) for Contraception. SSx: 1) Fever, 2) Dyspareunia (Painful Sexual Intercourse), 3) Vaginal Discharge and 4) Leukocytosis (WBC Elevation); 10) Endometriosis has a pathological Metastasis of Endometrial Tissue (Ectopic Endometrial Growth) presenting with Pelvic Pain and an Irregular Menstrual Cycle (Dysmenorrhea); SSx: 1) Dysuria, 2) Pelvic Pain, 3) Dyspareunia, and 4) Cyclical Tenderness of the Genital Organs; Tx and Dx via Laparoscopic Visualization and Procedural Excision of Endometrial Tissue; 11) Ectopic Pregnancy is the Abnormal Gestation of an Embryo (usually 3 Months) with two or more of the following Signs and/or Associations Warrants IBS Diagnosis; 2) Related to Defection (Bowel Movement or Stool Passage) or Improvement of Symptoms with Defecation; 3) Change in Frequency of Bowel Movement (Less Defecation or More); and/or 4) Change in Form/Appearance of Stool Consistency (As Diarrhea and Constipation abnormalities produce a Very unlike Consistency). Mx of IBS: 1) High Soluble Fiber Diet (20-30 Gram per diem) along with Exercise, Fluid Intake Adequacy, and Avoidance of Caffeine; 2) IBS-D (Diarrhea Predominance), then Loperamide and TCA; 3) IBS-C (Constipation) Bulking Agents (Psyllium) along with Lubiprostone, Linaclotide, Tegaserod, Polyethylene Glycol (PEG), Tricyclic Antidepressants (TCAs) as Depression is Associated with IBS; 4) Antispasmodics as in Hyoscyamine and Rifaximin for Pain Pro Re Nata (PRN). Antispasmodics are a questionable Adjuvant Therapy, as ACG has Recommended Against such Agent Indication (Controversy is usually avoided in USMLE Inquisitions); 5) Essential Oil Peppermint Oil for so-called Global Symptoms (Bloating). Furthermore, IBS Pearls (Wisdom yielding Addendums): 1) IBS is an Association or Correlation with Psychiatric Disorders, namely Generalized Anxiety Disorder (GAD), Post Traumatic Stress Disorder (PTSD) and Abuse (Sexual Abuse); 2) Localization of Pain is not Common in IBS (Localized Pain should trigger Aetiologic Investigations for other Causes); 3) While Defecation Alleviates IBS Abdominal Pain/Discomfort, this only suggests IBS and is not to be Pathognomonic of IBS; 4) Alarm Symptoms (Typical Stigmata of IBS) warrant Colonoscopy, in efforts to visualize the Organ for Determination of the ongoing and prevail Pathology (Abnormal Anatomy or Architectural Changes resulting in abnormal Physiology); 5) ACG, a Physicians' Guild Recommends Routine Serology (Serologic Testing for AntiGliadin Antibodies [AGA] or Anti-tTG-IgA Antibodies) for Symptoms Consistent with IBS-D. Goodness, I sure have a Nightmare with IBS, as it can be fairly obvious when so much Aetiologic Investigation has been Performed yet it thereafter will still remain highly unexplained and Mysterious. "Idiopathic" Aetiology is so indicative of the relative advancement of man in the field of knowledge. Socrates still remains an Authority with his Motto: As for me all I know is nothing....MD Paul W. Bolin, die Gesundheitfleiss moegliche wirt helfen die Kranken und die Sterbend aber sicherlich die Wissenschaft wirt retten die Welt von den Kranken. Heil!