1. pepsinogen --- pepsin by HCL
2. Third Session
2.1. Step (9): Review of Learning Objectives
2.1.1. celiac disesae
2.1.1.1. defenetion
2.1.1.1.1. immune mediated
2.1.1.1.2. no absorbtion of gluten
2.1.1.1.3. inflammatory
2.1.1.2. etiology
2.1.1.2.1. genetic * environmental
2.1.1.3. pathophysiology
2.1.1.3.1. immune mediated
2.1.1.3.2. dq2- dq8
2.1.1.4. presentation
2.1.1.4.1. weight loss
2.1.1.4.2. steatorrhea
2.1.1.4.3. vitamin defecincy
2.1.1.4.4. bleeding diathsis
2.1.1.4.5. ostepenia
2.1.1.4.6. skin rash
2.1.1.4.7. headache
2.1.1.4.8. prephral neuopathy
2.1.1.4.9. acid reflex
2.1.1.4.10. GI and non-GI symptoms
2.1.1.4.11. hypocalcemia
2.1.1.4.12. ear infection
2.1.1.5. diagnosis
2.1.1.5.1. sero-histopathological correlation
2.1.1.5.2. remission-responce with glutin free diet
2.1.1.6. investigation
2.1.1.6.1. serology
2.1.1.6.2. biopsy
2.1.1.6.3. cbc
2.1.1.6.4. biochem
2.1.1.6.5. microbiology
2.1.1.6.6. iron study
2.1.1.7. appraoch
2.1.1.7.1. education
2.2. Step (10): Management
2.2.1. managemt
2.2.1.1. goal
2.2.1.1.1. remission and education
2.2.1.2. glutin free diet
2.2.1.2.1. refer to dietition
2.2.1.2.2. special producs to facilitate QOL
2.2.1.3. follow up
2.2.1.4. supplement
2.2.1.4.1. vitamins
2.2.1.4.2. minerals
2.2.1.5. steroids
2.2.1.5.1. refratory cases
2.2.1.6. pnumococcal vaccine
2.3. Step (11): Feedback & Resources
2.3.1. medscape
2.3.2. up to date
3. Second Session
3.1. Step (6): Review of Learning Objectives
3.1.1. Basic macro-nutrient
3.1.1.1. General Function of GI system
3.1.1.1.1. Mouth
3.1.1.2. Cabrs
3.1.1.2.1. Break down starts in the mouth
3.1.1.2.2. In the stomach
3.1.1.2.3. In the intestine
3.1.1.3. Protein
3.1.1.3.1. STOMACH
3.1.1.3.2. DUEDENUM
3.1.1.3.3. SMALL INTESTINE `
3.1.1.4. Fat
3.1.1.4.1. EMULSIFICATION IN DEUDENUM
3.1.2. PATHPHYSIOLOGY OF DIARRHEA
3.1.2.1. 99 % MUST BE REABSORBED
3.1.2.2. MECHANISM
3.1.2.2.1. OSMOTIC
3.1.2.2.2. secretotory
3.1.2.2.3. MOTILITY RELATED
3.1.2.2.4. INFLAMMTION
3.1.3. DDX
3.1.3.1. irritible bowel syndrome
3.1.3.2. inflammtory bowl disease
3.1.3.2.1. immune mediated
3.1.3.3. infectious
3.1.3.3.1. choilera\ rota
3.1.3.4. food allergy
3.1.3.4.1. gluten-induced hypersensitvity
3.1.3.5. iatrogenic
3.1.3.5.1. Mg-comtaining anatcid
3.1.3.5.2. laxatiuve abuse
3.1.3.6. psychgenic
3.1.4. concern about cancer
3.1.4.1. be understanding
3.1.4.2. younger population is mostly free
3.1.4.2.1. dont invistagte
3.1.4.3. older population
3.1.4.3.1. investigate
3.1.4.4. Family Hx ?
3.1.4.4.1. cancer or inflammatory bowel syndrone
3.2. Step (7): Gathering Information & Inquiry Plan
3.2.1. History
3.2.1.1. presenting illness
3.2.1.1.1. diahrrea
3.2.1.1.2. tirdeneess
3.2.1.1.3. weight less
3.2.1.1.4. no vomit
3.2.1.1.5. bloating and tirdness
3.2.1.1.6. normal period
3.2.1.1.7. symptoms aggrevated by milk
3.2.1.2. past HX
3.2.1.2.1. MOUTH ULCER SINCE CHILDHOOD
3.2.1.3. SOCIAL
3.2.2. Physical Examination
3.2.2.1. GA
3.2.2.1.1. no pallor
3.2.2.2. vitals
3.2.2.2.1. 110\70
3.2.2.2.2. hight=158
3.2.2.2.3. weight=154
3.2.2.3. Gi
3.2.2.3.1. abd
3.2.2.3.2. dre
3.2.2.4. chest
3.2.2.4.1. normal
3.2.2.5. CVD
3.2.2.5.1. SYSTOLIC EJECTION MURMUR IN LEFT STERNAL ANGLE
3.2.3. Investigation
3.2.3.1. cbc
3.2.3.1.1. loW MCV
3.2.3.2. hb
3.2.3.2.1. low
3.2.3.2.2. FOLATE LOW
3.2.3.3. CHEMSRTY
3.2.3.3.1. ALBUMIN DECREASED
3.2.3.4. STOOL EXAM
3.2.3.4.1. NORMAL
3.2.3.5. ANTIBODY
3.2.3.5.1. ANTIGLYDEN ab
3.3. Step (8): Diagnostic Decision
3.3.1. Mechanism
3.3.2. Presentation
3.3.3. Supporting Data
3.3.4. ddx
3.3.4.1. IRRITIBLE BOWEL DISEASE
3.3.4.2. INFLAMMATORY BOWEL DISEASE
3.4. OBJECTIVES
3.4.1. TO identify celiac disease, pathophysiology, risk factors, work up. managment)
4. First Session
4.1. Step (1): Identifying Difficult Words & Cues
4.1.1. Difficult Words
4.1.2. Cues
4.1.2.1. 25y F
4.1.2.2. tiredness + bloating 3m
4.1.2.3. chronic diharreha
4.1.2.4. worried about cancer
4.2. Step (2): Problem Formulation
4.2.1. 25y F complianing of 3 m history of tiredeness and abdominal bloating. chronic dhiarrehea is noted. worried about having cancer.
4.3. Step (3): Hypotheses Generation
4.3.1. osmotic diarrhea
4.3.1.1. nutrition based cause
4.3.2. secreting dirrhea
4.3.2.1. cholera infection
4.3.3. gueardiasis
4.3.4. tiredness due to loss of fluid
4.3.5. irritation of the bowel
4.3.6. eating disorder
4.3.7. celiac disease
4.3.8. colorectal cancer is less likely
4.3.9. vesicles in the ear= herpes zoster infection.
4.4. Step (4): Hypotheses Organization
4.4.1. infectious vs non-infectious
4.5. Step (5): Learning Objectives
4.5.1. list the diffrential dignosis of bloating and diahrrea
4.5.1.1. emphasising over the common causes of diahrrhea
4.5.2. how to approach a patient with a concern of colon cancer
4.5.3. physiology of digestion and absorbtion
4.5.4. pathphysiology of diahrreah