[Link]’s disease.

• Also called: congenital megacolon

• A condition of the large intestine (colon) that causes difficulty passing stool.
• Hirschsprung’s disease involves missing nerve cells in the muscles of part or all of the large
intestine (colon). Present at birth, it causes difficulty passing stool.

[Link]- Ellison syndrome.

Zollinger-Ellison syndrome (ZES) is a group of symptoms comprised of severe peptic ulcer disease,
gastroesophageal reflux disease (GERD), and chronic diarrhea caused by a gastrin-secreting tumor of the
duodenum or pancreas (gastrinoma triangle) that results in increased stimulation of acid-secreting cells
of the stomach.
[Link].( Dizziness)

A sudden internal or external spinning sensation, often triggered by moving your head too
quickly. Vertigo is commonly caused by a problem with the way balance works in the inner ear, although
it can also be caused by problems in certain parts of the brain.

Causes; The most common causes include:

• Benign paroxysmal positional vertigo (BPPV)

• Head injury.
• Labyrinthitis.
• Vestibular neuronitis.
• Ménière’s disease.
• Taking certain types of medication.

Types; There are two types of vertigo, peripheral and central vertigo.
[Link] and Hallpike test.

Procedure;

• Position the patient sitting upright on the bed, such that when supine their head will hang over
the edge.
• Stand behind the patient, and turn their head to 45o to one side. Warn the patient about what
you are going to do.
• Supporting the neck, lay the patient flat in one quick smooth movement, ensuring the head
hangs over the end of the bed.
• Ask the patient to keep their eyes open and observe for any abnormal eye movements. You
should observe for at least 30 seconds.
• If positive, patient will experience vertigo and you will observe nystagmus:
[Link] nystagmus is seen if the superior semicircular canal is involved (most common)
[Link] nystagmus is seen if the lateral semicircular canal is involved
• Repeat the test for the other side
[Link].(Fainting)

Syncope is the medical term for fainting or passing out. It happens when you have a sudden,
temporary drop in the amount of blood that flows to your brain. Most of the time, a harmless, short-
term cause makes you faint.

Syncope can happen if you have:

• A sudden drop in blood pressure.

• A drop in your heart rate.
• Changes in the amount of blood in areas of your body.

Types: Syncope can be classified into four categories:

1. Reflex mediated
2. Cardiac
3. Orthostatic
4. Cerebrovascular.
[Link]’s node.

• Virchow’s node is a lymph node and is a part of the lymphatic system. It is the thoracic duct end
node. It receives afferent lymphatic drainage from the left head, neck, chest, abdomen, pelvis,
and bilateral lower extremities, which eventually drains into the jugulo-subclavian venous
junction via the thoracic duct.
• Virchow’s node is the enlargement of the left supraclavicular lymph node and is considered by
clinicians to be a strong indicator of metastatic abdominal malignancy.
• Virchow node (VN), leading to an appreciable mass that can be recognized clinically — a Troisier
sign

[Link] sign.
 Inspection for Position of trachea Trail’s sign: It is the undue prominence of the clavicular head of
sternomastoid on the side to which the trachea is [Link] is called Trail’s sign.

The pretracheal fascia encloses the clavicular head of stemomastoids muscle on both sides. When
the trachea is shifted to one side, the pretracheal fascia covering the stemomastoid muscle on that side
relaxes, producing the clavicular head more prominent on the side of tracheal deviation.

[Link]-chiari syndrome.

Budd-Chiari syndrome (BCS) is an uncommon disorder characterized by obstruction of hepatic venous

outflow. The obstruction may be thrombotic or non-thrombotic anywhere along the venous course from
the hepatic venules to junction of the inferior vena cava (IVC) to the right atrium.

Symptoms,

• Pain in the upper right part of the abdomen,

• An abnormally enlarged liver (hepatomegaly),
• Yellowing of the skin and the whites of the eyes (jaundice), and/or accumulation of fluid in the
space (peritoneal cavity)

[Link]’s breathing.

Kussmaul breathing is an abnormal breathing pattern characterized by rapid, deep breathing at a

consistent pace. It’s a sign of a medical emergency — usually diabetes-related ketoacidosis (DKA), which
can affect people with diabetes and people with undiagnosed Type 1 diabetes.
51. Fetor hepaticus.

• Fetor hepaticus is the characteristic breath of patients with severe parenchymal liver disease,
which has been said to resemble the odor of a mixture of rotten eggs and garlic.
• Fetor -a strong offensive smell.
• Foetor hepaticus is often associated with an acid – base disorder such as diabetic ketoacidosis,
chronic liver failure, condition in portal hypertension.

52. Jaw winking test/ Marcus-Gunn Jaw Winking test. Upper eyelid movement is seen on opening the
mouth, movement of the jaw to the contralateral side, chewing, sucking, swallowing, clenching teeth,
and protrusion of the jaw. Hypotropia on the affected side may be present with the cover test due to
associated superior rectus palsy.
[Link] for pendulosness of legs/ Wartenberg sign.

• To find out the spasticity of the quadriceps groups of muscles.

• The patient sits on the edge of a table with his legs hanging freely.
• The examiner lifts the patient’s legs simultaneously to the same horizontal level, then releases
them, permitting them to swing freely.
• Or the examiner pushes both legs backward, then suddenly removes his hands allowing the legs
to swing.
• If the legs swings freely there is spasticity present. If there is irregular swing of legs which is
regarded as spasticity of leg muscles especially the quadriceps groups of muscles .
54. Radial nerve test/ Radial nerve palsy test.

1. Wrist drop test

2. Thumb abduction test

3. Supination test

Wrist drop test:

• When testing for wrist-drop deformity, the patient should be asked to hold the affected arm out
with the forearm parallel to the floor.
• The back of the hand should be facing the ceiling and the fingers should be pointed downwards.
• If the radial nerve injury/ palsy the wrist joint will drop down.

Thumb extension test / thumb abduction test.

• Patient sits with the wrist in neutral, and thumb relaxed in adduction.
• Therapist stabilizes metacarpals by maintaining wrist in neutral in somewhat of a handshake
position.
• Resistance is applied to the lateral aspect of proximal phalanx in the direction of adduction.
Patient lifts thumb toward ceiling against resistance.
 ( a). (b)

Supination test/ Hand pronation test.

• Ask the patient to sit in a chair or couch.

• Now the examine hand should be hang freely without any resistance or movement.
• Ask the patient to keep their examined hand close to the body and then flex their elbow to
90⁰ .
• Make them a supine and pronation movement alternatively without any resistance.
• If active movement is done, apply some resistance and check for movement.
• Postive means difficulty in doing movements, conclude that radial nerve injury.
• Negative means the patient can move their forearm freely in both active , passive and
resisted manner.

[Link]’s syndrome.

• Gilbert syndrome is a common, harmless liver condition in which the liver doesn’t properly
process bilirubin.
• Bilirubin is produced by the breakdown of red blood cells. Gilbert syndrome is an inherited
genetic condition.
• Is is formed by the deficiency of enzymes which is helpful for the production of bilirubin in the
blood, called bilirubin-UGT enzyme.