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What is vitamin D? What are the causes, symptoms, complications and treatment of vitamin D deficiency?

What are the causes, symptoms, complications and treatment of vitamin D deficiency?

Contents

~~Table of Contents(toc)~~

vitamin d capsules

What is vitamin D?….
What are sources of vitamin D?…………
What is the function of vitamin D in our body? Why do we need vitamin D?…………
What is the daily requirement of vitamin D?………….
What causes vitamin D deficiency?……………
What are symptoms of vitamin D deficiency?…………
What are the complications of vitamin D deficiency?………..
How to prevent vitamin D deficiency?……..
How to treat vitamin D deficiency?….
How to test vitamin D in our body?…..
What is the dose of vitamin D supplementation?…..
Do we overdose on vitamin D?………..
What should I do if I think I lack vitamin D?……

What is vitamin D?

Vitamin D is an essential micronutrient which can be found in various food sources. Vitamin D is fat-soluble, and few foods naturally have vitamin D. Except fatty fish liver, other foods are poor sources of vitamin D. Vitamin D is needed for bone metabolism and calcium balance in the body.

What are sources of vitamin D?

Synthesis of vitamin D in skin is the main source of vitamin D for humans. The vitamin D in the skin is formed by exposure of Ultraviolet light into the skin, converting 7-dehydrocholesterol to provitamin D3. This is then converted to cholecalciferol by temperature dependent rearrangement. The sun exposure to face and arms only produces up to 200 International units per day of vitamin D.

Fatty fish liver is another major source. Minor sources include milk, meat and animal liver, eggs, some vegetables and mushrooms.

vitamin d and bone

What is the function of vitamin D in our body? Why do we need vitamin D?

After production in skin, or after taking vitamin D (D2 or D3 from food), our blood is converted to 25-hydroxyvitamin D and then to 1,25-hydroxyvitamin D in the kidney. This is the active form of vitamin D. The functions of vitamin D are:

Calcium Homeostasis
Bone metabolism
Phosphorus metabolism
Muscle strength
Prevention from cancer
Prevention form heart disease like hypertension and heart attack
Prevention from other endocrine diseases and diabetes
Boosting immune system
Helping brain development and prevention of cognitive function decline
Prevention from mental illnesses

What is the daily requirement of vitamin D?

Recommended dietary allowance RDA of vitamin D is as follows:

Up to 12 months of age: 400 IU per day (=10 mcg)
Children 1-18 years, people up to 70 years: 600 IU (=15mcg) per day
People above 70 years: 800 IU (=20mcg) per day

People often have low Vitamin D intake, and most people are deficient in vitamin D. Many people are at considerable risk for deficiency. Thus, it’s recommended for regular supplement of vitamin D to all the high-risk populations. Now a days milk fortification with vitamin D has also started to meet this requirement.

People with malabsorption disorders require high dose supplementation of vitamin D as high as 40000 IU per day.

What causes vitamin D deficiency?

Worldwide, billions of people lack vitamin D. Some factors mentioned below may cause vitamin D deficiency or resistance in our body:

Low exposure to sunlight
Low dietary intake
Low fat intake
Malabsorption disorders or syndromes
Residence in regions where there is low sun exposure
Impaired ability of body to use inactive vitamin D (liver or renal dysfunction)
Resistance of body to act to the vitamin D present in our body
Older age
High dose of steroids drug intake

vitamin d deficiency depiction

What are symptoms of vitamin D deficiency?

Most people are asymptomatic initially
Bone pain and tenderness
Muscle weakness
Fractures
Difficulty walking

What are the complications of vitamin D deficiency?

Increases bone loss
Osteopenia and osteoporosis
Hypocalcemia
Hypophosphatemia
Secondary hyperparathyroidism
Phosphaturia
Osteomalacia
Muscle weakness, cancers, decreased immunity or increased autoimmune diseases, asthma, hypertension, MI, diabetes, bad pregnancy outcomes

How to prevent vitamin D deficiency?

Get adequate exposure to direct sunlight, especially in the morning (10 am to 2 am) time when there is adequate concentration and band of UV light in sunlight
Eat fish and fish liver that have vitamin D (cod, salmon, swordfish, tuna)
Eat eggs, meat and animal liver
Eat fortified milk or juices with vitamin D

How to treat vitamin D deficiency?

Vitamin D deficiency is treated by supplementation of vitamin D by oral or injectable route.

How to test vitamin D in our body?

Serum vitamin D (25-hydroxyvitamin D) level can be measured by blood test to confirm or screen for vitamin D deficiency. The common consensus is that 30 ng/mL (nanogram per milliliter) or 75 nmol/L is sufficient for most individuals. However, the reference range may vary depending on the population and consensus.

Serum PTH (parathyroid hormone) level is inversely related to serum vitamin D level so it can also be measured to check for vitamin D deficiency.

What is the dose of vitamin D supplementation?

Despite adequate dietary and behavioral measures to prevent vitamin D deficiency, people may have deficiency and may even have clinical manifestations.
There are two forms of vitamin D supplementations available cynically for supplementation viz. Cholecalciferol (D3) and ergocalciferol (D2). These supplementations are available in various doses like 400, 600, 800, 1000, 2000, 5000, 10000, 50000, 60000 IU capsules, powder or tablets. In some countries they are available in Injectable form as well.

Vitamin d supplementation can be done by any of following regimen depending up on patient factors like severity, patients’ absorptive ability, compliance or clinical manifestations:

Initially 60000 IU of D2 or D3 once a week for 6-8 weeks (about 2 months) then 800 IU per day
1000 IU of D2 or D3 per day
600-800 IU of D2 or D3 per day
10000 to 60000 IU per day for malabsorption disorders depending upon severity of malabsorption and deficiency

In some cases, vitamin D metabolites like calcidiol or calcitriol or dihydrotachysterol may be used for treatment of vitamin D deficiency. Another modality of vitamin D deficiency treatment is artificial exposure to UVB (ultraviolet B) light.

Calcium supplementation may also be needed with supplementation of vitamin D.

Is vitamin D3 the same as vitamin D 25 hydroxyvitamin D3?

25-hydroxyvitamin D3 is one of the inactive forms of the vitamin D which is found in blood and its value is measured to check for vitamin D deficiency.

Is vitamin D same as D3 or D2?

Vitamin D has two forms, which are vitamin D2 and D3. The source of vitamin D3 is skin and animal foods where as vitamin D2 is found in plant sources.

Do we overdose on vitamin D?

Toxic dose of vitamin D supplementation is not clear though tolerable upper limit is set. For children above 9 years and adults, the largest upper limit is 4000 IU (100mcg) per day, while that for children it lower. Following symptoms might be seen if vitamin D toxicity or overdose occurs:

Decreased appetite
Weight loss
Irregular heartbeat

What should I do if I think I lack vitamin D?

If you think you have vitamin D deficiency you need to visit your doctor and he will ask you some questions about symptoms and signs of vitamin D deficiency. He may order some tests to confirm if you have vitamin D deficiency. After the reports he will treat it depending upon multiple factors and personalized treatment plan for you. He will also ask you for follow-up to confirm the correction of the deficiency, relief of symptoms, and help you with future prevention of the same condition. A repeat check of vitamin D level can usually be done after 3-4 months of supplementation intake.
You can also book an appointment with us if you think you have vitamin D deficiency or any health problem. Use the contact us button or the chat box below. Thank you for reading.

3 Set Loksewa Past Question Collection of Medical Officer (MBBS)

GASTRIC OUTLET OBSTRUCTION (GOO) Note Complete

~~Table of Contents(toc)~~

GASTRIC OUTLET OBSTRUCTION (GOO)

Definition

Partial or complete obstruction of the distal stomach, pylorus, or proximal duodenum, preventing normal gastric emptying into the duodenum.

Etiology

A. Congenital causes

Infantile hypertrophic pyloric stenosis (most common in infants)
Duodenal atresia
Annular pancreas
Preduodenal portal vein
Gastric/duodenal webs or membranes

B. Acquired causes

1. Benign causes

Peptic ulcer disease (most common in adults)
Chronic pancreatitis (fibrosis, pseudocyst compression)
Postoperative adhesions or anastomotic strictures
Ingestion of corrosives
Gallstone impaction (Bouveret syndrome)
Crohn’s disease
Tuberculosis (gastroduodenal)

2. Malignant causes

Carcinoma of the stomach (antral carcinoma)
Carcinoma of the pancreas (head region)
Duodenal carcinoma
Lymphoma involving pylorus

Pathophysiology

Obstruction → gastric stasis → accumulation of food, fluid, and secretions → gastric dilatation
Persistent vomiting → loss of H⁺, Cl⁻, K⁺ → hypochloremic, hypokalemic metabolic alkalosis
Dehydration → hypovolemia → renal compensation (paradoxical aciduria)

Clinical Features

Symptoms

Vomiting – projectile, non-bilious, of undigested food; may be late after meals
Fullness / bloating / early satiety
Epigastric pain (relieved by vomiting)
Weight loss and dehydration
Constipation and reduced urine output

Signs

Visible gastric peristalsis (from left to right across epigastrium)
Succussion splash (sloshing sound >6 hrs after meal)
Epigastric distension
Signs of dehydration: sunken eyes, dry tongue, hypotension
Palpable lump (in carcinoma or hypertrophic pyloric stenosis)

Investigations

Laboratory

Electrolyte imbalance: ↓Na⁺, ↓K⁺, ↓Cl⁻, ↑HCO₃⁻ (metabolic alkalosis)
Hemoconcentration (↑Hct)
Renal function tests – elevated urea/creatinine due to dehydration

Imaging

Plain X-ray abdomen:

Greatly distended stomach with fluid level, no gas beyond pylorus

goo plain x ray

Barium meal:

Delayed gastric emptying, “string sign” (narrow pylorus), or “beak-like narrowing”

GOO barium x ray

Endoscopy:

Visualize site of obstruction; exclude malignancy; can take biopsy

CT scan:
- Defines cause and extrinsic compression (pancreatic malignancy, pseudocyst)

Management

1. Initial (Stabilization)

Nil per oral (NPO)
Nasogastric decompression
IV fluids – correct dehydration and electrolyte imbalance
Correct metabolic alkalosis
Proton pump inhibitors / H₂ blockers
Nutritional support

2. Definitive treatment

a. Benign causes:

Peptic ulcer-related:
- Endoscopic balloon dilatation (first-line if fibrosis mild)
- Surgery if refractory:
  - Truncal vagotomy + antrectomy (Billroth I/II)
  - Gastrojejunostomy
Hypertrophic pyloric stenosis:
- Ramstedt’s pyloromyotomy
Chronic pancreatitis / pseudocyst:
- Treat underlying cause or cyst drainage

b. Malignant causes:

Resectable:
- Subtotal/total gastrectomy or pancreaticoduodenectomy (depending on origin)
Unresectable:
- Palliative gastrojejunostomy or endoscopic stenting

Complications

Severe dehydration and shock
Metabolic alkalosis with paradoxical aciduria
Aspiration pneumonia
Nutritional deficiencies
Gastric perforation (rare, late stage)

Summary Table

Feature	Benign	Malignant
Onset	Gradual	Rapid
Vomiting	Large, non-bilious, food particles	Small, may contain altered blood
Pain	Relieved by vomiting	Persistent
Visible peristalsis	Prominent	Often absent
Weight loss	Moderate	Marked
Endoscopy finding	Scarring, ulcer	Mass, irregular ulcer

Diploma in OTTM license examination model question

DIPLOMA IN OTTM – 50 MCQs

~~Table of Contents(toc)~~

operation theatre technology MCQs

Anatomy & Physiology

The largest organ in the human body is:
A) Liver
B) Skin
C) Brain
D) Lungs
The functional unit of the kidney is:
A) Nephron
B) Alveolus
C) Glomerulus
D) Bowman’s capsule
Which artery supplies the heart muscle?
A) Pulmonary artery
B) Coronary artery
C) Carotid artery
D) Subclavian artery
The normal range of adult respiratory rate is:
A) 8–10/min
B) 12–20/min
C) 22–28/min
D) 30–40/min
Which cranial nerve controls the diaphragm?
A) Vagus nerve
B) Phrenic nerve
C) Hypoglossal nerve
D) Trigeminal nerve
The total number of bones in adult human body is:
A) 204
B) 206
C) 208
D) 210
The largest gland in the human body is:
A) Pancreas
B) Liver
C) Thyroid
D) Adrenal
Gas exchange occurs in:
A) Trachea
B) Bronchi
C) Alveoli
D) Pleura
The hormone insulin is secreted by:
A) Adrenal cortex
B) Pancreas (Islets of Langerhans)
C) Pituitary
D) Thyroid
Which part of the brain controls balance and coordination?
A) Cerebrum
B) Cerebellum
C) Medulla
D) Pons

Microbiology & Infection Control

Autoclaving is done at:
A) 100°C for 15 min
B) 121°C for 15 min at 15 psi
C) 134°C for 5 min at 30 psi
D) 160°C for 1 hour
Bacteria are best stained by:
A) Gram stain
B) Ziehl-Neelsen stain
C) Wright’s stain
D) Leishman stain
The causative organism of gas gangrene is:
A) Staphylococcus aureus
B) Clostridium perfringens
C) Streptococcus pyogenes
D) Pseudomonas aeruginosa
The universal precaution includes all EXCEPT:
A) Wearing gloves
B) Recapping needles
C) Mask use
D) Handwashing
The most effective disinfectant for HIV virus is:
A) Phenol
B) Alcohol
C) Sodium hypochlorite
D) Lysol
The ideal temperature for storing blood is:
A) 0°C
B) 1–6°C
C) 10°C
D) Room temperature
Asepsis means:
A) Presence of microorganisms
B) Absence of pathogenic microorganisms
C) Infection
D) Sterility failure
The process of killing all microorganisms including spores is:
A) Disinfection
B) Sterilization
C) Pasteurization
D) Antisepsis
Which of the following is a spore-forming bacteria?
A) E. coli
B) Clostridium
C) Klebsiella
D) Neisseria
The standard concentration of formalin used for fumigation is:
A) 20%
B) 30%
C) 40%
D) 10%

OT Techniques & Sterilization

The sterile area in OT includes:
A) Scrub area
B) Operation table
C) Corridor
D) Changing room
Ethylene oxide sterilization is used for:
A) Linen
B) Rubber and plastic items
C) Glassware
D) Instruments
Instruments are arranged on:
A) Mayo table
B) Instrument trolley
C) Both A and B
D) Floor table
The position used for perineal surgeries is:
A) Supine
B) Lithotomy
C) Trendelenburg
D) Prone
The function of suction machine in OT is:
A) To provide oxygen
B) To remove blood and secretions
C) To monitor BP
D) To sterilize instruments
The blue zone in OT indicates:
A) Clean area
B) Sterile zone
C) Dirty area
D) Store
Drapes used in surgery should be:
A) Waterproof
B) Cotton
C) Plastic
D) Wool
The ideal air pressure in OT is:
A) Positive pressure
B) Negative pressure
C) Neutral
D) Variable
The most important step before scrubbing is:
A) Wearing gown
B) Wearing mask and cap
C) Touching sterile field
D) None
Scrubbing time for hands is:
A) 30 seconds
B) 1 minute
C) 3–5 minutes
D) 10 minutes

Anaesthesia & Surgery Basics

Local anesthesia acts by:
A) Blocking motor nerves
B) Blocking sensory nerves
C) Depressing CNS
D) Inducing sleep
Spinal anesthesia is given at the level of:
A) L1–L2
B) L3–L4
C) T10–T11
D) L5–S1
The color of oxygen cylinder is:
A) Black with white shoulder
B) Blue
C) Black with green shoulder
D) Green
The anesthetic agent causing malignant hyperthermia is:
A) Halothane
B) Ether
C) Succinylcholine
D) Nitrous oxide
The antidote for morphine overdose is:
A) Naloxone
B) Atropine
C) Neostigmine
D) Diazepam
The commonest complication of spinal anesthesia is:
A) Vomiting
B) Headache
C) Fever
D) Infection
Pulse oximeter measures:
A) Blood pressure
B) Heart rate
C) Oxygen saturation
D) CO₂ level
The color code for nitrous oxide cylinder is:
A) Black with white shoulder
B) Blue
C) White
D) Green
Minimum alveolar concentration (MAC) is related to:
A) Potency of inhaled anesthetic
B) Toxicity
C) Cost
D) Blood solubility
The safest muscle relaxant in renal failure is:
A) Vecuronium
B) Pancuronium
C) Atracurium
D) Rocuronium

Surgical Instruments & Procedures

Mosquito forceps are used for:
A) Holding skin
B) Clamping small blood vessels
C) Cutting sutures
D) Grasping tissue
The instrument used to hold bowel is:
A) Allis forceps
B) Babcock forceps
C) Kocher forceps
D) Artery forceps
The suture material absorbed by the body is:
A) Silk
B) Catgut
C) Nylon
D) Prolene
The size of needle used for IM injection in adult is:
A) 18G
B) 20G
C) 21G
D) 23G
The normal adult blood volume is approximately:
A) 2 L
B) 3 L
C) 5 L
D) 7 L
The instrument used to retract abdominal wall is:
A) Langenbeck retractor
B) Balfour retractor
C) Doyen retractor
D) Volkmann retractor
“Swab count” is done to prevent:
A) Hypotension
B) Retained foreign body
C) Hypoxia
D) Bleeding
Surgical asepsis is maintained by:
A) Sterile gloves
B) Clean apron
C) Hand wash only
D) Changing shoes
The first step in wound management is:
A) Suturing
B) Cleaning and debridement
C) Dressing
D) Bandaging
Postoperative infection usually occurs within:
A) 6 hours
B) 24 hours
C) 48–72 hours
D) 1 week

ANSWER KEY (1–50)

1–B
2–A
3–B
4–B
5–B
6–B
7–B
8–C
9–B
10–B
11–B
12–A
13–B
14–B
15–C
16–B
17–B
18–B
19–B
20–C
21–B
22–B
23–C
24–B
25–B
26–B
27–A
28–A
29–B
30–C
31–B
32–B
33–A
34–C
35–A
36–B
37–C
38–B
39–A
40–C
41–B
42–B
43–B
44–C
45–C
46–B
47–B
48–A
49–B
50–C

Why do some children have seizures while they have Fever and Is it dangerous?

Febrile Seizures

Based on Nelson Textbook of Pediatrics, 21st Edition and recent updates

Introduction

Febrile seizures are the most common seizure disorder in childhood, occurring in association with fever but without evidence of central nervous system infection or acute electrolyte imbalance. They represent a benign, age-limited condition affecting genetically predisposed children.

Epidemiology

Age group: 6 months to 5 years (peak: 12–18 months)
Incidence: ~2–5% of children in most populations
Recurrence rate: ~30–35% after first episode; higher in early onset (<1 year)
Family history: Positive in up to 25–40% cases, suggesting genetic susceptibility

Definition (Nelson)

A febrile seizure is defined as a seizure accompanied by fever (>38°C or 100.4°F), without evidence of CNS infection, metabolic abnormality, or a history of afebrile seizures.

Classification

1. Simple Febrile Seizure (SFS)

Generalized tonic-clonic in onset
Duration <15 minutes
Occurs once in 24 hours
No postictal neurological deficit

2. Complex (Atypical) Febrile Seizure (CFS)

Focal onset or focal features during/post seizure
Duration >15 minutes
Recurrent within 24 hours
May have postictal weakness (Todd’s paresis)

3. Febrile Status Epilepticus (FSE)

Febrile seizure lasting >30 minutes (or series lasting ≥30 min without full recovery)
Requires urgent management