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Objective: To find out causes of dyspepsia on upper gastrointestinal endoscopy. Setting: Endoscopyunit of Nishtar Hospital Multan. Period: May 2005 to August 2007. Material and methods: Patients suffering fromdyspepsia were referred by consultants of Nishtar Hospital Multan and doctors working in the periphery for endoscopy.Results: 502 patients were scoped for dyspepsia; 254(50.6%) were male and 248(49.4%) were female. Mean age was42.5 years and age range was 7-95 years. Most common lesion was gastroduodenitis (20% cases) followed by gastriculcer (5.4% cases). Ratio of duodenal ulcer to gastric ulcer was 1:2. 56% patients had no pathology; females were morelikely to have normal endoscopy. Conclusion: Gastroduodenitis is the most frequent organic cause of dyspepsia.Functional dyspepsia is more common among females.

To determine the etiology of dysphagia based on upper GI endoscopy in Nishtar Hospital Multan. Study design: Retrospective study. Place and Duration of study: This study was conducted at gastroenterology unit of Nishtar Hospital Multan from Feb 2013 to August 2014. Patients and methods: Three hundred and twenty three patients, ≥ 13 years old, who presented with history of dysphagia to the gastroenterology unit of Nishtar Hospital Multan. Results: Out of 323 patients, 43.7% were males and 56.3% were females. Mean age of patients was 44.37±17.395 years. Most common finding was benign stricture (28.5% cases) followed by no abnormality (21.7%), carcinoma esophagus (20.7%), achalasia (6.5%), esophageal web (4%), ulcers (3.7%), multiple pathologies (3.1%), pharyngeal cancer (2.2%), esophageal candidiasis (1.9%), reflux esophagitis (1.5%) and hiatus hernia (1.2%). Uncommon findings were incompetent LES (0.9%), extrinsic compression (0.9%), vocal cord paralysis (0.6%), barrett's esophagus (0.6%), herpes simplex esophagitis (0.6%), shatzki ring (0.3%), diverticulum (0.3%) and thick aryepiglottic folds (0.3%.). Conclusion: Esophagogastroduodenoscopy is the investigation of choice for patients of dysphagia. Most common finding in our study was benign stricture in young females, followed by carcinoma esophagus, achalasia, web, ulcer, pharyngeal cancer, reflux esophagitis, esophageal candidiasis and hiatus hernia. Incompetent LES, extrinsic compression, vocal cord paralysis, barrett esophagus, herpes simplex esophagitis, ring, diverticulum and thick aryepiglottic folds were rare causes. Measures should be taken to avoid the preventable causes by patient awareness and adequate treatment of predisposing factors.

Objectives: To determine the etiology of lower GI bleeding based oncolonoscopic findings Study design: Retrospective study. Place and Duration of study: Thisstudy was conducted at gastroenterology unit of Nishtar Hospital Multan from Feb 2013 toAugust 2014. Patients and methods: Two hundred and fifty four patients, ≥ 14 years old whopresented with history of lower GI bleeding to the gastroenterology unit of Nishtar HospitalMultan Results: Out of 254 patients, 59.05% were males and 40.95% were females. Mean ageof patients was 37.22±10.68 years. Most common findings were haemorrhoids (40.9% cases),ulcerative colitis(35.4%), no abnormality (8.2%), solitary rectal ulcer (7.5%), growth (7.1%),proctitis (3.5%), polyps(2%), rectal varix (1.2%), infective colitis (0.8%), uremic colopathy(0.8%), rectal prolapse (0.8%), multiple polyposis coli (0.8%), petechiae (0.8%), stricture (0.8%),diverticula(0.4%)and fissure (0.4%). Conclusion: Colonoscopy is the investigation of choice forpatients of lower gastrointestinal bleeding. More common colonoscopic findings in our studywere haemorrhoids, ulcerative colitis, solitary rectal ulcer, malignancy and proctitis. Polyps anddiverticula which are common in the west were uncommon in our patients. Rectal prolapse,petechiae, stricture, uremic colopathy and multiple polyposis coli were rare causes.

Objective: To observe clinical characteristics, etiology and maternal outcome in fulminant hepatic failure during pregnancy. Study Design: Descriptive Case Series. Setting: Department of Medicine, Nishtar Hospital Multan. Period: January 2013 to December 2017. Material & Methods: Twenty nine consecutive patients with fulminant hepatic failure during pregnancy were included in the study. Results: Mean age of patients was 27.06±6.92 years. 65.51% patients were from urban areas. Mean duration of gestation was 24.80±6.03 weeks. Jaundice and altered consciousness were observed in 100% cases, pallor in 79.31%, hepatomegaly in 20.68%, flapping tremors in 10.34%, ascites in 10.34% and splenomegaly in 6.89% cases. Complications observed were cerebral edema in 44.82%, renal failure in 24.13%, bleeding in 20.68% and hypoglycemia in 3.44%. Most common cause was acute hepatitis E (75.86%) followed by hepatitis B (13.79%) and hepatitis A (3.44%). No cause was found in 6.89% cases. Overall maternal mortality was 37.93% and fetal mortality was 72.41%. In 17.24% cases pregnancy was terminated therapeutically, 44.82% cases had spontaneous expulsion and in 37.93 % cases pregnancy continued. Maternal mortality was highest (45.45%) in patients who remained pregnant as compared to 20% when pregnancy was terminated therapeutically. Conclusion: Jaundice and altered conscious level is the most common clinical presentation. Hepatitis E is the most common cause of FHF in pregnancy. Maternal mortality in FHF during pregnancy is very high.