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86 Cards in this Set
- Front
- Back
Follow up for low grade dysplasia with barret's esophagus?
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yearly endoscopy with four quadrant biopsies every 2cm along the length of Barrett's segment for low grade
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Follow up for high grade dysplasia with barret's esophagus?
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every 3 months if focal; if multifocal needs intervention
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Treatment options of achalasia
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Botulin 85% but recurs
Dilation 90% not good in young Myotomy + fundoplication 95% |
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LGIB Surgery
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subtotal colectomy b/c segmental resections have 75% rebleed with 50% mortality
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Rates of bleeding detected by angio vs bleeding scan
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1.0ml/hr vs 0.1ml/hr
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MCC of death in FAP
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duodenal adenoCA
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Management of duodenal polyps in FAP showing only dysplasia
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Whipple
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Risk of malignancy in UC
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0.1-0.2%/year
2% @ 10 years 8% @ 20yrs 20% @ 30 |
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Rectal NETS
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10% of all GI NETs
more frequent and better prog than colon usually <1cm (can be removed endoscopically) <2cm have >70% mets less likely to secrete vasoacitve |
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Most common appendiceal malignancy
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1) Mucinous adenoCA
2) Carcinoid |
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When is R hemicolectomy indicated in appendiceal malignancies?
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All non NET and NET >2cm
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Location and pathophysiology of gastric ulcers
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Type 1 - near angularis incisura on lesser curve
Type 2 - a/w duodenal ulcer Type 3 - prepyloric Type 4 - GE junction |
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Gastric CA with + nodes should receive...
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fluorocil + XRT
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what type of fistulas can be managed with simple fistulotomy?
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intersphinteric
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contraindications to neostigmine
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Bradycardia
Renal impairment History of bronchospasm |
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Reasons for recurrent duodenal ulcer s/p highly selective vagotomy
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Spares branches to liver and biliary system
may miss criminal nerve of Grassi (right posterior vagus nerve) |
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Anal margin vs anal canal CA
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WLE vs Nigro protocol
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gallbladder polyps
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remove if
>10 mm symptomatic or >50 yo |
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Co-localization theory of pancreatitis
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cathepsin B mediated intra-acinar cell activation of digestive enzymes
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management of pancreatic pseudocysts
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2% of acute pancreatitis
85% single leave alone if asymptomatic or not growing for at least 6-12 weeks (40% will spontaneous resolution) to allow for maturation of wall |
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Pancreatic solid cystic tumors
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almost exclusively in young
women usually asymptomatic pancreatic resxn TOC |
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MC tumor of liver
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hemangioma
usually incidentally found <5cm usually homogeneous, hyperechoic, well circumscribed ass with posterior acoustic enhancement |
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CT description of hemangioma
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hypoattenuation
early peripheral enhancement progressive opacification toward center complete isoattenuation fill in occurring |
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Best imaging modality for hemangioma
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MRI
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treatent of desmoid tumors
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sulindac or tamoxifen
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Gene mutation in FAP
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APC
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Description of FNH lesion
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well circumscribed, nonencapsulated, nodular cirrhotic like mass
fibrous stellate central scar early enhancement with washout on delayed |
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Where are carcinoid derived from?
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amine precursor uptake and decarboxylation (APUD) neural crest (ectoderm)
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Intraductal papillary mucinous neoplasia of pancreas
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premalignant
15% have jaundice hallmark is thick mucin *multiple cysts and ducts |
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management of isolated gastric varices
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splenectomy if splenic vein thromobosis is cause
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Spigelian hernia
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usually b/n umbilicus and arcuate line
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Howship-Romberg sign
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50% present in obturator hernia
pain along medial thigh to knee flexion of hip exacerbates pain |
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Richter's hernia
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partial protrusion of antimesenteric intestine
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HCC
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initially low attenuation
enhance brightly with contrast become hypodense on delayed images |
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hepatic adenoma
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early peripheral enhancement
centripetal filling hyperintense on T2 |
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role of octreotide in carcinoid syndrome
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controls diarrhea but does not prevent progression of carcinoid valvular dz
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Management of Zenker's vs epiphrenic divertculum
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esophageal myotomy is on the same side of diverticulectomy in Zenker's and opposite in epiphrenic
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Studies needed for GERD workup
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Endoscopy +/- biopsy
pH probe Manometry |
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all patients with Schatzki's rings have
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sliding hiatal hernia
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Follow up for Barrett's s/p Nissen
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lifetime EGD
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Three approaches to esophagectomy
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Transhiatal
Ivor Lewis 3 hole esophagectomy all need pyloromyotomy |
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chemo for esophageal cancer
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5FU and cisplatin
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Dysphagia with smooth filling defect and intact mucosa with normal histology
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GIST --> enucleation if >5cm or symptomatic
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Management of caustic esophageal injury
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no NGT, NPO, IVF, antibx
Endoscopy Serial CXR/AXRs Gastro->barium swallow on HD 2-3 for 2nd/3rd degree burns |
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MC site of esophageal perforation
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cricopharyngeus
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Nutcracker vs DES
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single vs multiple prolonged, high amplitude contractions
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Gastrografin vs Barium in chest and abdomen
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Barium (inert) harmful to lungs so gastrografin first
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Management of esophageal perforations
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if not contained/systemic --> depends on time of dx/contamination
<24 hrs/clean --> primary repair, longitudinal myotomy, drains, buttress repair with flaps (pleura, pericardium, intercostal mm, omentum) POD 10 gastro/barium swallow For sick pts --> cervical esophagostomy, mediastinal washout, chest tubes, later G/J tube and esophagectomy |
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Type I gastric Carcinoids
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70-80%
Chronic atrophic gastritis Pernicious anemia Hypergastrinemia --> trophic effect on ECL cells (oxyntic fundic mucosa) F>M 2cm Multicentric <5% mets |
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Type II gastric carcinoids
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Least common
A/W hypergastrinemia of ZE syndrome/MEN 1 M:F Multicentric <2cm 10% mets |
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Type III gastric carcinoids
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15-20%
Sporadic No hypergastrinemia Most aggressive Solitary >5cm |
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what do all gastric carcinoids stain for?
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Chromogranin A
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What imaging modality is useful gastric carcinoids?
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Somatostatin receptor scintigraphy
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Percentage of gastric carcinoids that p/w carcinoid syndrome
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10%
treat with somatostatin |
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Effect of PPIs in UGIB
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prior to endoscopy reduces stigmata of recent hemorrhage but do NOT reduce mortality, re-bleeding, or need for surgery
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Where is bleeding duodenal ulcer usually?
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posterior in 1st portion (3 vessel ligations)
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What do you have to do with truncal vagotomy?
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pyloroplasty
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HSV vs truncal vagotomy
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decreased gastric atony, alkaline reflux, gastritis, dumping, diarrhea
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Incidence of biliary injuries in cholecystectomies
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0.2-2%
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Incidence of Duct of Luschka injuries
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0.04-0.2%
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Characteristics of colonic polyps that require rxn
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Poor diff
Haggitt level 4 invasion <2mm margin All sessile Pedunculated polyps with stalk invasion |
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Presentation of postpolypectomy syndrome
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pain, fever, high WBC
w/n 12 hrs-days no free air focal thickening of colonic wall |
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Gastric carcinoid incidence of all gastric CA and all carcinoids
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2-5% of all gastric CA and 1-3% of all carcinoids
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How do gastric carcinoids usually present?
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abdominal pain or GI bleeding
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5YRS for Type I-III gastric carcinoids
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90>75>50
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% of colon CA that p/w obstruction
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15%
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% of colon CA that are R sided
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25%
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Colonic stenting
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FDA approved
>90% success 1/2 the mortality of sx |
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AE of colonic stenting
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Perforation (4%)
Stent migration Re-obstruction 10% Pain & rectal tenesmus Bleeding |
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Long term survival in stenting vs emergency sx for obstructing colonic CA
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no difference
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Epiphrenic diverticula
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- Rare malignant mucosal transformation 0.3-3%
- A/w esophageal motility disorder (pulsion) - Distal third of esophagus - A/w mechanical obstruction of LES - Dysphagia, regurgitation, reflux, chest pain, halitosis - 45% risk of aspiration |
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SBO more frequent in retro or antecolic
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retro
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Early vs Late SBO s/p gastric bypass
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nternal hernias caused by jejuj's mesenteric defects typically occur late
Early SBO usually @ jej-jej |
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3 types of bile acid malabsorption
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Type I most common; ileal disease/rxn
Type II idiopathic Type III s/p vagotomy or cholecystectomy |
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Acute tachycardia & SOB s/p bariatric surgery
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usually normal exam and false negative CT
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What studies do you need before operating on GERD
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24H pH
Esophagoscopy UGI Esophageal manometry (partial vs 360 wrap) gastric emptying studies in DM |
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MC complication of EGD
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:Hypoxia (1.6%)
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MC benign esophageal neoplasm
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Leiomyoma
- Peak in 3rd-5th decades of life - Distal 2/3 of esophagus (80% muscularis propria) - Dysphagia, pain, weight loss - C-KIT negative - Mobile, nonobstructive mass projecting into lumen with normal overlying mucosa - TOC for 2cm - thorascopic enucleation |
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Most common GI carcinoid to produce malignant carcinoid syndrome
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ileum
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Where do carcinoid tumors arise from?
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enterochromaffin cells (kulchitsky)
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Where do GIST tumors arise from?
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Interstitial cells of Cajal
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Most common symptom in carcinoid syndrome?
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Flushing
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Surgical management in adult intussussception
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resection, lymphadenectomy and anastomosis
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Malrotation is found in 20% of people with?
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congenital diaphragmatic hernia
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Treatment for Crohn's perianal abscess above anal sphincter
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Surgical drainage
seton antbix |
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Peutz-Jegher's polyps are what type?
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hamartomas - not premalignant
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