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5th year CC ACT + Level 1 > GASTROINTESTINAL > Flashcards

GASTROINTESTINAL Flashcards

1
Q

GI bleed discharge score

safely from the ED

A

Glasgow Blatchford

Gi Bleed

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2
Q

Pancreatitis cause and markers

A

GET SMASHED
Gall Stone, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpian Sting, ERCP, Drugs

  • Amylase + lipase
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3
Q

Variceal bleeds treatment

A

Terlopressin and Broad Spec Abx

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4
Q

Vomiting Blood Causes

A 
Mallory Weis Tear
Duodenal Ulcer/ Peptic
Eroded ulcer
Epistaxsis swallowed
Varices
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5
Q

**Upper GI bleeding

Oesophageal

  • oesophagitis
  • cancer
  • mallory weiss tear
  • varices

Gastric

  • gastric cancer
  • dielafoy lesion
  • diffuse erosion gastritis
  • gastric ulcer
A

Oesophageal
Oesophagitis= small volume, usually hx of GORD
Cancer = Small volume, associated dysphagia, weightloss, recurrent
Mallory Weis tear = brisk moderate volume bright red blood following repeated vomiting. Malaena rare. Ceases spontaneously.
Varices = Large vol freshblood haemodynamically unstable

Gastric
Gastric cancer = frank hameatemesis or altered blood mixed with vomit. Erosion of major vessel = big bleed
Dieulafoy lesion = No prodromal features prior. Arteriovenous malformaiton produces considerable haemorrhage.
Diffuse erosive = Haemetemesis and epigastric discomfort. usually underlying cause e.g recent NSAID usage. Large volume haemorrhage may occur with haemodynamic comproise
Gastric ulcer: small low volume bleeds more common = fe deficient anaemia.

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6
Q

**Constipation
Cause

CF

IVX

drugs:

A

Cause: Bowel obstruction, paralytic ileus, ano-rectal stricture/fissure/prolapose, poor diet, medicaitons, hypothyroid, neuromuscular

CF: abdo pain, hair irregular stool, distension, tinkling bowel/asbent, pr bleeding

IVX: over 40 + recent change in bowel habit, PR, FBC, U+E, ca
sigmoidoscipy

Drugs:
Bulk forming: fybogel 
Stool softener
Stimulant laxative: co-danthramer or senna X in bowel obstruction 
Osmotic laxative: movicol- lactulose
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7
Q

** Diarrhoea

cause

syx

ivx
management
- drug Tx

A

Cause: gastroenteritis, drugs, colorectal cancer, uc/crohns, coeliac, c.diff

RF: food poisioining, travel, recent abx use

Syx: stomach cramps, V+N, anorexia, anaemia, fresh Pr bleed mucus

IvX: bloods, U+E, ESR, coeliac serology, sigmoidoscpy, stool sample, colonoscopy

Management: treat cause
ORAL rehydration
codiene phosphate or LOPERAMIDE

refer urgent if over 40+ 6 week change in bowel habit

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8
Q

Malnutrition

A
  • Nutritional deficiency state of protein, energy or micronutrients causing measurable harm to body composition, function or clinical outcome
  • PEM = protein-energy malnutrition

o Kwashiorkor = fair to normal energy but inadequate protein
- Oedema and hepatomegaly
o Marasmus = inadequate energy and protein= Ass with severe wasting

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9
Q

Oesophagitis and reflux / GORD

Cause
RF

CF:
IVX:

TX drugs:

A

Cause: defective sphincter, hiatus heria, increased intra abdominao pressure, h.pylori.

RF: smoking, obesity, pregnancy

CF: heartburn, retrosternal discomfort, acid brash,

IVX: FBC to exclude anaemia
Upper GI endoscopy of symtoms >4 weeks +55 yrs
Oesophageal PH monitoring

Management: lifestyle, avoid fatty spicy food and alcohol

TX: Antacids
Alginates = gaviscon
PPI lansoprazole
Ranitidine = h2 receptor agonist

Refer if > cancer eg weight loss, dysphagia

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10
Q

Oesophageal carcinoma

Most common?

CF:
IVX:

Management

A

SCC most common then adeno

RF: diet, alcohol, smokingm barrets

CF: dysphagia, vomiting, anorxia, dyspepsia

IVX: Bloods, endoscopy urget, CXR

MAnagement: abx prophylaxis and chemo/ surgery

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11
Q

Hiatus hernia

Sliding
Para-oesopheal

CF:

Management:

A

• Herniation of a part of abdominal viscera through the oesophageal aperture of the diaphragm
- Sliding (stomach moves up into oesophagus through current hole) and Para-oesophageal (out side)

RF: obesity, pregnancy, ascites

CF: Many are asymptomatic, Heart burn esp on bending or lying, GOR, Diff in swallowing

Management: Rx not needed if aymptomatic except for para-oesophageal hernias = fundoplication
PPI higher dose long term

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12
Q

Peptic ulcer

IVX:

Management:

A
  • Gastric and duodenal ulcers
Gastric = worsened by eating
Duodenal = relieved by eating

Cause: H.pylori, smoking, Nsaids

IVX: Upper GI endoscopy, stop PPI 2 weeks before
FE def anemia
Test for H pylori- carbon 13 urea breath test

Management: stop smoking, Triple therapy for 4 weeks
PPI + Amoxicilin + Clarithromycin / metronidazole

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13
Q

Gastric Carcinoma

cF:
which node associated?

ivx:

Management:

A

• Poor prognosis and non specific presentation
Cause: often adenocarcinoma at gastro-oesophageal junction

RF: pernicious anaemia, H.pylori, smoking

CF: dyspepsia, vomiting, decrease weight, epigastric mass, virchows node

IVX: refer- urgent 2 week wait if chronic gi bleeding/ progressive dyspepsia
FBC +LFTs + rapid access flexible endoscopy

Management: nutritional support, total/subtotal gastrectomy
Palliative chemo, corticosteroids, stenting to relieve dysphagia
Prevention: high intake fruit and veg and weight loss

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14
Q

Carcinoma of pancreas

95% are?

CF:

IVX:

A

Late presentation, early mets and poor survival rates
95% adenocarcinomas

RF: smoking, alcohol, chronic pancreatitis

CF: tumours of head pancreas can cause painless obstructive jaundice, anaemia, weight loss, acute pancreatitis, splenomegaly, diabetes

IVX: bloods, CA-19, amylase, hyperglycamiea,
USS of live and pancreas
abdo CT

Management: radical surgery- and chemo, palliation
mean survivial 6 months

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15
Q

Coealic disease

which HLA?

CF:

IVX:

A

HLA-DQ2 (90%) or HLA-DQ8 (its bad 2. 8 gluten)
Gluten - gliadin

CF: steatorrhoea, diarrhoea, abdo pain, bloating, N+V, angular stomatitis, fatigue, weakness, Fe def anaemia, weight loss, FTT, buttock wasting

IVX: ILA and HLA DQ2 testing
–> Ensure that the person has eaten gluten-containing foods in 1+ meal a day, for 6 weeks, before testing
Check serum i(Ig)A tTGA and total IgA first-line.
Endoscopy

Management: Life long gluten free diet.

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16
Q

Acute pancreatitis

Key clinical features?
which sign?

IVX

Management
pain relief?

A

Biggest cause = Gallstones and Alcohol
GETSMASHED
Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, scorpian bite, hyperlipdeamia, ERCP, drugs.

CF: sudden epigrastric pain RADIATES TO BACK, vomiting, grey turner sign

IVX: Serum amylase- raised
Serum lipase = RAISED

Management: NBM, FLUIDS analgesia = pethidine

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17
Q

Peritonitis

A
  • Inflammation in the peritoneum itself
  • SBP = spontaneous bacterial peritonitis = occurs in pts with ascites secondary to chronic liver disease

CF: fever, pain anywhere in abdo, guarding, rigidity and lie with knees flexed

IVX: Fbc raised Acc, blood cultures, culture peritoneal fluid, urinalysis and XR

Management: Iv fluids, systemtic abx and surgery to treat cause

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18
Q

Inguinal hernia

A

• Protrusion of abdo contents through the fascia in the abdo wall, through the internal inguinal ring

RF: infants- male, obesity, constipation

CF: swelling in groin, indirect- pain in scrotum, soft and reducible

IVX: US and reduce heria and occlude deep ring

In children repair asap, adults can be left/ reduced using mesh

INDIRECT – thro’ internal inguinal ring, passes along inguinal cancal thro abdo wall – LAT to inf Epigastric vessels
DIRECT – hernia thro’ post wall inguinal canal. More common elderly. MEDIAL to inf Epigastric vessels

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19
Q

Femoral hernia

A

• Protrusion of a viscus through a defect of the walls of its containing cavity into an abnormal position

RF: mainly females

CF: lump in groin, swells during coughing. pain if incarcerated

IVX: USS,CT, MRI

Management: high risk strangulation–> elective repairment

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20
Q

Incisional hernia

A

•Failure of wound to heal

CF: Bulge or protrusion at or near area of surgical incision

Management: Bulge or protrusion at or near area of surgical incision

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21
Q

Umbilical hernia

A

E.g Congenital hernia = omphalocele or Infantile
Adult- e.g. 90% acquired in women in pregnancy

If present over 4 yrs, then repair

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22
Q

Gallstones + biliary colic

A

Fair, Fat, Fertile, Female + Forty
Biliary colic: Stones made in GB → symptomatic with cystic duct obstruction, or if passed into CBD
⇒ Sudden RUQ pain – often following food
⇒ Radiating to R.Shoulder
⇒ Persists for 15 mins
⇒ Better with analgesia
⇒ A/w nausea + vomiting

x	Fever (suggests cholecystitis or cholangitis) 
x	Jaundice (suggests cholangitis)
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23
Q

Cholecystitis

CF:
what sign?

IVX

Treatment:

A

GB becomes inflamed following stone impaction at neck of GB
CF: Constant or colicky RUQ pain (biliary colic) –> Radiates to Back or R.Shoulder
Worse when eating Fatty Foods, GB mass at RUQ (gall stone), RUQ tender
⇒ Murphy’s sign (palpate RUQ, breathe in, ↑pain)
Fever, Nausea + Vomiting, bloating, NON peritonitic ± Obstructive Jaundice (if stone moves to CBD)

NB: pain is similar to biliary colic, but much more severe

IVX: Bloods, USS abdo to visualise stone
TX:
1. Analgesia, rehydrate, NBM
2. Abx – Co-Amoxiclav
3. Laparoscopic cholecystectomy – within 1 week!!
4. Open cholecystectomy – if GB perforation

Chronic: MRCP

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24
Q

Portal hypertension

Caused by?

Signs

A

Abnormally high pressure in hepatic portal vein (often caused by liver cirrhosis)

Portal HTN → oesophageal varices + HYPO-perfusion of kidneys + water/salt retention (→ascites, transudative pleural effusion, splenomegaly) + ↑CO

sings:
Ascites – can be detected clinically ≥ 1.5 litres
Caput medusae – veins radiating from umbilicus
Splenomegaly
Oesophageal varices → upper GI bleed

25
Q 
Viral hepatitis
A
B
C
D
E

TREATMENTS?

A

HEP A: Faeco-oral: fever, malaise, Nauesea –> jaundice
TX: Metocopramide + Chorphenamine

HEP B: Blood products (IVDU + sex), incubation 1-6 months. Jaundice, malaise, urticaria
TX: Metocopramide + Chorphenamine
- Peg interferon + active immunisation to high risk

HEP C: Blood, IVDU. Often acute –> chronic. Early infection mild. Jaundice. High risk hepatocelluar carcinoma. TX: PEG interferon and ribbavarin

HEP D: Need HBV –> may need liver transplant

HEP E Feaeco-oral, always acute. High risk in pregnancy.
TX: metoclopramide, chlorphenamine.

26
Q

Cirrhosis

CF decompensated

Signs:

Score for severity of Cirrhosis?

TREATMENT
for pruritis? for ascites?

A

Diffuse hepatic inflammation characterised by fibrosis

CF: Often asymptomatic (compensated) until obvious complications of liver disease (decompensated)

Initially vague systemic symptoms:
Fatigue + Malaise + Anorexia, Nausea + Weight loss + Jaundice + hair loss
Spider naevi, Leukonychia (↓Alb), Clubbing, Dupuytren’s contracture, Palmar erythema, Hepatomegaly
Hypogonadism: testicular atrophy or amenorrhoea, Gynaecomastia and Xanthelasma
Kayser-Fleischer ring – Wilson’s

Decompensated: Oedema + Ascites , Jaundice
Easy bruising due to coagulopathy
Oesophageal variceal rupture
Spontaneous bacterial peritonitis
Hepatic encephalopathy (Liver flap, Confusion, Drowsy, ↓GCS)

Bloods: LFTS, albumin, PT, INR
Liver USS, viral serology, genetic
Child-pugh score = severtiy of cirrhosis

Management: stop alcohol, treat cause
PRUTITIS –> COLESTERYRAMINE
SPIRONONELACTONE for ascites

27
Q

Ascites

Cause

CF

IVX

Management:

A

Excessive accumulation of fluid in abdominal cavity
Cause: Cirrhosis or malignancy

CF: Abdo distension and discomfort, weight gain, nausea and dyspnoea

IVX: Exam patient. lying down
look for stigmata of cirrhosis: : jaundice, muscle wasting, spider naevi, gynaecomastia, caput medusae, leukonychia, palmar erythema
Virchow’s node – L side supraclavicular node, upper abdo malignancy
Shifting dullness – change in resonance, repeat both side
Fluid thrill – large ascites only

FBC: LFTS detramhed, increased INR as lower alb

Imaging: Abso USS 1st line

Diagnostic ascetic tap / paracentesis
FBC + clotting
U+E
Abdo USS: Microscopy + albumin/ protein level

Management: Fluid and salt restriction = SPIRONOLACTONE
Therapeutic paracentesis to relieve resp distress

28
Q

Inflammatory bowel disease
UC

CF

IVX signs
test ?

Treatment
1. Initiate remission
2 Maintain

A

UC- Colonic and recla mucosa only, relapsing remitting

CF: diarrhoea, abdo pain Left Lower Quadrant, Aneamia, large joint arthritis

IVX:
AXR- thumb priting, lead pipe and mucosal islands
feaecal calcprotectin +ve for intestinal inflammation
Colonoscopy: continous red colon crypt abcesses

Biopsy: Plasma cells and mucosal base

  1. Induce remission Management: RECTAL Mesalazine + topical/po Prednisolone
  2. Mesalasie +-/ Infliximab to maintain

If failed = Proctocollectomy + ileostomy

29
Q

Diverticular disease

Severity classification ?

A

↑Intraluminal pressure → mucosa herniates through muscle layers of gut wall –> infected becomes diverticulitis common Descending large colon (left)

CF: Altered bowel habit – constipation
Abdominal colic – LEFT sided
⇒Relieved by defecation (do not confuse with IBS), Bleeding, Nausea + Flatulence
Diverticulitis: all features above + systemic pyrexia, anoreoxia, tender colon, bleeding stool

IVX: Bloods, CT colonography
HINCHY score = severity classification

Management: high fibre diet, analgeisa + abx
Acute: Hospital admission + segmental resection

30
Q

Appendicitis

Symtoms?
Key sign?

IVX

ABX
Treatment

A

Obstruction of appendix lumen - 10-20 yrs

CF: General central/peri-umbilical, colicky abdominal pain, Aggravated by movement, coughing etc, Nausea + Vomiting + Diarrhoea, Fever (mild) + Fatigue, Voluntary guarding Flushed face
LATE:
McBurney’s RIF pain (intense)
Involuntary guarding (absent in retrocaecal appendix)
Rovsing’s sign – palpate LIF and RIF pain
Psoas sign – pain on extending hip if retrocaecal

IVX: Urinalysis, Bloods, USS
Management: NBM, IV fluids, IV prophylactic Cefuroxime and metronidzaole

TX: Laparoscopic appendectomy

31
Q

Intestinal Obstruction

CF:

IVX:

CXR:

Management:

A

Simple, Closed loop or strangulated
Causes: adhesions, hernias, voluvulus, malignancy divertiuclar disease, faecal impaction, intussusception

CF: N+V- feaculant, constipatio Dehydration, abdo distension, colicky abdo pain

IVX: DRE, examinae herinal orrifices, AXR

  • small bowel: >3 cm, vulvulae conniventes cross lumen completely
  • large bowel: >6 cm haustra do not completely cross lumen

CXR erect for pneumoperiteum
Bloods + contrast enema CT

MANAGEMENT: Drip and suck NGT, avoid prokinetic drugs
Emergency surgery if closed loop

32
Q

Ileus

A

Non-mechanical obstruction (ileus), commonly paralytic i.e. absence of peristalsis → adynamic bowel

Causes: Post-abdo surgery, pancreatitis, hypokalaemia also ↓Mg+/↓Ca2+, uraemia, peritonitis, drugs (TCAs, Opioids)

  • Painless distension!
  • Bowel sounds absent entirely!!
  • No bowel movement or flatus
33
Q

Colorectal carcinoma

RF
CF:

Staging

Screening?

A

RF: IBD, HNPCC, pout-jegghers, obesity

CF: weight loss, anaemia, mass, colicky pain, tenesmus, change in bowel habit

IVX: Colonoscopy, FBC, LFT,
tumour markers

2 week refer over 40 with rectal bleeding/ change in bowel habit for 6 + weeks

DUKES STAGING!

Management: Surgery, radiotherapy and chemo

Bowel cancer screening 60-74 yrs every 2 yrs

34
Q

Irritable bowel syndrome

IVX to do?

Treatment:

A
  • Relapsing functional bowel disorder
  • Pain and discomfort ass with defecation or change in bowel habit

CF: exacerbated by stress, menstruation and gastroenteritis
6 month history of change in bowel, bloating and abdo pain

IVX: ca-125 to rule out ovarian Ca, faecal calprotein, bloods FBC

Managment: CBT, Loperamide, antispasmodics,

35
Q

Rectal prolapse

A
  • Weak anal sphincter, prolonged straining
    RF: elderly, multiparous

CF: mass protruding through anus after bowel movement -> can need manually replacing, pin, faecal incontinence, ulceration

IVX: DRE, barium enema, stool microspy and sweat test

MAnagement:
high fibre diet, mild laxative, surgery

36
Q

haemorrhoids

A

Disrupted and dilated anal cushions → piles

CF: Painless rectal bleed, bright red, often coasts stools/on tissue
- Anaemia/ fatigue due to bleed

IV: Abdominal + PR exam, palpate 3 cushions, prolapsing piles are obvious but internal are not palpable
Proctoscopy to visualise internal haemorrhoids

Management: 1. Fluid, fibre and good anal hygeine, topical analgesia = sterods

  • Surgery rubber band ligation
37
Q

Perianal abcess

A

Abscess (collection of pus) located in anal or rectal region

  • Caused by Infection (E.Coli or Staph), STI or blocked anal glands
  • RF: DM, Immunoscomp, CD, Diverticulitis, Anal sex

CF: painful, hardened tissue, swollen, lumps, discharge from pus from rectum, fever

ivx: DRE< proctologist’s-sigmoidoscopy

Management: Surgical incision + drainage, Analgesia,

38
Q

Anal fissure

A

Painful tear in squamous mucosa of lower anal canal

Causes: constipation, hard feaces, spasms, Crohns, Anal cancer

CF: Anal pain, exacerbation by pooping: feels like passing shards of glass, fresh bright red blood during pooping

Management: Analgesia- paracetemol + BULK forming laxative
Soak in shallow warm bath

39
Q

Sigmoid volvulus

A

Chronic constipation → colon becomes distended with gas → twists on mesenteric pedicle → closed loop obstruction

CF: Acute abdo pain colicky, gross abdo distensison, constipation, vomiting, palpable mass

IVX: DRE, AXR, = coffee bean, erect CRR air under diaphragmm

Management: Decompression=- sogmoidscope into rectum and pass flatus tube into obstructed loop - leave in for 24 hrs
Surgical: Resection of redudent sigmoid colon if recurrent

40
Q

2- Achalasia

Syx

Gold standard test?

Management>

A

Disorder of motility of the lower oesophageal or cardiac sphincter

SYX: Dysphagia of solid foods regurgitate, chest pain, heartburn

IVX: CXR: gastric air bubble small, signs of inhalation, dialted oesophagus behind heart
Barium swallow - contrast material passes slowly into stomach
- Manometry of oesophagus gold standard !!

  • Mangement: CCB (nimfedipine) and nitrates to reduce pressure in lower sphincter
41
Q

2- Gastritis

A
  • Inflammatiion of stomach lining making it swollen and painful
    Cause: infection eg h. pylori or alcohol or drugs such as NSAIDs

SYX: Dyspepsia, pain, loss of appetitie, bloating, N+V

IVX: bloods, gastroscopy,

Management: eat small meals, avoid irritating foods, reduce stress
–> Ranitadine + PPI
if H.pylori triple therapy
clarithromycin, amoxicillin and PPI

42
Q

2- Chronic pancreatitis

CF

Management:

A

Syx: Epigastric pain – severe, Radiates to back, Relieved sitting forwards/hot water bottle on back, Bloating, Steatorrhoea

IVX: US, CT, glucose test

Management: analgesia, coeliac plexus block, lipase eg CREON, Fat soluble vitamins (ADEK), insulin
Low fat diet no alcohol

43
Q

2- Chronic hepatitis

Symptoms

A

Inflammatory disease of the liver lasting >6 months
2 types: chronic persistent (no cell necrosis) and chronic active (cell necrosis)

Cause: viral help, metabolic, alcoholic fatty liver disease

Syx: fatigue, anorexai, muscle pain, arthralgia, weight loss, abdo distension, ankle swellling, haematemesis, pruritis, gynaecomastia

IVX: bilirubin, urobiillogen, LFTs,

44
Q

ALP

A

Hepatobillary tree and bones

45
Q

ALT

A

Hepatocellular damage

46
Q

The complete Rockall Score

A

estimates mortality in patients with active upper GI bleed who have had endoscopy.

47
Q

Murphys sign

A

Gall bladder hits hand on palpation –> cholecystitis

48
Q

AST

A

muscle

49
Q

** Upper GI Bleed

IVX
Treatment

A 
Endoscopy immediately afterr resuscitations for unstabel patients
 FBC every 4-6 hours
cross match 2-6 unuts
Coag profile
CXR
Erect and supine AXR]

Admit; if shocked, aged >60

Major ulcer bleed = ompereazole
Terlepressin 2mg IV if vasrices suspected

50
Q

2- Subphrenic abcess

Cause by?

CF:

A

Localised collections of pus underneath the right or left hemi-diaphragm
Often caused bu Generlaised Peritonitis following appendicitis, peptic ulcer or bowel surgery

CF: Swinging fever, N+V, malaise, abdo tenderness subcostal + dyspnoea if causes pleural effusion

IVX:WCC HIGH - US or CT abdo - CXR shws high diaphragm

51
Q

IBS: CHRONS

CF

IVX

INDUCE REMISSION?

A

Transmural inflammation mouth to anus

CF: Weight loss, FTT, lethargy, diarrhoea, abdo pain, anal structures
Lage join arthtitis + erythema nodosum

IV:X: faecal calprotectin +ve, AXR strictures, small bowel enema, colonoscopy, COBBLESTONE muscosal appearance, skip lesions
Gobley cells

Management: 
1. INDUCE REMISSION = PREDNISOLONE 
2. KEEP REMISSION = Azathoprine 
Consider Infliximab / methotrexate
Surgery if limited to distal ileum
52
Q

Liver abcess

A

Cause: infection –> collection of pus

CF: R upper quadrant pain, tenderness, hepatomegaly, Swinging fever, Night seats, N and V

Management: Metronidazole, drainage USS

53
Q

Perianal haematoma

A

Acutely painful condition with onest after straining at stool

Syx: Blue-black bulge in the skin near the margin of the anus, Pain

54
Q

Fistula in ano

A

Abnormal hollow tract or cavity that is lined with granulation tissue and that connects a primary opening inside the anal canal to a secondary opening in the perianal skin

  • Previous anorectal abscess
  • Ass with diverticular disease, IBD, malignancy, TB and actinomycosis

CF: perianal dischange, pain, swelling

55
Q

UC + chrons treatment

  1. remission
  2. maintinaing remission
A

UC

  1. MESALASINE
  2. MESALASINE –> AZIATHROPINE if doesnt work

CHRONS

  1. STEROIDS
  2. AZIATHROPINE
56
Q

Primary billiary cirrhosis

Primary sclerosing cholangitis

A 
Autoimmune chronic liver disease
1. igM
2.anti Microbial antibodies
3. middle aged females
= affectes the billiary tree

(Primary sclerosing cholangitis = UC = affects the duct (tube) like UC)

57
Q

PPIs side effects

A

Low Na and low Mg

58
Q

treat Hepatic encephalopathy

A

Lactulose!!!

Prevention = Rifaximin is a type of antibiotic

59
Q

surgical sievere

A 
Vascular
Infective 
Trauama 
autoimmune 
Metabolic
Iatrogenic
Neoplastic 
degenerative

5th year CC ACT + Level 1 (20 decks)

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