GI Stepup Flashcards
causes of viral gastroenteritis
Norwalk, Coxsackie virus A1, echovirus and adenovirus
rota in kids
labs in viral gastroenteritis
no fecal WBC
fried rice and vomiting within a few hours of eating it
bacillus cereus
bloody diarrhea and abdominal pain after eating chicken
campylobacter jejuni
which pathogen is assoc with bacterial GI upset and guillain barre
campylobacter jejuni
flaccid paralysis from honey
clostridium botulinum
Tx for adult botulism toxin from canned foods
botulism antitoxin
watery or bloody diarrhea post antibiotics
clostridium difficile
Tx C diff
metro or vanco
what is travelers diarrhea from
enterotoxigenic E coli
bloody diarrhea, abdominal pain, renal failure
E coli O157:H7
vomiting several hours after eating past salad
staph aureus
bloody diearrha, fever vomiting after eggs
salmonella
whats the most common foodbourne bacterial GI infection
salmonella from fresh produce
severe bloody diarrhea after eating
shigella
Tx for sigella bloody diarrrhea
hydration
can use cipro
if severe use tMP SMX
copious watery diarrhea after eating shellfood
vibrio cholera
Tx for vibrio cholera
tetracycline or doxy decrease length
watery diarrhea after oysters
vibrio parahaemolyticus
Bloody diarrhea and right lower pain after eating pork and fresh produce
yersinia
greasy foul smelling diarrhea with abdominal pain
giardia
Tx giardia
metro and hydration
mild to severe bloody diarrhea abdominal pain
after drinking water in poor area
entamoeba histolytics
Tx entamoeba histolytica
metro and paromomycin
watery diarrhea, abdominal pain, in immunocompromised patient
cryptosporidium
fever with myalgias and periorbital edema after eating undercooked pork
trichinella spiralis
Tx trichinella spiralis
albendazole, mebendazole
what causes neurocystercosis
taenia solium
fecal oral transmission
cysts in muscles, subcut tissues and brain
taenia solium neurocysticercosis
Tx for neurocysticercosis
albendazole and corticosteroid
Sx hepattis
malaise, arthralgias, fatigue, nausea, vomiting, RUQ pain, jaundice, scleral icterus, tender hepatomegaly, splenomegaly and lymphadenopathy
labs in hepatitis
bilirubinuria
increased AST and ALT!!!
increased alkaline phos
anti HAV IgM Ab
during acute illness
anti HAV IgG Ab
after resolution
how to test for HCV
Ab and PCR for HCV
Tx HCV
IFN alpha and can add ribavirin
Tx HBV
IFN-a or antivirals
what is the double stranded DNA hepatitis virus
HEPB
how does Hep A spread
fecal-oral
food (shellfish)
how is Hep B spread
sexual contact, blood and bodily fluids
prevention Hep B
vaccine
complications of Hep B
hepatocellular carcinoma
how does Hep C spread
blood, possible sexually
how does Hep D spread
blood, need Hep B to have infection
how does Hep E spread
water
fecal-oral
complications Hep E
high maternal mortality in pregnant women
Hep B markers for acute illness
HBsAg
HBeAg
anti-HBc IgM
DNA
Hep B markers for window period post exposure
anti-HBc IgM
Hep B markers for chronic infection with active viral repilication
+HBsAg
+HBeAg
+ antiHBc IgG
Hep B marker chronic infection low infectivitY
+HBSAG
+ ANTI-HBc IgG
Hep B marker for previoud infection
+ anti-HBs
+anti-HBc IgG
Hep B markers if had vaccination
only +antiHBs
what limits only solid foods
obstruction
what limits solids and liquids
neuromuscular pathology
patient has dysphagia, first step
barium swallow before EGD
Achalsia
impaired neuromuscular disorder
impaired peristalsis with decreased LES relaxation
what causes achalsia
intramural neuron dysfunction
signs achalsia
progressive dysphagia solids and liquids, regurg, cough, aspiration, heartburn, weight loss
birds beak
achalasia
Tx achalasia
nitrates and CCBs
pneumatic dilation
botulinum injections
myotomy
complications of achalasia
myotomy can cause GERD
Sx diffuse esophageal spasm
chest pain and dysphagia
corkscrew pattern on barium swallow
diffuse esophageal spasm
Tx diffuse esophgeal spasm
CCB
nitrates
TCA
secondary causes of achalasia
chagas, neoplasm, scleroderma
what relieves pain in diffuse esophgeal spasm but whats the trade off
nitrates help but worsen GERD
what causes zenker diverticulum
outpouching upper esophgaus by smooth mm weakness
Sx zenker
bad breath, regurg days after eating, dysphagia, feeling of aspiration, neck mass
Tx zenker diverticulum
cricopharyngeal myotomy or diverticulectomy
complications zenker
EGD can perforate
vocal cord paralysis
mediastinitis possible with surgery
labs to Dx GERD
esophageal pH monitoring
Tx for GERD
H2 antagonists and PPIs
complications GERD
esophageal ulceration, esophageal stricture, barrett esophagus, adenocarcinoma
most common esophageal CA in US
adenocarcinoma
most common esophageal CA in the world
squamous cell carcinoma
signs of esophageal cancer
progressive dysphagia solides then liquids too weight loss odynophagia reflux GI bleeding vomiting weakness cough hoarseness
how to Dx esophgeal CA
biopsy
Tx esophageal CA
resection
radiation and chemo for nonoperative
complications esophageal CA
mets
what is a sliding hiatal hernia
GE junction and stomach through diaphragm
most common
what is a paraesophageal hiatal hernia
stomach protrudes through diaphragm but GEJ at normal location
labs for hiatal hernia
barium swallow
CXR
Tx sliding hernias
reflux control
Tx for paraesophageal hiatal hernias
gastropexy or nissen fundoplication
complications hiatal hernias
incarceration of stomach in herniation
acute gastritis
rapidly developing superficial lesions secondary to NSAID use, alcohol, ingestion corosive material, stress
signs Sx gastritis
epigastric pain, indigestion, nausea vomiting, hematemesis, melena
labs for gastritis
+ urea breath test (ammonia producing bacteria)
+ IgG Ab to H pylori
antral Bx
what cells are attacked in pernicious anemia
the parietal cells
chronic gastritis usually attacks what part of stomach
antrum
associated condiitions with chronic gastritis in antrum
peptic ulcer disease and gastric cancer
Tx H pylori
PPI, clarithromycin, amoxicillin or metro
curling ulcer
secondary to severe burn or intracranial injury
H pylori causes what
most gastric ulcers and almost all duodenal
refractory peptic ulcer disease, next step
measure gastrin to look for zollinger ellison
free air under diaphgram in CXR of someone with known PUD
perforated ulcer
complications of peptic ulcer disease
hemorrhage
perforation gastroduodenal artery
perforation from anterior ulcers
lymphoproliferative disease
where are the gastrinomas causing zollinger ellison found
duodenum or pancreas
eating helps Sx of epigastric pain
duodenal ulcer
eating worsens Sx of epigastric pain
gastric ulcer
what type of NSAID to those with PUD
Cox2 selective
labs to Dx zollinger ellison
increased fasting gastrin
+ secretin stimulation
imaging for zollinger ellison tumor
SPECT to localize tumor
Tx for zollinger ellison
surgical resection
PPI and H2 antagonists
octreotide to reduce Sx
complications zollinger ellison
MEN1
most common gastric CA
adenocarcinoma
types of gastric Ca
ulcerating
polypoid
superfiicial spreading
linitis plastica
risk factors for gastric CA
H pylori FMH japanese tobacco alcohol Vit C def high consumption preserved fod
Sx gastric CA
weight loss anorexia early satiety n/v dysphagia epigastric pian enlarged left supraclavicular node (virchow) periumbical node (sister mary joseph node)
labs in gastric CA
increased CEA
increased 2 glucuronidase in gastric secretions
anemia
need Bx
barium swallow is showing thickend leather bottle stomach
(linitis plastica)
Tx for gastric CA
subtotal gastrectomy for lesions in distal third.
total gastrectomy if lesions in middle or upper
adjuvant chemo and radiation
complications gastric CA
poor prognosis in later detection
pathophys celiacs
IgA against anti tissue tansglutaminase and antiendomysial ab that cause jejunal mucosal damage
celiacs is assoc with what conditions
down syndrome and dermatitis herpetiformis
labs in celiac
anti endomysial Ab
antigliadin Ab
biopsy will show blunting of duodenal and jejunal villi
Tropical sprue
malabsorption from celiac sprue
acquired in tropical areas
sudan stain
indicates steatorrhea
D xylose test
if abrnomal then do Bx for sprue, whipple or bacterial overgrotwh
negative sudan stain and low stool pH
lactase deficiency
Tx celiac sprue
folic acid replacement
tetracycline
What can cause lactose intolerance
crohns or bacterial overgrowth
labs in lactose intolerance
+ tolerance test
+ lactose breath H test
whipple disease
from tropheryma whippelii
malabsorption
risk factors whipples
white male european
signs Sx whipples disease
weight loss, joint pain, abdominal pain, diarrhea, dementia, cough, bloating, steatorrhea, fever, vision abnormalities, lymphadenopathy, new heart murmur, wasting
labs in whipples
jejunal Bx will show foamy macrophages with PAS+ stain and villous atrophy
Tx for whipples
TMP SMX or ceftriaxone for 12 months
most common cause adult chronic diarrhea
lactase deficiency
most common cause acute diarrhea in kids
rotavirus
osmotic diarrhea
solute in bowel causing water to enter bowel too.
decreases with fasting
inflammtory diarrhea
autoimmune inflammatory process or chronic infection
Tx for inflammatory diarrhea
hydration
IBS
chronic abdominal pain and irregular bowel habits
in teens and adolescence
F>M
CBC, electrolytes and stool culture to rule out other GI diseases
Tx for IBS
assurance high fiber diet psychosocial therapy antispasmodic antidepressnats SSRI
IBD
disease of small and large bowel with Sx associated with inflammatory bowel processes, autoimmune reactions, extraintestinal manifestations and multiple complications
risk factors IBD
ashkenazi Jew
whites>blacks
bowel obstruction
mechanical that can lead to vascular compromise
adhesions, hernias and neoplasms
risk factors ischemic colitis
DM, atherosclerosis, CHF, PVD, lupus
extraintestinal findings in crohns
arthritis, anklyosing spondylitls, uveitis, nephrolithiasis
labs in crohns
ASCA +
pANCA rarely +
hemoccult +
Tx crohns
mesalamine antibiotics corticosteroids immunosuppressants surgical resections
extraintestinal manifestations UC
arthritis, uveitis, anklylosing spondylitis, primary sclerosing cholangitis, erythema nodosum, pyoderma gangrenosum
labs in UC
ASCA rare
pANCA frequently +
lead pipe colon without haustra
UC
Cure for UC
colectomy
complications UC
colon CA
hemorrhage
toxic megacolon
obstruction
multiple loops bowel with ladderlike appearance
Small bowel obstruction
labs in ischemic colitis
increased WBC increased serum lactate
imaging in ischmic colitis
barium enema shows diffuse change from localized bleeding “thumb printing”
sigmoidoscopy shows blood and edematous mucosa
Tx ischemic colitis
IV fluids, bowel rest, antibiotics, surgical resection if necrotic bowel
Tx SBO
NPO
maintain hydraion
nasogastric decompression
surgery if still there after decompression
what causes large bowel obstructions
neoplasm, diverticulitis, volvulus, congenital stricture
late feculent vomiting
LBO
Tx for LBO
NPO
maintain hydration
colonoscopy can relieve obstruction
surgery if colonoscopy does not help
what part of GI tract is most commonly invovled in ischmic colitis
left side
which GI pain is out of proportion to the PE
SBO
what causes appendicitis in children
lymphoid hyperplasia
what causes appendicitis in adults
fibroid bands or fecaliths
labs appendicitis
increased WBC with left shift
best test for appendicitis
Ct
woman with signs appendicitis, next step
urine B hCG
what is ileus
paralytic obstruction of bowel secondary to decreased peristalsis
what causes ileus
infection, ischemia, recent surgery, DM , opioid overdose
high clinical suspicision appendicitis
go right to surgery
imagin in ileus
distention affected bowel, air fluid levels, barium enema helps to rule it out
Tx for ileus
stop opioids, make patient NPO
colonoscopic decompression
which part of GI tract takes longest to recover post surgery
the colon
volvulus
rotation of bowel causing obstruction
usually at cecum and sigmoid
double bubble sign
volvuls
birds beak in distal abdomen
sigmoid volvulus
risk factors diverticulosis
low fiber diet
high fat diet
>60 years of age
most common cause acute lower GI bleeding in adults over 40 years old
diverticular disease
Tx diverticulitis
liquids only, PO antibiotics like cipro and metro
TMPSMX and metro
augmentin
internal hemorrhoids are from where
superior rectal veins above pectinate line
external hemorrhoids are from where
inferior rectal veins below pectinate line
painful
Tx anal fissure
stool softeners, sitz baths, topical nitro
partial sphincterotomy
throbbin rectal pain, fever and tenderness on DRE
anorectal abscess
Tx rectal fistula
formation between rectum and adjacent structures from unknown cause or secondary to IBD
Tx rectal fistula
fistulotomy, treat crohns patients with antibiotics
pilonidal disease
one+ cutaneous sinus tracts in superior midline gluteal celft
carcinoid arise from what
neuroectodermal cells that function as amine precursor uptake and decarboxylation cells (APUD)
where is carcinoid found
bronchopulmonary tree, ileum, rectum and appendix
labs in carcinoid
inc 5-HIAA in urine
increased serum serotonin
Imaging for carcinoid
CT or indium labeled octreotide scintigraphy
Tx carcinoid
2 cm extensive resection
risk factors colorectal CA
FMH UC colonic polyps hereditary polyposis syndromes low fiber/high fiber diet previous colon CA alcohol smoking and DM
labs for colonic CA
+ guaic stool
dec Hb Hct
Bx diagnostic
CEA increased in 70% to monitor course
what imaging is used to detect extent of colorectal CA
CT or PET
Tx colorectal CA
resection and lymph node dissection
adjuvant if + nodes
Familial adenomatous polyposis
hundred polyps
increased malignancy
need prophylactic subtotal colectomy
mutaiton in familial adenomatous polyposis
APC gene
gardner syndrome
lots of colonic polyps also with bone and soft tissue tumors
Turcot syndrome
many colonic adenomas with high malignancy. also CNS tumors
jevenile polyposis
hamartomatous polyps in colon small bowel and stomach
increased risk malignancy later in life
peutz jeghers
hamartomas with low risk maliganncy
mucocutaneous pigmentation of mouth hands and genitals
hereditary nonpoluposis colorectal cancer
proximal colon
many genetic mutations
stage III colorectal CA
lymph node involvement
stage II colorectal CA
penetration of tumor into colonic serosa or perirectal fat
prevention for colorectal CA
anual FOBT
flexible sigmoidoscopy every 5 years
or
colonoscopy every 1o years
GI bleeding separation
ligament of treitz, above is upper
below is lower GI bleed
causes upper GI bleeeds
PUD mallory weiss tears (longitudinal tears from vomiting) esophagitis esophgeal varices gastritis
causes lower GI bleeds
diverticulosis, neoplasm, UC, mesenteric ischemia, AVMs, hemorrhoids and meckel diverticulum
what is used to detect arteriovenous malformation in abdomen
angiography
Tx for GI bleeds
fluids
transgusions
Tx underlying cause
how to stop AVM from bleeding
vasopressin can help
causes of pancreatitis
hyper PTH Alcohol Neoplasm Cholelithiasis Rx ERCP Abdominal surgery Triglyceridemia Infeciton (mumps) Trauma Idioapthic Scorpion bite
grey turner sign
ecchymosis of flank
pancreatitis
cullen sign
umbilical ecchymosis
pancreatitis
labs in chronic pancreatitis
mildly increase amylase and lipase
low fecal elastase
radiolgy in chronic pancreatiis
pancreatic calcifications
enlargement or pseudocyts
imaging in acute pancreatitis
dilated loop of bowel, sentinel loop
may have pleural effusion and hemidiaphragm elevation
pseudocyst on CT or enlarged pancreas
complications chronic pancreatitis
ductal obstruction, malnutrition, glucose intolerance, pancreatic CA
complications acute pancreatitis
abscess, pseudocyst, necrosis, fistulas, renal failure, hemorrhage, shock, DIC, sepsis, resp failure
Ranson criteria
prognosis acute pancreatitis BAD if: glucose >200 AST>250 LDH >350 Age>55 WBC>16,000
where does adenocarcinoma of pancreas arise
head of pancreas
risk factors for pancreatic adenocarcinoma
chronic pancreatiis, DM, FMH, tobacco, high fat diet, male>female
obesity and sedentary ligestyle
Signs Sx pancreatic adenocarcinoma
abdominal pain radiating to back
anorexia, nausea, vomiting, weight loss, fatigue, steatorrhea, painless jaundice, nontender gallbladder that is palapable
splenomegaly if mass is in tail
labs in pancreatic adenocarcinoma
hyperglycemia increased CEA CA19-9 increased bili inc alk phos
best imaging for pancreatic adenocarcinoma
CT unless small then eRCP
surgery for pancreatic CA in head of pancreas
whipples procedure
complications pancreatic CA
bad prognosis
can have migratory thrombophelbitis- trousseau syndrome
whipples triad
insulinoma
Sx hypoglycemia with fasting
hypoglycemia and improvement after carbohydrate load
mutliple insulinomas
MEN1
what are the endocrine pancreatic CA
zollinger ellsion
insulinoma
glucagonoma
VIPoma
Sx insulinoma
HA visual changes, confusion, weakness, mood instabiliyt, palpitations and diaphoresis
labs in insulinoma
increased fasting insulin, high C peptide
Tx for insulinoma
resection
diazoxide and octreotide
what cells secrete glucagon
alpha cells in pancreas
Sx Signs glucagonoma
abdominal pain, diarrhea, weight loss, mental status changes, exfoliating rash(necrolytic migratory erythema) Sx of DM
labs in glucagonoma
hyperglycemia, increased glucagon
refractory DM
glucagonoma
Tx for glucagonoma
resection chemo and embolizaiton
where are VIPomas
non beta islet cells in pancreas
signs Sx VIPoma
watery diarrhea, wekaness, n/v and abdominal pain
labs in VIPoma
increased VIP, stool osmolality is secretory like
Tx VIPoma
surgical resection, corticosteroids, chemo, octreotide
pigmented stones are what
calcium bilirubinate from chronic hemolysis
complications cholelithiasis
recurrent
acute cholecystitis
pancreatitis
what causes acute cholecystitis
obsturction of cystic duct
labs in acute cholecystisi
icnreased WBC, increased bili and direct
increased alk phos sometimes
what is used to detect cytic duct obstruction
HIDA scan
complications acute cholecystis
perforation, gallstone ileus, abscess
charcot triad
RUQ pain, jaundice and fever
suspect cholangitis and do US or HIDA
What is cholangitis
infection bile ducts secondary to obstruction
signs Sx cholangitis
RUQ pain, chills, jaundice, fever, RUQ tenderness, change in mental status
labs in cholangitis
increased WBC increased bili total and direct increased alk phos increased aST ALT increased amylase \+ blood cultures
most sensitive test for cholangitis
HIDA
Tx cholantiis
hydration, IV antibiotics, endoscopic biliary drainage with delayed choecyetecomt
severe need emergency bile duct decompression
Sx signs adenocarcinoma of gallbladder
anorexia, weight loss, abdominal pain radiating to back, palpable gallbladder and juandice
resect to Dx
calcified gallbladder
adenocarcinoma of gallbladder in 10-30%
usually from chronic cholecystitis
Tx adenocarcinoma gallbladder
cholecystectomy, lymph node dissection, partial removal of adjacent hepatic tissue, radiation and chemo
Primary biliary cirrhosis
autoimmune with intrahepatic bile destruction
risk factors PBC
RA
sjogrens
scleroderma
F?M
signs Sx PBC
fatigue, pruritis, arthralgias, jaundice, xanthomas, skin hyperpigmentation, HSM
labs in PBc
inc alk phos, GGT normal LFTs increasd cholesterol increased direct and total bili \+ANA \+antimitochondrial!!!
Tx PBC
ursodeoxycholic acid to improve liver function and reduce Sx
colchicines or MTX
Primary sclerosing cholangitis
progressive destruction intra and extrahepatic ducts
leading to fibrosis and cirrhosis
risk factors for PSC
UC
male >female
Signs Sx: PSC
aSx, fatigue, pruritis, RUQ pain, fever, night sweats, jaundice, xanthomas M>F
labs in PSC
inc alk phos and GGT
normal LFTs
inc bili total and direct
maybe + pANCA
how to differentiat PBC and PSC
PBC has antimitochondrial Ab and gender is usually female
ERCP to be definitive
ERCP of PSC
stricturing and irregularity— beads on a string!!
Tx for PSC
endoscopic stenting for strictures
resection affected ducts
increase indirect bili
prehepatic
increase direct bili
posthepatic
what conjugates bilirubin
glucuronosyltransferase in hepatocytes
Gilbert
auto recessive or dominant
mild deficiency in glucuronosyltransferase so get inc indirect bili
Crigler Najar type I
auto recessive, severe deficiency in glucuronosyltransferase
increased indiret bili
get kernicterus as infant
Tx is phothterapy, plasmaphereis, Ca phosphate with orlistat and liver transplant
causes of increased indirect bili
hemolytic anemia, disorders erythropoiesis
internal hemorrhage
physiologic jaundice newborn
gilber, cirgler najar and hepatocellular disease
causes of increased direct bili
dubin johnson, rotor hepatocellular disease drug impairment PBC PSC gallstone obstruction cancers biliary atresia
Crigler najar II
mild deficiency
Tx with phenobarbital to help hepatic synthesis of glucuronyltransferase
labs in alcoholic liver disease
increased AST >ALT increast GGT increased alk phos increased bili prolonged PT decreased lipids increased WBC
fatty liver with many PMNs
alcoholic liver disease
Tx of alcoholic liver disease
stop drinking
thiamine
folic acid
high caloric intake
what causes cirrhosis
alcohol HBV HCV chrnoic obstruction PBC PSC hemochromatosis wilsons antitrypsin def NASH autoimmune hepatitis
paracentesis of ascites results in cirrhosis
small nodular livero n US
cirrhosis
what helps with encephalopathy from cirrhosis
lactulose and rifazimin
complications cirrhosis
portal HTN
hepatic encephalopathy
renal failure
spontaneous bacterial peritonitis
prehaptic causes of portal HTN
portal vein thrombosis
intrahepatic causes of portal HTN
cirrhosis, schistosomiasis, parenchymal disease and granulomatous disease
post hepatic causes of portal HTN
right sided HF
hepatic vein thrombosis
budd chiari syndrome
budd chiari syndrome
hepatic vein thrombosis secondary to hypercoagulability
paracentesis in portal HTN
serum-ascites albumin gradient >1.1
Tx for portal HTN
salt restriction and diuretics (furosemid and spironolactone)
IB antibiotics
dialysis
vsopressin for bleeding varices
severe portal HTN Tx
hepatic shunting bia laparotomy or transjugular intrahepatic portosystemic shunting
paracentesis has very high albumin and LDH
neoplastic etiology
do workup
Sx signs hemochromatosis
abdominal pain polydipsia and uria arthralgias, impotence, lethargy pigmented rash hepatomegaly testicular atrophy
labs in hemochromatosis
increased Fe, inc ferritin
inc transferrin
inc AST ALT
complications hematochromatosis
cirrhosis, hepatoma, CHF, DM hypopituitary
wilson disease
auto recessive
coper depositts in liver brain and cornea
labs in wilsons
dec serum ceruloplasm
increased urinary copper
inc AST ALT
Tx wilsons disease
trientine or penicillamine for copper chelation
zine for maintaence
supp B6
complications wilsons disease
fulminant hepatic failure and cirrhosis
most common liver neoplasms
are mets from breast lung or colon
benign hepatic tumors
hepatic adenoma, focal nodular hyperplasia, hemangiomas and cysts
OCP increase risk for what hepatic tumor
benigh
why is Bx of hepatic mass contraindicated
hypervascularity and risk of hemorrhage
what is the primary malignant hepatic tumor
hepatocellular carinoma
risk factors hepatocellular carcinoma
HBV HCV, cirrhosis, hemochromatosis, increased consumption alflotoxin from aspergillus infected foods
schistosomiasis
labs in hepatocellular carcinoma
increased AST aLT
inc alk phos
inc bili
inc AFP
acid base in pyloric stenosis
hypoCl
hypoK
metabolic alkalosis
string sign in stomach
pyloric stenosis
necrotizing enterocolitis
bilious vomiting, lethargy, poor feeding, diarrhea, hematochezia, abdominal distention, abdominal tenderness, shock
Bx in hirschrpung
absent ganglia
most common cause bowel obstruction
intussuception
risk factors intussuception
MEckel diverticulum, henoch schonlein purpura
adenovirus infections, CF
currant jelly stool
intussuception
sausage like abdominal mass
intussuception
Tx and Dx intussuception
barium ednema
intussuceptin in adult
CA until proven otherwise
meckel diverticulum is remnant of
vitelline duct
how to detect meckel diverticulum
technectium radionucleotide scan
