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Finals Studying - Condensed > Surgery > Flashcards

Surgery Flashcards

1
Q

part of bowel most likely to be affected by ischaemic colitis

A

splenic flexure

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2
Q

thumbprinting at splenic flexure

A

ischaemic colitis

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3
Q

part of bowel usually affected by mesenteric ischaemia

A

small bowel

usually embolism of SMA

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4
Q

Usual ABPI in diabetic

A

> 1.2 - causes calcification

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5
Q

Ix of mesenteric ischaemia

A

lactate

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6
Q

test to confirm H. pylori eradication

A

Urea breath test

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7
Q

who gets Hep A

A

travelers

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8
Q

transmission of Hep A

A

faecal - oral

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9
Q

is there a vaccine for Hep A?

A

Yes

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10
Q

Ix of Hep A

A

clotted blood for serology

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11
Q

Hepatitis that leads to chronic infection

A

Hep B

Hep C

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12
Q

transmission of Hep B

A

sex
mother - to - child
blood

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13
Q

HBsAg - what does it indicate

A

earliest marker of infection

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14
Q

is there a vaccine for Hep B?

A

yes

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15
Q

does vaccination against Hep B result in +ve HBsAg

A

no!!

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16
Q

Anti-HBsAg - what does it indicate

A

recovery
absence of infectivity
further immunity from Hep B

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17
Q

HBeAg - what does it indicate

A

+++ infectious

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18
Q

Anti-HBcAg (IgM) - what does it indicate

A

recent acute infection

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19
Q

Anti-HBcAg (IgG) - what does it indicate

A

with +ve HBsAg = chronic Hep B infection

with -ve HBsAg = infection in the remote past

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20
Q

autoantibodies in autoimmune hepatitis

A

Type 1 = ASMA, ANA

Type 2 = AMA

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21
Q

transmission of Hep C

A

sex
mother - to - child
blood

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22
Q

what other type of Hepatitis is hep D found with

A

Hep B

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23
Q

transmission of Hep E

A

faecal-oral

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24
Q

Where does Hep E come from

A

animals

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25
Q

is there a vaccine for Hep E?

A

no

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26
Q

Mx autoimmune hepatitis

A

short term Tx (<6m):
corticosteroid (pred)

long term Tx (>6m):
corticosteroid + immunosuppression

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27
Q

Mx alcoholic hepatitis

A
  1. prednisolone

2. pentoxyphylline

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28
Q

Mx of hep B

A
  1. pegylated interferon-alpha

2. tenofovir or entecavir

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29
Q

causes of acute pancreatitis

A

‘GET SMASHED’

G = gallstones
E = ethanol
T = trauma
S = steroids
M = mumps
A = autoimmune
S = scorpion bites
H = hypercalcaemia/hyperparathyroidism
E = ERCP 
D = drugs
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30
Q

drugs causing pancreatitis

A

mesalazine

azothioprine

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31
Q

Ix pancreatitis

A
  1. serum lipase/amylase
  2. CT (gold standard)
  3. CXR - to rule out other causes
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32
Q

complications of pancreatitis

A 
peripancreatic fluid collections
pseudocysts
pancreatic necrosis 
abscess
haemorrhage
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33
Q

presentation of chronic pancreatitis

A

dull abdo pain, worse 30mins after eating
radiates to back
steatorrhoea
diabetes mellitus

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34
Q

Ix chronic pancreatitis

A

gold standard = CT

also - pancreatic enzymes, HbA1c, ultrasound

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35
Q

location of most pancreatic ca

A

head of the pancreas

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36
Q

presentation pancreatic ca

A

painless jaundice (due to compression of the CBD)
anorexia
wt loss
steatorrhoea
Trousseau’s sign (clots in superficial veins in uncommon sites)

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37
Q

Ix pancreatic ca

A

Gold standard = pancreatic protocol CT

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38
Q

tumour marker pancreatic ca

A

ca 19-9

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39
Q

Mx pancreatic ca

A

surgery candidate:
Whipple’s procedure - pancreaticoduodenectomy + adjuvant chemo

non-surgical candidate:
ERCP + stenting

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40
Q

presentation of colonic polyps

A

incidental finding on qFIT - most common

  • rectal bleeding
  • mucus discharge
  • tenesmus
  • change in bowel habit
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41
Q

Mx of colonic polyps

A

colonoscopy +/- polypectomy

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42
Q

what type of ca is the majority of colorectal ca

A

adenocarcinomas

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43
Q

genetic conditions predisposing to colorectal ca

A

Familial Adenomatous Polyposis (FAP)

  • > 100 polyps
  • early onset
  • autosomal dominant
  • ass. with thyroid ca

Hereditary Non-Polyposis Colorectal Ca (HNPCC) (Lynch synd)

  • < 100 polyps
  • late onset
  • autosomal dominant
  • ass. with endometrial and gastric ca
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44
Q

how often are people screened in Scotland for colorectal ca

A

ever 2 years aged 50-74 y

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45
Q

presentation of colorectal ca

A

depends on site.

L side =
bleeding/mucus PR, altered bowel habit, tenesmus, mass PR

R side =
wt loss, anaemia, abdo pain

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46
Q

screening test for colorectal ca

A

QFit

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47
Q

tumour marker colorectal ca

A

CEA

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48
Q

Ix colorectal ca

A
  1. Colonoscopy
  2. CT colonography
  3. Double contrast barium enema

staging - CT chest/abdo/pelvis

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49
Q

dukes classification of colorectal ca

A 
A = confined to mucosa
B = invading bowel wall
C = lymph mets
D = distant mets
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50
Q

Mx colorectal ca

A

stage I - III:
colonic resection/colectomy + resection of regional lymph nodes

stage IV:
evaluate whether mets are resectable
if not - palliative

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51
Q

what nodes do colorectal ca spread to

A

mesenteric nodes

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52
Q

distant mets for colorectal ca

A

liver

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53
Q

Mx of rectal ca

A

anterior resection
or
abdomino-perineal excision of rectum

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54
Q

hartmann’s procedure

A
  • surgical resection of recto-sigmoid colon
  • close of anorectal stump
  • end colostomy
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55
Q

what is diverticular disease

A

presence of asymptomatic outpouchings of the gut wall

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56
Q

most common location of diverticular disease

A

sigmoid colon

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57
Q

cause of diverticular disease

A

lack of dietary fibre - weak gut wall - mucosal herniation

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58
Q

presentation diverticulitis

A

LIF pain
pyrexia
high WCC
generalized peritonism

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59
Q

Ix diverticular disease

A

colonoscopy

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60
Q

Ix diverticulitis

A

CT abdomen

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61
Q

Mx symptomatic diverticular disease

A

dietary modification = fibre supplements

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62
Q

Mx diverticulitis

A

analgesia + oral or IV Abx

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63
Q

Mx recurrent diverticulitis

A

colectomy

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64
Q

cause of pseudomembranous colitis

A

c. diff

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65
Q

presentation of pseudomembranous colitis

A 
recent Hx of Abx use 
diarrhea 
prolonged hospitalization/nursing home resident
abdo pain
fever
n+v
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66
Q

Mx pseudomembranous colitis

A

Non severe = Metronidazole

Severe = Vancomycin + Metronidazole

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67
Q

cause of ischaemic colitis

A

low flow in the IMA

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68
Q

presentation ischaemic colitis

A

lower left abdo pain +/- bloody diarrhea

tenderness

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69
Q

Mx ischaemic colitis

A

conservative - most resolve spontaneously

if gangrenous - resection + stoma

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70
Q

complications of ischaemic colitis

A

toxic megacolon
microscopic colitis
radiative colitis

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71
Q

presentation of microscopic colitis

A

chronic, watery diarrhoea

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72
Q

presentation of acute mesenteric ischaemia

A

+++ pain

biochem:
acidotic BG
increased lactate
increased WCC

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73
Q

g/s diagnostic Ix mesenteric ischaemia

A

CT angiogram

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74
Q

Mx acute mesenteric ischaemia

A

bowel resection

  • re-anastomose if poss
  • if not, stoma
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75
Q

presentation of chronic mesenteric ischaemia

A 
post-prandial abdo pain
wt loss (eating hurts0 
upper abdo bruit 
\+/- PR bleeding
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76
Q

Mx chronic mesenteric ischaemia

A

surgery - pros v cons, ongoing risk of infection

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77
Q

causes of large bowel obstruction

A

colorectal ca
sigmoid volvulus
caecal volvulus
strictures - diverticula, inflammatory

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78
Q

sigmoid volvulus on AXR

A

coffee bean appearance

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79
Q

caecal volvus on AXR

A

fetal appearance

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80
Q

presentation large bowel obstruction

A

colicky abdo pain
abdo distension
‘tinkling bowel sounds’
failure to pass faeces

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81
Q

Ix large bowel obstruction

A
  1. AXR (haustration - do not cross lumen’s width)

2. CT

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82
Q

Mx large bowel obstruction is signs of strangulation

A

straight to theatre - laparotomy + resection of bowel

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83
Q

Mx large bowel obstruction if no signs of strangulation

A

drip + suck

NBM 
NG tube (suck - to decompress bowel) 
IV fluids (drip)
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84
Q

Mx fissure-in-ano

A
  1. conservative - increase fibre and fluids, bulk forming laxatives
  2. topical GTN or Diltiazem
  3. Botulinum toxin A
  4. Surgery
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85
Q

how is the course of a fistula-in-ano predicted clinically

A

Goodsall Rule:

if posterior to transverse anal line - curved course
if anterior to transverse anal line - straight course

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86
Q

how is the course of a fistula-in-ano visualised

A

MRI

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87
Q

Mx rectal prolapse

A

surgery - rectopexy (abdo approach), or perineal approach

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88
Q

stomas that are spouted

A

small bowel stomas

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89
Q

stomas that are flat

A

large bowel stomas

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90
Q

what is a loop stoma

A

entire loop of bowel is brought through one abdominal incision, with both the proximal and distal openings exteriorized in the same sit

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91
Q

what is an end stoma

A

one end of the colon is brought through the abdominal incision and stitched to the skin

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92
Q

use of a loop ileostomy

A

to defunction the colon e.g. following rectal ca surgery

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93
Q

use of an end ileostomy

A

following complete resection of the colon

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94
Q

use of an end colostomy

A

if anastomosis of the colon is not achievable

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95
Q

use of a loop colostomy

A

defunctioning of a distal segment of colon

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96
Q

cause of biliary colic

A

stone lodged in CBD

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97
Q

presentation biliary colic

A

intermittent RUQ pain
worse on eating fatty foods
no fever

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98
Q

Ix biliary colic

A 
abdominal US 
inflammatory markers (normal)
99
Q

Mx biliary colic

A

outpatient cholecystectomy

100
Q

cause of acute cholecystitis

A

inflammation of the gallbladder secondary to impacted stones

101
Q

presentation acute cholecystitis

A

constant RUQ pain
Murphy’s +ve
Fever

102
Q

what is murphy’s sign

A

pressing RUQ elicits pain and catches breath on inspiration

pressing LUQ doesn’t elicit pain

103
Q

Mx acute cholecystitis

A

IV Abx - cefuroxime or ciprofloxacin+met
+
Early laparoscopic cholecystectomy

104
Q

what is ascending cholangitis

A

infection of the biliary tree

105
Q

cause of ascending cholangitis

A

E.coli

106
Q

presentation ascending cholangitis

A

Charcot’s Triad:
RUQ pain
fever
jaundice

107
Q

Ix ascending cholangitis

A

abdominal US

inflammatory markers

108
Q

Mx ascending cholangitis

A

sepsis 6

ERCP (after 24-48h)

109
Q

presentation bowel perforation

A

severe, generalized abdo pain
guarding
firm, peritonitic abdo
rebound and percussion tenderness

110
Q

Ix bowel perforation

A 
erect CR (air under diaphragm) 
urgent CT
111
Q

Mx bowel perforation

A

urgent surgical repair

112
Q

mechanism of enzyme inducers

A

these REDUCE the availability of drugs

113
Q

mnemonic for enzyme inducers

A

CRAPS out drugs

Carbamazepine
Rifampicin
bArbituates
Phenytoin 
St John's Wort
114
Q

mechanism of enzyme inhibitors

A

these INCREASE the availability of drugs

115
Q

mnemonic for enzyme inhibitors

A

Some Certain Silly Compounds Annoyingly Inhibit Enzymes, Grrr

Sodium valproate
Ciprofloxacin 
Sulphonamides
Cimetidine/Omeprazole 
Amiodarone, Antifungals 
Isoniazid 
Erythromycin/Clarithromycin 
Grapefruit juice
116
Q

mnemonic for Cytp450 substrates

A

COWPATS

Carbamazepine 
Oral contraceptive pill
Warfarin 
Phenytoin
Acetylcholinesterase inhibitors
Theophylline 
Steroids/Statins
117
Q

ALARMS symptoms

A 
A = anaemia 
L = loss of weight 
A = anorexia
R = rapid onset 
M = melaena 
S = swallowing difficulties
118
Q

If ALARMS symptoms are present, what Ix is first line?

A

urgent OGD

119
Q

If ALARMS symptoms are not present what is the Mx?

A
  1. Lifestyle changes + Antacids & r/v in 2w
120
Q

if anatacids and lifestyle changes do not help dyspepsia, what do you do next?

A 
test for H.pylori 
options - 
C-13 urea breath test
serum antibodies to h. pylori 
stool antigen test
121
Q

if H. pylori test comes back -ve, what is the Mx?

A

prescribe PPI

122
Q

if H. pylori test comes back +ve, what is the Mx?

A 
triple therapy for H.pylori 
1. PPI 
2. Amoxicillin or Metronidazole 
3. Clarithromycin 
for 10-14d
123
Q

presentation of gastritis

A

vomiting
epigastric pain
no suspicious features of malignancy

124
Q

causes of gastritis

A
  1. h. pylori
  2. NSAID use
  3. alcohol
  4. autoimmune
125
Q

non-invasive h. pylori testing

A

C-13 urea breath test
serum antibodies to h. pylori
stool antigen test

126
Q

presentation gastric ulcer

A

dyspepsia
epigastric pain
nausea + anorexia
MADE WORSE BY EATING

127
Q

presentation duodenal ulcer

A

dyspepsia
epigastric pain
MADE BETTER BY EATING

128
Q

most common cell type of gastric cancer

A

adenocarcinoma

129
Q

risk factors for gastric cancer

A 
h. pylori 
blood group A
pernicious anaemia 
smoking 
gastric adenomatous polyps
130
Q

types of gastric cancer

A

intestinal
- more common

diffuse

  • younger patients
  • worse prognosis
131
Q

invasive testing for H. pylori (at biopsy)

A

rapid urease “CLO” test

132
Q

presentation gastric cancer

A 
dyspepsia 
n+v 
wt loss 
dysphagia 
virchows node
133
Q

what is virchows node

A

enlarged left supraclavicular node - Troiser’s sign

lymph nodes from the digestiv eviscera drain to the thoracic duct

134
Q

Ix gastric cancer

A
  1. OGD + biopsy
  2. staging - CT chest/abod/pelvis
    - endoscopic USS
    - PET CT
135
Q

histology of gastric cancer

A

signet ring cells

136
Q

Mx gastric cancer

A

Localised tumour: endoscopic muscosal resection

<5cm from GOJ: total gastrectomy

> 5-10cm from GOJ: subtotal gastrectomy

137
Q

incubation period s. aureus

A

1-6h

138
Q

transmission s. aureus

A

cream cakes

139
Q

incubation period bacillus cerus

A

1-6h

140
Q

transmission bacillus cerus

A

rice

141
Q

incubation period clostriudium perfringens

A

1-6h

142
Q

transmission clostridium perfringens

A

contaminated meat

143
Q

incubation period E.coli 0157

A

12-48h

144
Q

most common cause of travellers diarrhoea

A

E.coli

145
Q

presentation E.coli 0157

A

sudden onset

severe bloody diarrhoea

146
Q

incubation period salmonella

A

12-48h

147
Q

transmission of salmonella

A

poultry

raw eggs

148
Q

Mx salmonella

A

ciprofloxacin

149
Q

incubation period shigella

A

48-72h

150
Q

transmission of shigella

A

door + toilet handles

schools

151
Q

Mx shigella

A

ciprofloxacin & co-trimoxazole

152
Q

incubation period campylobacter

A

48-72h

153
Q

transmission of campylobacter

A

dairy

most common cause of food poisoning

154
Q

complication of campylobacter

A

guillain barre syndrome

155
Q

Mx campylobacter

A

ciprofloxacin

156
Q

incubation period cholera

A

48-72h

157
Q

transmission cholera

A

food or poor sanitation

158
Q

presentation cholera

A

profuse watery diarrhoea

159
Q

incubation period giardiasis

A

> 7 days

160
Q

transmission giardiasis

A

protozoa

161
Q

incubation period amoebiasis

A

> 7 days

162
Q

transmission amoebiasis

A

protozoa

163
Q

incubation period norovirus§

A

12-48h

164
Q

transmission of norovirus

A

cruise ships (faecal-oral)

165
Q

incubatio nperiod rotavirus

A

12-48h

166
Q

transmission of rotavirus

A

children, winter

167
Q

PBC: M or F more common?

A

Females

168
Q

what is PBC

A

chronic liver disorder, causing progressive cholestasis and eventual cirrhosis (damage to interlobular ducts)

169
Q

presentation PBC

A 
ITCH
fatigue 
cholestatic jaundice 
RUQ pain 
xanthelasma
clubbing 
hepatosplenomegaly 
hyperpigmentation (esp over pressure points)
170
Q

autoantibody PBC

A

Anti-mitochondrial antibodies (AMA) - most specifc

171
Q

LFTs in PBC

A

cholestatic appearance - high bilirubin, high Alk phos, more than ALT

172
Q

Mx PBC

A

ursodeoxycholic acid

173
Q

Mx itch in PBC

A

cholecystramine

174
Q

complications of PBC

A

malabsorption
sicca syndrome
portal HTN
hepatocellular carcinoma

175
Q

what forms the hepatic portal vein

A 
superior mesenteric vein 
\+ 
gastric vein 
\+ 
splenic vein
\+ 
part of the inferior mesenteric vein
176
Q

where are the anastomoses of the portal venous system with the systemic venous system

A
  1. oesophageal and gastric venous plexus
  2. umbilical vein
  3. haemorrhoidal venous plexus
177
Q

what causes hepatic encephalopathy

A

+++ ammonia (normally removed by the liver), travels to the brain and causes fluid shift

178
Q

asterixis

A

‘liver flap’ seen in hepatic encephalopathy

179
Q

Mx hepatic encephalopathy

A

lactulose - to clear the gut

180
Q

pathology of ascites

A

renal dysfunction + portal HTN + splanchnic arterial vasodilation, leading to:

RAAS activation, leading to sodium and water retention

181
Q

Ix ascites

A

abdo USS

182
Q

Mx ascites

A
  1. paracentesis

2. intrahepatic portosystemic shunt (TIPSS) - connects hepatic vein to portal vein

183
Q

causes of spontaneous bacterial peritonitis

A

E.coli

Klebsiella

184
Q

prophylaxis for SBP

A

oral ciprofloxacin

185
Q

Mx SBP

A

mild - PO co-trimoxazole

severe - IV tazocin

186
Q

what is hepatorenal syndrome

A

cirrhosis + ascites + renal failure

187
Q

pathology of hepatorenal syndrome

A

abnormal haemodynamics

causes splanchnic & systemic vasodilation, but renal vasoconstriction

188
Q

types of hepatorenal syndrome

A

HRS type 1

  • rapidly progressive
  • v poor prognosis

HRS type 2

  • slowly progressive
  • poor prognosis
189
Q

Mx of hepatorenal syndrome

A

liver transplant
vasopressin analogues (terlipressin)
albumin
TIPPS

190
Q

energy daily requirement

A

30kcal/kg/day

191
Q

protein daily requirement

A

0.8-1g/kg/day

192
Q

components of the MUST score

A

BMI + wt loss score + acute disease effect score

0 = low risk 
1 = med risk 
2> = high risk
193
Q

types of enteric feeding

A

NG tube
NJ tube
PEG tube

194
Q

indications for enteric feeding

A

oral intake likely to be absent for 5-7d AND gut is functioning

195
Q

purpose of NG tube

A

short term use

196
Q

purpose of NJ tube

A

used if there is a problem with reflux or gastric emptying

197
Q

what is a PEG tube

A

percutaneous gastrostomy

- tube directly into stomach through abdo wall

198
Q

purpose of PEG tube

A

longer term feeding is needed (4-6w)
or
a mechanical swallowing obstruction

199
Q

indications for parenteral nutrition

A

intestinal failure

200
Q

how is parenteral nutrition administered

A

via central line

201
Q

what is refeeding syndrome

A

a ++ insulin surge on feeding someone who has been depleted of nutrition. therefore – potassium

202
Q

how to avoid refeeding syndrome

A

start feeding at around 10kcal/kg/day

203
Q

causes of hepatocellular carcinoma

A

cirrhosis - hep B, hep C, alcohol

204
Q

presentation hepatocellular carcinoma

A

wt loss
RUQ pain
acute liver failure
decompensated cirrhosis

205
Q

tumour marker hepatocellular carcinoma

A

AFP

206
Q

Mx hepatocellular carcinoma

A

surgical resection

207
Q

presentation liver haemangioma on US

A

hyperechoic spot - ring of fibrous tissue around it

208
Q

associations with liver adenoma

A

OCP

anabolic steroids

209
Q

Mx liver adenoma

A

males - excision (irrespective of size)

females - imaging after 6m

  • <5cm or decrease in size: annual MRI
  • > 5cm: excision
210
Q

cause of a liver hyatid cyst

A

parasite from tapeworms - Echinococcus granulosis

211
Q

Mx liver hyatid cyst

A
  1. albendazole (sterilizes the cyst)

2. surgical excision

212
Q

sources of a liver abscess

A

biliary sepsis

structures drained by the portal venous system

213
Q

mucosal inflammation only

A

ulcerative colitis

214
Q

transmural inflammation

A

crohn’s disease

215
Q

characteristic site of UC

A

rectum, and extends proximally

216
Q

characteristic site of crohn’s

A

can involve anywhere from mouth to anus

217
Q

microscopic changes in UC

A

crypt abscesses
reduced goblet cells
non-granulomatous

218
Q

microscopic changes in crohn’s

A

skip lesions
fissures
deep ulcers (cobblestoning)
fistula formation

219
Q

smoking - protective or increases risk of UC?

A

protective

220
Q

smoking - protective or increases risk of crohns?

A

increases risk

221
Q

genetic ass. with UC and crohns

A

HLA-B27 +ve

222
Q

presentation UC

A 
bloody stool 
proctitis 
mucus discharge
urgency 
tenesmus 
abdo pain
223
Q

condition associated with UC

A

PSC

224
Q

presentation of crohns

A

determined by site of disease

small intestine - abdo cramps, diarrhea, wt loss
mouth - ulcers, angular chelitis
anus - perianal pain, abscesses

225
Q

condition associated with crohns

A

PBC

226
Q

Ix UC

A
  1. stool studies - faecal calprotectin
  2. flexible sigmoidoscopy + biopsy
  3. colonoscopy
227
Q

Ix crohns

A
  1. stool studies - faecal calprotectin

2. colonoscopy - ‘cobblestoning’

228
Q

Ix acute exacerbation of UC

A
  1. abdo x-ray or CT
    ‘lead pipe colon’ - loss of haustra
    ‘thumb printing - mucosal oedema
229
Q

Mx UC

A
  1. 5-ASA (sulfasalazine, mesalazine)
  2. steroids (prednisolone, hydrocortisone)
  3. immunosuppressants (azathioprine, methotrexate)
  4. anti-TNF
  5. surgery
230
Q

Mx crohns’

A
  1. steroids (prednisolone, hydrocortisone)
  2. immunosuppressants (azathioprine, methotrexate)
  3. anti-TNF
  4. surgery
231
Q

surgery in UC - curative?

A

yes!

total protocolectomy with permanent ileostomy or ileo-anal anastomosis

232
Q

surgery in crohn’s - curative?

A

no

ileocaecal resection

233
Q

types of gallstones

A

cholesterol (90%)

pigment (10%)

234
Q

risk factors for gallstones

A

the 5 F’s

Fat 
Forty 
Fertile 
Female 
Family history
235
Q

what is mirizzis syndrome

A

gallstone in the gallbladder neck presses on the bile duct, causing jaundice

236
Q

complication of gallstones involving the gut

A

gallstone ileus

237
Q

Ix acute cholecystitiss

A
  1. bloods

2. USS (if inconclusive - MRCP)

238
Q

what is cholangiocarcinoma

A

cancer of the biliary system

239
Q

presentation of cholangiocarcinoma

A

painless jaundice
wt loss
pruritus
pale stools/dark urine

240
Q

Ix cholangiocarcinoma

A
  1. bloods - LFTs (obstructive pattern)
  2. MRCP
  3. CT/MRI
241
Q

Mx cholangiocarcinoma

A

resection, XRT

palliative

242
Q

inheritance of haemochromatosis

A

autosomal recessive

243
Q

presentation haemochromatosis

A 
fatigue
erectile dysfunction 
arthralgia 
'bronze diabetic' 
liver symptoms 
cardiomyopathy 
arthritis
244
Q

Ix of haemochromatosis

A
  1. iron studies

Finals Studying - Condensed (22 decks)

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