3rd year gi exam

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  • Created on: 05-04-16 16:13
HVPG for varices to develop and rupture
>10mmhg to develop and >12mmhg to rupture
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3 signs/ clinical features of acute variceal bleeds
Hypotension. Haematemesis. Malaena
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Management of acute variceal bleed
RESUS- o2, IV: blood, ABx, Terlipressin. GASTROSCOPY- w/in 1st 24hours
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HVPG in compensated and decompensated Cirrhosis
Comp- >6-10. Decomp- >12
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Feature diagnositc of cirrhotic ascties
High Serum-Ascites Albumin Gradient (SAAG) > 11mmol/L
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Ascites Management (3 things)
1. Na and H2O Retention (
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8 Complications of Cirrhosis
1) Variceal Bleeds. 2) Ascites (inc. 'Refractory' and 'Diuretic Intractable'). 3) Hyponatraemia ('Dilutional'). 4) AKI. 5) Hepatorenal Syndrome (Type 1 and 2). 6) Spontaneous Bacterial Peritonitis. 7) Hepatic Encephalopathy. 8) Hepatocellular Carcino
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6 Precipitating Factors for HE
Drugs (anti-dep). Dehydration (diuretics, LVP). Portosystemic Shunting (free/ circulating ammonia). Infection. Constipation. Hypokalaemia.
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1st and 2nd line treatment for HE
1st- Lactulose. 2nd- Rifaximin (400mg tds PO)
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Scottish Bowel Screening Programme
Aged 50-74, home-screening test every 2 years
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Managment for Acute Haematemesis in ED
Urgent Cross Match, IV access: FLUIDS, PPIs, Endoscopy immediately after RESUS if unstable or w/in 24hours if stable
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Types and site of oesoph carcinoma
Adenomacarinoma more common (in bottom 1/3 with frequent cell changes) Squamous Cell Carcinoma (any part but only type in top part)
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Blood supply to the fore, mid and hind gut
Foregut: celiac artery. Mid Gut: SMA. Hind Gut: IMA
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What is the primary peristaltic wave?
Starts in pharynx in response to swallowing. (Secondary= starts locally in response to direct stimulation)
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Define dysphagia
Difficulty swallowing- like something is stuck in your throat
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Describe eosinophilic oesophagitis including Mx
Occurs in atopic people= dysphagia & heartburn. Mx= elimination diet (most successful in children) and fluticasone
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Define Globus and Pts. most likely to get it
Feeling of a lump or tickle in throat- hysteria/ depression/OCD
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Define ordynophagia
painful swallowing eg. oesophagitis or infection
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Tests if oesoph. disease suspected (3)
1st = Endoscopy. 2nd= Barium Swallow (doesn't obtain biopsy) . 3rd= Oesophageal Manometry
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Pathophys of Achalasia (2)
1. Hypertonic lower oesoph sphincter. 2. Failure of propogated oesoph contraction => progresive gullet dilation
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Clinical Px of Achalasia
Progressive dysphagia- worsened w/ solids and eased by liquids. 'Bird's Beak' on barium swallow
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Mx. of Achalasia (4)
1.Nifedipine 2.Botulinum Toxin 3. Pneumatic dilatation 4. Surgical myotomy ('heller's')
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Mx. of diffuse oesoph spasm (chest pain mimicing angina) (4)
1.reassure 2. nitrates 3. calcium channel blockers 4.PPI
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Px. and Mx. of Jackhammer/ Nutcracker Oesoph.
V forceful peristaltic activity = episodic chest pain and dysphagia. Mx= Nitrates and Ca-channel-blockers
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PH Monitoring technique and Dx of reflux
Probe 5cm above lower oesoph sphincter. 23hours. PH Reflux
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Mx of GORD Algorthium
1. Antacids -> PPIs (full dose) -> PPIs (maintenance dose) -> H2-agonist -> Antacid [Fundoplcation if no response or side effects from PPIs]
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3 Complications of GORD
1. Oesophagitis 2. Barret's Oesoph. 3. Benign Oesoph Strictures
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Describe Barrets oesoph (=pathog)
Pre-malingnant condition when lower oesoph squamous cells are replaced by collumnar mucosca
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3 risk factors of barrets
1. Male (especially white) 2. >50 3. Obese
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Clinical Px
Asymptomatic until cancer/ oesophagitis Px (30 fold increase of adenocarcinoma)
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Who has a hiatus hernia (3 pts)
Pts with: 1. Oesophagitis, 2. Barrets, 3. Peptic Strictures
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4 Symptoms of Oesoph Cancer
1. Wt. loss 2. Dysphagia, 3. Chest Pain 4. Anaemia
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2 risk factors of oesoph Adeno.cc and 2 for Squam.cc
Adeon.= Reflux and Obesity Scc= Smoking and Alcohol
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5 Ix for Oesoph tumour
1. Endoscopy w/ biopsy 2. CT (staging) 3. EUS 4. Laproscopy 5. PET
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Define Rome II Criteria to Dx IBS
At least 12 months of Abdo pain w/ 2 of the following: 1. Relief by defaecation 2. Onset associated w/ change in stool freq 3. Onset associated w/ stool appearance
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Pts most commonly w/ IBS (5 risk factors)
1.Women 2. < 40 3. Family Hx 4. Emotional Stress 5. Food Intolerance 6. Past travellers diarr or Food poisoning
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4 lifestyle Mx modifications for IBS
1. Fibre rich food (low fod-map diet) 2. Increase fluid intake 3. Increase PA 4. Ritualised Bowel Habits
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IBS 2nd line Mx = Drugs
1. Bulk Forming (methylcellulose) 2. CONSTIPATION= Osmotic Laxatives (movicol) 3. DIARRHOEA= Loperamide &/or Mebeverine 4. DEPRESSION= eg. amitriptilline
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Alternative Mx of IBS
CBT or Biofeedback (re-educating PR muscles to relax not contract inappt during straining)
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Transmission of staph aureus to food poisoning
From poor hygeine from food handlers to food
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Incubation , Symptom & Resolution of Staph Aureus
Incub. = 6-12 hours. Symp.= Abrupt vomit. Resolut= w/in 24hours
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Food transmitting bacillus Cereus
Milk and Cooked Rice
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Incub, Symptom and Resolution of Bacillius Cereus
Incub.= 3-8hours. Symptom = Vomitting Resol. = Rapid onset and rapid resol
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Define acute, persistent and chronic Diarr
Loose/ Watery stools at least 3x a day for: Acute= >7 days. Persistent >1430 days
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Describe small and large gut diarr
Small gut= large volume, watery & smelly if malabsorbative. Large Gut= Smaller volumes often w/ blood or mucous
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2 bacteria causing vomitting
Staph Aureus and Bacillus Cereus
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Long -term complications of H.Pylori Infection
chronic gastritis § PUD § gastric carcinoma § gastric lymphoma § non-ulcer dyspepsia § recurrent abdo pain in childhood
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Candidates causing vomitting and diarr (2)
Norovirus and Rotavirus
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Ages that norovirus and Sapovirus affects
Noro.= all ages. Sapov.=
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Clinical picture of norovirus
vomiting at the start, profound nausea, moderate watery low volume diarrhoea (4-8 BM /day). Fever in about 40%. Duration usually 2-3 days (up to 6)
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What does rotavirus cause?
leading cause of severe dehydrating diarrhoea in childhood. [50% have a rash § 50% have respiratory symptoms § reddened eardrums common]
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3 infections that cause predominatnly diarr.
§ Clostridium perfringens § Vibrio cholerae § Enterotoxigenic E.coli
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Key clinical Px of cholera infection
Rice Water small bowel diarr. (worse in h pylori infectde Pts.)
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Mx. of cholera
single dose of 1g azithromycin
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Causative food and Symptoms of Salmonella
Poultry,Eggs & Fast-Food= Nausea, Vom. & Diarr.
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Food causing campylo bacter and Px.
Animal products eg. chicken , beef and milk. Px= severe abdo/ colick pain. Variable Diarr.
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Cause of Shigella and Px
Poor Sanitation. Large Gut Diarr (usually containing neutrophils)
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Px. and Mx of Giardia
Post- travels. Foul smelling malabsorp Diarr. Post-prandial bloating. Mx.= 400mg metronidazole tid, 5-7days.
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Causes of rose spots (rash on trunk)
Enteric (thyphoid) fever causes by Salmonella infection
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Px. and Mx of tropical sprue
attack of acute diarrhea, fever and malaise. Then chronic diarr and nutrient defic./ malabsorp. Mx. = tetracycline 250mg qid + folic acid 5mg daily for 1 month
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How is Hep A transmitted? (3)
1. Faecal-Oral. 2. Infected Water. 3. Uncooked Shellfish
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Clinical Px. of Hep A
Acute never Chronic Hep. Jaundice (increases w/ age) Preceededby malaise and anorexia. Feel unwell for 6weeks.
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Mx of Hep A
No Mx of acute Hep A rqd- vaccine to prevent is very effective
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Transmission of Hep B
1. Perinatal (90% infants born to hep b +ve mums) 2. Unclean Needles. 3. Sexually Transmitted
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Describe acute Hep B infection (3 symptoms)
1-4 months post-infection = 1. Jaundice. 2. Malaise, 3. RUQ Pain
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Describe chonic Hep B Infection
HBsAg positive > 6months
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Length of Immune tolerant phase of Hep B infection and 2 biochem results
>30 years. 1. HBeAg positive . 2. Normal ALT
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Biochem changes and length of Immune Active Hep B stage
ALT increases and HBeAg decreases. Lasts months-years until HBeAg completely cleared ("seroconversion").
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Markers of HBV infection (3)
1. ALT 2. HBeAg 3. HBV- DNA
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3 complications of HBV
1. Hepatocellular Carcinoma, 2. Cirrhosis, 3. Polyarteritis Nodosum
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Mx. of HBV (Chronic)
Anti-Virals: IFN-alpha (Peginterferon alfa-2a) . Entecavir, Telbivudine, Tenofovir disoproxil, Lamuvidine
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HCV Transmission route
Iv Drugs (60%) , Contaminated Blood Transfusion
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Px of HCV
Acute icteric (jaundice) Hep. Chronic silent infection follows in 50-85% Pts.
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HCV Complications and screening/Mx.
Cirrhosis => screening for oesophageal varices rqd.+ve => propanolol prophylaxis 40mg bd or carvdeiol. AND AFP & US screening for HCC every 6months
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HCV anti-viral Mx.
Pegylated interferon and ribavirin
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Interferon & Ribavarin Side Effects
INTERF.: Myalgia, Fatigue
 Injection site reaction, Dermatitis, Depression. RIBAV: Haemolytic Anaemia
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Name 2 specific drugs for chronic HCV
1. Sofosbuvir 2. Simeprevir (both given with interf. + ribav.)
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HEV Transmission Route
Faecal- oral in association w/ poor sanitation. Occurs in epidemics.
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Average incubation period of HEV
40 Days (15-60 day range)
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Chronic Sequelae of HEV
Immunosuppresion
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Indications of liver transplant
HCC NOT liver failure
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What is Rovsing’s sign?
Palpation in LLQ = Pain in RLQ => Appendicitus
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What is Grey-Turner’s sign?
Flank bruising = Acute Pancreatitis
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What is Cullen's Sign?
Oedema & Bruising around Umbilicus = Acute Pancreatitis
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+ve Murphy's sign Dx
Cholecystitis
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6 Pathogenic categories w/ example of cirrhosis aeitiology
1. Drugs/ Toxins (methotrexate or alcohol) 2. Infection (Hep.B or C) 3. Biliary (PBC or SBC. PSC) 4.Autoimmune (Hep.) 5. Metabolic (Wilson's) 6. Vascular (Budd-Chiari)
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Most common cause of Cirrhosis
Alcohol (50-60%)
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6 most common clinical features of Cirrhosis
1. Ascites. 2. Jaundice 3. Circulatory changes (spider nevi, palmar erythema) 4. Endocrince (Gynaecom., Hair loss) 5. Portal Hypertension (Variceal bleeding, hepato-splenomeg.) 6. Clubbing, leukonychia, flap, dupytrens
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Dx blood test results of cirrhosis (FBC, Clotting, U and Es, LFTs)
FBC= Anaemia, Thrombocytopenia. Clotting= Increased Pro-thrombin Time U and Es= Hyponatraemia and Decreased Urea. LFTs= Hyperbilirubin, (>100umol/L), Increased Transaminase and ALP. Decreased Albumin
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Specific Dx findings if PCB or PSC are the cause of cirrhosis
PCB= IgM. PSC= ANCA
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Specific Mx of PSC Cirrhosis
Ursodeoxycholicacid
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Mx. of bleeding Oesoph Varices (4/5)
1. Resus. 2. Endoscopic band ligation 3. Terlilpressin 4. Balloon Tamponade OR TIPSS
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Secondary Prevention of Variceal Bleeding (2)
IF Haemodynamically Stable: Band Ligation. Propanolol
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Primary prevention of Initial Variceal bleed (if non-bleeding varices detected on endoscopy)
1. Non-selective B-Blocker eg. 80-160mg/day Propanolol. OR Carvedilol 2. Band ligation of intolerant of B-Bs
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Mx. of ascites in Cirrhosis
Na restriction + Diuretics (spiro and furose. combo.)
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Side Effects of Terlipressin
Ischaemic local events at injection sites. Contraindicated in pregnancy
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3 Risks of inserting seng.-blake. tube
1. Oesoph. Perforation. 2. Aspiration 3. Malposition
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3 Indications for TIPSS
1. Uncontrolled/ Recurrent Variceal Bleeding. 2. Gastric Varies 3. Refractory Ascites
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2 Main treatments for gastric variceal bleeding
1. Inject Tissue Adhesives (Cyanacrolyte)) 2. Inject Thrombin
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Secondary prophylaxis of gastric variceal bleeding
AFTER 5 DAYS. Cyanacrolyte injection or thrombin. TIPSS if large or multiple varices
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4 Complications of Diuretic Therapy for Ascites
1. Electrolyte Imbalance 2. AKI 3. Painful Gynaecom. 4. Encephalopathy
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3 Mx options for refractory ascites
1. Repeated LVP (+albumin) 2. TIPSS 3. Liver Transplant
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Cause of the majority of AKI
Outpatients - diuretics and lactulose
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Define type 1 and type 2 HRS
Type 1 = Occurs acutely w/ acute liver disease or compensated cirrhosis => JAUNDICE 2. Type 2= Chronic development, usually w/ Refractory Ascites and MILD JAUNDICE
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Type 1 HRS Mx.
Terlipressin w/ Albumin
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Spontaneous Bacterial Peritonitis (SBP) Dx. and Mx
Dx= Ascitic fluid PMN count >250 cells per mm3. Mx= 3rd generation cephalosporins and albumin
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Timing of HCC screening
6 monthly AFP and USS
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Benefits of Albumin for acute decompenstaion cirrhosis Pts
Improves renal blood flow autoregulation
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4 causes of PUD
1. H. pylori 2. NSAIDS (mostly gastric) 3. Smoking 4. Gastrinoma (Zollinger-ellison)
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How does h.pylori cause PUD?
Oral transmission-> Releases cytotoxins (vacA and cagA) -> Somatostat. Decrease (normall inhibits hypersecretion of acid0-> Increased gastrin release
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3 Non-invasive tests to diagnoses H.Pylori
1. C-urea breath test 2. Serology (need to be off PPIs for 14days prior) 3. Stool Antigen Test
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Describe the Invasive and diagnostic test for h.pylori
CLO- antrum biopsy. PH measured. Yellow -> Red = +ve for HP
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4 Risk factors for NSAID induced PUD
1. >60 YRS old. 2. Previous PUD 3. Previous high dose NSAIDS 4. Concomitant CS use
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3 Specific clinical features of PUD
Recurrent abdo pain w/ 3 characteristics= 1. localised to epigastrium 2. Associated w/ food (worse post food but DU improved by eating) 3. Episodic Occurence
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3 Signs/ Symptoms of acute PUD
1. Haematemesis 2. Melena 3. Perforation
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Clinical sign of a silent Ulcer
Anaemia
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3 Investigations of PUD
1. Endoscopy 2.Barium meal examination 3.HP status [Re-endoscopy if think it's malignant]
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HP Eradication Mx. (1st line and second line)
1st (PPI w/ 2 ABx) = Lansoprazole 30mg twice daily (or omeprazole 20 mg BD) Clarithromycin 500mg twice daily Metronidazole 400mg twice daily all three for 1 week only 2nd= Lansoprazole 30mg twice daily(or omeprazole 20 mg BD) Clarithromycin 500mg
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Side Effects of HP Eradication
1.Diarrhoea 2. Metronidazole: metallic taste, flushing/vomiting (if taken with alcohol) -Nausea&vomiting -Abdominal cramps -Headaches -Rash
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NSAID Ulcers prescription change
To COX-2 eg. Rofecoxib or Celebcoxib
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6 Factors associated w/ Gastric Carcinoma
1. Smoking 2. Alcohol 3. HP 4. FAP 5. Diet rich in nitrosamines 6. Pernicious Anaemia (B12/ Folate Deficiency)
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4 Clinical Features of Z-E Syndrome
1.Multiple ulcers often unusual sites 2.Poor response to standard therapy 3.Complications are common 4.Diarrhoea (+++ Serum Gastrin)
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Emergency and Elective Indications for PUD Surgery
Emergency (Perforation or Bleeding) Elective (Gastric outflow obstruction or Recurrent ulcer post-op)
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3 symptoms of ulcer perforation
1. Peritonitis, shock 2.sudden severe pain 3. shoulder pain due to irritation of diaphragm
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4 Common causes of acute pancreatitis
1. Gallstones 2. Alcohol 3. Post-ERCP 4. Idiopathic
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Typical Px of Acute Pancreatitis (3)
1. Severe upper abdo pain Radiating to the Back 2. Nausea & Vomiting 3. Grey-turners or Cullens sign
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3 Ix for acute pancreatitis
1. Raised serum amylase or lipase 2. US or CT (6-10 days after admission) Pancreatic swelling 3. FBC (>wbc) and LFT (>AST)
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2 2nd line Ix of acute Pancreatitis
1. Fasting plasma lipids 2. Fasting Plasma Ca (after acute episodes)
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3 features that worsen acute panc severity
1. BMI> 30 2. Pleural Effusion on CXR 3. CRP>150mg/L (hours after admission)
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Acute Panc Mx.
1. Fluid Resus 2. Analgesia 3. Nil by mouth (dietician feeding options) 4. Monitor and treat any complications
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3 local and 3 general complications of Acute Panc
Local= panc. necrosis/ pseudocyst/ absess Generalised= Resp./Renal/ Circulatory Failure
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2 Indications/ Px for ERCP in acute panc.
1. Jaundice 2. Acute Cholangitis
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Cause of Early and Late Death in Acute Panc.
Early death= multi-organ failure. Late Death= Infected Panc. Necrosis
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Most common cause of chronic pancreatitis
Alcohol misuse (80 Western cases)
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Clinical Px of chronic Panc (3ish)
(middle-aged alcoholic male) 1. Epigastric pain radiating to back (episodically acute or slowly progressive) - pain relieved by alcohol or leaning forward 2. Wt loss/ Anorexia (post-prandial pain or malnutrition) 3. Steattorrhea
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3 parts of chronic panc Ix
1. Nutritional Assessment 2. Panc Function Tests (steatorr. or DM) 3. Panc Morphology ( CT, ERCP)
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Mx of chronic panc (4)
1. Alcohol counselling 2. Analgesia 3. Malnutrition Mx. (Creon) 4. Mx of complications
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4 Complications of Chronic Panc
1. Pseudocysts 2. PVT 3. Biliary obstruction (jaundice) 4. Panc Cancer
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Pancreatic resection option
1. Whipples Procedure (pancreatico-duodenectomy)
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4 risk factors for pancreatic cancer
1. Males 2. Smoking 3. Increased Age 4. Chronic Panc
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Most common Panc Cancer
Ductal panc. adenocarcinoma (90%)
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3 Px features of Panc Cancer
LATE Px 1. Central abdo pain (radiating to back) 2. Wt loss 3. Obstructive Jaundice
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Dx test for panc cancer
CT/ US
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Mx of Panc Cancer
Surgical resection (adds 1-2yrs to LE)- POOR PROGNOSIS= 5months median (all develop metastatic disease)
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6 Risk factors for gallstones
1. Fat 2. Female 3.>40 4 . Fertile (preg) 5. Fair (caucasians) 6. Family Hx
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4 clinical features of gallstones
1. Asymptomatic (80%) 2. Biliary colic 3. Acute Cholecystitis 4. Chronic Cholecystitis
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3 complications of gallstones
1. Acute pancreatitis 2. Gallstones ileus 3. Gallstone Cancer
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Px of biliary colic (2)
1. Episodic RUQ/ Epigast Pain (radiates to lower scapula) 2. Fatty food brings on pain
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Dx of biliary colic
Stones on USS
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Conservative, Medical and Surgical Mx of Gallstones
Conservative= low fat diet. ONLY IF SYMPTOMATIC: Medical= Oral Dissolution (ursodeoxycholic acid) Surgical= Cholecystectomy
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Px of Acute Cholecystitis (describe characteristic pain, associated symptoms &+VE Finding)
1.Pain in RUQ and Epigastrium & R Shoulder Tip/ Scapula region 2. Systemic Upset (nausea/ Vom) 3. = +ve Murphy's Test
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Medical Mx of Acute Cholecystitis
1. IV Fluids Resus 2. Analgesia 3. ABx
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Acute Cholecyst Surgery indications
Empyema or Perforation
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What tests differentiates between hepatic and obstructive Jaundice
LFT Pro Thrombin Time
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Px of Acute Cholangitis (TRAID)
Charcots Triad= 1. RUQ Pain 2. Fever +- Rigors 3. JAUNDICE
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Mx. of Acute Cholangitis
1. IV Fluids 2. IV ABx 3. ERCP Sphincteretomy or Cholecystectomy
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Clinical features of gallbladder Cancer
1. Repeated attacks of biliary colic ->2. jaundice and Wt loss 3. Palpable Mass in R.Hypochondrium
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LFTS in Gallbladder Ca
Cholestasis (BILE FLOW OBSTRUCTION) => Increased Bilirubin, ALT & AST
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5 Risk Factors for Colorectal Adenomas
1. Age (peaks at 75yrs old) 2. Western Diet (high fat, red meat, low fibre) 3. FAP 4. Lifestyle- smoking and decreased PA 5. ibd
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Amsterdam Dx. Criteria for HNPCC (3)
1.>3 fam members affected 2.> 2 Generations Affected 3. at least one fam member
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Emergency Px of Colorectal Ca
Bowel Obstruction= absolute constipation, vomitting, distention, localised abdo pain
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Left colon and Right Ca Symptoms
Left= fresh rectal bleeding and early obstruction. Right= Anaemia (occult bleeding), ABH, Obstruction= late Px.
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Ix of symptomatic pts.
1. Colonoscopy 2. Barium Enema and Flexible Sigmoidoscopy 3. CT abdo, chest, pelvis- for staging
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Emergency Surgical options (perforation or obstruction) (3)
1.Segmental excision and on-table colonic lavage 2.Colectomy and ileorectal anastomosis 3. Hartmann's procedure
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Elective Surgical Options for colo-rectal Ca (4)
1.Segmental resection (eg R-hemicolectomy, ant. resection etc) 2.Restorative rectal excision +/- colonic pouch 3.Transanal excision of rectal cancer 4Colonoscopic polypectomy
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Px. of anal carcinoma (5)
1.Ulcer, 2. warty lesion, 3.pruritis, 4 pain, 5bleeding
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1st line and 2nd line adjuvant chemo examples
1st= capecitabine. 2nd= Cetuximab
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Mx of anal Cancer
similar to rectal: Resection surgery w/ pre/post chemo
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Define range of normal bowel habit
Once every 3 days-> 3x a day
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Main cause of Diverticulosis
Low fibre diet (and increases alot with age)
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3 Clinical features of Diverticulitis
1. Suprapubic or LIF Pain/ Tenderness ('guarding') 2. Alternating Diarr. and Constipation (ABH) 3. Fever
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Ix for Diverticular Disease (2)
Barium Enema or Flexible Sigmoidoscopy/ Colonoscopy
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Conservative Mx for Diverticular disease (2)
1. High fibre Diet (if constipation) 2. Anti-spasmodics
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Mx of acute diverticulitis (2)
1.IV fluids. 2. ABx: 7days metronidazole (400mg 3xday)
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3 Complications of Diverticular disease
1. Perforation (Mx.= Hartmann's Resection) 2. Haemorrhage 3. Pericolic Absess (Mx= Drainage & ABx)
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Difference between External and Internal Haemorrhoids
Ext.= Below Dentate Line (covered in squamous epith.) -> V. Painful Internal = Above Dentate and covered in columnar epith
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3 grades of Internal Haemorrhoids
1st= bleed w/ defaecation. 2nd= Prolapse w/ defaecation but spontaneoulsy retract. 3rd= Prolapse w/ defaecation but require manual retraction
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4 Clinical features of Haemorrhoids
1. Bright red blood on toilet paper. 2. Pain. 3. Pruitis. 4. Mucus Discharge
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Conservative (1) and Non-Conserv. (3) Mx of Haemorrhoids
Conserv.= High fibre diet (prevent straining/ constipation) Non-Conserv. = 1. Injection Sclerotherapy. 2. Band Ligation 3. HALO
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4 Risk Factors of Chrons
1st= Genetics (NOD 2) 2. Smoking 3. Ashkenazi Jew 4. Low fibre & High refined sugar diet
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2 Age peaks of Chrons incidence
20-30 then 50-60
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3 Histological features of chrons
1. Skip Leisons. 2. Transmural fissuring/ Ulcers. 3. Non-caseating granulomas (cobblestone)
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3 Major symptoms of Chron's
1. Abdo pain 2. Watery Diarr. 3. Wt. loss (post-prandial pain) (4. Growth disturbance (in children))
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Extra-Intestinal manifestations ofIBD (6)
1. Athritis or OP 2. Skin Changes= erythema nodosum, gangrene. 3. Eyes=Iritis 4. TE 5. Oral = Glossitis/ Angular Stomatitis 5.Renal or Gallstones
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3 Principles of Chrons Mx
1. RESUS (correct metabolic & nutritional distrubances) 2. Treat Active Disease 3. Maintenance of Remission
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Blood test to distinguish IBD from IBS
Faecal Calproctecin (+ve in IBD)
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Mx of active chrons / induction of remission
CS= 9mg/ day Busenoide for 6 weeks (pred if no improvements from budes) + Vit D and Ca Supplements
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Chron's Maintenance Therapy
Immunosupp. = 5-ASA/ Azathioprine
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3 Common minor side effects of azathioprine
1. Nausea, 2. Fever/ Malaise 3. Skin Rash
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4 Indications for surgery in Chrons
1. Failure of Meds, 2. Sepsis (fistulae/ absess) 3. Obstruction 4. Colon Cancer
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Risk Factors for UC
1st = Genetics (NOD 2) 2. 20-40yrs old steady increase from 30) 3. Ashkenazi Jews => NOT SMOKING (could be protective?)
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2 Cardinal symptoms of UC
1. Rectal Bleeding 2. Mucus & Bloody Diarr
192 of 227
4 Provoking features of relapses
1. Stress 2. Gastroenteritis (eg. salmoell or e.coli) 3. ABx 4. NSAIDs
193 of 227
True-love and Witts criteria for UC Severity
Mild: 6 stools per day w/ blood & systemic disturbance
194 of 227
3 Histological features of UC
Colon Only= 1. Confined to mucosa 2. Loss of goblet cells, 3. Crypt Absess
195 of 227
Mx of active UC Disease and Maintenance
Oral 5-ASA and Azathioprine
196 of 227
Mx. of severe UC (3)
1. IV fluids and e's 2.IV Steroids (hydrocortisone or methylpred.) 3. Prophylactic LMWH
197 of 227
Indication for emergency colectomy in UC
Toxic Megacolon!! (colon diameter>6cm & nil response to meds for 7-10days)
198 of 227
Clinical Px of Coeliac in adulthood (20-30s) (3)
1. Diarr. 2. Florid Malabsorption signs (Wt.loss& Nut. deficiencies) 3. Oral ulcers= glossitis & angular stomatitis
199 of 227
Histology of Coeliac (3)
1. Villi blunting 2. Crypt hyperplasia 3. Inflamm. infiltrate into lamina propria
200 of 227
2 Complications of Coeliac Disease
1. Malignancy eg. Oesoph. (2 fold increased risk) 2. Metabolic Bone disease (OP or OM)
201 of 227
Severe extra-intestinal complication ofIBD
Adeoncarcinoma
202 of 227
Cause Pseudomembranous Collitis & Px
Course of Broad Spectrum ABx. Diarr. & Abdo Cramps usually w/in 1st week of ABX./ C.diff infection (post-op or hosp. admission)
203 of 227
Mx. of PMC
Vancomycin or Metronidazole
204 of 227
6 Causes of Haematemesis
1. Gastritis/ Gastric Erosions 2. Oesophagitis 3. Mallory-Weiss Tear 4. PUD 5. Gastro-oesophageal Varices 6. Oesoph.-gastric cancer
205 of 227
Histological pattern of GIST
'Spindle-cell' pattern
206 of 227
New Drug for GIST
Imatinib (Glivec)
207 of 227
Difference in pain from small bowel and large bowel obstruction
Small= central/ mid-abdo & colicky w/ short lasting spasms. Vomiting BEFORE constip. Large= Lower abdo. Longer spasms. Constip. BEFORE Vomit
208 of 227
What lymphoma is strongly associated w/ Coeliac disease
Enteropathy type T- cell lymphoma.
209 of 227
Most common tumour found in the appendix
(Neuroendocrine) Carcinoid tumour
210 of 227
How big do appendix tumours have to be for lymph node mets to be analysed?
>2cm
211 of 227
Most common cause of Apple Core Sign on Radiology
Colorectal carinoma
212 of 227
4 Prognositc factors for colorectal cancer
1. Depth of Local Invasion 2. Peritoneal Involvement 3. Circumferential Margin 4.Lymph Node Mets
213 of 227
2 Clinical signs of cholestasis
Pale Stool and Dark Urine
214 of 227
Cause of ALT>AST (2)
1. Viral Hepatitis 2. Non-Alcoholic Fatty Liver Disease
215 of 227
Cause of AST x2> ALT
Alcoholic Liver Disease
216 of 227
Common causes of acute liver failure in young adults treated by transplant
paracetamol OD
217 of 227
Cause of mallory bodies ( paranuclear eosinophilic microfilaments) in liver cells
Excessive alcohol consumption
218 of 227
What is the best single Lab finding to Dx Wilson's
Low Serum caeruloplasmin (major copper carrying protein in the blood)
219 of 227
Drug choice for Wilson's
Pencillamine
220 of 227
What diseases are pts w/ PBC at increased risk of?
Autoimmune eg. CREST, Thyroid and IBD
221 of 227
What is a diagnostic result in PBC (blood test &biopsy)
+ve AMA and Portal Hepatitis on biopsy
222 of 227
Drug/ Tx of PBC
Ursodeoxycholic acid (UDCA)
223 of 227
What do 80% of Pts. w/ PSC also have?
IBD and most commonly UC
224 of 227
Diagnostic test of choice for PSC and result
cholangiography- ERCP = stricturing and dilation in the intrahepatic or extrahepatic biliary tree, or both.
225 of 227
Mx of PSC
Currently no drugs=> ERCP w/ balloon dilatation
226 of 227
Define acute liver failure
development of hepatic encephalopathy or coagulopathy (INR
227 of 227

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