Gastroenterology

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Adult with epigastric pain, vomitting, and early satiety with PMH of PUD and pancreatitis

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Annular Pancreas

  • 50% discovered in childhood
  • Associated  with other congenital anomalies: EA, TEF, DA/DS/DD, inperforated anus, malrotation, Down’s
  • 85% 2nd portion of duodenum
  • Usually incidental finding but may cause duodenal obstruction and “double bubble” sign, N/V, abdominal pain*
  • TX: gastrojejunostomy, duodenojejunostomy
  • CX: periampullary PUD, pancreatitis

Duke DDX Duodenal Narrowing/Obstrucion

  • Congenital – duodenal artesia in neonates, annular pancreas, duodenal web/diaphragm, Ladd’s bands, duplication cyst
  • Inflammatory – postbulbar ulcer, Crohn, Infective(TB, Strongyloides), pancreatitis, XRT
  • Malignant – duodenal carcinoma, lymphoma, pancreatic carcinoma, mets
  • Trauma, intramural hematoma
  • SMA syndrome
  • Aortic anuerysm
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These signals are relayed buying clomid online safe which then is by a number of such as medial preoptic and paraventricular nulcei.
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