問題一覧
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شو الفرق ما بين chronic gastric ulcer and chronic doudenal ulcer
GU normal acid or hypoacid DU hyperacidic GU H.pylori 60% DU H.pylori 90% GU old age DU young age GU periodicity No DU periodicity present GU pain early after food relive by fasting and at night weight gain decrease DU pain late after food relive by food increase by fasting relive by alkalise milk and anti acid weight gain increase GU vomiting is common PU vomiting is rare GU ratio of hematomaisis:melena 60%to 40% DU ratio of hematomaisis:melena 40%to 60% melena defntion black tare stool hemorrhage GU>DU perforation DU>GU malignancy GU>DU
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شو هم ال tried of peptic ulcer disease
epigastric pain hematomassis melena
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best diagnose of peptic ulcer disease
EGDS and biopsy must be done for GU
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most specific test of ZES or gastrinoma or hypergastrinemia
secretation stimulating test
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secretation stimulation test كيف مبدأ العمل
الأصل عندما نعطي secretin يعمل stimulation for pancreatic enzymes and suppression to gastrin
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what are the methods of dx H.pylori
2 method invasive noninvasive
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what is the gold standart or best test of h.pylori
invasive antral mucosa biopsy and culture
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شو هي الطرق الأخرى for dx of H.pylori
rapid unease test (biopsy) بتاخذ عينه من المنطقه المتضرره وتضعها تحت microscopic اذا تغير لونها هذا بدل على وجود H.pylori
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شو الفرق بين invasive and noninvasive
invasive يحتاج إلى تنظير noninvasive لاتحتاج إلى تنظير
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شو هو most common used dx for H.pylori from invasive method
rapid urease test
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شو هو more common used for dx H.pylori and follow up of the treatment of peptic ulcer disease from noninvasive methods
urea breath test
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امثله أخرى من noninvasive method to dx H.pylori
serology ابتعتمد على antibody stool antigen
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treatment of peptic ulcer h.pyloriy related
medical triple 1ppi for 4wks 2antibiotics for 2wks 1penicillin 2metranidazole 3tetracycline 4macrophagis
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متى يلجأ إلى surgery in peptic ulcer disease
intractability بمعنى there is no healing after medical treatment dyspladia or cance هذا absolute indications for surgery بنلاقيه اكثر اشي في GU ........... هذه ال indication في حاله hemorrhage failure of endoscopy failure of radiology massive bleeding >8units recurrent (اذا دخلنا في المريض endoscopy وعاود رجع وصار عندوا bleeding) unstable patient ........... Pyloric stenosis perforation indication of emergency surgery
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اي مريض عنده GIT bleeding سواء upper or lower بشو بنبلش العلاج
ABC A airway security B breathing C circulation شو هي cannula التي توضع large pour cannula مثل 14cage يعني لونها orange او16cage لونها grea IVF PRBc infusion وبعد ذلك ابنعمل urgent GI endoscopy لاحظ اذا كان bleeding from esophageal varices اعمل urgent ballon
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most common indication of emergency laparotomy in peptic ulcer disease
perforation
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most common complication of peptic ulcer overall
bleeding
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شو هم أنواع GIT BLEEDING
upper GI bleeding lower GI bleeding
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من وين مصدر ال upper GI bleeding
above of ligament of Treitz ويتواجد مابين D2D3
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من وين مصدر lower GI bleeding
below the ligament of Treitz or below D3
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most common type of GI bleeding
upper GI bleeding
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most common cause of upper GI bleeding
Peptic ulcer disease
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in peptic ulcer disease who is more incidence
DU ونسبه المرضى 4-1
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with whom is the bleeding more
GU
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most common cause of lower Gl bleeding
upper GI bleeding
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most common lower cause of lower Gl bleeding in old age
diverticular disease 1st most common or angiedysplasia 2nd most common in old age
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most common lower cause of lower Gl bleeding in young age
hemorrhoids
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other causes of upper GI bleeding
Anticoagulant -drug induced antiplateletes امثله Dic VWD Hemophilia varices في مرضى liver cirrhosis, portal hypertension العلاج ABC esophageal balloon 24hr اسم ال balloon balckmar balloon Mallory wise tear موجد في ال lower third of the esophagus esophagitis gastritis tumor aortic enteric fistula Hemophilia Boerhaave's syndrome Mallory wise tear cause more bleeding more than Boerhaave's syndrome(Difention full rupture of the esophagus)
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patient that have upper GI bleeding شو بيجي معهم
hematemesis ولذلك if you put NGT سوف يكون هنالك blood + melena (black tear stool)
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most common site of Diverticuler disease in lower GI bleeding
in the sigmoid more in the left side painless massive bleeding
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most common site of angiedysplasia in lower GI bleeding
in the ascending colon more in the right side
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most common cause of lower Gl bleeding in children is
Meckel's diverticulum
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most common cause of lower Gl bleeding in infants is
anal fissure minimal bleeding and painful
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other causes of lower GI bleeding
colorectal cancer IBD ulcerative colitis >Crohn's disease T.B polyps hemorrhoids m.c.c of lower Gl bleeding in young age anal fissure minimum bleeding and painful rectal varices عند مرضى ال liver cirrhosis colitis pseudocolitis infection colitis
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شو هو ال ivf that should be used in patient with GIT bleeding
crystaloid fluid مثل Ringer lactate or normal saline
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شو هم أنواع ال jaundice
pre hepatic jaundice hepatic jaundice post hepatic jaundice
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كيف يتم علاج ال jaundice
pre hepatic jaundice ttt medical hepatic jaundice ttt medical post hepatic jaundice ttt surgical
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شو هم أنواع ال jaundice من ناحية direct or indirect
pre hepatic jaundice هو ابيرتفع indirect hepatic jaundice ممكن ايكون direct or indirect ابيرتفع في ال indirect هناك سببين لال Gilbert's syndrome او crigler najjer syndrome Post hepatic jaundice direct ابيرتفع
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أين لا يوجد او بكون negative Urin uro bilinogen or thecal uro bilinogen
post hepatic jaundice (Obstructive jaundice)
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في انو jaundice بكون ALP and GGT كثير عاليين
post hepatic jaundice (obstructive jaundice)
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bilirubin لما ايكون في ال urine مع انو واحد وليش
direct bilirubin لانه water saluble
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أين يكون bilirubin in urine negative negative
pre hepatic jaundice
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في انو jaundice بيكون haptoglobin بيكون decreased اما الباقي بكون normal
pre hepatic jaundice
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في انو jaundice بيكون LDH مرتفع اما الباقي بكون Normal
pre hepatic jaundice
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شو هم اسباب pre hepatic jaundice
hemolysis hyper thyroidisem heart failure hematoma
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شو هم اسباب ال hepatic jaundice
crigler najjer syndrome indirect Gilbert's syndrome indirect hepatitis direct sepsis direct TPN total parenteral nutrition direct liver cirrhosis direct C.F cystic fibrosis direct dopsin Johnson syndrome direct rotor syndrome direct
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شو هم اسباب post hepatic jaundice )obstructive jaundice(
مسببات CBD choledachalithiasis(Stone) cholangitis(التهاب ال CBD) Choledicyst choligiocarcinoma ascariasis inf pancreatic cancer doudenal cancer pancreatitis
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شو هو الي ما يسبب post hepatic jaundice وليش
cholilithisis السبب انها stone in gallbladder مش في CBD Cholilithiais ممكن يؤدي إلى jaundice بس في حاله واحده وهي barraiss syndrome
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شو هو ال jaundice الذي يعالج surgical
post hepatic jaundice (obstructive jaundice)
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شو هم ال types of surgical procedures
clean surgery the risk of infection less than 1.5% clean contaminated the risk of infection less than 3% contaminated the risk of infection up to 5% dirty the risk of infection 30-50%
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تعريف clean surgery procedure
No entry to any cavity and no need for antibiotics
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clean contaminated تعريف
entery to prepaired cavity مهم جدا بكون عندي miner break in the aseptic technique need prophylactic
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تعريف contaminated surgery procedures
entry to unprepaired cavity مهم جدا major break in the asceptic technique مثل عمليات colon obstruction or infected appendicitis or cholecystitis or acute Diverticulitis
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تعريف dirty surgical procedures
مهم جدا full break of the asceptic technique غالبا ما بكون فيها pus مثل abscess غالبا ما بكون فيها stool مثل purulant inflammation need antibiotics
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شو هو ال risk factor of esophageal cancer in general
male old age geography اهم cancer GI الذي له علاقه geography هو esophageal cancer لانه الاكل تاعهم بحتوي على hot liquid and hot food و أهم GI cancer له علاقه ب rase هو esophageal cancer مثل اليبان و كوريا و الصين smoking اهم GI cancer له علاقه ب smoking هو pancreas cancer Alkohol obesity مين هو GI cancer الذي له علاقه ب diat هو esophageal cancer
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most common GI cancer over all
colorectal cancer
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most common 2nd GI cancer
pancreas cancer
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شو هو ال risk factor for esophageal cancer for esophageal adenocarcinoma بالتحديد هم
severe GERD Barrett's esophagusوهو premalignant
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شو هو risk factor for esophageal cancer for SCC squamous cell carcinoma بالتحديد هي
achalasia plumer vinson syndrome systemic sclerosis
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most common site of esophageal cancer
in the upper 2/3 of the esophagus and the most histlogical type is SCC squamous cell carcinoma
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most common site of adenocarcinoma in esophageal cancer
lower 1/3 distal esophagus
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most common type of esophageal cancer over all
squamous cell carcinoma SCC
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شو هو most common sign and symptoms of esophageal cancer
silent
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شو هم other sign and symptoms of esophageal cancer
progressive dysphagia solid rather than liquids (it is usually early sign but usually late sign adenophagia ألم مع البلع aspiration hematemesis, anemia, pressure symptoms (pressure on treachea and can cause dyspnea, ممکن اصير عندوا stridor ويسبب reccurent laryngeal nerve ممكن ايصير عندوا ضغط على superior vena ممكن ايصير عندوا ضغط على horsiness of voice cava ويسبب superior vena cava syndrome( weight loss
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prognosis of GIT cancer ملاحظه
all GIT cancer (malignancy) have poor prognosis Except colorectal cancer CRC
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metastasis of esophageal cancer and all GIT cancer is to primary distant metastasis to
liver
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شو هم ال risk factor of gastric cancer
male old age H.pylori (most common cause of gastric cancer) وهو لأنواع محدده من ناحية ال histology adenocarcinoma هو ال most common وبيطلع في colomunar epithelial وتمثل 80% من gastric cancer MALT(mucosa associated lymphatics tumor) and most common site for it in GI tract in the stomach تمثل 5%من gastric cancer GIST gastro intestinal stromal tumor يشكل1-2%من gastric cancer اجى سوال the bigest risk factor of gastric cancer هو H.pylori HNPCC hereditary non polyposis بيجي معاه gastric cancer and colorectal cancer and endometrial cancer HDGC hyper dysplastic gastric cancer smoking هو major risk factor for pancreas cancer Alkohol dite ننتبه في esophageal cancer hot food and hot liquid في gastric cancer smoking food الواد المسرطنه مثل Nitrosamine pernicious anemia هي نفسها type A chronic straites chronic streit's اله عده انواع type A يكون bacterial الي هو H.pylori type B يكون atrophic type C يكون Chemikalien blood Gruppe A risk for gastric cancer blood Gruppe O risk for peptic ulcer previous gastric surgery gastric ulcer (هي من ال risk ولاكن ليس من major risk factor)
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sign an symptoms of gastric cancer
mostly silent بمعنى late onset of symptoms Anorexia and weight loss هدل m.c.symptome هدول بكون leat symptoms في ال advanced gastric cancer sign and symptoms in early stage iron deficiency anemia hematemesis melena dyspepsia عسر الهضم كمان من laet sign nussia and vomiting dysphagia hepatomegaly
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شو هم العلامات التي تدل على advanced leat gastric cancer
virchows node (left supraclavicular lymphadenopathy) plumber's shelf sign (تجمع العقد الليمفاوية في doclaus bauch) لما نعمل per rectum exam بتلاقي lymphnode in rectal بدل على leat advanced gastric cancer وواصل إلى peritoneum krukenberg tomurs (2nd ovarian metastasis) sister mary Joseph nodes (peri umbilical lymphnode) Irish nodes (left Axillary lymphadenopathy)
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most common type of gastric cancer
adenocarcinoma انتبه هناك 5%تكون lymphoma وتسمى أيضا MALTOMA mucosa associated lymph tissue tumor
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most common type of all mouth cancer such as in tongue pharynx inside the cheek lips
squamous cell carcinoma
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most common site of cancer in mouth
lower lip نوعه squamous cell carcinoma
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شو اهم risk factor for MALTOMA and adenocarcinoma in gastric cancer
H.pylori infection
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most common site of Lymphoma or MALTOMA in GIT
stomach
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شو هو best tx of adenocarcinoma in gastric cancer
in early stage ابنعمل curative surgery in leat stage ابنعمل paliative surgery
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شو هو ال best tx of MALTOMA lymphoma
اذا كانت low grade ننظر اذا كانت H.pylori related +ve بنعالجها therapy بمعنى eradication ننظر اذا كنت H.pylori not related _ve بنعالجها XRT )Radio therapy اذا كانت high grade بنعالجها XRT(Radio therapy ) +_ chemotherapy very rare نلجأ إلى surgery في MALTOMA in the stomach
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شو هم most common benign liver Neoplasia
hemangioma
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شو هم benign liver neoplasia
hemangioma very high risk for bleeding focal nodular hyperplasia FNH وهي 3m.c adenoma وهي 2m.c very high risk for bleeding
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في حالات benign liver neoplasia مثل hemangioma and adenoma هل ياخذ biopsy وليش
it is contraindicated because high risk of bleeding
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شو هم أنواع malignant of liver neoplasia
1primary 2secondary primary <secondary 1p.t-20p.t
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شو أنواع ال primary malignant liver neoplasia
hepatocellular carcinoma HCC angiosarcoma hepatoplastoma
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شو هو ال most common primary malignant liver neoplasia in adults
hepatocellular carcinoma HCC
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شو هو ال most common primary malignant liver neoplasia in pediatric
hepatoblastoma
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when we do CT scan for primary malignant liver neoplasia HCC angiosarcoma hepatoblastoma شو بنشوف معهم
hypervascularis lesion on ct scan
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شو تعريف secondary malignant liver neoplasia
secondary metastasis from other organ in to the liver
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شو بنشوف secondary malignant liver neoplasia in CT scan
hypo vascularaisation
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شو هو most common organ that metastasis in the liver
colorectal cancer
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most common organ of metastasis to the liver and not from GIT
lung
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اذا كانت single hyper vascularisaion lesion in malignant liver neoplasia
primary malignant liver neoplasia
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اذا كانت multiple hypo vascularisation lesion in malignant liver neoplasia بتكون
secondary malignant liver neoplasia
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what is the most common benign liver tumor
hemangioma cannot become malignant
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شو هو ال most common site of hemangioma
right lobe in the liver
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شو هو ال sign and symptoms of hemangioma
mostly small and silent-- no need for treatment at all rare large . . بعملوا pressure symptoms ولهذا بحاجه ل treatment rupture (rear)..if haben lead to hypo volumic Schock and the mortality is very high
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تعريف ال hemangioma
هي وحمه على الأوعية الدموية في Liver
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شو هو ال syndrome الي بصير في infant painless large abdominal mass from giant hemangioma +thrombocytopenia +bleeding شو اسم الطبق syndrome in infant
kasabach Merritt syndrome
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شو هو ال gold standart of dx of hemangioma
contrast CT scan with out biopsy (contraindicated)
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شو بنشوف على ال ct في hemangioma
hypervascularis lesion and peripheral to central enhancement ملاحظة hypervascolulris lesion تحصل مع benign liver tumor and primary malignant liver tumor
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شو هو ال tx of hemangioma
if silent no need for treatment (just observation and follow up) if if symptomatic (hepatic excision) انتبه اذا اجاك في الامتحان tx بكون hemangiomactomy هذا بكون خطأ
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في ال risk factor كقاعده عامه in benigen liver neoplasia مين اكثر
F>M
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ك قاعده عامه in malignant liver neoplasia انو اكثر يصاب male or female
M>F