Nir Hus Q 31 32 iv


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Nir Hus MD., PhD.

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Nir Hus Q 31 32 iv

  1. 1. Q: 31 - 32
  2. 2. Q31: Greatest risk factor gastric Adeno CA. <ul><li>In most of the western world gastric CA is relatively uncommon. </li></ul><ul><li>The overall incidence of this condition has decreased in the past few decades, but gastric carcinoma remains the second leading cause of cancer death worldwide. </li></ul><ul><li>The reported reductions in gastric cancer mortality may be linked to better refrigeration and a concomitant decrease in the intake of salted, pickled, smoked, and chemically preserved foods; </li></ul><ul><ul><li>however, this link remains controversial. </li></ul></ul><ul><ul><li>An inverse association with the consumption of fresh fruits and vegetables has also been noted. </li></ul></ul>
  3. 3. Q31: Greatest risk factor gastric Adeno CA. <ul><li>Associations have also been reported between cancer of the gastric cardia and infection with: </li></ul><ul><ul><li>Helicobacter pylori </li></ul></ul><ul><ul><li>Epstein-Barr virus </li></ul></ul>
  4. 4. Q31: Greatest risk factor gastric Adeno CA. <ul><ul><li>Gastric CA occurs 1.5 to 2.5 times more frequently in males than in females. </li></ul></ul><ul><ul><li>It is rarely diagnosed before the age of 40 </li></ul></ul><ul><ul><li>Its incidence peaks in the seventh decade of life. </li></ul></ul><ul><ul><li>African Americans, Hispanic Americans, and Native Americans are two times more likely to have gastric cancer than white Americans are </li></ul></ul><ul><li>The decline in incidence has not translated into an improvement in the 5-year survival rate. Across all races, the 5-year relative survival was 23% for the period extending from 1992 to 1999 </li></ul>
  5. 5. Q31: Greatest risk factor gastric Adeno CA. <ul><li>5-year survival rates after resection with curative intent are directly related to stage at presentation. </li></ul><ul><ul><li>Stage I: 43% </li></ul></ul><ul><ul><li>Stage II: 37% </li></ul></ul><ul><ul><li>Stage III: 18% </li></ul></ul><ul><ul><li>Stage IV: 20% </li></ul></ul>
  6. 6. Q32: Indication Cholecystectomy <ul><li>The most common indication for cholecystectomy is biliary colic caused by chronic cholecystitis and cholelithiasis. </li></ul><ul><li>Acute cholecystitis, secondary to obstruction of the cystic duct by a gallstone, is the second most common reason. </li></ul><ul><li>Pancreatitis and cholangitis caused by obstruction of the pancreatic duct and/or distal CBD by a stone are generally the third most common indication. </li></ul><ul><li>Despite the high incidence of gallstone disease in many countries, approximately 75% of patients with gallstones are asymptomatic. </li></ul>
  7. 7. Q32: Indication Cholecystectomy <ul><li>Ejection fraction of GB < 33% in otherwise normal studies. </li></ul><ul><li>Cholelithiasis in a pt. with DM and uncontrolled BG. </li></ul><ul><li>Acute cholecystitis requires urgent but not an emergency cholecystectomy. </li></ul><ul><li>Ascending Cholangitis is an emergency. </li></ul><ul><li>Don’t forget Acalculous cholecystitis in ICU settings of chronic pt. </li></ul>
  8. 8. Q32: Indication Cholecystectomy <ul><li>Severe jaundice is suggestive of common bile duct stones or obstruction of the bile ducts by severe pericholecystic inflammation secondary to impaction of a stone in the infundibulum of the gallbladder that mechanically obstructs the bile duct (Mirizzi's syndrome). </li></ul><ul><li>Ascending Cholangitis </li></ul><ul><ul><li>Presentation: fever, epigastric or right upper quadrant pain, and jaundice -- classic symptoms known as Charcot's triad. </li></ul></ul><ul><ul><li>With delay…Reynolds pentad -- fever, jaundice, right upper quadrant pain, septic shock, and mental status changes. </li></ul></ul>