Renal Cell Carcinoma with hepatic metastasis

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Renal Cell Carcinoma with hepatic metastasis

  1. 1. Renal Cell Carcinoma with Hepatic Metastasis
  2. 2. Introduction Underlying Disease: Renal Cell Carcinoma - Most common type of cancer - Carcinoma “Karkinos” meaning crab forming cancer. Secondary Disease: -Hepatic Metastasis -Pneumonia -Severe Fatty Liver
  3. 3. Introduction Etiology:  Smoking  Obesity  Hypertension Pathophysiology: 2 forms of RCC  Hereditary  Sporadic
  4. 4. Methodology Patient Finding Gathering of Data Analysis and Interpretation Evaluation and Implication Recommendation
  5. 5. Subjective Case: RCC with Hepatic Metastasis Subject: Mr. Levi O. Fernandez Age: 58 yrs. old Civil Status: Married, with 3 sons Occupation: Former Electrical Engineer in Japan
  6. 6. Subjective  Prior to his diagnosis, he experiences difficulty in urinating, fever, malaise, night sweats and hypertension.  He loves eating salty foods, softdrinks and sweets.  The foods he doesn’t like are pork and alcoholic beverages in relation to his religion as an Adventist.
  7. 7. Objective Table 1. Quantitative analysis of his 24-hour food recall Meal No. of exchanges CHO (g) PRO (g) FATS (g) ENERGY (kcal) Rice 10 230 20 - 1000 Meat Low fat 1 - 8 1 41 Medium fat 1 - 8 6 86 Veg. A 2 3 - - 6 Coffee (free food) 3 - - - - TOTAL - 233 36 7 1133
  8. 8. Objective  Nutrient Adequacy = Actual Nutrient Intake/Recommended Nutrient Intake *100 Protein = 36/60(100) = 60% Energy = 1133/2320(100) = 49%
  9. 9. Objective Food group Recommended servings Actual intake Variance grains 6-11 6 0-5 vegetables 3-5 2 1-3 fruits 2-4 0 2-4 dairy 2-3 0 2-3 Meat/poultry/fish 2-3 2 0-1 Fats, oils and sweets Use sparingly 5 - Table 2. Qualitative analysis of his 24-hour food recall
  10. 10. Assessment  Anthropometric Patient’s Height and Weight Pt. Ht. = 5’7 = 67 inches = 67 inches x 2.54 cm = 170.18 cm or 1.70 m Pt. Wt. = 73 kg
  11. 11. Assessment Desirable Body Weight DBW = 170.18- 100 = 70.18 = 70.18-7.018 (10% of 70.18) =63.162 or 63 kg
  12. 12. Assessment Body Mass Index BMI = wt. (kg)/ ht. (m)² = 73 kg/ 2.9 = 25.21
  13. 13. Assessment Total Energy Allowance TEA = Activity x DBW = 35.0 (light) x 63 kg = 2205 kcal
  14. 14. Assessment  Biochemical Clinical Chemistry Laboratory Findings/Result Reference Range Implication - LDL Cholesterol 4.41 <4.07 HIGH - Creatinine 135.2 umol/L 53.0-115.0 HIGH - CHOLE-HDL Ratio 8.28 <4.40 HIGH Table 3. Significant Laboratory Findings on Blood Chemistry
  15. 15. HEMATOLOGY Laboratory Findings/Result Reference Range Implication WBC COUNT 12.20 10^9/L 5.0-10.0 HIGH Segmenters 0.83% 0.45-0.65 HIGH Lymphocytes 0.17% 0.20-0.35 LOW Table 4. Significant Laboratory Findings on Hematology
  16. 16. Urinalysis Laboratory Findings/Result Reference Range Implication Physical examination - Color Brown red Yellow - Transparency cloudy Clear - Reaction Acidic ACIDIC Chemical Examination - Nitrite Positive NEGATIVE BACTERIURIA Table 5. Significant Laboratory Findings on Urinalysis
  17. 17. Sonography:
  18. 18. Radiological Test:
  19. 19. Final Histophatologic Diagnosis Kidney, Radical nephrectomy (left): RENAL CELL CARCINOMA, CLEAR CELL TYPE, FUHRMAN GRADE 2, 8.4 CM IN WIDEST TUMOR DIMENSION. RENAL CAPSULAR INVASION AND LYMPHOVASCULAR SPACE INVASION ARE PRESENT.
  20. 20. Plan  Diet Rx: 2520kcal; C445; P38; F79 2000 mg Na 1600 mg K (41 mEq) 500 mg P (39 mEq) 1200 Ca(60 mEq) 1500 ml fluid HBV - 2/3 (25.2) LBV - 1/3 (12.6)
  21. 21. Food group # of exchanges Pro Na K Ca P Fluid Cho Fat Milk A.powder ½ 4 80 200 180 125 0.3 6 5 Meat ¾ 26 - - - - - - - Lean Meat (V-A) 1 - 30 200 15 70 31.0 - 1 Fish (V-A) 1 ½ - 45 300 22.5 105 46.5 - 1.5 Egg (V-C) ¾ - 82.5 71.25 37.5 86 33.75 - 4.5 Total - 30 237.5 771.25 255 386 111.55 6 12
  22. 22. Food group # of exchanges Pro Na K Ca P Fluid Cho Fat Veg. B1 2 0.6 16 220 60 20 60 3 - Rice 6 12 - - - - - 118 - A 4 - 8 240 60 140 300 - - B 1 - 230 60 20 35 10 - - Total - 12.6 254 1520 140 195 370 121 - Total 3 & 4 - 42.6 492 1292 395 581 482 127 12
  23. 23. Food group # of exchanges Pro Na K Ca P Fluid Cho Fat Fruits 3 0 - - - - - - - A 2 0.8 6 240 20 20 95 20 - B 1 0.2 2 60 5 5 42 10 - Sugar 63.6 - - - - - - 384 - Total - 1.0 8 300 25 25 137 414 - 445 (prescribed) 127 (milk and vegetable and rice) 318 /5 = 63.6 or 64
  24. 24. Food group # of exchanges Pro Na K Ca P Fluid Cho Fat Fat - - - - - - - - - A 8 0.5 320 16.0 8.0 8.0 8.0 - 4.0 B ½ - 9 22.0 4.0 10.0 9.0 - 2.5 Free foods 4 - - - - - - - 20 Total 3,4,5 and 6 44.1 829 1630 432 624 636 541 74.5 Fat milk 5 Meat 12 17 – 79 = 62 / 5 = 12.4 or 12
  25. 25. Fluid rx = 1500 ml Inherent 636 ml 864 ml (additional oral fluid) Na rx = 2000 mg/day Inherent 829 mg 1171 mg/day (additional oral) 1200 – 432 = 768 = 1 tablet
  26. 26. Intervention Medical  Omeprazole, to maintain healing of erosive esophagitis  Vit. B complex, to treatment To Prevent Vitamin Deficiency Medications Inherited Disease Marked by Excretion of Sulfur in Urine Medications  Paracetamol, Taken as required for relief of mild-to-moderate pain or fever.  Clonidine, treat high blood pressure  Tramadol, treat moderate to severe pain  Tranexamic acid, used to control unwanted bleeding  Ceftriaxone, given before certain types of surgery to prevent infections that may develop after the operation  Centrum silver , For Multivitamins and minerals deficiency  Neobloc, H TN & chronic angina pectoris.
  27. 27. Intervention Diet  Maintain A Healthy Body Weight  Eating more vegetables and fruit  Potassium and sodium restriction  fluid  Low calorie diet
  28. 28. Evaluation  To check if the patient will follow the dietary plan, there should be a regular visit and report about the progress of his condition. Regular checkup in his physician is also recommended to have an update about his health status.
  29. 29. The End.

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