• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Renal Cell Carcinoma with hepatic metastasis
 

Renal Cell Carcinoma with hepatic metastasis

on

  • 226 views

Case study

Case study

Statistics

Views

Total Views
226
Views on SlideShare
226
Embed Views
0

Actions

Likes
0
Downloads
4
Comments
0

0 Embeds 0

No embeds

Accessibility

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Renal Cell Carcinoma with hepatic metastasis Renal Cell Carcinoma with hepatic metastasis Presentation Transcript

    • Renal Cell Carcinoma with Hepatic Metastasis
    • 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
    • Introduction Etiology:  Smoking  Obesity  Hypertension Pathophysiology: 2 forms of RCC  Hereditary  Sporadic
    • Methodology Patient Finding Gathering of Data Analysis and Interpretation Evaluation and Implication Recommendation
    • 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
    • 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.
    • 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
    • Objective  Nutrient Adequacy = Actual Nutrient Intake/Recommended Nutrient Intake *100 Protein = 36/60(100) = 60% Energy = 1133/2320(100) = 49%
    • 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
    • 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
    • Assessment Desirable Body Weight DBW = 170.18- 100 = 70.18 = 70.18-7.018 (10% of 70.18) =63.162 or 63 kg
    • Assessment Body Mass Index BMI = wt. (kg)/ ht. (m)² = 73 kg/ 2.9 = 25.21
    • Assessment Total Energy Allowance TEA = Activity x DBW = 35.0 (light) x 63 kg = 2205 kcal
    • 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
    • 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
    • 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
    • Sonography:
    • Radiological Test:
    • 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.
    • 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)
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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.
    • Intervention Diet  Maintain A Healthy Body Weight  Eating more vegetables and fruit  Potassium and sodium restriction  fluid  Low calorie diet
    • 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.
    • The End.