1. Carcinoma of the gallbladder is often diagnosed at late stages due to nonspecific symptoms and difficulty distinguishing it from chronic cholecystitis.
2. Risk factors include gallstones, age, female sex, and conditions causing chronic inflammation like anomalous pancreaticobiliary duct junction.
3. Staging is based on tumor invasion depth and lymph node involvement, with surgery being potentially curative for early stages.
4. Advanced or metastatic disease requires palliative approaches to relieve symptoms from biliary or bowel obstruction.
This Presentation gives summarized overview of Gall Bladder Carcinoma especially the management as per latest National Comprehensive Cancer Network(NCCN) Guidelines version 2.2013
This Presentation gives summarized overview of Gall Bladder Carcinoma especially the management as per latest National Comprehensive Cancer Network(NCCN) Guidelines version 2.2013
Gall bladder carcinoma seen in Indian popluation most common in women and presents at a very late stage .Survival is in months hence palliative treatment is being preferred .
GB cancer is the 5th most common GIT malignancy(worldwide).200 years later it is still considered to be a highly malignant disease with a poor survival rate
.Here is a brief description regarding
Gall bladder carcinoma seen in Indian popluation most common in women and presents at a very late stage .Survival is in months hence palliative treatment is being preferred .
GB cancer is the 5th most common GIT malignancy(worldwide).200 years later it is still considered to be a highly malignant disease with a poor survival rate
.Here is a brief description regarding
Pancreatic carcinoma is the most dreaded cancer with very dismal prognosis. It is characterized by obstructive jaundice, high colored urine and clay colored stool.
Benign Biliary Stricture is a common condition which we encounter during gastro practice. Here we discuss in detail about its diagnosis and management.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
3. Epidemiology
• 6500 cases annually (USA)
• 5th most common cause of GI malignancy (USA)
• Incidence increases with age
• 2-6 times more common in female
5. Risk factors
• Cholelithiasis
– 75-98% of all patient with Ca GB
– Cholesterols type stones
• Old age
• Female
• Anomalous pancreaticobiliary duct junction
• Typhoid carriers- chronic inflammation
• Others- IBD
6. • The risk of developing gallbladder carcinoma increases
directly with increasing gallstone size
• Relative Risk =2.4 with stone size 2- 2.9cm diameter
• Relative risk 10.1 with >3cm diameter stones
7. Lahmar A, Abid SB, Arfa MN, Bayar R, Khalfallah MT, Mzabi-Regaya S. Metachronous cancer of
gallbladder and pancreas with pancreatobiliary maljunction. World Journal of Gastrointestinal
Surgery. 2010;2(4):143-146. doi:10.4240/wjgs.v2.i4.143.
• Anomalous pancreaticobiliary duct junction
• with an incidence of 3.2%
in patients undergoing
ERCP or operative
Cholangiopancreatography
8. • Refluxed proteolytic pancreatic enzymes are activated in the
biliary tract and may induce biliary tract carcinoma
• The reflux of bile may activate pancreatic enzymes which may
cause chronic inflammation and metaplastic epithelial change
in the pancreatic duct and pancreatic cancer may eventually
develop
9. Etiology
• Gall stones and chronic inflammation
• 3.3 to 3% among patients with GSD
• Porcelain GB (10-25%)
• Helicobacter bilis and Helicobacter pylori (about six fold
higher risk)
• Chemicals methyldopa,oral contraceptives, isoniazid, and
occupational exposure in the rubber
10. Anatomic consideration
• The location of the primary tumor within the gallbladder and
the proximity of the portal vein, hepatic artery, and bile duct
are all important factors in the surgical management of this
tumor
11. • The gallbladder is attached to segments IVb and V of the liver and these
segments are involved early in tumors of the fundus and body of the
gallbladder- limited segmental resection often possible
12. • Tumors of the infundibulum or cystic duct readily obstruct the common
bile duct and may involve the portal vein.
• As with cholangiocarcinoma the tumor may be unresectable early in its
course-- tumor of this region require extended liver resections due to
proximity to portal pedicles
13. Pathology
• GB epithelium progresses from dysplasia to carcinoma in situ
to invasive carcinoma
• Area of dysplasia and carcinoma in situ is often missed in
routine cholecystectomy specimens as there are no
associated gross characteristics that would target an area for
histological sections
• Carcinoma in situ may appear within the Rokitansky aschoff
sinuses and often mistaken for invasive carcinoma
14. • Rate of progression of precursor lesions to invasive carcinoma
has estimated around 15 years
16. Gross morphology
• Difficult to diffrentiate grossly from chronic cholecystitis at
early stages and are often found incidentally on pathologic
sections
• 60% - fundus
• 30% body
• 10% neck
17. • Tumor arising from neck and hartmanns pouch may infiltrate
the cystic duct and common bile duct make it clinically
indistinguishable form hilar bile ducts tumor
19. • Infiltrative tumors cause thickening and indurations of GB wall
and extending to entire GB
• Spreads in the subserosal plane which is the same as the
surgical plane used for routine cholecystectomy if tumor
unrecognized during surgery leads to regional dissemination
• Becomes more advanced if infiltrates liver
20. • Nodular type
– Early invasion through GB wall into liver or neighboring
structures
– Easier to control surgically than infiltrative whose margins
are less defined
21. • Papillary ca
– exhibit a polypoid or cauliflower like appearance
– Better prognosis
– May be larger filling the lumen but with minimal
invasion
22. • Histopathological grading
– G1- well differentiated
– G3- undifferentiated
– Majority of patient present with G3 poorly
differentiated tumors
24. Pattern of spread
• Along peritoneal cavity
• Along needle biopsy sites
• Laparoscopic port sites
25. • direct extension to liver and other adjacent organs
– Gall bladder has thin wall, narrow lamina propia, and single muscle
layer
– Once penetrates to thin muscle layer has access to major lymphatic
and vascular channels
26. • tumor penetration into or through the muscularis has prognostic
implications because the lymphatic drainage of the gallbladder lies in the
layer between the muscle and the serosa.
• Also, most simple cholecystectomies for gallstone leave the serosa on the
liver side because the subserosal plane is the easiest for dissection.
• Thus, simple cholecystectomies performed for unsuspected gallbladder
cancer is likely to leave a positive margin for any tumor that penetrates
the muscle layer
27. • Autospy
• 94.4% lymphatic mets
• 64.% hematogenous dissemination
• Hematogenous form small veins extensding directly from gall
bladder to portal venous system of GB fossa leading to
segment IV and V of liver or via larger veins to portal venous
branch of segment V and VIII
28.
29.
30. 1-pericholedochal, nodes along
the common bile duct
2- cystic duct, node(s) along the
cystic duct
3-retroportal, nodes posterior
to the portal vein and cephalad to
the uncinate process
4-posterior superior
pancreaticoduodenal, nodes on
the posterosuperior aspect of the
head of the
pancreas
31. 5-hepatic artery, nodes
along the common or
proper hepatic artery
6-right celiac, nodes
located right of the
celiac axis and
posterior to the
common
hepatic artery
7-hilar, nodes within
the porta hepatis
32. Radiologic investigation
Discontinious GB mucosa
Echogenic mucosa
Submucosal echolucency
Inhomogenous mass replacing all or part of GB
Diffuse thickening of GB wall
Lypmh nodes- a soft tissue mass with AP diameter of
atleast 10mm showing ring like heterogenous
enhancement ( 89% accuracy)
Positive LN may alter surgeons decisions to operate or
change operative approach
33. MRCP
• More detail information than CT sccan and Usg
• Angiography
– Portal vein and hepatic artery encasement avoids
unneccesay laparotomy
• EUS
– Peripancreatic and periportal adenotpathy
– Needle bipdy can be performed
34. • Endoscopic and percutaneous cholangiographs
– GB cancer with obstructive jaundice- direct invasion or
compression of CHD or by pericholedochal LN
– Intraheptic bile ducts obstruction. High ALP
– Planning of palliative managemt of Gall bladder carcinoma
– Also indicated in atypical cases with vague sypmtoms and
abnormal lft where other imaging modalities have not
yeilded diagnosis
– Stricturing, distortion or nonfiling of bile ducts draining
segment IV and V with no effects on other segmental ducts
35. • Biliary colic or chronic cholecystitis, elderly
patients with atypical symptoms, suspicious lab
findings ( anemia, hypoalbunemnia or abnormal
LFT)
• USG- mnass, abnormal mucosal finnding, or
segmental duct dilatation
• CT scan
• Lab or radiologic investigation shows evidence for
ductal obstructionMRCP, ERCP or PTC
• Advanced mass encroaching on the porta
hepatis duplex USG or arteriography
36. Preop pathologic diagnosis
• Suscpicious mass- pre op biopsy contoversial
• Cholec( ystectomy as diagnositic biopsy
unaccesptale
• ERCP and bile cytology (73% sensitivity)
• Percutaneous FNAC- mass not considered for
surgical resection ( 88% accuracy)
• Percutaneous core needle biospy if FNAC fails
as high chance of needle tract seeding
37. staging
1. Modified Nevin system ( Donohue et.a l 1990, Nevin et. al
1976)
2. Japanese Biliary Surgical Society system (Onoyama et al
1995)
3. AJCC/UICC TNM staging system ( Beahrs and Myers 1983)
38.
39. management
• Stage O and Stage I ( Tis, T1a – Ca invades
lamina propia but don’t extend to muscularis)
• frequently detected on pathological
examination
• Imaging based staging
• Watch cholecystectomy specimen to ensure
negative margin
40. Margin postive
• No evidence of residual or
metastatic GB ca
• But cystic duct margin
positive
• Rexploration with CBD
excision , regional
lymphadenectomy and HJ
Margin negative,negative
imaging
• No further surgery
41. • Stage T1b ( cancer that invases the muscularis
but don’t extend to perimusccular connective
tissue
• T1 b cancer treat same as T2 Ca GB
42. Stage II ( T2NOMO)
• T2- cancer invasion into perimuscular
connectivetissue of GB
• regional LN mets- 28-63%
• Rexploration with liver resection and regional
lymphadenectomy of hepatoduodenal
ligament
43. • Preoperative T2 suscpicious
• staging
• In no contraindication
• Proceed for exploration with en bloc resection
of GB and adjacent liver to depth of at least 2 cm
with regional lymphadenectomy of
hepatoduodenal ligament
• Non anatomic
• Anatomic segment 4b, 5 resection – less bleeding
44. Stage III
• T3 lesions ( locally advanced cancers that
perforate the GB serosa or directly invade the
liver and/ or one adjacent organ and
• T1-T3 lesions associated with regional LN mets
45. Stage III
• Careful planning,individualized
• Liver invasion- hepatic resection seg 4b and 5
– Trisegmentectomy if GB foss bridges both right
and left hepatic lobes
– Enbloc resection of hepatic flexure of colon
– Long term survival- 15-63%
46. Stage IV
• IV A-Invasion to main portal vein, common
hepatic artery, multiple extrahepatic organs
• Stage IVB
– N2 and or distance mets
– Uresectable
– Main portal vein, CHA if reseccted – confers
morbidity and mortality ares
47. Adjuvant therapies
• Adjuvant chemoradiotherapy after resection
• External beam or intraoperative radiation
therapy alone or in combination with 5FU-
decreasse local recurrence
• Data inadequate
48. palliation
• Goal- relief pain, manifestation of biliary
obstruction ( pruritis and cholangitis) and
bowel obstruction
• Endscopic stenting than surgical bypass in
weeks to month survival
• Palliative radiotherapy
• Regional intra- arterial chemotherapy
andchemoradiotherapy
• Gemcitabine plus cisplantin