This document provides information on the diagnosis of gastric cancer. It discusses:
- Endoscopy as the main diagnostic tool, with biopsy having a sensitivity of over 90% for detecting gastric cancer. Multiple biopsies should be taken.
- Diffuse gastric cancers can be hard to detect with endoscopy alone, and barium studies may reveal abnormalities in these cases.
- Follow up endoscopy 8-12 weeks after initial endoscopy is recommended by some guidelines to verify healing, with biopsies of any remaining ulcers.
- No serologic markers have proven sufficiently sensitive or specific for diagnosis, though some show increased risk of gastric cancer.
Gastric Cancer - Deifinition , epidemiology , histological types and molecular genetics and WHO update
Reference - WHO Classificiation of tumors of Digestive system
Rosai and Ackermann
Kidney cancer is caused by uncontrolled cell growth in the kidneys. It is the seventh most common cancer and tenth most common cause of cancer death in men. Symptoms include blood in the urine, back or abdominal pain, and swelling. Diagnosis involves physical exam, blood and urine tests, and imaging like CT scans. Treatment depends on stage and may include surgery to remove part or all of the affected kidney, targeted therapy with drugs, immunotherapy to boost the immune system, and radiation therapy.
This document provides information on carcinoma of the stomach, including:
- Risk factors include H. pylori infection, diet, genetics, smoking.
- Types include intestinal and diffuse. Staging uses TNM and other classifications.
- Common symptoms are weight loss, abdominal pain, vomiting. Investigations include endoscopy and biopsy.
- Treatment depends on stage but commonly includes surgery such as gastrectomy along with lymph node dissection. Endoscopic resection may be used for early stages. Adjuvant therapy is sometimes used for later stages.
Core needle biopsy is a commonly used and reliable method for sampling breast lesions, allowing diagnosis in over 90% of cases. However, certain lesion types like fibroepithelial lesions, spindle cell lesions, papillary lesions, and radial scars can be difficult to diagnose with certainty on core biopsy alone. Immunohistochemistry and excisional biopsy are often needed in these problematic cases to arrive at a definitive diagnosis. Standardizing the reporting of core biopsies and following international guidelines helps ensure consistent and optimal patient care.
This document discusses hepatocellular carcinoma (HCC), the most common type of primary liver cancer. It covers the epidemiology, risk factors, pathogenesis, clinical presentation, diagnosis, prognostic factors, and treatment options for HCC. The highest rates are seen in regions where hepatitis B is endemic, and major risk factors include chronic hepatitis B and C infections, cirrhosis, and aflatoxin exposure. Diagnosis involves imaging tests like ultrasound, CT, and MRI along with blood tests. Treatment depends on tumor size and liver function, and may include resection, transplantation, ablation, embolization, or chemotherapy.
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 document discusses stomach cancer incidence, risk factors, diagnosis, staging and survival rates. It notes that approximately 760,000 stomach cancer cases are diagnosed worldwide each year, with most cases occurring in Eastern Asia. Key risk factors include H. pylori infection, smoking, and diets high in smoked, salted foods and red meat. Stomach cancers are typically diagnosed via endoscopy with biopsy and staged based on tumor size, lymph node involvement and metastasis. Five-year survival ranges from 71% for early stage IA to 4% for late stage IV disease.
This document provides information on the anatomy, histology, staging, and risk factors of gastric cancer. It discusses the divisions and layers of the stomach, innervation, blood supply, and lymphatic drainage. It describes the epidemiology of gastric cancer including higher rates in East Asia and associations with H. pylori infection and dietary factors. The document outlines the Borrmann, Lauren, and WHO histological classifications. It provides details on clinical presentation and diagnostic evaluation. Finally, it explains the AJCC and Japanese TNM staging systems including criteria for tumor (T), nodal (N), and metastatic (M) designations.
Gastric Cancer - Deifinition , epidemiology , histological types and molecular genetics and WHO update
Reference - WHO Classificiation of tumors of Digestive system
Rosai and Ackermann
Kidney cancer is caused by uncontrolled cell growth in the kidneys. It is the seventh most common cancer and tenth most common cause of cancer death in men. Symptoms include blood in the urine, back or abdominal pain, and swelling. Diagnosis involves physical exam, blood and urine tests, and imaging like CT scans. Treatment depends on stage and may include surgery to remove part or all of the affected kidney, targeted therapy with drugs, immunotherapy to boost the immune system, and radiation therapy.
This document provides information on carcinoma of the stomach, including:
- Risk factors include H. pylori infection, diet, genetics, smoking.
- Types include intestinal and diffuse. Staging uses TNM and other classifications.
- Common symptoms are weight loss, abdominal pain, vomiting. Investigations include endoscopy and biopsy.
- Treatment depends on stage but commonly includes surgery such as gastrectomy along with lymph node dissection. Endoscopic resection may be used for early stages. Adjuvant therapy is sometimes used for later stages.
Core needle biopsy is a commonly used and reliable method for sampling breast lesions, allowing diagnosis in over 90% of cases. However, certain lesion types like fibroepithelial lesions, spindle cell lesions, papillary lesions, and radial scars can be difficult to diagnose with certainty on core biopsy alone. Immunohistochemistry and excisional biopsy are often needed in these problematic cases to arrive at a definitive diagnosis. Standardizing the reporting of core biopsies and following international guidelines helps ensure consistent and optimal patient care.
This document discusses hepatocellular carcinoma (HCC), the most common type of primary liver cancer. It covers the epidemiology, risk factors, pathogenesis, clinical presentation, diagnosis, prognostic factors, and treatment options for HCC. The highest rates are seen in regions where hepatitis B is endemic, and major risk factors include chronic hepatitis B and C infections, cirrhosis, and aflatoxin exposure. Diagnosis involves imaging tests like ultrasound, CT, and MRI along with blood tests. Treatment depends on tumor size and liver function, and may include resection, transplantation, ablation, embolization, or chemotherapy.
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 document discusses stomach cancer incidence, risk factors, diagnosis, staging and survival rates. It notes that approximately 760,000 stomach cancer cases are diagnosed worldwide each year, with most cases occurring in Eastern Asia. Key risk factors include H. pylori infection, smoking, and diets high in smoked, salted foods and red meat. Stomach cancers are typically diagnosed via endoscopy with biopsy and staged based on tumor size, lymph node involvement and metastasis. Five-year survival ranges from 71% for early stage IA to 4% for late stage IV disease.
This document provides information on the anatomy, histology, staging, and risk factors of gastric cancer. It discusses the divisions and layers of the stomach, innervation, blood supply, and lymphatic drainage. It describes the epidemiology of gastric cancer including higher rates in East Asia and associations with H. pylori infection and dietary factors. The document outlines the Borrmann, Lauren, and WHO histological classifications. It provides details on clinical presentation and diagnostic evaluation. Finally, it explains the AJCC and Japanese TNM staging systems including criteria for tumor (T), nodal (N), and metastatic (M) designations.
The anal canal is approximately 4 cm in length extending from the anorectal junction to the anal verge. Anal cancers are rare and mostly squamous cell carcinomas arising from the anal transitional zone. Risk factors include HPV infection and immunosuppression. Combined chemoradiotherapy is the standard first-line treatment and results in high response rates and organ preservation compared to radiation alone. Salvage surgery may be considered for select cases after failed nonsurgical treatment or as primary treatment for those who cannot tolerate chemoradiotherapy. Prognosis depends on tumor stage, with 5-year survival rates ranging from 45-86% depending on depth of invasion and nodal involvement.
This document summarizes information about appendiceal adenocarcinoma. It discusses how the majority of patients present with acute appendicitis and describes the intestinal and mucinous tumor types. It also covers tumor classification, including mucinous tumors of uncertain malignant potential. Prognosis depends on factors like histologic type, T stage, and tumor grade. Treatment recommendations include simple appendectomy for early stage disease and hemicolectomy for more advanced tumors. Adjuvant chemotherapy and intraperitoneal hyperthermic chemotherapy are discussed as additional treatment options. Cytoreductive surgery can help palliate patients with peritoneal carcinomatosis.
Primary gastrointestinal lymphomas arise from lymphoid tissue in the gastrointestinal tract. They commonly involve the stomach and small intestine. Staging involves assessing whether the tumor is confined to the gastrointestinal tract or has spread to lymph nodes or distant sites. Radiologic examinations can demonstrate tumor appearance and extent, such as polypoid masses, ulcers, or circumferential thickening of the bowel wall. Accurately diagnosing primary gastrointestinal lymphoma and determining its stage is important for guiding treatment.
This document discusses nutrition support in surgery patients. It begins by outlining the aims of nutrition support to identify and meet the nutritional needs of at-risk patients. It then covers metabolic responses to starvation, increased energy and nutrient requirements in trauma/sepsis patients, methods of nutritional assessment, and factors that warrant nutrition support. The document provides details on enteral and parenteral nutrition support, including formulas, delivery methods, monitoring, and complications. It also addresses special considerations for burns patients and those with short bowel syndrome.
This document provides an overview of ductal carcinoma in situ (DCIS), also known as stage 0 breast cancer. It discusses the pathology, risk factors, diagnosis via mammography and biopsy, grading, treatment options including surgery and radiation therapy, and management of recurrence of DCIS. DCIS is defined as a pre-invasive proliferation of epithelial cells confined to the breast ducts. Left untreated, DCIS has an inherent tendency to progress to invasive breast cancer.
Gastrointestinal stromal tumors (GISTs) are rare sarcomas that arise from the gastrointestinal tract. Most commonly found in the stomach, they represent 0.2% of gastrointestinal tumors. While often asymptomatic, they can present with bleeding, pain, or obstruction. Diagnosis involves imaging such as endoscopy or CT scan followed by biopsy showing immunohistochemistry positive for CD117 in 95% of cases. Treatment involves surgical resection with clear margins although adjuvant therapy with imatinib is often used for higher risk tumors. Outcomes have improved greatly in the past two decades with 5-year survival rates now over 50% with appropriate treatment.
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
1) Ductal carcinoma in situ (DCIS), also known as stage 0 breast cancer, accounts for 20% of breast cancers in the US and represents the earliest non-invasive form.
2) Treatment options for DCIS include lumpectomy with or without radiation or total mastectomy. Factors such as tumor size, grade, and margin status help determine a patient's risk of recurrence and guide treatment decisions.
3) Short term side effects of breast radiation for DCIS typically include skin irritation, breast tenderness, and fatigue. Long term risks are generally low but may include lymphedema, lung inflammation, and fibrosis. Radiation reduces the risk of local recurrence by 50% compared to lumpectomy alone
This document outlines a seminar plan on benign breast disease presented by Dr. Jyotindra Singh and moderated by Dr. A. Bhaskar. It begins with an introduction and covers topics like anatomy, congenital abnormalities, classifications of benign breast disease, symptoms and possible diagnoses, diagnostic modalities, genetics, and recent advances. Under anatomy, it describes the location, structure, parenchyma, stroma, blood supply, venous and lymphatic drainage of the breast. It also discusses classifications of benign breast disease including proliferative and non-proliferative lesions. Common benign conditions like fibroadenomas, cysts, and radial scars are explained.
1. Gastric cancer incidence varies globally, with the highest rates in Eastern Europe, Japan, and China.
2. Risk factors include H. pylori infection, low socioeconomic status, smoking, and diets high in salt/pickled foods.
3. Symptoms are non-specific but include epigastric pain, weight loss, vomiting, and anemia. Diagnosis involves endoscopy with biopsy.
4. Treatment depends on stage - surgery for early stages and palliative chemotherapy for advanced cases.
This document discusses tumors of the appendix. It outlines different types of appendix tumors including mucocele, primary adenocarcinoma, cystadenocarcinoma, and carcinoid tumors. Mucocele occurs when the appendix lumen becomes blocked, causing a fluid-filled cyst. Ruptured mucocele or adenocarcinoma can lead to pseudomyxoma peritonei, where mucus accumulates in the abdominal cavity. Carcinoid tumors are the most common appendix tumors but are generally not aggressive. Management depends on tumor type but often involves surgical removal of the appendix or part of the colon.
This document provides an overview of nutrition in surgical patients. It discusses the basics of nutrition including caloric and protein requirements. The importance of nutrition for surgical patients is described along with the complications of malnutrition like infection and poor wound healing. Methods of nutritional assessment involving history, exams, and labs are outlined. Both enteral and parenteral nutrition are covered, including indications, contraindications, administration methods, and potential complications. The take home messages emphasize the importance of meeting caloric needs to avoid complications, using enteral nutrition when possible, and closely monitoring patients on nutrition support.
This document summarizes key information about cancer of the esophagus. It notes that in 2014 there were 18,170 new esophagus cancer cases in the US, with a lifetime risk of 0.5% and 5-year survival rate of 17.5%. Risk factors include tobacco, alcohol, Barrett's esophagus, obesity, and gastroesophageal reflux disease. The two main types are squamous cell carcinoma and adenocarcinoma, with adenocarcinoma now more common due to rising obesity rates. Staging involves assessing tumor depth (T), lymph node involvement (N), and metastases (M). Survival rates vary significantly based on cancer type, stage, and treatment received.
Pancreatic carcinoma ranks 13th in incidence worldwide but 8th as a cause of cancer death due to its poor prognosis. The majority of pancreatic cancers originate in the head of the pancreas. Clinical presentation is often nonspecific with weight loss, abdominal pain, and jaundice being common. Diagnosis relies on imaging such as CT, MRI, and EUS along with blood markers like CA19-9. Staging determines resectability and guides treatment, which may include surgery, chemotherapy, and radiation therapy. Prognosis remains poor even with treatment due to late stage at diagnosis and high rate of recurrence.
This document discusses colorectal cancer and provides an outline of topics to be covered, including clinical anatomy of the colon and rectum, definition and epidemiology of colorectal cancer, risk factors and pathogenesis, screening, pathology and staging, clinical presentation, investigations, treatment, and follow up. It then goes on to provide details on the clinical anatomy of the colon and rectum, definition of colorectal cancer, epidemiology, risk factors, screening recommendations, adenoma-carcinoma pathogenesis model, hereditary and non-hereditary forms, pathology and staging systems, patterns of spread, clinical presentation, and diagnostic workup.
This document discusses nutrition support for surgical patients, including enteral and parenteral nutrition. It outlines the goals of nutritional support as preventing catabolism, meeting energy requirements, and aiding tissue repair. Methods for estimating caloric and protein requirements are provided. The advantages of enteral over parenteral nutrition are described. Complications and their management for both enteral and parenteral nutrition are covered. Specific nutrients important for immune function, such as arginine, glutamine, and omega-3 fatty acids, are also discussed.
This document discusses carcinoma of the rectum. It begins by explaining the anatomy of the rectum and its blood supply, lymphatic drainage and innervation. It then discusses the epidemiology, risk factors, staging systems including Dukes and TNM classification. Signs and symptoms, diagnostic workup including endoscopic, radiological and biopsy evaluation are explained. Principles of surgical treatment including resection margins are outlined. The goal of surgery is eradication of the primary tumor along with adjacent mesorectal tissue.
Pancreatic cancer is the second most common gastrointestinal malignancy in the US. Risk factors include increasing age, male gender, African American race, smoking, obesity, and diabetes. The most common type is ductal adenocarcinoma, which accounts for 85-90% of cases. Overall survival is poor, with a 5-year rate of only 5%, due to most cases being diagnosed at an advanced stage when surgical resection is no longer an option.
This document outlines a seminar plan on carcinoma of the pancreas presented by Dr. Jyotindra Singh. The seminar will cover topics such as the anatomy and surgical anatomy of the pancreas, pancreatic tumors, modes of presentation, pre-operative workup, various surgeries and surgical videos, recent updates, studies and trials, and a take home message. The seminar introduction discusses that carcinoma of the exocrine pancreas accounts for over 90% of pancreatic tumors and remains an oncologic challenge with a 5-year survival rate of 3%.
Gastric cancer begins in the inner lining of the stomach and grows slowly over many years. Risk factors include infection with H. pylori bacteria, smoking, diet high in smoked foods, and family history. Early gastric cancer is diagnosed via endoscopy with biopsy. Advanced cancer signs include weight loss, abdominal pain, and vomiting. Treatment involves surgical resection of different extent depending on tumor stage, with some candidates for endoscopic mucosal resection. Adjuvant chemotherapy provides a survival benefit but side effects are common.
Gastric cancer causes over 10,000 deaths per year in the United States. Surgical resection with D2 lymphadenectomy is the standard treatment and improves survival compared to D1 lymphadenectomy. Adjuvant chemotherapy or chemoradiation after surgery has also been shown to improve survival for locally advanced gastric cancer. Minimally invasive approaches for gastric cancer resection have been shown to be as effective as open surgery with benefits of reduced blood loss, shorter hospital stays, and improved quality of life.
The anal canal is approximately 4 cm in length extending from the anorectal junction to the anal verge. Anal cancers are rare and mostly squamous cell carcinomas arising from the anal transitional zone. Risk factors include HPV infection and immunosuppression. Combined chemoradiotherapy is the standard first-line treatment and results in high response rates and organ preservation compared to radiation alone. Salvage surgery may be considered for select cases after failed nonsurgical treatment or as primary treatment for those who cannot tolerate chemoradiotherapy. Prognosis depends on tumor stage, with 5-year survival rates ranging from 45-86% depending on depth of invasion and nodal involvement.
This document summarizes information about appendiceal adenocarcinoma. It discusses how the majority of patients present with acute appendicitis and describes the intestinal and mucinous tumor types. It also covers tumor classification, including mucinous tumors of uncertain malignant potential. Prognosis depends on factors like histologic type, T stage, and tumor grade. Treatment recommendations include simple appendectomy for early stage disease and hemicolectomy for more advanced tumors. Adjuvant chemotherapy and intraperitoneal hyperthermic chemotherapy are discussed as additional treatment options. Cytoreductive surgery can help palliate patients with peritoneal carcinomatosis.
Primary gastrointestinal lymphomas arise from lymphoid tissue in the gastrointestinal tract. They commonly involve the stomach and small intestine. Staging involves assessing whether the tumor is confined to the gastrointestinal tract or has spread to lymph nodes or distant sites. Radiologic examinations can demonstrate tumor appearance and extent, such as polypoid masses, ulcers, or circumferential thickening of the bowel wall. Accurately diagnosing primary gastrointestinal lymphoma and determining its stage is important for guiding treatment.
This document discusses nutrition support in surgery patients. It begins by outlining the aims of nutrition support to identify and meet the nutritional needs of at-risk patients. It then covers metabolic responses to starvation, increased energy and nutrient requirements in trauma/sepsis patients, methods of nutritional assessment, and factors that warrant nutrition support. The document provides details on enteral and parenteral nutrition support, including formulas, delivery methods, monitoring, and complications. It also addresses special considerations for burns patients and those with short bowel syndrome.
This document provides an overview of ductal carcinoma in situ (DCIS), also known as stage 0 breast cancer. It discusses the pathology, risk factors, diagnosis via mammography and biopsy, grading, treatment options including surgery and radiation therapy, and management of recurrence of DCIS. DCIS is defined as a pre-invasive proliferation of epithelial cells confined to the breast ducts. Left untreated, DCIS has an inherent tendency to progress to invasive breast cancer.
Gastrointestinal stromal tumors (GISTs) are rare sarcomas that arise from the gastrointestinal tract. Most commonly found in the stomach, they represent 0.2% of gastrointestinal tumors. While often asymptomatic, they can present with bleeding, pain, or obstruction. Diagnosis involves imaging such as endoscopy or CT scan followed by biopsy showing immunohistochemistry positive for CD117 in 95% of cases. Treatment involves surgical resection with clear margins although adjuvant therapy with imatinib is often used for higher risk tumors. Outcomes have improved greatly in the past two decades with 5-year survival rates now over 50% with appropriate treatment.
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
1) Ductal carcinoma in situ (DCIS), also known as stage 0 breast cancer, accounts for 20% of breast cancers in the US and represents the earliest non-invasive form.
2) Treatment options for DCIS include lumpectomy with or without radiation or total mastectomy. Factors such as tumor size, grade, and margin status help determine a patient's risk of recurrence and guide treatment decisions.
3) Short term side effects of breast radiation for DCIS typically include skin irritation, breast tenderness, and fatigue. Long term risks are generally low but may include lymphedema, lung inflammation, and fibrosis. Radiation reduces the risk of local recurrence by 50% compared to lumpectomy alone
This document outlines a seminar plan on benign breast disease presented by Dr. Jyotindra Singh and moderated by Dr. A. Bhaskar. It begins with an introduction and covers topics like anatomy, congenital abnormalities, classifications of benign breast disease, symptoms and possible diagnoses, diagnostic modalities, genetics, and recent advances. Under anatomy, it describes the location, structure, parenchyma, stroma, blood supply, venous and lymphatic drainage of the breast. It also discusses classifications of benign breast disease including proliferative and non-proliferative lesions. Common benign conditions like fibroadenomas, cysts, and radial scars are explained.
1. Gastric cancer incidence varies globally, with the highest rates in Eastern Europe, Japan, and China.
2. Risk factors include H. pylori infection, low socioeconomic status, smoking, and diets high in salt/pickled foods.
3. Symptoms are non-specific but include epigastric pain, weight loss, vomiting, and anemia. Diagnosis involves endoscopy with biopsy.
4. Treatment depends on stage - surgery for early stages and palliative chemotherapy for advanced cases.
This document discusses tumors of the appendix. It outlines different types of appendix tumors including mucocele, primary adenocarcinoma, cystadenocarcinoma, and carcinoid tumors. Mucocele occurs when the appendix lumen becomes blocked, causing a fluid-filled cyst. Ruptured mucocele or adenocarcinoma can lead to pseudomyxoma peritonei, where mucus accumulates in the abdominal cavity. Carcinoid tumors are the most common appendix tumors but are generally not aggressive. Management depends on tumor type but often involves surgical removal of the appendix or part of the colon.
This document provides an overview of nutrition in surgical patients. It discusses the basics of nutrition including caloric and protein requirements. The importance of nutrition for surgical patients is described along with the complications of malnutrition like infection and poor wound healing. Methods of nutritional assessment involving history, exams, and labs are outlined. Both enteral and parenteral nutrition are covered, including indications, contraindications, administration methods, and potential complications. The take home messages emphasize the importance of meeting caloric needs to avoid complications, using enteral nutrition when possible, and closely monitoring patients on nutrition support.
This document summarizes key information about cancer of the esophagus. It notes that in 2014 there were 18,170 new esophagus cancer cases in the US, with a lifetime risk of 0.5% and 5-year survival rate of 17.5%. Risk factors include tobacco, alcohol, Barrett's esophagus, obesity, and gastroesophageal reflux disease. The two main types are squamous cell carcinoma and adenocarcinoma, with adenocarcinoma now more common due to rising obesity rates. Staging involves assessing tumor depth (T), lymph node involvement (N), and metastases (M). Survival rates vary significantly based on cancer type, stage, and treatment received.
Pancreatic carcinoma ranks 13th in incidence worldwide but 8th as a cause of cancer death due to its poor prognosis. The majority of pancreatic cancers originate in the head of the pancreas. Clinical presentation is often nonspecific with weight loss, abdominal pain, and jaundice being common. Diagnosis relies on imaging such as CT, MRI, and EUS along with blood markers like CA19-9. Staging determines resectability and guides treatment, which may include surgery, chemotherapy, and radiation therapy. Prognosis remains poor even with treatment due to late stage at diagnosis and high rate of recurrence.
This document discusses colorectal cancer and provides an outline of topics to be covered, including clinical anatomy of the colon and rectum, definition and epidemiology of colorectal cancer, risk factors and pathogenesis, screening, pathology and staging, clinical presentation, investigations, treatment, and follow up. It then goes on to provide details on the clinical anatomy of the colon and rectum, definition of colorectal cancer, epidemiology, risk factors, screening recommendations, adenoma-carcinoma pathogenesis model, hereditary and non-hereditary forms, pathology and staging systems, patterns of spread, clinical presentation, and diagnostic workup.
This document discusses nutrition support for surgical patients, including enteral and parenteral nutrition. It outlines the goals of nutritional support as preventing catabolism, meeting energy requirements, and aiding tissue repair. Methods for estimating caloric and protein requirements are provided. The advantages of enteral over parenteral nutrition are described. Complications and their management for both enteral and parenteral nutrition are covered. Specific nutrients important for immune function, such as arginine, glutamine, and omega-3 fatty acids, are also discussed.
This document discusses carcinoma of the rectum. It begins by explaining the anatomy of the rectum and its blood supply, lymphatic drainage and innervation. It then discusses the epidemiology, risk factors, staging systems including Dukes and TNM classification. Signs and symptoms, diagnostic workup including endoscopic, radiological and biopsy evaluation are explained. Principles of surgical treatment including resection margins are outlined. The goal of surgery is eradication of the primary tumor along with adjacent mesorectal tissue.
Pancreatic cancer is the second most common gastrointestinal malignancy in the US. Risk factors include increasing age, male gender, African American race, smoking, obesity, and diabetes. The most common type is ductal adenocarcinoma, which accounts for 85-90% of cases. Overall survival is poor, with a 5-year rate of only 5%, due to most cases being diagnosed at an advanced stage when surgical resection is no longer an option.
This document outlines a seminar plan on carcinoma of the pancreas presented by Dr. Jyotindra Singh. The seminar will cover topics such as the anatomy and surgical anatomy of the pancreas, pancreatic tumors, modes of presentation, pre-operative workup, various surgeries and surgical videos, recent updates, studies and trials, and a take home message. The seminar introduction discusses that carcinoma of the exocrine pancreas accounts for over 90% of pancreatic tumors and remains an oncologic challenge with a 5-year survival rate of 3%.
Gastric cancer begins in the inner lining of the stomach and grows slowly over many years. Risk factors include infection with H. pylori bacteria, smoking, diet high in smoked foods, and family history. Early gastric cancer is diagnosed via endoscopy with biopsy. Advanced cancer signs include weight loss, abdominal pain, and vomiting. Treatment involves surgical resection of different extent depending on tumor stage, with some candidates for endoscopic mucosal resection. Adjuvant chemotherapy provides a survival benefit but side effects are common.
Gastric cancer causes over 10,000 deaths per year in the United States. Surgical resection with D2 lymphadenectomy is the standard treatment and improves survival compared to D1 lymphadenectomy. Adjuvant chemotherapy or chemoradiation after surgery has also been shown to improve survival for locally advanced gastric cancer. Minimally invasive approaches for gastric cancer resection have been shown to be as effective as open surgery with benefits of reduced blood loss, shorter hospital stays, and improved quality of life.
Stomach cancer accounts for 1.3% of new cancers and 1.9% of cancer deaths in the US. Risk factors include H. pylori infection, smoking, and diet low in fruits and vegetables. Symptoms often present at advanced stages and include weight loss, abdominal pain, and nausea. Treatment involves surgery, with chemotherapy and radiation sometimes used adjuvantly or palliatively. Radiation improves local control after surgery and survival outcomes compared to surgery alone. It is also effective for palliation of symptoms from advanced disease.
- The document summarizes key landmark clinical trials investigating treatments for metastatic gastric cancer.
- The ToGA trial found that adding trastuzumab (Herceptin) to standard chemotherapy (cisplatin and fluoropyrimidine) significantly improved overall survival and progression-free survival in patients with HER2-positive metastatic gastric cancer compared to chemotherapy alone. Median overall survival was 13.8 months with chemotherapy plus trastuzumab versus 11.1 months with chemotherapy alone.
- The REAL-2 trial demonstrated that cisplatin plus capecitabine was as effective as cisplatin plus fluorouracil for advanced gastric cancer, with less toxicity. Cisplatin plus capecitabine has since
Gastric cancer discussion slides final version.pptnew.pptzoezettemarc
1) Peri-operative chemotherapy with ECX before and after surgery improves overall survival compared to surgery alone in resectable gastric cancer based on the MAGIC trial.
2) The ACTS-GT trial showed adjuvant S-1 chemotherapy improves 3-year survival compared to observation alone after D2 gastrectomy for stage II-III gastric cancer.
3) Combination chemotherapy improves survival over best supportive care alone in advanced gastric cancer, with regimens including anthracyclines and cisplatin or oxaliplatin showing better efficacy.
Carcinoma esophagus is a lethal disease and carries poor prognosis.The diagnosis is usually delayed and over all 5yrs survival is less than 15% In this presentation I have discussed carcinoma esophagus - its pathology, clinical features, investigations and treatment in nutshell
This document discusses gastric cancer, including its epidemiology, anatomy, classification, pathology, clinical features, staging, and prognosis. Some key points include:
- Gastric cancer is the fourth most common cancer worldwide and the second leading cause of cancer death. Incidence varies globally.
- Tumors can be classified based on their location in the stomach (proximal vs. distal) and histological type (intestinal vs. diffuse).
- Risk factors include H. pylori infection, diet, smoking, family history, and genetic conditions.
- Clinical features depend on tumor location but may include dysphagia, satiety, obstruction, and metastatic signs.
- Staging uses the TNM
Gastric cancer is the second most common cancer worldwide. It is most common in elderly men over 65 years old. Risk factors include family history, diet high in salt/fat/nitrates, H. pylori infection, and atrophic gastritis. Premalignant conditions include polyps, intestinal metaplasia, and dysplasia. Symptoms include dyspepsia and pain induced by meat that does not respond to treatment. Staging systems include Bormann's classification and the Japanese classification. Histologically, Lauren's classification divides gastric cancer into intestinal and diffuse types based on cell morphology and growth pattern.
Legacy of Sound offers a great and secured platform to the vocalists who are willing to work on Original music Sydney. Contact them to know more and get a chance to shape up your singing carrier.
1st Buikwe District Teachers' Forum - 1st Briefing Sessionlissalourenco
This document provides information about an upcoming teacher's forum project in Uganda. It introduces the project team and gives an overview of the project, which will involve teachers from the 1st Buikwe District participating in a forum from August 4-15, 2014 in Nkokonjeru, Uganda. The document outlines what participants can expect, including accommodation, food, transportation, health and safety considerations, and the daily routine. It emphasizes preparation, such as obtaining vaccinations and visas. The goal is to provide participants with all necessary information to feel prepared for the trip while maintaining cultural sensitivity.
El documento habla sobre la diferencia entre traductor e intérprete, destacando que un traductor se enfoca en traducir textos escritos mientras que un intérprete se dedica a la traducción oral y simultánea.
The document discusses finite automata and regular languages. There are two types of finite automata - deterministic (DFA) and nondeterministic (NFA). While NFAs are more expressive, any language defined by an NFA can also be defined by a DFA. The document provides examples of modeling systems with multiple automata using a single product automaton. It also defines the formal components of a finite automaton and describes computations and examples of regular operations on languages like union and concatenation.
This document discusses Herpes Simplex Virus (HSV) esophagitis. It provides information on the management and treatment of HSV esophagitis, which includes hemodynamic stabilization, pain management, and specific antiviral therapy. The treatment of choice is oral or intravenous acyclovir for 7-10 days. It may require longer treatment or alternative medications like foscarnet for acyclovir-resistant cases. Primary and suppressive prophylactic acyclovir treatment is also discussed for high-risk immunocompromised patients.
1st Buikwe District Teachers' Forum - 1st Briefing Sessionlissalourenco
This document provides information about an upcoming teachers' forum project in Uganda. It introduces the project team and gives an overview of the Great Generation organization and its mission. It outlines the agenda for an upcoming briefing session, including introductions, details about the project in Uganda from August 4-15, logistics for travel, accommodations, and health and safety considerations. Attendees are given guidance on preparation, what to expect on the ground, and appropriate behavior during the trip.
Clean Bell is working to achieve 100% waste segregation in Bellandur Ward-150 using a 2-bin + 1-bag process. Their objectives are 100% segregation through colored bins for wet, dry, and reject waste, and eliminating plastic bag usage. Residents purchase an 8L green bin for wet waste, 8L red bin for reject waste, and use white bags for dry waste, costing around Rs. 100 per household. Standardizing bin colors helps create a universal culture of segregation where residents know which bin is for wet versus dry waste. Their goal is for 5,000 households to properly segregate using this process to keep reject waste out of landfills and send dry waste to recycl
Gastrointestinal Tumors. Sites Of MalignancyEneutron
This document discusses gastrointestinal tumors, specifically esophageal cancer. It provides information on the two main types of esophageal cancer - squamous cell carcinoma and adenocarcinoma. Risk factors, clinical presentation, diagnosis and staging are summarized. Squamous cell carcinoma is more common worldwide and associated with smoking and alcohol use. Adenocarcinoma incidence is rising in the US and associated with Barrett's esophagus, obesity, and reflux. Dysphagia is the most common symptom. Diagnosis involves endoscopy with biopsy as well as endoscopic ultrasound and CT or PET for staging. Endoscopic ultrasound provides accurate assessment of tumor depth and lymph node involvement for staging.
The document discusses a case of a 45-year-old man referred for new onset dysphagia. An upper GI study showed a mass in the distal esophagus. The incorrect statement is that squamous cell cancer is unlikely in this location, as adenocarcinoma would be more likely given the patient's history of smoking, heartburn, and potential Barrett's esophagus. Biopsy would likely show adenocarcinoma at the gastroesophageal junction.
This document discusses benign disorders of the esophagus, focusing on GERD (gastroesophageal reflux disease). It covers the epidemiology, pathophysiology, symptoms, diagnostic tests and treatment options for GERD. Regarding treatment, lifestyle modifications and medications like antacids, H2 blockers, and proton pump inhibitors are discussed as first-line options. Endoscopic treatments and anti-reflux surgery are also mentioned.
1. The document discusses common mistakes that can occur during upper gastrointestinal endoscopy and how to avoid them. It describes mistakes like missing Cameron ulcers, Dieulafoy lesions, eosinophilic esophagitis, long segment Barrett's esophagus, and confusion between portal hypertensive gastropathy and gastric antral vascular ectasia.
2. Key recommendations include paying close attention to the cardia region in patients with large hiatal hernias, performing urgent endoscopy in cases of new bleeding, asking patients to cough to induce bleeding from possible Dieulafoy lesions, taking multiple biopsies to diagnose eosinophilic esophagitis, and actively searching for the Z-line in cases
This document summarizes information about esophageal and gastric cancers. It discusses the different types of esophageal cancers including squamous cell carcinoma and adenocarcinoma. It describes risk factors, symptoms, diagnosis, and treatment options for esophageal cancers. It also summarizes gastric cancers, providing information on types, risk factors, clinical features, evaluation, staging, differential diagnosis, and treatment/management. Primary gastric lymphoma is also briefly mentioned.
The document discusses gastric carcinoma (stomach cancer). It provides details on risk factors, clinical presentation, diagnostic testing including endoscopy, staging, treatment options including surgery, chemotherapy and radiation, complications, and prognostic factors. The highest rates of gastric cancer are seen in Japan, and it is more common in males and older individuals. Infection with H. pylori is a significant risk factor. Endoscopy with biopsy is the gold standard for diagnosis. Treatment depends on staging but may include surgery such as total or subtotal gastrectomy. Prognosis depends on depth of invasion and lymph node involvement.
This document provides an overview of ovarian cancer, including risk factors, pathology, diagnosis, screening, staging, and management. Some key points include:
- Ovarian cancer accounts for 3-4% of cancers in women and is the fourth leading cause of cancer death.
- Risk factors include family history, ethnicity, reproductive history, and use of hormones.
- Diagnosis involves physical exam, tumor markers like CA-125, ultrasound, CT or MRI to determine if a mass is benign or malignant.
- Staging follows the FIGO system from I to IV depending on extent of spread. Surgery and chemotherapy are the primary treatments.
Barrett's esophagus is a premalignant condition where the normal squamous epithelium of the esophagus is replaced by columnar epithelium, usually as a result of chronic gastroesophageal reflux disease. It is a risk factor for esophageal adenocarcinoma. Screening for Barrett's esophagus is recommended for men over 50 with chronic GERD symptoms. Treatment options for dysplasia include endoscopic ablation or resection. Esophageal cancer is often diagnosed via endoscopy and has a poor prognosis depending on stage. Risk factors include tobacco, alcohol, GERD, and obesity.
Coeliac disease is an immune-mediated enteropathy triggered by gluten in genetically susceptible individuals. It is diagnosed through a combination of clinical presentation, serology testing, and small intestinal biopsy showing villous atrophy. While serology tests are highly sensitive for classical coeliac disease, many atypical presentations involve seronegative or partial villous atrophy cases that can easily be missed. Adherence to a lifelong gluten-free diet is currently the only treatment, though enzymatic degradation of gluten may provide an alternative in the future.
This document discusses gastritis and Helicobacter pylori (H. pylori) infection. It defines gastritis as inflammation of the stomach lining and notes that it is usually caused by infectious agents like H. pylori, autoimmune issues, or hypersensitivity reactions. H. pylori is described as a common chronic bacterial infection that can lead to gastritis. Strains of H. pylori that produce vacuolating cytotoxin and cytotoxin-associated gene A are associated with more severe inflammation and increased risk of ulcers and precancerous lesions. The document provides classifications of gastritis and risk factors for conditions like stress-related gastric ulcers.
1. The document describes findings from 460 colonoscopies performed over 7 years. Ulcerative colitis was found in 141 patients (31%), most commonly affecting the rectum and left colon. Crohn's disease was rare, found in only 3 patients.
2. Ulcerative colitis causes inflammation and ulcers in the lining of the colon. Symptoms include bloody diarrhea, abdominal cramps, and weight loss. The disease involves periods of relapse and remission. In severe cases it can cause serious complications requiring hospitalization.
3. The causes of inflammatory bowel disease are unknown but involve genetic and environmental factors that trigger an immune response in the gastrointestinal tract.
Malignant ascites, an abnormal accumulation of fluid in the abdominal cavity, is commonly associated with cancers like ovarian cancer, gastrointestinal cancers, and breast cancer. It develops due to mechanical obstruction of lymphatic drainage by tumors and increased vascular permeability caused by cytokines. Diagnosis involves abdominal ultrasound or CT scan followed by diagnostic paracentesis of the fluid to examine for malignant cells. Treatment options include dietary salt restriction, diuretics, repeated paracentesis, indwelling catheters, peritoneovenous shunting, and intraperitoneal chemotherapy.
This document discusses various esophageal disorders including structural disorders like hiatal hernia and rings, motility disorders like achalasia, and conditions caused by reflux like GERD and Barrett's esophagus. It provides details on the causes, symptoms, diagnoses and treatments of these common esophageal problems.
Cancer of Oesophagus and Stomach - Treatment & Information in Kuching, SarawakTimberlandMedicalCentre
For more information, visit https://www.timberlandmedical.com
This presentation is by Dr. Wong Kwong Hieng (MBBch,FRCS,AM) General Surgeon at Timberland Medical Centre.
Timberland Medical Centre is a private hospital that has been in operation since 1994. We are strategically located at the 3rd Mile roundabout on Jalan Rock, Kuching, Sarawak, East Malaysia. Our hospital is 10 minutes from the Kuching International Airport and 15 minutes from the Central Bus Terminal. We continually seek to improve and upgrade our services and facilities, as we strive to provide the best medical care for our patients and customers.
This document discusses malignant disorders of the esophagus, specifically esophageal cancer. It provides details on the two main types - squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma is still more common worldwide, while adenocarcinoma is becoming more prevalent in the US and Europe. Risk factors include tobacco and alcohol consumption as well as conditions like Barrett's esophagus. Symptoms typically include dysphagia and weight loss. Diagnosis involves endoscopy with biopsy as well as imaging studies like CT and PET scans to stage the cancer.
This document provides information on Gastroesophageal Reflux Disease (GERD). It defines GERD as abnormal reflux of gastric contents into the esophagus causing troublesome symptoms or complications, with more than 2 heartburn episodes per week. Approximately 20% of adults experience frequent GERD symptoms. The document discusses the pathogenesis, risk factors, diagnosis and diagnostic tests, and treatment options for GERD including pharmacologic therapies, surgery, and endoscopic treatments. It provides details on classifications of esophagitis, guidelines for endoscopy and pH monitoring in GERD diagnosis and management.
Colorectal cancer is the third most common cancer worldwide and the fourth most common cause of cancer death. Risk factors include age over 50, personal or family history of colon polyps or inflammatory bowel disease, diet low in fiber/high in fat/red meat, smoking, alcohol, and sedentary lifestyle. Symptoms include rectal bleeding, blood in stool, abdominal pain, and changes in bowel habits. Screening allows early detection through colonoscopy. Staging determines treatment which may include surgery, chemotherapy, and radiation therapy. Nursing care focuses on managing anxiety, fatigue, pain, and other side effects.
This document provides guidelines for managing diabetes during Ramadan fasting. It was created by the International Diabetes Federation and Diabetes and Ramadan International Alliance. The guidelines cover epidemiology of diabetes and Ramadan fasting, physiology changes during fasting, risk stratification for fasting, diabetes education, and medication adjustments. The goal is to enhance healthcare provider knowledge to safely support patients with diabetes who choose to fast during Ramadan.
This review article summarizes the 2011 evidence-based practice guideline published by the American Society of Hematology for the diagnosis and treatment of immune thrombocytopenia (ITP). The guideline was created using a rigorous evidence-based approach and provides treatment recommendations using the GRADE system where evidence exists. It identifies a lack of evidence in several key areas of ITP therapy, such as comparative studies of front-line therapies and management of bleeding. The guideline covers diagnosis and treatment of ITP in both children and adults, including recommendations for initial treatment, management of non-responders, treatment of specific secondary forms of ITP, and treatment during pregnancy.
Two types of acute diarrhoeal emergencies are cholera, which causes acute watery diarrhoea, and Shigella dysentery, which causes acute bloody diarrhoea. Both are transmitted through contaminated water, food, hands, and vomit or stool of sick individuals. The first steps in managing a diarrhoeal outbreak are determining if there are an unusual number of similar cases, identifying whether patients have cholera or Shigella by their symptoms, and being prepared for a potential increase in cases.
The document provides guidelines for diabetic eye care developed by the International Council of Ophthalmology (ICO). It aims to improve eye care quality worldwide by addressing screening and management of diabetic retinopathy for different resource settings. The guidelines describe classifying and screening for diabetic retinopathy, detailed eye exams, treating retinopathy and macular edema, and managing special circumstances. It includes tables outlining follow-up schedules and treatment recommendations based on retinopathy severity and resource level.
This document discusses special considerations for managing chronic myeloid leukemia (CML) during pregnancy and in the pediatric population. For pregnancy:
- Tyrosine kinase inhibitors (TKIs) used to treat CML are teratogenic and known to cause fetal toxicities. TKI therapy during pregnancy has been associated with higher rates of miscarriage and fetal abnormalities.
- If a patient wants to conceive, discontinuing TKI therapy may be considered if a deep molecular response has been maintained for at least 2 years. Close monitoring would be needed if CML recurs during pregnancy.
- For pediatric CML management, no evidence-based recommendations exist since CML is relatively rare in children. Specialized care at a cancer center is
This document discusses several minor blood group systems beyond ABO and Rh, including I/i, Lewis, P, MN, and SsU. It provides details on the antigens and antibodies in each system, including frequencies, clinical significance, and serological characteristics. The key points are:
- Over 500 antigens beyond ABO have been identified on red blood cells.
- The I/i, Lewis, P, MN, and SsU systems involve antigens that are inherited based on allelic genes and their interactions.
- Antibodies in these systems are usually naturally occurring and clinically insignificant, though some like anti-S, anti-s, and anti-U can cause hemolytic disease of the new
This document provides a focused update to the 2013 ACCF/AHA guidelines for the management of heart failure. It was developed by a writing group comprised of experts from the ACC, AHA, HFSA, and other organizations. The update provides new recommendations on the use of biomarkers for diagnosis and prognosis of heart failure as well as for treatment of stages A through D. It also includes new recommendations on treating anemia, hypertension, and sleep disordered breathing in heart failure patients. The update was reviewed and approved by several committees and is intended to provide guidance for clinicians on best practices in heart failure management.
These guidelines provide recommendations for managing dyslipidemia and preventing cardiovascular disease. They were developed by a writing committee and task force of experts based on reviews of current literature. The guidelines note that medical decisions should be made using clinical judgment and local resources, as rapid changes in the field may lead to periodic revisions. The document aims to assist healthcare professionals while not replacing their independent judgment.
This document provides an overview of the process and methods used to develop recommendations for the testing, management, and treatment of hepatitis C virus (HCV) infection. A panel of HCV experts from various medical fields develops the guidance using an evidence-based approach. Recommendations are rated based on the strength of evidence. The guidance is intended to be a living document that is regularly updated as new treatments and information become available. Strict processes are in place to manage conflicts of interest among panel members.
This document provides information on drugs that are contraindicated (Pregnancy Category X) for use during pregnancy. It lists the generic and brand names of drugs across several therapeutic categories including cardiovascular, dermatological, gastrointestinal, infections/infestations, musculoskeletal, neoplasms, nutrition, OB/GYN, pain/pyrexia, respiratory, and urogenital systems. For some drugs, it specifies the trimester or stage of pregnancy during which they should be avoided. The document also explains the pregnancy categories (A, B, C, D, X) used to qualify contraindications and precautions for drug use during pregnancy.
Muslims believe that death comes by divine decree and marks the beginning of an eternal journey in the afterlife. Some terminally ill Muslim patients receive care in intensive care units that prolong their lives through significant medical intervention when they may instead suffer without meaningful benefit. There is limited information available about Islamic beliefs regarding end of life issues for Muslims living in non-Muslim countries. Withdrawal of futile treatment is permitted in Islamic law for terminally ill patients to allow death to take its natural course. "Do not resuscitate" orders are also permitted in certain situations according to Islamic rulings if three physicians agree treatment would be non-beneficial. However, hydration and pain management should continue until death.
This document reviews recent guidelines for treating painful diabetic neuropathy (DPN) and compares their recommendations. It finds that the main drug classes recommended as first-line treatment are anticonvulsants like pregabalin and gabapentin, antidepressants like tricyclic antidepressants and duloxetine, and opioids. Pregabalin and duloxetine are the only drugs approved to treat neuropathic pain in diabetes. The guidelines differ in their methodologies, with some based more quantitatively on clinical trial evidence while others incorporate additional factors. Patient characteristics may also influence which treatment is most appropriate.
This document provides guidance from NICE on the assessment and treatment of acute stroke. It outlines recommendations for promptly admitting patients to specialist stroke units, performing brain imaging, providing thrombolysis or mechanical clot retrieval if appropriate, administering antiplatelets or anticoagulants, managing blood pressure and blood sugar, assessing swallowing function and providing nutrition, and carrying out carotid imaging and endarterectomy if indicated. The pathway is designed to optimize stroke care from initial presentation through the acute and subacute phases of recovery.
1) A randomized clinical trial of 576 adults with acute sore throat found that a single dose of oral dexamethasone did not increase the proportion of patients with complete resolution of symptoms at 24 hours compared to placebo.
2) However, at 48 hours significantly more patients in the dexamethasone group experienced complete resolution of symptoms than those in the placebo group.
3) The study found no other significant differences between the dexamethasone and placebo groups in secondary outcomes such as duration of symptoms, health care use, time off work, or medication use.
This document provides guidelines for managing diabetes during Ramadan fasting. It was created by the International Diabetes Federation and Diabetes and Ramadan International Alliance. The guidelines cover epidemiology of diabetes during Ramadan, physiology of fasting and how it impacts diabetes, risk stratification of patients, education recommendations, and medication adjustments for various diabetes medications and high-risk patient groups, such as those with type 1 diabetes. The goal is to enhance healthcare professionals' knowledge to best support patients during Ramadan fasting.
May-Hegglin anomaly is part of a spectrum of disorders called MYH9-related disease. Mutations in the MYH9 gene cause macrothrombocytopenia (low platelet count with large platelets) and basophilic inclusions in white blood cells. A diagnosis can be facilitated by platelet electron microscopy and MYH9 gene sequencing. While each disorder in the spectrum has some unique characteristics, they are all characterized by macrothrombocytopenia and are now considered manifestations of MYH9-related disease.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
2. Epidemiology of gastric cancer
GC remains one of the most common forms ofGC remains one of the most common forms of
cancer worldwidecancer worldwide
~ 9.9% of new cancers~ 9.9% of new cancers
~ 870,000 new cases and 650,000 deaths/ yr~ 870,000 new cases and 650,000 deaths/ yr
~ 21,860 pts were diagnosed in 2006 in the US of~ 21,860 pts were diagnosed in 2006 in the US of
whom 11,430 are expected to die.whom 11,430 are expected to die.
Ferlay, Gobocan 2000: Lyon, IARCPress.Ferlay, Gobocan 2000: Lyon, IARCPress.
3. Atrophic gastritisAtrophic gastritis
Risk of developing GC during 4.4 yrs of follow-upRisk of developing GC during 4.4 yrs of follow-up
period was increased 5.7-foldperiod was increased 5.7-fold
Correa, P. Cancer 1982; 50:2554Correa, P. Cancer 1982; 50:2554
Hypochlorhydria microbial colonization, someHypochlorhydria microbial colonization, some
of which possess nitrate reductase, allowingof which possess nitrate reductase, allowing
nitrosation that is genotoxic.nitrosation that is genotoxic.
Loss of endocrine cells, which normally secreteLoss of endocrine cells, which normally secrete
EGF and TGF, thereby aiding the stomach inEGF and TGF, thereby aiding the stomach in
regenerating damaged tissue.regenerating damaged tissue.
Risk factors
Precursor lesions
4. Intestinal metaplasia/ dysplasia
H. pylori, bile reflux, induced experimentally byH. pylori, bile reflux, induced experimentally by
irradiationirradiation
More frequent in countries with high incidence of GCMore frequent in countries with high incidence of GC
Most pts with HG dysplasia already have or soonMost pts with HG dysplasia already have or soon
develop GCdevelop GC
In gastrectomy specimens for GC, 20-40 % of ptsIn gastrectomy specimens for GC, 20-40 % of pts
had dysplasia and GC developed at 21% for mild,had dysplasia and GC developed at 21% for mild,
and 57% for severe dysplasiaand 57% for severe dysplasia
Shimoyama, Virchows Arch 2000; 436:585.Shimoyama, Virchows Arch 2000; 436:585.
5. Environmental factors
Diet
Nitrates nitroso compounds.Nitrates nitroso compounds.
Diets low in vegetables, fruits, milk, and vit A andDiets low in vegetables, fruits, milk, and vit A and
high in fried food, processed meat, and fish.high in fried food, processed meat, and fish.
Vitamin C reduce the formation of carcinogenic n-Vitamin C reduce the formation of carcinogenic n-
nitroso compounds inside the stomach.nitroso compounds inside the stomach.
High salt intake damages stomach mucosa andHigh salt intake damages stomach mucosa and
increases the susceptibility to carcinogenesis inincreases the susceptibility to carcinogenesis in
rodents.rodents.
6. SmokingSmoking
The risk was increased by 1.5 to 1.60-foldThe risk was increased by 1.5 to 1.60-fold
AlcoholAlcohol
Not been demonstratedNot been demonstrated
Socioeconomic statusSocioeconomic status
2-fold increase in populations with low socioeconomic status2-fold increase in populations with low socioeconomic status
Gastric surgeryGastric surgery
Relative risk in the range of 1.5 to 3.0,Relative risk in the range of 1.5 to 3.0,
Helicobacter pyloriHelicobacter pylori
6-fold increase in the risk of GC6-fold increase in the risk of GC
7. Host-related factors
Blood group A.Blood group A.
20% excess of GC than those of group O, B, or AB.20% excess of GC than those of group O, B, or AB.
Familial predisposition.Familial predisposition.
GC has been described in association with certainGC has been described in association with certain
cancer syndromes (HNPCRC, FAP, Peutz Jeghers).cancer syndromes (HNPCRC, FAP, Peutz Jeghers).
There are reports of at least 45 families worldwideThere are reports of at least 45 families worldwide
withwith hereditary diffuse gastric cancerhereditary diffuse gastric cancer due to germlinedue to germline
mutations of the e-cadherin gene CDH1.mutations of the e-cadherin gene CDH1.
Blair, Clin Gastroenterol Hepatol 2006; 4:262.Blair, Clin Gastroenterol Hepatol 2006; 4:262.
8. Model of gastric carcinogenesis
Adapted from Elder, JB. Carcinoma of the stomach.
Gastroenterology, 5th ed, WB Saunders, Philadelphia, 1995, p. 862.
9. Clinical Features
Most GCs are diagnosed in symptomatic ptsMost GCs are diagnosed in symptomatic pts
presenting with advanced incurable disease.presenting with advanced incurable disease.
Surgically curable lesions are usually asymptomatic,Surgically curable lesions are usually asymptomatic,
and rarely detected outside a screening program.and rarely detected outside a screening program.
Weight loss and persistent abdominal pain are theWeight loss and persistent abdominal pain are the
most common symptoms at initial diagnosis.most common symptoms at initial diagnosis.
Ann Surg 1993; 218:583.Ann Surg 1993; 218:583.
10. Presenting symptoms in 18,363 pts
Adapted from Wanebo, HJ, Kennedy, BJ, Chmiel, J, et al,Adapted from Wanebo, HJ, Kennedy, BJ, Chmiel, J, et al,
Ann Surg 1993; 218:583.Ann Surg 1993; 218:583.
SymptomSymptom PercentPercent
Wt lossWt loss 6262
Abdominal painAbdominal pain 5252
NauseaNausea 3434
DysphagiaDysphagia 2626
MelenaMelena 2020
Early satietyEarly satiety 1818
Ulcer type painUlcer type pain 1717
11. ~ 25% of pts have a history of GU.~ 25% of pts have a history of GU.
Pseudoachalasia syndrome may occur as thePseudoachalasia syndrome may occur as the
result of involvement of Auerbach's plexus.result of involvement of Auerbach's plexus.
Kahrilas, am J med 1987; 82:439Kahrilas, am J med 1987; 82:439..
Feculent emesis or passage of recentlyFeculent emesis or passage of recently
ingested material in the stool.ingested material in the stool.
Occult GI bleeding with or without ID anemiaOccult GI bleeding with or without ID anemia..
12. Signs of tumor extension
Palpable abdominal massPalpable abdominal mass
Periumbilical nodule (sister Mary Joseph's node) or ltPeriumbilical nodule (sister Mary Joseph's node) or lt
supraclavicular LN (Virchow's node).supraclavicular LN (Virchow's node).
Morgenstern, am J Surg 1979; 138:703Morgenstern, am J Surg 1979; 138:703
Peritoneal spreadPeritoneal spread
Krukenberg's tumorKrukenberg's tumor
Blumer's shelf (mass in the cul-de-sac on PR)Blumer's shelf (mass in the cul-de-sac on PR)
Gilliland,. Br J Surg 1992; 79:1364.Gilliland,. Br J Surg 1992; 79:1364.
13. Ascites can be a manifestation of peritonealAscites can be a manifestation of peritoneal
carcinomatosis,carcinomatosis,
Palpable liver mass can indicate metastases.Palpable liver mass can indicate metastases.
Jaundice or clinical evidence of liver failure isJaundice or clinical evidence of liver failure is
seen in the preterminal stages of metastaticseen in the preterminal stages of metastatic
disease.disease.
Fuchs, N Engl J Med 1995; 333:32.Fuchs, N Engl J Med 1995; 333:32.
14. Paraneoplastic manifestations
Rarely seen at initial presentation.Rarely seen at initial presentation.
Dermatological findings:Dermatological findings:
Sign of Leser-Trelat.Sign of Leser-Trelat.
Sudden appearance of diffuse seborrheic keratoses.Sudden appearance of diffuse seborrheic keratoses.
Acanthosis nigricans.Acanthosis nigricans.
Velvety and darkly pigmented patches of skin folds.Velvety and darkly pigmented patches of skin folds.
Neither finding is specific for gastric cancer.Neither finding is specific for gastric cancer.
Dantzig, arch Dermatol 1973; 108:700.Dantzig, arch Dermatol 1973; 108:700.
15. Microangiopathic hemolytic anemiaMicroangiopathic hemolytic anemia
Membranous nephropathyMembranous nephropathy
Hypercoagulable states (Trouseau'sHypercoagulable states (Trouseau's
syndrome)syndrome)
Polyarteritis nodosaPolyarteritis nodosa
Poveda, J Intern Med 1994; 236:679.Poveda, J Intern Med 1994; 236:679.
17. Upper GI endoscopy
The mainstay for diagnosis of GC.The mainstay for diagnosis of GC.
The sensitivity and specificity is > 90%.The sensitivity and specificity is > 90%.
More sensitive and specific than alternatives.More sensitive and specific than alternatives.
The ability to perform Bx during endoscopyThe ability to perform Bx during endoscopy
adds to its clinical utility.adds to its clinical utility.
Graham, Gastroenterology 1982; 82:228.Graham, Gastroenterology 1982; 82:228.
18. Malignant and benign gastric ulcer
Malignant GU
of the cardia.
• absence of folds
radiating to the base
•exophytic appearance.
Benign GU in
the prepyloric region.
•well- circumscribed
•folds radiating to
the ulcer base.
19. Endoscopic appearances of gastric
cancer
Adenocarcinoma in the
antrum
(friable, ulcerated,
and circumferential mass)
Adenocarcinoma
of the cardia.
(large, lobulated,
ulcerated mass)
20. Since up to 5 % of malignant ulcers maySince up to 5 % of malignant ulcers may
appear benign grossly, it is imperative that allappear benign grossly, it is imperative that all
such lesions be evaluated histologicallysuch lesions be evaluated histologically
These data provide a strong rationale forThese data provide a strong rationale for
upper endoscopy as the initial diagnostic testupper endoscopy as the initial diagnostic test
for pts in whom gastric cancer is suspected.for pts in whom gastric cancer is suspected.
Karita, Gastrointest Endosc 1994; 40:749.Karita, Gastrointest Endosc 1994; 40:749.
21. Endoscopic techniques
A single Bx has a 70 % sensitivity forA single Bx has a 70 % sensitivity for
diagnosing GCdiagnosing GC
Performing 7 biopsies from the ulcer marginPerforming 7 biopsies from the ulcer margin
and base increases the sensitivity to > 98 %.and base increases the sensitivity to > 98 %.
Its important to take numerous Bx fromIts important to take numerous Bx from
smaller, benign-appearing GUsmaller, benign-appearing GU
22. Diffuse-type GC, so called "linitis plastica," can beDiffuse-type GC, so called "linitis plastica," can be
especially difficult.especially difficult.
Stiff, "leather-flask" appearing stomach on bariumStiff, "leather-flask" appearing stomach on barium
meal may be associated with a normal endoscopy.meal may be associated with a normal endoscopy.
These tumors tend to infiltrate the submucosa, soThese tumors tend to infiltrate the submucosa, so
superficial mucosal biopsies may be falsely negative.superficial mucosal biopsies may be falsely negative.
The combination of strip and bite Bx techniques.The combination of strip and bite Bx techniques.
23. Linitis plastica of the stomach
Fixed narrowing of the entire proximal stomach (arrows)
due to submucosal invasion by a GC.
24. Brush cytologyBrush cytology
Increases the sensitivity of single biopsies, but theIncreases the sensitivity of single biopsies, but the
extent to which it enhances diagnostic yield when 7extent to which it enhances diagnostic yield when 7
biopsies are obtained remains unknownbiopsies are obtained remains unknown
If bleeding with Bx is of concern, it is reasonable toIf bleeding with Bx is of concern, it is reasonable to
brush the ulcer base, since the risk of bleeding frombrush the ulcer base, since the risk of bleeding from
this technique is negligiblethis technique is negligible
Wang, Acta Cytol 1991; 35:195Wang, Acta Cytol 1991; 35:195
25. Follow up endoscopy for GU
Follow-up endoscopy remains controversial.Follow-up endoscopy remains controversial.
Most of the literature supporting the need forMost of the literature supporting the need for
follow-up of GU is based on older surgicalfollow-up of GU is based on older surgical
and radiologic, rather than endoscopic data.and radiologic, rather than endoscopic data.
More recent studies have called into questionMore recent studies have called into question
the common practice of repeating endoscopy.the common practice of repeating endoscopy.
26. The issue of whether it is cost-effective toThe issue of whether it is cost-effective to
routinely perform repeat endoscopy for allroutinely perform repeat endoscopy for all
gastric ulcers needs to be determined.gastric ulcers needs to be determined.
The American Society of GI EndoscopyThe American Society of GI Endoscopy
recommends follow-up endoscopy 8 to 12recommends follow-up endoscopy 8 to 12
weeks after initial endoscopy and initiation ofweeks after initial endoscopy and initiation of
therapy to verify healing, with repeat biopsiestherapy to verify healing, with repeat biopsies
performed on remaining ulcers.performed on remaining ulcers.
Gastrointest Endosc 1988; 34:21SGastrointest Endosc 1988; 34:21S..
27. Serologic markers
No serologic markers have been proven to be useful.No serologic markers have been proven to be useful.
Increases in serum pepsinogen II.Increases in serum pepsinogen II.
Decreases in the pepsinogen I: pepsinogen II ratio.Decreases in the pepsinogen I: pepsinogen II ratio.
Has been used in screening programs to identify ptsHas been used in screening programs to identify pts
at increased risk for GC but are insufficientlyat increased risk for GC but are insufficiently
sensitive or specific for establishing a diagnosis.sensitive or specific for establishing a diagnosis.
Harie,. Cancer 1996; 77:991.Harie,. Cancer 1996; 77:991.
28. Barium studies
Can identify both malignant GUs and infiltratingCan identify both malignant GUs and infiltrating
lesionslesions
Some early gastric cancers also may be seenSome early gastric cancers also may be seen
However, false negative barium studies can occur inHowever, false negative barium studies can occur in
as many as 50 % of casesas many as 50 % of cases
This is a particular problem in early GC in which theThis is a particular problem in early GC in which the
sensitivity of barium meals may be as low as 14 %sensitivity of barium meals may be as low as 14 %
Dooley, CP Ann intern med 1984; 101:538Dooley, CP Ann intern med 1984; 101:538
30. Malignant and benign gastric ulcer
Malignant GU of the distal LC.
biconvex meniscus sign with
a nodular ulcer mound
Benign GU of the LC
ulcer crater has smooth margins
and projects beyond gastric wall
31. Staging
Accurate tumor staging appropriateAccurate tumor staging appropriate
treatment.treatment.
TNM staging system of the AJCCTNM staging system of the AJCC
Methods:Methods: CT scanCT scan
EUSEUS
laparoscopylaparoscopy
PET scanPET scan
33. CT scan
Recent data have shown the following results with CTRecent data have shown the following results with CT
scanning for staging of GC:scanning for staging of GC:
Accurate staging — 40 to 50 %Accurate staging — 40 to 50 %
Understaging as the depth of invasion isUnderstaging as the depth of invasion is
underestimated — 10 to 35 %underestimated — 10 to 35 %
Overstaging as the depth of invasion isOverstaging as the depth of invasion is
overestimated — 6 to 14 %overestimated — 6 to 14 %
Botet Radiology 1991; 181:419.Botet Radiology 1991; 181:419.
34. The accuracy of determining LN involvementThe accuracy of determining LN involvement
is no better, with overall accuracy ratesis no better, with overall accuracy rates
between 50-60%.between 50-60%.
CT is better for evaluating more widelyCT is better for evaluating more widely
metastatic disease, especially liver mets;metastatic disease, especially liver mets;
however, the risk of false positive and falsehowever, the risk of false positive and false
negative results still exists.negative results still exists.
Sussman, Radiology 1988; 167:33Sussman, Radiology 1988; 167:33
35. Endoscopic ultrasonography
Newer and more accurate means of preoperativeNewer and more accurate means of preoperative
staging of GC.staging of GC.
Has low risk, although it is more invasive than CTHas low risk, although it is more invasive than CT
Risk of serious complications of 0.3 %, most of whichRisk of serious complications of 0.3 %, most of which
occurred in the setting of obstructing esophagealoccurred in the setting of obstructing esophageal
tumors.tumors.
Pollack, BJ, EUS. Semin Oncol 1996; 23:336.Pollack, BJ, EUS. Semin Oncol 1996; 23:336.
36. Pooled data for over 2000 pts who underwent EUSPooled data for over 2000 pts who underwent EUS
found an accuracy of 77% for staging the depth offound an accuracy of 77% for staging the depth of
invasion and 69% for nodal stageinvasion and 69% for nodal stage
Most inaccuracies are due to understaging nodalMost inaccuracies are due to understaging nodal
involvement and the depth of invasioninvolvement and the depth of invasion
Distinguishing T2 from T3 lesions is especiallyDistinguishing T2 from T3 lesions is especially
difficult.difficult.
37. Although EUS has been shown to accuratelyAlthough EUS has been shown to accurately
assess the presence of distant mets in oneassess the presence of distant mets in one
report, its field of vision is only 5 to 7 cm andreport, its field of vision is only 5 to 7 cm and
its utility for this purpose is still in question.its utility for this purpose is still in question.
EUS guided FNA of suspicious nodes andEUS guided FNA of suspicious nodes and
regional areas is being evaluated, and mayregional areas is being evaluated, and may
further add to its accuracyfurther add to its accuracy
Chang, JJ,. Gastrointest Endosc 1994; 40:694Chang, JJ,. Gastrointest Endosc 1994; 40:694..
38. Laparoscopy
Laparoscopy, while more invasive than CT or EUS,Laparoscopy, while more invasive than CT or EUS,
has the advantage of directly visualizing the liverhas the advantage of directly visualizing the liver
surface, the peritoneum, and local LNs.surface, the peritoneum, and local LNs.
It is a sensitive modality for diagnosing liver metsIt is a sensitive modality for diagnosing liver mets
and, in one review, it diagnosed peritoneal mets inand, in one review, it diagnosed peritoneal mets in
23% of pts in whom no such involvement was seen23% of pts in whom no such involvement was seen
by CT.by CT.
Conlon, KC, Semin Oncol 1996; 23:347.Conlon, KC, Semin Oncol 1996; 23:347.
39. Summary
The ultimate choice of staging modalities is largelyThe ultimate choice of staging modalities is largely
dependent upon pt selection and local expertise.dependent upon pt selection and local expertise.
CT should be performed to look for M disease, itCT should be performed to look for M disease, it
should not be relied upon for assessing T or N.should not be relied upon for assessing T or N.
Paracentesis should be performed when ascites isParacentesis should be performed when ascites is
detected.detected.
40. Liver lesions on CT should be biopsiedLiver lesions on CT should be biopsied
Laparoscopy should be considered in selected ptsLaparoscopy should be considered in selected pts
EUS is better than CT at assessing tumor depth andEUS is better than CT at assessing tumor depth and
perhaps LN, particularly if FNA is performedperhaps LN, particularly if FNA is performed
41. Its use has been shown to alter therapy in ~ 1/3 ofIts use has been shown to alter therapy in ~ 1/3 of
ptspts
At present, the use of EUS depends largely uponAt present, the use of EUS depends largely upon
local availability and expertiselocal availability and expertise
Any pt with good PS ultimately requires laparotomyAny pt with good PS ultimately requires laparotomy
for curative or palliative surgery unless unresectabilityfor curative or palliative surgery unless unresectability
is clearly demonstrated.is clearly demonstrated.