Gastric cancer is the sixth most common cancer and third leading cause of cancer death worldwide. Risk factors include infection with H. pylori bacteria and low fruit/vegetable intake. Precancerous conditions include atrophic gastritis and intestinal metaplasia. Diagnosis involves endoscopy with biopsy. Treatment options include surgery to remove all or part of the stomach, chemotherapy, and radiation therapy. Post-operative care focuses on managing complications and preventing issues like dumping syndrome.
The stomach J-shaped. It has two surfaces (the anterior & posterior), two curvatures (the greater & lesser), two orifices (the cardia & pylorus). It has fundus, body and pyloric antrum.
Blood supply
The left gastric artery
Right gastric artery
Right gastro-epiploic artery
Left gastro-epiploic artery
Short gastric arteries
Stomach cancer begins when cancer cells form in the inner lining of your stomach. These cells can grow into a tumor. Also called gastric cancer, the disease usually grows slowly over many years.
It could be:
malignant or benign
primary or secondary
The stomach J-shaped. It has two surfaces (the anterior & posterior), two curvatures (the greater & lesser), two orifices (the cardia & pylorus). It has fundus, body and pyloric antrum.
Blood supply
The left gastric artery
Right gastric artery
Right gastro-epiploic artery
Left gastro-epiploic artery
Short gastric arteries
Stomach cancer begins when cancer cells form in the inner lining of your stomach. These cells can grow into a tumor. Also called gastric cancer, the disease usually grows slowly over many years.
It could be:
malignant or benign
primary or secondary
reviewed the literature ;Multidisciplinary management of gastric cancer
Yixing Jianga and Jaffer A. Ajani
; pictures taken from Sabiston textbook of surgery.
This Presentation gives summarized overview of Gall Bladder Carcinoma especially the management as per latest National Comprehensive Cancer Network(NCCN) Guidelines version 2.2013
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
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.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Gastric cancer
1.
2. GASTRIC CANCER
• Gastric cancer is the sixth most common cancer and the third most
common cause of cancer-related death in the world.
• Generally, stomach cancer rates are about twice as high in males as
in females.
• The average age for developing gastric cancer is 70 years.
3. ETIOLOGY AND RISK FACTORS
• Infection with H. pylori is the largest risk factor for gastric cancer
because it carries the cytotoxin-associated gene A (CagA) gene.
• Patients with pernicious anemia, gastric polyps, chronic atrophic
gastritis, and achlorhydria (absence of secretion of hydrochloric acid)
are 2 to 3 times more likely to develop gastric cancer.
4. RISK FACTORS
• Eating pickled foods, nitrates from processed foods, and salt added to food.
• A low intake of fruits and vegetables.
• Gastric surgery
• Barret esophagus
• GERD
• Obesity
5. PATHOPHYSIOLOGY
• Gastric cancer usually begins in the glands of the stomach mucosa.
• Atrophic gastritis and intestinal metaplasia (abnormal tissue development)
are precancerous conditions.
• Inadequate acid secretion in patients with atrophic gastritis creates an
alkaline environment that allows bacteria (especially H. pylori) to multiply.
• This infection causes mucosa-associated lymphoid tissue (MALT)
lymphoma, which starts in the stomach
6. CLINICAL MANIFESTATIONS
Early Gastric Cancer
• Indigestion
• Abdominal discomfort initially relieved with antacids
• Feeling of fullness
• Epigastric, back, or retrosternal pain
7. CLINICAL MANIFESTATIONS
Advanced Gastric Cancer
• Nausea and vomiting
• Obstructive symptoms
• Iron deficiency anemia
• Palpable epigastric mass
• Enlarged lymph nodes
• Weakness and fatigue
• Progressive weight loss
8. COMPLICATIONS OF GASTRIC CANCER
• Pathologic peritoneal and pleural effusions
• Obstruction of the gastric outlet, gastroesophageal junction, or small bowel
• Bleeding in the stomach from esophageal varices or at the anastomosis
after surgery
• Intrahepatic jaundice caused by hepatomegaly
• Extrahepatic jaundice
• Inanition from starvation or cachexia of tumor origin
9. DIAGNOSIS
• The goal of obtaining laboratory studies is to assist in determining optimal
therapy. Potentially useful tests in patients with suspected gastric cancer
include the following:
• CBC: May be helpful to identify anemia, which may be caused by bleeding,
liver dysfunction, or poor nutrition; approximately 30% of patients have
anemia
• Electrolyte panels
• Liver function tests
• Tumor markers such as CEA and CA 19-9: Elevated CEA in 45-50% of
cases; elevated CA 19-9 in about 20% of cases
10. DIAGNOSIS
• Esophagogastroduodenoscopy (EGD): To evaluate gastric wall and lymph
node involvement
• Double-contrast upper GI series and barium swallows: May be helpful in
delineating the extent of disease when obstructive symptoms are present or
when bulky proximal tumors prevent passage of the endoscope to examine
the stomach distal to an obstruction
• Chest radiography: To evaluate for metastatic lesions
• CT scanning or MRI of the chest, abdomen, and pelvis: To assess the local
disease process and evaluate potential areas of spread
• Endoscopic ultrasonography (EUS): Staging tool for more precise
preoperative assessment of the tumor stage
11. DIAGNOSIS
• Biopsy
• Biopsy of any ulcerated lesion should include at least six specimens taken from
around the lesion because of variable malignant transformation..
• Histologically, the frequency of different gastric malignancies is as follows:
Adenocarcinoma - 90-95%
Lymphomas - 1-5%
Gastrointestinal stromal tumors (formerly classified as either leiomyomas
or leiomyosarcomas) - 2%
Carcinoids - 1%
Adenoacanthomas - 1%
Squamous cell carcinomas - 1%
12. SURGICAL MANAGEMENT
• The surgical approach in gastric cancer depends on the location, size, and
locally invasive characteristics of the tumor.
Types of surgical intervention in gastric cancer include the following:
• Total gastrectomy, if required for negative margins
• Esophagogastrectomy for tumors of the cardia and gastroesophageal
junction
• Subtotal gastrectomy for tumors of the distal stomach
• Lymph node dissection.
13. CHEMOTHERAPY
• Antineoplastic agents and combinations of agents used in managing gastric
cancer include the following:
• Platinum-based combination chemotherapy: First-line regimens include
epirubicin/cisplatin/5-FU or docetaxel/cisplatin/5-FU
• Trastuzumab in combination with cisplatin and capecitabine or 5-FU
• Ramucirumab
14. NEOADJUVANT, ADJUVANT, AND PALLIATIVE
THERAPIES
Potentially useful therapies in gastric cancer include the following:
• Neoadjuvant chemotherapy
• Intraoperative radiotherapy (IORT)
• Adjuvant chemotherapy (eg, 5-FU)
• Adjuvant radiotherapy
• Adjuvant chemoradiotherapy
• Palliative radiotherapy
• Palliative-intent procedures (eg, wide local excision, partial gastrectomy, total
gastrectomy, simple laparotomy, gastrointestinal anastomosis, bypass)
15. PRE OPERATIVE NURSING MANAGEMENT
• NG tube aspirations
• To correct malnutrition before surgery, the health care provider may
prescribe enteral supplements to the diet and/or total parenteral
nutrition (TPN).
• Vitamin, mineral, iron, and protein supplements are essential to
correct nutritional deficits.
16. POST OPERATIVE NURSING MANAGEMENT
• Monitor for the complications of surgery (bleeding, infection, paralytic ileus).
• Auscultate the lungs for adventitious sounds (crackles or reduced breath
sounds), and monitor for the return of bowel sounds.
• Auscultate the lungs for adventitious sounds (crackles or reduced breath
sounds).
• Monitor for the return of bowel sounds.
• Provide pulmonary exercises and early ambulation to prevent respiratory
complications and deep vein thrombosis.
17. POST OPERATIVE NURSING MANAGEMENT
• Monitor for the complications of surgery (bleeding, infection, paralytic ileus).
• Auscultate the lungs for adventitious sounds (crackles or reduced breath
sounds), and monitor for the return of bowel sounds.
• Auscultate the lungs for adventitious sounds (crackles or reduced breath
sounds).
• Monitor for the return of bowel sounds.
• Provide pulmonary exercises and early ambulation to prevent respiratory
complications and deep vein thrombosis.
18. DUMPING SYNDROME MANAGEMENT
• Eat small, frequent meals
• Avoid drinking liquids with meals
• Avoid foods that cause discomfort
• Eliminate caffeine and alcohol consumption
• Begin a smoking-cessation program, if needed
• Administer B12 injections, as prescribed
• Lie flat after eating for a short time
