This document discusses interval colorectal cancer (CRC) diagnosed after a colonoscopy that did not detect cancer. It provides background on CRC screening and defines interval CRC. It examines the scope of the problem and explanations for interval CRC, including missed lesions, new lesions, and incompletely resected lesions. It discusses approaches to prevent interval CRC, such as improving bowel preparation, cecal intubation rates, adenoma detection rates, and adherence to surveillance recommendations. Future directions discussed include improved technologies, training and quality assurance programs.
Colonoscopy is effective for detecting pre-cancerous polyps but requires adequate withdrawal time for full inspection. New quality measures like withdrawal time of over 6 minutes have improved polyp detection rates. Screening colonoscopy seems to be the most cost-effective strategy for preventing colorectal cancer, though capacity is limited. Advanced techniques may further increase polyp detection, especially of small polyps, but their effectiveness requires more research. High-risk patients benefit most from colonoscopy surveillance due to their higher chance of developing new polyps.
The document discusses the role of various prophylactic surgeries in cancer prevention. It covers surgeries to reduce risk of breast cancer, ovarian cancer, colon cancer, gastric cancer, and medullary thyroid cancer for patients with genetic mutations or family histories that increase cancer risk. For each cancer type, it describes genetic factors, screening guidelines, timing of risk-reducing surgeries, and surgical options. The goal of these surgeries is to prevent cancer or detect it at an early stage through procedures such as mastectomy, salpingo-oophorectomy, colectomy, and thyroidectomy.
Rapid review of current service provision following cancer treatmentNHS Improvement
NHS Improvement carried out a rapid review of current provision of services for breast, prostate and colorectal cancer patients following treatment during the summer of 2009 at the request of the National Cancer Survivorship Initiative (NCSI). This publication shares the findings from this review.
(Published September 2010)
2012 Project design of an Integrated Well Woman Clinic combining a Women's Health assessment with Screening and Early Diagnosis of Breast and Gynecological Cancers
This document discusses oesophageal endoscopy procedures and their uses. It covers the anatomy and technology behind endoscopes, as well as various diagnostic and therapeutic applications. Key points include:
- Endoscopy has advanced from a purely diagnostic tool to one capable of various therapies for conditions like GERD, achalasia, and obesity.
- Imaging technologies like chromoendoscopy and narrow band imaging help detect early neoplastic lesions and distinguish between dysplastic and non-dysplastic tissue.
- Endoscopy is used to diagnose and treat conditions that cause dysphagia like peptic strictures, Schatzki rings, eosinophilic esophagitis, and post-surgical an
This document discusses treatment options for colorectal liver metastases. It summarizes that resection provides the best chance for long-term survival, with 5-year survival rates of 45-60%. Radiofrequency ablation can treat small, unresectable tumors but does not replace resection. While chemotherapy provides a median survival of 14.5 months, combining chemotherapy with resection can yield 5-year survival of 37-58%. The document discusses various approaches for increasing resectability and managing synchronous primary and metastatic tumors. It emphasizes the importance of a multidisciplinary team approach at high-volume centers for optimal outcomes.
Colonoscopy is effective for detecting pre-cancerous polyps but requires adequate withdrawal time for full inspection. New quality measures like withdrawal time of over 6 minutes have improved polyp detection rates. Screening colonoscopy seems to be the most cost-effective strategy for preventing colorectal cancer, though capacity is limited. Advanced techniques may further increase polyp detection, especially of small polyps, but their effectiveness requires more research. High-risk patients benefit most from colonoscopy surveillance due to their higher chance of developing new polyps.
The document discusses the role of various prophylactic surgeries in cancer prevention. It covers surgeries to reduce risk of breast cancer, ovarian cancer, colon cancer, gastric cancer, and medullary thyroid cancer for patients with genetic mutations or family histories that increase cancer risk. For each cancer type, it describes genetic factors, screening guidelines, timing of risk-reducing surgeries, and surgical options. The goal of these surgeries is to prevent cancer or detect it at an early stage through procedures such as mastectomy, salpingo-oophorectomy, colectomy, and thyroidectomy.
Rapid review of current service provision following cancer treatmentNHS Improvement
NHS Improvement carried out a rapid review of current provision of services for breast, prostate and colorectal cancer patients following treatment during the summer of 2009 at the request of the National Cancer Survivorship Initiative (NCSI). This publication shares the findings from this review.
(Published September 2010)
2012 Project design of an Integrated Well Woman Clinic combining a Women's Health assessment with Screening and Early Diagnosis of Breast and Gynecological Cancers
This document discusses oesophageal endoscopy procedures and their uses. It covers the anatomy and technology behind endoscopes, as well as various diagnostic and therapeutic applications. Key points include:
- Endoscopy has advanced from a purely diagnostic tool to one capable of various therapies for conditions like GERD, achalasia, and obesity.
- Imaging technologies like chromoendoscopy and narrow band imaging help detect early neoplastic lesions and distinguish between dysplastic and non-dysplastic tissue.
- Endoscopy is used to diagnose and treat conditions that cause dysphagia like peptic strictures, Schatzki rings, eosinophilic esophagitis, and post-surgical an
This document discusses treatment options for colorectal liver metastases. It summarizes that resection provides the best chance for long-term survival, with 5-year survival rates of 45-60%. Radiofrequency ablation can treat small, unresectable tumors but does not replace resection. While chemotherapy provides a median survival of 14.5 months, combining chemotherapy with resection can yield 5-year survival of 37-58%. The document discusses various approaches for increasing resectability and managing synchronous primary and metastatic tumors. It emphasizes the importance of a multidisciplinary team approach at high-volume centers for optimal outcomes.
Acs0535 Procedures For Rectal Cancer 2004medbookonline
This document discusses procedures for treating rectal cancer. It begins by outlining the goals of treatment which are to cure or control the cancer, maintain bowel continuity and function, and minimize morbidity. A variety of treatment regimens are available from local excision to multimodality therapy involving chemoradiation and surgery. The key steps in treatment are preoperative evaluation and staging of the cancer, determination of the surgical approach and postoperative care. Modern treatment often involves multimodality therapy with chemoradiation before and after surgery.
Early detection of oral cancer can save lives. Oral cancer involves regions in the oral cavity and oropharynx, including the lips, tonsils, tongue, cheeks and other areas. Precancerous lesions and conditions can be detected through visual examination techniques like toluidine blue staining, VELscope, chemiluminescence and the Identafi system. Salivary biomarkers like proteins, genes, microbiota, oxidative stress markers and interleukins also show promise for early detection of oral cancer. Genetic changes in oncogenes and tumor suppressor genes influence tumor proliferation, progression, angiogenesis and metastasis.
Dr Ian Katz, Dermatopathologist, from Southern Sun Skin Cancer Clinic and Southern Sun Pathology, discusses the pro and cons of using shave biopsies in clinical skin cancer practice.
The document summarizes the conclusions from the 13th International Breast Cancer Conference held in St Gallen in March 2013. The conference panel reviewed evidence and treatment recommendations for early breast cancer. Key conclusions included: 1) breast conserving surgery is usually preferable to mastectomy if radiation can be given; 2) axillary dissection is not always needed if sentinel nodes are positive; and 3) systemic adjuvant therapies like chemotherapy depend on tumor subtype, with luminal A usually needing endocrine therapy only.
The document describes a proposed integrated screening program for breast, cervical, ovarian, and endometrial cancers. The program would be implemented through Well Woman Clinics that provide comprehensive screening and early detection using cost-effective methods. The goals are to downstage cancers, improve outcomes, and reduce mortality. Screening would include clinical breast exams, cervical screening tests, and transvaginal ultrasounds. Positive cases would be referred for diagnostic procedures. The proposal outlines strategies for clinic operations, training, research, and public outreach to promote screening.
This document discusses cancer screening and provides statistics and information about cancer incidence, mortality, prevalence, and screening. It notes that screening aims to detect cancer early through routine tests when it may be easier to treat. The benefits of screening include finding cancers before symptoms appear and improving survival rates, but there are also risks like false positives requiring additional testing and overdiagnosis. The document provides data on the most common cancers and mortality rates in the UK, as well as trends in cervical cancer mortality following the introduction of screening. It outlines the criteria for effective screening tests and examples of cancers currently screened for in clinical practice like breast, cervical, and colorectal cancers.
This document summarizes a panel discussion on optimizing integrated colorectal cancer treatment. It provides a case study of a patient diagnosed with Stage III rectal cancer who underwent chemotherapy, radiation therapy, and surgery followed by additional chemotherapy. The roles of MRI, nutrition support, enterostomal therapy, and psychosocial support during treatment are then outlined. Key points made include that MRI is the standard for staging rectal cancer and helps determine need for pre-operative treatment. Nutrition interventions like fluid intake and small frequent meals can help manage symptoms. Enterostomal therapists assist with stoma care. Psychosocial support addresses depression, body image, sexuality, and relationship issues common during treatment.
Probability of cancer in pulmonary nodules detected on first screening CT scanShadab Ahmad
More than 20% of participants in low-dose CT screening programs were found on their first scan to have one or more lung nodules that required further investigation.
SOP CONFERENCE PROTOCOLS FOR BEGINNERSKanhu Charan
This document provides guidelines and standard operating procedures for stereotaxy radiosurgery and stereotactic body radiation therapy. It discusses patient selection criteria and protocols, simulation, treatment planning, quality assurance procedures, responsibilities of clinical team members, and patient follow-up. Standardized checklists and protocols are recommended to ensure safety and accuracy in patient localization, treatment planning and delivery for different anatomical sites. Strict quality assurance of equipment, imaging, treatment planning systems and patient-specific validation tests are essential parts of the procedures.
Dr. Ashutosh Mukherji's document discusses contouring for rectal cancers. It provides guidelines for clinical target volume (CTV) delineation based on international consensus. The CTV should encompass the tumor, mesorectum, presacrum, and lymph node regions depending on tumor stage and location. Proper contouring is important for administering precise radiotherapy doses to treat rectal cancer while avoiding unnecessary radiation to healthy tissues.
1) Preoperative chemoradiotherapy improves local control rates and tumor downstaging for rectal cancer compared to postoperative chemoradiotherapy or radiotherapy alone.
2) The addition of chemotherapy to radiotherapy, whether in the preoperative or postoperative setting, improves local control and disease-free survival compared to radiotherapy alone.
3) For patients who achieve a clinical complete response after preoperative chemoradiotherapy, observation without surgery may be feasible, with local recurrence rates of approximately 30% that can often be successfully salvaged.
Anil K. Sood, M.D., Professor
Vice Chair, Translational Research
Departments of Gynecologic Oncology and Cancer Biology
Co-Director, Center for RNAi and Non-Coding RNA
Director, Blanton-Davis Ovarian Cancer Research Program
Colorectal cancer is a major health problem worldwide. Screening is crucial for early detection and improved outcomes, with various tests available like fecal occult blood tests. Treatment involves surgery, with laparoscopic techniques now standard and robotic surgery showing promise. For rectal cancer, total mesorectal excision or organ preservation approaches are used depending on stage, along with potential neoadjuvant chemoradiation. Ongoing research continues to refine screening strategies and surgical techniques to further enhance colorectal cancer management.
This document discusses early gastric cancer diagnosis and treatment. It notes that magnifying endoscopy is a key modality for effective early gastric cancer diagnosis, but diagnostic criteria are not unified. A proposed diagnostic algorithm called MESDA-G is hoped to enhance early diagnosis and reduce mortality. Early gastric cancer is defined as cancer restricted to the mucosa or submucosa. Endoscopic resection may stage and treat early gastric cancer, but has risks of missing lymph node metastases. Predictors of lymph node metastases include lymphovascular invasion and positive nodes on EUS. Early gastric cancer limited to the mucosa without these poor features may be suitable for endoscopic resection alone.
The CROSS trial found that neoadjuvant chemoradiotherapy followed by surgery significantly improved long-term overall and progression-free survival compared to surgery alone for patients with resectable esophageal or esophagogastric junction cancer. At a minimum follow-up of 5 years, median overall survival was 48.6 months for chemoradiotherapy plus surgery versus 24 months for surgery alone. Both squamous cell carcinoma and adenocarcinoma subtypes benefited. Neoadjuvant chemoradiotherapy using carboplatin and paclitaxel is now considered the standard of care for these patients.
Briefing Note: Cervical Cancer Screening in the Gwassi Division, Suba Distric...sarahsteklov
A briefing note on cervical cancer screening practices in the Gwassi Division, Suba District, Nyanza Province, Kenya. Includes WHO guidelines, a pilot study in a neighboring region and interview and survey data from the community.
1) NAFLD is the most common liver disorder worldwide, with prevalence increasing due to western diets and sedentary lifestyles. Currently, no medicine is the standard treatment.
2) Lifestyle changes including weight loss through calorie restriction and increased physical activity are the most effective management strategies. Weight loss of at least 7% can improve liver histology.
3) The best available treatment combines dietary changes, tailored exercise, and drugs for comorbidities. Liver protection supplements like EPL may provide additional benefits. Several investigational drugs show promise but require further study.
This document discusses endoscopic full-thickness resection (EFTR), a new endoscopic technique for removing subepithelial tumors without extraluminal growth. EFTR allows complete resection of tumors while minimizing risk of residual tissue and improving pathological diagnosis. It is best suited for skilled endoscopists treating large or submucosal tumors in the upper or lower GI tract. The procedure requires a team of trained medical staff, specialized instruments for resection and closure, and carries several challenges around promotion, training and device development to further improve outcomes.
1) The document outlines a 6-step approach to evaluating patients with gas-related symptoms, including clarifying the predominant symptom, timing relative to meals, dietary factors, associated GI symptoms, medications/supplements, and risk factors.
2) Potential causes are discussed depending on symptom onset, such as gastric issues for soon after eating and small bowel issues for over 1 hour later.
3) Treatment focuses on identifying and
This document summarizes guidelines for the management of upper gastrointestinal bleeding (UGIB). It discusses initial patient assessment and risk stratification, the role of endoscopy within 24 hours, endoscopic findings that predict risk of rebleeding, endoscopic therapies, post-endoscopy management including PPI infusion, and strategies to prevent recurrent bleeding related to causes like H. pylori and NSAID use. Endoscopy is important to determine the source of bleeding and apply therapies when needed to reduce risks of additional bleeding, surgery, and mortality. Post-endoscopy care involves PPI therapy and follow up based on risk level.
Acs0535 Procedures For Rectal Cancer 2004medbookonline
This document discusses procedures for treating rectal cancer. It begins by outlining the goals of treatment which are to cure or control the cancer, maintain bowel continuity and function, and minimize morbidity. A variety of treatment regimens are available from local excision to multimodality therapy involving chemoradiation and surgery. The key steps in treatment are preoperative evaluation and staging of the cancer, determination of the surgical approach and postoperative care. Modern treatment often involves multimodality therapy with chemoradiation before and after surgery.
Early detection of oral cancer can save lives. Oral cancer involves regions in the oral cavity and oropharynx, including the lips, tonsils, tongue, cheeks and other areas. Precancerous lesions and conditions can be detected through visual examination techniques like toluidine blue staining, VELscope, chemiluminescence and the Identafi system. Salivary biomarkers like proteins, genes, microbiota, oxidative stress markers and interleukins also show promise for early detection of oral cancer. Genetic changes in oncogenes and tumor suppressor genes influence tumor proliferation, progression, angiogenesis and metastasis.
Dr Ian Katz, Dermatopathologist, from Southern Sun Skin Cancer Clinic and Southern Sun Pathology, discusses the pro and cons of using shave biopsies in clinical skin cancer practice.
The document summarizes the conclusions from the 13th International Breast Cancer Conference held in St Gallen in March 2013. The conference panel reviewed evidence and treatment recommendations for early breast cancer. Key conclusions included: 1) breast conserving surgery is usually preferable to mastectomy if radiation can be given; 2) axillary dissection is not always needed if sentinel nodes are positive; and 3) systemic adjuvant therapies like chemotherapy depend on tumor subtype, with luminal A usually needing endocrine therapy only.
The document describes a proposed integrated screening program for breast, cervical, ovarian, and endometrial cancers. The program would be implemented through Well Woman Clinics that provide comprehensive screening and early detection using cost-effective methods. The goals are to downstage cancers, improve outcomes, and reduce mortality. Screening would include clinical breast exams, cervical screening tests, and transvaginal ultrasounds. Positive cases would be referred for diagnostic procedures. The proposal outlines strategies for clinic operations, training, research, and public outreach to promote screening.
This document discusses cancer screening and provides statistics and information about cancer incidence, mortality, prevalence, and screening. It notes that screening aims to detect cancer early through routine tests when it may be easier to treat. The benefits of screening include finding cancers before symptoms appear and improving survival rates, but there are also risks like false positives requiring additional testing and overdiagnosis. The document provides data on the most common cancers and mortality rates in the UK, as well as trends in cervical cancer mortality following the introduction of screening. It outlines the criteria for effective screening tests and examples of cancers currently screened for in clinical practice like breast, cervical, and colorectal cancers.
This document summarizes a panel discussion on optimizing integrated colorectal cancer treatment. It provides a case study of a patient diagnosed with Stage III rectal cancer who underwent chemotherapy, radiation therapy, and surgery followed by additional chemotherapy. The roles of MRI, nutrition support, enterostomal therapy, and psychosocial support during treatment are then outlined. Key points made include that MRI is the standard for staging rectal cancer and helps determine need for pre-operative treatment. Nutrition interventions like fluid intake and small frequent meals can help manage symptoms. Enterostomal therapists assist with stoma care. Psychosocial support addresses depression, body image, sexuality, and relationship issues common during treatment.
Probability of cancer in pulmonary nodules detected on first screening CT scanShadab Ahmad
More than 20% of participants in low-dose CT screening programs were found on their first scan to have one or more lung nodules that required further investigation.
SOP CONFERENCE PROTOCOLS FOR BEGINNERSKanhu Charan
This document provides guidelines and standard operating procedures for stereotaxy radiosurgery and stereotactic body radiation therapy. It discusses patient selection criteria and protocols, simulation, treatment planning, quality assurance procedures, responsibilities of clinical team members, and patient follow-up. Standardized checklists and protocols are recommended to ensure safety and accuracy in patient localization, treatment planning and delivery for different anatomical sites. Strict quality assurance of equipment, imaging, treatment planning systems and patient-specific validation tests are essential parts of the procedures.
Dr. Ashutosh Mukherji's document discusses contouring for rectal cancers. It provides guidelines for clinical target volume (CTV) delineation based on international consensus. The CTV should encompass the tumor, mesorectum, presacrum, and lymph node regions depending on tumor stage and location. Proper contouring is important for administering precise radiotherapy doses to treat rectal cancer while avoiding unnecessary radiation to healthy tissues.
1) Preoperative chemoradiotherapy improves local control rates and tumor downstaging for rectal cancer compared to postoperative chemoradiotherapy or radiotherapy alone.
2) The addition of chemotherapy to radiotherapy, whether in the preoperative or postoperative setting, improves local control and disease-free survival compared to radiotherapy alone.
3) For patients who achieve a clinical complete response after preoperative chemoradiotherapy, observation without surgery may be feasible, with local recurrence rates of approximately 30% that can often be successfully salvaged.
Anil K. Sood, M.D., Professor
Vice Chair, Translational Research
Departments of Gynecologic Oncology and Cancer Biology
Co-Director, Center for RNAi and Non-Coding RNA
Director, Blanton-Davis Ovarian Cancer Research Program
Colorectal cancer is a major health problem worldwide. Screening is crucial for early detection and improved outcomes, with various tests available like fecal occult blood tests. Treatment involves surgery, with laparoscopic techniques now standard and robotic surgery showing promise. For rectal cancer, total mesorectal excision or organ preservation approaches are used depending on stage, along with potential neoadjuvant chemoradiation. Ongoing research continues to refine screening strategies and surgical techniques to further enhance colorectal cancer management.
This document discusses early gastric cancer diagnosis and treatment. It notes that magnifying endoscopy is a key modality for effective early gastric cancer diagnosis, but diagnostic criteria are not unified. A proposed diagnostic algorithm called MESDA-G is hoped to enhance early diagnosis and reduce mortality. Early gastric cancer is defined as cancer restricted to the mucosa or submucosa. Endoscopic resection may stage and treat early gastric cancer, but has risks of missing lymph node metastases. Predictors of lymph node metastases include lymphovascular invasion and positive nodes on EUS. Early gastric cancer limited to the mucosa without these poor features may be suitable for endoscopic resection alone.
The CROSS trial found that neoadjuvant chemoradiotherapy followed by surgery significantly improved long-term overall and progression-free survival compared to surgery alone for patients with resectable esophageal or esophagogastric junction cancer. At a minimum follow-up of 5 years, median overall survival was 48.6 months for chemoradiotherapy plus surgery versus 24 months for surgery alone. Both squamous cell carcinoma and adenocarcinoma subtypes benefited. Neoadjuvant chemoradiotherapy using carboplatin and paclitaxel is now considered the standard of care for these patients.
Briefing Note: Cervical Cancer Screening in the Gwassi Division, Suba Distric...sarahsteklov
A briefing note on cervical cancer screening practices in the Gwassi Division, Suba District, Nyanza Province, Kenya. Includes WHO guidelines, a pilot study in a neighboring region and interview and survey data from the community.
1) NAFLD is the most common liver disorder worldwide, with prevalence increasing due to western diets and sedentary lifestyles. Currently, no medicine is the standard treatment.
2) Lifestyle changes including weight loss through calorie restriction and increased physical activity are the most effective management strategies. Weight loss of at least 7% can improve liver histology.
3) The best available treatment combines dietary changes, tailored exercise, and drugs for comorbidities. Liver protection supplements like EPL may provide additional benefits. Several investigational drugs show promise but require further study.
This document discusses endoscopic full-thickness resection (EFTR), a new endoscopic technique for removing subepithelial tumors without extraluminal growth. EFTR allows complete resection of tumors while minimizing risk of residual tissue and improving pathological diagnosis. It is best suited for skilled endoscopists treating large or submucosal tumors in the upper or lower GI tract. The procedure requires a team of trained medical staff, specialized instruments for resection and closure, and carries several challenges around promotion, training and device development to further improve outcomes.
1) The document outlines a 6-step approach to evaluating patients with gas-related symptoms, including clarifying the predominant symptom, timing relative to meals, dietary factors, associated GI symptoms, medications/supplements, and risk factors.
2) Potential causes are discussed depending on symptom onset, such as gastric issues for soon after eating and small bowel issues for over 1 hour later.
3) Treatment focuses on identifying and
This document summarizes guidelines for the management of upper gastrointestinal bleeding (UGIB). It discusses initial patient assessment and risk stratification, the role of endoscopy within 24 hours, endoscopic findings that predict risk of rebleeding, endoscopic therapies, post-endoscopy management including PPI infusion, and strategies to prevent recurrent bleeding related to causes like H. pylori and NSAID use. Endoscopy is important to determine the source of bleeding and apply therapies when needed to reduce risks of additional bleeding, surgery, and mortality. Post-endoscopy care involves PPI therapy and follow up based on risk level.
Kurdistan Board GEH J Club git-Skin CONNECTIONS.Shaikhani.
This document discusses several gastrointestinal manifestations of dermatologic disorders including epidermolysis bullosa, mastocytosis, hereditary hemorrhagic telangiectasis, and melanoma. It provides case studies and details on clinical features, pathophysiology, and management for each condition. Primary dermatologic diseases can involve the gastrointestinal tract, and systemic diseases may affect both the skin and GI organs simultaneously. Recognition of underlying dermatologic disorders is important for gastroenterologists in making an accurate diagnosis.
Cirrhosis is irreversible scarring of the liver caused by various chronic liver injuries and diseases. It is a major global health issue and the 13th leading cause of death worldwide. The major causes of cirrhosis are hepatitis B, hepatitis C, alcoholism, and non-alcoholic fatty liver disease. Patients with cirrhosis have progressive liver damage and fibrosis that leads to complications including portal hypertension, ascites, variceal bleeding, hepatic encephalopathy, and liver cancer. Without treatment, survival is typically 10-13 years after diagnosis but can decrease to just 2 years once complications develop.
Cirrhosis affects women differently than men. Women are more likely to clear HCV spontaneously and less likely to develop advanced fibrosis from HCV when premenopausal due to protective effects of estrogen. However, postmenopausal women lose these benefits. Women also have a lower risk of progression to cirrhosis and HCC from HBV than men. Pregnancy in women with cirrhosis carries significant risks for both mother and fetus and requires close multidisciplinary management throughout.
GIT Kurdistan board GEH J Club: Liver-GIT ConnectionShaikhani.
The Lebanese society of GE held its annual congress in 2014. The congress brought together engineers and experts from various industries to discuss challenges and opportunities in engineering. Key topics of discussion included infrastructure projects, renewable energy development, and strategies for supporting continued innovation in Lebanon.
Diverticular disease is very common, often found incidentally during colonoscopy. It involves pouches forming in the colonic wall. Risk factors include obesity, smoking, and medications like NSAIDs. While often asymptomatic, it can cause abdominal pain, diverticulitis, or segmental colitis. Mild uncomplicated diverticulitis may not require antibiotics, while complicated cases involving abscesses or perforation require hospitalization, IV antibiotics, and possibly surgery.
Endoscopy plays an important role in the diagnosis and management of gastrointestinal tract (GIT) and pancreatobiliary cancers. It allows for direct visualization of the organs and tissues and facilitates biopsy sampling for histological examination. Endoscopy guided techniques also help in staging and treating various GIT and pancreatobiliary cancers.
This document discusses cardiac hepatopathy, which is liver damage caused by underlying cardiac disorders. It can manifest as congestive hepatopathy from chronic passive venous congestion, or acute cardiogenic liver injury from acute cardiocirculatory failure. Congestive hepatopathy is characterized histologically by necrosis in zone 3 of the liver and presents with elevated cholestasis markers. Acute cardiogenic liver injury shows striking elevations in transaminases and presents necrosis primarily in zone 3 as well. Both forms of cardiac hepatopathy carry prognostic implications and their treatment involves managing the underlying heart condition.
This document defines and discusses chronic pancreatitis. It begins by defining chronic pancreatitis as a progressive inflammatory disease of the pancreas that damages the gland and causes exocrine and endocrine dysfunction. It then classifies chronic pancreatitis into three forms: chronic calcifying pancreatitis, chronic obstructive pancreatitis, and steroid-responsive pancreatitis. The document goes on to discuss risk factors, pathogenesis, clinical features, diagnosis, and management of chronic pancreatitis.
This document discusses irritable bowel syndrome (IBS) and its relationship to endometriosis. IBS is a common gastrointestinal disorder characterized by abdominal pain and altered bowel habits. It predominantly affects females. Endometriosis, which affects 12-23% of menstruating women, can cause similar symptoms to IBS. Women with endometriosis are six times more likely to be diagnosed with IBS. The management of IBS focuses on developing a therapeutic relationship with the patient, diet modifications, increasing fiber intake, alternative therapies like peppermint oil and herbal supplements, and probiotics which may improve symptoms. Surgery has no role in treating IBS.
This document discusses fertility and family planning considerations for patients with inflammatory bowel disease (IBD). It notes that while most IBD patients have successful pregnancies, they often have fewer children than the general population due to fears and misperceptions about fertility when taking IBD medications. For women with quiescent disease and no pelvic surgery, infertility rates are similar to the general population at 5-14%. Active disease can impair fertility through inflammation, malnutrition and other factors. Medications like sulfasalazine, methotrexate and anti-TNF drugs may also temporarily impact fertility in some patients. The document recommends addressing nutritional deficiencies, investigating for occult disease activity or celiac disease in infertile patients, and consulting an
This document discusses gastrointestinal diseases that are more prevalent in obese women compared to men. It notes that obesity is associated with higher risks of GERD, NAFLD, and gallstones in women. Some key differences between women and men are discussed, such as the protective effects of female sex hormones against NAFLD before menopause. Modest weight loss through diet and lifestyle changes can help treat obesity-related gastrointestinal conditions by reducing fat deposits and abnormal liver enzymes.
1. Colorectal cancer (CRC) is the second most common cause of cancer and cancer-related mortality in men and women.
2. CRC carcinogenesis occurs primarily through two pathways: the adenoma-carcinoma sequence (85% of cases) and the serrated polyposis pathway (15% of cases).
3. Hereditary CRC syndromes like Lynch syndrome, Familial Adenomatous Polyposis (FAP), and Peutz-Jeghers syndrome (PJS) are associated with the highest risks of developing CRC.
This document discusses the management of liver disease in pregnant women. It notes that 3-5% of pregnant women have abnormal liver tests, even though they are generally young and healthy. Managing liver disease in pregnancy can be challenging as treatment decisions must consider the health of both the mother and unborn fetus. Liver diseases in pregnancy are categorized into those that are pre-existing or coincidental and unrelated to the pregnancy, and those that are related to the pregnancy itself.
Colorectal cancer is a major health problem globally. Several factors can predispose individuals to developing colorectal cancer, including inflammatory bowel disease, type 2 diabetes, family history of colorectal cancer or polyps, and certain hereditary syndromes. Screening is recommended for average risk individuals beginning at age 50, and involves tests to detect cancer or pre-cancerous polyps like fecal immunochemical tests, flexible sigmoidoscopy, or colonoscopy. For those with polyps or history of colorectal cancer, surveillance is important to monitor for recurrence or new lesions. Symptoms of colorectal cancer depend on tumor location but often include changes in bowel habits and bleeding.
1. Irritable bowel syndrome (IBS) is a common chronic condition characterized by abdominal pain and altered bowel habits that affects 10-15% of the population.
2. IBS is diagnosed based on fulfilling the Rome III criteria through symptom assessment alone in the absence of red flags. Testing is generally not required but celiac serology may be considered in some cases.
3. Treatment involves diet modification, medication based on stool pattern (e.g. linaclotide for IBS-C, loperamide for IBS-D), and psychological therapies if needed. Further testing is pursued only if red flags are present.
Colorectal cancer screening and computerized tomographic colonographySpringer
This document discusses quality considerations for colorectal cancer screening programs that utilize both optical colonoscopy and CT colonography. It notes that adenoma detection rates, colonoscopy withdrawal times, and bowel preparation quality impact the effectiveness of optical colonoscopy screening. Maintaining high quality in these areas is important for any integrated CRC screening program that uses both modalities. Fatigue in endoscopists can negatively impact adenoma detection rates, so scheduling approaches need to account for this. Effective patient education on bowel preparation is also key to ensuring screening program success and adherence.
Surgical management of colorectal cancer.pptxHamSayshi1
Surgical treatment of Colorectal Cancer Current Treatment Guidelines 2024...A reveiw of literature
palliative management of CRC and Mechanical bowel preparation in case of CRC alongwith Treatment guidleines of grade 4 CRC in presence of metastasis
This document discusses colonoscopy procedures and techniques for screening and surveillance of colorectal cancer (CRC). It finds that a withdrawal time of over 6 minutes during colonoscopy and screening individuals over age 50 are effective strategies. New techniques like narrow band imaging and fluorescence imaging show promise in detecting more polyps but have not been proven superior to standard colonoscopy. Surveillance intervals should be tailored to individual risk factors like number and size of previous polyps. Improved endoscopic technologies may further increase polyp detection rates and decrease unnecessary biopsies in the future.
1. The document discusses treatment options and strategies for rectal cancer patients who achieve a clinical complete response after neoadjuvant chemoradiation therapy.
2. Key points discussed include patient selection criteria for active surveillance versus surgery, optimal timing of response assessment, and surveillance schedules for patients undergoing a watch-and-wait approach.
3. Studies presented showed that outcomes for complete responders managed non-operatively can be comparable to those having surgery, though local recurrence rates are higher with the non-operative approach. Strict patient selection and close surveillance are important.
This document summarizes new guidelines and current issues regarding colorectal cancer screening. It discusses efficacy versus effectiveness of screening strategies and quality indicators for colonoscopy, such as adenoma detection rates and withdrawal times. While withdrawal time alone may not predict future neoplasia, adenoma detection rates over 20% are associated with lower risk of interval cancer. Endoscopist specialty and volume have shown mixed results as predictors of colonoscopy quality outcomes. Overall, the document emphasizes the importance of quality standards and monitoring in colorectal cancer screening programs.
This document provides updated guidelines for colorectal cancer screening. It recommends colonoscopy or fecal immunochemical testing (FIT) for average risk patients beginning at age 45 and ending at age 85. Increased risk patients should begin screening earlier, at age 40 or 10 years before the youngest affected family member. High or highest risk patients require specialist referral. Screening intervals are 10 years for colonoscopy and annually for FIT. Detection and removal of polyps can reduce colorectal cancer incidence and mortality.
Petruzziello L. La Colonscopia di qualità e le Procedure operative. ASMaD 2016Gianfranco Tammaro
1) Colorectal cancer screening through colonoscopy has been shown to reduce CRC incidence and mortality by detecting and removing precancerous polyps.
2) Quality indicators like adequate bowel preparation, adenoma detection rates, and cecal intubation rates are important for colonoscopy effectiveness.
3) New technologies like HD imaging, water jets, and wide-angle endoscopes aim to improve polyp detection rates and make the procedure more comfortable and effective.
Mistakes in colonoscopic surveillance in IBD and how to avoid them
In 3 sentences:
People with IBD have an increased risk of colorectal cancer that is not always appreciated, so it is important to follow surveillance guidelines tailored to individual risk factors and select expert endoscopists who perform high-quality colonoscopies. Detailed reports and second opinions are also needed when dysplasia is detected to guide management decisions between endoscopic resection or surgery depending on the individual patient's overall risk factors and prognosis.
Colorectal Cancer Screening - What does the evidence really say?Jarrod Lee
Colorectal cancer is one of the most common cancers around the world. Screening has been proven to detect cancers in early curable stages, and to even prevent them. Yet, few topics are as controversial as colorectal cancer screening in medicine today. We take an evidence based approach to examine what the science truly says about the different modalities of cancer screening.
Regional lymph node management in breast cancerShreya Singh
Regional lymph nodes, including the axillary, supraclavicular, and internal mammary nodes, are important sites of potential breast cancer spread. Axillary ultrasound and sentinel lymph node biopsy help assess lymph node status. Several landmark trials have evaluated the benefits of radiotherapy to regional lymph nodes. The EBCTCG meta-analysis found regional radiotherapy reduced recurrence and breast cancer mortality in patients with 1-3 or 4+ positive lymph nodes. Current guidelines recommend regional radiotherapy for patients with extensive lymph node involvement or other high-risk features.
This document discusses screening and diagnosis of colorectal cancer. It covers risk factors like aging, hereditary factors, diet, and inflammatory bowel disease. Common presentations include changes in bowel habits, hematochezia, and obstructive symptoms. Screening tests aim to detect early-stage cancer and include colonoscopy every 10 years, annual fecal immunochemical testing, and computed tomography colonography every 5 years. For high-risk patients, more frequent screening is recommended. Diagnostic tests following positive screening include colonoscopy, stool DNA testing, and imaging. Genetic testing guides screening for familial cancer syndromes.
Peritoneal Carcinomatosis : Dr Amit DangiDr Amit Dangi
Here are the key steps:
1. The left subphrenic space is entered by incising the peritoneum overlying the left hemidiaphragm.
2. The peritoneum is dissected off the left hemidiaphragm in a cephalad direction towards the diaphragmatic crus.
3. The peritoneum is then stripped down the left paracolic gutter towards the pelvis, removing all peritoneal surfaces.
4. The left subphrenic peritonectomy is then completed, exposing the left hemidiaphragm and removing all peritoneal surfaces in the left subphrenic space.
COLONIC POLYPS AND ITS FOLLOW UP PRESENTATION.pptxNazim Arain
Colonoscopic polypectomy is a common procedure to remove colonic polyps. Polyps may develop into colon cancer over time through the adenoma-carcinoma sequence. Screening tools like colonoscopy allow for detection and removal of polyps, preventing progression to cancer. Risk factors for colon polyps include obesity, diet high in red and processed meats, smoking, and family history.
The document discusses anal canal carcinoma and its management. It covers the epidemiology, etiology, risk factors, carcinogenesis, morphology, clinical features, classification, screening, diagnosis, staging, treatment and recent advances of anal canal carcinoma. Screening and removing precancerous polyps is important for prevention. Diagnosis involves imaging and biopsy. Treatment depends on staging and may include surgery, chemotherapy and radiation. Ongoing research focuses on improved screening, staging and minimally invasive treatment options.
Gastroenterologist Dr. Patricia Raymond takes medicine seriously, and herself lightly. As a female gastroenterologist, she is, in fact, a “Chick who checks cheeks”. Dr. Raymond’s mission is to decrease the fright and ‘ick’ that keep about 50% of Americans from getting their screening colonoscopy at age 50—using laughter and knowledge to combat the fear. You can enjoy some of that humor at her website ColonJoke.com. And you can watch her music parody videos on YouTube at www.ButtMeddler.com. Please give a warm welcome to Dr. Pat Raymond’s alter ego, the divine….Ms Butt Meddler!
This document discusses treatment options for colorectal liver metastases. It summarizes that resection provides the best chance for long-term survival, with 5-year survival rates of 45-60%. Radiofrequency ablation can treat small, unresectable tumors but does not replace resection. For resectable tumors, options include chemotherapy with or without resection. A multidisciplinary team approach is important for evaluating all treatment possibilities.
This document summarizes the current best practices for the management of incidental gallbladder cancer discovered after cholecystectomy. It reviews the available literature on pathology and staging, timing and type of re-resection, and the role of adjuvant therapies. The key findings are that early stage T1a cancers often do not require additional surgery and have a very low risk of recurrence. For T1b or higher cancers, preoperative imaging and restaging is recommended followed by extended resection with lymphadenectomy. While the optimal approach remains controversial, re-resection within 4-8 weeks of initial surgery tends to have the best outcomes. Adjuvant chemotherapy may provide a benefit for higher stage or node-positive cancers but requires
This document summarizes a systematic review of the management of incidental gallbladder cancer discovered after cholecystectomy (gallbladder removal surgery). The review identified studies on incidence rates, staging, timing and type of additional surgery, and outcomes. It finds that early-stage (T1a or less) cancers have very low recurrence risks with cholecystectomy alone. For T1b or higher cancers, additional surgery is typically recommended 4-8 weeks after initial surgery to remove more tissue. The type and extent of additional surgery remains controversial, and adjuvant chemotherapy has not been proven to provide clear benefits. Overall survival depends mainly on cancer biology and staging rather than surgical factors.
This document discusses the management of ovarian cancer. It covers risk-reducing salpingo-oophorectomy (RRSO) for high-risk patients, surgical staging techniques including open and minimally invasive approaches, management of early-stage disease including adjuvant chemotherapy and radiation, cytoreductive surgery and goals for advanced-stage disease, and the role of interval debulking surgery after neoadjuvant chemotherapy. Complete resection of all tumor is the optimal outcome for advanced ovarian cancer to improve survival outcomes.
Dietary fiber from whole foods like grains, legumes, vegetables, and fruits has demonstrated benefits for gastrointestinal (GIT) health. Isolated and extracted fibers also show promising regulatory effects on the gut and microbiome. However, fibers have varying physicochemical properties depending on their origin and processing that influence their functional characteristics and clinical applications. More research is needed, including well-designed randomized controlled trials, to determine which fiber sources, characteristics, doses and durations optimize GIT health benefits and manage gastrointestinal disorders. Combining fibers with different physiological effects may be a promising therapeutic strategy.
- Coronaviruses typically cause common colds but SARS-CoV and MERS-CoV can cause pneumonia, respiratory failure, and death. A novel coronavirus, SARS-CoV-2, emerged in Wuhan, China in late 2019 and caused a global pandemic.
- SARS-CoV-2 spreads mainly through respiratory droplets when people cough, sneeze or talk within 6 feet of each other. Asymptomatic and pre-symptomatic people are highly infectious.
- COVID-19 symptoms range from mild to critical illness. The elderly and those with pre-existing conditions are at higher risk for severe disease. Diagnosis involves PCR testing of respiratory samples.
- Sexual dysfunction and infertility are more prevalent in men with IBD compared to the general population.
- Depression is the most consistent negative predictive factor of sexual function among men with IBD.
- Sulfasalazine can reversibly reduce male fertility, so it is recommended to discontinue 3-4 months prior to conception. Most other IBD medications do not significantly impact fertility.
- Men with IBD have an increased risk of prostate cancer and prostate cancer screening guidelines for higher risk patients should be followed.
The document summarizes a consensus clinical care pathway for women with inflammatory bowel disease (IBD) who are considering pregnancy or are pregnant. The pathway was created by an expert multidisciplinary team representing multiple societies to provide standardized, evidence-based recommendations for gastroenterology and obstetric providers to ensure healthy pregnancies for women with IBD. It addresses the lack of consistent advice available previously by compiling available data on therapeutic options for IBD that have increased over the last 15 years and putting them into an easily accessible format for clinical practice.
This document provides an overview of geriatrics and common issues in caring for elderly patients. It discusses how biological age is more important than chronological age in clinical decision making. Frailty and disability are also addressed. Common geriatric problems like falls, delirium, incontinence and adverse drug reactions are examined in terms of presentation, evaluation, and management strategies. The importance of a comprehensive assessment, considering multiple comorbidities and functional status, is emphasized in developing treatment plans for elderly patients.
Upper and lower GI endoscopies have diagnostic, therapeutic, and screening indications. For upper endoscopy, common diagnostic indications include dyspepsia in patients over age 60 or with red flags, upper GI bleeding, and dysphagia. Therapeutic uses include treatment of bleeding, removal of foreign bodies, dilation of strictures, and stenting. Screening is done for portal hypertension, Barrett's esophagus, eosinophilic esophagitis, and cancers. Lower endoscopy indications involve diagnostic evaluation of bleeding, abdominal pain, diarrhea, and screening of average-risk adults over 50 and high-risk groups. Therapeutic colonoscopy is used for polypectomy, bleeding treatment, and stricture dilation
Dr. Hiwa Abubakir and Dr. Mohamed Alshekhani discuss the management of nonvariceal gastrointestinal bleeding. They recommend endoscopy within 24 hours, or earlier for high-risk patients, to identify and treat the bleeding source. A variety of endoscopic tools can be used for hemostasis, including injection of adrenaline combined with clips, bands, electrocautery, or laser coagulation. Newer tools like over-the-scope clips are best for high-risk or recurrent bleeders. Doppler probes help ensure complete vessel occlusion. Additional prothrombotic agents or interventions may be needed in some cases.
The document discusses antithrombotic strategies for patients with diabetes who are at risk of cardiovascular events. It proposes strategies for primary prevention, stable coronary artery disease, acute coronary syndromes, ischemic stroke, peripheral artery disease, atrial fibrillation, and venous thromboembolism. More aggressive antithrombotic therapies are associated with greater reduction in recurrent cardiovascular events for patients with diabetes. However, these strategies must be weighed against the risk of bleeding. Further clinical trials are still needed to better understand optimal antithrombotic treatment for cardiovascular patients with diabetes.
1) Gastric carcinoma is the third leading cause of cancer death worldwide, with highest incidence in East Asia and parts of South America.
2) Risk factors include H. pylori infection, smoking, diet high in salted/preserved foods, and family history of gastric cancer.
3) Early detection through endoscopy in dyspeptic patients over 50 years old or with red flags can improve outcomes, as resection allows for potential cure in early gastric cancer confined to mucosa or submucosa.
This document summarizes guidelines for the diagnosis and management of irritable bowel syndrome (IBS). It defines IBS and its subtypes based on the Rome IV criteria. It recommends diagnosing IBS based on symptoms in the absence of alarm features or abnormal test results. Limited testing like fecal calprotectin can help distinguish IBS from inflammatory bowel disease. Treatment involves dietary changes, probiotics, antispasmodics, antidepressants, and targeted therapies depending on IBS subtype and predominant symptoms. For refractory cases, a multidisciplinary approach including psychological support may help manage persistent symptoms.
GIT 4th indication for upper GI endoscopy.Shaikhani.
Upper gastrointestinal endoscopy has diagnostic, therapeutic, and screening indications. Diagnostically, it is used to detect diseases causing dyspepsia like gastric cancer, investigate upper GI bleeding, diagnose dysphagia, remove foreign bodies, assess GERD, detect esophageal varices, and diagnose celiac disease. Therapeutically, it treats upper GI bleeding, removes foreign bodies, dilates strictures, treats achalasia, places stents, treats GERD, eradicates Barrett's esophagus, inserts feeding tubes, and performs bariatric procedures. Screening indications include detecting Barrett's esophagus, portal hypertension, and cancers of the esophagus and stomach in high-risk patients
The document discusses various autoimmune and cholestatic liver diseases including primary biliary cholangitis, primary sclerosing cholangitis, and intrahepatic cholestasis of pregnancy. It provides details on the epidemiology, clinical features, diagnosis, and management of these conditions. It also includes several multiple choice questions to test understanding of topics covered in the document.
1. The document outlines 19 potential mistakes that can occur during colonoscopy procedures. These include doing colonoscopies without proper indications or patient evaluation, failing to adequately prepare the colon, misdiagnosing conditions like ulcerative colitis or hemorrhoids, not performing important parts of the exam like ileal intubation or biopsies, and not adhering to quality standards. Addressing these issues can help improve safety, accuracy of diagnoses, and overall quality of colonoscopy.
This document provides an overview of inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease. It discusses risk factors, clinical manifestations, diagnostic testing, and treatment approaches. The main points are:
- IBD is characterized by idiopathic inflammation of the gastrointestinal tract. The two main types are ulcerative colitis and Crohn's disease.
- Genetic and environmental factors contribute to risk. Smoking increases risk for Crohn's but decreases risk for ulcerative colitis.
- Symptoms vary based on disease location but may include abdominal pain, diarrhea, bleeding, weight loss, and nutritional deficiencies. Extraintestinal manifestations are more common with Crohn's.
This document provides information on irritable bowel syndrome (IBS), including its definition, diagnostic criteria, subtypes, differential diagnosis, evaluation, and management approaches. Some key points:
- IBS is a common functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits. It affects 10-15% of the population.
- Diagnosis is based on fulfilling the Rome symptom criteria, with subtyping based on predominant stool pattern. Additional testing is usually not needed in absence of alarm features.
- Treatment involves reassurance, dietary modifications, antispasmodics, laxatives/antidiarrheals based on subtype, and tricyclic antidepressants/SSRIs for refractory cases.
This document discusses the classical and long-term indications for PPI use, including GERD, Barrett's esophagus, use with NSAIDs, use with anti-platelets, and non-ulcer dyspepsia. For GERD, guidelines recommend daily PPI for erosive esophagitis but intermittent PPI courses may be sufficient for many patients. For Barrett's esophagus, the absolute cancer risk reduction with daily PPI is low. For NSAID and anti-platelet users at high risk of bleeding, the benefits of daily PPI are well documented. Intermittent PPI courses are often sufficient for non-ulcer dyspepsia, though some patients may require long-
This document discusses potential long-term side effects of PPI use including increased risk of dementia, chronic kidney disease, and fractures. It notes that the evidence for associations between PPI use and these conditions is not conclusive. The document advises using the lowest effective dose of PPIs for indicated conditions and avoiding long-term daily use when possible. It also stresses the importance of only prescribing PPIs for appropriate indications and discontinuing them when no clear benefit exists.
The document summarizes short-term side effects of PPIs (proton pump inhibitors), which are generally well tolerated. The most common side effects are headache, diarrhea, abdominal pain and nausea. Diarrhea appears to be related to acid suppression and the overall incidence is less than 5%, though it may be dosage and age related. PPIs are considered safe for short-term use and have similar safety profiles to H2 blockers. PPIs should be used cautiously in patients with liver disease.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Lecture 6 -- Memory 2015.pptlearning occurs when a stimulus (unconditioned st...AyushGadhvi1
learning occurs when a stimulus (unconditioned stimulus) eliciting a response (unconditioned response) • is paired with another stimulus (conditioned stimulus)
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdfrightmanforbloodline
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
low birth weight presentation. Low birth weight (LBW) infant is defined as the one whose birth weight is less than 2500g irrespective of their gestational age. Premature birth and low birth weight(LBW) is still a serious problem in newborn. Causing high morbidity and mortality rate worldwide. The nursing care provide to low birth weight babies is crucial in promoting their overall health and development. Through careful assessment, diagnosis,, planning, and evaluation plays a vital role in ensuring these vulnerable infants receive the specialize care they need. In India every third of the infant weight less than 2500g.
Birth period, socioeconomical status, nutritional and intrauterine environment are the factors influencing low birth weight
2. Abstract:
• There is good evidence that CRC screening has been successful at
reducing both CRC incidence&death.
• Colonoscopy, utilized as either a primary screening tool or a follow-
up exam when other screening tests are positive, has significantly
contributed to these encouraging trends.
• Colonoscopy is not perfectly sensitive for detection of neoplasia &
CRC can be diagnosed within a short interval following colonoscopy
that did not detect one (Interval CRC).
• The literature surrounding these cases has rapidly expanded over
the last decade.
3. Abstract:
• The common explanations for these cancers including missed
lesions, new lesions & incompletely resected lesions.
• Current approaches to prevention largely center on consistent
adherence to quality colonoscopy standards.
• Prevention:
• Advances in technology to better visualize the colon & adequately
resect detected neoplasia.
• Improvement in training.
• Development of a culture of continuous quality improvement will
be essential to maximize the benefits of colonoscopy in daily clinical
practice.
4. Background:
• The aim of CRC screening is to reduce the risk of developing & dying
from CRC& there is good evidence that it is successful.
• The average annual incidence/mortality from CRC is declining with
22% reduction in the incidence &screening accounted for half of this
observed decline.
• CRC is a significant public health burden.
• To reduce morbidity&mortality from CRC will require expansion of
screening&improved therapeutics when disease is discovered.
• Current guidelines endorse a panel of options for screening.
• Colonoscopy is a primary screening option & the primary follow-up
exam when another modality is positive&effective colonoscopy is
critical to the success of any screening program.
• Colonoscopy is the gold standard for direct evaluation of the colon,
but it remains imperfect.
5. Background:
• Interval CRC: CRC diagnosed within a short interval following a
colonoscopy where cancer had not been detected.
• Over the last decade or so, ICRC has increased substantially.
6. Interval CRC: Definition
• Different terms:
• “Post-colonoscopy”, “missed”, “interval” CRC: describe CRC after a
colonoscopy exam that did not detect one.
• We favor “interval cancer” :Why
• 1.it is a more general term, can be used to describe similar events
when other screening modalities are being used.
• 2. Factors in addition to the “missed” lesions likely contribute.
• Interval colon: “CRC diagnosed after a screening or surveillance
exam in which no cancer is detected & before the date of the next
recommended exam.”
• “interval post colonoscopy cancer (PCCRC)” where the
circumstances (i.e., the timing of the cancer relative to the prior
recommended interval) are known.
7.
8. PCCRC: The scope of the problem
• Establishing the scope of the problem is challenging because of
important methodological differences between studies, variably
defined as cases occurring within 36 months of colonoscopy in some
series, but significantly longer in other studies .
• interval PCCRC:2.6-9.0%(3.7%).
• A large study ( n =9,167) in adenoma-bearing population who had
all neoplastic lesions removed at baseline found that 58 individuals
were diagnosed with cancer during a median follow-up of 4 years
;6/1,000 ; 1.7 cases / 1,000 person-years of follow-up.
• A conservative estimate for interval PCCRC in an average patient
considering a screening colonoscopy is in the range of 1/1,000
colonoscopy exams, significantly > some other risks routinely
consented for(e.g. perforation)& we would recommend routinely
including this risk when obtaining informed colonoscopy consent.
9. PCCRC: Explanation
• For most cases, it is difficult to determine the precise “cause”:?
• 1.Because of unknowns surrounding tumor biology & cancer growth
rates.
• 2. There is the issue of whether a prior colonoscopy missed a cancer
or the opportunity to prevent a cancer.
• Generally, there are 3 predominant explanations:
• (1) Missed neoplasia (either cancer or significant polyps).
• (2) New lesions.
• (3) Incompletely resected lesions.
10. PCCRC Explanation: Missed lesions
• The most important contributor to interval PCCRC.
• In 58 interval PCCRCs, 30 (52%) were attributed to missed lesions.
• Optical colonoscopy missed a CRC when present ~5.3% of the time.
• In the landmark study, a 2.1-6% miss rate for adenomas ≥1 cm was
observed,with sessile / flat lesions about five times more likely to
be missed than pedunculated ones.
• Factors specifically contributing to missed flat adenomas were size,
location, bowel prep quality, withdrawal time, proficiency of the
colonoscopist.
11. PCCRC Explanation: Incomplete resection
• 19% of PCCRC due to incomplete resection.
• Incomplete resection was identified overall in 10% of polyp
resections, with higher rates observed for larger polyps & sessile
serrated polyps (SSPs)& piecemeal removals.
• 27% developed cancer in a colonic segment where a polypectomy
had been performed during the prior colonoscopy exam, but may
be de novo cancer or missed CRC in the same segment.
12. PCCRC Explanation: New lesions
• A relatively less frequent explanation, possibly accounting for about
¼ of the observed cases, because CR carcinogenesis is a lengthy
process,but this may differ between polyps sub-types(> in SSPS) ,
CRcs, ages.
• Interval cancers display the CIMP (57 vs. 33%)& microsatellite
instability (30.4% vs. 10.3%) ( 10,18,36 ), so SSPs might be the
culprit lesion in many of these cases.
• Another factor that may relate interval PCCRC & serrated polyps is
their typical proximal location in the bowel & interval cancers are
more often proximally located, although it is more difficult to reach
the right colon by colonoscopy.
13. PCCRC : Prevention
• Currently, the practice of high-quality colonoscopy is centered on:
• Adequate preparation
• Cecal intubation
• Adenoma detection.
• Proper surveillance.
14. PCCRC prevention: Bowel preparation
• Inadequate colonic cleansing likely accounts for a significant
proportion of missed lesions&often results in longer, more diffi cult
&incomplete exams&, it can also contribute to incomplete resection
if the borders of identified polyps cannot be clearly delineated.
• Suboptimal or inadequate bowel preparations may occur in a
quarter -third of patients undergoing colonoscopy.
• The single best way to improve bowel preparation is to uniformly
adopt “split-dose” or even “same-day” preparation.
• Improved patient education through high-quality educational
materials has been shown to improve bowel preparation relative to
conventional instruction specially in elderly & those with multiple
comorbid conditions.
15. PCCRC prevention: Cecal intubation
• Patients who underwent colonoscopy by endoscopists with cecal
intubations rates of ≥95% were nearly 30% less likely to be
diagnosed with a proximal interval PCCRC than those who
underwent colonoscopy by endoscopists with cecal intubation rates
<80%.
• The reasons for not accomplishing cecal intubation ;looping of the
scope&patient discomfort,more pronounced in females, as colon is
often longer & more redundant, leading to more discomfort, longer
insertion times&lower completion rates&interval PCCRC more
predominant in women.
• Currently, guidelines recommend a cecal intubation target of 90%
for all examinations & 95% for routine screening exams.
• If the exam is incomplete, re-attempts may be successful&
completion may be improved at tertiary referral centers or with
endoscopists experienced with difficult colonoscopies.
16. PCCRC prevention: Adenoma detection
• With respect to interval cancer prevention, adenoma detection rate
(ADR) is likely the single most important quality metric.
• ADRs <20% were associated with the risk of developing interval
cancer.
• interval &fatal interval cancers were 48-62% lower with ADRs >33%
compared with ADRs <19% & 3% decrease in the risk of interval
cancer for each 1% improvement in ADR.
• Targets for ADR updated with the overall target set at 25% for
screening exams &a gender-specific target of 30% for males & 20%
for females.
17. PCCRC prevention: F/U Surv recommendations
• Underutilization of colonoscopy (i.e. not bringing individuals back in
a timely manner) can facilitate the development of “new” lesions.
• Cancer survival is directly linked to the stage at diagnosis.
• Delayed examinations can have a significant impact on the success
of CRC screening & surveillance programs.
• overutilization of colonoscopy (i.e bringing individuals back earlier
than the time frame recommended) can also cause harm.
• Colonoscopy is not without risk& repeating it unnecessarily at short
intervals can directly, negatively impact the patient,drain
resources& decrease the availability of colonoscopy to those that
need it, including those that remain unscreened.
• Colonoscopy is, at times, both underutilized&overutilized&there is
good evidence that guidelines are not followed.
18. PCCRC prevention: F/U Surv recommendations
• If no adenomas are detected on an average risk screening
colonoscopy, a 10-year follow-up interval is recommended.
• if no adenomas were detected because the exam was incomplete,
performed in a patient with a poor prep, or by a provider with a
poor baseline ADR, a “successfully” applied 10-year follow-up
recommendation may do more harm than good.
• Natural language processing may become a valuable tool to support
the tracking of the accuracy of surveillance reccomendations.
19.
20. Future direction: improved technology
• To improve mucosal inspection— particularly on the proximal
aspect of haustral folds where lesions can easily be overlooked&
3rd eye Retroscope, demonstrated modest increases in adenoma
detection
• Accessory devices to flatten folds to enhance proximal view using a
small plastic cap showed no improvement in adenoma detection.
• Balloon devices &bristles at the tip of the scope: more work in
larger populations is needed.
• Enhanced viewing of the mucosa ,the Fuse Full Spectrum Endoscopy
colonoscopy platform uses multiple contiguous video monitors fed
by additional side-facing lenses , demonstrated a significantly lower
adenoma miss rate.
21. Future direction: improved technology
• 1. it is advisable that colonoscopists know their limits when it
comes to attempting difficult polypectomies.
• Attempting but not completing polypectomy can leave behind a
scar that can make subsequent attempts even by an experienced
endoscopist more challenging.
• Tattooing lesions for subsequent removal by a more experienced
endoscopist might help, although care should be taken to avoid
injecting too near the lesion to avoid tracking into its submucosa&
the potential to adversely affect subsequent attempts.
• Evidence support the role of high magnification endoscopy to
detect residual tissue &using argon photocoagulation to reduce
recurrence when resecting large polyps in a piecemeal manner.
22. Future direction: training&QA programes
• Improve the training of the colonoscopy technique & quality
assurance of those individuals or programs providing it.
• Prior training of the endoscopist (e.g., gastroenterology vs. surgery)
has been associated with interval cancer &highlights its importance
& with training, ADR can imprve.
• A real culture of quality assurance/improvement is needed to move
practice forward.
• Quality assurance work requires measurement, assessment&
follow-up to determine whether change has occurred &durable.
• Developing the appropriate expertise within practices to
continuously monitor & improve colonoscopy is critical to
preventing interval PCCRC & maximizing the benefit of CRC
screening programs.
23. CME Qs:
• 1. A 66-year-old female presents for her first screening colonoscopy. She has a
history of chronic constipation, current tobacco use, T2DM& medically
complicated obesity (BMI 35.4 kg/m2). Her pre-procedure vital signs were
stable& propofol sedation was used. During the procedure, cecal intubation was
documented by photographs of the appendiceal orifice, terminal ileum& ICV.
Bowel preparation was fair. During the withdrawal phase of the exam, she
develops a loud sonorous breathing pattern&her O2 saturation drops below 90%,
possibly due to sleep apnea. One 6-mm sessile suspected adenoma is resected
quickly by cold snare in the descending colon. Upon completion of her
colonoscopy, her O2 saturation is >92%. Your withdrawal time for the procedure
was 4 minutes & 15 seconds.
• Which one of the following factors is the strongest contributor to her risk of
developing an interval colorectal cancer?
• A. Obesity
• B. Tobacco abuse
• C. Low colonoscopic withdrawal time
• D. Incomplete resection of the descending colon polyp
24. CME Qs:
• 2. A 74-year-old female with depression schedules a surveillance colonoscopy.
Her last colonoscopy was performed 3.5 years ago, during which a 18-mm tubular
adenoma was resected from her ascending colon in a piecemeal fashion. Full
dose PEG was utilized to prepare for this procedure& bowel preparation was fair.
Today, her vital signs are stable& her physical examination is unremarkable. Due
to consistently poor colon preparation for prior procedures, her endoscopist now
routinely utilizes split-dose PEG for all colonoscopies. Which one of the following
potential measures would most likely increase the likelihood of identifying
adenomas during this procedure?
• A. Documenting cecal intubation by ICV photographs
• B. Increasing colonoscopic withdrawal time
• C. Provision of high quality educational materials geared to improve colon
preparation
• D. Utilization of narrow band imaging
25. CME Qs:
• 3. An ambulatory endoscopy center has developed a quality improvement task
force to improve patient safety / quality of colonoscopy performed in their unit.
Adenoma detection rates, cecal intubation rates& overall colonoscopic
preparation quality are measured&reported for each endoscopist privileged to
perform colonoscopy in the unit. The task force decides to update the informed
consent form with emerging data regarding patient risk for the development of
colorectal cancer between a normal screening colonoscopy& a follow-up
examination. Noting that multiple studies vary significantly, they decide to
reference the Nurses’ Health Study & the Health Professional’s Follow-Up Study.
Based on this study, what data should they use to describe approximate interval
colorectal cancer development risk after a negative screening colonoscopy?
• A. 20 cases of colorectal cancer per 1,000 colonoscopies
• B. 0.7 cases of colorectal cancer per 1,000 colonoscopies
• C. 1 case of colorectal cancer per 100 colonoscopies
• D. 5 cases of colorectal cancer per 1,000 colonoscopies