Part 2 Flashcards
(35 cards)
Q101 Colon cancer: clinical forms (symptomatics, diagnostics)
Symptoms according to location
-Right sided carcinomas (10%) ascending colon and cecum
Iron deficiency anaemic and melena/diarrhea
Left sided carcinomas (10%) transverse and descending colon
Changes in blood habits, blood streaked stool and colicky abdominal pain due to obstruction
Rectum and sigmoid (30%)
Changes in stool structure (pencil), hematoscheiza, tenesmus, rectal pain
Advanced disease-palpable abdominal mass, intestinal obstruction or perforation)
Metastases: liver, lung, lymph nodes symptoms
Q102 Colon cancer complications
-Right side lesion: bleeding and diarrhoea; anaemia and electrolyte loss, malnourishment and weight loss
Left sided lesion: obstructions and perforation
-Small bowel obstruction and ileocecal fistulas
-Sigmoid tumors; colovesical fistula-> UTIs, faecaluria, pneumatoria, haematuria
-Uterostasis
Distant mts: lung, liver, bone and brain
Q102 Surgery for colon cancer
- right side hemicolectomy - resect right side colon including hepatic flexure, ileocaecal valve, part of distal ileum with end to end, ileocolonic anastasmosis
- extended right side hemicolectomy if tumour is in proximal or middle transverse colon
- left side hemicolectomy - resection of descending colon including left flexure and sigmoid colon
- sigmoid colectomy
- total abdominal colectomy (hereditary and multifocal)
- regional lymph node dissection
- resection of mts in liver, lung
103 Stomach cancer Clinical features
Unspecific eg dyspepsia
Early satiety, anorexia, weight loss
Chronic iron deficiency anaemia
GI signs abdominal pain, nausea, vomiting, dysphagia
Acute GI bleeding haememesis and melena
Late stages; palpable tumour, gastric outlet obstruction, then mts in liver, bone
MALIGNANT ACANTHOSIS NIGRICANS GASTRIC ADENOMA
enlarged lymph nodes
104 Stomach cancer diagnostics and surgical treatment
Dgs
Lab CBC (iron deficiency anaemia), electrolytes, liver function tests, tumor markers (CEA, CA19.9)
Upper endoscopy with biopsy
barium swallow
+ staging through US, CT, Endoscopy, Endo US, dg laparoscopy
104 stomach cancer surgical treatment
Endoscopic resection- early stage or localised
Radical gastrectomy and lymahdenectomy
Roux en y gastric bypass; end to end anastomosis - esophagojejunostomy (remaining stomach) or gastrojejunostomy (remaining stomach)
Alternative subtotal gastrectomy
105 intestinal polyps classification
Low malignant potential
o Hamartomatous polyps – seen in inherited syndromes e.g. juvenile polyposis o Inflammatory polyps (pseudopolyps) – seen in ulcerative colitis
o Mucosal polyps – benign, usually < 5 mmo Submucosal polyps – benign, most common submucosal lipoma - Moderate malignant potential – serrated polyps
o Hyperplastic polyps – minimal risk of malignancy, small (< 5 mm) o Sessile serrated polyps – risk of malignancy ∼ 5%, > 5 mm in size o Traditional serrated adenoma – risk of malignancy ∼ 5%
- High malignant potential – adenomatous polyps
o Tubular adenoma – risk of malignancy < 5%, can be anywhere in colon
o Tubulovillous adenoma – risk of malignancy ∼ 20%
o Villous adenoma – risk of malignancy ∼ 50% (large adenomas), common in rectum
105 intestinal polyps clinics
- can be asymptomatic
- blood in stool
- constipation/diarrhea
- mucus in stool
105 intestinal polyps treatment
snare polypectomy - ped polyps if <2cm
endoscopic mucosal resection for large sessile polyps
surgical resection if >2cm, if malignant, if hereditary
106 intestinal polyps diffuse polyposis syndromes
- familial adenomatous polyps
- peutz jeghers
- juvenile polyposis syndrome
- cowden syndrome
- cronkhite canada syndrome
110 inguinal hernia treatment possibilties
Open hernia repair
a) Indications
- Complicated hernias
- Previous preperitoneal surgeries (e.g. hysterectomy, cesarean section)
- Presence of ascites
- Inability to undergo surgery under general anesthesia
- Recurrent hernia – if patient initially had a laparoscopic hernia repair
b) Procedure
- Lichtenstein repair – reinforcement by implementation of a synthetic mesh between the
abdominal internal oblique muscle and the aponeurosis of the abdominal external oblique
muscle
- Shouldice repair – doubling of the transverse fascia and fixation of the abdominal internal
oblique muscle and transverse muscle at the inguinal ligament by suture (non-mesh repair)
II. Laparoscopic hernia repair
a) Indications
- Bilateral hernia
- Recurrent hernia – if patient initially had an open hernia repair
b) Procedure
- Transabdominal preperitoneal repair (TAPP) – laparoscopic, preperitoneal mesh
implementation between the parietal peritoneum and transverse fascia
- Total extraperitoneal repair (TEP) – laparoscopic, extraperitoneal mesh implementation
between parietal peritoneum and transverse fascia
108 complications of diverticulosis of large bowel, diagnostics
- divirticulitis
- diverticular bleeding
- perforation
- fistula
- intestinal obstruction
- ileus
DG; abdominal ct with oral and iv contrast
Abdominal US
Colonoscopy
109 classifications inguinal hernia
direct inguinal hernia : funicular, dual hernia
indirect inguinal hernia: bubunocele, funicular, complete scrotal
117 drug treatment of BPH
Indications -mild bph, uncomplicated moderate bph with minimal discomfort due to symptoms
Alpha blockers
eg tamsulosin, doxazosin, alfuzosin, inhibiting a1 receptor in prostate urethra or bladder neck–> smooth muscle relaxation, decreased resistance to urinary outflow, symptom improvement
SE headache, ED, dizzy, orthostatic hypotension
5 alpha reductase inhibitors
eg finasteride, dutasteride
prevent conversion of testosterone to DHT,lower DHT in prostate, decrease prostate growth and increased apoptosis
SE gynacomastia, SD, decreased libido
Parasympatholytic/anticholinergic- oxybutynin, darifenacin etc for pt with irrititative symptoms with no post void
Phosphodiesterase type 5 inhibitors, tadafil smooth muscle relaxation, for pt with mild/mod symptoms and erectile dysfunction
118 surgical treatment of BPH
Indications- SEVERE BPH with or without complications, moderate BPH with complications
Types:
1. TURP; transurethral resection of the prostate (resection of hyper plastic prostate tissue under cystoscopic guidance with a cautery resectoscope), remove tissue in layers, leaves the capsule intact. Peripheral zone left intact (ca risk after turp same as for rest of pop)
2 TUIP transurethral incision of prostate; deep incision through the prostate urethra into prostate; widens bladder neck no removal of tissue
Laser/radiofrequency/microwave ablation
Open/laporoscopic prostatectomy
119 prostate cancer symptoms and diagnostics
usually adenocarcinoma early stage: usually asymptomatic -fatigue, weight loss, loss of appetite -hematuria -urinary retention, hydronephrosis -incontinence -erectile dysfunction mts
DG, Digital rectal exam PSA >4ng/ml indicates malignancy, alkaline phosphatase, prostate acid phosphatase urine culture biopsy Staging - ct, X-ray us scintography
120 treatment methods of prostate cancer
- watchful waiting; regular follow ups with restaging
- definitive treatment radiation therapy with or without prostatectomy
- radiation therapy localised disease, using external beam therapy, brachytherapy
- radical prostatectomy for localised disease, with lymphadenectomy
- anti androgen therapy- androgen sensitive localised high grade or metastatic prostate cancer
- medical castration GnRH agonists leprolide or antagonist degarelix
- surgical castration bilateral orchiectomy
Disseminated disease; chemo with docetaxel, antindrogen therapy, osteoclast inhibitor in bone mts
management of castration resistant prostate ca
-continue ADT and chemo docetaxel/immunotherapy
+
-asymptomatic bone mts- zolendronic acid each 3-4 weeks/denosumab
or +
symptomatic bone mts
-single: palliative external beam radiotherapy or multifocal: iv radoopharmaceuticals
121 hydrocele: what is it?
painless accumulation of fluid within tunica vaginalis of scrotum surrounding one or two testicles
121 hydrocele aetiology
- Idiopathic (most common)
- failed closure of processus vaginalis during development, peritoneal fluid flows into scrotum, or if theres no connection to peritoneal cavity could be due to increased secretion or decreased resorption by tunic vaginalis - secondary (due to underlying pathology) Trauma, tumour, torsion e.g. lymphatic filiarias
121 hydrocele diagnostics
- physical exam
- communicating hydrocele will increase in size with valsava maneuver and are reducible
- noncommunicating hydrocele no affected with valsalva and are not reducible
- positive translumination
-ultrasound; hypo echoic fluid
121 hydrocele treatment
-usually resolve spontaneously within 6 months of birth
indications for surgery:
- no resolution by 1 year of age
- excessive discomfort
- underlying pathology
- testicle not palpable
- risk of infertility
-procedure; surgical excision or percutaneous aspiration
122 testicular torsion diagnostics
Clinical picture; sudden pain, swelling, nausea and vomiting, tender testicle
Physical exam; absent cremasteric reflex, no relief of pain on elevation of testes
Lab- urine dipstick and inflammatory markers to exclude epididymitis
US of scrotum
Doppler US
122 testicular torsion treatment
URGENT TREATMENT!!
–> MEDICAL EMERGENCY…. within 6 hours of onset
Manual detorsion - buy time and relieve symptoms
immediate surgical exploration with reduction and orchidopexy
to CL side
Removal of necrotic testes
123 Urinary tract stones : aetiology and types
Calcium 80% (phosphate -hyperparathyroidism and hypercitraturia.)
and oxalate-hyperparathyroidism, hyperoxaluria, hypercitraturia)
Struvite 10% -upper UTI with urease prod bacteria
Uric acid 10% - persistent acidic urine, gout, hyperuricemia/uricosuria
Cysteine 1%; cystinuria AR disorder
