Decker Flashcards
Compare RFA vs SBRT
RFA and SBRT are both safe minimally invasive modalities, though SBRT yields higher rate of local control
RFA –> improved survival in patients with T1a tumors compared to T1b tumors.
Reported local recurrence is higher after RFA
Overall survival appears to be similar when comparing RFA with SBRT.
Overall survival is better with T1a compared to T1b cancers when ablation is used.
Contrast induced nephropathy
For the majority of patients with CIN, creatinine levels return to baseline within 7 to 10 days
IV hydration can reduce the incidence
rise in creatinine notice 1-2 days
NAC can help but not good evidence
What to preserve during mesorectal resection
Denonvilliers fascia separates the anterior rectum from the posterior to the covering of the prostate and seminal vesicles or vagina –> resected –>It is the anterior margin of a total mesorectal excision.
The midsacral artery, pudendal nerve, presacral veins, and hypogastric nerves should all be preserved during the resection.
indications for visceral transplantation?
Candidates for intestinal and multivisceral transplantation have permanent intestinal failure with life-threatening complications from parenteral nutrition.
Catheter-related complications, such as thrombosis of two or more central veins, are indications for visceral transplantation.
lymphoma work up
FNA –> flow cytometry –> if not adequate –> fresh tissue
chronic liver-intestinal transplantation rejection
Chronic rejection is manifested clinically as chronic diarrhea with failure to thrive.
Most patients have resumed total parenteral nutrition to maintain nutrition.
Histologic characteristics include loss of villous architecture with loss of crypts of Lieberkuhn.
Varices bleeding management
1st –> rubber banding or intravariceal sclerotherapy with a sclerosing agent is performed
2nd –> balloon tamponade with 4port minnesota tube
IV somatostatin at the same time
propanolol should not be started during bleeding but should be started when bleeding stop
if liver transplant candidates –> no surgical intervention –> only TIPS (transjugular intrahepatic portosystemic shunt)
if not transplant candidates –> distal splenorenal shunt (DSRS) can be performed if the patient is not actively bleeding.
if emergency –> central portacaval shunt may be placed. Esophageal transection is also a reasonable choice in this setting.
Ebb Phase of metabolic responses to critical illness
(1) an elevated blood glucose level,
(2) normal glucose production,
(3) elevated free fatty acid (FFA) levels,
(4) a low insulin concentration,
(5) elevated levels of catecholamines and glucagon,
(6) an elevated blood lactate level,
(7) depressed oxygen consumption,
(8) below-normal cardiac output, and
(9) below-normal core temperature
Flow phase of metabolic response to critical illness
(1) a normal or slightly elevated blood glucose level;
(2) increased glucose production;
(3) normal or slightly elevated FFA levels, with flux increased;
(4) a normal or elevated insulin concentration;
(5) high normal or elevated levels of catecholamine and an elevated glucagon level;
(6) a normal blood lactate level;
(7) elevated oxygen consumption;
(8) increased cardiac output; and
(9) elevated core temperature.
End point of fluid resuscitation
(1) SBP higher than 90 mm Hg,
(2) HR lower than 120 beats/min,
(3) hemoglobin concentration equal to or greater than 10 g/dL, and
(4) CVP equal to or greater than 10 cm H2O.
what is chloride-resistant metabolic alkalosis? Tx?
chloride-resistant alkalosis is characterized by an increased urine Cl– concentration and ongoing Cl– loss that cannot be abolished by Cl– replacement. Most commonly, the proximate cause is increased mineralocorticoid activity.
Treatment involves identification and correction of the underlying disorder.
what is chloride-responsive metabolic alkalosis? tx?
Chloride-responsive metabolic alkalosis usually occurs as a result of loss of Cl– from the stomach, such as through vomiting or gastric drainage.
Treatment consists of replacing the lost Cl– either slowly with NaCl or relatively rapidly with KCl or even HCl. Given that chloride-responsive alkalosis is usually accompanied by volume depletion, the most common therapeutic choice is to give saline along with KCl.
