GB cancer Flashcards
Stem: A 74- year- old patient with DM, HTN underwent cholecystectomy for cholecystitis and at operation the gallbladder was found to be thickened and fixed to the liver.
Stem: A 74- year- old patient with DM, HTN underwent cholecystectomy for cholecystitis and at operation the gallbladder was found to be thickened and fixed to the liver.
Q1: What’s the most probable diagnosis for a thickened, fixed gallbladder in an elderly female?
GB Cancer ( adenocarcinoma )
Q2: What’s the main risk factor of this tumor in the UK?
Gall stones
What are other risk factors?
Smoking / Family Hx / Elderly / Female/ Obesity / Gall polyps / porcelain GB
Q3: Where does gallbladder cancer spread to first?
Liver – Local nodes
Q4: What’s the most common pathological type of gallbladder cancer?
Adeno
Q5: If the wound breaks down with yellowish and smelly discharge, what’s your diagnosis?
Local infection (Bacterial)
Q6: What’s the most common organism causing surgical site infection?
S. Aureus
Q7: If you have minimal inflammation without local cellulitis, what will you do?
I&D – Sample for C&S – Clean wound and keep the wound open
Few days later, the patient’s condition deteriorates with high fever, tachycardia, the wound, and the surrounding local tissues become very congested with purple discoloration and tissue necrosis
Q8: What’s the most probable diagnosis now?
Nec. Fascitis
Q9: What are the most common organisms causing necrotizing fasciitis?
Strept. Pyogens (Grp a stertococci) / Others S. Aureus / Cl.Perfringens / vibrio / Bacteroids
Q10: How can you suspect the diagnosis of necrotizing fasciitis?
Prodromal signs Fever unwell, Local signs Cellulitis with crepitation
Lab; LRINEC ≥ 6 ( NEC.F is highly considered)
Q11: What are the pathological changes in necrotizing fasciitis?
Extensive necrosis and thrombosis of Blood vessels
Q12: How would you treat such patient? Who would you involve in the care of this patient?
Nec. Fasc
According CCrisp protocol – ABX for C&S
Defintive ttt early ext debridement of all necrotic tissue until healthy tissue are reached and we might need a relook after 24hr and redebridment
– Surgeon / ITU specialist / Anesthetist / Microbiologist and plastic surgeon
Few days after receiving treatment including broad-spectrum antibiotics, the patient developed bloody diarrhea.
Q13: What’s the differential diagnosis of post-operative bloody diarrhea?
Pseudomembrance colitis / Ischemic colitis / hosp. acquired GE (noro virus)/ IBD
Colonoscopy was done,
what can you see?
Multiple yellowish eruption with inflamed ulcerated mucosa in btw
Q14: What’s the treatment of this condition?
Non sever TLC < 15 – > Oral Vancomycin 10-14 dys / Erythromycin / Metronidazole
Severe TLC > 15 / High fever / AKI – > Vanco + Metro
Nor responding like in Toxic megacolon – > Colectomy
Q13: What’s the pathological process responsible for this picture?
Psaudomemb colitis
Bact. Exotoxins cause damage of the mucosa these will lead to exudation of ptns and inflame cells forming pseudo membrane.
Q13: How you clinically suspect pseudomembranous colitis? And how to confirm the diagnosis?
Hx of Broad spectrum Abx / Clinical signs fever Pain diarrhea
- Confirmed by ELIZA for toxins / PCR for toxins / x-ray to role out Toxic megacolon.