GB Cancer + Pseudomembranous Colitis (19) Flashcards
What is the most common type of malignant neoplasm of the gall bladder?
Adenocarcinoma
What are the causes of GB cancer?
- Cholelithiasis (gall stones)
- Chronic cholecystitis
What are the risk factors for GB cancer?
- Age > 70 yrs
- Female sex
- Family history
- Ethnicity (Mexicans/native American)
- Smoking
- Gall stones (most common)
- GB polyp >1 cm
- Porcelain GB
- Chronic infection by S. typhus
- ABPJ
- Choledochal cyst
- Obesity
Where does GB cancer spread to first?
Direct invasion to liver (segment 4/5)
What are the possible sites of spread for GB cancer?
- Porta hepatis lymph nodes
- Liver (segment V)
- CBD
- Stomach
- Duodenum
What is the most common organism causing surgical site infections?
Staph. aureus
What is the pathology of GB cancer?
Adenocarcinoma
Name three organisms likely to be associated with necrotizing fasciitis?
- Group A streptococcus (Strep. Pyogenes)
- Staph. aureus
- Clostridium perfringens
- Bacteroides fragilis
- MRSA
What is the diagnosis for necrotizing fasciitis?
- Cellulitis
- Crepitus
- Laboratory: LRINEC (laboratory risk indicator for necrotizing fasciitis)
Score
- C-reactive protein (CRP) > 150 mg/L: 4 points
- White blood cell (WBC) count > 15,000/mm³: 4 points
- Hemoglobin < 13.5 g/dL: 3 points
- Sodium < 135 mmol/L: 2 points
- Creatinine > 1.6 mg/dL: 2 points
- Glucose > 180 mg/dL: 1 point
The total score is calculated by adding up the points for each criterion. A score of 6 or higher is highly suggestive of necrotizing fasciitis.
- Score >= 6 → necrotizing fasciitis is highly considered
What is the pathology of necrotizing fasciitis?
Extensive necrosis with thrombosis of blood vessels
What is the management for necrotizing fasciitis?
- Hemodynamic support according to CCrISP protocol
- Surgical debridement
- Antibiotics according to culture and sensitivity
Who to involve in care for necrotizing fasciitis?
- ITU specialist
- Plastic surgeon
What can cause bloody diarrhea in a patient who is improving from treatment?
- Pseudomembranous colitis
- Ischemic colitis
- Hospital-acquired infective gastroenteritis, norovirus
- Inflammatory bowel disease
What is the pathogenesis of pseudomembranous colitis?
- Triggered by antibiotic therapy that disrupts the normal microbiota and allows C. difficile to colonize and grow
- The organism releases toxins that disrupt epithelial function
- The associated inflammatory response includes characteristic volcano-like eruptions of neutrophils from colonic crypts that spread to form mucopurulent pseudomembranes.
