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Chirurgie > San > Flashcards

San Flashcards

1
Q

Bursa retromamara a lui Chassaignac

A

Intre aponevroza pectoralului mare si fata post a glandei

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2
Q

Ligamentul suspensor al mamelei

A

Fuziunea foitelor ant si post care se continua pana la clavicula

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3
Q

Reteaua Haller

A

Retea venoasa superficiala la niv tesutului adipos premamar

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4
Q

Anomalii si vicii de conformatie

A

Amastia, atelia, politelia, polimastia de a lungul liniei lactee

Mamelon ombilicat, mastoptoza

Atrofia, hipertrofia, ginecomastia

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5
Q

Semne malignitate imagistica

A

Contur neregulat
Margini spiculate
Micro calcificari

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6
Q

Indicatii ecografie san

A

Paciente tinere
San dens
Sarcina
Af. inflamatorii/traume acute
Implant
!!! Extensie tumorala si adneopatii

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7
Q

Indicatii RMN (depistare precoce)

A

Paciente risc genetic crescut
Mamo/Eco neconcludente
Monitorizare post terap

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8
Q

Alte imagini imagistice san:

A

CT
Scintigrafie mamara
Ductoscopie
Galactografie
Termometrie cutanata
DOBI

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9
Q

Traumatismele sanului dau:

A

Citosteatonecroza

Tumefactie nodulara sau prost delimitata, dureroasa, aderenta la planuri, retracta mamelonul, cu ganglioni mariti, sensibili, consist elastica

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10
Q

Inflamatii acute san (infectii, hormonale, frecv sarcina), diagnostic pozitiv

A

Evidentierea puroiului in lapte
Cultura si antibiograma

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11
Q

Diagnostic diferential inflamatie acuta san

A

Angorjarea sanului: congestie fiziologica daca gl nu e golita complet de lapte, tumefactie fara inflamatie

Mastita carcinomatoasa la tinere gestatie sau lactatie
Culturi neg + cel tumorale la citologia laptelui

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12
Q

Forme de inflamatii acute san:

A

Abces premamar(Supramastita)
Abces retromamar(Inframastita)
Abces tuberos(infl a gl sudorale areolare)
Mastita acuta

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13
Q

Tratament inflamatii acute san

A

Intreruperea alaptarii cu golirea sanului
Antibiotice
Ains
Br-ergocriptina (anti-prl)
Pansamente alcoolizate
Chirurgical in supuratii

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14
Q

Inflamatii cronice san:

A

Abcesul cronic: cele incorect tratate

Galactocelul: canal galactofor obstruat cu retentia laptelui, fara adenopatii.

Tbc san: abces rece, cu adenita

Sifilisul doicilor: sancru(cu microadenopatii), sifilide, gome(fara adenopatii)

Actinomicoza mamara

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15
Q

Mamela secretanta SINDROM

A

!Adolescente
Stabilim daca este uni sau bilaterala
Daca este lactata sau purulenta/sanguinolenta(cel mai frecv papilom, apoi dilatatii simole subareolara, carcinom ductal)

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16
Q

Adenofibromul mamar

A

Cea mai frecventa
Dimensiuni variabile, consistenta crescuta, alb rosiatica, incapsulata, cu mici cavitati
!!! 20-30 ani, in periferie
Crestere lenta si transformare maligna rara

17
Q

Tumora Phylodes (fibroadenom intracanalic)

A

Tumora giganta, consistenta neomogena, fara adenopatii, semne cutanate
Forme benigne, maligne, borderline

18
Q

Mastoza Fibrochistica (Boala Reclus)

A

Etiologie: inflamatorie, hormonala, embrioplazica, stres, alcool, cafea

Tumori multiple, scleroase, cu lichid, bilaterale, neregulate, mobile, sensibile, fara adenopatii
Dureri crescute premenstrual, secretie mamelonara

In forme de placard biopsia se impune

19
Q

Tratament mastoza fibrochistica:

A

Medicamentos (tinere, incipenta, circumscrisa):
-topic cu progesteron
-ains, antioxidanti vit c
-fac. ai diferentierii vit e
-blocanti hormoni (tamo, ralo)

Chirurgical: crestere rapuda sau susp de malignizare

20
Q

Chistul solitar:

A

Tumora mare, mobila, delimitata, continut lichid, sensibila, crestere rapida, fara adneopatii

Frecv in preclimax

Excizie in caz de chist complex cu comp solida, ev rapida, susp de malignizare

21
Q

Tumori maligne nonepiteliale san

A

T. Phylodes Maligna
Liposarcom
Hemangiosarcom
Rabdomiosarcom
Limfom malign
Limfom malign histiocitar

22
Q

Particularitati sarcom mamar

A

1%, dupa 40 ani, met hematogen
Mare, neregulata, insule solide/chisturi, incapsulata, creste rapid, cu celule fuziforme sau rotunde

Debut insidios cu nevralgii, durere

Tegumente subtiri, retractie, circ colat, nedureroasa, cons neregulata, aderenta, fara adenopatii

23
Q

Factori de risc (mediu) cancer san

A

Iradierea, UV
Dieta(grasimi, proteine)
Alcool
Stres
Contraceptive orale
Traumatisme

24
Q

Factori de risc(autologi) cancer mamar

A

Varsta >45-50
Menarha <12
Menopauza >55
Prima sarcina >30
Nuliparitatea
Obezitate
Benigne precanceroase
Def imune
Endocrine (hipertir, hiperfoliculin)

Genetici

25
Q

Forme carcinom mamar (microscopic)

A

Epiteliom glandular (cilindric, cubic)
Epiteliom papilar (vegetatii intracanalicular)
Alveolar (poligonale in gramezi)
Medular (in cordoane)

26
Q

Serologie cancer mamar

A

Ag: CA 15-3, TAG 72, MCA
Catepsina D

27
Q

Tnm cancer san

A

T1a 0-1 cm, T1b 1-2 cm
T2 (2-5 cm)
T3 (5-10cm)
T4 (>10 sau invazie locala)
T4a (pectoral)
T4b (piele)
T4c (ambele)
T4d (mastita carcinomatoasa)
N1 (gg ipsilaterali)
N1a (+semne inflamatorii)
N1b (fermi cu susp de semne)
N2 (fixati la tegumente/intre ei)
N3 (supraclaviculari/contralateral)

M1 (metastaze br,bo,h,l)

28
Q

Stadializare cancer san

A

Stadiu 0: Tis N0 M0
Stadiu 1: T1/T2, N0/N1a, M0
Stadiu 2: T1/T2, N1b, M0
Stadiu 3: N2/N3
Stadiu 4: M1

29
Q

Forme clinice carcinom mamar

A
  1. Cancer mamar tumoral
  2. Cancer mamar infraclinic
  3. Boala Paget a sanului
  4. Cancer multicentric
  5. Mastita acuta carcinomatoasa
    (Grava, in perioada de lactatie)
  6. Schir mamar
  7. Cancer asociat cu sarcina
  8. Bilateral
  9. La barbat
30
Q

Boala Paget a sanului

A

Cancer cu originea in epiteliul canalelor galactofore, foarte rara, palpare cadr central retromamelonar

31
Q

Chimioterapice cancer san:

A

5 fluorouracil
Ciclofosfamida
Dexorubicin
Toxotel

32
Q

Imuniterapice

A

Nespec: bcg, polidin, catastim
Interferon
Spec: Ac avastin, erbitux

Chirurgie (16 decks)

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