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Clin Med 2 > Tx > Flashcards

Tx Flashcards

1
Q

Groin Hernia

A 
ASx- monitor
Surgical:
- moderate to severe sx
- Urgent- incarceration
- Emergency- strangulation, bowel obstruction
- Laproscopic/open
- Mesh: durable and longevity
- Aloderm: human cadaver skin; less likely to get infected
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2
Q

Femoral

A

Surgery

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3
Q

Spigelian hernia

A

Surgery; very painful and complicated; trapped easily

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4
Q

Richters Hernia

A

Surgery

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5
Q

Parastomal Surgery

A

Based on sx

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6
Q

Rectus Abdominus Diastasis

A

conservative- weight loss, abdominal exercise

surgical- cosmetic/ severe sx

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7
Q

Conservative Tx Hemorrhoids

A

Dietary- increase water and fiber intake
Toilet habits- avoid lingering
Sitz bath- soaks anus and keeps it clean

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8
Q

Office procedures Hemorrhoids

A
  • banding
  • coagulation
  • sclerotherapy
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9
Q

Initial Grade 1 or 2 or External

A
  • Dietary therapy
  • educate about toilet habits
  • oral/ local analgesic
  • topical agents to reduce swelling/ treat dermatitis (topical astringent and protectants, topical corticosteriods, topical antiinflammatory agents)
  • Decrease sphincter spasms (antispasmotic)
  • Venoactive agents to increase venous tone
  • Banding
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10
Q

Who gets surgery

A
  • sx despite conservative measures
  • grade 4 (+/-) strangulation
  • Grade 3 with symptoms
  • severe pain with thrombosis
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11
Q

Surgery

A
  • hemorrhoidectomy
  • hemorrhoidal artery ligation
  • staple hemmorrhoidectomy
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12
Q

Thrombosed Hemorrhoids

A

Excision and I&D

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13
Q

Rectal Abscess

A
  • I&D

- ABX only if cellulitis

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14
Q

Rectal Fistula

A

Surgery- eradicate fistula and preserve fecal continence with little rubber tubing tie that they use to tie and pinch off fistula

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15
Q

Anal fistula goals

A
  • relax internal sphincter
  • maintain less trauma with stooling
  • pain relief
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16
Q

Medical Tx Anal fistual

A
  • cortisone
  • topical nitro, diltiazem, bathanechol
  • oral: nifedipine, diltiazem
  • botulin toxin to paralyze the rectal spasm
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17
Q

Surgical Tx anal fistula

A
  • failure of other tx
  • lateral sphincterotomy
  • dilatation
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18
Q

constipation

A

Initial Management
- patient education
- dietary changes: more fiber and water
- bulk- forming laxatives (metamucil, citrucel, fibercon, benefiber)
PRN
- non-bulk forming laxatives (milk of magnesia, miralax, lactulose, senna, biscodyl)
- Enemas- (colace and mineral oil)

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19
Q

Post op give what for constipation

A

colace and senna

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20
Q

Fecal impact

A
  • Disimpact and colon evacuation: manual fragmentation, mineral oil enemal to soften and lubricate, PEG after evactuate a little
  • identify causes
  • maintain bowel regimen
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21
Q

Pilonidal Disease

A
  • sitz bath
  • I&D if abscess
  • surgical excision of sinus tract and cysts
  • ABX for cellulitis
  • be careful shaving hair in gluteal area
  • recurrent
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22
Q

Tx SBO

A

NPO
IVF
NG tube- decompress intestine
Surgery- done for all the other causes except adhesions and Crohn’s; if adhesion/Crohn give the patient 4 days on other tx before surgery

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23
Q

Tx appendicitis

A

NPO
IVF
IV ABX- broad spectrum
Surgery- appendectomy

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24
Q

Tx toxic megacolon

A 
Non-operative (first line)
- IVF
- Correct lab abnormalities
- ABX for IBD or infectious (Vanco+Flagy for cdiff)
- intravenous corticosteroids (IBD)
- NPO
- Bowel decompression with NGT
Surgery if no improvement
- subtotal colectomy with end-ileostomy (50% mortality)
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25
Q

Tx ischemic bowel disorder

A
  • IVF
  • Anti-coag (IV heparin)
  • IV vasodilator (glucagon systemically or papverine through a catheter)
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26
Q

When does patient need to be in OR ischemic bowel disorder

A

4-6 hrs

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27
Q

Tx for ischemic bowel disease to infarct

A
  • emergent laporatomy- restoration of interrupted blood flow with arteriotomy/ bypass graft and resection of infarcted bowel
  • look again 24-48hrs later to see if alive or dead bowel
  • need vasodilators
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28
Q

Tx colonic ischemia

A 
Support
-IVF
- NPO
- Empiric ABX for moderate/severe
- NGT
- no meds that promote ischemia
- optimize cardiac and pulmonary functions
Surgery
- laparotomy with resection if clinical deterioration despite support
- patient will receive colostomy bag
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29
Q

Tx pancreatic cancer

A
  • only curative approach is surgery
  • stage 1 to 2b is most likely to be cured by radical resection
  • do a whipple if tumor in head of pancreas
  • distal pancreatectomy is tumor in body or tail
  • chemotherapy
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30
Q

What is a wipple

A
  1. resection of head of pancreas
  2. excise the duodenum and bile duct
  3. reconstruction with intestine
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31
Q

Protein Energy Malnutrition

A

• Call your nutrition colleagues ASAP
• Should be followed daily by nutrition consultant
o Help manage dietary requirements
o Correct electrolyte abnormalities
o Replace vitamins and minerals
o Supplements with enteral or parenteral nutrition

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32
Q

Obesity

A 
•	Close follow-up is essential 
•	Identify and refer those patients who are motivated to active 
treatment programs 
•	Programs are multifactorial and emphasize maintenance of weight loss
o	Dietary instruction and education
o	Behavior modification
o	Exercise
o	Medications
o	Bariatric surgery
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33
Q

Anorexia

A
  • Goal is restoration of normal body weight and elimination of psychological features
  • Inpatient treatment programs are available but may also be necessary in severe cases for management of volume status and electrolytes
  • Psychotherapy and medications are available however show little evidence of improvement
  • Referral to psychiatrist is essential 

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34
Q

Bulimia

A
  • Supportive care to include psychotherapy
  • Antidepressants may be helpful
  • All patients should be referred to psychiatrist
  • Long term psychiatric prognosis is worse with bulimia nervosa than with anorexia nervosa
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35
Q

Iron deficient

A

• Identify cause of iron deficiency anemia as often this can be a result of occult blood loss
Oral iron
o Ferrous sulfate 325 mg PO one-three times daily
o Continue 3-6 months after restoration of normal labs
Parenteral iron is indicated if:
o Refractory to PO iron

o GI disease
o Hemodialysis

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36
Q

Thiamine deficient

A

replace thiamine, initially IV followed by PO

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37
Q

B12 deficient

A

IM or subcutaneous injections of 100 mcg
• Daily for first week
• Weekly for first month
• Monthly for life

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38
Q

Folic acid deficiency

A

folic acid 1mg PO daily

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39
Q

Vitamin D

A 
o	Ergocalciferol (D2) 50,000 units once weekly x8 weeks
o	Cholecalciferol (D3) 2,000 units daily
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40
Q

HCC

A

Surgical- Only long term cure
- Resection = tumor <5cm and no/minimal cirrhosis
- Liver transplant – only cure
Medical/palliative – very advanced disease
- Sorafenib (VEGF blocker) slows progression with advanced HCC

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41
Q

Chronic HCV

A
  • Treatment recommended for EVERYONE 
• - Typically treatment is 12 weeks w/o cirrhosis and 24 weeks w/ cirrhosis 

  • ledipasvir (90 mg)/sofosbuvir (400 mg) = Harvoni for 12 weeks
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42
Q

Chronic HBV

A

ETV (Entecavir), Tenofovir

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43
Q

Alcoholic hepatitis

A

Emergent treatment to improve short term mortality

  • Steroids = methyprednisolone 32mg/daily for 1 mo (MELD >18)
  • Pentoxiphylline = if steroids contraindicated

General Treatment

  • ETOH cessation
  • Correct nutritional deficiencies (folate, thiamine, zinc)
  • Assist with abstinence (naltrexone, acamprosate, baclofen)

Liver transplant considered only after 6 mo abstinence period from alcohol

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44
Q

Autoimmune hepatitis

A

o Corticosteroids

o +/- Azathioprine

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45
Q

HCV

A

8-12 weeks Ledipasvir/sofosbuvir (Harvoni)

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46
Q

HAV

A

Symptomatic treatment

47
Q

GI varicies

A

Emergent Treatment

  • 2 large bore IV access/Central access

  • pRBC txn hb >7
  • NGT w/ lavage (Try to clamp down on bleed; Don’t do unless GI told you to do it)
  • Octreotide 50mcg/hr
  • Balloon tube tamponade (Minnesota or Blakemore)
  • Endoscopy (definitive treatment); Varix ligation (banding), inject, sclerotherapy
  • TIPS (transjugular intrahepatic portosystemic shunt)
  • Angiotherapy (percutaneous transhepatic embolization)
  • Surgical 

48
Q

Prevent rebleed GI varicies

A
  • nadolol titrated to maximal tolerated dose

- Endoscopic: Band ligation

49
Q

Hepatic encephalopathy

A
  • Lactulose (PO, NGT, rectal and titrate to 3-4 BM’s per day) ; Titrate to number of bowel movements a day
  • Antibiotics (xifaxan-nonabsorbable antibiotic which absorbs ammonia)
50
Q

Ascites

A

Medical therapy

  • Na+ restriction (<1.5g)
  • Fluid restriction (<1.5L)
  • Diuretics (Second line therapy)- Spironolactone or Furosemide

Surgical

  • Large volume paracentesis (5-7L (max 10L))
  • TIPS
  • liver transplant
51
Q

UGIB

A
  • Hospitalization
  • Two large bore peripheral IV
  • Type and cross for blood
  • IVF resuscitation and/or blood transfusion and/or clotting factors (500mL or 2L given of IVF); give pRBC is Hgb less than 7; INR>1.5 FFP
  • IV PPI BID* (Esomeprazole, pantoprazole)
  • IV Octreotide* 50mcg IV bolus -> continuous infusion 50mcg/hr x3-5 days
  • Reversal agents for anticoagulant or antiplatelet therapies +/-
  • Prokinetic agents (e.g. erythromycin 3mg/kg IV) 30-90 minutes before endoscopic to aid in visualization
  • Endoscopy (hemodynamically stable) +/- endoscopic therapy; Injection therapy (epinephrine), thermal coagulation, hemostatic clips, fibrin sealant, band 
ligation
  • Rare intervention: angiography with transarterial embolization, surgical 
treatment (vagotomy, pyloroplasty, etc) – typically if failed endoscopy
    Endotracheal intubation – massive bleeding
52
Q

UGIB- ESOPHAGEAL VARICIES

A
  • Prophylactic antibiotics – esophageal varices – broad spectrum
  • Intrahepatic portosystemic shunt placement (TIPS)
  • Balloon Tamponade – Blakemore tube (requires intubation)
53
Q

LGIB

A
  • Hospitalization
  • Two large bore peripheral IV or a central line
  • Type and cross for blood
  • IVF resuscitation and/or blood transfusion and/or clotting factors
  • Reversal agents for anticoagulant or antiplatelet therapies +/-
  • Colonoscopy with therapy
  • CT angiography with sclerotherapy
54
Q

Small bowel Adenocarcinoma

A

Surgical

55
Q

small bowel Carcinoid

A

surgical

56
Q

small bowel sarcoma

A

surgical + Imatinib (advanced disease)


57
Q

small bowel lymphoma

A

Surgical Excision (Node negative) + Chemotherapy (Node positive)

58
Q

General diarrhea management

A

o Fluid replacements- Oral vs IV
o Nutrition repletion- Sugar, salt, water
o Antibiotic therapy- Fluoroquinolones
o Antimotility agents- Loperamide, Pepto-Bismol
o Probiotics

59
Q

C.diff

A

o Stop inciting antibiotic

o Contact precautions- soap and water
o Vancomycin or Metronidazole

60
Q

Campylobacter

A

supportive in healthy patients- IVF, antiemetics
• Antibiotic therapy for immunocompromised and severe disease
o Fluoroquinolones (Levoflox, Ciproflox), Azith

61
Q

Salmonella

A

o IVF replacement
o Electrolyte repletion
o Antibiotic therapy not indicated in healthy patients
o Ciproflox or Levoflox for severe disease, immune compromised patients

62
Q

Shigella

A

o Supportive with IVF, electrolyte repletion
o Self limiting lasting average 7 days
o Antibiotic therapy not indicated in healthy patients
• Fluoroquinolone (not Cipro due to resistance), Azith, Bactrim for severe disease and immune compromised

63
Q

botulism

A

o Antitoxins

64
Q

cholera

A

o aggressive volume repletion- IV or oral fluid and electrolytes
o antibiotics for moderate to severe volume depletion
• macrolides, fluoroquinolones, tetracyclines

65
Q

Intestinal Entomoeba

A

o Metronidazole
o Tinidazole
o Ornidazole

66
Q

cryptosporidium

A

antiparasitic meds- Nitazoxanide

67
Q

giardia

A

Metronidazole, Tinidazole, Nitazoxanide

68
Q

traveler’s diarrhea

A

o Flouroquinolones- Ciproflox, Levoflox

69
Q

IBS

A 
Dietary modification-
•	Low gas producing foods (beans, onions, celery, bananas, apricots, bagels, pretzels etc.) Etoh, caffeine
•	Lactose avoidance
•	Low fodmap diet- fermentable foods (honey, corn syrup, apples, pears, mangoes, cherries etc.)
•	Gluten avoidance
Physical activity
Adjunctive pharmacologic therapy:

-Patients with IBS-Constipation
•	PEG (polyethylene glycol) therapy
o	Lubiprostone
o	Linaclotide
70
Q

Mild UC

A
  • Aminosalicylates (5-ASA) drugs- colon version of motrin that only releases in the distal colon
  • Mesalazine PR suppository or budesonide rectal foam preferred if mild proctitis
  • Rectal and oral 5-ASA i.e po sulfasalazine and PR mesalazine if distal colon inflammation
  • After remission long term maintenance with 5-ASA recommended
71
Q

Mild/moderate UC

A
  • Budesonide orally – targets colon minimal systemic affect
  • Prednisone
  • Taper over 60 days
72
Q

Severe UC

A
  • Hospitalization and IV steroids w/ IVF
  • Methylprednisolone 60mg/d
  • Steroid resistant disease = anti-biologics (when you fail on steroids do an induction therapy with an immunosuppressant)
  • TNF-alpha blocker (MC)- infliximab, adalimumab, Golimumab
  • VGEF blocker (only use if fail on TNF)- Vedolizumab
  • Cyclosporine = last resort
73
Q

Maintenance UC

A
  • 5-ASA if response to 5-ASA or steroids
  • Budesonide
  • Immunosuppresants
  • Azathioprine or 6-MP
  • If inflixamab induction then continue with agent for maintenance or azathioprine (same for Golimumab)
  • Probiotics help with maintaining remission
74
Q

Surgery in UC

A

colectomy is curative in UC
–Emergency: Life-threatening complications related to fulminant disease such as toxic megacolon unresponsive to medical treatment
–Urgent: Severe disease admitted to hospital and not responding to intensive medical treatment

75
Q

Diarrhea with CD

A
  • Loperamide
  • Terminal ileal disease or resection= bile acid sequestrant
  • Short gut = low fat diet
76
Q

Mild CD

A

o Colon and small bowel disease = mesalamine

o 5-ASA derivatives, which are mainstay of UC, have shown to be less useful in treatment of CD

77
Q

Moderate/severe

A

Steroid therapy
• Short course for severe systemic symptoms and/or refractory to anti-inflammatories
• Treat until remission and then slow taper (60 days)
Immunosuppressants
o Azathioprine (6-MP active metabolite)
o Methotrexate- in adults it can be used for induction and maintenance
TNF – alpha blockers
o Steroid dependent and unable to taper
o Fistula treatment not responding to abx and conventional therapy
o Infliximab, Adalimumab, certolizumab pegol,
o Induction doseage until remission and then maintenance doseage
Anti-integrins
oLose responsiveness to TNF-alpha blockers or don’t respond at all
oVedolizumab

78
Q

Fistula due to CD

A

o Antibiotic therapy- metronidazole and ciprofloxacin
o Immunosuppressants and TNF-alpha blockers
o Surgery

79
Q

Celiac

A

Diet
o Essential therapy = removal of ALL gluten
o Improvement in 2 weeks on diet
o Often assoc w lactose intolerance either temp or lifelong thus avoid dairy until sx resolution
Supplements
o VitA,B12,D,E
o Initial stages only required usually not long term
Steroids
o Prednisone or budesonide 2 or more wks
• Try and get disease under control
o Unintentional or intentional gluten ingestion may trigger severe diarrhea, hypovolemia, electrolyte imbalance

80
Q

Lactose intolerance

A

o Goal of therapy is patient comfort and determining 
“threshold” of intake when symptoms occur
o Spread lactose intake throughout the day in quantity <12g (1 cup of milk) and most pts tolerate this w/o lactase
o Lactase enzyme replacement - Lactaid, Lactrase, Dairy Ease
o Calcium supplementation if exclude dairy (prevent osteoporosis)

81
Q

Cholelithiasis

A

Asymptomatic (incidental finding) – Expectant management
o Give them signs and symptoms to look out for and to come back if they develop these symptoms
Symptomatic – Prophylactic Cholecystectomy

82
Q

Cholecystitis

A
  • Admit to the hospital (IVF, pain management, ABX)
  • Cholecystectomy- Want to take them out 24hrs from diagnosis
  • Pre-op antibiotic prophylaxis towards gram neg rods and anaerobes
  • Cipro & Flagy; 3rd Gen Ceph + Flagyl,;Carbapenem; Pip and Tazo
83
Q

Percutaneous Drainage Indications in cholecystitis:

A

Pericholecystic abscess, CBD obstruction; significant edema and swelling

84
Q

Choledocolithiasis Treatment

A

Removal of the common bile duct stone either endoscopically (ERCP) or surgically.

85
Q

Acute Cholangitis Treatment

A
  • Admit to the hospital
  • Empiric Antibiotic Treatment- Zosyn, Unasyn, Flouroquinolone + Flagyl, Cabapenem
  • Establish biliary drainage- ERCP
  • Sphincterotomy with stone extraction and/or
  • Stent placement if mass or stenosis or significant swelling
86
Q

PSC

A

liver transplant

87
Q

Acute pancreatitis

A
  • Admit to the hospital
    • Assess for severity upon diagnosis (next slide)
    • Attempt to discover underlying cause
    • NPO
    • IVF (Lactated Ringer’s or NS)
    • Parenteral analgesia
    • Parenteral antiemetics
    • Repeat labs assessing BUN/Creatinine, HCT q8-12 hours
    • Serial exams assess for fluid overload
    • Nutrition: Introduction of clear fluids->low fat diet
88
Q

Chronic pancreatitis

A

• Low fat diet; refrain from alcohol
• Steatorrhea- FDA-Approved Pancreatic Enzyme
o Decreases diarrhea
o Restores absorption nutrients
• Endoscopic treatment –sphincterotomy, stenting, stone extraction, drainage of pseudocyst
• Whipple, total pancreatectomy or autologous islet cell transplantation 


89
Q

Diverticulitis Medical

A

Antibiotics – Coverage Enterobacteriaciae & Gram Neg Anaerobe (B.Frag)
o Cipro & Flagyl (IV or PO) (first line)
o Augmentin PO
o Ertapenem (IV)
o Zosyn (IV)
o 2nd or 3rd Cephalosporin plus Flagyl IV

IVF (admitted)

Analgesia & Antiemetics PRN (IV vs PO)

NPO vs Clear Diet vs normal diet

90
Q

Diverticulitis Surgical

A

One Stage Procedure
o Colon Resection with primary anastomosis
Two-stage Procedure (two different procedures)
• Colonic Resection with end colostomy (Hartmann’s procedure)

91
Q

Diverticulosis surgical- who gets it

A
  • Emergent Surgery: free perforation, +/- bowel obstruction

- Urgent Surgery: failure of medical treatment; colonic obstruction; abscess failing non-operative intervention

92
Q

Diverticular Bleed

A

Resuscitation if bleeding hasn’t stopped
o Two large bore IV
o IVF NS
o Type and Cross for blood
o Transfuse pRBCS PRN
• Colonoscopy (first step)-Treat active bleeding
• Angiography (2nd step)- Alternative to colonoscopy if bleeding cannot be found
• Surgical Intervention (Segmental Colectomy)- Hemodynamically unstable

93
Q

Polyps

A

polypectomy

94
Q

Lynch

A

colectomy

95
Q

FAP

A
  • prophylactic colectomy

- Chemoprophylaxis NSAID and COX2- Celecoxib

96
Q

colorectal cancer

A

Surgery – Resection of primary colonic or rectal cancer is the treatment of choice in all stages
Chemotherapy – Stages III&IV Colon cancer

97
Q

antibodies against the epidural growth factor receptor (EGFR)

A

Cetuximab and Panitumab

*Used only in Stage IV and always adjunct to traditional chemotherapy

98
Q

Rectal cancer

A

Stage I : Excellent prognosis surgery alone

Stage II & Stage III: Chemoradiation + Surgery

99
Q

Anal cancer

A

Stage 0-3
- Chemoradiotherapy (Neoadjuvant): 5-FU + Mitomycin + Radiotherapy
- Progression of disease or persisting disease necessitates surgery
Stage 4
- Systemic Chemotherapy: Cisplatin + 5-FU

100
Q

Active bleed PUD

A
  • IVF, Blood transfusion
  • High dose IV PPI (Protonix)bolus and drip
  • Endoscopic Intervention
    o Epinephrine injection
    o Hemoclips
    o Thermal coagulation
  • Surgery
101
Q

PUD

A
  • Consider PPI – Non H.Pylori and Non-NSAID ulcer

- Advise discontinue of tobacco, minimize alcohol, avoid spicy foods

102
Q

Gastritis

A
  • H. Pylori – Triple therapy (PPI +Amoxicillin + Clarithromycin)
  • D/c offending agent
  • Antacids (Alka-Seltzer, Maalox, Mylanta, Rolaids)
  • H2RA: cimetidine (Tagamet), famotidine (Pepcid), e.g
  • PPI: omeprazole (Prilosec), lansoprazole (Prevacid), pantaprazole (Protonix
103
Q

GERD

A 
Lifestyle modifications
o Lose weight
o Avoid exacerbating foods
o Avoid large meals
o Eat 3 hours before lying down
o Elevate head of the bed
Meds
o Antacids- symptomatic
o H2RA- mild
o PPI- severe
Surgery- Nissen Fundoplication
104
Q

Isolated Eosinophillia esophagitis

A

Elimination and elemental diets
PPI
Topical Glucocorticoid- Fluticasone 440-880mcg BID
Esophageal dilatation to tx strictures

105
Q

Candida esophagitis

A

fluconazole

106
Q

pill induced Esophagitis

A

stop agent
take pill with 8oz water
stay upright for over 30 min after taking pill
eat in 30 min of pill
take antacids, sulcrafate, lidocaine, PPI

107
Q

Esophageal bleed due to varicies

A
  • 2 large bore IV access/Central access
  • pRBC txn (target 25-30)
  • Octreotide 50mcg/hr
  • Desmopression 1-2 mg q 4 hours
  • Endoscopy *- Varix ligation (banding)
  • Band ligation*
    Last resort
    TIPS (transjugular intrahepatic portosystemic shunt)
    Angiotherapy
    Balloon tube tamponade
108
Q

Boerhaave syndrome

A

IVF resuscitation
Broad Spectrum Antibiotics
Prompt Surgical Intervention (mainstay tx)- Left thoracotomy

109
Q

Mallory weiss tear

A 
Stable patient- healing in 24-48hrs without intervention
• IVF PRN
• Anti-emetics
• Sulcrafate for 1-2wks
• PPI for 1-2wks
• D/c home
Unstable Patient
• H/H q6
o pRBC for hemodynamic support PRN
o HCT <30 w/ CAD and symptoms
• Correct coagulopathy (warfarin)
o Vitamin K/FFP/PCC
• EGD
• Admit
110
Q

Zenker Diverticulum

A

myotomy

111
Q

Esophageal stricture

A 
Lifestyle Modifications
o Weight loss
o Avoid exacerbate food and medications
o Small meals &amp; eat slowly and deliberately
Rx
o PPI
o Intralesion steroid injection- If PPI and/or dilation fails; Only benign lesion
EGD w/ Esophageal dilation*
112
Q

Dysmotility Disorder

A 
Lifestyle
- eat slow, not at bed time
CCB/Nitrates
Botulism injection into LES
Pneumatic dilation
Heller Myotomy
113
Q

Esophageal carcinoma

A

Surgery- Esophagectomy
- for N2 and greater
Chemo and XRT for everyone else
-5-FU, Cisplatin, Paclitaxel, Anthracyclines

114
Q

Gastric cancer

A

Surgery- mainstay tx
- Total gastrectomy
- Esophagogastrectomy- Tumor @ GEJ and Cardia
- Subtotal gastrectomy- Tumors of distal stomach
Adjuvant chemoradiotherapy
o Post-operatively = std of care in US
o 5-FU and Leucovorin

Clin Med 2 (25 decks)

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