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Методички онкология / 5 курс / Студентам / 3 печень панкреас

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Kharkiv National Medical University

Department of Oncology

guidance for students of 5th year

medical faculties

 

 

Module 1

Content Module 1

Theme 3 liver cancer. Pancreatic Cancer

          Background.

Malignant tumors of the liver and pancreas - one of the difficult problems of oncology. Among all malignancies liver cancer is 1-2%. Men suffer more than women (3:1), aged 50-70 years. The most common tumor of head of Pancreas cancer is 60%, the body of cancer - 10% tail - 5% total defeat - about 25%.

An important problem is the extremely low efficiency of treatment. Weather is often poor. Onkonastoroha, correct assessment of clinical manifestations, use of modern methods of diagnosis and timely referral to specialized hospitals will significantly improve treatment outcomes.

 

Specific goals

Be able to:

1. On the basis of complaints, anamnesis, objective research, to identify the main syndromes of liver tumors, pancreatic cancer, put a preliminary diagnosis.

2. Appoint additional examination methods and evaluate their data

3. Conduct a differential diagnosis between the various diseases of liver, pancreas, put the final diagnosis.

4. Appoint treatment

5. To carry out rehabilitation and preventive measures

 

Contents of training

Theoretical questions to topics that students should learn:

1. Clinical symptoms of liver cancer, pancreatic cancer.

2. Diagnosis of liver, pancreas.

3. Classification of liver and pancreas.

4. Question metastasis

5. Epidemiology of tumors of the liver, pancreas, morbidity and mortality in cancer of the liver, pancreas, etiological factors and Precancer disease pathogenesis.

6. The principles and tactics of treatment of liver cancer, pancreatic cancer, and long-term results of R E treatment, diagnosis and treatment of recurrences and metastases of the liver and pancreas.

7. Predisposing factors and precancerous conditions, prevention.

8. Examination of disability, prognosis, rehabilitation patients

 

Information necessary for learning training content, and you can know the following references:

1.       Selected lectures on cancer under. Ed G. .. Cooper, S. Antipov - L in Ghana, JSC "Lugansk Oblast Printing", 2009 - 560 pages

2.       Handbook of Oncology. Under editors prof. S.A.Shalymova Sci. Yu.A.Hrynevycha Sci. D.V.Myasoedova. Kiev, "Health." - 2000.

3.       Heshelin SA - TNM classification of malignant tumors and complete cure in the bathroom at tech onkol patients. - Kyiv, "Health", 1996. - 184 pages

4.       Pinchuk VG s et al. CANCER. Dictionary-Handbook. - Kiev: "Science. D in ICA, "1992.

5.       Translators NI Chemotherapy opuholevыh diseases. - Moscow. - 2000. - P. 3-85, 116-119.

6.       GV Bondar, Dumanskyy Y., Popovic A., Bondar VG Stomach cancer, 30 years Search: successes and problems. - Archive wedge. and эksperym. honey. - 2000, (4): 520-3.

7.       Zarydze DG Эpydemyolohyya and prevention of cancer. - Journal of Ross. Acad. honey. Science. - 2001, (9): 43-6.

8.       Lecture on

 

After mastering on the theme proposed move to the solution of educational problems.

 

Problem number 1

The patient in '60 jaundice for 3 weeks, started without pain intensity and AI increases. Abdominal palpation soft. P O positive symptom Kurvuaz'ye. With ultrasound biliary marked enlargement of the gall bladder and choledochal. What ne p shoprychyna these changes.

A. Cancer Pancreatic head room at za

B. gallstone min at Rob

C. Chronic indurativny pa n kreatyt

D. Infectious gap and Titus

E. Liver Cancer

 

Problem number 2

Patient in '62 turned to a therapist about pain and mezoh tive trunk area that radiates to the lumbar region, general weakness, poor appetite, weight loss. OBJECTIVE: patient subnutrition, skin and sclera pale yellow, soft belly. In the right upper quadrant palpable enlarged, baa with painful gallbladder. Urine dark, feces bezbar tion in

A. gallstone min at Rob, m f hanichna Jo in tyanytsya

B. Hemolytic Oct ference I

C. P and renhi m atozna Oct ference I

D. C and liver development

E. Cancer head of pancreas, m e hanichna Jo in tyanytsya

 

Problem number 3

The patient arrived in '62 with complaints of persistent dull pain, HN S whose pain in the right upper quadrant. Periodically bouts of pain dramatically exacerbated. Last 2 Months appeared weakness, loss of appetite. In the history of the patient in '20 zhelchekamennuyu min at Rob, calculous cholecystitis. 0b'yektyvno: skin and sclera in the village would kterychni, liver near the edge of the arc, in the region of the gallbladder is muscle stiffness. A fessionalism blood: Hb - 93h / l Er - 4x Oct. 12 / L, L - 6.7 x 10 9 / l, ESR-25   mm / h, total bilirubin 180.6 mmol / l. Urinalysis: a reaction to bile pigments positive for urobilin - negative.

A. gallstone min at Rob

B. Cancer of the gall bladder at th

C. Viral g e patyt

D. Cancer Gall at output at current pr

E. Pancreatic hall at za

 

Problem number 4

Patient S., 48 years old, was hospitalized in the infectious disease department with complaints of yellowing of the skin and sclera of the eye. Examination: Ultrasound of gallbladder and bile duct stones not know and deno. Pancreas (head) is not increased. In biochemical examination of blood - a sharp increase faction straight at th bilirubin. Diagnosis - infectious hepatitis shot. Consultation oncologist - suspected tumor of the pancreas. What is OBST tion to VIC at Nata for further diagnosis?

A. duodeno at graphy

B. Rh-metry aneu n ka

C. Computed tomography of the puncture

D. Hastroduoden at Osprey I

E. Fluoroscopy (column I) of the stomach

 

Problem number 5

To the doctor turned patient, aged 49, complaining of the appearance of yellow I baser for 3 weeks, skin itching, general weakness, CCS d tion to 6 kg. Borders liver Kurlov 15 x 12 x 10 cm, slightly rounded edge of the liver, under the edge of the rib fate liver palpable tuhoelastychne, maloruhome oval formation fo r we to 7 x 4 cm. Stoel clay-gray. Total bilirubin 256 mmol / liter, direct - 96 mmol / l. Your decrees front diagnosis

A. A tumor or cyst of the right hepatic fate

B. Botkin's disease

C. Tumor gallbladder

D. Tumor pa n e kreatoduod tional zone

E. Dropsy gall bladder at th

 

Problem number 6

The patient in '48 diagnosed with pancreatic cancer T3N0M0, almost total defeat. Select the type of surgery.

A. Pankreatod in odenalna resection

B. The distal resection pi d gastric cancer

C. cholecystitis with volume

D. Bypass holets and stoeyun at a nastomoz

E. Pancreatectomy

 

Problem number 7

Patient 62 years for 2 months experienced general weakness, dull epigastric pain, lost appetite, lost 12 lbs. Two weeks ago, back home he noticed yellowing of the skin, which at hresuye Ave. Cal gray, dark urine. An examination of the right upper quadrant palpable enlarged bile busy n th bubble. What research effectively help determine the cause of jaundice?

A. Ultrasound pankr e atoduoden and flax zone

B. angiograms and raphy

C. Oral and holanhiohr raphy

D. Hastrofibr at oxidized

E. Fluoroscopy gastrointestinal

 

Problem number 8

Patients 47 years and three months noticed progressive pozho in shadow skin, dark sech in achromatic and feces. When OBST is Jenny found a large tumor papilla placed rum and 2 cm. Distant metastases were found. What is the treatment for the patient would be best where?

A. Papilosfin k retot at miya

B. pancreatoduodenal resection

C. Konservaty in on therapy spazmolit and Kami and bile Ginn e pr e Paraty

D. Holedohot at miya from outside w it drains in the bathroom lounge is Doha

E. Biliodihestyvnyy anastomosis

Standards of answers: 1 - A, 2 - E, 3 - B, 4 - C, 5 - D, 6 - E, 7 - A, 8 - B.

 

Brief guidelines for the work of students in the practice

Originally performed input control knowledge through tests and oral answers, solving situational problems. Students begin to himself constantly at work with patients under the supervision of the teacher. Collects ana m nezu, physical examination of patients with cancer of the pancreas, liver, study data added t Covo examination of patients. A leading detection syndromes, d and ferentsiyuvannya disease and other previous study dia g nozu. Outline a treatment plan. During the test, each student at Lane dit physical examination of the patient (inspection, palpation of lymph nodes, abdomen, percussion, auscultation). During classes, students interpret Chapter boratorni data ultrasonographycal endoscopic, radiological, and c tolohichnyh and histopathological studies. In intensive care and resuscitation students learn principles of intensive therapy and supervision wa Kimi min at the same rhyme. Work in a dressing room, operating room. Next conducted final test. Summarizes lessons, oholoshuyut b Xia results counter at human knowledge and skills.

 

Process Map practical lessons

Number

Stages classes

Training time

Textbooks

Prospect Place at driving lessons

Mr. Means and learning

Equipment

1

Determination of n con t o Primary role of knowledge

30 min

Tests, surveys

Slides and would face, renth e nohramy

Classrooms

2

Addressing Mr. and vchalnyh with a t e inthis we

4:00

Case patients at historical Rhee minutes at the paper, the development and l lit diagnostician and ki and medication in the bathroom

Stories about patients like leaves appointments, CT-grams, MRI program, radiographs

Chamber scarf in vibrational, and operations on, classrooms, and endoscope ical room and no

3

Definition in s tern level sform at vanosti knowledge and skills. Summing pi d bag.

30 min

Tests, surveys

Slides and would face, renth e nohramy, ci f we

Classrooms

 

Due to the fact that the department conducted watershed and final evaluation, as an example, give a few tests

 

 

Final test control

Test number 1

The patient in '60 jaundice for 3 weeks, started without pain intensity and AI increases. Abdominal palpation soft. P O positive symptom Kurvuaz'ye. With ultrasound biliary marked enlargement of the gall bladder and choledochal. What has research shown to the patient?

A. retroperitoneal ultrasound lymfovuzliv

B. Renthenorafiya lung

C. CT abdomen

D. MRI of the brain

E. Biochemical analysis of blood

 

Test number 2

Patient in '62 turned to a therapist about pain and mezoh tive trunk area that radiates to the lumbar region, general weakness, poor appetite, weight loss. OBJECTIVE: patient subnutrition, skin and sclera pale yellow, soft belly. In the right upper quadrant palpable enlarged, baa with painful gallbladder. Urine dark, feces bezbar in ny. What is the primary research tool?

A. abdominal ultrasound

B. Renthenorafiya lung

C. CT abdomen

D. MRI of the brain

E. Biochemical analysis of blood

 

Test number 3

Patient '66 addressed precinct to the doctor complaining of persistent dull pain, HN S whose pain in the right upper quadrant. Periodically bouts of pain dramatically exacerbated. Last 2 Months appeared weakness, loss of appetite. In the history of the patient in '20 zhelchekamennuyu min at Rob, calculous cholecystitis. 0b'yektyvno: skin and sclera s in bi kterychni, liver near the edge of the arc, in the region of the gallbladder is muscle stiffness. Which doctor do next?

A. Clinical analysis of blood and urine  

B. Clinical urinalysis and radiography lung

C. CT abdomen

D. Clinical analysis of blood and urine tests, blood chemistry, abdominal ultrasound

E. Biochemical analysis of blood and CT scan of the chest cavity

 

Test number 4

Patient C, 4 to 6 years Ula and hospitalized in the infectious disease department with complaints of yellowing of the skin and sclera of the eye. Examination: Ultrasound of gallbladder and bile duct stones not know and deno. Pancreas (head) is not increased. In biochemical examination of blood - a sharp increase faction straight at th bilirubin. Diagnosis?

A. cholelithiasis

B. Stomach Cancer

C. Cancer head of pancreas  

D. Cancer of large duodenal papilla

E. indurativny pancreatitis

 

Test number 5

To the doctor turned patient, 50 years old, complaining of the appearance of yellow I baser for 3 weeks, skin itch, general weakness, CCS d tion to 6 kg. Eid P edge rib fate liver palpable tuhoelastychne, maloruhome oval formation fo r we to 7 x 4 cm. Stoel clay-gray. Total bilirubin 256 mmol / liter, direct - 96 mmol / l. Your decrees front diagnosis

A. A tumor or cyst of the right hepatic fate

B. Botkin's disease

C. Tumor gallbladder

D. dropsy of the gall bladder at th

E. Tumor pa n e kreatoduod tional zone

 

Test number 6

The patient in '48 diahnostov ano pancreatic cancer T3N1 M 1 (hep), almost total defeat. Select the type of surgery.

A. Pankreatod in odenalna resection

B. Bypass holets and stoeyuno and nastomoz

C. cholecystitis with volume

D. Distal resection pi d gastric cancer

E. Pancreatectomy

 

Test number 7

Patient 62 years for 2 months experienced general weakness, dull epigastric pain, lost appetite, lost 12 lbs. Two weeks ago, back home he noticed yellowing of the skin, which at hresuye Ave. Cal gray, dark urine. An examination of the right upper quadrant palpable enlarged and tense zhovchevyy bubble. What is the diagnosis?

A. cholelithiasis

B. Stomach Cancer

C. Cancer of head of pancreas  

D. Cancer of large duodenal papilla

E. indurativny pancreatitis

 

Test number 8

Patient April 9 years, and three months noticed progressive pozho in shadow skin, dark urine and feces achromatic. When OBST is Jenny found a large tumor papilla placed rum and 2 cm. Deleted metas basins have been identified. What research is most informative?

A. Histological

B. Cytological  

C. X-ray  

D. Endoscopic

E. Identification of tumor markers  

Standards of answers: 1 - C, 2 - A, 3 - D, 4 - D, 5 - E, 6 - B, 7 - C, 8 - A.

 

Methodological developments amounted MD Associate Professor GV Trunov

 

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