5.2.1. Preparation stage:
At the beginning of class, the instructor introduces students to the basic tasks of occupation plan. To control the output level of knowledge of students each proposed to solve typical issues in diagnosis - you can use situational clinical problem.
5.2.2. Main stage:
Polls and surveys patients spend most students alternately under the control of the teacher. To evaluate the accuracy of surveys consistently attracted other students.
When patients surveyed students' attention is drawn to the collecting history of the disease, the presence of chronic inflammation and precancerous diseases RP and RPG or nutrition, drinking alcoholic beverages. Mark pathogenic role of heredity.
There are primary and secondary (metastatic) liver cancer. Metastatic cancer occurs 50 times more often than the original. In the development of liver cancer aflatoxins play a significant role - the waste products of plesenevoho fungus that affects food (grain, flour). A direct correlation between the incidence of liver cancer and liver spread of opisthorchiasis.
Distinguish: anchor, solid as a single node and diffuse form of liver cancer. Histologically distinguish cancer that develops from cells pechinkovyz - hepatocellular (malignant hepatoma) and holanhiotselyulyarnyy - hepatic bile ducts.
Patients with liver cancer complain of pain in the right upper quadrant, loss of appetite, weight loss. OBJECTIVE: most common symptom is hepatomegaly, sometimes - tuberosity of the liver, increasing temperatuty, ascites, jaundice. This late symptoms.
Diagnosis: Ultrasound can detect focal changes in 85% of patients with liver cancer. Determination of alpha-fetoprotein (AFT) in serum of patients. In hepatocellular liver cancer AFP determined in 70% of patients.
Treatment. Hepatectomy with liver allotransplantatsiyeyu. Chemotherapy of 5-fluorouracil and ftorafurom - improvement in 20-25% of patients.
In recent years, a growing incidence of pancreatic cancer (prostate cancer). In Ukraine, it takes 7 among all malignant tumors (7-10 cases per 100,000 of us.). Fatty foods, alcohol, smoking, cancer genes in foods, nitrates, nitrites prone prostate cancer.
Most affected head cancer. body and tail are affected less. Histologically differentiated adenocarcinoma, including lining and nedeferentsiyovanyy cancer. RPZ quickly metastasizes to lymph nodes in the area of cancer, target the liver and liver. When obturation choledochal appears jaundice - in 90% of cases positive symptom Courvoisier. In cancer, the body and tail of the pancreas no jaundice. Patients complain of epigastric pain, anorexia, weight loss, pain radiating to the back. Sometimes a tumor palpable. Dyfdiahnoz conducted with stomach cancer.
Diagnosis: radiography of the stomach and duodenum. In cancer, head cancer is unfolded horseshoe duodenum, narrowing bowel tumor and cancer in the body of cancer - a shift back wall of the stomach doperedu.
When laparoscopy is advanced gallbladder, dissemination to the peritoneum and liver metastases. Liver ultrasound detects density cancer foci and density cancer. CT detects tumors and their sizes in the gland.
Treatment. In cancer of the head - pancreatic-duodenal resection. Often impose bilidyhestyvni anastomoses. Assign 5-fluorouracil, mitomycin C adriablastyn.