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5.3. Quiz:

Primary and metastatic liver cancer. Case rate and mortality.

Company growth and histological structure. Etiopathogenesis and holanhiotselyulyarnoho hepatocellular cancer. Prevention.

Symptoms of liver cancer. Periods of development and clinical forms.

Diagnostic methods: reaction Abelyeva-Tatarinov, radioisotope scanning. Sonography, CT, puncture liver laparoscopy.

Principles of treatment.

Case rate and mortality from prostate cancer. Prevention.

Pathomorphology: localization, macroscopic forms, histological structure, metastasis.

Symptoms of prostate cancer. The clinical picture depending on the tumor.

Diagnosis. The value of history, objective and laboratory studies.

Differential diagnosis of jaundice on the basis of tumor of pancreatic head.

Modern methods of examination: relaxation duodenohrafiya, endoscopic retrograde Cholangiopancreatography, CT.

Principles of surgical treatment. Results.

5.4. Final stage:

Control and correction of professional skills and knowledge held by solving situational and clinical tasks, tests for self-control. Assesses knowledge and skills students study each assessment.

The teacher has homework, recommended literature on the subject next class basic and additional.

VI. Materials for methods of classes

6.1.Materialy control baseline (rising levels) of students: test tasks (correct answers are marked *)

test tasks

Patient '63 sick for two weeks when I noticed ikterychnist sclera been reported slight pain arching nature in the right upper quadrant. After two days of onset, was cal gray ochrodermia skin which gradually increased. When Dr. Jenny revenues to the department overall is satisfactory. When ultrasonography revealed Expand Mr. tion of intrahepatic and extrahepatic bile ducts and the main avenue at current pancreas. Which diagnosis is most likely?

A. Eral tumor and hepatic ducts

B. Holed at holitiaz with a schemlennya calculus in supraduod e onal cha s tyni choledochal

C. Cholestatic viral norm d e patytu

D. C and liver development

E. Tumor great do at denalnoho Soso h ka *

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. Pancreatic Cancer head room at zi *

B. Gallstone min at Rob

C. Chronic indurativny pa n kreatyt

D. Infectious gap and Titus

E. Liver Cancer

Patient in '62 turned to a therapist about pain and mezoh tive trunk area that radiates to the lumbar region, general weakness, poor Titus is up, 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.

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

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

C. Hemolytic Oct ference I

D. P and renhi-Oct atozna I ference

E. C and liver development

              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 s in bekterychni, liver near the edge of the arc, in the region of the gallbladder is muscle stiffness. Blood: Hb - 93h / l Er - 4 (1012 / L, L - 6.7 - (109 / l, ESR-25   mm / h, total bilirubin 180.6 mmol / l. Urinalysis: a reaction to bile pigments positive for urobilin - negative.

A. Viral g e patyt

B. Pancreatic hall at za

C. Gallstone min at Rob

D. Cancer Gall at output at current pr

E. Cancer of the gall bladder at first. *

              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. Computer tons of mohrafiya with puncture *

B. Duodeno at graphy.

C. R e-graphy aneu n ka

D. Hastroduoden at oxidized.

E. Fluoroscopy (graphy) of the stomach and duodenohrafiyu

              To the doctor turned patient, aged 49, complaining of the appearance of yellow I baser for 3 weeks, skin itch, 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. With a broken down bilirubin 256 mmol / liter, direct - 96 mmol / l. Your decrees front diagnosis

A. Tumor or cyst of the right hepatic fate

B. Botkin's disease

C. Tumor pa n e kreatoduod tional zone *

D. Tumor gall bladder at th

E. Dropsy of the gall bladder at th


              6.2. Materials for the methods of the main stage classes H Abir radiographs, tables, owner of anticancer chemotherapy, hospital records and medical history of patients, findings of morphological studies of biopsies (if possible micropreparations) medicines.

6.3. Materials for the final stage of the study: clinical case studies (Correct answers are marked *)


Problem number 1. Patient A., '55, turned in CCCs with complaints of pain in the right upper quadrant and epigastrium, loss of appetite, weight loss, fever, increased abdominal volume. In history: moved hepatitis B, liver cirrhosis suffer. Objectively: skin and visible mucous icteric, palpable enlarged, dense liver, which comes from the subcostal to 12 cm in it palpable dense nodes. Determine the presence of ascitic fluid in the abdominal cavity. When puncture abdominal ascitic fluid sero-hemorrhagic nature - 6 p. Liver ultrasound: a diffuse increase in detected multiple nodes. Study on AFP revealed the presence of serum.

1. Put diagnosis.

A. Exacerbation of chronic hepatitis. Ascites

B.   Cirrhotic ascites

C. Tumor of the gallbladder

D.   Hepatocellular carcinoma liver T 4 N2M1. Ascites. *

E. Hepatocellular liver cancer T 3 N 1 M 0. Ascites.

2. Assign treatment.

A. In ydalennya ascitic fluid. Chemotherapy *

B.   Vnutryocherevyna polychemotherapy

C. Radiotherapy

D.   Removing ascitic rydyny.

E. Removing ascitic rydyny. Radiotherapy.


Problem number 2. Patient S., 60 years old, turned to the clinic with complaints of epigastric pain, anorexia, weight loss, itching and jaundice. He considers himself a patient for 3 months, not treated. OBJECTIVE: ikterychnist skin and sclera, abdominal palpation revealed resistance in the epigastrium, enlarged gall bladder. When radiography of the stomach and duodenum: Advanced Horseshoe duodenum, the narrowing of the intestine. CT: found a tumor in the head of the pancreas to 9 cm in diameter. Diagnosis: cancer of head of pancreas. jaundice. Assign treatment.

A. imposition holetsystoyeyuno ­ anastomosis

B.   polychemotherapy

C. imposition holetsystoyeyuno ­ anastomosis + polychemotherapy *

D.   pancreatoduodenal resection

E. symptomatic therapy


Problem number 3. Patient 47 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 and rum 2 cm distant metastases were found. What is the treatment for the patient would be best where?

A. Konservaty in the ter and Pius spazmolit and Kami and bile Ginn e pr e Paraty

B. Papilosfin k retot at miya

C. Pankreatoduodenal b for resection *

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

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


Problem number 4. 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 Avenue at matsuyetsya increased stressful zhovchevyy bubble. What research effectively help you Install and cause 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 5. The patient in '48 diagnosed with pancreatic cancer T3N0M0, almost total defeat. Select the type of surgery.

A. Bypass holets and stoeyu Mr. oanast at MOH

B. Cholecystitis with volume

C. Distal resection pi d stomach cancer at ing

D. Pancreatectomy *

E. Pankreatod in odenal b for resection

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