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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 and ROCK PKK polyposis or nutrition, drinking alcoholic beverages. Mark pathogenic role of heredity.

Marked relationship colon cancer with the nature of power. Foods with a high content of protein and fat is favorable for the emergence of this disease. Has the value and duration of contact with carcinogens intestinal epithelium, depending on the intestinal passage. Smoking also increases the risk of disease.

Different parts of the colon tumor affects the process differently. Often happens cancer cecum - 20-25%, sigmoid colon cancer 10-12%, ascending colon 10-12%, descending colon 8-10%, 4-12% lumbar colon, hepatic and splenic angles of 5-7%.

Macroscopically differentiated exophytic, endophytic and mixed (mezofitnu) form of tumor growth. Symptoms of colon cancer varied. It is due to anatomical shape of the tumor and associated with certain anatomofiziolohichnymy differences between certain parts of the colon. Some symptoms are often present in tumors of the right half (pain, anemia, diarrheal symptoms palpabelnist tumor symptoms of inflammation), others occur more frequently in lesions of the left half of the large intestine (obstruction, enterocolitis, abnormal discharge). Expedient but highlight clinical forms in the form of the disease occurs: 1. Constrictive form. 2. Enterokolitychna form. 3. Anemic form. 4. Diarrheal form. 5. Psevdozapalna form. 6. Tumoral form. 7. Pain shape.

For diagnostics used: an objective examination of the patient, laboratory tests (complete blood count, fecal occult blood), X-ray, fibrokolonoskopiya, laporoskopiyu.

Discussion of additional examination methods, rationale and preliminary clinical diagnoses made ​​in navchaniy room in the absence of the patient.

In justification of the diagnosis draws attention to the stage of the disease, clinical group, location and spread of tumor.

A differential diagnosis of benign tumors and precancerous diseases of the colon. Formulated a final diagnosis.

Radical treatment is the only operation. In cancer, blind, ascending colon and hepatic angle performed right hemicolectomy. When the tumor in the left half of the colon is left-sided hemicolectomy. Carcinoma of transverse colon and sigmoid colon resection shows, retreating 5 - 6 cm from the edge of the visible tumor. Radiation therapy is not effective. Chemotherapy as palliative method used in inoperable tumors, and after conventionally radical and palliative operations. Often prescribed: 5-fluorouracil, mitomycin, adriablastyn.

Patients after surgery for cancer of the colon tovtsoyi should be under constant supervision of the conduct of their endoscopy, ultrasound and laboratory tests (determination of REE).

In patients with colon cancer after radical surgery quickly recovers full performance. During the examination of performance should take into account the stage of the process, the tumor, the nature of the treatment as well as profession, age and sex of the patient.

P'yaterichne survival of patients with colon cancer after radical surgery reaches 50-60%, while the first and second stages of 80%.

Marked association of rectal cancer with the nature of power. Foods with a high content of protein and fat is favorable for the emergence of this disease.

The upper limit of the rectum corresponds to a height of 15 cm from the edge of the anal opening. In the rectum are three divisions: nyzhnoampulyarnyy (5 cm) serednoampulyarnyy (5 - 10 cm), verhnoampulyarnyy.

The most frequent symptom PKK - the presence of abnormal discharge. Admixture of blood in the stool that appears before or during defecation defecation, observed in 75-90% of patients. Bleeding associated with destruktyrnymy processes. Other abnormal discharge (mucus, pus) also appear in the decay of the tumor and the presence of inflammation, which is typical for the later stages.

Another group of symptoms - constipation, change in the form of feces, trains stool (tenesmus) - associated with bowel dysfunction.

Pain in rectal tumors depend on a number of reasons. Recurrent abdominal pain pereymysti indicate intestinal obstruction. Constant pain can be the result of local distribution process. Intestinal obstruction occurs in 30% of patients

Finger research rectum is mandatory and indispensable method for diagnosing PKK. Great importance sigmoidoscopy and irihoskopiya.

Discussion of additional examination methods, rationale and preliminary clinical diagnoses made ​​in navchaniy room in the absence of the patient.

In justification of the diagnosis draws attention to the stage of the disease, clinical group, location and spread of tumor.

A differential diagnosis of benign tumors and precancerous diseases of the colon. Formulated a final diagnosis.

To treat the PKK used for surgery, radiotherapy and cytotoxic methods. The method of operation depends on the tumor in the rectum.

1)               intraperitoneal (anterior) resection of the rectum is performed by placing the tumor distance of 12 cm from the anal opening;

2)               Abdominal-perineal extirpation of the rectum (Operation Kenyu-Miles) - when the tumor below 6 - 7 cm from the back passage opening.

3)               Abdominal-anal resection of the rectum - tumors located at a distance of 7 - 12 cm from the anal opening.

4)               Operation Hartmann - in the presence of contraindications for applying intraperitoneal anastomosis.

Radiation treatment is a palliative method in the local spread of the tumor or in the presence of contraindications to surgery.

Chemotherapy is ineffective. Sometimes used in inoperable patients in advanced stages of 5-fluorouracil, or ftorafur. More effective polychemotherapy (5-fluorouracil, mitomycin C, adriablastyn).

Five-year survival of patients with CRC is 50-60%, and in the early stages of 70-80%.

About 50% of patients with rectal cancer throughout life after surgery with artificial vidhidnyk. This impede somatic and psychological rehabilitation. Therefore, expanding indications for organ preservation is one of the ways rehabilitation of such patients. After extirpation of the rectum with the formation of artificial vidhidnyka patients with debilshoho recognized disabled (II disability group) and only occasionally returning to previous work not related to physical activity.

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