→ BizKITs:都是英文.....我錯了.. 02/05 22:44
1. 65歲男性主訴暗紅色血便達三週之久，而且偶而有腹部絞痛或覺得解不乾淨的感覺：A. 除了必要的理學檢查，應排那些檢查以利 確定診斷？B. 若此時，病人已有合併腸阻塞的情形，則手術的選擇方式有那些？
D/D
Lower GI bleeding
Diverticular disease
IBD
Colonrectal carcinoma and polyos
Ischemic bowel disease
hemorrhoids
Tenesmus
Inflammatory bowel disease (IBD)
Anorectal abcess
Infectious colitis (infection of the colon)
Colorectal cancer or tumors
GI bleeding
Upper GI bleeding- NG tube , EGD
Lower GI bleeding- angiography , technetium 99m-labeled RBC scanning , colonscopy
Lab Studies:
complete blood count; serum chemistries- may fine anemia ;
liver and kidney function tests – preoperative workup
carcinoembryonic antigen (CEA) test
Rigid proctosigmoidoscopy
Direct visualization of the lesion, and provides an estimation of the size of the lesion and degree of obstruction.
Obtain biopsies of the lesion, assess ulceration, and determine the degree of fixation .
An accurate measurement of the distance of the lesion from the dentate line
Endorectal ultrasound
Assessing depth of invasion of rectal cancers
The accuracy of detection of lymph node involvement ranges from 73-86%
Overestimation of staging and nodal involvement occurs more often than understaging
Endorectal surface-coil MRI
An alternative to ERUS, this technique is touted as equally or more accurate than ERUS in lymph node staging.
Metastatic workup
Chest radiograph
CT scan
MRI - liver metastases
PET
CEA scan
Surgery
Transanal excision
Transanal endoscopic microsurgery
Sphincter-sparing procedures
Low anterior resection
Abdominal perineal resection
Surgery
Anterior resection
"no touch" isolation technique - resection is performed segmentally (eg, right or left hemicolectomy) with end-to-end anastomosis
Partial hepatectomy for colorectal cancer metastases
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