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Week 1 by Mind Map: Week 1

1. Third Session

1.1. Step (9): Review of Learning Objectives

1.1.1. Giude lines evaluate the patinet amd stage and there are many appreaches resectab

1.1.2. Resectable

1.1.3. Metastatic

1.1.4. Chemotherapy Adjuvant to remove what is left Neoadjuvant Prior to surgery in oreder to shrink the size of tumoer Types Side effects Different from one person to another Drugs 5-FU Lucoverin

1.1.5. Biological agent

1.1.6. Staging Stage 1 Only surgical resiction Stage 2 Surgery Stage 3 Surgery and chemo Stage 4 Palliative

1.1.7. Preop clean the bowel content Bicolax Decide about the tumore site

1.1.8. Surgery right hemicolictomy transever hemi left hemicolectmy total colectomy

1.1.9. Screening preevois cancer or polyp - family history - IBD - radiation Colonescopy sTOOL Heme occult Immune chemistery Imaging Enema Recomended for every patient above 50 relative with colon cancer 10 years erlier or at 40 years Rigid sigimodosopy - or flixble

1.1.10. Follow up colonoscpy within 6 monthes

1.1.11. Survallance follow up for 5 years history and exame CEA anoual CT sace for first 3 years pelvic anually for 5 - 6 years rectosemgid for 5 -6 years

1.1.12. urgent operation - same was done for mother - examinatio under anstesia and colonscopy - there is tumer wafound - polyps were found

1.1.13. 10 days follower - admited because of pain and disrtention - obstruction - labroscopy no evidenca of maligangny in th evacity or liver - given 5 FU - some side efects - disk end block- 4 weeks later given another cycle

1.1.14. follow up 1 year later >> better but dysparunia adino APC stage 3 substage c 1 - both polyp were tubulovillis

1.2. Step (10): Management

1.3. Step (11): Feedback & Resources

1.3.1. Medscap

1.3.2. Current

1.3.3. uptodate

1.3.4. lectures

2. Second Session

2.1. Step (6): Review of Learning Objectives

2.1.1. Normal habits of bowel movement Asborbtion of water soccurs in the colon and as this happens fecal material become more solid - strech in the sigmoid adn rectum producing a reflex -- fecal matarial will go up back again to the ascinding if you do not go to the toilt within couple of mintues - and then there will be more absorbtioion of water and let it more diffecutl 2 - 3 times a day Constipation Dia nORMAL CHARACTERSITCS Soft Brown in color

2.1.2. How to approach a patient with colorectal bleeding and a change in bowel habits UGIB melena LGIB hematochezia Rectoragea with out defecation amount of bleeding Age More than 50 years you start to suspect malignancy Chracter of bleeding Time Color Pain Associated symptoms Diff Hemorroid Fissures Rectal ulcers

2.1.3. Colorectal cancer Epidemiology 6 5 life time risk Clinical features Right side Left side Metastatic Risk factors Age Family IBD Diet Smoking Familial Pathogenesis Most casis start with polyps Most common type is adinocarcinoma Genes implicated If the cells were to generat faster such as in the case of IBD make it mre susptible to cancer Screening Colonoscopy occult blood How to diffrentiat between rectal and colon cancer Surgery Symptoms Sigmoidoscopy CT Staging TMN is the most accurate way

2.2. Step (7): Gathering Information & Inquiry Plan

2.2.1. History constipation Present history rectal bleeding 6 weeks ago Bright red with muscus No anal pain Abdominal pain and tenderness No change in appetite, fever Has to got to the toilet many times Herbal tea was prescribed OCT Personal pARENTS Secretory Smoking Past medical 2 years ago had cholesystoctomy C- section Family Maternal mother treated for abdominal malignancy Mother at age 65 diagnosed with colon cancer Sister with breast cancer

2.2.2. Physical Examination Thin and looks pale 130/80 90 beats regular 37 18 162 - 60 Rectal examination is fine only hard mass at the tip of the finger Dark blood seen on gloves Lungs normal Abdominal examination Scars cosis with past history Fulness and mild tendernss in the flanck CVE normal Neurological normal

2.2.3. Investigation biopsy shows ulcerative lesions, infiltration and poorly differentiating cells Colonoscopy report Midozolam and pethidin Large lesion ocupying 75 percent of the anterior rectal wall 1 anterior ulcerative lesion in the aterior rectal wall

2.3. Step (8): Diagnostic Decision

2.3.1. Mechanism

2.3.2. Presentation 38 years old females presented with rectal bleeding (fresh blood), pale on examination, tender abdomen, palpable mass over the tip of the finger

2.3.3. Supporting Data Bleeding, pale, tneder, ulcertative lesions in biopsy, mutible polyps

2.3.4. Objectives Management of colocrectal cancer, screening

3. First Session

3.1. Step (1): Identifying Difficult Words & Cues

3.1.1. Difficult Words "clock work" very regular

3.1.2. Cues female 38 years old rectal bleeding mucus in stool change in bowel habits constipation (straining) several visits to the toilet to be satisfied concerned about operation

3.2. Step (2): Problem Formulation

3.2.1. 38 years old female presented with rectal bleeding, constipation and a change in bowel habits.

3.3. Step (3): Hypotheses Generation

3.3.1. rectal bleeding is seroius Infectious

3.3.2. Fistula

3.3.3. Neoplasm Obstructing the myentric plexus leading to cinstipation Right side cancer presnts with chronic anemia Left side presents with constipation

3.3.4. Vascular insult By infection Increased pressure

3.3.5. Hemorrhoids

3.3.6. Bleeding UGIB distal to the ligament of Teritz LGIB Hematochezia

3.3.7. Inflammatory bowel disease

3.3.8. Irritable bowel syndrome

3.4. Step (4): Hypotheses Organization

3.4.1. Infectious

3.4.2. Neoplasm

3.4.3. Inflammatory

3.4.4. Neurological

3.5. Step (5): Learning Objectives

3.5.1. 1- To describe the normal habits of bowel movement

3.5.2. 2- How to approach a patient with rectal bleeding and change in bowel habits Differential, history, physical examination and invistigation

3.5.3. 3- To identify colorectal cancer (pathogenesis, risk factors, clinical features)