ANESTHESIA CHECK 2a

3. INTERCURRENT DISEASE AND RISK

3.1 ISCHAEMIC HEART DISEASE:

Patients with ischaemic heart disease within three months of an

episode of Myocardial Infarction (MI) have a risk of 30%

possibility of a second MI.Those between 4 and 6 months, the rate

drops to 16%,those with an episode of more than 7 months the risk

drops to 6%.

Main complications are because of heart failure and arrhythmias.

3.2 HYPERTENSION

In cases of diastolic pressure of less than 110 mm Hg, there is

no increased risk in the absence of ischaemia of the myocardium

those with a diastolic pressure of more than 120 mm Hg, the risk

increases.

3.3 ENDOCRINE

Patients with a history of diabetes have an increased risk.

Those on steroid therapy and with hypothyroidism also carry a

high risk.

Hyperthyroid patients have a 2% chance of storm in the

postoperative period.

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ANESTHESIA INTRODUCTION

ANAESTHESIA

1. INTRODUCTION

Surgical treatment of disease requires gaining access to deeper

tissues through the skin.

* The skin being a sensitive organ, is well provided with

sensory nerves.

* Thus,it becomes important to interrupt the sensory

pathways of skin and deeper tissues (anaesthesia)if

surgical treatment is to be given.

* There are essentially two primary modes of rendering a

patient insensitive to pain while undergoing surgical

procedure:

- General anaesthesia (central nervous system depression)

- Regional anaesthesia (local anaesthetic agents).

2. PRE-ANAESTHETIC EVALUATION

1. A thorough clinical examination of the patient is essential

to establish the health status of the patient.

2. To detect the effects of the disease process for which he is

undergoing the surgical procedure.

3. To detect any inter-current disease that he/she might be

suffering from.

 

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ONCOLOY 11

10.2 PALLIATIVE SURGERY

In cases where the carcinoma has spread and radical surgery

cannot be done. Palliative surgery is undertaken to bypass an

obstruction without removing the tumour (colostomy) and in some

cases to relieve the pain fig.

The use of chemotherapy and radiotherapy in combination with

surgery in various TNM stagings and gradings is in practice to

improve treatment outcomes.

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ONCOLOGY 10 SURGERY

10. SURGICAL OPTIONS IN CARCINOMA

10.1 Curative Surgery

This is planned for those cases where the primary tumour is

confined to the organ and the involved lymph nodes and

intervening lymphatics can be removed in one continuity (en-

block).

This is also referred to as radical surgery. The GI Tract is

then reconstructed see fig above

Curative surgery for secondries or recurrance is also possible

with follow up with markers and practice of second look in

colonic surgery.

 

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ONCOLOGY 9 tumor markers

SPECIFIC MARKERS                                      

9.1 Carcino embryonic antigen (CEA)

This  marker correlates well with the  presence of  carcinoma  in

the gastrintestinal tract especially mentioned in relation to  Ca

of  colon.   Na marker is available for oesophagus,  Stomach  and

pancreatic carcinoma.

Ovarian  CA  125  is  most  reliable  for  diagnosis  of  ovarian

carcinomas  Prostate carcinoma, Prostatic specific antigen  (PSA)

is useful marker for detecting prostate carcinoma

9.2 Hepatocellular Carcinoma

Serum  alpha feto protein (AFP) in 50-80% of patients with  liver

carcinoma, this marker is positive

Carcinoids 5 hydroxindole-acetic  acid (5HIRA)  is  useful  for

diagnosis and management of this tumour.

Fall in level of marker is indication of good response to treatment.

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ONCOLOGY 8

Diagnosis

Endoscopy provides a rapid method of examination and obtaining

material for biopsy. It is suitable for GI tract, urinary tract

and respiratory tract.

Imaging through radiology and newer techniques like ultrasound,

CT scanning and NMR are also efficient diagnostic means.

Pathologic review of tissue for microscopic examination is a

dependable method of diagnosis.

The means of obtaining material are:

* Fine Needle Aspiration Cytology (FNAC) is now widely

available for superficial and deeply situated swellings

(approached with the help of imaging techniques)

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ONCOLOGY 7

7. Presentations

* It can present as a swelling usually painless.  

  Occasionally in inflammatory carcinoma breast, there is pain

* Obstruction of lumen of organ of origin

  - dysphagia in Ca oesophagus

  - vomiting in Ca Stomach

  - Pain (colic) Intestine

  - Retention urine Ca prostate

* Hemorrhage

  - Hematuria GU Ca

  - Hematemasis Stomach Ca

  - Rectal bleeding in rectal carcinoma

* Compression adjoining structures

  - Pressure on vena cava

  - Nerve root pain

* Metastasis

  - Pleural effusion

  - ascetic

  - Pathologic fracture

* Asymptomatic

  - Usually discovered on investigation of vague ill health

    cases

 

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