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2016年9月15日 星期四

[醫如往常] Senior Clerkship Day 12: Ob/Gyn 翁醫師PGY觀念

    20160913
    Morning Meeting
    Ovarian cancer seeding
    Ileostomy for stage T4 TX
    Stent 只能放在直線. 15cm
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    王醫師
    Endometrial cancer
    Serous p53
    Mucinous Kras
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    Lymph node metastasis
    5% well differentiated
    20% poor differentiated
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    醫師PGY觀念
    ECG Poor progression: Ant. AMI
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    Pelvic surgery
    Post op
    Walking within 2 weeks

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    Chemo-man

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    Cataract
    1. DM
    2. Galactosemia
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    大球性貧血megaloblastic anemia
    intrinsic factor: parietal cells in the fundus and body of the stomach
    Haptocorrin (also known as HC, R protein, and transcobalamin I, TCN1), is a glycoprotein secreted by the salivary glands which binds to vitamin B12 Vitamin B12 is acid sensitive and in binding to transcobalamin I it can safely pass through the acidic stomach to the duodenum.In the less acidic environment of the small intestine, pancreatic enzymes digest the glycoprotein carrier and vitamin B12 can then bind to intrinsic factor. This new complex is then absorbed by the epithelial cells (enterocytes) of the ileum. Inside the cells, B12 dissociates once again and binds to another protein, transcobalamin II (TCN2); the new complex can then exit the epithelial cells to be carried to the liver.
    Neurological symptoms: Sensory or motor deficiencies (absent reflexes, diminished vibration or soft touch sensation), subacute combined degeneration of spinal cord, seizures,[11][12][13][14] or even symptoms of dementia[15] and or other psychiatric symptoms may be present.
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    Absorption part
    Duodenum: Vit. B9, Fe
    Ilium: Vit. B12
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    Amiodarone
    Side Effect
    1. Thyrotoxicity
    2. Liver toxicity
    3. Lung toxicity
    4. Skin pigmentation
    5. Corneal deposition
    Lab follow up
    1. TSH, free T4
    2. AST/ALT
    3. CXR
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    Postoperative fever
    the five Ws.
    Wind         POD1-2         the lungs, i.e. pneumonia, aspiration, and pulmonary embolism. Once attributed to atelectasis, but a recent review suggests that is not supported by existing clinical evidence.
    Water         POD3-5(7)         UTI; urinary tract infection, related to indwelling catheter (during surgery or currently i.e. Foley catheter )
    Walking (or VEINS, which then sounds like "Weins")         POD4-6(14)        deep vein thrombosis or pulmonary embolism
    Wound         POD5-7(14)         surgical site infection, which in obstetrics or gynaecology, may refer to the uterus(or womb, sounding like wound).
    Wonder drugs or “What did we do?”         POD7+         drug fever, infections related to intravenous lines or reaction to blood products
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    Post-OP
    1. Vital sign: TPR
    2. Pain control
    3. U/O monitor
    4. Drug amount
    5. Wound: dry, clean, color, what, serosanguinous
    6. Ambulation
    7. Diet
    8. Passing gas, fluid support
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