DSE
Bile duct blood supply, cystic arteries
Carcinoid
- origin of tissue
- early symptom not present b/c serotonin is filtered by liver
- lesions in rectum or ovary not filtered by liver since the blood doesn't travel through liver
multibasin drainage? multi nodal basin drainage?
hospice
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FOLFOX is a chemotherapy regimen for treatment of colorectal cancer, made up of the drugs
- FOL– fluorouracil (5-FU)
As a pyrimidine analogue, it is transformed inside the cell into different cytotoxic metabolites which are then incorporated into DNA and RNA, finally inducing cell cycle arrest and apoptosis by inhibiting the cell's ability to synthesize DNA. It is an S-phase specific drug and only active during certain cell cycles.
Capecitabine is a prodrug that is converted into 5-FU in the tissues. It can be administered orally.
- F – folinic acid (leucovorin)
Folinic acid is a 5-formyl derivative of tetrahydrofolic acid. It is readily converted to other reduced folic acid derivatives (e.g. tetrahydrofolate). Since it does not require the action of dihydrofolate reductase for its conversion, it will be unaffected by inhibition of this enzyme by drugs such as methotrexate.
This, therefore, allows for purine/pyrimidine synthesis to occur; so normal DNA replication and RNA transcription processes can proceed.
- OX – oxaliplatin (Eloxatin)[1]
- The exact mechanism of action of oxaliplatin is not known. In vivo studies showed oxaliplatin has anti-tumor activity against colon carcinoma through its (non-targeted) cytotoxic effects. Median patient survival is approximately 5 months greater compared to the previous standard treatment.
DSE - dobutamine stress echocardiography
for pts unable to exercise on treadmill, dobutamine administered to mimick the exercise state of heart and then measured for coronary flow
Dobutamine is a beta-1 adrenergic agonist. It is a direct-acting agent whose primary activity results from stimulation of the beta-adrenoceptors of the heart, increasing contractibility and cardiac output. Since it does not act on dopamine receptors to induce the release of norepinephrine (an alpha-1 agonist), dobutamine is less prone to induce hypertension than dopamine. Chronotropic, arrhythmogenic, and vasodilative effects are negligible. Dobutamine is indicated when parenteral therapy is necessary for inotropic support in the short-term treatment of patients with cardiac decompensation due to depressed contractility, which could be the result of either organic heart disease or cardiac surgical procedures.
--------------------------------------------------------Cystic arteries
In the classic arrangement, occurring with a frequency of approximately 70%, a singular cystic artery originates from the geniculate flexure of the right hepatic artery in the upper portion of the hepatobiliary triangle [1]. A site of origin from a more proximal or distal portion of the right hepatic artery is also considered relatively normal.
After separating from the right hepatic artery, the cystic artery travels superiorly to the cystic duct and produces 2 to 4 minor branches, known as Calot’s arteries, that supply part of the cystic duct and cervix of the gallbladder before dividing into the major superficial and deep branches at the superior aspect of the gallbladder neck:
- The superficial branch (or anterior branch) passes sub-serously over the left aspect of the gallbladder.
- The deep branch (or posterior branch) runs between the gallbladder and gallbladder fossa, terminating at the peritoneum attached to the liver surface.
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Carcinoid tumours are apudomas that arise from the enterochromaffin cells throughout the gut.
They are most commonly found in the appendix, where they rarely metastasise. The next most common affected area is the small intestine especially the ileum. In cases of metastases it can lead to carcinoid syndrome. This is due to the production of 5-hydroxytryptamine (5-HT, serotonin), which is released into the systemic circulation, which leads to symptoms of
- cutaneous flushing
- diarrhea
- bronchoconstriction
- right-sided cardiac valve disease. "TIPS" - Tricuspid Insufficiency, Pulmonic Stenosis
APUD refers to a type of cell in the mucosa. It is an acronym, referring to the following:
- Amine
- Precursor
- Uptake and
- Decarboxylation
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multi basin drainage
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Hospice
Palliative care (from Latin palliare, to cloak) is any form of medical care or treatment that concentrates on reducing the severity of disease symptoms or slowing the disease's progress, rather than providing a cure. The goal is to prevent and relieve suffering and to improve quality of life for people facing serious, complex illness.
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