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PT, 65 y.o. AAM, David Towell - Coggle Diagram
PT, 65 y.o. AAM
Rectal Adenocarcinoma
Pathophysiology
A clonal mutation evolves giving a cell survival-immortality advantage allowing for the development of further mutations providing for characteristic hallmarks including proliferation, invasion, and metastasis.
Three major pathways to CRC; chromosomal instability, mismatch repair, and hypermethylation.
Medications
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VEGF Inhibitors: Bevacizumab, Aflibercept, Ramucirumab
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Treatment
Systemic therapy: palliation of symptoms, improve quality of life, prolong survival
Endocavitary radiation: allows larger doses of radiation to be delivered to a smaller area in a shorter period of time
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Pulmonary Embolism
Treatment
Pulmonary embolectomy
This procedure is done to remove a pulmonary embolism in severe cases in which the embolus is very large or the patient has not responded well to anticoagulation or thrombolytic therapy
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Vena cava filter
A small metal device is placed into the inferior vena cava to prevent formed blood clots from traveling to the lungs
Laboratory values
D-dimer: measures the levels of D-dimer in the blood, which is a protein that is made when a blood clot dissolves in the body. A negative result will rule out pulmonary embolism
Troponin: after a diagnosis of a pulmonary embolism, a troponin test may be ordered to evaluate if any cardiac injury has occurred
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Medications
Fibrinolytics
Fibrinolytics are used to dissolve and destroy blood clots that have already formed. They work by converting the inactive plasminogen proenzyme into the active enzyme plasmin that degrades fibrin, a protein essential in blood clot formation.
Common fibrinolytic drugs include tenecteplase, reteplase, alteplase, streptokinase, and urokinase
Anticoagulants
Anticoagulants are used to prevent clot formation by binding selectively and reversibly to clotting Factor Xa, inhibiting the ability to form blood clots. These medications can be given orally, through injection, or through an IV drip.
Examples of anticoagulant medications include apixaban, dabigatran, edoxaban, rivaroxaban, warfarin, and heparin
Pathophysiology
A pulmonary embolism occurs when a blood clot, typically originating in the venous system of the lower extremities travels through the bloodstream and becomes lodged in an artery of the lung, cutting off blood flow to the pulmonary tissues.
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Symptoms
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Dizziness, lightheadedness
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Anemia
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Treatment
Monitor with pulse oximetry, cardiac monitor, and a sphygmomanometer. Provide supplemental oxygen via nasal cannula or face mask. Establish 2 large-bore intravenous (IV) lines, and infuse crystalloid solution.
Obtain fresh frozen plasma (FFP), coagulation factors, and platelets, if indicated.
Pathophysiology
Anemia is characterized by a reduction in the number of circulating RBCs, amount of hemoglobin, or volume of packed RBCs. Classified as acute or chronic
Laboratory values
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Mean Corpuscular Volume: helps identify the classification of anemia as microcytic, normocytic, or microcytic
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Risk Factors
Diet low in iron, B12, folate, and copper
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Signs and Symptoms
Fatigue, weakness, arrhythmias, shortness of breath, dizziness, chest pain, headache
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