26 June 2009

Journal of The Association of Physicians of India

Journal of The Association of Physicians of India.

Free full text available from Volume 48, 2000 onwards to current. Apart from regular issues some special issues are also available.



24 June 2009

Treating Ulcerative Colitis

Treating Ulcerative Colitis
By:Robert Theobald III, D.O.
Vein Associates, P.A.

* Ulcerative colitis is a chronic inflammatory disease of unknown etiology
* Primarily affects the colon and rectum
* Lesions are characterized by superficial infiltration of the bowel wall by inflammatory white cells
* Results in mucosal ulcerations and crypt abscesses
Clinical Presentation
Clinical Presentation Symptoms
Colitis Activity Assessment
* The diagnosis of UC is based on the clinical picture, stool examination, colonoscopic appearance, and histologic assessment of biopsied specimens
* The differential diagnosis includes infectious, chemical, IBS, ischemia, and miscellaneous
Disease Distribution at Presentation
Current Pharmacotherapy
Fallingborg Study
New Therapy for Treatment of UC
Natural Remedies

Treating Ulcerative Colitis.ppt


Stoma Care Basics

Stoma Care Basics

Two basic types of diversions
* Urinary
* Fecal

Urinary Diversions
Reasons for diversions
* Removal of bladder from cancer
* Neurogenic bladder, congenital anomalies, strictures, trauma to the bladder, and chronic infections with deterioration of renal function

Types of diversions
* Incontinent
Ileal Conduit
Cutaneous ureterostomy
Continent Diversions
Kock Pouch
Indiana Pouch
Continent urinary diversions
* Breakdown of the anastomoses in the GI tract.
* Leakage from the ureteroileal or ureterosigmoid anastomosis
* Paralytic ileus
* Obstruction of ureters
* Wound infection
* Mucocutaneous separation
* Stomal necrosis
Wound infection
Mucocutaneous separation
Stomal necrosis
Nursing Management
* Pre-op Care
Postoperative Care
Stomal prolapse
Bowel Diversions
Surgical interventions
Loop stoma
End Stoma
End stoma with Hartmann’s pouch
Double-barrel stoma
Continent fecal diversions
Ileoanal reservoir
Kock Pouch
Special considerations for patients who have ileoanal reservoirs
Nursing Management- preoperative
More to consider pre-op
More post op considerations:
Good stoma Bad stoma
More about stomas
What about pouching?
What do we need to observe and document?
What about eating?
What to avoid
Other food issues you need to know about
Management options for permanent descending colostomy
One and two piece units
Ileostomy care
Protect the skin!
Important to know
More to know
Patient Teaching
Managing odor
When you teach ostomy care
Routine Skin Care
More considerations
Adaptation to a stoma

Stoma Care Basics.ppt


Non-Inflammatory Bowel Disorders

Non-Inflammatory Bowel Disorders
Colon Cancer
Intestinal Obstruction

* Describe defining characteristics for the lower GI tract disorders discussed
* Develop intervention and teaching plans for the client with a lower GI tract disorder
* Appreciate the psychosocial impact of these disorders for the client and family

Hernia—a protrusion of a portion of the bowel through an abnormal opening or weakness in the muscle wall.
Common locations:
inguinal (men)

Types of Herniation
o Reducible
o Irreducible
o Strangulated: a surgical emergency
* Herniorraphy: puts bowel back in place
* Hernioplasty: repairs muscle weakness

Post op Care
Colon Cancer
Most prevalent in population
Colon Cancer
S/S may vary with tumor location
L sided tumor
R sided tumor
* Fatigue
* Vague crampy/colicky type pain
* Occult blood in stool
* Anemia
Colon Cancer
* Decreased H&H
* CEA elevated
* Stool for occult blood (+)
* Liver tests may be high
* Sigmoidoscopy or Colonoscopy for biopsy
* Barium Enema or CT

Colon Cancer: Collaborative Care
Treatment and prognosis depend on staging results.
Colon Cancer: Collaborative Care
Client education includes dietary impact on ostomy:
Psychosocial issues for the ostomy client:
Other post-op needs:
Intestinal Obstruction
Causes of Intestinal Obstruction
Signs/Symptoms of Obstruction
Treatment of Obstruction
Inflammatory Bowel Syndromes
Acute: Appendicitis
Chronic: Ulcerative colitis
Crohn’s disease
Diverticular disease
Nursing care is supportive
Inflammatory Bowel Disease
RLQ abdominal pain
Ulcerative Colitis
Signs/symptoms common to both:
* weight loss
* fatigue
* perineal skin breakdown
* low grade fever
* psychosocial distress
Inflammatory Bowel Disease: Complications
Treatment: Medications
Nutrition less than Body Requirements
Important points of care for the client on TPN/PPN
Diverticular disease
Diverticular disease: Nursing care

Non-Inflammatory Bowel Disorders.ppt


Sexuality & Fertility Issues in Cancer Patients

Sexuality & Fertility Issues in Cancer Patients
bt:Carolyn Vachani, MSN, RN, AOCN

Scope of Sexuality Issues
* 40-100% of cancer patients experience some form of sexual dysfunction
* Issues do not always resolve after therapy
* Almost all cancer treatments have the potential to alter sexual function (surgery, chemotherapy, radiation, hormones)
* Represents major quality of life (QOL) issue
* With intervention, up to 70% of patients can have improved functioning

To Optimize QOL, Nurses Can:
* Learn evidence-based information on how diagnosis/treatment affects sexual function
* Conduct assessments before/during therapy
* Inform patients of possible changes
* Educate clients & partners
* Provide guidance & suggestions for adapting to changes
* Know resources & refer when needed

Survey of Physician/Patient Communications
Nurses’ Beliefs
Johnson’s Behavioral Model
PLISSIT Model for Communication
Sexual Dysfunction in Men
* Chemo/hormonal therapy: Erectile dysfunction, decreased libido, ejaculatory dysfunction, gynecomastia, penile/ testicular atrophy, and infertility
* Radiation/ brachytherapy: Urinary issues, impotence, bowel dysfunction, penile/ testicular atrophy
* Surgery: Urinary issues, impotence, body image, pain, retrograde ejaculation

Sexual Dysfunction in Women
* Chemo/Hormone therapy: Irregular menses, early menopause, hot flashes, insomnia, irritability, depression, vaginal dryness, painful intercourse, infertility, and decreased libido
* Radiation/ brachytherapy: Pelvic fibrosis, vaginal atrophy/stenosis, scarring, decreased lubrication, urinary effects, erythema, edema, ulceration, decreased elasticity, shortening, and increased irritation of vagina
* Surgery: Body image, bowel changes, ROM issues, menopause, pain, changes in vaginal size/sensitivity, loss of nipple

General Nursing Interventions
Ostomy Surgery: Interventions
Interventions for Male Issues
Interventions for Female Issues
Radiation-Induced Vaginal Stenosis
Other Interventions for Women
* www.eyesontheprize.org (online community for gynecologic cancers)
* Support groups (Gilda’s Club, Wellness Community)
* www.oncolink.org
* www.ustoo.org (prostate cancer website)
* www.fertilehope.org
* www.resolve.org (fertility)
* ACS Sexuality booklets
(available on ACS website)

Pregnancy & Treatment
Risk of Infertility: Radiation
Radiation Risk to Future Pregnancy
Risk of Infertility: Chemo
Azoospermia likely, and are often given with other highly sterilizing agents, adding to the effect
Busulfan (600 mg/M2)
Ifosfamide (42 g/m2)
BCNU (300 mg/m2)
Nitrogen mustard
Actinomycin D
Azoospermia in adulthood if treated before puberty
BCNU (1 g/m2)
CCNU (500 mg/m2)
Prolonged or permanent azoospermia in 90% of men; platinum agents 50%
Chlorambucil (1.4 g/m2)
Cyclophosphamide (19 g/m2)
Procarbazine (4 g/m2)
Melphalan (140 mg/m2)
Cisplatin (500 mg/m2)
Known Effect on Sperm Count
Chemotherapy (dose to cause effect)

Risk for Infertility: Surgery
* Orchiectomy (bilateral)
* Penectomy
* Prostate or bladder surgery damage
* Prostatectomy
* Hysterectomy
* Oopherectomy (bilateral)

Options for fertility preservation in men
* Sperm banking – only after puberty
* Intracytoplasmic sperm injection (ICSI)
* GnRH agonist/antagonists
* Cryopreservation of testicular tissue, then transplant or grow in vivo (+ births in mice)

Options for Fertility Preservation in Women
* Embryo freezing – cycle 12-14 days, 10-25% chance of pregnancy per embryo stored, cost $8-12,000, then cost of storage, thaw & implanting
* Ovarian transposition (oophoropexy) – move ovaries from XRT field, can be laparoscopic, cost ?, been done for 30yrs, 16-90% success rate
* Egg cryopreservation – cycle 12-14 days, 2% chance of live birth per thawed egg, cost ~$8,000, then cost of storage, thaw, fertilizing & implanting

Options for Fertility Preservation in Women
* GnRH agonist/antagonist : theory is to stop proliferation
* Ovarian tissue freezing: 60% follicles lost to freezing, have been 2 live births
* Radical trachelectomy: for cervical cancer, experimental?
Assessing Ovarian Function in Survivors
* FSH & Estradiol
* Anti-Mullerian hormone (AMH)
* Antral follicle count
Financial Assistance
Local Sites for Sperm Banking
* 3 National organizations (by mail)
o www.cryolab.com
o www.reprot.com
o www.xytextissues.com
* Women’s Institute; 815 Locust / Plymouth Meeting
* Penn Fertility 3701 Market
* Fairfax Cryobank 3401 Market (http://www.fairfaxcryobank.com/)
* Drexel Fertility Bala Cynwyd / Center City
* Reproductive Science Institute Jenkintown (http://www.rsiinfertility.com/)
* Women’s Health Group of PA Bryn Mawr

Local Sites for Women
* Women’s Institute: 815 Locust / Plymouth Meeting (http://www.womensinstitute.org/)
* Penn Fertility: 3701 Market (http://www.pennhealth.com/fertility)
* Drexel Fertility: Bala Cynwyd / Center City (http://www.drexelfertility.medem.com)
* Women’s Health Group of PA: Bryn Mawr (http://www.mainlinefertility.com)

Sexuality & Fertility Issues in Cancer Patients.ppt


Gastrointestinal Conditions & Ostomy Surgeries

Gastrointestinal Conditions & Ostomy Surgeries

Type of Gastrointestinal conditions

* Irritable Bowel Syndrome (IBS)
* Diverticulosis/Diverticulitis
* Inflammatory Bowel Diseases

Irritable Bowel Syndrome (IBS)
Causes of IBS
What makes the symptoms of IBS worse?
* large meals
* bloating from gas in the colon
* Medicines
* wheat, rye, barley, chocolate, milk products, or alcohol
* drinks with caffeine, such as coffee, tea, or colas
* stress, conflict, or emotional upsets
Diagnosis of IBS
Treatment for IBS
* No cure for IBS – MDs treat symptoms
* For Constipations – use of laxatives
* Antispasmotic to control colon spasms
* Antidepressants
* Muscle relaxants for bladder & intestines

Stress & IBS
* Stress can stimulate colon spasms in people with IBS
Diet & IBS
* For many people careful eating reduces IBS symptoms
IBS Summary
* IBS is a disorder that interferes with the normal functions of the colon. The symptoms are crampy abdominal pain, bloating, constipation, and diarrhea.
* IBS is a common disorder found more often in women than men.
* People with IBS have colons that are more sensitive and reactive to things that might not bother other people, such as stress, large meals, gas, medicines, certain foods, caffeine, or alcohol.
* IBS is diagnosed by its signs and symptoms and by the absence of other diseases.
* Most people can control their symptoms by taking medicines (laxatives, antidiarrhea medicines, antispasmodics, or antidepressants), reducing stress, and changing their diet.
* IBS does not harm the intestines and does not lead to cancer. It is not related to Crohn’s disease or ulcerative colitis.
* Many people have small pouches in their colons that bulge outward through weak spots, like an inner tube that pokes through weak places in a tire. Each pouch is called a diverticulum (pl. diverticula).
* The condition of having diverticula is called diverticulosis. About 10 percent of Americans over the age of 40 have diverticulosis. The condition becomes more common as people age. About half of all people over the age of 60 have diverticulosis.
* When the pouches become infected or inflamed, the condition is called diverticulitis. This happens in 10 to 25 percent of people with diverticulosis.
* Diverticulosis and diverticulitis are also called diverticular disease.

* Bleeding
* Abscess, Perforation & Peritonitis
* Fistula
* Intestinal obstruction

Causes of Diverticular Disease
Diagnosis of Diverticular Disease
Treatment of Diverticular Disease
* Diverticulosis
Points to Remember
* Diverticulosis occurs when small pouches, called diverticula, bulge outward through weak spots in the colon (large intestine).
* The pouches form when pressure inside the colon builds, usually because of constipation.
* Most people with diverticulosis never have any discomfort or symptoms.
* The most likely cause of diverticulosis is a low-fiber diet because it increases constipation and pressure inside the colon.
* For most people with diverticulosis, eating a high-fiber diet is the only treatment needed.
* You can increase your fiber intake by eating these foods: whole grain breads and cereals; fruit like apples and peaches; vegetables like broccoli, cabbage, spinach, carrots, asparagus, and squash; and starchy vegetables like kidney beans and lima beans.
* Diverticulitis occurs when the pouches become infected or inflamed and cause pain and tenderness around the left side of the lower abdomen

Ulcerative Colitis
Symptoms of Ulcerative Colitis
* anemia
* fatigue
* weight loss
* loss of appetite
* rectal bleeding
* loss of body fluids and nutrients
* skin lesions
* joint pain
* growth failure (specifically in children)

Causes of Ulcerative Colitis
Diagnosis of UC
Treatment of UC
Crohn’s Disease
Causes of Crohn’s Disease
Symptoms of Crohn’s Disease
Diagnosis of Crohn’s Disease
Complications of Crohn’s Disease
Drug treatment
Other treatments
Ostomy Surgeries
Urinary Stomas
Psychosocial/Vocational implications

Gastrointestinal Conditions & Ostomy Surgeries.ppt


Journal Title Abbreviations

Journal Title Abbreviations

Biological Journals And Abbreviations: http://home.ncifcrf.gov/research/bja/

ISI Journal Abbreviations Index: http://library.caltech.edu/reference/abbreviations/
Journal titles covered by ISI: Institute of Scientific Information.

Journals Title Abbreviations: http://www.library.ubc.ca/scieng/coden.html
From the Science and Engineering Library, University of British Columbia

Mathematical Reviews' Abbreviations of Names of Serials: http://www.ams.org/mathscinet/searchjournals

Medline Journal Abbreviations: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Journals
Just type in your abbreviated journal title.

If you do not find your title using any of the resources above, the following website links to several other journal abbreviation sources:

All That JAS: Journal Abbreviation Sources: http://www.public.iastate.edu/~CYBERSTACKS/JAS.htm

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