Clinical case scenario of ca rectum.pptx

Clinical case scenario of ca rectum

1. CLINICAL CASE PRESENTATION Roll – 61-65 Dr. Bikram Rout 1

2. History

3. Name : Mr. X Age : 58 Y /M Address : West Bengal Occupation : farmer Socio economic status : upper lower religion : hindu Doa : 08.04.2023 Doe : 13.04.2023

4. Chief complaints c/o Bleeding per rectum since 6 months c/o weight loss and generalised weakness since 3 months.

5. History of present illness The patient was apparently alright 6 months back  when he started developing bleeding per rectum which was visible as a streak of blood In the Stool mixed with mucous, which was bright red in colour , Associated with constipation Not associated with pain. No H/o fever,  pain abdomen, vomiting H /o of significant weight loss  & loss of appetite. No history of Perineal injury or trauma.

6. Past history There were no History of similar complaints in the past . the patient is not a known case of dm , htn , thyroid disorders , copd , asthma Past medical history: Past surgical history: none

7. Family history No similar history in the family members No H/o any carcinoma in the family No h/o any chronic disease in the family

8. Personal history Married Having mixed indian diet Sleep and appetite was normal Bladder habits were normal. Bowel Habits two times a week. There was history of smoking tobacco for last 30 years( 30 pack years)

9. Examination

10. General examination The Patient was examined in a well lit room with proper concent and presence of an attendant. The patient was conscious and well oriented to time place and person Decubitus: sitting position   Normal built and well nourished   No signs of vitamin and micronutrient deficiency   No signs of dehydration BMI :  

11. Vitals PR: 72/min , regular in rhythm , normovolemic , no special characters ,arterial wall was just palpable , radio radial synchrony present , no radio femoral delay , all peripheral pulses were felt RR: 20/min , regular and Abdomino-thoracic BP: 114/70 mm Hg in right arm supine position TEMP : Afebrile to touch Spo2 : 96%

12. Cardinals Pallor Icterus Clubbing Cyanosis Lymphadenopathy Edema ABSENT

13.                       Digital   Rectal examination Position: Left LAteral (Sims Position) ANAL ORIFICE appears Normal, without any mass No anal skin tags , fissure , Ulcer or swelling Inspection

14. Palpation There was no palpable swelling , Mass or induration . Anal tone was normal. Anal Mucosa appears smooth and non tender . Gloves was stained with blood mixed mucous.

15. Abdominal examination INSPECTION THE ABDOMEN IS NOT DISTENDED UMBILICUS IS CENTER AND INVERTED ALL QUADRANTS MOVE WITH RESPIRATION NO SCAR MARKS NO VISIBLE MASS NO ENGIRGED VEINS , PULSATIONS ,OR PERISTALSIS HERNIAL ORIFICES APPEARS TO BE INTACT

16. Palpation No local rise of temperature Soft and non tender No palpable mass No organomegaly present

17. Percussion Shifting dullness absent Tympanic node all over abdomen Normal bowel sounds heard Auscultation

18. Respiratory examination Normal bilateral breath sounds were Heard

19. Cardiovascular exam Normal S1 S2 heard No murmers were heard

20. Neurological examination No focal neurological deficit

21. Investigations

22. Investigations For diagnosis For staging Routine investigations Proctoscopy Colonoscopy Punch biopsy and histopathology of the lesion Tumor markers Barium enema / CT colonography Endoluminal ultrasound CT abdomen , pelvis and chest MRI pelvis PET scan Chest X ray CBC LFT RFT Urine routine microscopy ECG PT / aPTT / INR

23. Proctoscopy About 13 cm long Used to inspect Anus and Ano rectal junction Biopsy can be taken from suspicious areas

24. Colonoscopy Localise and to take biopsy from lesions Detect synchronous lesions

25. CT / MR COLONOGRAPHY

26. Barium enema

27. Trans rectal endoluminal ultrasound

28. Tumor markers • CEA : Carcino Embryonic Antigen • 46% Sensitive and 89% specific for diagnosis of Colorectal cancer. • May be elevated in gastritis, peptic ulcer disease, diverticulitis, liver disease, COPD , diabetes and any acute or chronic inflammatory state. • CEA levels are significantly higher in cigarette smokers than in non-smokers. • Therefore, CEA should not be used as a reliable screening or diagnostic test for CRC.

29. • CEA levels do have value in the prognosis and follow-up of patients with diagnosed CRC • Patients with preoperative serum CEA >5 ng/mL have a worse prognosis, stage for stage, than those with lower levels • Elevated preoperative CEA levels that do not normalize following surgical resection imply the presence of persistent disease and the need for further evaluation.

30. CT

31. Investigations