male, mid aged teacher,
passing small bowl motions, with fresh bloody crap
receding hair line and over weight
father had cancer at 60
little bro had it too
constipation

large solid mass upon rectal exam
occasional drinker
had colonoscopy 10 yrs ago

going for CAT scan and colonosocypy

wat wud u like to know????? biopsy, blood tests,

DD:
-colon cancer
-rectal cancer
-colorectal cancer
-internal hemorrhoids
-inflammation of rectum
-tchulangaishlonghe

-def. (incidence, prevalence),differential diagnosis, minor ---kee hai---
-pathophysio, pathology ---mona---
-risk factors, causes, signs and symptoms (how does the bleeding occur?) ---fuad---
-investigations,cancer markers ---shakir, prish---
-treatment, other treatment, and management, follow up, palliative care, what aspects of care might a palliative care team deal with? ---ujin, waiting---
-prevention, advice of dr to pts to reduce risks ---jun beng---
-complications, prognosis (staging of cancer, dukes criteria, TNM) ---alex--
-What factors influence outcome of surgery ---piggy---
-psychosocial, implications on family, can they influence incidence of cancer? religion? is it protective or causative? what sorta pain will he feel in the end of his life? ---tick---

DD
Gastritis
Dyspepsia
Gastric ulcer
Duodenal ulcer
cron's disease
Acute cholecystitis
Lactose intolerance

Cholangitis
Choledocholithiasis - gallstone in the CVD' accumilates near papillae
Cholecystitis - stone in cystic duct from gallbladder

Learning issues

1. Definition, prevalence, incidence, Anatomy (biliary tree, site of obstruction)- (JB)
2. pathophysiology (cholesterol and bile pigment gallstone eg calcium binerubinate) ( Shakir)
3. Signs and symptoms - which disease causes which symptoms (all three!!) (Pik Yin)
4. causes and risk factors (Mona)
5. examination and investigations (blood test, liver function test, imaging techniques) and types of gallstones (Prish and HT)
6. treatment- pain relief, antibiotics, hydration and surgery. cholecystectomy (lapro and open)- ERCP, Spinchterotomy and stone collection, choledocholithomy
, bile duct clearance (Alex, kaarthik and KH)
7. complications (gallstone induced pancreatitis, surgical problems regarding choledocholithomy and mortality and morbidity) and prognosis (Fuad And EJ)

Learning Issues


1. Read the 2003 clinical practice guidelines www.acadmed.org.my/cpg/CPG-Obesity.pdf
www.nhmrc.gov.au/publications/pdf/n33.pdf (Ewe jin, Kaarthik)

2. visit www.ifnotdieting.com, read the 3 articles printed under Australian Family Physicians under Tips for long term weight management (Fuad)

3. using the internet or other sources, find out what each of the diet involves and what are the proposed mechanisms by which it is aimed to produce weight loss.
what is the scientific support for the diets being effective and what are the possible risks and disadvantages in following these diets (Atkins-Prisheila, Ornish and Pritikin-Mona, Sears-Kee Hao, The Zone-Huey Ting and The South Beach Diet-Alex, weight watchers-Pik Yin)


4. Search the internet beginning with the key words "unilever + atkins diet" to find example to explore the questions as to what potential impact a popular diet such as the Atkins diet mught have on:-

(a) the low fat diet industry
(b) the food industry in general. (Shakir)

The Atkins diet is apparently inconsistent with main stream healthy diet recommendations. What impact do these have on mainstream public health nutrition campaigns and how should these issues be addressed. (Jun Beng)