Rehabilitation Care

Type of constipation – organic constipation

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Due to changes in the intestine caused by the organic form of constipation, functional constipation than the natural frequency of the low incidence, but more significant meaning as a disease. So as a diagnosis of constipation, the first thing to do the necessary checks. Organic will be divided into congenital and acquired regret.
Type of constipation – organic constipation 1) congenital constipation: constipation, including congenital megacolon and sigmoid colon through bowel disease led to a long residence time in the intestines, water is due to constipation and intestinal absorption of most moving films produced for the day after tomorrow . Hirschsprung's disease intestinal nerve cells is the absence of an intestinal malformations, a familial tendency to occur.
To men, male: female was 4:1, more common in infants, neonatal Hirschsprung meconium at birth, not after discharge or discharge delay, or even intestinal obstruction, and more need to plug enema or embryo Price (enema) more meconium after discharge. With age, the sick child was seen as constipation, bloating, general malnutrition, and more need to help bowel enema or other means.
Type of constipation – organic constipation 2) acquired constipation: Colorectal cancer is one of the important symptoms of constipation, common over the age of 40, without any symptoms, as long as constipation or sudden change in bowel habits, may suggest intestinal there was a serious disease, it is necessary and self-doubt colorectal cancers. Colorectal lesions outside the colon caused by the narrow cavity, such as uterine cancer, ovarian cancer, cancerous peritonitis caused by oppression, and oppression caused by invasive colon lumen narrowing, etc., can lead to constipation.
Type of constipation – organic constipation 3) drug-induced constipation: drug-induced constipation mainly seen in the solution recover from illness stabbed anticholinergic agents (eg, atropine, belladonna ,654-2 and others antacids, anti-depressants agents, analgesic Wei matter (morphine, etc.), anti-hyperthyroid drugs, etc., there is the role of inhibition of intestinal remote, long-term use may produce a functional constipation, called drug-induced constipation.
Type of constipation – organic constipation 4) symptoms of constipation: Constipation is a symptom of other diseases that cause secondary symptoms of constipation. The representative diseases cerebral embolism, cerebral hemorrhage, spinal cord injury, depression, hypothyroidism, diabetes, peritonitis, fractures, excessive fertilizer and so on.

The general classification of diarrhea

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The general classification of diarrhea from mild disease can be divided into acute and chronic diarrhea, acute diarrhea. From the cause, the diarrhea can be divided into infectious and non-infectious diarrhea. From the onset mechanism, can be divided into hyperosmolar diarrhea, secretory diarrhea, exudative diarrhea, malabsorption diarrhea, bowel movements of diarrhea. From the season, the diarrhea can be divided into spring, summer and sub-version of learning, machine word version of the rain, school clothes in odd numbers to plot Prince Lee Sang Lee diarrhea more common.
To describe all aspects of diarrhea, diarrhea for more and better understanding, to prevent and governance, the purpose of improving the quality of life and standard of living.
Diarrhea in the general classification (1) acute diarrhea
1) acute intestinal diseases: acute intestinal infections, including viruses, bacteria, amoeba, schistosomiasis and other infections; bacterial food poisoning, such as Clostridium botulinum, salt, Proteus, caused by Staphylococcus aureus.
2) acute poisoning: animal toxins, such as puffer fish bile poisoning plant poisoning, such as the poisonous weed poisoning; chemical poisons, such as organic phosphorus, arsenic poisoning.
3) diseases: such as typhoid, paratyphoid diseases such as leptospirosis.
4) drug-induced diarrhea: laxatives, anti-cholinergic drugs, antibiotics, anti-cancer drug, such as during the medication can cause diarrhea.
5) Other: If allergic purple epilepsy, thyroid crisis, adrenal crisis and so on.
The general classification of diarrhea (2) chronic diarrhea
1) stomach diseases: chronic atrophic gastritis, gastric achlorhydria after subtotal gastrectomy psychosis.
2) Intestinal diseases: intestinal infectious diseases such as intestinal tuberculosis, chronic amoebiasis disease, chronic bacterial sexually transmitted disease, schistosomiasis, hookworm, intestinal diseases such as candidiasis; non-infectious intestinal diseases, such as inflammatory colitis, radiation (such as cancer radiotherapy, etc.) colitis, ischemic colitis, etc.; intestinal tumors, such as colon cancer, intestinal lymphoma; intestinal malabsorption, such as adult milk deceive diarrhea, small bowel resection after the short bowel syndrome; intestinal disorders such as irritable bowel syndrome.
3) pancreatic diseases: such as chronic pancreatitis, membrane adenocarcinoma.
4) liver diseases: such as cirrhosis, liver cancer.
5) endocrine and metabolic disorders: such as hyperthyroidism, diabetes, adrenal insufficiency and so on.
6) drug-induced diarrhea: such as oral thyroxine, digitalis and other drugs.


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  • Chronic diarrhea is divided into which two classifications:
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Thin anastomotic causes and preventive measures

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Repeated occurrence of anastomotic main reasons for anastomotic healing is a direct impact on several factors, followed by secondary infection, anastomotic edema due to inflammation, poor healing, which lean more appeared later. A direct impact on anastomotic healing for the following reasons.
The incidence of anastomotic thin and prevention of anastomotic Department a. poor blood supply. Stomach in the process of free, generally right gastric vein and the right gastroepiploic vein difficult to damage. However, in the free operation of esophageal and gastric stretch and kneading over powerhouse, can cause tissue damage, submucosal or intramuscular hematoma formation of small blood vessels rupture, causing blood supply to poor fit of the Ministry of anastomotic healing. Gastric cardia cancer in particular to do some or most of the resection, the Ministry of gastric blood supply cut off even worse suture, it is free in the course of the esophagus and stomach, attention should be handy to operate, to protect the esophagus and gastric serous muscular layer of the integrity of the is consistent with the Ministry of blood supply to maintain a good thin to prevent an important part of anastomosis. Free in the stomach in particular should pay attention to cut off the upper pole of the spleen and stomach ligaments, especially the stomach ligaments were too short, do not expand so as not to damage the stomach clamped beam. It is the bottom of the esophagus due to stomach – gastric anastomosis, such as anastomotic where damage will affect the blood supply and may even cause perforation of gastric necrosis.
The incidence of anastomotic thin and prevention of b. esophageal anastomosis edge of a rope is not good. Esophageal anastomosis edge of a rope is not good, but also affect anastomotic healing. Teaching film often cut off after esophageal retraction, after cutting off the stomach mucosa and often has turned outward, affecting the fit neatly fit on the edge of the rope. When cutting the esophagus with a large right angle clamp bronchus clamp or clamp off the esophagus, not only can prevent esophageal stump bleeding, anastomosis surgical field clear, and prevent the retraction of esophageal mucosa and reduce the outflow of the contents of the surgical field contamination. Partial eversion of the gastric mucosa close, bleeding that much, but there is a clear benefit in the surgical field exposure, easy to suture the esophagus and stomach tight margins on the rope. The distance between each suture needle too close match will be organized by the Ministry of blood supply, depopulation of the esophagus and stomach tight rope is not easy, but also affect healing. Each suture needle from the general (stitch length) to 0.3cm, esophagus and stomach tight to the rope is appropriate margin. Suture depth (margin) should be more than 0.5cm, suitable elastic suture ligation, suture ligation of tight too shallow, postoperative edema may cut off suture anastomosis anastomotic healing and the formation of thin. A large number of clinical cases confirmed that more than 0.5cm deep from the tangential suture only beneficial in the healing of anastomosis, anastomotic stenosis does not cause.
The incidence of anastomotic thin and prevention of anastomotic tension is too large c. also affect anastomotic healing. Internally used by the majority of patients who end side of the esophagus and stomach, "Scarf Type" embedded legal and responsible tone of the door match the stomach cancer of the esophagus after partial resection of the stomach of a set of end-esophageal gastric anastomosis, anastomotic embedded human stomach in 4cm. Folded part of the stomach longer, not oppression and stomach consistent with the Department of the outer esophageal muscular layer embedded suture, far away from the anastomosis, anastomotic blood supply to the small impact. "Scarf-style" embedded esophageal anastomosis suturing muscle and stomach muscle pulp only 3-4 needles all week. Partial resection of gastric cardia, gastric esophageal anastomosis sets only need 4-5 stitches. At the same time the two anastomosis can reduce anastomotic tension, anastomotic protection is conducive to the healing anastomosis.
Anastomotic healing caused more of several reasons, patients who are surgical operations with technical proficiency to some extent. Intraoperative exposure of the surgical field clear, gentle and meticulous operation, suture tight and accurate, the incidence of anastomotic thin significantly reduced. Intraoperative contamination and postoperative chest infection operating fluid, may cause secondary infection caused anastomotic anastomotic thin. Therefore, patients with severe obstruction, esophageal surgery should be done before washing and oral antibiotics, elimination of esophageal inflammation. Intraoperative strict protection for the surgical field, reduce pollution chest after surgery to maintain patency of thoracic drainage, excluding pleural effusion, the lung expansion as soon as possible, and before and after surgery to give sufficient quantities of antibiotics, thin anastomosis are very necessary measures to prevent .

External irradiation and complications of esophageal

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Radiation reactions and complications of esophageal (a) response to external irradiation
Esophageal exposure to systemic reactions are mild, such as loss of appetite, fatigue, decreased blood and so on, generally do not deal with.
1. Esophageal reaction
Exposure to 1 – 2 weeks, tumor volume of 10 – 20Gy, esophageal mucosal congestion and edema, dysphagia may increase, generally do not have to deal with. Irradiated volume of 30 – 40Gy, may occur after chest pain and swallowing pain, symptomatic treatment or anti-inflammatory treatment.
2. Tracheal response
When the tumor reached 30–40Gy/3–4 weeks after irradiation, there will be bronchitis inflammatory response, mainly as a dry cough, severe post-radiation can be converted to intractable cough, increased upper respiratory tract infection, cough may be given , anti-inflammatory and other symptomatic treatment.
Radiation reactions and complications of esophageal (b) complications
Mainly for bleeding, occur in approximately 1%. Found in tumor piercing fiber membrane perforation, penetration when the trachea or mediastinum, causing pneumonia or mediastinitis, the rate was 3% – 4%. As technology improved irradiation, radiotherapy rare pneumonia caused by radiation, but the elderly who have chronic respiratory disease should pay attention. Radiation myelopathy is a serious complication of radiotherapy, the rate was 1% – 4%, the incubation period after radiotherapy often 6 months to 2 years.
External radiation reactions and complications of esophageal, its clinical manifestations of a transient and progressive two: a transient typically lasts 2 – 3 months, symptoms disappeared; for severe cases of paraplegia and even death. Therefore, we should minimize the amount of the spinal cord to prevent the occurrence of radiation myelitis.

Esophageal cancer chemotherapy Notes Lomustine

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Lomustine chemotherapy esophageal Notes:
Notes Lomustine (1) The drug has gastrointestinal reactions, can be pre-served sedatives, antiemetics, or at bedtime can prevent vomiting.
Notes Lomustine (2) the patient should be fasting medication, medication that day can not drink.
(3) liver dysfunction disabled.
Notes Lomustine (4) a white blood cell count less than 4X109 / L, platelet count less than 50X109 a / L were banned.

How to control the transfer and proliferation of malignant tumor

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Transfer and spread of malignant tumors is one of the biological characteristics of malignant tumors, its occurrence, so that cancer patients often lose the opportunity to cure the patient received greater pain, are often the cause of death of malignancy. Therefore, prevention of tumor metastasis and proliferation of great significance to the prevention and treatment.
Malignant tumor and spread on a detailed mechanism for the transfer has not yet fully understand how to effectively prevent the transfer and diffusion, is still a difficult problem in oncology. But knowledge is not currently looking to prevent the transfer and spread of malignant tumors should note the following.
(1) As the cancer grows slowly in the early stages of the transfer and diffusion of rare, so early detection and prevention of early diagnosis is the best way to transfer and diffusion. Surgery for malignant tumors and tumor resection should be emphasized enough surrounding tissue to prevent the infiltration of tumor treatment. Radical surgery should be done all the tumor tissue, surrounding tissue, lymph node, etc. should be submitted pathology examination. Should be much more careful in the surgery to prevent surgical instruments, etc., causing iatrogenic seeding metastases. For some estimates of tumor metastasis may occur, should be supplemented by local or systemic chemotherapy.
(2) should be taken to remove some of the promotion of tumor metastasis and proliferation factors. The tumor has been found that could be mass, in particular has made clear the nature of its pathology are malignant, the tumor should be trying to avoid irritation. Do not often touch, but can not squeeze hard, nor on the mass to heat and physical therapy to prevent shedding of tumor cells to promote metastasis, that is, medical staff during the inspection operation is also to be gentle.
(3) As the tumor thrombus and tumor metastasis and proliferation are closely related, and thus can play to prevent blood coagulation, fibrinolysis to enhance the role of drugs and related measures, is also considered a preventive role in tumor metastasis and proliferation has been tested in preventing or reduce tumor metastasis.
(4) the transfer and proliferation of malignant tumor, more importantly, measures should be to strengthen the body's immunity, so that the body's immune surveillance system to play a normal role for anti-cancer initiative. Suppression of immune function will lead to tumor development and metastasis, and specific or non-specific immune stimulation often due to the increase of immunity and inhibit tumor growth, invasion and metastasis. Therefore, to improve immune function, not only remove at any time off from the tumor into the blood and lymph of the tumor cells, but also for the treatment of primary tumor lesions has an important role.

Transfer and diffusion of primary liver cancer

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Transfer and diffusion of primary liver cancer 1. Intrahepatic proliferation of cancer cells directly or sinus by sinusoidal space, direct spread to other parts of the liver, metastasis foci showed a satellite-like distribution, but also away from the primary cancer, this ways to transfer the first and most common; also may invade the portal vein and the formation of tumor emboli, such as tumor thrombus in the liver off, then rise to multiple metastases, portal vein tumor thrombus obstruction can cause portal hypertension and refractory ascites.
Primary liver cancer metastasis and proliferation 2. metastasis outside the liver cancer can be a direct violation of adjacent tissues, such as the cross-chest, gallbladder, stomach, duodenum, pancreas, transverse colon, inferior vena cava, but also from the surface of the liver off, planted in the abdominal cavity, causing peritoneal carcinomatosis, ascites, female patients with metastatic ovarian cancer may.
Transfer and diffusion of primary liver cancer 3. Hematogenous metastasis of cancer cells through the portal vein invasion, retrograde transfer to the portal vein, the formation of thrombosis and spread to internal organs; such as a small branch of hepatic vein invasion of tumors, the occurrence of systemic metastasis, most found lung, followed by bone marrow, can also be transferred to the kidney, brain, skin, etc.; also occur because of hepatic vein thrombosis, can be gradually extended to the inferior vena cava to the right heart chamber or even the smaller off to a pulmonary embolus, the can cause pulmonary embolism, the formation of lung metastases.
Transfer and diffusion of primary liver cancer 4. Lymph node metastasis through the lymphatic vessels mainly transferred to the neighboring lymph nodes, such as the lymph nodes around the hepatic portal and hepatic veins can also be transferred to the para-aortic, supraclavicular, film, spleen and lymph nodes, etc. . On metastasis, low incidence of cirrhosis in 30% 60% cirrhosis than -70% of metastasis, this is not the type of cancer in these two different biological characteristics, but Primary liver cirrhosis associated with poor outcome, life is short, too late to have extrahepatic metastases.

Chemical carcinogens cause cancer easily

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The incidence of cancer caused by many reasons, chemical carcinogens cause cancer is one of the easier one of the reasons, but chemical carcinogens is also a need to promote cancer cell growth period.
Easy to chemical carcinogens cause cancer in the early stages can be divided into several processes: carcinogens into the body and then enter the body cells, is metabolized in cells and activation, activation of carcinogens and DNA genetic material within the nucleus combined with the damage and to, DNA damage repair process in a genetic mutation, gene mutation that oncogene activation. This step by step changes are the key to determine whether the cancer formation.
Cancer cells generated by a gateway is the activation of carcinogens, most of the carcinogens in the normal state does not do anything "bad", just as into human cells under the action of the enzyme in the cell is metabolized, it has a carcinogenic sex. In fact, the carcinogenic activity of cellular enzyme is not the responsibility, on the contrary should be the enzyme responsible for cell removal of toxic chemicals, these substances by chemical reaction metabolized, so that you can invade the body of toxic substances in the body. Unfortunately, this metabolism and sometimes all odds, in the metabolic process generates an intermediate product in question, may take advantage of this intermediate role in the human body. If by chance is a carcinogen, then it had to recognize trouble. This unfortunate person in the cancer journey a step forward.
Easy to chemical carcinogens cause cancer, AAF this is a pesticide, but shortly after the development found to have carcinogenic and is disabled. Mixed in the feed to AAF 38 AAF feeding of poultry after the metabolic activity of the role of the mouse, you can trigger the formation of liver cancer in mice. However, when prairie dogs fed the same no matter what. AAF chemical structure can be seen in the lower right there is a NH-type structure, if the NH into the N-OH when it can cause liver cancer, can not make this change happens naturally occurring enzymes, which will not lead to liver cancer . This is another step which is from the N-OR NO 503 into a change in genetic variation can make the change. This example can be seen from the cancer-causing carcinogens are not so easy to achieve.
Easily lead to cancer chemical carcinogen, benzo flower is a common carcinogen, it is produced in the process of biomass burning, roughly calculate what the United States annually to produce 700 tons of benzo surprised. Its structure is linked as the tortoiseshell 5 (Figure 39). Under normal circumstances, is not carcinogenic. In the event of a change in chemical structure to become a carcinogen. There were two French scientists Pulu Man proposes a couple hypothesis, that the field K is carcinogenic in 1974, and was raised in the Bay area is the area of cancer that flower in the benzo-10 loci and DNA resulting combination of genetic variation. It can make us understand that even though chemical carcinogens into the body cells, but also through some changes in order to play their role in cancer. This does not mean we can be complacent to carcinogens, and the carcinogens into your body is equivalent to have lifted one foot into the cancer, the cancer opened the first door.

The cause of prevention of malignant lymphoma

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Since the exact cause of lymphoma is not clear, to take active preventive measures wonders there are certain difficulties. Clinically the cause according to the study of malignant lymphoma, appropriate for the prevention of high-risk groups, there may be blocking the delayed occurrence of the disease. Obtained complete remission after treatment for the patients given aggressive treatment if the measures are likely to extend the remission period and even prevent cancer recurrence. Therefore, for the prevention of malignant lymphoma should be aware of the following causes tens of thousands of faces:
attention to climate change, the military on active treatment to prevent HIV infection;
Malignant lymphoma, pay close attention to the cause to prevent large shallow expanse of licensing changes in the lymph nodes, for the odd family member should be similar to patients on high alert;
exercise, and improve the body's immune resistance to bow knife blade;
Cause of malignant lymphoma aggressive treatment and prevention may be relevant to the real him Benbingfasheng chronic diseases such as chronic lymphadenitis, autoimmune diseases;
For the shallow expanse of lesions, should pay attention to the skin clean and avoid unnecessary damage or stimulation.