~Teachingcenter的醫學筆記~

胰臟癌、脾臟切除手術(for ITP treatment)、軟組織病變、胃癌、膽管結石

術前診斷：Periampullary cancer, suspect Pancreas head cancer
Comorbidity：
DM ( - )、HTN ( - )、Liver disease ( - )、Renal disease：( - )、Heart disease：( - )、Lung disease：( - )、Coagulopathy：( - )
Previous OP history：No or Yes：_____ and when ____
ASA：class __
Image：
   CXR：unremarkable
   EKG：normal sinus rhythm
PE：
 Abdomen：
    soft and flat
    mild tenderness at epigastric area
    muscle guarding：(+)、 rebounding pain：( - )  
    OP scar：No or Yes：_____ and where ____
OP indication：
   Suspicion of malignant transformation and Resectable with good general performace
Laboratory data：
Treatment plan：
     1. Arrange pylorus-preserving pancreaticoduodenectomy +/- tube jejunostomy
     2. NPO after midnight prior to the day of surgery
     3. Bowel prep before surgery
     4. Blood products preparation
     5. Postoperative ICU management after operation, if indicated
     6. Well explain the disease entity, risk, options and prognosis of operation to patient and patient's family

術前診斷：Immune thrombocytopenic purpura (ITP)
Comorbidity：
DM ( - )、HTN ( - )、Liver disease ( - )、Renal disease：( - )、Heart disease：( - )、Lung disease：( - )、Coagulopathy：( - )
Previous OP history：No or Yes：_____ and when ____
ASA：class __
Image：
   CXR：unremarkable
   EKG：normal sinus rhythm
PE：
 Abdomen：
    soft and flat
    no tenderness
    Spleen：impalpable
    OP scar：No or Yes：_____ and where ____
OP indication：
   Hematological disorders
Laboratory data：
Treatment plan：
     1. Arrange Laparoscopic splenectomy
     2. NPO after midnight prior to the day of surgery
     3. Bowel prep before surgery
     4. Blood transfusion, if indicated
     5. Postoperative ICU management after operation, if indicated
     6. Well explain the disease entity, risk, options and prognosis of operation to patient and patient's family

術前診斷：Soft Tissue Neoplasm
Comorbidity：
DM ( - )、HTN ( - )、Liver disease ( - )、Renal disease：( - )、Heart disease：( - )、Lung disease：( - )、Coagulopathy：( - )
Previous OP history：No or Yes：_____ and when ____
ASA：class __
 Image：
   CXR：unremarkable
   EKG：normal sinus rhythm
PE：
    Mass：
      size： * cm at
      shape：oval
      border：well-defined
      consistence：elastic
      mobility：fixed
      compressibility：compressible
      tenderness：mild tenderness
      skin change：Nil
OP indication：
     Growing or Symptomatic tumor
Laboratory data：
Treatment plan：
     1. Arrange Excision of tumor
     2. NPO after midnight prior to the day of surgery
     3. Well explain the disease entity, risk, options and prognosis of operation to patient and patient's family

術前診斷：Gastric Cancer
Comorbidity：
DM ( - )、HTN ( - )、Liver disease ( - )、Renal disease：( - )、Heart disease：( - )、Lung disease：( - )、Coagulopathy：( - )
Previous OP history：No or Yes：_____ and when ____
ASA：class __
Image：
   CXR：unremarkable
   EKG：normal sinus rhythm
 PE：
  Neck：LN：impalpable
   Abdomen：
     soft and flat
     mild tenderness at epigastric area
     muscle guarding：(-)、 rebounding pain：( - )  
   OP scar：No or Yes：_____ and where ____
 OP indication：
   Biopsy-proved malignancy and resectable with good general performance
Laboratory data：Treatment plan：
     1. Arrange subtotal gastrectomy + D2 LN dissection
     2. NPO after midnight prior to the day of surgery
     3. Bowel prep before surgery
     4. Blood products preparation
     5. Postoperative ICU management after operation, if indicated
     6. Well explain the disease entity, risk, options and prognosis of operation to patient and patient's family

術前診斷：Choledocholithiasis & Hepatolithiasis with cholangitis
Comorbidity：
DM ( - )、HTN ( - )、Liver disease ( - )、Renal disease：( - )、Heart disease：( - )、Lung disease：( - )、Coagulopathy：( - )
Previous OP history：No or Yes：_____ and when ____
ASA：class __
Image：
   CXR：unremarkable
   EKG：normal sinus rhythm
PE：
   Abdomen：
      soft and flat
      mild tenderness at epigastric area
      muscle guarding：(-)、 rebounding pain：( - )  
   OP scar：No or Yes：_____ and where ____
 OP indication：
   Eliminate the source of infection
Laboratory data：Treatment plan：
     1. Arrange choledocholithotomy with T-tube drainage
     2. NPO after midnight prior to the day of surgery
     3. Bowel prep before surgery
     4. Blood products preparation
     5. Postoperative ICU management after operation, if indicated
     6. Well explain the disease entity, risk, options and prognosis of operation to patient and patient's family