Internal Medicine

P1: SBT

0521779407-02 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:18

Adenocarcinoma/Ampulla of Vater Adenovirus 63

management

What to Do First

■establish diagnosis by ERCP with biopsy

■assess patient’s ability to undergo attempted resection

General Measures

■support nutrition

■provide biliary drainage

specific therapy

■Whipple resection for 75% of patients will lead toa5yearsurvival

up to 60% if marginsfree of tumor

■radiation and chemotherapy not very effective

follow-up

■serial visits with physical examination, liver chemistries

complications and prognosis

■as high as 40% 5-yr survival, but combined 5-yr survival for all stages

is∼10%.

■slowly growing compared to cholangiocarcinoma

Adenovirus..........................................

CAROL A. GLASER, MD

history & physical

History

■DNA viruses; 51 distinct serotypes

■Humans only host

■Types 31, 40, 41 causes of gastroenteritis (especially younger)

■Spread person-to-person, respiratory, fecal-oral and contaminated

fomites

➣Epidemic keratoconjunctivitis: usual method of spread is by con-

taminated ophthalmic instruments+eye solutions, hand – to –

eye contact, swimming pools

■Incubation period 4–12 days

➣Account for 2–5% total respiratory illness (higher% children)

Epidemics of disease associated with- contaminated swimming

pools, day care centers, hospitals, military recruits