Oncology- Bone Anatomy and Physiology (Pharma Learning Kit,

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During exercise, generalized vasodilatation occurs because of the accumulation of vasodilatory metabolites. What occurs if a red blood cell is placed in a hypotonic solution? Vomiting does not relieve the pain. -Tachycardia, tachypnea, hypotension, fever -Voluntary/Involuntary guarding -Decreased or absent bowel sounds -Abdomen may be distended with intraperitoneal fluid -Blood from necrotizing pancreatitis dissects through soft tissues and causes a bluish discoloration around the umbilicus (Cullen’s sign) or flanks (Gray Turner sign) 21 Serum amylase: -usually increases immediately with onset of pancreatitis & peaks within a few hours (However, may be normal in pancreatitis) -remains elevated 3-5 days -no correlation between magnitude of elevation & severity of pancreatitis -can also be elevated with SBO, perforated duodenal ulcer, other intra-abdominal inflammatory conditions Urine amylase: -may be more sensitive than serum amylase in detection of pancreatitis (lipids may interfere with measurement of serum amylase) -levels remain elevated for several days longer than serum amylase Pancreatic-specific amylase: -More specific for pancreatitis (88-93%) Serum lipase: -Remains elevated longer than serum amylase. 23 Prognosis: <2: Mortality-0 3-5: Mortality 10-20% >7: Mortality >50% *Only useful for 1 st 48h APACHE II score: (acute physiology & chronic health evalutation) -uses vital signs, labs, age, and chronic health status of patient - >8 is severe Criteria for acute pancreatitis not due to gallstones At admissionDuring the initial 48 h Age >55 y Hematocrit fall >10 points WBC >16,000/mm 3 BUN elevation >5 mg/dL Blood glucose >200 mg/dL Serum calcium <8 mg/dL Serum LDH >350 IU/L Arterial PO 2 <60 mm Hg Serum AST >250 U/dL Base deficit >4 mEq/L Estimated fluid sequestration >6L Criteria for acute gallstone pancreatitis At admissionDuring the initial 48 h Age >70 y Hematocrit fall >10 points WBC >18,000/mm 3 BUN elevation >2 mg/dL Blood glucose >220 mg/dL Serum calcium <8 mg/dL Serum LDH >400 IU/L Base deficit >5 mEq/L Serum AST >250 U/dL Estimated fluid sequestration >4L RANSEN’S CRITERIA 24 TREATMENT: *Mild pancreatitis: (no systemic complications, low Ranson’s & Apache II score) -IVF resuscitation/maintenance -Pain management (avoid morphine due to Sphicter of Oddi contraction) -Supportive (rest the pancreas) -NPO -NGT -H2 blockers *No abx unless suspect infection -Slow feeding after pain subsides, amylase decreases, patient feels hungry 25 Severe Pancreatitis: (Ranson’s >7, Apache II >8, systemic symptoms) -ICU & Supportive Care -TPN vs jejunal feeds -If necrotizing: Flagyl, Imipenim, 3 rd gen cephalosporin, Diflucan prophylaxis -If necrotizing & septic: Consider necrosectomy 26 Biliary Pancreatitis: -Treatment controversial -Cholecystectomy once pancreatitis improves before discharge home -If patient still has pancreatitis, but CBD is obstructed, ERCP with sphincterotomy & stone extraction is indicated -Routine ERCP is not indicated due to risk of post-ERCP pancreatitis 28 -Pain: Midepigastric RUQ or LUQ Penetrating through to the back Steady & boring (not colicky) Often exacerbated by eating & drinking -Pain causes patient to lay still -Nausea/Vomiting -Anorexia, malabsorption, weight loss -Diarrhea/Steatorrhea due to pancreatic exocrine dysfunction -Diabetes due to pancreatic endocrine insufficiency 29 CHRONIC PANCREATITIS: Incurable, chronic, inflammatory condition -Associated with ETOH in 70% of cases Multiple hit theory: Multiple episodes of acute pancreatitis cause inflammatory changes that result in chronic inflammation & scarring 30 Chronic Calcific Pancreatitis Chronic Obstructive Pancreatitis Chronic Inflammatory Pancreatitis Chronic Autoimmune Pancreatitis Asymptomatic Pancreatic Fibrosis AlcoholPancreatic tumors UnknownAssociated with autoimmune disorders (e.g., primary sclerosing cholangitis) Chronic alcoholic HereditaryDuctal stricture Endemic in asymptomatic residents in tropical climates TropicalGallstone- or trauma-induced pancreas divisum Hyperlipidemia Sjögren's syndrome Hypercalcemia Primary biliary cirrhosis Drug-induced Idiopathic 32 I.

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Publisher: Ciba-Geigy (1991)


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