Book 5, Case 3-Carcinoid

Question 1

Carcinoid constellation:

And if you see this, what could you get to diagonose?

Answer 1

The constellation of diarrhea, flushing, and cardiac
involvement (i.e. pulmonic stenosis or tricuspid regurgitation) is referred to as the carcinoid
triad. If time allowed, this could be further investigated by measuring urinary excretion of 5-
hydroxyindoleacetic acid (5-HIAA).

Question 2

What is carcinoid syndrome?

Answer 2

Carcinoid syndrome is the term applied to the complex of signs and
symptoms that results when a carcinoid tumor releases excessive amounts of circulating
hormones, such as histamine, bradykinin, tachykinin, and serotonin, into systemic
circulation. In the case of non-intestinal tumors (i.e. head and neck, lungs, and breast) or
gastrointestinal tumors that have metastasized to the liver, these substances bypass the portal
circulation and result in a variety of symptoms including cutaneous flushing of the upper
body (bradykinin and/or histamine), bronchoconstriction (bradykinin, histamine, and/or
serotonin), diarrhea (serotonin), right-sided heart disease (possibly secondary to serotonin
and/or tachykinin), hypotension (bradykinin and/or serotonin), and hypertension (serotonin).

Question 3

Why do people with carcinoid syndrome have tricuspid regurg?

Answer 3

Serotonin-induced fibrosis can
lead to valvulopathy (tricuspid and/or pulmonary valve stenosis or regurgitation), pulmonary
hypertension, and right-sided heart failure. The left side of the heart is protected by the

pulmonary degradation of serotonin, except in the case of pulmonary metastasis or right-to-
left intracardiac shunt.

Question 4

What do you do preoperatively to reduce carcinoid crisis (hypotension and bronchospasm)?

Answer 4

• somatostatin analgoue-can slow tumor growth. preferably 2 days prior to surgery and then continue for a week post op
• Increase IV volume
• administer an anxiolytic
• H2 blocker to attenuate histamine
• alpha and beta adrenegic blockers to prevent catecholamine mediated release of vasoactive substances

Question 5

Pt has VP shunt-how are you preparing them for surgery?

Answer 5

consult NS to discuss VP shunt functionality

and also i will take measures to reduce risk of incracranial pressures-low insufflation pressure

Question 6

Pathophys of aspiration pneumonitis:

Signs and sxs:

Answer 6

aspiration of gastric material: damage to capillary endothelium which can result in pulmonary edema and atelectasis. Signs and sxs: hypoxemia (earliest sign), tachypnea, wheezing, bronchospasm. Radiographic findings can take 6-12 hours

Question 7

Would you routinely give prophylactic abx for aspiration pna?

Answer 7

no. but if pt had sbo consider it. or consult ID lol. Not recommended if not fecal content due to drug resistance and super infection or if clinical condition worsens after 2-3 days

Question 8

LIM-why is it alarming?

Answer 8

designed to alarm when flow of current from isolated power supply to ground is at unacceptable level

un plug most recent thing plugged in (faulty equipment) and keep on until you find the problem.
and if in the middle of the case and it were a life supporting thing, then continue oto use it until replacement comes.