Other Flashcards
Medications for high-output ostomy
Cholestyramine, somatostatin
What is the benefit of looking at PFS over OS?
Not confounded by additional lines of treatment (due to frequent crossover)
Where and what % potassium is excreted throughout the GI tract? Why is this significant?
10% stomach
20% small bowel
30% colon
Diarrhea - can result in significant hypokalemia
How do you repair a ureteral injury based on location (above/below pelvic brim)?
Upper 2/3: ureteroureterostomy (may need Psoas Hitch or Boari flap if not enough length)
Lower 1/3: ureteroneocystotomy (reimplantation)
Cysto to ensure efflux from both orifices
*Always leave a DRAIN in! It will leak!
How do you repair bladder injury based on size/location?
<2mm: leave a foley in, expectant mgmt
=1cm: 1-layer closure, foley for 5-7d
>1cm: 2-layer closure, test integrity intraop, maintain foley, cystogram at removal
Re-epithelialization occurs in 4-5d
Full strength at 21d
Trigone injury*** - call Urology, ensure ureters ok, often will need ureteral stents
Signs of unidentified urinary tract injury
leakage of urine from vagina/incision flank pain hematuria, oliguria, anuria abdominal pain, distension Ascites --> peritonitis --> ILEUS N/V, fever, sepsis
Diagnosing urinary tract injury
Exam, labs, imaging
Lytes, Cr, BUN
If ascites –> tap for Cr
Imaging: US good first line if not SICK (hydronephrosis, ascites), CT, retrograde pyelogram (XR w/con), cystogram (XR w/retrograde con)
Postop antibiotics for urinary tract injury?
NO if identified intraop
If foley maintained postop: NO abx
Delayed detection of urinary tract injury
May be very sick, febrile, septic.
Elevated WBC, BUN, Cr. Low Na.
STABILIZE FIRST - resuscitate, abx, correct obstruction with PCNT/stents. Delay final surgical correction ~12weeks.
ECOG scale
0 fully active, no restrictions
1 restricted in strenuous activity
2 ambulation, self care, up >50% time, doesn’t work
3 limited self care, confined to bed/chair >50%
4 completely disabled, unable to perform self care, 100% confined
5 dead
Emetogenic Risk scale (frequency of emesis without propylaxis)
High >90%
Mod 30-90%
Low 10-30%
Min <10%
Neutropenia grade
Grade 1 - LLN to ANC 1500
Grade 2 - 1000-1500
Grade 3 - 500-1000
Grade 4 - <500
Neutropenic fever
ANC<1500 AND
single temp > 101F, or 1hr sustained temp >100.4
MASCC score to determine high vs low risk FN
Organisms causing neutropenic fever
60% GP
40% GN
Staph epi most common
Also fungi (candida, aspergillus) and virus (Zoster)
How frequently will you ID source of neutropenic fever?
20-30% will identify organism
Management of neutropenic fever
Start abx within 1hr of diagnosis to decrease mortality
Cefepime, zosyn, meropenem (need pseudomonas coverage)
MRSA coverage with Vanc if risk (port, line, soft tissue infection, PNA)
Anaerobe coverage if GI infection
Mortality of neutropenic fever if hospitalized
5-11%
GCSF administration and utility
Help increase ANC Make thrombocytopenia WORSE Figrastim - 3d course after chemo PEGfilgrastim - 1x dose Avoid administering 48hrs before and 24hrs after chemo
GCSFs adverse effects
Bone pain (treat with antihistamine and aleve), splenic rupture (rare)
When to use GCSF?
Primary ppx - to prevent neutropenia (decrease FN risk, infection related mortality, and all cause mortality)
Secondary ppx - for patient with history of neutropenia
Therapeutic - ONLY for FN, if very sick, suspect fungal infection, PNA
Should you give antibiotic prophylaxis for patients with neutropenia?
NO it is not cost effective
Early effects of radiation
fatigue (takes up to 6 months to improve), diarrhea, dysuria (from EBRT)
Late effects of radiation
cystitis, proctitis, diarrhea (may be chronic), bone marrow depression, chronic anemia, narrowing of the terminal ileum (due to its position fixed in the pelvis by cecum) (from EBRT)
vaginal atrophy (only from VBT)
How can you protect the small bowel from radiation?
RT done with full bladder - to push small bowel out of the pelvis
How far does VBT penetrate for treatment dose?
0.5cm depth
What is the role of BRAF, and what does mutation cause? What other protein in this pathway is a target of drugs targeting this pathway?
Cell signaling pathway promoting normal growth. Mutation can result in stimulation of growth/cell replication. MEK is downstream of BRAF, and is a target of immunotherapies.
What cumulative dose of RT results in ovarian failure?
800cGy
