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BioScience II > Test #2 Carcinoid tumors PPt-Josh > Flashcards

Test #2 Carcinoid tumors PPt-Josh Flashcards

1
Q

What is a rare, slow-growing cancer.

A

Carcinoid tumor

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2
Q

Carcinoid tumors are a type of neuroendocrine tumor oringinating in the cells of the ______ system

A

Neuroendocrine system

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3
Q

Carcinoid tumors usually start in what 2 places

A

Digestive tract
or
Lungs

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4
Q

with Carcinoid tumors the EARLY STAGES don’t produce symptoms, therefore the average age of diagnosis is what?

A

60 years old

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5
Q

in the LATER STAGES the Carcinoid tumors sometimes produce hormones that can cause what?

A

Carcinoid syndrome

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6
Q

Carcinoid syndrome is usually produced by a 1 cm tumors in the _____ and _____

A

ileum

Jejunum

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7
Q

What are the most common NEUROENDOCRINE tumor? with an est 1.5 clinical cases per 100,000 popultions?

A

Carcinoid tumors ( no shit right this is what the fucking topic is)

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8
Q

Most Carcinoid tumors are _____ growing without symptoms, however aggressive and metastatic disease does occur!

A

slow

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9
Q

Carcinoid tumors specifically in the _________ can also metasasize! (hint part of the GI tract)

A

appendix

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10
Q

Carcinoid tumors most common in what race

A

African americans (another good reason to be white)

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11
Q

Carcinoid tumors arise from what cells? and where are those cells located?

A 
enterochromaffin cells (ECL)
located in the digestive tract 
(thus the reason it is usually located in the intestines)
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12
Q

Carcinoid tumors are found in what intestinal Glands.

A

crypts of lieberkuhn

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13
Q

Carcinoid tumors are usually found in the intestinal glands crypts of lieberkuhn, but can also be found where else

A 
lungs
mediastinum
thymus
liver
pancreas
bronchus
ovaries
prostate
kidneys
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14
Q

In children Carcinoid tumors mostly occur in the ______and are benig and asymptomatic

A

Appendix

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15
Q

Carcinoid tumors mainly secrete what?

A

Serotonin

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16
Q

Carcinoid tumors mainly secrete serotonin, but what other 4 peptides are also secreted

A

chromograins
pancreatic polypeptide
5-hydroxytrptophan (5-htp)
histamine

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17
Q

Carcinoid tumors can metastasize to bone and be associated with what disorders

A

atypical carcinoid syndrome
acromegaly
cushing’s disease
other endocrine diseases

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18
Q

what are the 7 main things Carcinoid tumors secret

A 
Serotonin
Histamine
Dopamine
Substance P
Corticotrophin
Prostaglandins
kallikrein
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19
Q

how are Carcinoid tumors classified?

A

based on location in the primitive gut (foregut, midgut, hindgut) that gives rise to the tumor!!!
AKA “the site of origin”

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20
Q

Foregut tumors are divided into what 2 types

A

Sporadic primary tumors

tumors secondary to achlorhydria

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21
Q

Foregut Tumors:

what are examples of Sporadic primary tumors

A 
Carcinoids of the 
lung
bronchus
stomach
proximal duodenum
pancreas
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22
Q

what Class of tumor are derived from the 2nd portion of the duodenum, the jejunum, the ilium, and the right colon (ascending)

A

Midgut

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23
Q

The midgut tumors produced high or low levels of peptides

A

high

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24
Q

what Carcinoid tumors classification arise from the transverse, descending colon, and rectum?

A

Hindgut

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25
Q

what class of Carcinoid tumors rarely cause carcinoid syndrome, are asymptomatic even when metastatic

A

Hindgut

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26
Q

With hindgut metastasis to where is common

A

bone

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27
Q

do hindgut tumors rarely or commonly secrete peptides

A

rarely

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28
Q

what is the most common location of a Carcinoid tumors

A

Appendix

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29
Q

Pulmonary Carcinoid tumors TYPICAL:

they typically cause high levels of ______ and _____ in the blood?

A

serotonin

CgA

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30
Q

Pulmonary Carcinoid tumors TYPICAL:

cause HIGH levels of ______ in the urine?

A

5-HIAA

31
Q

Pulmonary Carcinoid tumors TYPICAL:

are malignant lung masses in central airways common or uncommon?

A

Uncommon (only 2%)

32
Q

Pulmonary Carcinoid tumors TYPICAL:

what are s/s

A

cough
hemoptysis
recurrent pneumonia
occasional chest pain

33
Q

Pulmonary Carcinoid tumors TYPICAL:

are diagnoses how?

A

microscopic exam post removal!

AKA biopsy

34
Q

Pulmonary Carcinoid tumors TYPICAL:

what is treatment?

A

surgical removal
lobectomy
laser/argon plasma coagulation

35
Q

on so that was TYPICAL now we are goig to ATYPICAL

A

just want to ensure no confusion

36
Q

Pulmonary Carcinoid tumors ATYPICAL:

these are tumors whith what levels if serotonin and CgA in blood

A

normal

37
Q

Pulmonary Carcinoid tumors ATYPICAL:

these have ________ levels of 5-HIAA in urine and _____levels of serotonin and 5-HTP in urine

A

normal

high

38
Q

Carcinoid Syndrome:

These are an array of symptoms that occur ______ to a carcinoid tumor

A

secondary

39
Q

Carcinoid Syndrome:

are they common? or uncommon?

A

uncommon (10%) of pts

40
Q

Carcinoid Syndrome:

what are S/S?

A 
Flushing (head and upper thorax)
Diarrhea (abd cramps d/t serotonin)
left heart failure 
bronchoconstriction
Right heart failure (more common than left)
41
Q

Carcinoid Syndrome:

most of the symptoms are causes by what 2 hormons/peptides?

A

serotonin & kallihrein

42
Q

Carcinoid Syndrome additional S/S:

what happens to Pulmonic and tricuspid valves?

A

thickening and stenosis

43
Q

Carcinoid Syndrome additional S/S:

what can happen to the endocardial tissue?

A

endocardial fibrosis

44
Q

Carcinoid Syndrome additional S/S:

what can occur to the liver?

A

hepatomegaly

45
Q

Carcinoid Syndrome additional S/S:

Gi symptoms

A

diarrhea
Cramps
nausea
Vomiting

46
Q

Carcinoid Syndrome additional S/S:

what can occur with the skin

A

Flushing

Apparent cyanosis

47
Q

Carcinoid Syndrome additional S/S:

what can occur with the respiratory system

A

Cough
wheezing
Dyspnea

48
Q

Carcinoid Syndrome additional S/S:

what can occur with the pelvis

A

retroperitoneal and pelvis fibrosis

49
Q

Carcinoid Syndrome:
occurs in 10% of pts, with tumors, and becomes apparent when _________ substances from the tumor enter systemic circulation escaping hepatic degradation

A

vasoactive

50
Q

Carcinoid Syndrome:
Fact #1- if primary tumor is from the GI tract (serotonin released into the hepatic portal circulation), carcinoid syndrome generally doesn’t occur until the tumor has metastasized to the ______

A

Liver

51
Q

Carcinoid Syndrome:

Fact #2- if the primary tumor is in the _______, no mets is needed for a carcinoid syndrome to occur

A

Lungs

52
Q

what is a term used to describe when all carcinoid syndrome symptoms occur at teh same time?

A

carcinoid crisis

53
Q

S/S of Carcinoid CRISIS

A

flushing
tachycardia
bronchospasm
widely fluctuating BP

54
Q

Is carcinoid crisis potentially fatal

A

you bet your ass

55
Q

what are the most common causes of Carcinoid crisis?

A

Anesthetic intervention

Radiological and surgical intervention

56
Q

what does CgA stand for?

A

Chromagranin A

57
Q

pts with Carcinoid Syndrome secrete more than ____mg of 5-HIAA per/day

A

25mg

58
Q

Carcinoid Syndrome:

ways to diagnosis

A 
24 hr urine
CgA labs
Imaging (octreoscan)
CT/MRI/PET
Barrium swallow
Laparotomy
59
Q

Anesthesia Implications: Preop

minimize tumor activity before the day of sx with what drug?

A

Octreotide

60
Q

Anesthesia Implications: Preop

what is the octreotide infusion rate? and for how long preop

A

50-100mcg/hr

12 hrs

61
Q

Anesthesia Implications: Preop

the uncontrolled hormone release precipitated by the surgical stimulus can cause what?

A

HTN crisis and Hemodynamic collapse

62
Q

Anesthesia Implications: Techniques Regional

when should you insert it

A

prior to GA

63
Q

Anesthesia Implications: Techniques Regional

why is it benificial

A

reduction in carcinoid crisis

64
Q

Anesthesia Implications: Techniques Regional

what is a draw back of Epidurals

A

hypotension -> tx with vasoconstrictors

lead to exaggerated response

65
Q

Anesthesia Implications: Techniques GETA

Avoid what drugs

A 
Morphine
Atricurium
Keatamine
EPI
Norepi
isopuretol
66
Q

Anesthesia Implications: Techniques GETA

drugs good to use

A 
propofol
remifentanil
vec roc
etomidate
fentanyl
67
Q

Anesthesia Implications: Techniques GETA

what is the best VAA to use b/c it has the lowest metabolic rate

A

Isoflurane

68
Q

Anesthesia Implications: Intraop

what are some monitors you may want?

A

a-linw
PA cath
CVP
ABGS

69
Q

Anesthesia Implications: Intraop

what is the best drug for HTN treatment?

A

Octreoide 20-25mcg boluses

70
Q

Octreotide:

what is it

A

an analogue of somatastatin-blunts vasoactive and bronchoconstriction effects of carcinoid tumor secretion.

71
Q

Octreotide:

MOA

A

mimics inhibitory effects of somatostatin, inhibits release of serotonin, gastrin, vasoactive intestinal peptide, secretin, motilin, and pancreatic polypeptide

72
Q

Octreotide:

SE

A 
N/v
bradycardia
Conduction defects
QT prolongation
Abd cramps
73
Q

Thats it!!!

A

A special thanks goes out to david Holt for his exhilarating presentation

BioScience II (39 decks)

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