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Bioscience II Brandon > 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
what class of Carcinoid tumors rarely cause carcinoid syndrome, are asymptomatic even when metastatic
Hindgut
26
With hindgut metastasis to where is common
bone
27
do hindgut tumors rarely or commonly secrete peptides
rarely
28
what is the most common location of a Carcinoid tumors
Appendix
29
Pulmonary Carcinoid tumors TYPICAL: | they typically cause high levels of ______ and _____ in the blood?
serotonin | CgA
30
Pulmonary Carcinoid tumors TYPICAL: | cause HIGH levels of ______ in the urine?
5-HIAA
31
Pulmonary Carcinoid tumors TYPICAL: | are malignant lung masses in central airways common or uncommon?
Uncommon (only 2%)
32
Pulmonary Carcinoid tumors TYPICAL: | what are s/s
cough hemoptysis recurrent pneumonia occasional chest pain
33
Pulmonary Carcinoid tumors TYPICAL: | are diagnoses how?
microscopic exam post removal! | AKA biopsy
34
Pulmonary Carcinoid tumors TYPICAL: | what is treatment?
surgical removal lobectomy laser/argon plasma coagulation
35
on so that was TYPICAL now we are goig to ATYPICAL
just want to ensure no confusion
36
Pulmonary Carcinoid tumors ATYPICAL: | these are tumors whith what levels if serotonin and CgA in blood
normal
37
Pulmonary Carcinoid tumors ATYPICAL: | these have ________ levels of 5-HIAA in urine and _____levels of serotonin and 5-HTP in urine
normal | high
38
Carcinoid Syndrome: | These are an array of symptoms that occur ______ to a carcinoid tumor
secondary
39
Carcinoid Syndrome: | are they common? or uncommon?
uncommon (10%) of pts
40
Carcinoid Syndrome: | what are S/S?
``` Flushing (head and upper thorax) Diarrhea (abd cramps d/t serotonin) left heart failure bronchoconstriction Right heart failure (more common than left) ```
41
Carcinoid Syndrome: | most of the symptoms are causes by what 2 hormons/peptides?
serotonin & kallihrein
42
Carcinoid Syndrome additional S/S: | what happens to Pulmonic and tricuspid valves?
thickening and stenosis
43
Carcinoid Syndrome additional S/S: | what can happen to the endocardial tissue?
endocardial fibrosis
44
Carcinoid Syndrome additional S/S: | what can occur to the liver?
hepatomegaly
45
Carcinoid Syndrome additional S/S: | Gi symptoms
diarrhea Cramps nausea Vomiting
46
Carcinoid Syndrome additional S/S: | what can occur with the skin
Flushing | Apparent cyanosis
47
Carcinoid Syndrome additional S/S: | what can occur with the respiratory system
Cough wheezing Dyspnea
48
Carcinoid Syndrome additional S/S: | what can occur with the pelvis
retroperitoneal and pelvis fibrosis
49
Carcinoid Syndrome: occurs in 10% of pts, with tumors, and becomes apparent when _________ substances from the tumor enter systemic circulation escaping hepatic degradation
vasoactive
50
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 ______
Liver
51
Carcinoid Syndrome: | Fact #2- if the primary tumor is in the _______, no mets is needed for a carcinoid syndrome to occur
Lungs
52
what is a term used to describe when all carcinoid syndrome symptoms occur at teh same time?
carcinoid crisis
53
S/S of Carcinoid CRISIS
flushing tachycardia bronchospasm widely fluctuating BP
54
Is carcinoid crisis potentially fatal
you bet your ass
55
what are the most common causes of Carcinoid crisis?
Anesthetic intervention | Radiological and surgical intervention
56
what does CgA stand for?
Chromagranin A
57
pts with Carcinoid Syndrome secrete more than ____mg of 5-HIAA per/day
25mg
58
Carcinoid Syndrome: | ways to diagnosis
``` 24 hr urine CgA labs Imaging (octreoscan) CT/MRI/PET Barrium swallow Laparotomy ```
59
Anesthesia Implications: Preop | minimize tumor activity before the day of sx with what drug?
Octreotide
60
Anesthesia Implications: Preop | what is the octreotide infusion rate? and for how long preop
50-100mcg/hr | 12 hrs
61
Anesthesia Implications: Preop | the uncontrolled hormone release precipitated by the surgical stimulus can cause what?
HTN crisis and Hemodynamic collapse
62
Anesthesia Implications: Techniques Regional | when should you insert it
prior to GA
63
Anesthesia Implications: Techniques Regional | why is it benificial
reduction in carcinoid crisis
64
Anesthesia Implications: Techniques Regional | what is a draw back of Epidurals
hypotension -> tx with vasoconstrictors | lead to exaggerated response
65
Anesthesia Implications: Techniques GETA | Avoid what drugs
``` Morphine Atricurium Keatamine EPI Norepi isopuretol ```
66
Anesthesia Implications: Techniques GETA | drugs good to use
``` propofol remifentanil vec roc etomidate fentanyl ```
67
Anesthesia Implications: Techniques GETA | what is the best VAA to use b/c it has the lowest metabolic rate
Isoflurane
68
Anesthesia Implications: Intraop | what are some monitors you may want?
a-linw PA cath CVP ABGS
69
Anesthesia Implications: Intraop | what is the best drug for HTN treatment?
Octreoide 20-25mcg boluses
70
Octreotide: | what is it
an analogue of somatastatin-blunts vasoactive and bronchoconstriction effects of carcinoid tumor secretion.
71
Octreotide: | MOA
mimics inhibitory effects of somatostatin, inhibits release of serotonin, gastrin, vasoactive intestinal peptide, secretin, motilin, and pancreatic polypeptide
72
Octreotide: | SE
``` N/v bradycardia Conduction defects QT prolongation Abd cramps ```
73
Thats it!!!
A special thanks goes out to david Holt for his exhilarating presentation

Bioscience II Brandon (11 decks)

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