oncology emergecy

1. Oncologic
emergencies
AyaElgendy

2. GIT :
Intestinal obstruction , perforation
Bleeding
Biliary obstruction
Respiratory :
Air way obstruction
Malignant pleural effusion
Cardiac :
SVC obstruction
Pericardial tamponade
Urological :
Hematuria
Obstructive uropathy

3. Neurological :
Spinal cord compression
Increased ICT & brain herniation
Neoplastic meningitis
Hematological :
DIC
Leucopenia
Bleeding tendency
Metabolic :
Tumor lysis syndrome
Lactic acidosis
Endocrinal:
Acute adrenal insufficiency
Paraneolpastic:
Hypoglycemia
Hypercalcemia
hyponatremia

4. INtestinal obstruction :
Causes :
1 ) Benign :
Adhesions , hernia , radiation enteritis
2 ) Malignant :
Intra abdominal malignancy
Extra abdominal malignancy
3) Pseudo obstruction::
Malnutrrition
Radiation therapy
Electrolyte imbalance
Prolonged bed rest

5. Cardinal signs :
Pain
Vomiting
Constipation
Distention
Severity depend on :
Site of obstruction
Age
Underlying pathology
Associated Intestinal ischemia
90% reliable + mass/ high pitched intestinal sounds

6. Investigations:
1 ) Laboratory investigation
CBC
K, Na
LDH, lipase, amylase
2) radiological :
A- x ray erect and supine
B- gastrograffin follow through
c-gastrograffin enema
d - US
E- CT

15. Gastrograffin follow through :
Adva :
1) After 24 h if not appear in colon >>> failure of non operative management
2) therapeutic
Precautions :
1) aspiration pneumonia
2) shock like state
3 ) anaphylaxis
Intake :
1) immediate with admission
2) after 24-48 h after admission

16. Colonoscopy :
Limited if suspect malignancy
Precautions :
1) Not emergent case
2) Stent available
3 ) CO2 insuffilation:

17. Perforation:
Loss intestinal continuity
Causes :
IO
Perforated DU , GU
trauma
NSAIDs

18. Cardinal signs :
1) S&S of cause : IO , petic ulcer
2) signs of peritonitis :
tachycardia
tachypnea
hypotension
absent bowel sounds

19. Investigations:
1 ) Laboratory investigation
CBC
K, Na
RBS
2) radiological :
A- x ray erect and supine
B- US ( peritoneal diagnostic tap)
C- CT
3) Laparoscopic assessment

21. Management :
Surgical intervention after resuscitation ( NPO , NGT , fluids ,
analgesia and triple Abs )
goals :
1) correct underlying problem
2) ttt cause
3 ) remove necrotic tissue

22. ● Bleeding
1) Primary bleeding
* During the surgical procedure.
* Documented on the operation note.
2)Reactive bleeding
* Bleeding within 24 hours of the operation.
*During surgery patients often become relatively hypotensive and vasoconstricted.
3) Secondary bleeding
* Bleeding occurring within 7-10 days after the operation.
* Wound infection.

23. ● Intraoperative bleeding blood loss exceeding 1000 mL or requiring a blood transfusion.
Preoperative :
1 ) correct anemia and bleeding disorders
2) anticipate patients with high risk ( post RT , adhesions )
3) blood preparation
4) anatomy orientation
5) incision and good exposure

24. Intraoperative :
1 ) call for assistance
2) anesthesia team for monitoring loss , UOP
3) proper light
4) Proper visualization of bleeding vessel
5) Maneuvers and techniques to reduce bleeding
6) Proximal and distal control
7) Proper instrumentation
8)Avoid blind suturing and efforts
9)Have Confidence and patience
10)Keep a clear head even in presence of massive hemorrhage
11)Boost moral support of assistants and nursing

25. Post-operative bleeding
signs :
1 )Tachycardia
2 )Hypotension (typically develops late)
3)Tachypnoea
4)Cool peripheries
5)Pre-syncope/syncope
6)Confusion/agitation
7)Swelling and/or bruising at the wound site (secondary to haematoma
formation)
8)Bleeding from the wound site
9)Increasing tenderness at the wound site

27. * Treat all problems when discovered.
* Re-assess regularly and after every intervention to monitor a patient’s
response to treatment.
* Make use of the team around you
* continuous monitoring equipment
* call for help early
*Review results as they become available (e.g. laboratory investigations).
* Your assessment and management should be documented clearly in the
notes, however, this should not delay initial clinical assessment, investigations
and interventions.