Diferencia entre revisiones de «Neutropenic enterocolitis»
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==Evaluation== | ==Evaluation== | ||
===Workup=== | ===Workup<ref>Machado NO. Neutropenic enterocolitis: A continuing medical and surgical challenge. N Am J Med Sci. 2010 Jul; 2(7): 293–300.</ref>=== | ||
CT A/P: cecal distention | *CBC with neutropenia, thrombocytopenia | ||
*Blood cultures positive in ~25-85%, frequently bowel organisms | |||
*CT A/P: cecal distention, wall thickening, pneumatosis intestinalis, intestinal perforation, fat stranding | |||
*Avoid endoscopic evaluation due to risk of perforation, hemorrhage, bacterial translocation, worsening sepsis | |||
==Management== | ==Management== | ||
Revisión del 11:40 11 feb 2017
Background
- Necrosis of bowel wall secondary to polymicrobial invasion
- Involves terminal ileum and colon
- May progress to full-thickness infarction/perforation
- Occurs 10-14d after cytotoxic therapy
Clinical Features
- Fever
- RLQ pain
- Nausea
- Vomiting
Differential Diagnosis
Oncologic Emergencies
Related to Local Tumor Effects
- Malignant airway obstruction
- Bone metastases and pathologic fractures
- Malignant spinal cord compression
- Malignant Pericardial Effusion and Tamponade
- Superior vena cava syndrome
Related to Biochemical Derangement
- Hypercalcemia of malignancy
- Hyponatremia due to SIADH
- Adrenal insufficiency
- Tumor lysis syndrome
- Carcinoid syndrome
Related to Hematologic Derangement
Related to Therapy
- Chemotherapy-induced nausea and vomiting
- Cytokine release syndrome
- Chemotherapeutic drug extravasation
- Differentiation syndrome (retinoic acid syndrome) in APML
- Stem cell transplant complications
- Catheter-related complications
- Tunnel infection
- Exit site infection
- CVC obstruction (intraluminal or catheter tip thrombosis)
- Catheter-related venous thrombosis
- Fracture of catheter lumen
- Oncologic therapy related adverse events
RLQ Pain
- GI
- Appendicitis
- Perforated appendicitis
- Peritonitis
- Crohn's disease (terminal ileitis)
- Diverticulitis (cecal, Asian patients)
- Inguinal hernia
- Mesenteric ischemia
- Ischemic colitis
- Meckel's diverticulum
- Neutropenic enterocolitis (typhlitis)
- Appendicitis
- GU
- Other
Evaluation
Workup[1]
- CBC with neutropenia, thrombocytopenia
- Blood cultures positive in ~25-85%, frequently bowel organisms
- CT A/P: cecal distention, wall thickening, pneumatosis intestinalis, intestinal perforation, fat stranding
- Avoid endoscopic evaluation due to risk of perforation, hemorrhage, bacterial translocation, worsening sepsis
Management
- Bowel rest
- NG suction
- IVF
- Broad spec antibiotics
Disposition
- Surgial consult (possible right hemicolectomy)
See Also
- ↑ Machado NO. Neutropenic enterocolitis: A continuing medical and surgical challenge. N Am J Med Sci. 2010 Jul; 2(7): 293–300.