Test #2 Carcinoid tumors PPt-Josh Flashcards Preview

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

Flashcards in Test #2 Carcinoid tumors PPt-Josh Deck (73):
1

What is a rare, slow-growing cancer.

Carcinoid tumor

2

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

Neuroendocrine system

3

Carcinoid tumors usually start in what 2 places

Digestive tract
or
Lungs

4

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

60 years old

5

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

Carcinoid syndrome

6

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

ileum
Jejunum

7

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

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

8

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

slow

9

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

appendix

10

Carcinoid tumors most common in what race

African americans (another good reason to be white)

11

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

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

12

Carcinoid tumors are found in what intestinal Glands.

crypts of lieberkuhn

13

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

lungs
mediastinum
thymus
liver
pancreas
bronchus
ovaries
prostate
kidneys

14

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

Appendix

15

Carcinoid tumors mainly secrete what?

Serotonin

16

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

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

17

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

atypical carcinoid syndrome
acromegaly
cushing's disease
other endocrine diseases

18

what are the 7 main things Carcinoid tumors secret

Serotonin
Histamine
Dopamine
Substance P
Corticotrophin
Prostaglandins
kallikrein

19

how are Carcinoid tumors classified?

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

20

Foregut tumors are divided into what 2 types

Sporadic primary tumors
tumors secondary to achlorhydria

21

Foregut Tumors:
what are examples of Sporadic primary tumors

Carcinoids of the
lung
bronchus
stomach
proximal duodenum
pancreas

22

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

Midgut

23

The midgut tumors produced high or low levels of peptides

high

24

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

Hindgut

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