Documentos de Académico
Documentos de Profesional
Documentos de Cultura
DR. YU LING LEE TSAI RII MEDICINA INTERNA HOSPITAL GENERAL SAN JUAN DE DIOS
CONTENIDO
O Sndrome de vena cava superior
O Derrame pericrdico O Compresin medular O Metstasis cerebral O Sndrome de hiperviscosidad O Obstruccin de va aerea O Herniacin cerebral
INTRODUCCION
O El cncer es la segunda causa de muerte
en Estados Unidos O En 2007 mas de 1.4 millones de casos son diagnosticados y 559,000 muertes O Cancer pulmonar - hombres O Cancer de mama - mujeres
Selected Oncologic Emergencies, Sandra Ugras-Rey and Mark Watson, Medicine and Surgery , chapter 12
ETIOLOGIA
O Proceso agudo o subagudo causado por
Oncologic Emergencies, Behl et al, Crit Care Clin 26 (2010) 181205 Selected Oncologic Emergencies, Sandra Ugras-Rey and Mark Watson, Medicine and Surgery , chapter 12 Anthony S. Fauci, Eugene Braunwald, Dennis L. Kasper; Harrison Principios de Medicina
PRESENTACION CLINICA
O Edema periorbitario, cuello, cara y tronco
O Tos, disnea, hemoptisis, estridor y disfagia O Edema en hombro y dilatacion venosa O Cefalea, confusin y coma O Signo de Stoke O Sndrome de Rubin
Oncologic Emergencies, Behl et al, Crit Care Clin 26 (2010) 181205 Selected Oncologic Emergencies, Sandra Ugras-Rey and Mark Watson, Medicine and Surgery , chapter 12 Anthony S. Fauci, Eugene Braunwald, Dennis L. Kasper; Harrison Principios de Medicina
DIAGNOSTICO
O Radiografa: ensanchamiento mediastinal
O Tomografa O Resonancia magntica
Oncologic Emergencies, Behl et al, Crit Care Clin 26 (2010) 181205 Selected Oncologic Emergencies, Sandra Ugras-Rey and Mark Watson, Medicine and Surgery , chapter 12
MANEJO
O Obstruccin de va aerea
O Sintomas neurolgicos O Marcador de mal pronstico O Diagnstico histolgico O Colocacin de Stent O Radioterapia y Quimioterapia O Supervivencia 25% al ao
Oncologic Emergencies, Behl et al, Crit Care Clin 26 (2010) 181205 Selected Oncologic Emergencies, Sandra Ugras-Rey and Mark Watson, Medicine and Surgery , chapter 12 Anthony S. Fauci, Eugene Braunwald, Dennis L. Kasper; Harrison Principios de Medicina
ETIOLOGIA
O Tumores benignos
O Tumores malignos
O Mesotelioma
Oncologic Emergencies, Behl et al, Crit Care Clin 26 (2010) 181205 Selected Oncologic Emergencies, Sandra Ugras-Rey and Mark Watson, Medicine and Surgery , chapter 12 Anthony S. Fauci, Eugene Braunwald, Dennis L. Kasper; Harrison Principios de Medicina
PRESENTACION CLINICA
O Triada de Beck
O Disnea O Discomfort torcico O Fatiga O Presin de pulso estrecho O Pulso paradjico O Roce pericardico O EKG y Rx trax (90%)
Oncologic Emergencies, Behl et al, Crit Care Clin 26 (2010) 181205 Selected Oncologic Emergencies, Sandra Ugras-Rey and Mark Watson, Medicine and Surgery , chapter 12 Anthony S. Fauci, Eugene Braunwald, Dennis L. Kasper; Harrison Principios de Medicina
MANEJO
O Ecocardiograma
O No hay ventaja drenar derrames O
O
O O O O
asintomaticos Quimioterapia sistmica e intrapericardica Pericardiostoma sufxifoidea Pericardiotoma percutanea Ventana pericardica Escleroterapia Supervivencia media de menos de 1 ao
Oncologic Emergencies, Behl et al, Crit Care Clin 26 (2010) 181205 Selected Oncologic Emergencies, Sandra Ugras-Rey and Mark Watson, Medicine and Surgery , chapter 12 Anthony S. Fauci, Eugene Braunwald, Dennis L. Kasper; Harrison Principios de Medicina
COMPRESION MEDULAR
COMPRESION MEDULAR
O Complicacin neurolgica devastador (5
(15 20%)
O Linfoma no hodgkin, carcinoma de celula
Oncologic Emergencies, Behl et al, Crit Care Clin 26 (2010) 181205 Selected Oncologic Emergencies, Sandra Ugras-Rey and Mark Watson, Medicine and Surgery , chapter 12 Anthony S. Fauci, Eugene Braunwald, Dennis L. Kasper; Harrison Principios de Medicina
FISIOPATOLOGIA
O Via hematgena
O Extensin de lesin paravertebral (15%) O Destruccin de vertebra O Compresin causa desmielinizacin, dao
Oncologic Emergencies, Behl et al, Crit Care Clin 26 (2010) 181205 Selected Oncologic Emergencies, Sandra Ugras-Rey and Mark Watson, Medicine and Surgery , chapter 12
PRESENTACIN CLINICA
O Dolor de espalda (90%)
O Localizacion mas frecuente es la columna
Oncologic Emergencies, Behl et al, Crit Care Clin 26 (2010) 181205 Selected Oncologic Emergencies, Sandra Ugras-Rey and Mark Watson, Medicine and Surgery , chapter 12 Anthony S. Fauci, Eugene Braunwald, Dennis L. Kasper; Harrison Principios de Medicina
DIAGNOSTICO
O Resonancia magnetica: gold standard
O Radiografa simple O Tomografia
TRATAMIENTO
O Aliviar el dolor y recuperar la funcin
neurolgica
O Esteroides O Radioterapia O Cirugia descompresiva
Oncologic Emergencies, Behl et al, Crit Care Clin 26 (2010) 181205 Selected Oncologic Emergencies, Sandra Ugras-Rey and Mark Watson, Medicine and Surgery , chapter 12
METASTASIS CEREBRAL
METASTASIS CEREBRAL
O Tumor intracraneal mas comn
O Cancer pulmonar O Cancer de mama y melanoma O Supervivencia de 4 semanas sin
tratamiento
O Indice de Karnofsky O Enfermedad sistemica
O Tumor primario
Oncologic Emergencies, Behl et al, Crit Care Clin 26 (2010) 181205 Selected Oncologic Emergencies, Sandra Ugras-Rey and Mark Watson, Medicine and Surgery , chapter 12
FISIOPATOLOGIA
O Diseminacin hematogena
O Edema cerebral e incremento de presion
IC O Hidrocefalia
PRESENTACIN CLINICA
O 75% tiene sntomas neurologicos
O Cefalea en 50% O Dficit neurologico focal O Convulsiones O Cambios neurocognitivos O Incremento de Presin intracraneana
O Triada de Cushing O Cefalea, nausea y vmitos O Debilidad, ataxia, cambio de estado mental
Oncologic Emergencies, Behl et al, Crit Care Clin 26 (2010) 181205 Selected Oncologic Emergencies, Sandra Ugras-Rey and Mark Watson, Medicine and Surgery , chapter 12
DIAGNOSTICO
O Resonancia magnetica con contraste
O Tomografia
TRATAMIENTO
O Dexametasona
O Manitol O Hiperventilacin O Radioterapia O Cirugia O Radiocirugia estereotactica O Quimioterapia O Antiepilepticos
Oncologic Emergencies, Behl et al, Crit Care Clin 26 (2010) 181205 Selected Oncologic Emergencies, Sandra Ugras-Rey and Mark Watson, Medicine and Surgery , chapter 12
SINDROME DE HIPERVISCOSIDAD
SINDROME DE HIPERVISCOSIDAD
O Se refiere a las consecuencias clnicas
O Mieloma mltiple
O Leucemias agudas
Oncologic Emergencies, Behl et al, Crit Care Clin 26 (2010) 181205 Selected Oncologic Emergencies, Sandra Ugras-Rey and Mark Watson, Medicine and Surgery , chapter 12
FISIOPATOLOGA
O Discrasia de clulas plasmticas
O Efectos adversos en perfusin tisular O Hematocrito O Protenas O Inmunoglobulinas
O IgM O IgA
Oncologic Emergencies, Behl et al, Crit Care Clin 26 (2010) 181205 Selected Oncologic Emergencies, Sandra Ugras-Rey and Mark Watson, Medicine and Surgery , chapter 12
PRESENTACION CLNICA
O Trada clsica
O Anormalidades neurolgicas O Cambios visuales O Sangrado
Oncologic Emergencies, Behl et al, Crit Care Clin 26 (2010) 181205 Selected Oncologic Emergencies, Sandra Ugras-Rey and Mark Watson, Medicine and Surgery , chapter 12
DIAGNOSTICO
O Examen fsico
O Panel de electrolitos O Tiempos de coagulacin O Viscosidad srica O Frote periferico O Niveles de Ig
Oncologic Emergencies, Behl et al, Crit Care Clin 26 (2010) 181205 Selected Oncologic Emergencies, Sandra Ugras-Rey and Mark Watson, Medicine and Surgery , chapter 12
TRATAMIENTO
O Plasmaferesis
O Leucofresis O Flebotoma O Hidratacin O Diurticos O Transfusin de clulas
Oncologic Emergencies, Behl et al, Crit Care Clin 26 (2010) 181205 Selected Oncologic Emergencies, Sandra Ugras-Rey and Mark Watson, Medicine and Surgery , chapter 12
OBSTRUCCION AEREA
O Lesiones locales o metastasicas
O Carcinoma broncogenico primario (30%) O No modifica la supervivencia O Otros tumores primarios: Tidoides,
PRESENTACION CLINICA
O Estridor
O Disnea O Hemoptisis O Tos O Sibilancias, disminucion de entrada de
aire
DIAGNOSTICO
O Radiografia simple
O Tomografia O Broncoscopia O Espirometria
TRATAMIENTO
O Establecer una via aerea patente
O Stent O Laser O Terapia fotodinamica O Radioterapia O Quimioterapia
HERNIACION CEREBRAL
FISIOPATOLOGIA
O Ocurre cuando incrementa la presin
intracraneana debido a una masa en crecimiento O Lesiones primarias, metastsicas o hemorragia O Hematoma subdural, absceso cerebral, hidrocefalia aguda y necrosis cerebral inducida por radiacin
Selected Oncologic Emergencies, Sandra Ugras-Rey and Mark Watson, Medicine and Surgery , chapter 12
TIPOS
O Uncal
O Central O Tonsilar
Selected Oncologic Emergencies, Sandra Ugras-Rey and Mark Watson, Medicine and Surgery , chapter 12
MANEJO
O Hiperventilacin
O Manitol O Dexametasona
Selected Oncologic Emergencies, Sandra Ugras-Rey and Mark Watson, Medicine and Surgery , chapter 12
GRACIAS