Oropharyngeal
Risk factors of oral cancer?
Tobacco use, excessive alcohol intake
Lip: exposure to sun, pipe stem irritation
Chronic irritation (jagged tooth, poor dental care)
HPV
Risk factors of esophageal cancer?
Smoking, alcohol abuse, injury/chronic irritation of esophagus (asbestos and cement dust, achalasia - delayed emptying of lower esophagus, Barrett's esophagus)
Risk factors for stomach cancer
H. pylori, auto-immune-related inflammation, repeated exposure to irritants (bile, NSAIDS, tobacco use), diets high in smoked foods, salted fish and meat, pickled vegetables
Gastric Outlet Obstruction management
Decompress stomach - use Ng to suction and ensure patent
IV fluids, may need surgery, pain relief, allow the ulcer to being healing, decrease inflammation and edema
Risks of Peritonitis
Surgery, trauma (gunshot wound, stab wound), Peritoneal dialysis, perforated PUD, Inflammation extending from an organ outside the peritoneal area.
CM of oral cancer?
Ulcers, changes in mucosa (leukoplakia, erythroplakia), sore throat, sore mouth, voice changes
Late CM: increased salivation, slurred speech, dysphagia, toothache, and earache
CM of esophageal cancer? Early or late onset?
Late onset
Progressive dysphagia, pain, weight loss, regurgitation of blood-flecked esophageal contents
CM of stomach cancer
Tumor infiltration into gastric lumen, weight loss, early satiety, anorexia, indigestion, abdominal discomfort or pain, N&V, chronic blood loss -> anemia, fatigue
Perforation management
Monitor VS frequently, IV fluid, I&O hourly, stop spillage of gastric or duodenal contents into the peritoneal cavity, NG tube to suction, IV antibiotics, pain medication
CM of Peritonitis
Signs of infection (sepsis), pain, tender. Distended abdomen, rigid abdominal muscles, reboud tenderness. N&V, anorexia, diminished peristalsis, paralytic ileus -> could progress to shock.
Interprofessional care for oral cancer?
Surgery (small tumor removal, partial removal mandible or tongue, radial neck dissection)
Radiation (may be primary treatment, combined with surgery after 6 weeks, palliative)
Chemotherapy (prior to surgery to shrink lesions, decreased metastasis, sensitize cancer cells to radiation, treat metastases)
Complications of esophageal cancer?
Hemorrhage (if erodes through esophagus and into aorta)
Esophageal perforation with fistula formation
Esophageal obstruction
Inerprofessional management for stomach cancer and preop
Surgery: Partial gastrectomy, or Total gastrectomy (esophagojejunostomy)
Preop needs: Treat malnutrition and anemia
Drugs for PUD
Antibiotics for H. pylori
Proton pump inhibitors
H2-receptor blockers
Cytoprotective drugs (sucralfate)
Antacids
Different types of hematemesis (vomiting blood)
Bright red (not in contact with gastric secretions)
Coffee ground (been in the stomach for some time)
Massive bleeding or hemorrhage >1500mL of blood loss
Pre & Post op care for oral cancer
Pre-op: Nutrition consult (enteral, parenteral feeding considerations)
Post-op: Patent airway – secretions (suctioning), May require tracheostomy, Verbal communication impaired (ability to write)
Interprofessional care for esophageal cancer? Pre & Post - op needs
Esophagectomy (Removal of part or all of esophagus, Use of Dacron graft to replace resected part)
Esophagogastrostomy (Resection of portion of esophagus and anastomosis of remaining portion to stomach)
Pre-op (Nutrition therapy: improve nutrition & physical status (weight gain), Parenteral or enteral nutrition)
Postoperative Care (NPO until x-ray studies show no esophageal leak, NG suction in place (do not manipulate), Aspiration pneumonia, Chest drainage, Parenteral & fluid therapy, gastric intubation)
AIRWAY!!!!
Post op needs for interprofessional management for stomach cancer
Postop needs: NG tube until peristalsis returns, When peristalsis returns – begin with small amount clear liquid and advance
Surgical therapy for PUD
Vagotomy (cut vagus nerve to reduce gastric acid secretion)
Billroth I (A): gastroduodenostomy
Billroth II (B): gastrojejunostomy
Pyloroplasty: surgical enlargement of the pyloric sphincter to facilitate the easy passage of contents from the stomach
Interventions for GI Bleed
Establish 2 IV accesses- 16 or 18 gauge needle, IV NS or LR (priority), Prepare to give blood /pRBCs, IV PPI (pantoprazole)
Supplemental O2 nasal cannula or non-rebreather mask
NPO and NG may be needed
Place on ECG monitoring
Obtain blood for lab: CBC, clotting studies, type & crossmatch
Indwelling urinary catheter to monitor I&O
Other considerations with oral cancer
Stomatitis (provide adequate oral/mouth care)
Pain and discomfort (soft liquid diet)
Self-image due to disfiguring surgery
Xerostomia (especially after surgery or radiation treatment) –use saliva substitutes
Nutrition (orders, supplements, route)
Nutritional therapy for esophageal cancer?
After surgery, parenteral fluids given, Jejunostomy, gastrostomy, or esophagostomy feeding tube may be placed, Swallowing study may be done before patient can have oral fluids, When permitted, water (30–60 mL) is given hourly, Gradual progression to small, frequent, bland meals, Maintain upright position, Observe for intolerance of feeding
Often prescribed to prevent anemia
Vitamin B12
Dumping syndrom CM & Interventions
Clinical Manifestations: Generalized weakness, sweating, palpitations, dizziness, abdominal cramps, borborygmi, urge to defecate, usually lasts less than 1 hour
Interventions to alleviate dumping syndrome: 6 small meals, No fluids with meals, Avoid concentrated sweets, Increase protein and fat, Short rest period after eating
Management for Peritonitis
Fluid and electrolyte replacement (major focus), Analgesics, NG Suction/antiemetics, Fluid in belly = respiratory distress (O2 & positioning), Antibiotics (broad spectrum then specific), The main focus is to identify and eradicate the source of 20 infection, Prepare for Emergency Surgery
Monitor for hypovolemia, BP