Neutropenic enterocolitis: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Oncologic emergencies DDX}} | {{Oncologic emergencies DDX}} | ||
{{Abd DDX RLQ}} | |||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 22:23, 19 July 2016
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
Diagnosis
Workup
CT A/P: cecal distention and wall thickening
Management
- Bowel rest
- NG suction
- IVF
- Broad spec antibiotics
Disposition
- Surgial consult (possible right hemicolectomy)