Tumor Rupture and Organ
7.7 Abdominal Compartment
Syndrome Although mostly seen in adult patients who have sustained trauma, abdominal compartment syndrome ACS may occur in pediatric patients, including those with large tumor masses at pre- sentation or as a postoperative complication Fisher and Rheingold 2011 ; Terpe et al. 2012 . The mechanism of ACS appears to be ischemia- reperfusion injury with associated bowel isch- emia or necrosis Beck et al. 2001 . Two large prospective studies report the incidence of ACS among children admitted to the intensive care unit to be 1 , irrespective of an oncologic diagnosis and with high risk of mortality Cheatham et al. 2007 . Increased intra- abdominal pressure IAP leads to multiorgan compromise by initially impairing respiratory mecha nics which alter cardiac output leading to organ hypoperfusion and subsequent renal and cerebral insuffi ciency De Backer 1999 . Although no defi nitive ACS diagnostic crite- ria exist for the pediatric population, children are thought to require an IAP of ≥20 mmHg with associated organ compromise Beck et al. 2001 ; Cheatham et al. 2007 ; Fisher and Rheingold 2011 . Patients with ACS will present with a tense and distended abdomen with associated hypotension, oliguria or anuria and respiratory compromise Beck et al. 2011 . The aims of ACS management are to: 1 improve abdominal wall compliance with positioning and medications; 2 decrease intraluminal content with nasogas- tric suction; 3 decrease extraluminal content with percutaneous catheter decompression of intraperitoneal air or fl uid; and 4 optimize fl uid balance to reduce end-organ hypoperfusion with- out worsening IAH. Elevating the head of the bed increases IAP and should be avoided; similarly, sedatives and analgesics will increase abdominal muscle tone and should be minimized, as possi- ble. Studies in adults with ACS are investigating neuromuscular blockade as a means to decrease IAP. Careful aggressive fl uid resuscitation with hypertonic crystalloids and colloids should be attempted although refractory IAH or end-organ damage requires immediate surgical decompres- sion Cheatham et al. 2007 .7.8 Summary
Prompt identifi cation of abdominal emergencies in pediatric oncology patients can be a chal- lenge due to decreased signs and symptoms of infl ammation in the immunocompromised host. Successful outcomes require vigilance for atypi- cal presentations in immunocompromised chil- dren; early initiation of broad-spectrum, empiric antibiotics to reduce infection-related mortality; supportive care measures such as volume resusci- tation and bleeding control; identifi cation of incit- ing chemotherapeutic agents as well as radiation therapy; appropriate utilization of imaging modalities; and a multidisciplinary team approach with oncology, surgery, and radiology to acceler- ate diagnosis and treatment. Prompt diagnosis and early medical management reduces the necessity of invasive measures. The majority of guidelines for care of these emergent issues are based on consensus panels and expert opinion due to a lack of randomized controlled trial data. References Abdulrahman MA, Fallone CA, Barkun AN 2004 Nasogastric aspirate predicts high-risk endoscopic lesions in patients with acute upper GI bleeding. Gastrointest Endosc 59:172–178 Albano EA, Sandler E 2004 Oncologic emergencies. In: Altman AJ, Reaman GH eds Supportive care of chil- dren with cancer: current therapy and guidelines from the children’s oncology group, 3rd edn. The John Hopkins University Press, Baltimore Andreyev HJ, Davison SE, Gillespie C et al 2012 Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment for cancer. Gut 61:179–192 Arul GS, Spicer RD 2008 Gastrointestinal complica- tions. In: Carachi R, Grosfeld JL, Azmy AF eds The surgery of childhood tumors, 2nd edn. Springer, New York Beck R, Halberthal M, Zonis Z et al 2001 Abdominal compartment syndrome in children. Pediatr Crit Care Med 2:51–56 Büyükaşik Y, Ozcebe OI, Sayinalp N et al 1988 Perianal infections in patients with leukemia: importance of the course of neutrophil count. Dis Colon Rectum 41:81–85 Cheatham ML, Malbrain ML, Kirkpatrick A et al 2007 Results from the International Conference of Experts on intra-abdominal hypertension and abdominal com- partment syndrome. II. Recommendations. Intensive Care Med 33:951–962 Chui CH, Chan MY, Tan AM et al 2008 Appendicitis in immunocompromised children: still a diagnostic and therapeutic dilemma? Pediatr Blood Cancer 50:1282–1283 Cloutier RL 2010 Neutropenic enterocolitis. Hematol Oncol Clin North Am 24:577–584 De Backer D 1999 Abdominal compartment syndrome. Crit Care 3:R103–R104 Demshar R, Vanek R, Mazanec P 2011 Oncologic emer- gencies: new decade, new perspectives. AACN Adv Crit Care 22:337–348 Fisher MJ, Rheingold SR 2011 Oncologic emergencies. In: Pizzo PA, Poplack DG eds Principles and practice of pediatric oncology, 6th edn. Lippincott Williams Wilkins, Pennsylvania Gagneja HK, Sinicrope FA 2002 Gastrointestinal emergencies. In: Yeung SJ, Escalante CP eds Oncologic emergencies. BC Decker Inc, Hamilton Garg R, Agarwala S, Bhatnagar V 2010 Acute pancre- atitis induced by ifosfamide therapy. J Pediatr Surg 45:2071–2073 Gray TL, Ooi CY, Tran D et al 2010 Gastrointestinal complications in children with acute myeloid leuke- mia. Leuk Lymphoma 51:768–777 Gupta H, Davidoff AM, Pui CH et al 2007 Clinical implications and surgical management of intussuscep- tion in pediatric patients with Burkitt lymphoma. J Pediatr Surg 42:998–1001 Guyatt G, Gutterman D, Baumann MH et al 2006 Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American College of Chest Physicians Task Force. Chest 129:174–181 Haut C 2005 Oncological emergencies in the pediat- ric intensive care unit. AACN Clin Issues 16: 232–245 Hobson MJ, Carney DE, Molik KA et al 2005 Appendicitis in childhood hematologic malignancies: analysis and comparison with typhlitis. J Pediatr Surg 40:214–220 Kaste SC, Rodriguez-Galindo C, Furman WL 1999 Pictorial essay: imaging pediatric oncologic emergen- cies of the abdomen. AJR Am J Roentgenol 173:729–736 Kearney SL, Dahlberg SE, Levy DE et al 2009 Clinical course and outcome in children with acute lympho- blastic leukemia and asparaginase-associated pancre- atitis. Pediatr Blood Cancer 53:162–167 Knoderer HM, Robarge J, Flockhart DA 2007 Predicting asparaginase-associated pancreatitis. Pediatr Blood Cancer 49:634–639 Krishnamoorthi R, Ramarajan N, Wang NE et al 2011 Effectiveness of a staged US and CT protocol for the diagnosis of pediatric appendicitis: reducing radia- tion exposure in the age of ALARA. Radiology 259:231–239 Kumar A, Singh N, Prakash S et al 2006 Early enternal nutrition in severe acute pancreatitis: a prospective randomized controlled trial comparing nasojejunal and nasogastric routes. J Clin Gastroenterol 40: 431–434 Kumar S, Gariepy CD 2013 Nutrition and acute pancre- atitis: review of the literature and pediatric perspec- tives. Curr Gastroenterol Rep 15:338 McAteer JP, Sanchez SE, Rutledge JC, Waldhausen JH 2014 Isolated appendiceal typhlitis masquerading as perforated appendicitis in the setting of acute lympho- blastic leukemia. Pediatr Surg Int 30:561–564 7Parts
» Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Introduction Supportive Care in Pediatric Oncology irantextbook.ir 93df
» History and Physical Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Defi ning the Risk for Serious
» Initial Laboratory Evaluation Diagnostic Evaluation
» Chest Radiography CXR A supine CXR may identify pleural effusions,
» Computed Tomography CT Radiographic Imaging
» Magnetic Resonance Imaging MRI
» Positron Emission Tomography PET
» Aspergillus Galactomannan GMN Biomarkers for Invasive
» 1,3-β- Biomarkers for Invasive
» Polymerase Chain Reaction PCR
» Viral Studies Diagnostic Evaluation
» Invasive Procedures: Diagnostic Evaluation
» Adult FN Guidelines Empiric Management
» Monotherapy Versus Combination Therapy
» Which Monotherapy to Choose A Cochrane review of antipseudomonal beta-
» Alterations in Initial Empiric FN Antibiotic Management
» Outpatient Management of FN Although there remains a lack of one uniform
» Choice of Empiric Antifungal Therapy
» Duration of Antimicrobial Empiric Management
» Endovascular Sources Empiric Management
» Adjunctive Treatment Empiric Management
» Emergence of Resistant Empiric Management
» Red Blood Cell Administration
» Granulocyte Transfusion Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Hemolytic Transfusion Risks of Blood Product
» Infection and Sepsis Risks of Blood Product
» Allergic Reactions Risks of Blood Product
» Febrile Nonhemolytic Risks of Blood Product
» Transfusion-Related Acute Risks of Blood Product
» Transfusion-Associated Risks of Blood Product
» Iron Overload Risks of Blood Product
» Laboratory Risk Factors Supportive Care in Pediatric Oncology irantextbook.ir 93df
» General Management Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Alkalinization Urinary alkalinization has been a long-standing
» Allopurinol Allopurinol inhibits xanthine oxidase, an enzyme
» Rasburicase Rasburicase, recombinant urate oxidase, converts
» Renal Interventions Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Pathophysiology Superior Vena Cava
» History and Physical Exam SVCSSMS should be suspected in a patient
» Imaging Studies The diagnosis of SVCSSMS is often made on
» Other Studies Tissue is required to make a defi nitive diagnosis
» Treatment Superior Vena Cava
» History and Physical Exam Small pericardial effusions are frequently asymp-
» Imaging and Other Studies The presence of a pericardial effusion can be
» History and Physical Exam Many patients with small pleural effusions are
» Imaging Studies When a pleural effusion is suspected, a chest
» History and Physical Exam Patients with pheochromocytoma typically have
» Laboratory Studies The diagnosis of pheochromocytoma is best made
» Imaging Studies Clinical Presentation
» Pulmonary Leukostasis Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Presentation Spinal Cord Compression
» Differential Diagnosis Spinal Cord Compression
» Imaging MRI of the spine can help narrow the differential
» Surgery Surgery in spinal cord compression can be uti-
» Radiation Therapy The advantages of external beam radiation ther-
» Outcomes Spinal Cord Compression
» Presentation Altered Mental Status
» Initial Management Altered Mental Status
» Metabolic The metabolic causes of AMS or seizure in pedi-
» Chemotherapy-Associated Neurotoxicity Differential Diagnosis
» Posterior Reversible Encephalopathy Syndrome
» Outcomes Altered Mental Status
» Initial Management Increased Intracranial
» Soft Tissue A large meta-analysis of published data suggests
» Cerebrospinal Fluid Hydrocephalus is an excess of CSF within the
» Hemorrhage and Thrombosis Differential Diagnosis
» Idiopathic Intracranial Hypertension Differential Diagnosis
» Presentation of Stroke Cerebrovascular Disease
» Differential Diagnosis Cerebrovascular Disease
» Etiology of Stroke in Pediatric
» Ischemic Stroke After an ischemic stroke is diagnosed, the patient
» Hemorrhagic Stroke Hematomas can expand over several hours from
» Acute Lymphoblastic Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Acute Myelogenous Leukemia Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Acute Promyelocytic Leukemia Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Chronic Myelogenous Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Management of Tumor Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Leukapheresis Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Hyperhydration Other Treatment Modalities
» Hydroxyurea Other Treatment Modalities
» Cranial Irradiation Other Treatment Modalities
» Pseudohyperkalemia Hyperleukocytosis has been noted to cause pseudo-
» Pseudohypoxemia Due to the rapid consumption of oxygen by leu-
» Pseudohypoglycemia Consumption of glucose by excess leukocytes
» Pseudothrombocytosis Leukemic blast lysis can lead to cell fragmenta-
» Transfusion Practice with Other Supportive Care
» Anesthetic Procedures Other Supportive Care
» Neutropenic Enterocolitis Gastrointestinal Infection
» Perirectal Abscess Gastrointestinal Infection
» Gastrointestinal Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Pancreatitis Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Bowel Obstruction Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Abdominal Compartment Supportive Care in Pediatric Oncology irantextbook.ir 93df
» ALL Risk Factors Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Other Malignancies Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Central Venous Catheters Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Diagnosis Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Nociceptive Pain Types of Pain
» Neuropathic Pain Types of Pain
» World Health Organization Pharmacologic Treatment
» Intermittent Opioid Use Pharmacologic Treatment
» Long-Acting Opioids Pharmacologic Treatment
» Breakthrough Dosing Pharmacologic Treatment
» Opioid Rotation Pharmacologic Treatment
» Patient-Controlled Analgesia Pharmacologic Treatment
» Constipation Side Effects of Opioids
» Nausea and Vomiting Nausea and vomiting are rare opioid side effects
» Pruritus Pruritus is a common side effect of opioid use
» Sedation Side Effects of Opioids
» Confusion and Agitation Renal and hepatic function should be checked
» Respiratory Depression When dosed appropriately, opioids rarely result
» Myoclonus Patients receiving very high doses of opioids for
» Urinary Retention Urinary retention can be caused by any opioid but
» Calcium Channel Blockers Neuropathic Pain
» Serotonin and Norepinephrine Neuropathic Pain
» Tricyclic Antidepressants Neuropathic Pain
» Interventional Techniques Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Vincristine-Related Peripheral Oncology-Specifi c Pain
» Osteonecrosis Oncology-Specifi c Pain
» Post-lumbar Puncture Oncology-Specifi c Pain
» Mucositis Pain Oncology-Specifi c Pain
» Pathophysiology of Emesis Chemotherapy-Induced
» Principles of Emesis Control in the Cancer Patient
» Emetogenicity of Chemotherapy Chemotherapy-Induced
» Dopamine Receptor Antagonists Classes of Antiemetics
» Corticosteroids Classes of Antiemetics
» Cannabinoids The plant Cannabis contains more than 60 differ-
» Other Antiemetic Agents Antihistamines
» Alternative Therapies Ginger Classes of Antiemetics
» Management of CINV Management of CINV Table
» Special Considerations Anticipatory Nausea and Vomiting
» Radiation-Induced Nausea Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Initiation The initiation stage occurs immediately following
» Primary Damage Response Pathophysiology of Oral Mucositis
» Signal Amplifi cation Pathophysiology of Oral Mucositis
» Ulceration Ulceration is the phase with the most clinical sig-
» Healing Pathophysiology of Oral Mucositis
» Clinical Course of Oral Mucositis
» Assessment Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Palifermin Prevention and Treatment
» Low-Level Laser Therapy Prevention and Treatment
» Glutamine Prevention and Treatment
» Cryotherapy Prevention and Treatment
» Oral Care Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Oral Infections Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Nutrition Assessment Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Dietary Counseling Nutrition Intervention
» Appetite Stimulants Nutrition Intervention
» Enteral Tube Feeding Nutrition Intervention
» Parenteral Nutrition Nutrition Intervention
» Nutrition and Survivorship Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Management of Neutropenia Hematologic Toxicity
» Management of Thrombocytopenia Hematologic Toxicity
» Management of Anemia Hematologic Toxicity
» Somnolence Syndrome Central Nervous System
» Lhermitte’s Sign Central Nervous System
» Skin Complications Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Oral Mucositis Head and Neck
» Ear Complications Head and Neck
» Laryngeal Complications Head and Neck
» Dysphagia and Esophagitis Gastrointestinal
» Nausea, Vomiting and Anorexia
» Pneumonitis Major Organ Infl ammation
» Pericarditis Major Organ Infl ammation
» Hepatitis Major Organ Infl ammation
» Nephropathy Major Organ Infl ammation
» Cystitis Major Organ Infl ammation
» Risk Stratifi cation Prevention of Bacterial
» Adult Data Antimicrobial Approaches
» Pediatric Data Data regarding the utility of bacterial prophylaxis
» Risks of Prophylaxis Prevention of Bacterial
» Guidelines and Current Usage of Antibacterial Prophylaxis
» Protocols for Line Placement and Care
» Antibiotic and Ethanol Locks
» Chlorhexidine Cleansing Chlorhexidine gluconate CHG is a bactericidal
» Future Directions Prevention of Bacterial
» Risk Stratifi cation Prevention of Fungal
» Approaches to Antifungal Prophylaxis
» Guideline Recommendations for Antifungal Prophylaxis
» Limitations of Current Options for Antifungal Prophylaxis
» Risks of Prophylaxis Prevention of Fungal
» Biomarkers Prevention of Fungal
» Future Directions Prevention of Fungal
» Risk Stratifi cation Prevention of Pneumocystis
» Approaches to PCP Prophylaxis
» Summary of the Recommendations
» Future Directions Prevention of Pneumocystis
» Postexposure Chemoprophylaxis Prevention of Viral Infections
» Suppressive Therapy Prevention of Viral Infections
» Future Directions Prevention of Viral Infections
» Hand Hygiene Infection Control Practices
» Mandatory Vaccination Infection Control Practices
» Hospital Isolation Practices Infection Control Practices
» Visitor Screening Policies Infection Control Practices
» Work Restriction Infection Control Practices
» Cytomegalovirus CMV Status of Transfused Blood
» Treatment of Myelosuppression with
» Prevention of Febrile Neutropenia, Delay
» Treatment of Febrile Neutropenia
» Treatment of Myelosuppression Clinical Usage of Myeloid Growth Factors
» Comparison of Granulocyte Colony-Stimulating Factor
» Optimal Dosing Adult guidelines recommend dosing of 5 mcgkg
» Route of Administration Optimal Administration of Colony-Stimulating Factors
» Optimal Timing Optimal Administration of Colony-Stimulating Factors
» Erythropoietin Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Interleukin-11 Platelet Growth Factors
» Thrombopoietin Receptor Agonists Platelet Growth Factors
» Immune Status Prior Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Immune Status During Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Immune Recovery After Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Immunization Practice Prior Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Diphtheria, Tetanus, and Acellular Pertussis
» Pneumococcal Conjugate Vaccine Recommendations
» Hemophilus Infl uenzae Type b
» Inactivated Infl uenza Vaccine Although in a Cochrane review Goossen et al.
» 2009 H1N1 Pandemic Vaccine Seven studies have reported on effi cacy of the
» Live Attenuated Infl uenza Vaccine
» Meningococcal Conjugate Vaccine Recommendations
» Varicella Zoster Virus Recommendations
» Recommendations Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Treatment of Hypogammaglobulinemia Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Vaccination of Household Contacts
» Peripherally Inserted Central Catheter
» External Tunneled Central Venous Catheter
» Implanted Port Types of Central Venous
» Catheter Insertion Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Exit Site Infection Infection
» Prevention of Infection Infection
» Drug Precipitate or Lipid Residue Occlusion Thrombotic Occlusion
» Evaluation of Catheter- Related Thrombosis
» Treatment of Catheter- Related Thrombosis
» Special Considerations During Anticoagulation Therapy
» Contraindications of Anticoagulant Therapy
» Skin Antisepsis Catheter Maintenance
» Central Venous Catheter Dressings
» Hub Care Catheter Maintenance
» Central Venous Catheter Flushing and Locking
» Chlorhexidine Bathing Chlorhexidine has been shown to be effective in
» Antiseptic Needleless Connectors and Antiseptic
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