Neutropenic Enterocolitis

Neutropenic Enterocolitis 1.

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CHIEF COMPLAINT •Neutropenic Enterocolitis HPI a. Concern: b. Onset•Sudden •Gradual c. Duration: ____ •Recent •A few days •Many days •A few weeks •Many weeks •A few months •Many months •A few years •Many years •Recurrent •N/A. d. Severity: •Mild •Moderate •Severe •Absent •Normal •Increased •Decreased •Stable •No significant change from prior visit. •Details e. Location: Right lower quadrant

f. Radiation:

g. Quality : •Improving •No change •Worsening •Burning pain •Constricting •Crushing •Dull pain •Heavy •Sharp pain •Squeezing •Stabbing h. Frequancy i. Status j. Context k. Aggravated by : l. Relieved by m. Associated Symptoms n. Pertinent Negatives o. Notes 3.

ROS

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SYMPTOMS o Right lower quadrant abdominal pain o Fever o Watery or bloody diarrhea o Nausea o Vomiting o Abdominal distention o Oral and pharyngeal mucositis

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HISTORY

a. FAMILY HISTORY •Diabetes •Hypertension b. SOCIAL HISTORY c. PAST MEDICAL HISTORY •Myelodysplastic syndromes •Multiple myeloma •aplastic anemia •AIDS •Cyclic neutropenia •Solid malignant tumors •Lymphomas d. SURGICAL HISTORY •Solid organ and bone marrow transplantation e. CHRONIC CONDITIONS •AIDS

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ALLERGIES PHYSICAL EXAMINATION Abdominal distention, absence of bowel sounds, and a tympanitic abdomen may suggest an ileus. The abdomen may be markedly tender, especially in the right lower quadrant. The cecum may be palpated as a boggy mass. Rebound tenderness may suggest colonic perforation

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SPECIFIC DATA LIKE GRADING

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TESTS TO BE ORDERED •Complete blood count •Stool studies •Blood cultures •Plain abdominal radiographs •Abdominal ultrasonography •CT scan •Colonoscopy

•Flexible sigmoidoscopy 10. ASSESSMENT/PLAN o Bowel rest and nasogastric suction o Close monitoring of patients using serial abdominal examinations in an intensive care setting o Intravenous fluids, blood, and platelet transfusions as necessary o Parenteral broad-spectrum antibiotics: Antibiotics should include agents covering enteric gram-negative and anaerobic organisms, including Clostridium species. Metronidazole also may be considered if pseudomembranous colitis cannot immediately be excluded. o Cultures: Obtain blood cultures for fungus and consider antifungal agents if patients do not respond to antibiotics. o Avoidance of certain medications: Anticholinergic agents, antidiarrheal drugs, and narcotics may worsen the condition or further confuse the clinical picture o Surgical plan •Cecostomy and drainage •A 2-stage right hemicolectomy

or total abdominal colectomy, with or without a primary anastomosis •Defunctioning of the colon with a loop ileostomy

11. EDUCATION 12. MEDICATION •Metronidazole •Cefepime •Ceftazidime •Ceftriaxone •Ticarcillin •clavulanate •Piperacillin •tazobactam •Vancomycin •Imipenem •Cilastatin •Amikacin •Gentamicin •Tobramycin •Amphotericin B 13. FOLLOW UP