- Carcinoid syndrome
- Epidemiology
- Can arise from lungs, bronchi, stomach appendix, colon and rectum
- Derived from enterochromaffin cells
- Secrete 5HT, dopamine, substance P, PGs & Kallikrenin
- Clinical features
- Symptoms usually appear after hepatic metastasis
- Paroxysmal in nature
- Flushing
- Tachycardia
- Fluctuating BP
- Bronchospasm
- Diarrhoea, lachrymation, rhinorrhoea
- Bleeding, weight loss
- Can be associated with exercise or alcohol
- Right sided heart disease can also occur
- Precipitants
- Anaesthesia
- Surgical interventions
- Radiological interventions
- Diagnosis
- Urinary 5-HIAA
- Serum chromograffin A
- CT + contrast (hypervascular lesions)
- Operative management
- Epidural reasonable
- Aim for stable CVS status
- Morphine and atracurium can cause histamine release
- Invasive monitoring
- Low CVP for hepatic resection
- Vasopressors are unpredictable and can worsen hypotension
- Boluses of 20-50μcg octreotide can be useful
- Vasopressin may be best
- HDU care
- Pre-op assessment
- Look for complications
- Obstruction
- Electrolyte imbalances
- Dehydration
- Anaemia
- CVS
- Right sided failure
- Biventricular failure
- Coronary artery spasm
- Orthopnoea, PND, low ET, peripheral oedema
- Resp
- Bronchospasm
- Secondaries can cause obstruction
- Pre-treat with octreotide
- 50μcg/hr for 12 hrs before surgery
- S/E - bradycardia, long QT, N&V, conduction defects
- Ix
- CXR
- Secondaries, miliary shaddowing
- ECG
- U&E/LFT
- FBC
- ECHO
- CEACCP
Link:ceaccp.oxfordjournals.org/content/early/2010/12/16/bjaceaccp.mkq045.full.pdf