I always ask my patients about their BOWEL MOVEMENTS !!
It's important because the GUT is important in #hematology 😮😲
A short thread about the numerous complications that arise in this longgggggg tract 👇🏻
1/14 🧵
#MedTwitter
It's important because the GUT is important in #hematology 😮😲
A short thread about the numerous complications that arise in this longgggggg tract 👇🏻
1/14 🧵
#MedTwitter
How longggg is long?
The small+large intestine measure > 800cm (more in ♂️)
That's >27ft in length😮
That's long, taller than a 🦒(~18 ft), as tall as a 3-story 🏘️
The surface area (small bowel alone) is 2,700 sq. ft, bigger than most #Mumbai homes 😭😂
2/14
The small+large intestine measure > 800cm (more in ♂️)
That's >27ft in length😮
That's long, taller than a 🦒(~18 ft), as tall as a 3-story 🏘️
The surface area (small bowel alone) is 2,700 sq. ft, bigger than most #Mumbai homes 😭😂
2/14
This long tract can develop numerous complications in patients w/ blood disorders!!
It is one of the most common organs involved in GVHD (along w/ skin + liver), can be fatal 😭😄
Let's go through a few complications we encounter routinely 👇🏻
#MedTwitter
3/14
It is one of the most common organs involved in GVHD (along w/ skin + liver), can be fatal 😭😄
Let's go through a few complications we encounter routinely 👇🏻
#MedTwitter
3/14
1. GI bleeding 🩸🩸
I hate this the most 😡 Some common causes:
-Thrombocytopenia
-Bleeding d/o (VWD, especially type III)
-Anticoagulation (especially NOAC)
-Mucositis (post chemo/radiotherapy)
-Neutropenic colitis
-Peptic ulcers (steroids etc)
-GVHD
-DIC
4/14
I hate this the most 😡 Some common causes:
-Thrombocytopenia
-Bleeding d/o (VWD, especially type III)
-Anticoagulation (especially NOAC)
-Mucositis (post chemo/radiotherapy)
-Neutropenic colitis
-Peptic ulcers (steroids etc)
-GVHD
-DIC
4/14
2. Diarrhoea and constipation 😭😭
Very common & extremely important to address as it can mess up patient management and quality of life 😞
Always ask for this in outpatient & definitely during in-patient rounds!
A good bowel movement = a happy patient
#MedTwitter
5/14
Very common & extremely important to address as it can mess up patient management and quality of life 😞
Always ask for this in outpatient & definitely during in-patient rounds!
A good bowel movement = a happy patient
#MedTwitter
5/14
Diarrhoea 😭😭
≥ 3 unformed stools/day, can be much more in these patients!
Causes:
-Chemotherapy/Radiation
-Neutropenic colitis
-Antibiotics
-GVHD
-INFECTIONS, INFECTIONS, INFECTIONS
#MedTwitter
6/14
≥ 3 unformed stools/day, can be much more in these patients!
Causes:
-Chemotherapy/Radiation
-Neutropenic colitis
-Antibiotics
-GVHD
-INFECTIONS, INFECTIONS, INFECTIONS
#MedTwitter
6/14
What infections?
Any !! Bacteria, viruses, parasites. These patients are immunocompromised so bugs galore 🦠
Some common bugs we encounter:
•Clostridium difficile (C. diff) (I hate it)
•Gram negative bacteria
•CMV and other herpes viruses
#MedTwitter
7/14
Any !! Bacteria, viruses, parasites. These patients are immunocompromised so bugs galore 🦠
Some common bugs we encounter:
•Clostridium difficile (C. diff) (I hate it)
•Gram negative bacteria
•CMV and other herpes viruses
#MedTwitter
7/14
Constipation !
Very bothersome, especially for older adults 😭
Common causes:
-Medications like opioids for pain mgmt
-Dietary changes (⤵️ fibre)
-Immobilization (🏥)
-neuropathy (platins, vinca alkaloids)
-worsening of underlying co-morbidity
#MedTwitter
8/14
Very bothersome, especially for older adults 😭
Common causes:
-Medications like opioids for pain mgmt
-Dietary changes (⤵️ fibre)
-Immobilization (🏥)
-neuropathy (platins, vinca alkaloids)
-worsening of underlying co-morbidity
#MedTwitter
8/14
3. Nausea and vomiting🤮
Horrible complication. In the past many patients would stop treatment fearing this 😭😭
Now we have some great drugs (5-HT3i❌/ NK1 ❌/steroids) to manage this complication🙏🏻
Common causes:
-Chemo/radiotherapy
-GVHD
-Infections
9/14
Horrible complication. In the past many patients would stop treatment fearing this 😭😭
Now we have some great drugs (5-HT3i❌/ NK1 ❌/steroids) to manage this complication🙏🏻
Common causes:
-Chemo/radiotherapy
-GVHD
-Infections
9/14
Chemo/radiotherapy remains the most common cause🤮
Chemo induced nausea & vomiting (CINV):
-40% patients affected
-Anthracycline/platins/ high dose cytarabine/ cyclophosphamide are common culprits
-Can be acute/delayed/anticipatory/refractory
#MedTwitter
10/14
Chemo induced nausea & vomiting (CINV):
-40% patients affected
-Anthracycline/platins/ high dose cytarabine/ cyclophosphamide are common culprits
-Can be acute/delayed/anticipatory/refractory
#MedTwitter
10/14
Treating CINV:
•5HT3 antagonist: ondensetron/granisetron/ palonosetron
•NK1 receptor antagonist: aprepitant/fosaprepitant/ netupitant
•Dexamethasone
•Olanzepine
•Cannabinoids
#MedTwitter
11/14
•5HT3 antagonist: ondensetron/granisetron/ palonosetron
•NK1 receptor antagonist: aprepitant/fosaprepitant/ netupitant
•Dexamethasone
•Olanzepine
•Cannabinoids
#MedTwitter
11/14
4. Esophagitis:
p/w chest pain, heartburn, dysphagia
Causes:
-Radiation
-Candida/CMV
-GVHD
-Drugs (Bisphosphonate/ oral iron)
-Eosinophilic esophagitis
#MedTwitter
12/14
p/w chest pain, heartburn, dysphagia
Causes:
-Radiation
-Candida/CMV
-GVHD
-Drugs (Bisphosphonate/ oral iron)
-Eosinophilic esophagitis
#MedTwitter
12/14
5. Neutropenic enterocolitis:
Dreaded complication in neutropenic patients😭
Mucositis➡️Breakdown of gut-blood barrier➡️bacterial translocation into blood
Usually polymicrobial (gram neg)
Fever, abdo pain, bloody diarrhoea
Diagnosis: clinical +CT
CT👇🏻 cecal wall thickening
Dreaded complication in neutropenic patients😭
Mucositis➡️Breakdown of gut-blood barrier➡️bacterial translocation into blood
Usually polymicrobial (gram neg)
Fever, abdo pain, bloody diarrhoea
Diagnosis: clinical +CT
CT👇🏻 cecal wall thickening
Thank you for reading !
This is just a brief overview of the complications that involve the intestine 👍🏻
Follow for more threads 🧵
14/14
#MedTwitter
This is just a brief overview of the complications that involve the intestine 👍🏻
Follow for more threads 🧵
14/14
#MedTwitter
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