Honc: Late recurrence of breast CA

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Clinic course • Patient diagnosed with dyspepsia versus delayed gastric emptying • Given omeprazole BID with improvement • Over 2-3 urgent care visits… • H pylori checked • Sent for gastric emptying study • Sent for small bowel follow through • Prescribed ondansetron with improvement in symptoms 20
Mechanism of Nausea and Emesis • Coordination between CNS, PNS, GI tract • Brainstem: ▫ “vomiting center” or central pattern generator Indistinct collection of nuclei in medulla Coordinates efferent respiratory, GI, autonomic activity associated with n/v Final effector pathway through which a variety of afferent stimuli can activate emesis ▫ Area Postrema aka “chemoreceptor trigger zone” Circumventricular, caudal end of 4 th ventricle Outside BBB, accessible to emetic stimuli borne in blood or CSF Important source of afferent input to vomiting center Muscarinic, dopamine, serotonin, nerukinin-1, histamine receptors • Higher brainstem/Cortex • Vagus and Splanchnic nerves – carry input from GI tract (terminates in brainstem in nucleus tractus solitarius) 21
Page 1 and 2: Morning Report August 11, 2011 Nanc
Page 3 and 4: MKSAP Question On physical examinat
Page 5 and 6: MKSAP Question Which of the followi
Page 7: MKSAP Question Although most cases
Page 10 and 11: HPI Summary • Nausea and associat
Page 12 and 13: Oncologic History The patient had a
Page 14 and 15: Physical Exam • BP 100/52 Pulse 8
Page 16: Differential Nausea/Vomiting 16
Page 19: Labs 13.7 9.2 261 38.9 HbA1C 7.5 13
Page 24 and 25: 6 weeks later, returns to PCP…
Page 26 and 27: Indications for referral 26
Page 28 and 29: CT Abd/Pelv • Metastatic disease.
Page 30 and 31: MRI Head • Multiple lesions in th
Page 32 and 33: CT Chest • RUL pulmonary nodule h
Page 34 and 35: Brain metastasis • Any cancer can
Page 36 and 37: Sir William Richard Gowers (20 Marc
Page 38 and 39: Patient course • Started on oral
Page 40 and 41: Primary Tumor CTCs Bone Marrow Expa
Page 42 and 43: Brain metastasis in HER2+ breast ca
Page 44 and 45: References • Keane JR. Neurologic

Honc: Late recurrence of breast CA

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