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Big 4 Acute Onc Presentations (Liver Capsule Pain (Masses in the liver…
Big 4 Acute Onc Presentations
Liver Capsule Pain
Masses in the liver stretch the capsule
Very responsive to NSAIDs and steroids
May present with abdominal pain and jaundice
May be due to liver mets
Differentials
:
Ca in head of pancreas
Obstructive liver mets
Hepatitis
Gallstones
Pancreatitis
Requires imaging and bloods
Follow WHO analgesic ladder
VTE
Hyper coagulable state, increased risk of VTE
Large pelvic masses - increase VTE risk further
Lung, pancreas, brain, ovary, gastric and renal highest risk
LMWH needed for at least 6 months
DVT, PE
May present with worsening SOB
Bloods, Wells, CTPA, D-dimer, ECG
Subacute Bowel Obstruction
Abdominal distension and vomiting
History: vomit, flatus, urinary
Exam: bowel sounds, ascites, palpable masses?
AXR, USS, full bloods, CT scan: check for evidence of perforation
Management:
Bowel rest - NBM
IV fluids
NG decompression if required
Surgical opinion
Analgesia and antiemetics
if not resolving consider chemotherapy or steroids
Haemorrhagic Brain Mets
May present with seizures or neuro features
Differentials:
Alcohol/drug withdrawal
Electrolyte imbalance (do U&E)
Hypoglycaemia(glucose)
Infections - encephalitis(CRP)
Trauma(clotting)
Epilepsy
Stroke
Brain mets
Management
Discuss with neurosurgeon
IV Dexamethasone w/PPI
Stop / reverse anticoagulation
Pain relief