[醫如往常] Senior Clerkship Day 13: Ob/Gyn Venous thromboembolism; VTE; Prolapse

Venous thromboembolism; VTE

R2李醫師

21% have cancer, and survival decrease

1. Pancreas
2. Brain
3. AML

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D dimer does not always elevate. <0.5

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common

Clear cell of ovarian cancer

Pre-operation

Left common iliac artery

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Risk factor

Clear cell: Massive ascites

Endometrial cancer:

• Extrauterine spread
• Non-endometrioid cancer

Cervical cancer:

• Age
• Size
• Figo stage

BMI

Recurrence

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Tx

Inferior vena cava filter

Heparin

Graduated compression socking

Heparin induced thrombocytopenia (Renal metabolism)

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Khorana Risk Score

Cancer type

Stomach+2

Pancreas+2

Lung+1

Lymphoma+1

Gynecologic+1

Bladder+1

Testicular+1

Other0

Pre-chemotherapy platelet count ≥350×109/L

+1

Hemoglobin level <10 g/dL or using RBC growth factors

+1

Pre-chemotherapy leukocyte count ≥11×109/L

+1

BMI ≥35 kg/m2

+1

Score Interpretation

Risk Group	Score	2.5-month Rate of VTE
Low	0	0.3 - 0.8%
Intermediate	1 - 2	1.8 - 2.0%
High	≥3	6.7 - 7.1%

來自 <http://www.mdcalc.com/khorana-risk-score-venous-thromboembolism-cancer-patients/#about-equation>

Original/Primary Reference

    Khorana AA, et al. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood 2008;111:4902-7.

Validation

    Dutia M, et al. Risk Assessment Models for Cancer-Associated Venous Thromboembolism. Cancer 2012;118:3468-76.

Other References

    Lyman GH, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013 Jun 10;31(17):2189-204. doi: 10.1200/JCO.2013.49.1118. Epub 2013 May 13.

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Prolapse

嚴教授(R31)

Bearing down sensation of pelvic organ

不要寫falling sensation!

Descensus uteri

Prolapse

Hard: uterus

Soft: cystocele

傍晚比較嚴重

睡午覺會改善

Tx

Kegel exercise

Vaginal pessary 副作用太多, 太緊不舒服，通常是不能做手術才使用

Mesh 可能會排斥

Prevention

生產後

Uterus 6 weeks 才會恢復

抱小孩要坐著抱

不要提重物

補充estrogen

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魏武帝曹操從馬上跌下後常常頭暈：SAH

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出血傾向食物

豆漿，芝麻， 蜂膠

aspirin

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Airplane要reconfirm

才不會因為overbooking沒位置

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