Part 5: Care of Site Specific Side Effects: VI. RTT to Abdomen/Pelvis

Mnemonic for Abdomen/Pelvis

FU! Don’t Come Close Now Sexual Predator!

Fistulas & Ulcerations

Diarrhea

Constipation

Cystitis
N/V

Sexual Dysfunction

Web for Abdomen/ Pelvis effects

1. NV

1. NV

2. Diarrhea

2. Diarrhea

Diarrhea occurs at what dose?

40 Gy & above

Irradiation to this organ is the primary cause of diarrhea?

small bowel

At a cellular level, how does RTT cause diarrhea

highly proliferative cells in intestinal lining

Highly proliferative- 20-50 Million cells sloughed off/minute

When does diarrhea occur?

Starts: 2 weeks into tx

Ends: 2 weeks after tx ends

Small intestine has 3 features that increase the surface area to enhance absorption/ digestion. List them,

1. arrangement of small intestine in Peaks & Valleys

2. villi

3. microvilli

What is the functional unit of the small intestine?

villi

microvilli aka

brush border

Effects of RT to villi and microvilli

villi and microvilli can easily slough off during tx, may be so bad as to require rest from tx

Diarrhea side effects

1. malnutrition

2. dehydration

3. electrolyte loss

Dietary interventions for diarrhea

Avoid foods that stimulate/ irritate the GI tract:

1. coffee/ tea

2. very hot/ cold foods/liquids

3. spicy food

4. lactose

What type of diet is recommended for diarrhea patients:

low residue diet

Medical interventions for diarrhea

1. anti-diarrheal

2. sitz bath (Epsom salts)

Anti-diarrheals

1. OTC

2. Prescription

1. OTC:

   1. Pepto-Bismol

   2. Imodium AD- BEST OTC

   3. Paregoric (pare el gori gori)

   4. Kaopectate (KaKao)

2. Prescription

   1. Lomotil aka Loperamide (lo per amide)

Which side effect to abdomen/ pelvis is rare?

Constipation

(FYI: we usually cause diarrhea )

3. constipation

3. constipation

If constipation is not a side effect of radiation, why is it a common complaint amongst patients?

it is a common side effect of many pain meds

4. fistulas & ulcerations

4. fistulas & ulcerations

term. fistula

def. an abnormal tube-like passage from one cavity to another

term. diverticuli

an outward sack or pouch

fyi: stuff can get stuck there

term. polyp

an inward, usually benign, growth

term. colostomy

an artificial opening into the colon for elimination purposes

May be temporary or permanent

Colostomy may be permanent if:

tumor is closer to anus → no room to reattach colon after surgical excision

Colostomy may be temporary if:

tumor is more proximally located → reattachment after healing is complete

Illeostomy:

surgical opening by bringing out the ileum (end of small intestine) out onto the surface of the skin.

Internal waste passes out of the ileostomy and is collected in _

an external pouching system stuck to the skin

Where are ileostomies usually sited?

above the groin,

right side of abdomen

Ileostomies are being replaced by the proffered alternative:

K-Pouch or BCIR

This surgery turns the small intestine into an internal reservoir (no external appliance needed)

FYI: poop is stored there and patient can manually get ride of it by turning a valve

5. cystitis

5. cystitis

FYI: what is cystitis

inflammation of the bladder

urostomy aka

ureteroileostomy

ureter(o) ile(um) ostomy

urostomy / ureteroileostomy

anastomosis (ana stoma osmosis) of the ureters to (an isolated loop) of the ileum drained trough a stoma on the abdominal wall

symptoms of cystitis

1. frequency & urgency of voiding

2. burning sensation

3. low back pain

4. hematuria (blood in urine)

Interventions for cystitis

1. force fluids

2. Avoid irritating foods/ substances:

   1. coffee/tea

   2. alcohol

   3. tobacco

   4. pepper

   5. curry

Role of pH in cystitis

↓ (acidic) pH = ↓ risk of infection

FYI: so get some vitamin C

UCD stand for

Urinary collection devices

def. a simple utensil that allows an individual to empty their bladder into a container hygienically without spilling urine

term urinary collection device

a type of urinary collection device is a/an ___

Catheter

urinary catheterization aka

cathing

term. urinary catheterization

a catheter (plastic tube) is inserted into a patient’s bladder via their urethra

What are the 2 purposes of urinary catheterization?

1. drain urine freely from bladder

2. inject liquids for tx or diagnosis of bladder conditions

The procedure or catheterization is usually done by ___

a clinician often a nurse

tho self-catheterization is possible as well

Types of catheters list (3)

1. Foley catheter

2. Robinson catheter

3. External Texas/ Condom catheter

term. Foley catheter

def. indwelling retention catheter

What holds a Foley catheter in position?

an inflatable balloon

Besides holding the catheter in place, what is another purpose of the balloon in a Foley catheter?

air in balloon can be used as a contrast agent

Biggest downside of catheters?

they are a common source of infection

What types of catheters are the most commonly used

#16 or #14 French tip catheters

term. Robinson catheter

def. a flexible catheter used for short-term drainage of urine

True or False: The Robinson catheter has a balloon to hold it in place

False , it has no balloon, so it cannot stay in place unaided

term. External Texas/ Condom catheter

def. catheter used for incontinent males.

main benefit of External Texas/ Condom catheter

lower risk of infection than an indwelling catheter

6. sexual dysfunction- when testes/ ovaries are in the field

6. sexual dysfunction

Sexual Dysfunction in males:

List the 3 primary effects:

1. permanent/ temporary Sterility (FYI: decreased sperm count)

2. permanent/ temporary Impotence

3. Chromosomal Damage (genetic mutations)

____ are much more sensitive than mature sperm

spermatogonia

name of the cells that produce testosterone

Leydig cells

True or False: Spermatogonia and Leydig cells are very radiosensitive

False:

Spermatogonia- very radiosensitive

Leydig Cells- radioresistant

What is a result of Leydig cells being radioresistant?

testosterone levels remain the same UNLESS very high doses are used

Fields that can involve the testes?

TNI, Inverted Y, Hockey Stick/ Dog Leg

TNI, Inverted Y and Hockey Stick/Dog Leg are also used for

Hodgkin’s Disease

FYI: TNI treats almost all lymph nodes of the body

(Inverted Y/ Hockey Stick) field is mostly associated with Hodgkins Disease, while (Inverted Y/ Hockey Stick) is mostly associated with testicular cancer

(Inverted Y/ Hockey Stick) field is mostly associated with Hodgkins Disease, while (Inverted Y/ Hockey Stick) is mostly associated with testicular cancer =

Field used to treat 1 testicle

hockey stick/ dog leg

WITH SHIELDING

Hockey stick field uses doses of _____

400cGy dogs have 4 legs

Even with shielding, hocky stick fields expose the testicles to ____ rads

80-250 rads (enough to cause temporary sterility)

Sterility in males doses:

1. temporary

2. permanent

1. temporary: 50 cGy

2. permanent: 500 cGy

When does reduction of sperm count happen?

Begins: 6-8 weeks into tx

Ends: continues for several months- years

Most oncologist recommend from childbearing for a period of ___

2 years (to prevent genetic mutations)

Intervention for sterility

sperm banks before tx

Impotence

When does it happen?

Beings: a couple of weeks into tx

Ends: extends for several weeks after tx

How RTT affects testosterone levels:

Testosterone levels unaffected by RTT, there might be a mild decrease in some patients

For females, if ___or ___ is in the tx field, there might be side effects

ovaries

vagina

Ovaries in tx field side effects

1. Decreased libido

2. Permanent/ Temporary Sterility

3. Chromosomal Damage

4. Atrophy of Vaginal Mucosa

Sterility in females doses:

1. temporary

2. permanent

1. temporary: 800cGy (8 = OOva)

2. Permanent: 20-30 Gy

term. atrophy of vaginal mucosa

shrinkage of the vaginal size & decrease in lubrication

vagina in tx field side effects

1. fibrosis & stenosis (FYI: narrowing or closing)

2. decreased or absent lubrication

3. May effect epithelial lining like any other epithelium: inflammation, mucositis, ulcer etc.

Prophylactic medical innervation for RTT where ovaries would be in the tx field

Ovaries can be surgically displaced

How often after RTT should women wait for childbearing

2 years (to prevent genetic mutations)

Intervention for decreased lubrication of vagina:

KY Jelly or Lubrifax (NOT VASELINE)

Intervention for preventing vaginal stenosis:

1. intercourse

2. vaginal dilator

Intervention for yeast infections for women

Diflucan

Other interventions for females for genital side effects

1. sitz bath

2. steroid based cream

3. sexual counseling