Increased in: Colon cancer (72%), lung cancer (76%), pancreatic cancer (91%), stomach cancer (61%), cigarette smokers, benign liver disease (acute 50% and chronic 90%), benign GI disease (peptic ulcer, pancreatitis, colitis). Elevations >20 ng/mL are generally associated with
malignancy. For breast cancer recurrence (using 5 ng/mL cutoff), sensitivity 44.4% and specificity 95.5%.
Monitoring after surgery: Test is used to follow progression of colon cancer after surgery (elevated CEA levels suggest recurrence 3–6 months before other clinical indicators), although such monitoring
Short Gut syndrome
In adults, 480cm normal small bowel length, <180 increase risk of SGS and <60cm (with colon) are unlikely to achieve independence from parenteral nutrition.
Surgical site Infection:
Clean contaminated- 3-5%
Gross Contaminated 30%
Central line infection: how many CFU?
>15 colony forming uits = line infection
Temp <36C (<96.8F)
RR >20 or PaCO2 <32
WBC >12k or <4k or >10% band
SIRS + long with either a culture-proven or visually identified infection
Severe sepsis refers to sepsis plus at least one of the following signs of hypoperfusion or organ dysfunction:
Areas of mottled skin
Capillary refilling requires three seconds or longer
Urine output <0.5 mL/kg for at least one hour, or renal replacement therapy
Lactate >2 mmol/L
Abrupt change in mental status
Abnormal electroencephalographic (EEG) findings
Platelet count <100,000 platelets/mL
Disseminated intravascular coagulation
Acute lung injury or acute respiratory distress syndrome (ARDS)
Cardiac dysfunction (ie, left ventricular systolic dysfunction), as defined by echocardiography or direct measurement of the cardiac index
Septic shock exists if there is severe sepsis plus one or both of the following despite adequate resucitation:MAP <60 mmHg (or <80 mmHg if the patient has baseline hypertensionMAP >60 mmHg requires dopamine >5 mcg/kg per min, norepinephrine <0.25 mcg/kg per min, or epinephrine <0.25 mcg/kg per min .
Adequate fluid resuscitation:
20 to 30 mL/kg of starch,
infusion of 40 to 60 mL/kg of saline solution
PCWP 12 to 20 mmHg.
(CVP) of 8 to 12 mmHg
Refractory Septic Shock
>60 mmHg (or >80 mmHg if the patient has baseline hypertension) requires dopamine >15 mcg/kg per min, norepinephrine >0.25 mcg/kg per min, or epinephrine >0.25 mcg/kg per min despite adequate fluid resuscitation
0.1-1 mcg/kg/min (max 5)
Mortality rate of SIRS, sepsis, severe sepsis, and septic shock