Question

Case Study 2:

A 53-year-old female presents with excruciating abdominal pain mainly in the lower quadrants of her abdomen. Her blood pressure was 183/110 with a heart rate of 110 bpm, afebrile, and not diaphoretic. The patient reports having nausea for several days along with several episodes of vomiting. A full blood panel was ordered along with ultrasound imaging and CT scans.

Lab work: revealed elevated levels of CA125 along with elevated levels of lymphocytes and monocytes indicative of some form of cancer. She also has a sodium level of 128 mEq/L (normal 135-145 mEq/L) and potassium level of 2.0 mEq/L (normal 3.5-5 mEq/L).

Imaging studies reveal a sizeable mass on her left ovary. The patient is given “PainFree-eril,” a potent drug that blocks the receptors for substance P. A couple months later, she presents to the Emergency Department with the same complaint, only this time she states that pain medicine is no longer working. She was given a terminal diagnosis of ovarian cancer along with various chemotherapeutic drugs. Given her history and prognosis, her oncologist admits her to the hospital. In the admission orders, there is a consult for an anterolateral cordotomy to be performed by a neurosurgeon. This would result in cutting across the anterolateral region of her lumbar spine. The patient agrees to the procedure.

A) List three possible affected areas of the patient’s referred pain given her chief complaint.

B) The patient is given a potent drug that blocks the receptors for substance P. What would be the benefit of such a drug – be specific as to emphasize the specific neural pathway involved.

C) The patient is recommended for an anterolateral cordotomy. Explain the rationale behind this treatment? What would be the possible side effects of such a treatment?

Answer 1

side effects of cordtomy are dysthesia, urinary retention, apnea