raging esophagus from chemo

nrsang97, BSN, RN · Jan 15, 2009

I am just guessing at this, could he have ment a severe case esophagitis?

TXstudentRN · Jan 15, 2009

I am just guessing at this, could he have ment a severe case esophagitis?

My initial thought too. Was it on a computer system... maybe a typo?

ohmeowzer RN, RN · Jan 15, 2009

no it wasn't a typo , when they called the egd results to me the nurse called and told me " raging esophagus" i said oh okay ( pretending i knew what it was .lol) i think it may have been a severe case of esophagitis.. you maybe right...

caroladybelle, BSN, RN · Jan 15, 2009

I have no clue what a "raging esphagus" is. And I have been oncology certified for over 10 years.

The MD probably meant raging esophagitis - inflammation of the those mucous membranes. This very common in chemo patients. The cells of the skin, bone marrow, hair and GI tract are rapidly reproducing and those prone to damage from old line (nontargeted) chemotherapy and from radiation.

In addition, once the oral mucous membranes get irritated, people eat and drink less because irritation and pain, leading to dehydration and drying of the oral mucosa, leading infection with opportunistic flora (also promoted by the compromised immune system typical of chemo patients), leading to worsening infection, pain and inflammation. Iften spreading to the esophagus.

Good oral care, even if painful, helps it clear. Rinses like "Larry's Solution" or "Magic Mouthwash" help reduce pain and inflammation, and help it heal, and may be swallowed to coat the esophagus. These compounded liquids contain variations on the following: Benedryl, decadron, xylocaine, carafate, and other soothing meds.

Pts on chemo should rinse w/saline 4 to 6 times per day. If it burns, it may be buffered with a small amount of baking soda. Pt should not use standard alcohol based mouthrinses - these dry the mouth and disrupt the healthy oral flora/membrane conditions. Some BMT patients use special peroxide or fluoride rinses per the MD - these may be controversial in nonBMT patients and need to be left to be recommended by the oncology prescriber.

Xylocaine can be used in some patients, but it burns and can be dangerous, especially if swallowed. In esophagitis this often may be problematic due to risks of aspiration and of the burning themselves with hot liguids after xylocaine use.

In severe cases, they may be TPN and/or PCA pain med. If it is an extended case as described below, GI rest may be indicated until the heal.

Mucositis from chemo/rad can extend from the lips and oral membranes through the GI tract to the orifice in some cases, thus abdominal and rectal pian/bleeding as well as diarrhea in some really bad cases.

NurseKatie08, MSN · Jan 15, 2009

I had a patient with radiation esophagitis...wonder if this is along the same lines?

leslie :-D · Jan 15, 2009

I had a patient with radiation esophagitis...wonder if this is along the same lines?

yes, it is.

whether it is rad or chemo induced, esophagitis is a very common, painful effect.

leslie

ohmeowzer RN, RN · Jan 15, 2009

thank you all for your responses. you have taught me alot.

Daytonite, BSN, RN · Jan 16, 2009

i would have called the doctor and asked what he meant except that i know. i had radiation therapy of the face and neck and it is no picnic. the word "raging" is merely a modifier that means furious, with great intensity, to spread unchecked as in a disease and is describing the severity of the esophagitis the doctor had observed.he wanted to stress that the irritation was really, really, really widespread and bad. raging was a good word to use. i'm sure the patient is in quite a lot of discomfort with it. one of the problems is that she wasn't eating as a result, is she?

ohmeowzer RN, RN · Jan 16, 2009

i would have called the doctor and asked what he meant except that i know. i had radiation therapy of the face and neck and it is no picnic. the word "raging" is merely a modifier that means furious, with great intensity, to spread unchecked as in a disease and is describing the severity of the esophagitis the doctor had observed.he wanted to stress that the irritation was really, really, really widespread and bad. raging was a good word to use. i'm sure the patient is in quite a lot of discomfort with it. one of the problems is that she wasn't eating as a result, is she?

poor lady went home on tpn. her daughter called me at work today and said she is much better. she has had stage 4 breast cancer for about a year now. she had a double mastectomy many years ago and the cancer just resurfaced. she is failrly young. thank you for your insight, i appreciate all your replies .