Hematology and Oncology Book

Cancer

  • Bowel Obstruction in Terminally Ill Patient

http://www.fpnotebook.com/

Bowel Obstruction in Terminally Ill PatientAka: Cancer Related Bowel Obstruction

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  1. See Also
    1. Bowel Obstruction
  2. Epidemiology
    1. Mechanical Ileus Incidence in Hospice care: 3%
    2. Common end-stage cancer causes
      1. Ovarian Cancer
      2. Colon Cancer
  3. Symptoms
    1. Crampy Abdominal Pain from bowel fluid secretion
  4. Differential Diagnosis
    1. See Constipation in Cancer
  5. Management: Terminally ill, comfort care patients
    1. Surgery usually not indicated for terminally ill
      1. High mortality
      2. High rate of recurrence
    2. Inhibit bowel fluid secretion
      1. Octreotide (Sandostatin)
    3. Adequate pain management
      1. Titrate morphine dosage to pain
    4. Treat associated Nausea and Vomiting
      1. See Nausea in Cancer
      2. Haloperidol (Haldol)
      3. Diphenhydramine (Benadryl)
      4. Avoid Metoclopramide (Reglan)
  6. Management: Partial Small Bowel Obstruction
    1. Stool Softener
    2. Osmotic Laxative
    3. Nausea and pain management at above
    4. Restrict Fluids
    5. Prokinetic agents (e.g. Metoclopramide)
    6. Consider Corticosteroids
    7. Avoid Nasogastric Tube if possible
  7. References
    1. Ross (2001) Am Fam Physician 64(6):1019

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