Malignant Bowel obstruction

Question 1

6 common antiemetics and their mechanism of action

Answer 1

1. dopamine antagonist (domperidone, metoclopramide, and haloperidol)
2. Ondansetron - 5HT3 receptor antagonist
3. Cyclizine - antihistamine
4. Buscopan - antimuscarinic (rarely used for nausea)
5. Dexamethasone - used for raised ICP, reduce oedema around tumour
6. Proclorperazine - acts on both histamine and dopamine receptor (RARELY used, causes EPS)

Question 2

Acute management of bowel obstruction

Answer 2

1. NBM
2. NGT
3. IV fluids
4. Analgesia
5. (Surgical if not treated conservatively)

Question 3

Management of Partial obstruction

Answer 3

1. Oral intake
2. Analgesia
3. Metoclopramide - prokinetic, helps push the stool down

Question 4

Management of complete bowel obstruction

Answer 4

1. CEASE metoclopramide (causes colic pain, rebound vomit and perforation from squeezing against tight blockade)
2. Buscopan - antispasmodic, antisecretory, NV reduction.
3. Ocreotide - reduce blood flow to the gut, less secretion

Question 5

Signs of complete bowel obstruction

Answer 5

1. Worsening abdo pain
2. Absent bowel sound
3. increased distension
4. vomiting
5. absent flatulence

Question 6

General mouth care of vomiting patient

Answer 6

1. frequent mouth wash with water
2. Use of biotene roducts
3. Moisten oral cavity with frequent sips of fluid and plain water sprays
4. Gentle teeth brushing with soft brush
5. Induce saliva - sugar free pineapple, frozen lemon slice, frozen tonic water
6. lip palms

Question 7

Definition of stomatitis

Answer 7

Inflammation of the mouth or lips which can result in problems with eating, drinking and adherence to oral medications

Question 8

What are the causes of stomatitis

Answer 8

Xerostomia, chemotherap, radiotherapy, infection

Question 9

What are the causes of dysphagia and odynophagia

Answer 9

1. Neuromuscular
2. Mechanical - tumour, stricutre
3. Infective

Question 10

Investigations for Dysphagia

Answer 10

1. Referral to speech pathologist
2. Videofluoroscopy
3. CT scan

Question 11

Management of dysphagia

Answer 11

1. Mediastinal mass - chemo/radiotherapy
2. Luminal obstruction - oesophageal stenting, laser treatment
3. Esophagitis - usually self-limiting, treat infection if present
4. Corticosteroids
5. NGT

Question 12

6 Reversible cause of Anorexia

Answer 12

1. Nausea and vomiting
2. Dysphagia due to tumour obstruction
3. Mucositis from treatment
4. Constipation
5. Altered taste
6. Inadequately controlled pain

Question 13

How should you manage nutritional support of anorexic patient

Answer 13

1. Small portion of food
2. Patient preference to guide food
3. Avoid strong smells
4. Pureed food if difficulty eating

Question 14

Options for pharmacological management of anorexia

Answer 14

1. Prokinetic - metoclopramide, domperidone
2. Dexamethasone - improve appetite
3. Progestational drugs