Malignant Bowel obstruction

Question 1

Malignant Bowel Obstruction

Answer 1

1. Surgical resection: curative intention.
2. Inoperable: stent (NO more chemo) vs vent gastrostomy
3. Days-weeks: Medical management

Question 2

Medical management

Answer 2

1. Drainage of gastric fluids and replacement by intravenous fluids +/- Parenteral nutrition
2. Pain management: OPIOIDs
3. Antiinflamation: Dexa 8-16mg/day
4. Antiemitic

• Incomplete obstruction: Reglan+Dexa
• Complete: Haldol+Dexa

1. Antisecretive:

• Anticholinergics: Hyoscine, glycopyrrolate, scopolamine
• Octreotide: Peak 0.5-2hrs, duration 8-12 hrs; 50-100mcg sq q8hr titrate to 0.3 to 0.6 mg/day: decrease secertion, peristalsis, splanic blood-flow

Question 3

Daily mixture

Answer 3

1. bolus of 50 mL of amidotrizoate orally
2. metoclopramide (60 mg)
3. octreotide (0.3 mg)
4. dexamethasone (12 mg)

• IV bolus and then intravenous infusion,

Question 4

Amidotrizoate (Diatrizoate/ DX102)

Answer 4

• Gastrografin/ Cystografin
• an ionic radiopaque contrast agent
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