Palliative Care Flashcards
physical symptom burden ovarian cancer
abdominal swelling/distension constipation ascities/pleural effusion pressure symptoms nausea/ vomiting bleeding endocrine symptoms pain
what do you ask in a nausea history (TEACH ED)
T- triggers E- exacerbating/alleviating factors A- associated symptoms C- colour, volume, pattern etc H- how are your bowels E- exclude regurgitation D- drugs
(always follow with examination)
what are some causes of nausea and vomiting
gynaecological malignancy raised ICP medications (chemo) migraines motion sickness pregnancy gastroenteritis/infection mental health disorders (eg.bulimia)
what neurological-receptors are involved in nausea
serotonin
histamine
dopamine
acetylcholine
where is the vomiting centre located
the medulla
what areas act on the vomiting centre to induce nausea and vomiting
cerebral cortex (emotions, sights, raised ICP, anxiety, smell etc) Vestibular centre (motion) Chemoreceptor trigger zone (metabolic/drugs) Gastrointestinal tract (distension, stasis, tumour, constipation)
what drugs can be used to treat nausea and vomiting from the cerebral cortex
Dexamethasone
Aprepitant
Benzodiazapines
(act on GABA, NK1, 5HT)
what drugs can be used to treat nausea and vomiting coming from the vestibular centre
Cyclizine
Levomepromazine
Hyocine
(act on H1, and ACh)
what drugs can be used to treat nausea and vomiting coming from chemoreceptor trigger zones
Haloperidol
Levomepromazine
Ondansetron
what drugs can be used to treat nausea and vomiting coming from the GI tract
Metoclopramide
Levomepromazine
Ondansterone
Dexamethasone
classic history of cerebral disease (raised ICP and anxiety) nausea and vomiting
worse in the morning
associated with headache
classic history of N&V caused by oncological treatment (chemo/radio)
predictable from history
nausea main complaint
classic history of impaired gastric emptying N&V
not usually nauseated - feel it as soon as they have something to eat
continues to worsen until committing and large volume and then feeling fine again
classic history of chemical and metabolic N&V
persistent nausea
little relief from vomiting
causes of chemical and metabolic N&V
medication advanced cancer sepsis kidney or liver impairment biochemical
think - calcium, sodium, magnesium, urea
causes of impaired gastric emptying
locally advanced cancer
drugs
radio damage to gut
autonomic neuropathy
what are some non-pharmacological managements for N&V
avoid cooking have small meals keep bowels moving to prevent constapation acupressure bands acupuncture psychological approaches calm, reassuring environments
what is anticipatory nausea
worrying so much about being sick that it make you nauseous
what is malignant bowel obstruction (MBO)
bowel obstruction in the setting of intraabdominal cancer (primary or mets)
MBO does not have to be caused directly by the cancer
causes of MBO
mechanical (intraluminal, intramural, extramural compression)
dynamic ileus (tumour infiltration of mesentery, muscles or nerves)
two main types of MBO
complete - blocking the bowel and nothing is going to get through
partial/subacute - incomplete blockage up to 50%
what is the pathophysiology behind MBO
colicky pain comes from gut pushing against obstruction
secretions build up
reduced absorption
inflammatory response
increased intraluminal pressure leads to hypoxia, gangrene and perforation
symptoms of MBO
nausea vommiting pain impaired appetite thirst absent bowel motions and flatulence paradoxical diarrhoea gradual onset over weeks
management of MBO
surgery - if single blockage
medical treatment
what is the medical treatment for MBO
Analgesics (opioids, hyoscine butylbrommide for colicky pain)
anti-emetics (metoclopramine (not in colicky as gut already pushing against blockage)
steroids (dexamethasone to reduce inflammation)
anti-secretory agents (buscopan, octreotide)
Laxatives (decussate or movicol to soften stock in partial obstruction
