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Reproductive & Sexual Health > Palliative care in gynaecological malignancy > Flashcards

Palliative care in gynaecological malignancy Flashcards

1
Q

What are the physical symptoms of gynaecological malignancy?

A
  • pain
  • nausea and vomiting
  • constipation
  • bleeding
  • treatment related
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2
Q

What are the social complicatons of gynaecological malignancy?

A
  • altered body image
  • fertility issues
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3
Q

What are the emotional complicatons of gynaecological malignancy?

A

Fear

Worry about the future

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4
Q

What are the spiritual complicatons of gynaecological malignancy?

A

Why me

Why now

family and carers

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5
Q

Describe the history for N&V?

A
  • triggers, volume, pattern
  • exacerbating and relieving factors, including individual and combinations of drugs tried and routes used
  • bowel habit
  • medication – consider drugs that may:
    • contribute to the nausea and vomiting
    • cause harm
    • not take effect due to the nausea and vomiting
  • exclude regurgitation as this will require a different approach. If suspected consider seeking advice
  • check for other concurrent symptoms.
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6
Q

Describe examination for N&V

A
  • general review for signs of dehydration, sepsis and drug toxicity
  • central nervous system
  • abdomen (for example organomegaly, bowel sounds, succussion splash)
  • check temperature, pulse and respiration
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7
Q

What is succussion splash?

A
  • sloshing sound heard through the stethoscope during sudden movement of the patient on abdominal auscultation
  • It reflects the presence of gas and fluid in an obstructed organ, as in gastric outlet obstruction.
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8
Q

What are the cerebral cortex causes of nausea and vomiting?

A

Emotions, sight, smell, raised ICP, anxiety

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9
Q

What are the chemoreceptor trigger zone causes of nausea and vomiting?

A

Metabolic (uraemia, ca) drugs

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10
Q

What are the vestibular centre causes of N&V?

A

Motion

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11
Q

What are the GI tract causes of N&V?

A

GI distension, stasis, tumour, mass, constipation, XRT

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12
Q

What receptors are targeted in cerebral cortex to prevent stimulation of the vomiting centre?

What drugs do this?

A

GABA, NK1, 5HT

Dexamethasone, aprepitant, benzodiazepines

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13
Q

What receptors are targeted in the vestibular centre to prevent stimulation of the vomiting centre?

What drugs do this?

A

H1, ACh

Cyclizine, levomepromazine, Hyoscine

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14
Q

What receptors are targeted in the CTZ to prevent stimulation of the vomiting centre?

What drugs do this?

A

D2, 5HT, ACh

Haloperidol, levomepromazine, ondansetron

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15
Q

What receptors are targeted in the GI tract to prevent stimulation of the vomiting centre?

What drugs do this?

A

5HT, D2, ACh

Metoclopramide, levomepromazine, odensetron, dexamethasone

caution in obstruction

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16
Q

What are the causes of cerebral disease induced N&V?

A

Compression / irritation by tumour, raised ICP, anxiety

17
Q

What is the clinical picture of cerebral disease causing N&V?

A

Worse in morning

Associated headache

18
Q

What are the causes of impaired gastric emptying induced N&V?

A

Locally advanced cancer, drugs, radiotherapy damage to gut, autonomic neuropathy

19
Q

What is the clinical picture of impaired gastric emptying causing N&V?

A
  • not usually nauseated
  • then very nauseated
  • large volume vomits
  • feels better after being sick
20
Q

What are the causes of oncological treatment induced N&V?

A

Chemotherapy

Radiotherapy

21
Q

What is the clinical picture of oncological treatment causing N&V?

A

Predictable from history

Often nausea is main complaint

22
Q

What are the causes of chemical/metabolic induced N&V?

A

Medication, advanced cancer, sepsis, kidney or liver impairment, biochemical

23
Q

What is the clinical picture of chemical/metabolic disturbance causing N&V?

A

Think: calcium, sodium, magnesium, urea

Persistent nausea

Little relief from vomiting

24
Q

What is the non-pharmacological treatment for N&V?

A
  • Regular mouth care
  • Keep bowels moving to avoid constipation contributing
  • Encouraging small meals, rather than large meals
  • Avoid cooking or preparing food
  • A calm and reassuring environment
  • Acupressure bands (for example Seaband®)
  • Acupuncture
  • Psychological approaches
25
Q

What is malignant bowel obstruction?

A

Clinical evidence of bowel obstruction in the setting of a diagnosis of intra-abdominal cancer OR non-intra abdominal cancer with clear intraperitoneal disease

26
Q

What causes malignant bowel obstruction

A

Cancer

Adhesion- Post-radiotherapy

Constipation

27
Q

What ar ethe mechanical and adynamic causes of MBO?

A
  • Mechanical
    • intraluminal
    • intramural
    • extramural extrinsic compression
  • adynamic ileus (functional)
    • tumour infiltration of mesentery, muscle or nerves
28
Q

What is the different classifications of MBO?

A

Complete or partial (subacute)

29
Q

Describe the pathophysiology of obstruction?

A
  • Proximal accumulation of secretions
  • Distension of gut
    • Further secretions
    • Reduced absorption of water and sodium
    • Inflammatory response - gut wall oedema
    • Increased motor activity
    • Increased intra-luminal pressure – hypoxia, gangrene and perforation
30
Q

What are the symptoms of obstruction?

A
  • Nausea
  • Vomiting
  • Pain
    • Continuous or Colicy
  • Anorexia/thirst
  • Systemic symptoms from underlying cancer
  • Reduced then absent bowel motions/flatus
  • Paradoxical diarrhoea

Gradual onset over weeks- time can be taken to consider best management.

31
Q

What are the management options for MBO?

A

Surgery

Self-expanding metallic stents

Venting procedures

32
Q

What are the surgical options for management of MBO?

A

Resection

Palliative colostomy or ileostomy

Self-expanding metallic stent

33
Q

What are the medical managment aims for MBO?

A
  1. if partial obstruction promote resolution
  2. relieve pain and colic
  3. reduce vomiting to acceptable level for patient
  4. relieve nausea
  5. relieve thirst
  6. achieve hospital discharge
34
Q

What analgesic options are available for MBO?

A

Opioids

Hyoscine butylbromide for colicky pain (will slow down the bowel)

35
Q

What antiemetics are available for use in MBO?

A

Metoclopramide 30mg/24hrs if not contra-indicated and partial/subacute obstruction

36
Q

What steroids can be used for MBO and why?

A

Dexamethasone- 8-16mg/24 hrs

May promote resolution

May reduce symptoms

Low side effect incidence

Reproductive & Sexual Health (54 decks)

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