Supportive Care

Question 1

Impacted rectum, soft stools

Answer 1

Rectal stimulant
- bisacodyl/phosphate enema
Commence/increase stimulant PO after disimpacted

Question 2

Impacted rectum, hard stools

Answer 2

Lubricate with glycerin/olive oil enema
Followed by phosphate enema
Commence/increase stimulant/softener PO once disimpacted

Question 3

Empty rectum, not dilated

Answer 3

Exclude obstruction
Regular laxatives
Additional laxative for 3d if needed

Question 4

Dilated empty rectum

Answer 4

High fleet enema over several days until resolution
Substitute stimulant laxative with softener/osmotic agent if colic
Increase stimulant laxative with(out) softener if no colic

Question 5

Intestinal obstruction management

Answer 5

Gut rest
NBM
IV hydration

Question 6

Operable obstruction

Answer 6

Stenting if not multiple levels/rectal tumours
Pain relief w opioids if colic
Haloperidol if NV
NGTor octreotide if high volume vomiting

Question 7

Incomplete I/O

Answer 7

Steroids (8-16mg) 
Pain relief w fentanyl 
Buscopan if pain not relieved 
Metoclopramide if NV
Continue to clear bowels

Question 8

I/O Dietary advice

Answer 8

Low residue/low fibre diet

Limit fat intake

Question 9

Diarrhoea management

Answer 9

Codeine 30-50mg Q4-6h PRN
- caution in COPD, asthma, hepatic/renal disease
Diphenoxylate/atropine 1-2 tab TDS-QDS max 8/day
Loperamide 4-16mg
Octreotide 50-200mcg SC BD-TDS

Question 10

Diarrhoea advice

Answer 10

Small frequent meals
Low fibre food
Maintain good fluid intake
Reintroduce protein then fats once diarrhoea resolves

Question 11

Dyspnea management

Answer 11

Oxygen for hypoxic patient 
Opioids for SOB (morphine) 
Dexamethasone 8-16mg/day for peri-tumoural edema 
S/L Lorazepam 0.5mg PRN/BD 
IV/SC midazolam 5-10mg/24h PRN

Question 12

NV Management

Answer 12

Domperidone 
Metoclopramide 10mg TDS, max 20mg QDS
Haloperidol 
Ondansetron 
Buclizine 
Mirtazapine 
Olanzapine

Question 13

Xerostomia management

Answer 13

Frequent oral rinses
Sips of water/juice 
Mouth care before and after meals and at bedtime 
Soft, moist foods 
Increase intake of fluids during meals 
Suck on hard, sugarless candies 
Lubricate oral cavity 
Lip moisturiser 
Pilocarpine 5-10ml TDS

Question 14

Delirium management

Answer 14

Haloperidol 500mcg-3mg PO/SC OD

Benzodiazepines

Question 15

Pruritis management

Answer 15

Emollient use
Crotamiton 10% cream
Topical corticosteroid
Lidocaine patches