Malignant bowel obstruction - Revision history

Ostermayer: Prepared the page for translation

2026-01-04T23:41:55Z

Prepared the page for translation

← Older revision		Revision as of 23:41, 4 January 2026
Line 1:		Line 1:
	<languages/>		<languages/>
	<translate>		<translate>


	==Introduction==		==Introduction==
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	**Pelvic malignancies, especially ovarian cancer		**Pelvic malignancies, especially ovarian cancer
	**GI malignancies such as colorectal pancreatic cancer		**GI malignancies such as colorectal pancreatic cancer



Line 15:		Line 17:
	*Often a preceding waxing and waning course of [[Special:MyLanguage/nausea and vomiting\|nausea and vomiting]] with [[Special:MyLanguage/constipation\|reducing frequency of bowel movements]] and abdominal distension for a few weeks.		*Often a preceding waxing and waning course of [[Special:MyLanguage/nausea and vomiting\|nausea and vomiting]] with [[Special:MyLanguage/constipation\|reducing frequency of bowel movements]] and abdominal distension for a few weeks.
	*As the illness progresses an obvious mechanical bowel obstruction may develop. See [[Special:MyLanguage/Small bowel obstruction#Clinnical Features\|Small bowel obstruction#Clinnical Features]]		*As the illness progresses an obvious mechanical bowel obstruction may develop. See [[Special:MyLanguage/Small bowel obstruction#Clinnical Features\|Small bowel obstruction#Clinnical Features]]



Line 22:		Line 25:
	{{Constipation DDX}}		{{Constipation DDX}}
	<translate>		<translate>



Line 30:		Line 34:
	**May be appropriate if stenting or surgery would be considered		**May be appropriate if stenting or surgery would be considered
	**Will often distinguish between unifocal (which may be amenable to endoscopic stenting or surgery) versus multi-focal obstructions (which portends a poor prognosis)		**Will often distinguish between unifocal (which may be amenable to endoscopic stenting or surgery) versus multi-focal obstructions (which portends a poor prognosis)



Line 41:		Line 46:
	*Sodium [[Special:MyLanguage/docusate\|docusate]] 200mg twice daily (or an alternative stool softener)		*Sodium [[Special:MyLanguage/docusate\|docusate]] 200mg twice daily (or an alternative stool softener)
	*+/- [[Special:MyLanguage/Dexamethasone\|Dexamethasone]] 8mg daily SC		*+/- [[Special:MyLanguage/Dexamethasone\|Dexamethasone]] 8mg daily SC



Line 61:		Line 67:
	*In patients where comfort and quality of life are the key concerns, IV fluids may not be helpful unless thirst is an issue.		*In patients where comfort and quality of life are the key concerns, IV fluids may not be helpful unless thirst is an issue.
	*In patients where life-prolongation is very important, IV hydration and TPN in hospital or in the home setting may be appropriate.		*In patients where life-prolongation is very important, IV hydration and TPN in hospital or in the home setting may be appropriate.



Line 66:		Line 73:

	*Admission		*Admission



Line 71:		Line 79:

	*[[Special:MyLanguage/Bowel obstruction\|Bowel obstruction]]		*[[Special:MyLanguage/Bowel obstruction\|Bowel obstruction]]



Line 78:		Line 87:

	[[Category:GI]]		[[Category:GI]]

	</translate>		</translate>

Ostermayer: Prepared the page for translation

2026-01-04T23:18:32Z

Prepared the page for translation

← Older revision		Revision as of 23:18, 4 January 2026
Line 1:		Line 1:
			<languages/>
			<translate>

	==Introduction==		==Introduction==
	*[[Bowel obstruction]] in malignancy is complex in etiology
			*[[Special:MyLanguage/Bowel obstruction\|Bowel obstruction]] in malignancy is complex in etiology
	*Underlying pathophysiology often involves combination of physical mechanical obstruction plus ileus / motility related issues, usually in patients with disseminated peritoneal metastases		*Underlying pathophysiology often involves combination of physical mechanical obstruction plus ileus / motility related issues, usually in patients with disseminated peritoneal metastases
	*Common causes		*Common causes
	**Pelvic malignancies, especially ovarian cancer		**Pelvic malignancies, especially ovarian cancer
	**GI malignancies such as colorectal pancreatic cancer		**GI malignancies such as colorectal pancreatic cancer


	==Clinical features==		==Clinical features==
	*Often a preceding waxing and waning course of [[nausea and vomiting]] with [[constipation\|reducing frequency of bowel movements]] and abdominal distension for a few weeks.
	*As the illness progresses an obvious mechanical bowel obstruction may develop. See [[Small bowel obstruction#Clinnical Features]]		*Often a preceding waxing and waning course of [[Special:MyLanguage/nausea and vomiting\|nausea and vomiting]] with [[Special:MyLanguage/constipation\|reducing frequency of bowel movements]] and abdominal distension for a few weeks.
			*As the illness progresses an obvious mechanical bowel obstruction may develop. See [[Special:MyLanguage/Small bowel obstruction#Clinnical Features\|Small bowel obstruction#Clinnical Features]]


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{Constipation DDX}}		{{Constipation DDX}}
			<translate>


	==Evaluation==		==Evaluation==

	*The appropriate extent of investigations and treatment varies based on how advanced the patients malignancy is as well as his or her wishes.		*The appropriate extent of investigations and treatment varies based on how advanced the patients malignancy is as well as his or her wishes.
	*CT scan		*CT scan
	**May be appropriate if stenting or surgery would be considered		**May be appropriate if stenting or surgery would be considered
	**Will often distinguish between unifocal (which may be amenable to endoscopic stenting or surgery) versus multi-focal obstructions (which portends a poor prognosis)		**Will often distinguish between unifocal (which may be amenable to endoscopic stenting or surgery) versus multi-focal obstructions (which portends a poor prognosis)


	==Management==		==Management==


	==="Pre-Bowel Obstruction"===		==="Pre-Bowel Obstruction"===

	*In patients at high risk of a full blown malignant bowel obstruction who have no abdominal pain but increasing distension, nausea, vomiting and reducing bowel movements:		*In patients at high risk of a full blown malignant bowel obstruction who have no abdominal pain but increasing distension, nausea, vomiting and reducing bowel movements:
	*[[Metoclopramide]] 30mg via CSCI over 24 hours		*[[Special:MyLanguage/Metoclopramide\|Metoclopramide]] 30mg via CSCI over 24 hours
	*Sodium [[docusate]] 200mg twice daily (or an alternative stool softener)		*Sodium [[Special:MyLanguage/docusate\|docusate]] 200mg twice daily (or an alternative stool softener)
	*+/- [[Dexamethasone]] 8mg daily SC		*+/- [[Special:MyLanguage/Dexamethasone\|Dexamethasone]] 8mg daily SC


	===Clear Malignant Bowel Obstruction===		===Clear Malignant Bowel Obstruction===

	*In many patients surgery or stenting is unlikely to be helpful, although for very proximal unifocal lesions or for patients otherwise very fit and healthy it may be worth considering		*In many patients surgery or stenting is unlikely to be helpful, although for very proximal unifocal lesions or for patients otherwise very fit and healthy it may be worth considering
	*Usually malignant bowel obstruction is indicative that a patient is coming into the last few weeks or month of life. A kind but frank discussion about this is usually helpful.		*Usually malignant bowel obstruction is indicative that a patient is coming into the last few weeks or month of life. A kind but frank discussion about this is usually helpful.
	*If vomiting and abdominal pain are very severe, consider drainage NG tube. If severe vomiting and discomfort are not major issues then it may be best to avoid an NG tube, especially if a more comfort-based approach to treatment is being considered		*If vomiting and abdominal pain are very severe, consider drainage NG tube. If severe vomiting and discomfort are not major issues then it may be best to avoid an NG tube, especially if a more comfort-based approach to treatment is being considered
	*Treat vomiting and distension with anti-secretorary agents:		*Treat vomiting and distension with anti-secretorary agents:
	**[[Ranitidine]] 150mg via [[CSCI]] over 24 hours		**[[Special:MyLanguage/Ranitidine\|Ranitidine]] 150mg via [[Special:MyLanguage/CSCI\|CSCI]] over 24 hours
	**[[Octreotide]] 600mg via CSCI over 24 hours		**[[Special:MyLanguage/Octreotide\|Octreotide]] 600mg via CSCI over 24 hours
	*Treat nausea with an anti-emetic, e.g.		*Treat nausea with an anti-emetic, e.g.
	**[[Haloperidol]] 2.5mg via CSCI over 24 hours		**[[Special:MyLanguage/Haloperidol\|Haloperidol]] 2.5mg via CSCI over 24 hours
	**+ Haloperidol 1mg SC 2-hourly PRN for nausea		**+ Haloperidol 1mg SC 2-hourly PRN for nausea
	*Treat abdominal pain with an anti-spasmodic + an opioid, e.g.		*Treat abdominal pain with an anti-spasmodic + an opioid, e.g.
	**Hyoscine butylbromide 60mg via CSCI over 24 hours		**Hyoscine butylbromide 60mg via CSCI over 24 hours
	**A low dose opioid via CSCI over 24 hours and SC PRN		**A low dose opioid via CSCI over 24 hours and SC PRN
	*Also consider [[dexamethasone]] 8mg daily SC		*Also consider [[Special:MyLanguage/dexamethasone\|dexamethasone]] 8mg daily SC
	*If intractable vomiting persists, consider a venting PEG.		*If intractable vomiting persists, consider a venting PEG.
	*In patients where comfort and quality of life are the key concerns, IV fluids may not be helpful unless thirst is an issue.		*In patients where comfort and quality of life are the key concerns, IV fluids may not be helpful unless thirst is an issue.
	*In patients where life-prolongation is very important, IV hydration and TPN in hospital or in the home setting may be appropriate.		*In patients where life-prolongation is very important, IV hydration and TPN in hospital or in the home setting may be appropriate.


	==Disposition==		==Disposition==

	*Admission		*Admission


	==See also==		==See also==
	*[[Bowel obstruction]]
			*[[Special:MyLanguage/Bowel obstruction\|Bowel obstruction]]


	==References==		==References==

	<references/>		<references/>

	[[Category:GI]]		[[Category:GI]]
			</translate>

Rossdonaldson1: /* Disposition */

2022-04-23T11:31:47Z

Disposition

← Older revision		Revision as of 11:31, 23 April 2022
Line 45:		Line 45:

	==Disposition==		==Disposition==
			*Admission

	==See also==		==See also==

ClaireLewis at 23:01, 29 September 2019

2019-09-29T23:01:23Z

← Older revision		Revision as of 23:01, 29 September 2019
Line 1:		Line 1:
	==Introduction==		==Introduction==
	*Bowel obstruction in malignancy is complex in ~~aetiology~~		*[[Bowel obstruction]] in malignancy is complex in etiology
	*Underlying pathophysiology often involves combination of physical mechanical obstruction plus ileus / motility related issues, usually in patients with disseminated peritoneal metastases		*Underlying pathophysiology often involves combination of physical mechanical obstruction plus ileus / motility related issues, usually in patients with disseminated peritoneal metastases
	*Common causes		*Common causes
Line 7:		Line 7:

	==Clinical features==		==Clinical features==
	*Often a preceding waxing and waning course of nausea and vomiting with reducing frequency of bowel movements and abdominal distension for a few weeks.		*Often a preceding waxing and waning course of [[nausea and vomiting]] with [[constipation\|reducing frequency of bowel movements]] and abdominal distension for a few weeks.
	*As the illness progresses an obvious mechanical bowel obstruction may develop. See [[Small bowel obstruction#Clinnical Features]]		*As the illness progresses an obvious mechanical bowel obstruction may develop. See [[Small bowel obstruction#Clinnical Features]]

Line 17:		Line 17:
	*CT scan		*CT scan
	**May be appropriate if stenting or surgery would be considered		**May be appropriate if stenting or surgery would be considered
	**Will often ~~distiguish~~ between unifocal (which may be amenable to endoscopic stenting or surgery) versus multi-focal obstructions (which portends a poor prognosis)		**Will often distinguish between unifocal (which may be amenable to endoscopic stenting or surgery) versus multi-focal obstructions (which portends a poor prognosis)

	==Management==		==Management==
	==="Pre-Bowel Obstruction"===		==="Pre-Bowel Obstruction"===
	*In patients at high risk of a full blown malignant bowel obstruction who have no abdominal pain but increasing distension, nausea, vomiting and reducing bowel movements:		*In patients at high risk of a full blown malignant bowel obstruction who have no abdominal pain but increasing distension, nausea, vomiting and reducing bowel movements:
	*Metoclopramide 30mg via CSCI over 24 hours		*[[Metoclopramide]] 30mg via CSCI over 24 hours
	*Sodium docusate 200mg twice daily (or an alternative stool softener)		*Sodium [[docusate]] 200mg twice daily (or an alternative stool softener)
	*+/- Dexamethasone 8mg daily SC		*+/- [[Dexamethasone]] 8mg daily SC

	===Clear Malignant Bowel Obstruction===		===Clear Malignant Bowel Obstruction===
	*In many patients surgery or stenting is unlikely to be helpful, although for very proximal unifocal lesions or for patients otherwise very fit and healthy it may be worth ~~considereding~~		*In many patients surgery or stenting is unlikely to be helpful, although for very proximal unifocal lesions or for patients otherwise very fit and healthy it may be worth considering
	*Usually malignant bowel obstruction is indicative that a patient is coming into the last few weeks or month of life. A kind but frank discussion about this is usually helpful.		*Usually malignant bowel obstruction is indicative that a patient is coming into the last few weeks or month of life. A kind but frank discussion about this is usually helpful.
	*If vomiting and abdominal pain are very severe, consider drainage NG tube. If severe vomiting and discomfort are not major issues then it may be best to avoid an NG tube, especially if a more comfort-based approach to treatment is being considered		*If vomiting and abdominal pain are very severe, consider drainage NG tube. If severe vomiting and discomfort are not major issues then it may be best to avoid an NG tube, especially if a more comfort-based approach to treatment is being considered
	*Treat vomiting and distension with anti-secretorary agents:		*Treat vomiting and distension with anti-secretorary agents:
	**Ranitidine 150mg via [[CSCI]] over 24 hours		**[[Ranitidine]] 150mg via [[CSCI]] over 24 hours
	**Octreotide 600mg via CSCI over 24 hours		**[[Octreotide]] 600mg via CSCI over 24 hours
	*Treat nausea with an anti-emetic, e.g.		*Treat nausea with an anti-emetic, e.g.
	**Haloperidol 2.5mg via CSCI over 24 hours		**[[Haloperidol]] 2.5mg via CSCI over 24 hours
	**+ Haloperidol 1mg SC 2-hourly PRN for nausea		**+ Haloperidol 1mg SC 2-hourly PRN for nausea
	*Treat abdominal pain with an anti-spasmodic + an opioid, e.g.		*Treat abdominal pain with an anti-spasmodic + an opioid, e.g.
	**Hyoscine butylbromide 60mg via CSCI over 24 hours		**Hyoscine butylbromide 60mg via CSCI over 24 hours
	**A low dose opioid via CSCI over 24 hours and SC PRN		**A low dose opioid via CSCI over 24 hours and SC PRN
	*Also consider dexamethasone 8mg daily SC		*Also consider [[dexamethasone]] 8mg daily SC
	*If intractable vomiting persists, consider a venting PEG.		*If intractable vomiting persists, consider a venting PEG.
	*In patients where comfort and quality of life are the key concerns, IV fluids may not be helpful unless thirst is an issue.		*In patients where comfort and quality of life are the key concerns, IV fluids may not be helpful unless thirst is an issue.

Rossdonaldson1: /* Differential Diagnosis */

2019-06-24T21:08:19Z

Differential Diagnosis

← Older revision		Revision as of 21:08, 24 June 2019
Line 11:		Line 11:

	==Differential Diagnosis==		==Differential Diagnosis==
			{{Constipation DDX}}

	==Evaluation==		==Evaluation==

Mholtz at 19:11, 30 July 2017

2017-07-30T19:11:30Z

← Older revision		Revision as of 19:11, 30 July 2017
Line 53:		Line 53:
	<references/>		<references/>

	[[Category: ~~Palliative Medicine~~]]		[[Category:GI]]

Mholtz at 05:00, 31 May 2017

2017-05-31T05:00:12Z

← Older revision		Revision as of 05:00, 31 May 2017
Line 1:		Line 1:
	==Introduction==		==Introduction==
			*Bowel obstruction in malignancy is complex in aetiology
	Bowel obstruction in malignancy is complex in aetiology		*Underlying pathophysiology often involves combination of physical mechanical obstruction plus ileus / motility related issues, usually in patients with disseminated peritoneal metastases
			*Common causes
	Underlying pathophysiology often involves combination of physical mechanical obstruction plus ileus / motility related issues, usually in patients with disseminated peritoneal metastases		**Pelvic malignancies, especially ovarian cancer
			**GI malignancies such as colorectal pancreatic cancer
	==Common causes==

	Pelvic malignancies, especially ovarian cancer

	~~Gastrointestinal~~ malignancies such as colorectal ~~cancer or pancreas~~ cancer

	==Clinical features==		==Clinical features==
			*Often a preceding waxing and waning course of nausea and vomiting with reducing frequency of bowel movements and abdominal distension for a few weeks.
			*As the illness progresses an obvious mechanical bowel obstruction may develop. See [[Small bowel obstruction#Clinnical Features]]

	~~Often a preceding waxing and waning course of nausea and vomiting with reducing frequency of bowel movements and abdominal distension for a few weeks.~~		==Differential Diagnosis==

	~~As the illness progresses an obvious mechanical bowel obstruction may develop. See [[Small bowel obstruction#Clinnical Features]]~~

	~~==Investigations==~~

	The appropriate extent of investigations and treatment varies based on how advanced the patients malignancy is as well as his or her wishes.		==Evaluation==
			*The appropriate extent of investigations and treatment varies based on how advanced the patients malignancy is as well as his or her wishes.
	CT scan		*CT scan
	*May be appropriate if stenting or surgery would be considered		**May be appropriate if stenting or surgery would be considered
	*Will often distiguish between unifocal (which may be amenable to endoscopic stenting or surgery) versus multi-focal obstructions (which portends a poor prognosis)		**Will often distiguish between unifocal (which may be amenable to endoscopic stenting or surgery) versus multi-focal obstructions (which portends a poor prognosis)

	==Management==		==Management==

	==="Pre-Bowel Obstruction"===		==="Pre-Bowel Obstruction"===
			*In patients at high risk of a full blown malignant bowel obstruction who have no abdominal pain but increasing distension, nausea, vomiting and reducing bowel movements:
	In patients at high risk of a full blown malignant bowel obstruction who have no abdominal pain but increasing distension, nausea, vomiting and reducing bowel movements:		*Metoclopramide 30mg via CSCI over 24 hours
			*Sodium docusate 200mg twice daily (or an alternative stool softener)
	Metoclopramide 30mg via CSCI over 24 hours		*+/- Dexamethasone 8mg daily SC
	Sodium docusate 200mg twice daily (or an alternative stool softener)
	+/- Dexamethasone 8mg daily SC

	===Clear Malignant Bowel Obstruction===		===Clear Malignant Bowel Obstruction===
			*In many patients surgery or stenting is unlikely to be helpful, although for very proximal unifocal lesions or for patients otherwise very fit and healthy it may be worth considereding
			*Usually malignant bowel obstruction is indicative that a patient is coming into the last few weeks or month of life. A kind but frank discussion about this is usually helpful.
			*If vomiting and abdominal pain are very severe, consider drainage NG tube. If severe vomiting and discomfort are not major issues then it may be best to avoid an NG tube, especially if a more comfort-based approach to treatment is being considered
			*Treat vomiting and distension with anti-secretorary agents:
			**Ranitidine 150mg via [[CSCI]] over 24 hours
			**Octreotide 600mg via CSCI over 24 hours
			*Treat nausea with an anti-emetic, e.g.
			**Haloperidol 2.5mg via CSCI over 24 hours
			**+ Haloperidol 1mg SC 2-hourly PRN for nausea
			*Treat abdominal pain with an anti-spasmodic + an opioid, e.g.
			**Hyoscine butylbromide 60mg via CSCI over 24 hours
			**A low dose opioid via CSCI over 24 hours and SC PRN
			*Also consider dexamethasone 8mg daily SC
			*If intractable vomiting persists, consider a venting PEG.
			*In patients where comfort and quality of life are the key concerns, IV fluids may not be helpful unless thirst is an issue.
			*In patients where life-prolongation is very important, IV hydration and TPN in hospital or in the home setting may be appropriate.

	~~In many patients surgery or stenting is unlikely to be helpful, although for very proximal unifocal lesions or for patients otherwise very fit and healthy it may be worth considereding~~		==Disposition==

	~~Usually malignant bowel obstruction is indicative that a patient is coming into the last few weeks or month of life. A kind but frank discussion about this is usually helpful.~~

	If vomiting and abdominal pain are very severe, consider drainage NG tube. If severe vomiting and discomfort are not major issues then it may be best to avoid an NG tube, especially if a more comfort-based approach to treatment is being considered

	~~Treat vomiting and distension with anti-secretorary agents:~~

	~~Ranitidine 150mg via [[CSCI]] over 24 hours~~
	~~Octreotide 600mg via CSCI over 24 hours~~

	~~Treat nausea with an anti-emetic, e.g.~~

	~~Haloperidol 2.5mg via CSCI over 24 hours~~
	~~+ Haloperidol 1mg SC 2-hourly PRN for nausea~~

	~~Treat abdominal pain with an anti-spasmodic + an opioid, e.g.~~

	~~Hyoscine butylbromide 60mg via CSCI over 24 hours~~
	~~A low dose opioid via CSCI over 24 hours and SC PRN~~

	~~Also consider dexamethasone 8mg daily SC~~

	~~If intractable vomiting persists, consider a venting PEG.~~

	~~In patients where comfort and quality of life are the key concerns, IV fluids may not be helpful unless thirst is an issue.~~

	~~In patients where life-prolongation is very important, IV hydration and TPN in hospital or in the home setting may be appropriate.~~

	==See also==		==See also==
			*[[Bowel obstruction]]

	~~[[Bowel obstruction]]~~		==References==
			<references/>

	[[Category: Palliative Medicine]]		[[Category: Palliative Medicine]]

Neil.m.young: Text replacement - "== " to "=="

2016-07-06T17:50:26Z

Text replacement - "== " to "=="

← Older revision		Revision as of 17:50, 6 July 2016
Line 1:		Line 1:
	== Introduction==		==Introduction==

	Bowel obstruction in malignancy is complex in aetiology		Bowel obstruction in malignancy is complex in aetiology
Line 5:		Line 5:
	Underlying pathophysiology often involves combination of physical mechanical obstruction plus ileus / motility related issues, usually in patients with disseminated peritoneal metastases		Underlying pathophysiology often involves combination of physical mechanical obstruction plus ileus / motility related issues, usually in patients with disseminated peritoneal metastases

	== Common causes==		==Common causes==

	Pelvic malignancies, especially ovarian cancer		Pelvic malignancies, especially ovarian cancer
Line 11:		Line 11:
	Gastrointestinal malignancies such as colorectal cancer or pancreas cancer		Gastrointestinal malignancies such as colorectal cancer or pancreas cancer

	== Clinical features==		==Clinical features==

	Often a preceding waxing and waning course of nausea and vomiting with reducing frequency of bowel movements and abdominal distension for a few weeks.		Often a preceding waxing and waning course of nausea and vomiting with reducing frequency of bowel movements and abdominal distension for a few weeks.
Line 17:		Line 17:
	As the illness progresses an obvious mechanical bowel obstruction may develop. See [[Small bowel obstruction#Clinnical Features]]		As the illness progresses an obvious mechanical bowel obstruction may develop. See [[Small bowel obstruction#Clinnical Features]]

	== Investigations==		==Investigations==

	The appropriate extent of investigations and treatment varies based on how advanced the patients malignancy is as well as his or her wishes.		The appropriate extent of investigations and treatment varies based on how advanced the patients malignancy is as well as his or her wishes.
Line 25:		Line 25:
	*Will often distiguish between unifocal (which may be amenable to endoscopic stenting or surgery) versus multi-focal obstructions (which portends a poor prognosis)		*Will often distiguish between unifocal (which may be amenable to endoscopic stenting or surgery) versus multi-focal obstructions (which portends a poor prognosis)

	== Management==		==Management==

	=== "Pre-Bowel Obstruction"===		==="Pre-Bowel Obstruction"===

	In patients at high risk of a full blown malignant bowel obstruction who have no abdominal pain but increasing distension, nausea, vomiting and reducing bowel movements:		In patients at high risk of a full blown malignant bowel obstruction who have no abdominal pain but increasing distension, nausea, vomiting and reducing bowel movements:
Line 35:		Line 35:
	+/- Dexamethasone 8mg daily SC		+/- Dexamethasone 8mg daily SC

	=== Clear Malignant Bowel Obstruction===		===Clear Malignant Bowel Obstruction===

	In many patients surgery or stenting is unlikely to be helpful, although for very proximal unifocal lesions or for patients otherwise very fit and healthy it may be worth considereding		In many patients surgery or stenting is unlikely to be helpful, although for very proximal unifocal lesions or for patients otherwise very fit and healthy it may be worth considereding
Line 66:		Line 66:
	In patients where life-prolongation is very important, IV hydration and TPN in hospital or in the home setting may be appropriate.		In patients where life-prolongation is very important, IV hydration and TPN in hospital or in the home setting may be appropriate.

	== See also==		==See also==

	[[Bowel obstruction]]		[[Bowel obstruction]]

	[[Category: Palliative Medicine]]		[[Category: Palliative Medicine]]

Neil.m.young: Text replacement - " ==" to "=="

2016-07-05T23:45:58Z

Text replacement - " ==" to "=="

← Older revision		Revision as of 23:45, 5 July 2016
Line 1:		Line 1:
	== Introduction ==		== Introduction==

	Bowel obstruction in malignancy is complex in aetiology		Bowel obstruction in malignancy is complex in aetiology
Line 5:		Line 5:
	Underlying pathophysiology often involves combination of physical mechanical obstruction plus ileus / motility related issues, usually in patients with disseminated peritoneal metastases		Underlying pathophysiology often involves combination of physical mechanical obstruction plus ileus / motility related issues, usually in patients with disseminated peritoneal metastases

	== Common causes ==		== Common causes==

	Pelvic malignancies, especially ovarian cancer		Pelvic malignancies, especially ovarian cancer
Line 11:		Line 11:
	Gastrointestinal malignancies such as colorectal cancer or pancreas cancer		Gastrointestinal malignancies such as colorectal cancer or pancreas cancer

	== Clinical features ==		== Clinical features==

	Often a preceding waxing and waning course of nausea and vomiting with reducing frequency of bowel movements and abdominal distension for a few weeks.		Often a preceding waxing and waning course of nausea and vomiting with reducing frequency of bowel movements and abdominal distension for a few weeks.
Line 17:		Line 17:
	As the illness progresses an obvious mechanical bowel obstruction may develop. See [[Small bowel obstruction#Clinnical Features]]		As the illness progresses an obvious mechanical bowel obstruction may develop. See [[Small bowel obstruction#Clinnical Features]]

	== Investigations ==		== Investigations==

	The appropriate extent of investigations and treatment varies based on how advanced the patients malignancy is as well as his or her wishes.		The appropriate extent of investigations and treatment varies based on how advanced the patients malignancy is as well as his or her wishes.
Line 25:		Line 25:
	*Will often distiguish between unifocal (which may be amenable to endoscopic stenting or surgery) versus multi-focal obstructions (which portends a poor prognosis)		*Will often distiguish between unifocal (which may be amenable to endoscopic stenting or surgery) versus multi-focal obstructions (which portends a poor prognosis)

	== Management ==		== Management==

	=== "Pre-Bowel Obstruction" ===		=== "Pre-Bowel Obstruction"===

	In patients at high risk of a full blown malignant bowel obstruction who have no abdominal pain but increasing distension, nausea, vomiting and reducing bowel movements:		In patients at high risk of a full blown malignant bowel obstruction who have no abdominal pain but increasing distension, nausea, vomiting and reducing bowel movements:
Line 35:		Line 35:
	+/- Dexamethasone 8mg daily SC		+/- Dexamethasone 8mg daily SC

	=== Clear Malignant Bowel Obstruction ===		=== Clear Malignant Bowel Obstruction===

	In many patients surgery or stenting is unlikely to be helpful, although for very proximal unifocal lesions or for patients otherwise very fit and healthy it may be worth considereding		In many patients surgery or stenting is unlikely to be helpful, although for very proximal unifocal lesions or for patients otherwise very fit and healthy it may be worth considereding
Line 66:		Line 66:
	In patients where life-prolongation is very important, IV hydration and TPN in hospital or in the home setting may be appropriate.		In patients where life-prolongation is very important, IV hydration and TPN in hospital or in the home setting may be appropriate.

	== See also ==		== See also==

	[[Bowel obstruction]]		[[Bowel obstruction]]

	[[Category: Palliative Medicine]]		[[Category: Palliative Medicine]]

Neil.m.young: Text replacement - "* " to "*"

2016-07-05T21:12:08Z

Text replacement - "* " to "*"

← Older revision		Revision as of 21:12, 5 July 2016
Line 22:		Line 22:

	CT scan		CT scan
	* May be appropriate if stenting or surgery would be considered		*May be appropriate if stenting or surgery would be considered
	* Will often distiguish between unifocal (which may be amenable to endoscopic stenting or surgery) versus multi-focal obstructions (which portends a poor prognosis)		*Will often distiguish between unifocal (which may be amenable to endoscopic stenting or surgery) versus multi-focal obstructions (which portends a poor prognosis)

	== Management ==		== Management ==