constipation and the cancer patient. constipation definition physiology of gi tract etiology...
TRANSCRIPT
![Page 1: Constipation and the Cancer Patient. Constipation Definition Physiology of GI tract Etiology Assessment Treatment](https://reader036.vdocuments.mx/reader036/viewer/2022062511/5515135a550346c77d8b4be3/html5/thumbnails/1.jpg)
Constipation and the Cancer Patient
![Page 2: Constipation and the Cancer Patient. Constipation Definition Physiology of GI tract Etiology Assessment Treatment](https://reader036.vdocuments.mx/reader036/viewer/2022062511/5515135a550346c77d8b4be3/html5/thumbnails/2.jpg)
ConstipationDefinition
Physiology of GI tract
Etiology
Assessment
Treatment
![Page 3: Constipation and the Cancer Patient. Constipation Definition Physiology of GI tract Etiology Assessment Treatment](https://reader036.vdocuments.mx/reader036/viewer/2022062511/5515135a550346c77d8b4be3/html5/thumbnails/3.jpg)
ConstipationAssessment methods
Etiology
Concomitant disease
Pharmacologic treatment
Preventative strategies
![Page 4: Constipation and the Cancer Patient. Constipation Definition Physiology of GI tract Etiology Assessment Treatment](https://reader036.vdocuments.mx/reader036/viewer/2022062511/5515135a550346c77d8b4be3/html5/thumbnails/4.jpg)
DefinitionPassage of small, hard stools
Painful passage (straining)
Prolonged interval
N range: 1 in 3d to 3 in 1d
![Page 5: Constipation and the Cancer Patient. Constipation Definition Physiology of GI tract Etiology Assessment Treatment](https://reader036.vdocuments.mx/reader036/viewer/2022062511/5515135a550346c77d8b4be3/html5/thumbnails/5.jpg)
PhysiologyCoordinated effort:
motility (peristalsis)
intact ANS
hormonal activity
mucosal transport
defecation reflex
![Page 6: Constipation and the Cancer Patient. Constipation Definition Physiology of GI tract Etiology Assessment Treatment](https://reader036.vdocuments.mx/reader036/viewer/2022062511/5515135a550346c77d8b4be3/html5/thumbnails/6.jpg)
Symptom PrevalencePain
Fatigue/Asthenia Constipation
Dyspnea
Nausea
Vomiting
Delirium
Depression/suffering
80 - 90%
75 - 90%
70%
60%
50 - 60%
30%
30 - 90%
40 - 60%
![Page 7: Constipation and the Cancer Patient. Constipation Definition Physiology of GI tract Etiology Assessment Treatment](https://reader036.vdocuments.mx/reader036/viewer/2022062511/5515135a550346c77d8b4be3/html5/thumbnails/7.jpg)
EtiologyMalignancy
Medications
Concurrent Disease
![Page 8: Constipation and the Cancer Patient. Constipation Definition Physiology of GI tract Etiology Assessment Treatment](https://reader036.vdocuments.mx/reader036/viewer/2022062511/5515135a550346c77d8b4be3/html5/thumbnails/8.jpg)
Malignancy EffectsDirect
obstruction by tumor in wall
external compression by tumor
neural damage
L/S spinal cord
cauda equina/pelvic plexus
hypercalcemia
![Page 9: Constipation and the Cancer Patient. Constipation Definition Physiology of GI tract Etiology Assessment Treatment](https://reader036.vdocuments.mx/reader036/viewer/2022062511/5515135a550346c77d8b4be3/html5/thumbnails/9.jpg)
Malignancy EffectsSecondary effects
poor po intake
dehydration
weakness/inactivity
confusion
depression
unfamiliar toilet arrangements
![Page 10: Constipation and the Cancer Patient. Constipation Definition Physiology of GI tract Etiology Assessment Treatment](https://reader036.vdocuments.mx/reader036/viewer/2022062511/5515135a550346c77d8b4be3/html5/thumbnails/10.jpg)
MedicationsOpioids
Anticholinergic activity
phenothiazines
tricyclic antidepressants
antiparkinsonian agents
Antacids
![Page 11: Constipation and the Cancer Patient. Constipation Definition Physiology of GI tract Etiology Assessment Treatment](https://reader036.vdocuments.mx/reader036/viewer/2022062511/5515135a550346c77d8b4be3/html5/thumbnails/11.jpg)
Opioid effects Ileocecal & anal sphincter tone
Peristaltic activity in SI & C
Impaired defecation reflex
sensitivity to distension
internal anal sphincter tone
‘lyte & water absorption in SI & C
![Page 12: Constipation and the Cancer Patient. Constipation Definition Physiology of GI tract Etiology Assessment Treatment](https://reader036.vdocuments.mx/reader036/viewer/2022062511/5515135a550346c77d8b4be3/html5/thumbnails/12.jpg)
MedicationsDiuretics
Anticonvulsant
Iron supplements
Antihypertensive Rx
5HT3 Antagonists
Vinca alkaloids
![Page 13: Constipation and the Cancer Patient. Constipation Definition Physiology of GI tract Etiology Assessment Treatment](https://reader036.vdocuments.mx/reader036/viewer/2022062511/5515135a550346c77d8b4be3/html5/thumbnails/13.jpg)
Concurrent DiseaseDiabetes
Hypothyroidism
Hypokalemia
Hernia
Anal fissure/stenosis
Hemorrhoids
![Page 14: Constipation and the Cancer Patient. Constipation Definition Physiology of GI tract Etiology Assessment Treatment](https://reader036.vdocuments.mx/reader036/viewer/2022062511/5515135a550346c77d8b4be3/html5/thumbnails/14.jpg)
Neuropathy & Constipation
Autonomic neuropathy
diabetes
spinal cord disease
chemotherapy
Parkinson’s disease
ALS/MS
Dementia
![Page 15: Constipation and the Cancer Patient. Constipation Definition Physiology of GI tract Etiology Assessment Treatment](https://reader036.vdocuments.mx/reader036/viewer/2022062511/5515135a550346c77d8b4be3/html5/thumbnails/15.jpg)
ComplicationsHemorrhoids
Rectal prolapse
Fecal impaction
Obstruction
Perforation
Nausea/vomiting
Urinary retention
![Page 16: Constipation and the Cancer Patient. Constipation Definition Physiology of GI tract Etiology Assessment Treatment](https://reader036.vdocuments.mx/reader036/viewer/2022062511/5515135a550346c77d8b4be3/html5/thumbnails/16.jpg)
AssessmentHx/PE
Digital rectal exam
Abd X-ray
Blood work (Ca, K, TSH)
![Page 17: Constipation and the Cancer Patient. Constipation Definition Physiology of GI tract Etiology Assessment Treatment](https://reader036.vdocuments.mx/reader036/viewer/2022062511/5515135a550346c77d8b4be3/html5/thumbnails/17.jpg)
HistoryLast BM? BM freq? Previous freq?
Stool characteristics?
Defecation painful?
Urge present but no stool?
No urge to defecate?
Blood with stool?
Nausea/vomiting?
![Page 18: Constipation and the Cancer Patient. Constipation Definition Physiology of GI tract Etiology Assessment Treatment](https://reader036.vdocuments.mx/reader036/viewer/2022062511/5515135a550346c77d8b4be3/html5/thumbnails/18.jpg)
Physical ExamPhysical appearance
Abdomen:
masses, distention
bowel sounds
DRE
Pelvic exam
![Page 19: Constipation and the Cancer Patient. Constipation Definition Physiology of GI tract Etiology Assessment Treatment](https://reader036.vdocuments.mx/reader036/viewer/2022062511/5515135a550346c77d8b4be3/html5/thumbnails/19.jpg)
Constipation ScoreFlat plate of abdomen
4 quadrants
ascending, transverse
descending, rectosigmoid
0=none, 1=<50%, 2=>50%, 3=100%
CS>7/12 requires treatment
![Page 20: Constipation and the Cancer Patient. Constipation Definition Physiology of GI tract Etiology Assessment Treatment](https://reader036.vdocuments.mx/reader036/viewer/2022062511/5515135a550346c77d8b4be3/html5/thumbnails/20.jpg)
TreatmentProphylaxis
good symptom control
activity
adequate hydration
recognize drug effect
create a favorable environment
![Page 21: Constipation and the Cancer Patient. Constipation Definition Physiology of GI tract Etiology Assessment Treatment](https://reader036.vdocuments.mx/reader036/viewer/2022062511/5515135a550346c77d8b4be3/html5/thumbnails/21.jpg)
Treatment: Laxatives80% pts need laxatives
Little research to guide choice
Softener and stimulant best
May require oral/rectal routes
Enemas useful in impaction
![Page 22: Constipation and the Cancer Patient. Constipation Definition Physiology of GI tract Etiology Assessment Treatment](https://reader036.vdocuments.mx/reader036/viewer/2022062511/5515135a550346c77d8b4be3/html5/thumbnails/22.jpg)
LaxativesBulk forming agents: psyllium
Surfactants: docusate
Contact cathartics: senna, bisacodyl
Osmotic laxatives: lactulose
Saline osmotics: MgOH, Phosphasoda
Enemas: oil, saline, soap suds, Fleet
![Page 23: Constipation and the Cancer Patient. Constipation Definition Physiology of GI tract Etiology Assessment Treatment](https://reader036.vdocuments.mx/reader036/viewer/2022062511/5515135a550346c77d8b4be3/html5/thumbnails/23.jpg)
Other ApproachesProkinetic agents: cisapride,
domperidone, metoclopramide
Antibiotics: erythromycin
Opioid antagonist: naloxone
Chlolinergic: pilocarpine
Herbal preparations: mulberry, rhubarb, licorice
![Page 24: Constipation and the Cancer Patient. Constipation Definition Physiology of GI tract Etiology Assessment Treatment](https://reader036.vdocuments.mx/reader036/viewer/2022062511/5515135a550346c77d8b4be3/html5/thumbnails/24.jpg)
ConclusionsConstipation common problem
Many causes
Prevention important
Assessment key
Opioid Rx+laxative Rx
Treat aggressively