Palliative

Question 1

List 4 areas that when triggered can cause N & V

Answer 1

Cerebral cortex,
Chemoreceptor trigger zone,
Vestibular centre,
GI tract

Question 2

What are 4 causes of cerebral cortex related N&V?

Answer 2

Emotions,
Sight,
Smell,
Raised ICP

Question 3

What is 1 cause of vestibular centre related N&V?

Answer 3

Motion

Question 4

What is 2 causes of chemoreceptor trigger zone related N&V?

Answer 4

Metabolic caused by sepsis, kidney/liver impairment, advanced cancer
Drugs

Question 5

What are 5 causes of GI tract related N&V?

Answer 5

GI distension, 
Stasis,
Tumour mass, 
Constipation, 
Radiotherapy

Question 6

What 3 receptors are associated with cerebral cortex related N&V?

Answer 6

Maybe GABA, NK1, 5HT

Question 7

What 3 receptors are associated with CTZ N&V?

Answer 7

D2, 5HT, ACh

Question 8

What 2 receptors are associated with vestibular centre related N&V?

Answer 8

H1, ACh

Question 9

What 3 receptors are associated with GI tract related N&V?

Answer 9

5HT, D2, ACh

Question 10

List 3 antiemetics for cerebral cortex related N&V

Answer 10

dexamethasone, aprepitant, benzodiazepines

Question 11

List 3 antiemetics that treat CTZ related N&V

Answer 11

Haloperidol,
Levomepromazine,
Ondansetron

Question 12

List 3 antiemetics for vestibular centre related N&V

Answer 12

Cyclizine,
Levomepromazine,
Hyoscine

Question 13

List 4 antiemetics for GI tract related N&V - note, caution in obstruction!

Answer 13

Metoclopramide,
levomepromazine,
Ondansetron,
Dexamethasone

Question 14

What is clinical picture indicating N&V related to cerebral disease? (2)

Answer 14

Worse in morning,

Associated headache

Question 15

What is clinical picture of N&V caused by oncological treatments?

Answer 15

Predictable from history,

Often nausea is main complaint

Question 16

What is clinical picture for N&V caused by impaired gastric emptying?

Answer 16

Not usually nauseated then very nauseated,
Large volume vomits,
Feel better after being sick

Question 17

What is the clinical picture for chemical/metabolic related N&V?

Answer 17

Persistent nausea with little relief from vomiting

Question 18

What 4 substances are associated with chemical/metabolic N&V?

Answer 18

Calcium,
Sodium,
Magnesium,
Urea

Question 19

List some non-pharmacological treatments for N&V

Answer 19

Mouth care, 
Avoid constipation,
Small meals, 
Avoid cooking, 
Acupressure band, 
Acupuncture

Question 20

Malignant bowel obstruction definition

Answer 20

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

Question 21

Malignant bowel obstruction can be caused by tumour or benign causes, list 3 benign causes

Answer 21

Adhesions, post-radio, constipation

Question 22

MBO occurs in 3-15% of all cancer patients. What two cancers is it particularly common in?

Answer 22

Ovarian (most common) and colon cancer

Question 23

Outline causes of MBO

Answer 23

MBO can be mechanical (intraluminal, intramural or extramural extrinsic compression) or be caused by adynamic ileus (tumour infiltration of mesentery, muscle or nerves)

Question 24

MBO can be complete or partial - true/false?

Answer 24

True

Question 25

OUtline the pathophysiology of obstruction

Answer 25

Proximal accumulation of secretions and gut distension Gut distension causes further secretions alongwith reduced water and sodium absorption, inflammatory gut wall oedema, increased motor activity and increased intra-luminal pressure Cycle = secretion - distension - secretion

Question 26

List symptoms of MBO

Answer 26

``` gradual onset over weeks of: N&V, Pain (continuous/colicky), Anorexia/thirst, Reduced then absent bowel motions/flatus, Paradoxical diarrhoea, Systemic from cancer ```

Question 27

Management of MBO

Answer 27

Drip and suck before surgery, | Surgical: resection, palliative colostomy or ileostomy, self expanding metallic stent

Question 28

Pharmacological option for analgesic for MBO

Answer 28

Opioids or hyoscine butylbromide for colicky pain

Question 29

What is important to remember about hyoscine butylbromide?

Answer 29

Will slow down bowel

Question 30

Pharmacological option for antiemetic for MBO

Answer 30

Metoclopramide 30mg/24hrs if partial/sub-acute obstruction

Question 31

Pharmacological option for steroids for MBO

Answer 31

Dexamethasone

Question 32

Pharmacological option for anti-secretory agents for MBO

Answer 32

Buscopan or octreotide

Question 33

Pharmacological option for laxative for MBO

Answer 33

Docusate or laxido in partial obstruction

Question 34

What is important to remember about pharmacological treatment for MBO

Answer 34

Make sure it can be absorbed - N&V patients do not take oral meds