malignant obstruction ovarian cancer

[leah12386]

SCENARIO

MRs Chamberlain is a  56 yr old lady with advanced ovarian cancer. She  has come into hospital with nausea and vomiting over last 48 hrs.  She has not  passed flatus or had a bowel action for 3 days and you suspect she may have  a bowel obstruction. The Intern in emergency wants to immediately insert a nasogastric tube but your arrival halts this procedure doe the interim.     MY QUESTIONS ARE:

1.    Describe the advantages and disadvantages of nasogastric tube insertion in the palliative setting?

2.    How would you assess her nausea and vomiting?

3.     You determine she has a malignant bowel obstruction  -  what management options do you have?  Consider
         both pharmacological and nonpharmacological options.


I am  new nurse  and require to answer these questions. Can you please help me?

[Annekathryn Goodman, M.D.]

Hi There
thank you for your questions

a nasogastric tube can give instant relief to someone who has a distended stomach and duodenum from a small bowel obstruction.

Some bowel obstructions will resolve after several days of decompression by NG tube so that is usually always the first intervention I consider.

Based on the xraybfindings, there are some people with an obstruction due to an isolated obstructing lesion or due to an adhesion. If these people do not improve after 1-2 days of NG drainage, surgery is the next step.

It is trickier if the bowel obstruction is due to blockages in multiple areas of the bowel or if the bowel is functionally obstructed due to wide spread coating of cancer on the bowel. That is called carcinomatosis b. In that setting, the person will benefit from the placement of a gastrostomy tube to drain the stomach so that the NG tube can be removed.

So you see how important a CT scan is in helping sort this out.  Even at the end of life vomiting continuous is just horrible and avoidable.  Medications do not help much. this is a mechanical problem not a pharmacologic one.

aids with octreotide to reduce small intestine secretions and antiemtetics such as ondansetron and compazine and prednisone may alleviate some suffering but not too much.  Motility agents such as reglan should bot be used as that will increase suffering by forcing the bowel to peristalse against a fixed obstruction.

I know that the placement of an NG tube may seem horrible but it helps and is a temproary maneuver on the way to controlling this terrible porblem
best wishes

[leah12386]

Thankyou for your help. Much appreciated.