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TM. The EPEC-O Project Education in Palliative and End-of-life Care - Oncology. The EPEC TM O Curriculum is produced by the EPEC TM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.
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TM The EPEC-O Project Education in Palliative and End-of-life Care - Oncology The EPECTMO Curriculum is produced by the EPECTM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.
EPEC– Oncology Education in Palliative and End-of-life Care – Oncology Module 3i: Symptoms – Diarrhea
Diarrhea . . . • Definition: stool that is looser than “normal” and /or increased in frequency
. . . Diarrhea Epidemiology • Impact: • At best, annoying • At worst, life-threatening • Prevalence: • 30 to 90% of patients on some antineoplastic agents
Key points • Pathophysiology • Assessment • Management
Pathophysiology • 7 to 9 liters of fluid reach the large intestine daily • Loose stools occur if even less than100 ml not absorbed • Chemotherapy: damaged intestinal mucosa and increased fluid overwhelm large bowel capacity • Irinotecan has cholinergic effect
Causes of diarrhea • Infections • Gastrointestinal bleeding • Malabsorption • Medications • Obstruction • Overflow incontinence • Stress
Assessment • History • What is “normal” for the patient? • Description of stool (consistency, frequency, volume, blood, etc.) • Onset and duration of diarrhea • Presence of weight loss • Systemic symptoms • Medications can be causative (including chemotherapy) • Physical • Examine for signs of dehydration, fever
Management • Establish normal bowel pattern • Avoid gas-forming foods • e.g., milk (lactose) • Increase bulk • Transient, mild diarrhea • Attapulgite • Bismuth salts
Managementof persistent diarrhea • Loperamide • Diphenoxylate / atropine • Paregoric • Tincture of opium • Octreotide
Chemotherapy-associated diarrhea • May be life-threatening • Aggressive oral hydration • Expectant management • Loperamide 4 mg then 2 mg q 2 h until diarrhea-free for 12 hours • Octreotide for refractory diarrhea • Admit for severe diarrhea, nausea, vomiting, fever, sepsis, or bleeding
Carcinoid-associated diarrhea • Opioid for mild case • Cholestyramine • Octreotide
Pancreatic insufficiency-associated diarrhea • Low-fat diet • Exogenous pancreatic lipase
Summary Use comprehensive assessment and pathophysiology-based therapy to treat the cause and improve the cancer experience.