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Section III: GI Symptoms

Section III: GI Symptoms. Anorexia and cachexia Constipation Diarrhea Nausea/vomiting. Anorexia and Cachexia. ANOREXIA Loss of appetite, usually with decreased intake CACHEXIA Lack of nutrition and wasting Wholihan & Kemp, 2010. Causes of Anorexia and Cachexia. Disease related

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Section III: GI Symptoms

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  1. Section III: GI Symptoms • Anorexia and cachexia • Constipation • Diarrhea • Nausea/vomiting

  2. Anorexia and Cachexia • ANOREXIA • Loss of appetite, usually with decreased intake • CACHEXIA • Lack of nutrition and wasting Wholihan & Kemp, 2010

  3. Causes of Anorexia and Cachexia • Disease related • Psychological • Treatment related

  4. Assessment of Anorexia and Cachexia • Physical findings • Impact on function and QOL • Calorie counts/daily weights • Lab test • Skin breakdown Coyne, 2007; Wholihan & Kemp, 2010

  5. Treatment of Anorexia and Cachexia • Dietary consultation • Odor control • Medication • Artificial nutrition & hydration • Counseling

  6. Constipation • Infrequent passage of stool • Frequent symptom in palliative care • PREVENTION IS KEY!

  7. Causes of Constipation • Treatment related • Opioids • Other medications • Disease related • Obstruction • Hypercalcemia • Neurologic • Inactivity

  8. Assessment of Constipation • Bowel history • Abdominal assessment • Rectal assessment • Medication review

  9. Treatment of Constipation • Medications • Dietary/fluids • Other approaches

  10. Diarrhea • Frequent passage of loose, nonformed stool • Effects • Fatigue • Caregiver burden • Skin breakdown

  11. Causes of Diarrhea

  12. Assessment of Diarrhea • Bowel history • Medication review • Infectious processes

  13. Treatment of Diarrhea • Treat underlying cause • Dietary modifications • Hydration • Pharmacologic agents

  14. Nausea and/or Vomiting • Common in advanced disease • Assess etiology • Acute, anticipatory or delayed? • Causes physical and psychological distress

  15. Physiological GI Metabolic CNS Psychological Disease related Treatment related Other Causes of Nausea and Vomiting

  16. Assessment of Nausea and Vomiting • Physical exam • History • Lab values

  17. Pharmacologic Treatment of Nausea and Vomiting • Anticholinergics • Antihistamines • Steroids • Prokinetic agents • Other

  18. Non-Drug Treatment ofNausea and Vomiting • Distraction and/or relaxation • Dietary • Small/slow feedings • Invasive therapies

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