Quick Tip: It is important to distinguish between complete and incomplete, reversible and irreversible bowel obstruction because the management is very different.
Risk factors/possible causes:
Pattern and severity of symptom(s) depends on whether high (vomit early, less distension) or low obstruction (early constipation and distension, later vomiting), or obstruction at multiple levels.
Vomiting may be large volume and faeculent; nausea may be relieved by vomiting.
Constipation and/or overflow diarrhoea may be present.
Abdominal pain - constant or colicky; abdominal distension, palpable tumour mass, tympanic percussion, tinkling/abnormal bowel sounds.
Immediate action – is admission appropriate?
Consider patient’s wishes, documented emergency health care plans or other records, and guidance from family/others.
If YES - admit as emergency. Give medication for symptom relief during transfer, i.e. stat dose opioid analgesic (appropriate to analgesic history) and stat dose of anti-emetic (either metoclopramide 10mg SC if no colic or cyclizine 50mg SC if colic).
On admission check blood count and renal function; perform erect and supine abdominal X-ray/consider CT scan; seek urgent surgical opinion; start IV fluid resuscitation; consider decompression of distended gut with NG tube. Exclude constipation or manage appropriately.
If NO – or if admitted but surgical decision is for supportive care only...
In cases of advanced cancer, consider trial of corticosteroids with dexamethasone (e.g. 9.9mg injectable formulation SC or IV), review effect after 5 days and stop if no effect. Reduce gradually if benefit. Change to oral when possible.
Quick Tip: For any palliative patient at risk of having a seizure, it is helpful to ensure that an Emergency Health Care Plan is prepared.
Immediate action for treatment of status epilepticus
Follow up – seizure management in the non-dying patient
Follow up – seizure management in last days of life
Alternatively, or additionally, sodium valproate and levetiracetam can be given via the subcutaneous route. Seek advice from Specialist Palliative Care Team if needed.