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The management of bowel obstruction in advanced gynaecological malignancy

Doreen Oneschuk

in Palliative Care Consultations in Gynaeoncology

This chapter focuses on malignant bowel obstruction (MBO), a common complication in women diagnosed with ovarian cancer, colorectal cancer, and other gynaecological malignancies. MBO generally ... More

This chapter focuses on malignant bowel obstruction (MBO), a common complication in women diagnosed with ovarian cancer, colorectal cancer, and other gynaecological malignancies. MBO generally afflicts 25–42 per cent of patients with advanced ovarian cancer, but rarely occurs in patients with endometrial cancer. MBO develops by the existence of mechanical obstruction from an extrinsic occlusion of the bowel lumen, intraluminal occlusion of the lumen, luminal obstruction due to tumour growth in the bowel wall, and adynamic ileus. Bowel obstruction can also be caused by other non-malignant factors such as adhesion, post-irridation bowel damage, hernias, and inflammatory bowel disease. Management of MBO includes pain management, pharmacological management, and non-pharmacological management. In patients with MBO, pharmacological treatment is generally successful. Only patients who are strictly considered as appropriate candidates for surgery and parenteral nutrition are given such treatments.Less

SNPs, HapMap, and common disease

Julian C. Knight

in Human Genetic Diversity: Functional Consequences for Health and Disease

The extent of single nucleotide polymorphism is reviewed, together with insights gained into the nature of allelic architecture in terms of haplotypes, linkage disequilibrium and recombination. The ... More

The extent of single nucleotide polymorphism is reviewed, together with insights gained into the nature of allelic architecture in terms of haplotypes, linkage disequilibrium and recombination. The utility of SNPs in defining genetic determinants of common disease is discussed including the rationale, results and diverse applications of the International HapMap Project. The recent development and application of genome-wide association studies is reviewed including the Wellcome Trust Case Control Consortium study of seven common diseases. Issues relating to design, analysis and interpretation of such studies are described. A detailed review of age-related macular degeneration and inflammatory bowel disease is presented, two common multifactorial diseases where genome-wide association studies have recently enjoyed considerable success. Research in these diseases illustrates the timeline of different approaches used in defining genetic determinants of common disease and how such analyses can provide novel insights into disease pathogenesis.Less

Central Control of Gastrointestinal Function

Pamela J. Hornby and Paul R. Wade

in Central Regulation of Autonomic Functions

This chapter builds on a basic understanding of the central nervous system (CNS) as coordinator of regional gastrointestinal (GI) tract reflexes. The dorsal vagal complex in the CNS permissively ... More

This chapter builds on a basic understanding of the central nervous system (CNS) as coordinator of regional gastrointestinal (GI) tract reflexes. The dorsal vagal complex in the CNS permissively governs the largely autonomous control by the enteric nervous system (ENS) of functions such as absorption, secretion and motility. The CNS actively coordinates voluntary and autonomic communication for complex behavioral functions, such as swallowing, emesis and defecation. The CNS and ENS communicate with inflammatory cells, endocrine cells and microbiota to maintain GI homeostasis and their dysfunction can give rise to clinical disorders. For example, stress or enteritis may predispose individuals to Irritable Bowel Syndrome in which altered bowel function is accompanied by visceral pain. Neural modulation of immune cells and release of inflammatory mediators may contribute to Inflammatory Bowel Diseases. Thus, the bi-directional brain-gut axis maintains GI health and its perturbation contributes to GI disorders.Less

Gastrointestinal and genitourinary disorders

Fabrizio Benedetti

in Placebo Effects: Understanding the mechanisms in health and disease

Irritable bowel syndrome is one of the best models of gastrointestinal disorders to use as a model for understanding placebo mechanisms. Several brain regions are inhibited by a placebo treatment in ... More

Irritable bowel syndrome is one of the best models of gastrointestinal disorders to use as a model for understanding placebo mechanisms. Several brain regions are inhibited by a placebo treatment in patients suffering from irritable bowel syndrome. In general, gastrointestinal symptoms can be conditioned, which indicates that learning may play an important role. Subjective symptoms are more affected than objective symptoms in genitourinary disorders. In addition, expectation is known to be crucially involved in sexual functions.Less

Chapter 4

Sri G. Thrumurthy, Tania Samantha De Silva, Zia Moinuddin, and Stuart Enoch

in SBA MCQs for the MRCS Part A

Chapter 5

Sri G. Thrumurthy, Tania Samantha De Silva, Zia Moinuddin, and Stuart Enoch

in Title Pages

Chapter 6

Sri G. Thrumurthy, Tania Samantha De Silva, Zia Moinuddin, and Stuart Enoch

in SBA MCQs for the MRCS Part A

Head and Neck Surgery

Stuart Winter and Declan Costello (eds)

in Title Pages

Lower Limb—Pelvis, Hip, Femur, Knee, and Tibia

Alex Trompeter and David Elliott (eds)

in Trauma for the FRCS (Tr + Orth) Examination

Colorectal cancer

Peter Hoskin and Wendy Makin

in Oncology for Palliative Medicine

This chapter discusses colorectal cancer, which is the second most common malignancy in the United Kingdom. It has an incidence of 30,000 cases annually and is the cause of the deaths of over 20,000 ... More

This chapter discusses colorectal cancer, which is the second most common malignancy in the United Kingdom. It has an incidence of 30,000 cases annually and is the cause of the deaths of over 20,000 people per year. The risk of developing colorectal cancer increases with age, with sharp probability from the age of 50 onwards. Colorectal cancer, or bowel cancer, develops by a sequence of events, from dysplasia through malignant transformation within the adenomatous polyp. This process is often linked with predisposing genetic factors and exposure to environmental carcinogens. This cancer is predominant in people with familial polyposis coli as well as hereditary non-polyposis colon cancers (HNCC). However, 25 per cent of colorectal cancer and polyposis is attributed to spontaneous genetic mutation and not family history. Other discussions in the chapter are the pathology of bowel cancer, management strategies of early-diagnosed colorectal disease, problems associated with recurrent and late-diagnosed colorectal disease, and palliation of late-diagnosed bowel cancer.Less

Symptom control in care of the dying

Paul Glare, Andrew Dickman, and Margaret Goodman

in Care for the Dying: A Pathway to Excellence

This chapter discusses symptom control in care of the dying. It is divided into three sections, each of which is written by a single author. The first section, written by Paul Glare, looks at the ... More

This chapter discusses symptom control in care of the dying. It is divided into three sections, each of which is written by a single author. The first section, written by Paul Glare, looks at the influence of the Liverpool Care Pathway for the Dying Patient (LCP) on symptom control, and the most common symptoms found in a dying patient. Pain management and managing agitation in dying patients are also studied. Andrew Dickman is the author of the second section, which focuses on the use of syringe drivers and managing respiratory tract secretions and dyspnoea in dying patients. Finally, the third section is prepared by Margaret Goodman, and it studies bowel care, micturition difficulties, mouth care, and mobility or pressure area care. Deciding when to stop administering nursing interventions is also discussed.Less

Assessment of Novel Therapies for Constipation: Focus on Opioid Analgesics

Russell K. Portenoy and Eduardo Bruera

in Issues in Palliative Care Research

Pain control is a primary goal of palliative care. The World Health Organization (WHO) guidelines for pain control specify an escalating series of therapies, but the ultimate resource for the control ... More

Pain control is a primary goal of palliative care. The World Health Organization (WHO) guidelines for pain control specify an escalating series of therapies, but the ultimate resource for the control of severe pain remains the opioids. Forty to forty-five percent of patients presenting for hospice care complain of constipation on admission. Work is needed to define the mechanisms by which opioids produce constipation. The secondary effects of opioid receptor activation also may be further defined and present new opportunities for pharmacological intervention. Those developing opioid alternatives, especially opioids with differing receptor affinities, have been unable to separate the analgesic properties from the side effects of opioids. Methods to optimize opioid use and traditional bowel care methods are being examined, but it is difficult at times to compare the results of interventions as the model and definition of success vary widely between publications.Less

Malignant bowel obstruction

S. Lawrence Librach, A. Nina Horvath, and E. Anne Langlois

in Palliative Medicine: A case-based manual

This chapter explains via a case study the desired skills, attitudes, and knowledge necessary to diagnose and manage malignant bowel obstruction (MBO). It addresses several questions such as: What is ... More

This chapter explains via a case study the desired skills, attitudes, and knowledge necessary to diagnose and manage malignant bowel obstruction (MBO). It addresses several questions such as: What is the likelihood that the patient will develop bowel obstruction at some time during her cancer journey? What is the pathophysiology of MBO? What are the common symptoms of MBO? What are the indications for and outcomes of surgery in patients with MBO?Less

Non-Pain Symptom Management

James L. Hallenbeck

in Palliative Care Perspectives

This chapter discusses the management of non-pain symptoms in terminally ill patients. These symptoms include nausea and vomiting, constipation, bowel obstruction, dyspnea, and cachexia. The chapter ... More

This chapter discusses the management of non-pain symptoms in terminally ill patients. These symptoms include nausea and vomiting, constipation, bowel obstruction, dyspnea, and cachexia. The chapter explains the pathophysiology, principles of therapy and recommended treatment for each of these symptoms. It also suggests that palliative care should not be so much about what the practitioners do as about why they do it.Less

Understanding Cancer

Cathy Hughes

in Adult Nursing Practice: Using evidence in care

The aim of this chapter is provide an overview of cancer, a biologically similar, but diverse, group of diseases. Understanding the disease process will ... More

The aim of this chapter is provide an overview of cancer, a biologically similar, but diverse, group of diseases. Understanding the disease process will help the practising nurse to plan nursing care and to seek appropriate specialist advice. Cancer can affect almost any part of the body and has significance for different age groups and within different cultures, so the effect on the individual, the prognosis, and the treatment will significantly differ depending upon cancer site and treatment setting. This chapter will outline symptoms in relation to the site of the body affected to illustrate the effect of cancer on an individual, and consideration will also be given to the wider impact of the disease. This chapter is underpinned by the principles of evidence-based patient-centred care and will focus on the concepts associated with promoting lifestyles that reduce the risk of developing cancer, screening to identify those at risk, detection of early disease, and the care and management of the individual with and beyond cancer. Cancer refers to a condition in which there is abnormal growth of cells. The characteristics of cancer cells are that they divide uncontrollably, do not require stimulation for growth as do normal cells, and are not restrained by the presence of neighbouring cells. Because cancer is concerned with a failure in the growth control mechanism of the cell at a gene or DNA level and because there are potentially as many different types of cancer as there are types of body cell, no two cancers are exactly alike (Cancer Research UK, 2009). The site at which a cancer first develops (primary cancer), such as lung or breast, is often used broadly to describe it; however, cancer is generally defined by the origin of the type of cell that has become cancerous. The most frequent sites and types of cancer are as follows….● Carcinomas—arise in epithelial cells in the skin, gastrointestinal tract, and other internal organs, and make up about 85% of all cancers (Cancer Research UK, 2010a) ● Haematological (blood and lymphatic system) cancers—arise from blood or bone marrow cells; include leukaemia, lymphoma, and myeloma, and make up about 7% of all cancers, but leukaemia is the commonest cancer in children (Cancer Research UK, 2010b)… Less

Nerves Redux

Edward Shorter

in How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown

We might have thought that the concept of nerves ended in 1957 when the United States Post Office Department initiated a fraud proceeding against John Winters of New ... More

We might have thought that the concept of nerves ended in 1957 when the United States Post Office Department initiated a fraud proceeding against John Winters of New York City, who had been promoting a product called Orbacine containing bromide and niacin for “every-day nervousness and its symptoms.” Although Winters’ claims went a bit beyond nerves, the Post Office wanted an end to the whole business and Orbacine disappeared. But the concept of nerves had enemies other than the Post Office. Three in particular had tried to do away with it: psychoanalysis, psychopharmacology, and the DSM series. All failed to kill it completely, and the concept lingers on because of its obvious face value: Our patients clearly have a nervous illness or something resembling it. They do not have a “mood disorder.” In medicine the nervous syndrome, the condition that dare not speak its name, has taken on various allures. Once upon a time, hysteria was the equivalent of a nervous diagnosis in women. There were physicians who had little patience with calling their former hysteric patients “depressed”: They remained hysteric! Jacques Frei, a member of the department of psychiatry of the University of Lausanne in Switzerland, noted in 1984 “the importance that depressive symptomatology has taken today as a call for help among female hysterics. . . . It seems that the hysterical woman today has a better chance of a hearing if she presents with a depressive picture, even evoking suicidal ideas.” Although hysteria today is discredited as a diagnosis, it is interesting that older clinicians such as Frei saw it as a diagnosis that trumped depression; he even argued that his patients at Cery Hospital were modeling their symptoms to conform to the new diagnoses. The 1950s and 1960s saw alternative diagnoses to the nervous syndrome come and go, fragments of clinical experience that seemed to make sense to individual physicians but were not more widely taken up because their originators did not have prestigious academic appointments. Take “the housewife syndrome” that Palma Formica proposed in 1962. Less

Gastrointestinal Disorders of Infancy and Childhood

Michael Farrell, Alison Cassin, and Rebecca Wilhelm

in Pediatric and Adult Nutrition in Chronic Diseases, Developmental Disabilities, and Hereditary Metabolic Disorders: Prevention, Assessment, and Treatment

This chapter discusses gastrointestinal disorders of infancy and childhood, including biochemical and clinical abnormalities and factors to be considered in nutritional evaluation. Management of ... More

This chapter discusses gastrointestinal disorders of infancy and childhood, including biochemical and clinical abnormalities and factors to be considered in nutritional evaluation. Management of gastroesophageal reflux, liver disease, inflammatory bowel disease, and short bowel syndrome are specifically discussed, as are vitamin supplementation and enteral and parental nutrition.Less

Generalized Anxiety Disorder

Vladan Starcevic, MD, PhD

in Title Pages

The main characteristics of generalized anxiety disorder (GAD) are chronic pathological worry, other manifestations of nonphobic anxiety, and various symptoms of ... More

The main characteristics of generalized anxiety disorder (GAD) are chronic pathological worry, other manifestations of nonphobic anxiety, and various symptoms of tension. Physical symptoms of anxiety are usually less prominent in GAD than in panic disorder, but they can still be an important component of clinical presentation. Behaviors that are often seen in other anxiety disorders, such as overt avoidance, are conspicuously absent. Unlike all other anxiety disorders, it is more likely for GAD in clinical setting to co-occur with a primary condition for which help has been sought–usually depression or other anxiety disorder–than to be the main reason for seeking professional help. Generalized anxiety disorder is one of the more controversial members of the family of anxiety disorders: it seems that almost every aspect of GAD has provoked debates that do not show signs of abating. Paradox, disagreement, debate, and controversy are the words most commonly associated with GAD. It is small wonder then that the list of ‘‘hot topics’’ related to GAD could be very long indeed. Listed below is a selection of issues thought to represent adequately a more comprehensive list…. 1. What are the characteristic features of GAD that would help in its conceptualization? Pathological worry, other cognitive aspects of anxiety, manifestations of tension, and/or (some) symptoms of autonomic arousal? What combination of these features would ensure that GAD is diagnosed adequately and recognized in clinical practice? 2. What is the relationship between pathological worry and GAD? 3. How can different views on what constitutes the essence of GAD be reconciled? Is GAD a single entity or are there two or more ‘‘types’’ of GAD with distinct clinical characteristics? 4. How is GAD related to depressive disorders, other anxiety disorders, and personality disturbance? Where are its boundaries? In view of its close relationship with depression, should GAD be classified along with depression and perhaps renamed accordingly? 5. Can GAD exist on its own, without depression or other anxiety disorders? What could be features specific enough for GAD that would allow it to establish itself as an independent and valid psychopathological and diagnostic entity? 6. What are the pathophysiological correlates of pathological worry and other aspects of chronic anxiety in GAD? 7. What are the underlying mechanisms and purpose of pathological worry in GAD? What is the meaning of chronic anxiety? Less

What is Fibromyalgia?

Daniel J. Wallace and Janice Brock Wallace

in All About Fibromyalgia: A Guide for Patients and their Families

When the Arthritis Foundation tried to categorize the 150 different forms of musculoskeletal conditions in 1963, it created a classification known as soft ... More

When the Arthritis Foundation tried to categorize the 150 different forms of musculoskeletal conditions in 1963, it created a classification known as soft tissue rheumatism. Included in this listing are conditions in which joints are not involved. Soft tissue rheumatism encompasses the supporting structures of joints (e.g., ligaments, bursae, and tendons), muscles, and other soft tissues. Fibromyalgia is a form of soft tissue rheumatism. A combination of three terms—fibro (from the Latin fibra, or fibrous tissue), myo- (the Greek prefix myos, for muscles), and algia (from the Greek algos, which denotes pain)—fibromyalgia replaces earlier names for the syndrome that are still used by doctors and other health professionals such as myofibrositis, myofascitis, muscular rheumatism, fibrositis, and gener­alized musculoligamentous strain. Fibromyalgia is not a form of arthritis, since it is not associated with joint inflammation. In the late 1980s, a Multicenter Criteria Committee under the direction of Dr. Frederick Wolfe at the University of Kansas was formed to define fibromyalgia. In their study, 293 patients with presumed fibromyalgia were compared with 265 patients who had other rheumatic diseases in 16 centers throughout North America. The groups were evaluated for a variety of symptoms, signs, and laboratory abnormalities in an effort to ascertain which factors were the most sensitive and specific for defining the disorder. In other words, the investigators wanted to identify the most frequently found features of fibromyalgia (sensitivity) that could help doctors differentiate it from other disorders (specificity). The list in Table 1 was 88.4 percent sensitive and 81.1 percent specific in identifying fibromyalgia patients. As a result, these criteria were endorsed in 1990 by the American College of Rheumatology (ACR), the association to which nearly all 5,000 rheumatologists in the United States and Canada belong. Focusing on Table 1 and Figure 3, fibromyalgia essentially is: 1. Widespread pain of at least 3 months’ duration (this rules out viruses or traumatic insults which resolve on their own). 2. Pain in all four quadrants of the body (picture cutting the body into quarters, as in a pie): right side, left side, above the waist, below the waist. Less