Common symptoms in cancer patients with MIO

Vomiting Intermittent or continuous Develops early and in large amounts in Biliary vomiting is almost odourless gastric, duodenal, and small bowel and indicates an obstruction in the obstruction and develops later in large upper part of the abdomen. The bowel obstruction presence of bad smelling and faeculent vomiting can be the first sign of an ileal or colonic obstruction

Nausea

Intermittent or continuous

Colicky pain

Variable intensity and localization due to distension proximal to the obstruction secondary to gas and fluid accumulation most of which is produced by the gut; present in 75% of patients

If it is intense, periumbilical, and occurring at brief intervals, it may be an indication of an obstruction at the jejunum-ileal level. In large bowel obstruction the pain is less intense, deeper, and occurs at longer intervals

Overall acute pain that begins intensely and becomes stronger, or pain that is specifically localised, may be a symptom of a perforation or an ileal or colonic strangulation. Pain that increases with palpation may be due to peritoneal irritation

Continuous pain

Variable intensity and localisation; present in 90% of patients

Due to abdominal distension, tumour mass, and/or hepatomegaly

Dry mouth

Due to severe dehydration and metabolic alterations but mostly due to the use of drugs with anticholinergic properties and poor mouth care

Constipation

Intermittent or complete

In case of complete obstruction there is no evacuation of faeces and no flatus

In case of partial obstruction the symptom is intermittent

Overflow Result of bacterial liquefaction of diarrhoea faecal material

Overflow Result of bacterial liquefaction of diarrhoea faecal material

Gastrointestinal symptoms caused by the sequence of distension-secretion-motor activity of the obstructed bowel occur in different combinations and intensity depending on the site of obstruction. The symptoms referred to by the patient should be monitored daily. Vomiting can be evaluated in terms of quantity, quality, and number of daily episodes. Numerical or verbal scales can be used to assess other symptoms, such as nausea, pain, dry mouth, drowsiness, dyspnoea, hunger, thirst, etc.

When a patient with cancer presents with suspected bowel obstruction, a full assessment should be performed. Various radiological investigations can be performed in patients with signs and symptoms of MIO. There is no point in proceeding with any of these, however, if the patient is too ill or has declined surgery.

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