16. Section III: GI Symptoms
Anorexia/cachexia
Constipation
Diarrhea
Nausea/vomiting
Xerostomia (at a glance)

17. Anorexia and Cachexia
Anorexia: loss of appetite, usually with decreased intake
Cachexia: lack of nutrition and wasting
Wholihan, 2015

18. Causes of Anorexia and Cachexia
Primary cause: under investigation
Disease-related
Psychological
Treatment-related
Wholihan, 2015

19. Assessment of Anorexia and Cachexia
Physical findings
Impact on function and QOL
Calorie counts/daily weights
Lab tests
Skin breakdown
Wholihan, 2015

20. Treatment of Anorexia and Cachexia
Dietary consultation
Medications
Parenteral/enteral nutrition
Odor control
Counseling
Wholihan, 2015

21. Constipation Infrequent or difficult passage of stool
Frequent symptom in palliative care
Prevention is key

22. Causes of Constipation
Disease-related (e.g. obstruction, hypercalcemia, neurologic, inactivity)
Treatment-related (e.g. opioids, other meds)

23. Assessment of Constipation
Bowel history
Abdominal assessment
Digital rectal assessment
Medication review
Economou, 2015

24. Treatment of Constipation
Medications
Other approaches
Prevention
Economou, 2015

25. Diarrhea Frequent passage of loose, nonformed stool
Effects (e.g. fatigue, caregiver burden, skin breakdown)

26. Causes of Diarrhea Disease-related Malabsorption Concurrent diseases
Psychological
Treatment-related

27. Assessment of Diarrhea
Bowel history
Medication review
Infectious processes

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

29. Nausea and Vomiting Common in advanced disease
Assessment of etiology is important
Acute, anticipatory, or delayed
Chow et al., 2015; Tipton, 2014

30. Causes of Nausea and Vomiting
Physiological (GI, metabolic, CNS)
Psychological
Disease-related
Treatment-related
Other

31. Assessment of Nausea and Vomiting
Physical exam
History
Lab values
Dehydration

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

33. Non-Drug Treatment of Nausea and Vomiting
Distraction/relaxation
Dietary
Small/slow feeding
Invasive therapies

34. Symptom At a Glance: Xerostomia
Dry mouth
Difficulty in mastication, swallowing, and speech
Can be caused by medications, radiation, and systemic diseases
Blush & Larsen, 2015

35. Case Study on Assessment and Management of Symptoms: MARGARET—Part III
With the advancement of Margaret’s co-morbidities, what would your role be in encouraging weight loss?
Is there hope that Margaret could reverse these various conditions?
What role would the palliative care team have in this aspect?