Saturday, April 7, 2012

Blogs to Boards: Question 5


This is the fifth in a series of 41 posts from both GeriPal and Pallimed to get our physician readers ready for the hospice and palliative medicine boards. Every week GeriPal and Pallimed alternates publishing a new question, as well as a discussion of possible answers to the question (click here for the full list of questions).  

Question 5

In hospice IDT, you discuss the case of a 68 year old female with ovarian cancer with abdominal pain and sudden onset nausea and vomiting. She has had no recent bowel movements and is on minimal opioids. You suggest a trial of octreotide for a likely malignant bowel obstruction and the nurses say “Doctor! You say we can use octreotide for everything! Is there anything octreotide can’t be used for in hospice?”

Which one of the following is not a potential scenario to use octreotide? Choose the best answer.

a) A 37 year old male with end stage alcoholic hepatitis who starts vomiting blood 
b) A 90 year old with a severe diarrhea with a history of a rectal tumor and radiation burns to the perineal area 
c) A 42 year old female with a tense distended abdomen leaking a small amount from a previous paracentesis site. 
d) A 27 year old male with a malignant wound with copious drainage 
e) A 31 year old female with abdominal pain from opioid-induced constipation 


Discussion:

1 comment:

Bruce Scott MD said...

I think I accidentally submitted a previous comment before completing it.

I certainly said something incorrect in that comment (claiming that the 2nd Edition of Twycross HPCFUSA didn't have info on octreotide--don't know why I misremembered this).

HPCF has a section on octreotide. The reference to octreotide use in tumor anti-secretory effects is Harvey M and Dunlop R (1996) Octreotide and the secretory effects of advanced cancer. Palliative Medicine. 10: 346-347

This use is new to me. I would have gotten the question wrong if it weren't for choice E, which was pretty clear.

We did have one case where we used depot octreotide successfully in a palliative patient with intractable diarrhea. Most of his bowel was resected, but he did not want to pursue a surgical solution (absolutely would not consider any intervention that would lead to an ostomy). Brought him in to the unit to test the effect of subcutaneous octreotide (as well as adjust his analgesia). When he responded to the octreotide, we got pharmacy approval to use the depot version. he came in to the hospital for his monthly shots then.