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Title:Driska in zaprtje
Authors:Škrbinc, Breda (Author)
Language:Slovenian
Tipology:1.04 - Professional Article
Organisation:Logo OI - Institute of Oncology
Abstract:Driska (diareja) in zaprtje (obstipacija) sta relativno pogosta bolezenska znaka bolnikov z rakom. Pojavljata se kot znaka osnovne rakave bolezni ali kot posledici specifičnega onkološkega zdravljenja, to je operativnega zdravljenja, zdravljenja z obsevanjem ali pa sistemskega zdravljenja z zdravili. Driska pomeni bolezensko stanje, ko je iztrebljanj več in so obilnejša, blato pa mehko ali tekoče. Drisko v okviru sistemskega zdravljenja z zdravili povzročajo nekateri citostatiki, tarčna zdravila, hormonska zdravila in tudi nekatera zdravila, ki jih uporabljamo v podpornem zdravljenju. Ta zdravila povzročijo drisko na podlagi različnih mehanizmov, eden pomembnejših je sprememba črevesne flore. V obravnavi bolnika z drisko kot posledico zdravljenja s sistemskimi zdravili za zdravljenje raka, je potrebno najprej opredeliti stopnjo driske. V primeru blage do srednje hude driske je primerno zdravljenje na domu z ustreznim dietnim režimom in sintetičnim opioidom brez analgetičnega učinka loperamidom. Če se driska na ta način v 1 – 2 dneh umiri, 12 ur po zadnjem tekočem odvajanju zdravljenje zaključimo, oz. če driska ostaja nespremenjena zdravljenje z dieto in loperamidom intenziviramo, praviloma dodamo tudi antibiotik iz skupine kinolonov. V kolikor tudi to zdravljenje driske ne umiri, so potrebne dodatne laboratorijske in mikrobiološke preiskave, praviloma pa tudi intenzivnejše zdravljenje. Bolnik z izhodiščno hudo drisko, ali zmerno drisko z vročino, krčevitimi bolečinami v abdomnu in bruhanjem ter bolnik, ki se mu stanje sprva zmerne driske ob dietnem režimu in loperamidu poslabšuje, sodi v bolnišnico, kjer je potrebno parenteralno zdravljenje z intenzivnim nadzorom. Tudi zaprtje, to je stanje, ko pri bolniku ugotovimo redko iztrebljanje majhnih količin trdega blata, ki ga spremlja mučno napenjanje, je lahko posledica neposrednega ali posrednega učinka osnovne rakave bolezni ali pa specifičnega onkološkega zdravljenja, to je operativnega zdravljenja, zdravljenja z obsevanjem ali sistemskega zdravljenja z zdravili, najpogosteje podpornega zdravljenja z opioidnimi analgetiki. Vzrok zaprtja je pogosto kombiniran, zato je tudi zdravljenje zaprtja kompleksno. Glede na bolnikovo specifično situacijo se odločimo za bolniku prilagojeno kombinacijo nefarmakoloških in po potrebi tudi farmakoloških ukrepov, ki jih je praviloma potrebno izvajati redno in dosledno, da bolniku zagotovimo čim boljšo kvaliteto življenja, ki mu jo sicer zaprtje s posledičnim splošnim neugodjem, bolečinami v abdomnu in oslabljenim apetitom pomembno okrni.
Year of publishing:2009
COBISS_ID:25710041 Link is opened in a new window
UDC:616-006
ISSN on article:1408-1741
OceCobissID:65324032 Link is opened in a new window
URN:URN:NBN:SI:doc-CY4Y5X1C
Note:BSDOCID145263;
Views:1855
Downloads:423
Files:.pdf PDF - Presentation file, download (64,37 KB)
 
Journal:Onkologija
Onkološki inštitut
 
Metadata:XML RDF-CHPDL DC-XML DC-RDF
Rights:by Authors
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License:CC BY 4.0, Creative Commons Attribution 4.0 International
Link:http://creativecommons.org/licenses/by/4.0/
Description:This is the standard Creative Commons license that gives others maximum freedom to do what they want with the work as long as they credit the author.
Licensing start date:31.08.2018

Secondary language

Language:English
Title:Diarrhoea and Constipation
Abstract:Diarrhoea and constipation are fairly frequent disorders in cancer patients. They may be symptomatic of a malignant disease or may develop as a sequel of specific cancer therapy, e.g. surgery, radiotherapy, or systemic treatment. Diarrhoea is frequent passing of increased amounts of loose or leaky stools. In systemic therapy, diarrhoea may be induced by certain cytostaics, target and hormonal drugs, and also some drugs applied as supportive therapy. These drugs cause diarrhoea establishing different mechanisms; the most frequent is the changed bacterial flora of the colon. The first step in the management of patients who suffer from cytostatic-induced diarrhoea is to assess the disease grade. The patients with mild or moderate disease should be referred to home care, advising them to follow appropriate dietetic regime and the therapy with a synthetic opioid without analgesic effect, e.g. loperamid. If the symptoms withdraw in 1-2 days, the therapy with loperamid should be discontinued 12 hours after the last loose stool. In case the symptoms persist, the dietetic regime and therapy with loperamid should be intensified and an antibiotic from chinolon group should be prescribed additionally. If the disease still persists, the therapy should be further intensified and additional laboratory and microbiology tests should be made. The patients with severe disease or moderate symptoms of diarrhoea accompanied by fever, abdominal pain and vomiting, and the patients with moderate diarrhoea in whom the symptoms get worse despite dietetic regime and loperamid, should be referred to parenteral treatment and intensive care in the hospital. On the other hand, constipation, a condition of the digestive system in which patients experience hard feces that are difficult to expel, may also be directly or indirectly induced by malignant disease, or by specific cancer treatment, e.g. surgery, radiotherapy, or systemic treatment, and most frequently by supportive treatment with opioid analgesics. Constipation is induced by a combination of causes, therefore, its treatment requires a complex approach. Considering the specificity of each patient’s condition, the therapist should prescribe a combination therapy of non-pharmacological and, if needed, of pharmacological interventions that should be carried out regularly and consistently in order to assure to the patient the best quality of life and to alleviate the symptoms of constipation which cause general discomfort, abdominal pain, and low appetite.

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