This advice is sourced from Dr Ros Taylor a senior palliative physician
Q. How should I best assess abdominal pain in a patient with advancing cancer?
A. You should assess abdominal pain as you usually would, with a history and examination. Exploring changes in bowel habit is key. Knowing the patients underlying illness and the location of any metastases or other pathology is also important.
In any palliative care patient with abdominal pain always consider bowel obstruction, particularly if they are vomiting. This can present subacutely with more subtle symptoms (less pain, infrequent vomiting). If any suspicion refer for urgent CT.
Common causes of abdominal pain we see towards the end of life:
- Constipation is the commonest cause (often linked to analgesia and immobility)
- Dyspepsia is very common (often a side effect of medication or because the patient isn't eating). Review NSAIDs and consider a PPI
- Liver metastases cause a dull ache in the right side of the abdomen. They are tender to touch and respond well to steroids e.g. dexamethasone 4mg daily
- Peritoneal metastases (e.g. from bowel or gynaecological cancer) give a colicky pain from pressure on the bowel. Treat with a low residue diet (see downloads) and buscopan. Consider other causes of colicky pain e.g. biliary colic, renal colic, bowel obstruction.