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 there is associated vomiting. If any suspicion refer for urgent CT.
Common causes of abdominal pain we see towards the end of life:
- Constipation is a common cause (often linked to analgesia, anticholinergics and immobility). Explore changes in bowel habit.
- Dyspepsia is very common (often a side effect of medication or because the patient isn't eating). Review NSAIDs and consider a PPI or H2 Antagonists.
- Liver metastases cause a dull ache in the right side of the abdomen, as the liver capsule is stretched. Liver metastases respond well to opioids and steroids e.g. Dexamethasone 4mg-6mg daily
- Peritoneal metastases (e.g. from bowel or gynaecological cancer) cause 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.
- Urinary retention or infection.
- Tumour pain often responds to opioids and paracetamol. Pancreatic pain may need neuropathic agents if coeliac plexus involved.