Palliative gastroenterology:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2006
|
| Schriftenreihe: | Gastroenterology clinics of North America
35,1 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XIV, 228 S. Ill., graph. Darst. |
| ISBN: | 1416035540 |
Internformat
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| 650 | 4 | |a Gastrointestinal Diseases |x therapy | |
| 650 | 4 | |a Gastrointestinal diseases |x Therapy | |
| 650 | 4 | |a Palliative Care | |
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Datensatz im Suchindex
| _version_ | 1804135315762315264 |
|---|---|
| adam_text | CONTENTS VOLUME 35 « NUMBER 1 • MARCH 2006
Preface xiii
Todd H. Baron and Geoffrey P. Dunn
Palliative Care: A Promising Philosophical
Framework for Gastroenterology 1
Geoffrey P. Dunn
Since the 1970s, much lias happened to establish palliative care as
a health philosophy that will enrich the practice ol gastrocnlcrology;
conversely, developments in gastrocnlcrology have already unproved
palliative care. Several recent concepts from the held ol gastrocntcrol
ogy such as the second brain and intestinal lailurc lit well within
the conceptual framework of palliative care. This type ol synergy will
ultimately encourage the application ol this philosophy to a much
broader spectrum of patients than those deemed to be at end of life.
This broader spectrum of care can be described as palliative
gastroenterology.
Palliative Care Assessment: What Are We Looking For? 23
Kenneth Rosenfeld
This article provides an overview of palliative care assessment for the
gastroenterologic specialist. An evidence based conceptual model ol
high quality end of lifc care is proposed, and an approach lo assessment
is offered, recognizing that comprehensive palliative assessment
generally requires participation ol an interdisciplinary team with
expertise in each of the important palliative domains. The gasiroentcr
ologist has the opportunity and responsibility to screen loi problems in
each domain, relei the patient to appropriate team members lot a mnie
detailed assessment, and integrate data to collaboiatively develop
a management plan. Because the rclicl ol siilleriug and the cine ol
disease are dual obligations, m situations in which cure is no longei
possible, alleviating sullciing m patients and their caiegivers must be
emphasized.
Conveying Adverse News in End of Life Situations 41
M. Bruce Dratler. Man Katherine Burns, and Heather L. Dratler
This article examines cultural and religious differences m altitudes
about deatfi: suggests different methods ol conveying adverse news to
patients and their families, based on studies and personal experiences:
vii
and recommends methods that physicians can learn for tailoring
adverse news to specific patients of all ages and dieir families in die most
sensitive, compassionate, and honest way possible.
Assessment of Quality of Life Outcomes in the
Treatment of Advanced Colorectal Malignancies 53
Imran Hassan, Robert C. Cima, and Jeff A. Sloan
Health outcomes research has demonstrated that when evaluating die
efficacy of palliative treatment strategies it is important to not only
assess conventional endpoints, such as survival and tumor response
rates, but too also evaluate patient related outcomes such as quality of
life. With time and further successful experiences such as diose cited in
diis article, quality of life outcomes may eventually become the
standard measure in determining die efficacy of various palliative
interventions in patients with advanced colon and rectal malignancies.
Endoscopic Approaches for Palliation of Luminal
Gastrointestinal Obstruction 65
Douglas G. Adler and Shehzad N. Merwat
Much of the workload of a typical gastroenterologist is devoted to
screening patients for gastrointestinal malignancies. Efforts such as
colorectal cancer screening via colonoscopy and endoscopic surveil¬
lance of patients with Barrett s esophagus are widespread and widely
endorsed. In recent years, the armamentarium of endoscopy has
broadened considerably and now affords physicians a variety of
nonsurgical means to palliate malignant obstruction of die gastrointes¬
tinal tract. This article reviews endoscopic techniques to treat malignant
esophageal, biliary, small bowel, and colonic obstruction.
The Role of Endoscopically Placed Feeding or
Decompression Tubes 83
Stephen A. McClave and Christine S. Ritchie
Endoscopically placed gastrostomy tubes are often considered in
palliative care settings, but die scientific basis for establishing benefit
or harm is limited by a deardi of mediodologically adequate studies.
Decisions must be preceded by an honest discussion of risks and
benefits of artificial nutrition in a particular setting, filtered through die
values of each patient and family. The use of percutaneous endoscopic
gastrostomy (PEG) placement should honor patient autonomy and
arise from the determination of the goals of care. PEG tubes for
decompression are often efficacious for symptom relief. Overall, die
morbidity related to die PEG procedure used for decompression is only
sfighdy higher dian when the same technique is used for nutritional
purposes.
viii
Palliation of Malignant Obstructive Jaundice 101
Todd H. Baron
Malignant obstructive jaundice may cause anorexia, malabsorption
with weight loss, pruritus, and social embarrassment. Relief of
malignant obstructive jaundice results in improved quality of life.
Palliation of malignant obstructive jaundice may be achieved surgically,
percutaneously, or endoscopically. Nonsurgical methods of palliation
using biliary stents have become the mainstay of palliation and are
preferred over surgical methods. Expandable metal stents offer
prolonged patency over traditional plastic stents. Novel approaches to
palliation of hilar cholangiocarcinoma include the use of photodynamic
therapy and brachydierapy for selected patients.
Medical Palliation of the Jaundiced Patient with Pruritus 113
Nora V. Bergasa
Cholestasis secondary to infiltration of the liver by malignant tumors or
by obstruction of the biliary tree can be complicated by pruritus. The
clinician and ancillary personal must recognize how debilitating pruritus
is and identify the treatment of this symptom as a priority. This article
reviews the pharmacologic treatment of the pruritus of cholestasis, with
an emphasis on that condition secondary to malignancy. There are few
data from controlled clinical trials in this group of patients; thus, much
of die discussion will center on the treatments used for the pruritus of
cholestasis that is not secondary to malignancy but, nevertheless, may
be useful in that difficult situation.
The Role of Radiation Therapy in the Palliation
of Gastrointestinal Malignancies 125
David D. Howell
Radiation therapy is an important treatment to consider for palliation of
various symptoms of advanced and metastastic gastrointestinal
malignancies. When one considers the array of options for treatment,
multidisciplinary collaboration among all those involved in a patient s
care, die surgeon, radiation oncologist, medical oncologist, primary care
provider, and palliative care specialist, is ideal for addressing each
situation in each patient, especially where there might be a variety of
options for palliative treatment. Generally, combinations of interven¬
tions are needed to optimize the palliation of a patient s various
problems. The goal of providing relief to the patient in the least amount
of time with the least amount of morbidity and the greatest expectation
for the durability of response is paramount.
ix
Managing Nonmalignant Chronic Abdominal Pain
and Malignant Bowel Obstruction 131
Lesley K. Bicanovsky, Ruth L. Lagman, Mellar P. Davis,
and Declan Walsh
Abdominal pain is a symptom that requires a complex differential
diagnosis, assessment by history, physical examination, and radiographs
and evidence based management. Many illnesses cause nonspecific
abdominal complaints. Crucial to the diagnosis is the separation of
functional from organic etiologies. This article discusses selected common
nonmalignant causes for chronic abdominal pain and malignant bowel
obstruction. Understanding die neuroanatomical padiways for visceral
pain aids in die understanding of pain presentation and management. The
pain of chronic pancreatitis is managed based on the symptoms and
padiological changes to the pancreas. Irritable bowel syndrome is
managed best by controlling the most troublesome symptom. Colic,
continuous pain, nausea, and vomiting are the recognizable symptoms of
bowel obstruction. This usually requires a triple drug combination of
antiemetics, antimuscarinics, and opioids for relief. Appropriate symptom
management, along with medical or surgical intervention will enhance
quality of life.
Surgical Palliation of Bowel Obstruction 143
Robert S. Krouse
Malignant bowel obstruction is a common problem facing general
surgeons who treat cancer patients. Patients must be selected for
surgery carefully, as morbidity and mortality are common, and
improvement in quality of life is frequently unclear. Multiple surgical
options are available, and the surgical team must be prepared for the
many different scenarios that may be seen in die operating room. As
there is no clear algoridim for patients widi this condition, future
research should focus on die best treatment approaches for patients
with malignant bowel obstruction.
Endoscopic Ultrasound Guided Pain Control for
Intra abdominal Cancer 153
Michael J. Levy and Maurits J. Wiersema
This article summarizes percutaneous and surgical mediods for
performing celiac plexus neurolysis and focuses on die technical aspects
of endoscopic ultrasound guided celiac plexus neurolysis. Published
literature concerning endoscopic ultrasound guided celiac plexus
neurolysis is reviewed, indications are proposed, and opinions are
offered concerning potential future applications and investigational
needs as diey apply to diis technique.
X
Percutaneous Guided Pain Control: Exploiting
the Neural Basis of Pain Sensation 167
Michael D. Adolph and Costantino Benedetti
The gastroenterologist frequently encounters painful conditions in
suffering patients. Performing regular pain assessments and applying
basic pain medicine principles will augment the care of patients in pain.
Although systemic opioid analgesia remains the primary means of
controlling cancer pain, 10% to 15°/o of cancer patients may need
additional interventions to achieve relief. Percutaneous guided tech¬
niques play a role in the multidisciplinary approach to pain therapy.
These measures exploit the neural basis of pain to relieve pain and its
associated suffering.
Palliation of Malignant Ascites 189
Stefanie M. Rosenberg
The management of recurrent, symptomatic malignant ascites can be
problematic for physicians and patients. The most common, low risk
method is large volume paracentesis. Patient disease progression often
leads to rapid reaccumulation of ascites, which requires frequent return
visits to the hospital for symptom management. Other techniques have
been developed to achieve palliation of symptoms, including tunneled
external drainage catheters, peritoneal ports, and peritoneovenous
shunting.
Palliative Care for Patients with End Stage Liver
Disease Ineligible for Liver Transplantation 201
William Sanchez and Jayant A. Talwalkar
The number of patients with end stage liver disease (ESLD) is
increasing, while the number of donor organs available for trans¬
plantation remains stable. Patients with ESLD are subject to numerous
physical and psychosocial symptoms that negatively affect their health
and perceived quality of life. Physicians caring for patients with ESLD
must be familiar with palliative measures for common complications of
ESLD, such as ascites, pruritus, hepatic enccphalopathy, fatigue, and
anorexia. Early discussions between the patient and physician about
advance directives and the goals of therapy are important. Hospice care
is appropriate for many patients with ESLD regardless of whether there
is a complicating hepatocellular malignancy.
Index 221
xi
|
| adam_txt |
CONTENTS VOLUME 35 « NUMBER 1 • MARCH 2006
Preface xiii
Todd H. Baron and Geoffrey P. Dunn
Palliative Care: A Promising Philosophical
Framework for Gastroenterology 1
Geoffrey P. Dunn
Since the 1970s, much lias happened to establish palliative care as
a health philosophy that will enrich the practice ol gastrocnlcrology;
conversely, developments in gastrocnlcrology have already unproved
palliative care. Several recent concepts from the held ol gastrocntcrol
ogy such as "the second brain and "intestinal lailurc" lit well within
the conceptual framework of palliative care. This type ol synergy will
ultimately encourage the application ol this philosophy to a much
broader spectrum of patients than those deemed to be at "end of life."
This broader spectrum of care can be described as palliative
gastroenterology.
Palliative Care Assessment: What Are We Looking For? 23
Kenneth Rosenfeld
This article provides an overview of palliative care assessment for the
gastroenterologic specialist. An evidence based conceptual model ol
high quality end of lifc care is proposed, and an approach lo assessment
is offered, recognizing that comprehensive palliative assessment
generally requires participation ol an interdisciplinary team with
expertise in each of the important palliative domains. The gasiroentcr
ologist has the opportunity and responsibility to screen loi problems in
each domain, relei the patient to appropriate team members lot a mnie
detailed assessment, and integrate data to collaboiatively develop
a management plan. Because the rclicl ol siilleriug and the cine ol
disease are dual obligations, m situations in which cure is no longei
possible, alleviating sullciing m patients and their caiegivers must be
emphasized.
Conveying Adverse News in End of Life Situations 41
M. Bruce Dratler. Man Katherine Burns, and Heather L. Dratler
This article examines cultural and religious differences m altitudes
about deatfi: suggests different methods ol conveying adverse news to
patients and their families, based on studies and personal experiences:
vii
and recommends methods that physicians can learn for tailoring
adverse news to specific patients of all ages and dieir families in die most
sensitive, compassionate, and honest way possible.
Assessment of Quality of Life Outcomes in the
Treatment of Advanced Colorectal Malignancies 53
Imran Hassan, Robert C. Cima, and Jeff A. Sloan
Health outcomes research has demonstrated that when evaluating die
efficacy of palliative treatment strategies it is important to not only
assess conventional endpoints, such as survival and tumor response
rates, but too also evaluate patient related outcomes such as quality of
life. With time and further successful experiences such as diose cited in
diis article, quality of life outcomes may eventually become the
standard measure in determining die efficacy of various palliative
interventions in patients with advanced colon and rectal malignancies.
Endoscopic Approaches for Palliation of Luminal
Gastrointestinal Obstruction 65
Douglas G. Adler and Shehzad N. Merwat
Much of the workload of a typical gastroenterologist is devoted to
screening patients for gastrointestinal malignancies. Efforts such as
colorectal cancer screening via colonoscopy and endoscopic surveil¬
lance of patients with Barrett's esophagus are widespread and widely
endorsed. In recent years, the armamentarium of endoscopy has
broadened considerably and now affords physicians a variety of
nonsurgical means to palliate malignant obstruction of die gastrointes¬
tinal tract. This article reviews endoscopic techniques to treat malignant
esophageal, biliary, small bowel, and colonic obstruction.
The Role of Endoscopically Placed Feeding or
Decompression Tubes 83
Stephen A. McClave and Christine S. Ritchie
Endoscopically placed gastrostomy tubes are often considered in
palliative care settings, but die scientific basis for establishing benefit
or harm is limited by a deardi of mediodologically adequate studies.
Decisions must be preceded by an honest discussion of risks and
benefits of artificial nutrition in a particular setting, filtered through die
values of each patient and family. The use of percutaneous endoscopic
gastrostomy (PEG) placement should honor patient autonomy and
arise from the determination of the goals of care. PEG tubes for
decompression are often efficacious for symptom relief. Overall, die
morbidity related to die PEG procedure used for decompression is only
sfighdy higher dian when the same technique is used for nutritional
purposes.
viii
Palliation of Malignant Obstructive Jaundice 101
Todd H. Baron
Malignant obstructive jaundice may cause anorexia, malabsorption
with weight loss, pruritus, and social embarrassment. Relief of
malignant obstructive jaundice results in improved quality of life.
Palliation of malignant obstructive jaundice may be achieved surgically,
percutaneously, or endoscopically. Nonsurgical methods of palliation
using biliary stents have become the mainstay of palliation and are
preferred over surgical methods. Expandable metal stents offer
prolonged patency over traditional plastic stents. Novel approaches to
palliation of hilar cholangiocarcinoma include the use of photodynamic
therapy and brachydierapy for selected patients.
Medical Palliation of the Jaundiced Patient with Pruritus 113
Nora V. Bergasa
Cholestasis secondary to infiltration of the liver by malignant tumors or
by obstruction of the biliary tree can be complicated by pruritus. The
clinician and ancillary personal must recognize how debilitating pruritus
is and identify the treatment of this symptom as a priority. This article
reviews the pharmacologic treatment of the pruritus of cholestasis, with
an emphasis on that condition secondary to malignancy. There are few
data from controlled clinical trials in this group of patients; thus, much
of die discussion will center on the treatments used for the pruritus of
cholestasis that is not secondary to malignancy but, nevertheless, may
be useful in that difficult situation.
The Role of Radiation Therapy in the Palliation
of Gastrointestinal Malignancies 125
David D. Howell
Radiation therapy is an important treatment to consider for palliation of
various symptoms of advanced and metastastic gastrointestinal
malignancies. When one considers the array of options for treatment,
multidisciplinary collaboration among all those involved in a patient's
care, die surgeon, radiation oncologist, medical oncologist, primary care
provider, and palliative care specialist, is ideal for addressing each
situation in each patient, especially where there might be a variety of
options for palliative treatment. Generally, combinations of interven¬
tions are needed to optimize the palliation of a patient's various
problems. The goal of providing relief to the patient in the least amount
of time with the least amount of morbidity and the greatest expectation
for the durability of response is paramount.
ix
Managing Nonmalignant Chronic Abdominal Pain
and Malignant Bowel Obstruction 131
Lesley K. Bicanovsky, Ruth L. Lagman, Mellar P. Davis,
and Declan Walsh
Abdominal pain is a symptom that requires a complex differential
diagnosis, assessment by history, physical examination, and radiographs
and evidence based management. Many illnesses cause nonspecific
abdominal complaints. Crucial to the diagnosis is the separation of
functional from organic etiologies. This article discusses selected common
nonmalignant causes for chronic abdominal pain and malignant bowel
obstruction. Understanding die neuroanatomical padiways for visceral
pain aids in die understanding of pain presentation and management. The
pain of chronic pancreatitis is managed based on the symptoms and
padiological changes to the pancreas. Irritable bowel syndrome is
managed best by controlling the most troublesome symptom. Colic,
continuous pain, nausea, and vomiting are the recognizable symptoms of
bowel obstruction. This usually requires a triple drug combination of
antiemetics, antimuscarinics, and opioids for relief. Appropriate symptom
management, along with medical or surgical intervention will enhance
quality of life.
Surgical Palliation of Bowel Obstruction 143
Robert S. Krouse
Malignant bowel obstruction is a common problem facing general
surgeons who treat cancer patients. Patients must be selected for
surgery carefully, as morbidity and mortality are common, and
improvement in quality of life is frequently unclear. Multiple surgical
options are available, and the surgical team must be prepared for the
many different scenarios that may be seen in die operating room. As
there is no clear algoridim for patients widi this condition, future
research should focus on die best treatment approaches for patients
with malignant bowel obstruction.
Endoscopic Ultrasound Guided Pain Control for
Intra abdominal Cancer 153
Michael J. Levy and Maurits J. Wiersema
This article summarizes percutaneous and surgical mediods for
performing celiac plexus neurolysis and focuses on die technical aspects
of endoscopic ultrasound guided celiac plexus neurolysis. Published
literature concerning endoscopic ultrasound guided celiac plexus
neurolysis is reviewed, indications are proposed, and opinions are
offered concerning potential future applications and investigational
needs as diey apply to diis technique.
X
Percutaneous Guided Pain Control: Exploiting
the Neural Basis of Pain Sensation 167
Michael D. Adolph and Costantino Benedetti
The gastroenterologist frequently encounters painful conditions in
suffering patients. Performing regular pain assessments and applying
basic pain medicine principles will augment the care of patients in pain.
Although systemic opioid analgesia remains the primary means of
controlling cancer pain, 10% to 15°/o of cancer patients may need
additional interventions to achieve relief. Percutaneous guided tech¬
niques play a role in the multidisciplinary approach to pain therapy.
These measures exploit the neural basis of pain to relieve pain and its
associated suffering.
Palliation of Malignant Ascites 189
Stefanie M. Rosenberg
The management of recurrent, symptomatic malignant ascites can be
problematic for physicians and patients. The most common, low risk
method is large volume paracentesis. Patient disease progression often
leads to rapid reaccumulation of ascites, which requires frequent return
visits to the hospital for symptom management. Other techniques have
been developed to achieve palliation of symptoms, including tunneled
external drainage catheters, peritoneal ports, and peritoneovenous
shunting.
Palliative Care for Patients with End Stage Liver
Disease Ineligible for Liver Transplantation 201
William Sanchez and Jayant A. Talwalkar
The number of patients with end stage liver disease (ESLD) is
increasing, while the number of donor organs available for trans¬
plantation remains stable. Patients with ESLD are subject to numerous
physical and psychosocial symptoms that negatively affect their health
and perceived quality of life. Physicians caring for patients with ESLD
must be familiar with palliative measures for common complications of
ESLD, such as ascites, pruritus, hepatic enccphalopathy, fatigue, and
anorexia. Early discussions between the patient and physician about
advance directives and the goals of therapy are important. Hospice care
is appropriate for many patients with ESLD regardless of whether there
is a complicating hepatocellular malignancy.
Index 221
xi |
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| series2 | Gastroenterology clinics of North America |
| spelling | Palliative gastroenterology guest ed. Todd H. Baron ... Philadelphia [u.a.] Saunders 2006 XIV, 228 S. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Gastroenterology clinics of North America 35,1 Gastro-enterologie gtt Palliatieve behandeling gtt Gastrointestinal Diseases therapy Gastrointestinal diseases Therapy Palliative Care Palliative care Baron, Todd H. Sonstige oth Gastroenterology clinics of North America 35,1 (DE-604)BV000613725 35,1 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=014772725&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Palliative gastroenterology Gastroenterology clinics of North America Gastro-enterologie gtt Palliatieve behandeling gtt Gastrointestinal Diseases therapy Gastrointestinal diseases Therapy Palliative Care Palliative care |
| title | Palliative gastroenterology |
| title_auth | Palliative gastroenterology |
| title_exact_search | Palliative gastroenterology |
| title_exact_search_txtP | Palliative gastroenterology |
| title_full | Palliative gastroenterology guest ed. Todd H. Baron ... |
| title_fullStr | Palliative gastroenterology guest ed. Todd H. Baron ... |
| title_full_unstemmed | Palliative gastroenterology guest ed. Todd H. Baron ... |
| title_short | Palliative gastroenterology |
| title_sort | palliative gastroenterology |
| topic | Gastro-enterologie gtt Palliatieve behandeling gtt Gastrointestinal Diseases therapy Gastrointestinal diseases Therapy Palliative Care Palliative care |
| topic_facet | Gastro-enterologie Palliatieve behandeling Gastrointestinal Diseases therapy Gastrointestinal diseases Therapy Palliative Care Palliative care |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=014772725&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
| volume_link | (DE-604)BV000613725 |
| work_keys_str_mv | AT barontoddh palliativegastroenterology |