Hospice & Palliative Care

End Stage Disease Progression and Complications – Gastrointestinal Disorders (Learning Hospice)

End-stage progression of GI disorders may vary according to the type of disorder but may include:

  • Anorexia / Difficulty eating: Patients may benefit from supplementary feedings, small frequent meals, parenteral nutrition, or feeding tubes. Oral foods may require modification, such as in consistency (soft or puréed). Some may tolerate only bland foods.
  • Ascites: this may result in abdominal pressure and shortness of breath. Patients may need to be positioned with the head elevated. In some cases, parade tests may relieve symptoms for a short period but fluid tends to recur.
  • Constipation or diarrhea: Diet modifications (increased fiber and fluids, prune juice) may help alleviate constipation and antispasmodics / anti secretory drugs may reduce diarrhea.
  • Bowel obstruction: Abdomen may become hard and distended. If patient is not a candidate for surgery, such as colonic stunting, an NG tube may help relieve symptoms temporarily. A venting gastrostomy may be placed to reduce discomfort as well as nausea and vomiting.
  • Pain: Opioids are often needed to relieve pain, especially associated with bowel obstruction.
  • Nausea and Vomiting: Antiemetics may provide some relief.

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