厌食和恶病质综合征的处理课件.ppt

厌食和恶病质综合征的处理Management of Anorexia and Cachexia Robert Twycross April 2005 症状处理Symptom Management 敬告！并不总是能完全缓解症状 Warning! Cannot always relieve symptoms completely 替代目标：帮助患者更多地感觉到症状受到控制从而更少地感到被疾病所压倒 Alternative aim: helping a patient to feel more in control and therefore less overwhelmed 症状的原因Causes of Symptoms 临床诊断基于： Clinical diagnosis based on: 可能性 probability 对病程的认识 pattern recognition “我没有胃口”‘I have no appetite’ 鉴别诊断 Differential diagnosis: 1. 厌食（对食物不感兴趣）或只有早饱感（觉得食物诱人但患 者在吃了几口以后就觉得饱胀） 2. 原发性厌食（恶病质综合征） 或 继发性厌食 3. 躯体的（例如，引起呕吐）或精神心理的（例如,感到抑郁） 1.Anorexia (not interested in food) or early satiety alone (the thought of food is appealing but the person feels full after a few mouthfuls) 2. Primary anorexia (cachexia syndrome) or secondary anorexia 3. Physical (e.g. nauseated) or psychological (e.g. depressed) 继发性厌食Secondary Anorexia Fatigue 疲劳 Nausea 恶心 Malodour 恶臭 Altered taste 味觉改变 Gastric stasis, e.g. constipation 胃停滞，例如便秘 Oropharyngeal pathology 口咽部疾病 Pain 疼痛 早饱感Early Satiety  Gastric stasis 胃停滞 Post-gastrectomy 胃切除术后 Massive hepatomegaly 巨大型肝肿大 Massive ascites 大量腹水 胃停滞（胃排空延迟）Gastric Stasis (Delayed Gastric Emptying) 在晚期癌症中常见: 症状：早饱+/- , 上腹饱胀，返酸，呃逆，嗳气，恶心， 呕吐 体征：振水音？ Common in advanced cancer: Symptoms: early satiety +/-,epigastric fullness, acid reflux, hiccup,belching, nausea, vomiting Signs: succussion splash? 胃停滞的原因Causes of Gastric Stasis 失动力型消化不良 Dysmotility dyspepsia 便秘 Constipation 药物，例如阿片类，抗毒蕈碱类药 Drugs, e.g. opioids, antimuscarinics 胰头癌 Cancer of head of pancreas 引起神经病变的腹膜后癌 Retroperitoneal cancer causing neuropathy 瘤旁自主性神经病变 Paraneoplastic autonomic neuropathy 脊髓压迫综合征 Spinal cord compression 评估Evaluation 这是谁的问题？ 患者的还是亲属的？ 聆听患者的和亲属的忧虑 Whose problem is it? The patient’s or the family’s? Listen to the patient’s and the family’s fears 解释Explanation 对亲属的解释 Explain to the family: 一个濒死的病人对食物丧失兴趣是正常的 it is normal for a dying patient to lose interest in food 如果可能，在需要时才提供食物（使用