厌食和恶病质综合征的处理课件

厌食和恶病质综合征的处理ManagementofAnorexiaandcachexiaRoberttwycrossApril2005厌食和恶病质综合征的处理1症状处理的学问:EEMMATheScienceofSymptomManagement:EEMMAEvaluation[assessment]评估Explanation解释Management[treatment治疗Monitoring监护Attentiontodetail注意细节症状处理的学问:EEMMA2症状处理SymptomManagement敬告!并不总是能完全缓解症状WarningCannotalwaysrelievesymptomscompletely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Alternativeaim:helpingapatienttofeelmoreincontrolandthereforelessoverwhelmed症状处理3症状的原因CausesofSymptoms癌症衰弱cancerdebility冶疗并发疾病treatmentconcurrentsorder在癌症晚期,症状常常由多种原因列起Inadvancedcancer,symptomsoftenhavemultiplecauses症状的原因CausesofSymptoms4厌食和恶病质综合征的处理课件5“我没有胃口”Ihavenoappetite鉴别诊断D讲erentialdiagnosis: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(notinterestedinfood)orearlysatietyalone(thethoughtoffoodisappealingbutthepersonfeelsfullafterafewmouthfuls)2.Primaryanorexia(cachexiasyndrome)orsecondaryanorexia3.Physical(e.g.nauseated)orpsychological(e.g.depressed“我没有胃口”6继发性厌食Secondaryanorexiague疲劳2.Nausea恶心3.Malodour恶臭4.Alteredtaste味觉改变5.Gastricstasis,e.g.constipation胃停滞,例如便秘6.Oropharyngealpathology口咽部疾病7.Pain疼痛继发性厌食7早饱感Earlysatiety1.Gastricstasis胃停滞2.Post-gastrectomy胃切除术后3.Massivehepatomegaly巨大型肝肿大4.Massiveascites大量腹水早饱感8胃停滞(胃排空延迟)GastricStasis(DelayedGastricEmptying)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?Commoninadvancedcancer.Symptoms:earlysatiety+/epigastricfullness,acidreflux,hiccup,belching,nausea,vomitingSigns:succussionsplash?胃停滞(胃排空延迟)9胃停滞的原因Causesofgastricstasis1.失动力型消化不良Dysmotilitydyspepsia2.便秘Constipation3.药物,例如阿片类,抗毒蕈碱类药Dπugs,e.gopioids.antimuscarinics4.胰头癌Cancerofheadofpancreas5.引起神经病变的腹膜后癌Retroperitonealcancercausingneuropathy6.瘤旁自主性神经病变Paraneoplasticautonomicneuropathy7.脊髓压迫综合征Spinalcordcompression胃停滞的原因10厌食和恶病质综合征的处理课件11厌食和恶病质综合征的处理课件12厌食和恶病质综合征的处理课件13厌食和恶病质综合征的处理课件14厌食和恶病质综合征的处理课件15厌食和恶病质综合征的处理课件16厌食和恶病质综合征的处理课件17厌食和恶病质综合征的处理课件18厌食和恶病质综合征的处理课件19厌食和恶病质综合征的处理课件20厌食和恶病质综合征的处理课件21厌食和恶病质综合征的处理课件22厌食和恶病质综合征的处理课件23厌食和恶病质综合征的处理课件24厌食和恶病质综合征的处理课件25厌食和恶病质综